Reviewing the risks of floating neck rings and why water safety is best based on communication

Two articles in which we hope to show that there is a better way.

The hidden risks of floating neck rings for babies

Images of the first Baby Spa opened in Australia (Perth), a few years after Baby Spas started gaining popularity in China, show babies of various ages floating supported by purple neck rings in tubs, after which they receive a massage. The pictures conjure up a dream of busy parents: calm babies floating safely under supervision, their faces securely maintained above water, while adults can relax and sip smoothies on the side, confident that babies are having a treat. Floating tanks for adults are gaining popularity around the world after research has confirmed the benefits of floating in warm water, but do these benefits apply to young babies? And might neck rings have detrimental effects on the development of babies’ spines and therefore nervous systems and brain development? Is this device missing the point about what babies can gain from being in water? STA and Birthlight would like to issue a message of caution about the use of neck rings for babies as a buoyancy aid for floating, from the perspective of baby swimming teachers concerned with promoting aquatic activities that best support infant development.

In today’s world, babies spend a lot of time in contraptions that isolate them from human contact. Some are necessary, like safe baby car seats. Others like electric rocking cradles and chairs, bouncers and strollers, are marketed as labour saving for parents, enjoyable and even positive for babies. Floating neck rings are part of this global culture of baby contraptions. Parents do not have to get in the water and babies are kept safe from accidental submersion, but let’s look at the hidden costs and risks. These are physical, neurological and psychological, and as everything with babies, they are interlinked.

When babies hang vertically in water with their heads supported by a semi-rigid foam structure –particularly those under 5 months-, concern arises about compression of the soft and subtle vertebrae in their necks, and strain in ligaments and muscles. Infant development is cephalo-caudal (proceeding from the head down), and head control is the first huge task babies master in their early months, followed by rolling. The main body movements that help babies to achieve these first milestones are restricted by neck rings. Even allowing for buoyancy, active kicking, (first involuntary and later voluntary), may put undue pressure on the neck because the neck ring makes the integration of upper and lower body movements difficult, if not impossible. Furthermore, this has an impact on the optimal development of the spinal curves. Babies are born with a C shape spine, without lumbar or cervical curves.(1) It is integrated movements of their whole bodies that assist the formation of the spinal curvature, which will help them to sit, stand and walk. By maintaining a locked position of the upper back and pectoral muscles involved in early head movements, neck rings artificially create a spinal extension that may weaken rather than strengthen babies’ lower backs in the medium to long term. Cranio-sacral connections (2) are now well recognised. Few babies are born without some compression in their neck and cranium, due to their fetal position in utero at the time of birth, even if they are born by cesarean section. Some may even have experienced having their cords round their necks. It seems a shame to lose the potential loosening of tension that being in water can allow and perhaps even to add further compression by using a neck ring.

Alternating between spinal extension and flexion is essential to help babies’ primitive reflexes integrate and to support the emergence of postural reflexes. These are foundational layers for the patterns of movement that develop later. Babies need to be kept free as much as possible to practise the movement sequences allowing more mature patterns that supersede the primitive reflexes. As pointed by Sally Goddard Blyth, 'Reflex integration is written into the developmental blueprint of every normal infant. Provided that the baby has space and opportunity to move, to exercise and to practice movements, the reflexes of infancy should wax and wane in accordance with nature's developmental plan'.(3) By fixating the baby’s head position, the neck ring hinders the healthy development of the neuro-pathways accompanying the emergence of postural reflexes, while possibly encouraging a prolonged reliance on earlier primitive reflexes.

This is particularly important in the case of one of the main primitive reflex, the asymmetric tonic reflex, that prompts babies to extend and turn their limbs to the opposite side of their heads. This reflex later gives way to the postural segmentary rolling reflex, the beginning of fun rotations and possibly the key foundation movement of early swimming. Babies floating in neck rings can move their arms and their legs, this is true, but they do so in a linear plane with hardly any scope for lateral movement. Neck rings inhibit full body rotation. In addition, the artificial vertical position maintained by the neck ring impairs babies’ preferred body balance in water, usually at an angle of about 30 to 45 degrees to the water surface until well into their second year. Rotation is also key for the healthy development of the vestibular system, upon which our sense of balance and our proprioception, the ability to sense stimuli arising within the body regarding position, motion, and equilibrium, depends ever since mid-pregnancy. Vestibular stimulation is one of the great boons of baby swimming activities, as water allows rotations in 3D in contrast with land-based movements determined by gravity. If babies are encouraged to rotate early in water, they uniquely work out their way to surface to breathe after gaining strength and coordination of leg and arm movements in their second or third year.

