25 June 2018

Brexting: can smartphone addiction hurt babies?

Clinical Technology Women

In a now-famous experiment in the 1970s, mothers were asked to sit across from their seated infants, but instead of saying “hello”, smiling or cooing, the mothers were told to remain expressionless and unresponsive. 

Their babies got very distressed very quickly. 

As reported by developmental psychologist Edward Tronick in his 1978 paper: “The infant orients toward the mother and greets her. But when she fails to respond, he sobers and looks wary.

“He occasionally smiles briefly, yet warily in less and less convinced attempts to get the interaction back on track. As these attempts fail, the infant eventually withdraws, orients his face and body away from his mother with hopeless expression, and stays turned away from her.”

This was dramatically different to the normal situation, in which the mother greeted her baby with a gentle, high-pitched voice, and the baby burst a giant grin, made a few cute noises, and wiggled its arms and legs around. 

“The still-face mothers in our study remained unresponsive for only three minutes, yet their infants found even such a temporary violation greatly disturbing,” Dr Tronick said. 

Another “still face” experiment, conducted by researchers at the University of Miami Medical School in the 1980s, found that four-month-old babies were more distressed by their mother’s apparent emotional unavailability than their mother’s physical absence. 

Through decades of literature, the “still face” haunts tiny humans. It’s a curious phenomenon, which has been replicated in numerous studies. But what, if anything, does this have to do with modern motherhood? 

For some experts, a mother whose eyes and fingers are glued to a digital device such as a smartphone while she is breastfeeding or bottle-feeding looks scarily similar to the still-face mum of experiments past. 

“You could definitely see a parent who is engaging with their phone and not their baby being kind of that ‘still face’,” Assistant Professor Alison Ventura, a researcher at California Polytechnic State University, says.

The habit of “brexting”, or breastfeeding while using a smartphone, appears to be widespread.

Professor Ventura’s data, published this year in the Journal of Nutrition Education and Behavior, showed that mothers were using a smartphone, tablet, computer or watching TV during one-quarter of feeds. The rate of distraction was the same across breastfeeding and bottle-feeding mothers. The analysis, which was the first of its kind, included self-reported data from 75 mothers with babies under the age of six months. During the study, which lasted a few days, around 80% of mothers reported using technology during at least one feed. 

“Both breast and bottle-feeding mums seem to be distracted,” says Professor Ventura. 

“But I think we need more research to understand how that might be impacting the feeding interaction.”

Another of Professor Ventura’s observational studies, published in Appetite in 2015, revealed that older, bottle-fed babies consumed more formula when their mothers were distracted. Technology was one of the primary distractions noted by the researchers.  

“Mindless eating”, or not paying attention to meals, is known to contribute to obesity in adults. Could “mindless feeding”, or bottle feeding while scrolling through Facebook or Instagram, be causing babies to pile on the kilos?

“It might,” says Professor Ventura. “We just can’t say that from just one observational study. You’d need to follow mums and babies over time to get a better sense of that.”

It’s thought that around 20% of adult obesity is caused by overfeeding babies. 

Breast-fed babies have some agency in the feeding process; they have to work for their nutrition, and usually stop when they’re full. Bottle-fed babies, however, are more vulnerable to coercive feeding as formula can just be poured down their throats.

It’s possible that parents can respond to their babies feeding cues, while multitasking with a mobile phone, says Professor Ventura. It may also be the case that parents are simply replacing traditional distractions, such as reading or housework, with technology.

But the chime of a smartphone notification has more pulling power than many of us like to admit. A more worrying hypothesis is that there is something novel and addictive about smartphones that lures parents away from their children. If this is true, inventions such as the Swipe and Feed baby bottle that doubles as a smartphone holder may be copping criticism for good reason. 

More than half of Australians surveyed in 2016 agreed that social media was “becoming addictive”, and that it was hard to break the habit.  

Mothers who are holed up at home with a newborn may find it particularly hard to put their phones down, Dr Kristy Goodwin (PhD), an expert on the impact of technology on families, says. 

Like the rest of us, mothers crave connection with the outside world. They have a desire for competency and often “use Dr Google as a crutch”, says Dr Goodwin.

“Many social media platforms and games have design features that aim to hijack your attention and provide endless streams of information,” says Jocelyn Brewer, a psychologist with an interest in digital technology. 

Personalised news feeds can trigger FOMO (fear of missing out) in a mother who is at home, sleep deprived, and lonely. “Generally, I recommend the ‘3Ms’ when it comes to tech use: mindful, meaningful and moderate, in order to keep a healthy balance within your ‘digital diet’.”

 “The whole world is in your lap, it’s in your house all the time,” said one mother, aged 20, who was interviewed as part of a 2016 qualitative study run by Assistant Professor Jenny Radesky, a developmental behavioural paediatrician University of Michigan.

Smartphones can provide an important moment of self-care for mothers, but “moms in my studies report that mobile devices can also be a huge source of stress – [creating], for example, interpersonal conflict, information overload, or unexpected demands from work email,” Professor Radesky told The Medical Republic. 

Babies can sense when their mother’s sympathetic nervous system is activated, so Professor Radesky recommends that mothers avoid using aspects of their device that cause them stress when around their offspring. 

Distractions, such as focusing on a smartphone, can negatively impact on the normal hormonal responses involved in “letting down” milk, particularly in the early days of breastfeeding, says Dr Anita Bearzatto, a general practitioner and a lactation consultant based in Melbourne. 

“The negative impact on feeding would be more likely if the information they were reading or watching was worrying or anxiety provoking,” she says. 

WHO ARE THE REAL VICTIMS? 

When the first news report about brexting appeared the US three years ago, the parenting blogosphere prickled with anger. 