When babies over three months are placed in neck rings, this may also interfere with the neuro pathways associated with the head-righting reflex that helps babies aged between 3 and 6 months respond to their spontaneous desire to sit up. It takes a disproportionate effort and muscular tension for babies in neck rings to try and right themselves up, which they are naturally driven to do. Neck rings not only fail to assist the fundamental evolution of primitive into postural reflexes, but they also make babies passive rather than enabling them to physically take advantage of challenges and opportunities while being in water. A device that claims total safety and apparent comfort for babies, yet deprives them of a freedom to move which we now know can have long term implications, (4) cannot be promoted for routine use without serious warnings to all parents.

One of the main benefits of baby swimming in which babies are supported in their parents’ arms is precisely that babies can enjoy freedom of movement in an unbounded space yet within holds that are not static but constantly responding to the fluid properties of water. Touch, in water as on land, is vitally important to enable babies’ safe self-expression through body language. (5) Second by second, the mutual adjustments of parent and baby in water, particularly if the parent is relaxed, are not only conducive to babies’ spontaneous movements that correspond to their developmental stage, but are also part of communication and a mutual learning process. The fact that babies are social and learn through inter-personal and intimate relations mediated by loving care (6) is now too well known to be ignored for the sake of using a new gadget on the block. The benefits of being in a large tub or pool with a parent are incommensurate with the limited sensory stimuli that babies floating in neck rings may receive; besides greater freedom of movement, tactile contact with a loved person is crucial to promote the integration of the senses, or “synaesthesia”, that underscores babies’ learning as an intersubjective process. (7) In water, the undistracted moments of intimacy that allow parents to get to know, understand and respond to their babies are magical triggers for more neuro-pathways, those that consolidate babies’ sense of being securely loved. Babies’ memory has recently been shown to be far more developed, even before birth, than we thought was possible even two decades ago. (8) The fetal experience of floating within the safety of the mother's body, with alternating periods of activity and rest, needs to be continued in this way after birth, if at all. The connection with the aquatic environment can enhance togetherness and belonging in a dynamic engagement with a parent to build trust, strengthen the bonding process and lead to secure attachment.

The experience of a close bond is perhaps what draws more and more fathers to baby swimming as a guys’ “to-do-thing” with their babies. The neurophysiology of attachment is possibly one of the most interesting areas of late twentieth century scientific research on parenting. (9) To place babies in neck rings on their own in water is to seriously miss out on what the water can uniquely offer to promote and mediate a dynamic connection between parents and their babies. As Shawn Tomlinson puts it, “a neck ring creates a vacuum where the baby is incapacitated and cannot connect with anyone or anything. There are no safe boundaries to touch or feel. Self-expression through body language, which the water ideally facilitates, is lost because movements are restricted”. Following Tiffany Fields, Shawn points out further that tactile contact, crucially missing in the Baby Spa experience, “provides a feedback loop for body awareness and body mapping. This happens especially in water, where sensory integration or dysfunction can happen so easily due to all the senses being exposed and stimulated”. While disengaging from the world in floating tanks can be wonderfully relaxing for stressed adults, it is not what babies want nor need.

When they are not asleep, babies want to grow by being active. In their intense first year of life, babies learn by finding their midline, rolling over, sitting up, crawling and eventually walking. Water expands babies’ opportunities to explore the reflexes, movement patterns and pathways for sensory and motor development that help them reach and integrate these milestones, and water parenting facilitates self-awareness, effective movement strategies and integrated relationships. The risks linked to the frequent use of a device that restricts both movement and closeness for babies in water must be carefully evaluated, so that parents can make better informed decisions.

Françoise Freedman and Shawn Tomlinson

27/03/2017


(1) Eliott, L. 1999.What’s going on in there: How the Brain and Mind Develop in the First Five Years of Life. New York: Bantam Books.

(2) https://www.craniosacraltherapy.org/Whatis.htm. Introduction to Biodynamic Craniosacral Therapy. by Michael Kern, DO., R.C.S.T., M.I.Cr.A., N.D.. Life and motion. Life expresses itself as motion.

(3) Goddard Blyth, Sally. 2002. Reflexes Learning and Behaviour: A Window into the Child’s Mind.  p.27.
Goddard Blyth, Sally. 2005. What babies and children really need: How Mothers and Fathers Can Nurture Children's  Growth for Health and Wellbeing (Early Years). Stroud: Hawthorn Press. p.154.

(4) Hannaford, Carla. 2007 (1995) Smart Moves: Why Learning is not All in your Head. Great River Books.

(5) Fields, Tiffany. 2014. Touch (updated second edition). MIT Press. P.5. See also MiamiTouch Research Institute: www6.miami.edu/touch-research

(6) Murray, Lynne. 2014. The Psychology of Babies: How relationships support development from birth to two. London: Constable. Gerhardt, Sue. 2004. Why Love Matters: How affection shapes a baby’s brain. London: Routlege.

(7) Bullowa, Margaret ed. Before Speech: The Beginning of Interpersonal Communication. (See chapter by C. Trevarthen on synaesthesia and inter-subjectivity)

(8) Dirix, C et al. 2009.  Aspects of Fetal Learning and Memory. Child Development Volume 80, Issue 4.
Pages 1251–1258

(9) Sunderland, Margo. 2016 (second updated edition). The Science of Parenting. Dorling Kindersley.

 


 

Communication, not conditioning, best promotes infants’ water safety

On ITV Good Morning 10th May 2016, Keri Morrison, a mother whose lost her 2 years and 10 months old son in a tragic drowning accident, spoke as an advocate for the US based Infant Swimming Resource's Self-Rescue® program (IRS).  Paul Thompson, from Water Babies, was in the studio to contrast their respective approaches to water safety for infants. Scientific research was invoked but no convincing argument was put forward against the very powerful fear-based call for action ‘to save babies’ lives’.
 What has worried me most about this interview and the related clips posted on YouTube about the drown-proofing of infants through flip and float is the endorsement of the extreme mixed messages that babies receive in this training.

On the one hand, the training involves visible physiological and mental stress. To develop a new specific combined motor and cognitive function with the aim of back floating for survival upon the eventuality of falling in water, babies undergo intense repetitive stressful stimulation. The six months old baby on the clip uses protest cues: crying, spluttering, arm and leg movements. These cues are deliberately suppressed in exchange for imposing a pattern of midline alignment for coordinated limb movements that can support her head afloat. The trade off, the other hand of the process, is an emphatic sensory reward as the trainer offers visual and auditory signals in expressions of praise. The rising intonations of the praise lavished on the baby after each floating attempt went straight to her limbic system, creating a positive affective association with the practice. Babies crave for and love this reinforced communication: they are wired to thrive on it.

What to make of this ambivalence? It definitely seems pernicious for those of us who believe that ignoring babies’ signals of distress is not right, both ethically and for their brain development, even if this is in their best long term interests. I say ‘believe’ because there are powerful arguments at stake here and it is not easy to disentangle the threads of best practice on the basis of patterns of brain activity , . In the flip and float, the limbic system, located in the inner brain, is involved with its collection of small structures dealing with emotional reactions, stress responses and reward-seeking behaviours. It also includes the hippocampus is involved in memory formation and spatial learning, and the hypothalamus, that acts as control center for stress, regulating the release of cortisol and other hormones while the amygdala evaluates threats and triggers the body’s stress response.

Early years drowning is a serious matter. It is imperative to save babies and children’s lives. The stats used to support drown-proofing programs send a wave of fear that reach the core of our triune brain: mega threat to our offspring, ACTION needed for survival! If there is a way of preventing tragedy, let’s go for it! Book now!
But then the neo-cortex kicks in with its more evolved skeptical appraisal. Wait a minute!
 Does this method actually save lives beyond anecdotal show cases? If so, which age group benefits most? (we know from statistics in the USA that the majority of toddler drowning occurs in shallow water rather than in deep water, often baths or paddling pools where infants could stand up if they did not panic). The three to six year olds who most commonly fall in swimming pools are well able to learn to swim. This leaves a window of vulnerability, 20 months to 36 months, when back floating could be most valuable for survival.