“Yes, I breastfeed my infant daughter while texting,” Georgina Dent wrote in Mamamia. “I am also guilty of branking. Of bremailing. Of bracebooking. Of branstagramming. Of brweeting. Of breading … Some argue this interferes with bonding with my baby. I’d argue the only person capable of mounting that argument is someone who has never had a baby.”

Elsewhere, Milli Hill wrote in The Telegraph: “Do the ‘experts’ who’ve spoken out against brexting really think that nursing mums should just be sitting there and gazing in adoration at their child like a statue of the Madonna?” 

The issue didn’t go away. Tabloids around the world ran hot with takes on this latest “crime” against newborns. 

But the intensity of the outrage dwarfed the original criticisms. 

In fact, all this fury seemed to be directed at precisely two clinicians from Pomona Valley Medical Center in California who had spoken out about brexting in a local news outlet in 2015. Almost all the experts who were interviewed on the topic since then, including everyone I spoke to for this story, took a very balanced approach. 

“I think it’s up to mothers to decide if their mobile device use is problematic during breastfeeding,” says Professor Radesky.

“Shaming mothers is never OK,” Dr Bearzatto says. “Most mothers are doing the best they can at a challenging time in their lives. The debate about brexting could easily increase a mother’s anxiety around breastfeeding and motherhood.”

For the vast majority of mothers “there will be absolutely no harm” from brexting, says Amy Brown, a professor of public health at Swansea University in Wales. “If anyone is really worried about a mother looking at her smart phone during a feed, why not find a way to help her out? Is she struggling with something? Overwhelmed? Lonely?”

“Goodness, I’d never raise it in a consultation. Never. How presumptuous,” Adjunct Associate Professor Pamela Douglas, a GP and the medical director of Possums Education, says in relation to brexting.  “I think that’s disempowering to women,” she says. “Women want good information about how to make breastfeeding work. That’s our job. Then they will work out how to find that balance between the baby’s needs and their own need to get tasks done.”

There are so many real issues around breastfeeding, why focus on brexting? For instance, around 96% of Australian women say they intend to breastfeed, but only 39% of women are still breastfeeding at the end of three months. “It’s not that women aren’t trying, they simply aren’t getting the right support from clinicians,” says Professor Douglas. “Women try so hard. Women are heroic in what they try to do.”

Women who present with breastfeeding troubles, such as difficulty latching, and breast pain, often get unhelpful advice in Australia, says Professor Douglas.

Many lactation experts and dentists are still using an old model, which explains milk transfer through the action of the infant’s tongue. Under this old model, issues with breastfeeding are presumed to be caused by mouth connective tissue tightness, and babies are referred for frenotomies, often to dentists. (Rates of Medicare-funded frenotomies have increased 420% in 10 years in Australia, and this does not capture those performed by dentists.)

“That model is outdated,” says Professor Douglas. “Breastfeeding doesn’t particularly require the tongue to extend beyond the lower gum. It doesn’t require the tongue to have to lift independently.”

Professor Douglas has conducted analytic research, based on ultrasound studies, in collaboration with Associate Professor Donna Geddes from the University of Western Australia. Their research has overturned the old biomechanical model of breastfeeding, replacing it with her “Gestalt model”.

In this model, milk transfer depends on the baby’s jaw dropping to create a vacuum, and the baby’s mouth being deeply buried into the breast to maximise breast-tissue volume inside the mouth.  Painful, inefficient breast feeding is largely caused by positional instability,  resulting in breast tissue drag, says Professor Douglas. “[Tissue drag] is like sucking through a squashed straw,” she says. “You don’t get the same milk transfer.Then the baby fusses and back-arches, or damages the mother’s nipples. 

“But this is not because of a problem with the mouth and tongue, it’s because of the way the baby is fitting into the mother’s body.”

To promote pain-free, enjoyable breastfeeding, “we want as much breast tissue volume in that baby’s mouth as possible, and no breast-tissue drag”, says Professor Douglas.

A good way to reach this “sweet spot” is to lean back and let the baby fall into the chest starting above the breast, holding the baby horizontally across the body with both arms, then use micromovements to adjust the baby’s position, she says. Paying attention to breast sensations and the baby’s cues is particularly important while mothers are building a breastfeeding relationship. 

Once mother and baby are happily paired, however, mothers will find it easier to create a stable fit and hold. And, yes, they can probably even hold a smartphone between their hands at the same time, says Professor Douglas. 

Brexting may seem like a storm in a bottle. But this much bitterness and anger didn’t come out of nowhere. It seems that no matter what you do as a mother, you can bet that someone out there will have a nasty opinion about it. 

And that fear of judgment is actually what stops a lot of mothers from continuing breastfeeding past the three-month mark, Dr Lisa Amir, a breastfeeding expert at La Trobe University, says. 

“Some mothers – if they are not so confident – think it is not suitable for them to breastfeed if they are out and about,” she says. “If it’s a shopping centre or a park or public transport, they feel self-conscious. They feel someone might tell them off, which in fact happens very rarely, but it often gets in the news.

“We need to be reassuring mothers that it is actually illegal for people to be told that they can’t breastfeed,” says Professor Amir. 

And one can’t help but wonder, if mothers felt safe breastfeeding in public, would brexting even be an issue?

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Lou Lewis
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Lou Lewis
2 months 23 days ago

I would love to hear Dr Charlie Teo’s (one of Sydney’s leading neurosurgeons) opinion on newborn babies being exposed to phones so early life and what he thinks the short to long-term problems may be from a brain point of view. Personally I would not be comfortable if I was holding the baby right next to my mobile phone, especially after all the research Dr Teo has done in this field.
Regards
Lou

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