Are there different age-based techniques for flip and float? What happens when the ‘righting reflex’ that prompts a baby to sit up and therefore to reject back floating between 5 and 10 months, is forcefully suppressed? In the first year, which is the year of major brain growth through the ‘pruning and blooming’ of synapses to create the neuron networks used in later life, babies are most sensitive to repetitive stimulation. Developmental psychologists explain how this creates ‘habituation’ –the baby ignores the signal of a bell ringing during sleep if it is repeated at regular intervals- and ‘resilience’: the neurons start firing less after some time but there is a change in the setting of nervous system arousal, commonly shown through levels of cortisol in the body. Neurobiologist Bruce Perry refers to the ‘defeat response’, when regulatory modulators are compromised in threat response patterns. The monkey that gets electric shocks and is offered a banana after each shock gets desensitized, or withdraws in the corner and refuses bananas. Are drown-proofing conditioning methods more suitable to induce resilience in younger babies? Do they produce ‘toxic stress’ for sensitive toddlers?

When is the best time for inculcating water safety in infants? How many children trained in drown-proofing fail to become ‘resilient’ and develop extreme sensitivity, perhaps losing the enjoyment of water? While this is not in the interest of drown-proofing ‘programs’ to alert parents to this possibility, statistically, it must be actualized in at least a minority of children trained. Russian parents with traumatized toddlers trained in the Tjarkovsky method, that is founded on desensitization of babies through repeated dives, have turned to Birthlight to restore their children’s rejection of being in water through gentle communicative moves. It is not clear whether this rejection was induced by forceful conditioning or by the temporary loss of connection between baby and primary carer. When a baby is pushed under, as when a baby is left to sleep alone, sensory contact is lost. The special feature about back floating conditioning is that loving signals are maintained and communicated to the baby throughout.

In both the ‘flip and float’ method and the Tjarkovsky method, enforcement is at the service of a higher cause: saving lives in the former, and developing superior brains in the latter. This is seductive and moreover the outcome is presented as a valuable competence that babies have gained.

As human parents, we use loving conditioning a lot in our interaction with babies so that we can get on with our lives in families and society. Even before the publication of Sue Gerhardt’s book ‘Love Matters’ in 2004, the importance of caring interaction in infants’ self-regulation of affect and the fact that learning is best done in a loving environment were well known. Her book provided neuro-scientific arguments against practices such as ‘controlled crying’ and finally nailed the remnants of Victorian child-raising in their coffin. 
Now is there such a thing as a loving rod? Hurting a kid with loving signals? Without the pretense of ‘cognitive enhancement’ or the mandate of saving lives, as in drown-proofing, this is exactly what child abuse is about.

Back floating enforcement with loving praise takes us in one of many gaps between neuroscience and parenting common sense. We need some amount of resilience to function as social human beings but using the rod, loving rod or its psychological equivalents is bound to cause trauma and detrimental mental and physiological effects in life, at least to those sensitive members of society. Evolution is taking us towards higher brain function without the need for resilience: recent research on oxytocin, on the polyvagal system and the connection between vagus nerve, heart and immunity shows that the ‘relaxation response’ induces modes of brain functioning preferable in all ways to the adrenalin/cortisol driven stress loops of the fight/flight response.

If enforced back floating for survival, through the mixed messages it conveys to babies between stress and rewarding praise, results in compromising at least some of the drown proofed babies’ capacity for trust, empathy and compassion, is it worth it given the lack of hard evidence for its outcomes? What is the real trade off for suppressing babies’ signals of distress communicated so visibly during training? If, as neuroscience shows in increasing detail and complexity, early experiences are translated into precise physiological patterns of response in the brain that then set the neurological rules for how we deal with our feelings and those of other people, is this the best we can do?

Violence, even coated in loving words and with the highest motive, always has a price tag. Authors such as Joseph Chilton-Pearce have eloquently written about the need for eradicating parenting violence since pregnancy. There is always another way. Listening and responding to cues in a real dialogue that gives babies the autonomy they deserve at every stage of their development enriches the connection between cognition and affect that is inscribed in our human physiology and increasingly unraveled in neuro-physiology research.

In the two years when I lived with Amazonian forest people and in all my subsequent trips I have only come across one case of toddler drowning, a little boy who followed older children into boggy water he could not be pulled out of. Why are so many infants drowning in affluent societies in spite of all the protection devices, admonitions and regulations?
Amazonian parents, together with African rainforest pigmy parents are reputed to be the gentlest parents in the world. I watched in wonder how they patiently trained their infants to stop on the edges of the raised platforms of houses standing on stilts in water. There never seemed to be any drama: babies were pulled back, played with a little, left to crawl to the edge again until something seemed to click and the babies stopped and sat there. This sometimes instilled an urge in me to go and grab them for safety until I learnt to trust this style of parenting. Had I interfered on basis of my fear, I could have disrupted a wonderful body-based dialogue made of thousands of minute body signals that these far more sensitive parents learn from childhood within their culture. In water, close physical connection between infants’ bodies and the bodies of close adults or siblings in swimming or wading provided the foundation for independent swimming.

It is true that parents cannot watch their children 24/7 and all parents have experienced instances of toddlers getting into scrapes within very short windows of inattention. But there is a lot that can be done before resorting to drown-proofing: calmly and patiently instilling the need to wait for an adult to give permission for entering the water (Amazonian parenting style); teaching toddlers to regain their footing in baths and paddling pools as soon as they learn to stand up, which can be a real fun game; creating the fun conditioning of taking off to mum or dad and going back to bar or pool deck, reinforcing communication, trust and a clear sense of achievement in the infant; jumping in and returning to poolside, since after all most toddlers fall very close to water edge, are probably some of the most valuable water safety skills that can be taught from six months onwards. All these practices are characterized by an absence of coercion, whether crude or disguised under rewarding praise. The infant is the agent, has to initiate and carry out the actions. This can be infuriating when a toddler is not in the mood to participate, but it’s also good to explore and negotiate boundaries and time needs to be made for that, saving tantrums or refusals later on.

Parenting programs that on paper save time, trouble and in the case of drown-proofing, is presented as life-saving, fits well in a society in which resilience is used and valued even at the cost of medicating infants who respond with extreme sensitization. At Birthlight, we have taken on the task of gently leading parents to enjoy the infinite pleasures of watching and responding to their infants in a true communication that sets a reliable long term basis for trust and open dialogue and promotes what Chilton Pearce has called ‘creative competence’. This is all important between the third trimester of pregnancy and the second year, when brain plasticity is greatest, with lasting consequences of the neuron networks set at this time. Water uniquely supports a focused interaction between parents and infants with the mutual adjustments that result from learning and brain regulation based on affect. Water encourages playful sensory-motor exploration that is inevitably curtailed, at least to some extent, by using back floating as a default position. Water safety is best based on communication, not on conditioning. We would not have it any other way. We give heartfelt thanks to Amazonian forest parents who currently face the pollution of their waters and the destruction of their environment for showing us in practice what gentle parenting can be.

In the absence of studies to assess the physiological stress levels of infants undergoing drown-proofing or the impact of drown-proofing on the developing child, perhaps the policy statement on controlled crying issued by the Australian Association of Infant Mental Health could be issued as a warning to parents: ‘(controlled crying) is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences’.

Françoise Barbira Freedman
Birthlight Founder & Director

29/03/2017

My baby swimming journey

Birthlight’s pioneering techniques are at the forefront of international approaches to baby swimming. Françoise received the prestigious Virginia Hunt Award in 2009 for her contributions to early swimming and together with other birthlight tutors she continues to innovate to in promoting a life long enjoyment of swimming from an early start.

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Center on the Developing Child: Harvard University


Baby’s Brain: The Urban Child Institute. http://www.urbanchildinstitute.org/why-0-3/baby-and-brain
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Perry, Bruce (2013) Seven Slide Series of video webcasts. Video 2: Sensitization and Tolerance.

https://www.youtube.com/watch?v=qv8dRfgZXV4

https://www.youtube.com/watch?v=1uCn7VX6BPQ


Gerhardt, Sue. (2004) Why love matters: how affection shapes a baby’s brain. East Sussex” Brunner-Routledge.


Shore, Allan. (1994) Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. New Jersey: Erlbaum.


Tracey, Kevin (2012): Andersson, U; Tracey, KJ (2012). "Reflex principles of immunological homeostasis". Annual Review of Immunology 30: 313–35.


Chilton Pearce, Joseph (2002) The crack in the cosmic egg: new constructs of mind and reality. 


Chilton Pearce, Joseph (2012) The Heart-Mind Matrix: How the Heart Can Teach the Mind New Ways to Think. Inner Traditions.

 

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