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Thursday, August 1, 2013

Will I hurt my baby if I give her formula?


Ahhhh breastfeeding. All at once a source of bonding, empowerment, joy and sometimes complete and utter misery. There. I said it. It’s not all ponies and sunshine. Women work extremely hard in most cases to establish functional nursing and often, it can be a trying experience especially in the first month after birth. Many mothers are also faced with the challenge of working while trying to maintain milk supply through pumping in the workplace.
The first few days and weeks after birth, especially for first-timers, can be downright scary because women generally don’t produce milk until day three or four of life. That leaves an uncomfortable gap of several days that breastfed infants are only getting colostrum and not much else. While colostrum delivers some nutritional and immunological proteins, it's not enough for an infant to grow. Indeed most newborns lose weight in the first 1-2 weeks of life. This is where it helps to stop and remember: humans have been dealing with this reality across millennia of survival.  In other words, while an infant may seem hungry or in danger of starvation, usually he or she is not. When milk comes in, usually sometime between the second and fifth day after birth (but could be longer), the infant begins to receive sufficient nutrients. As a result, the vast majority of breastfed babies do well though they all lose significant weight in the beginning and by two weeks have surpassed their birth weight.

BUT, not all babies are great breastfeeders and not all moms are able to nurse. The reasons are many and the list below includes some common barriers.  In the past I've had several moms in my practice who had sworn to breastfeed exclusively without a drop of formula. Many of them accomplished their mission, with or without much difficulty. However, some have had to use formula as a supplement to nursing. And I have to tell you, they were all so upset about it. The reasons for feeling they failed by having to use formula vary from woman to woman and are closely linked to their personal beliefs, cultural backgrounds and the availability of social support systems. However, a common thread stitching its way through these ladies’ minds and guilt-emitting neurons is the notion that breast milk is a purer, more natural form of feeding and formula is, well, somehow evil. If “evil” is too strong, then maybe “impure” would be a better adjective. There is suspicion of this product that is mass produced in factories by large corporations. There seems to be a deep fear of somehow tainting or hurting the baby if he or she is exposed to formula.

Some common barriers to breastfeeding: 
  • Insufficient supply   
  • Latching difficulty (weak suck, large breasts, inverted nipples, tongue tie)  
  • Hectic schedule   
  • Lack of spouse/family support  
  • Poverty 
  • Maternal Illness  
  • Infant illness  
  • Maternal use of medicine

When this happens I have what I call the “breast is best but formula is not evil” conversation with the family. Let’s take a look at what’s factually correct and what is misunderstood in infant feeding:


1) “Breast is best.” I gotta tell you, I hate this phrase. The word “best” just irks me because, while it props up women who can nurse their babies, it simultaneously suggests that anything else a mother does is kind of lousy. What about women who do both? What about women who have barriers to establishing supply that is sufficient or just couldn't nurse at all? This is where breakthebabyphobia rears its ugly head. 

While breastfeeding has been shown many times over to be wonderful for babies (and moms) - giving your infant formula will not break him/her!
While there are volumes written about the benefits of human breast milk versus formula, there is almost no data regarding benefits or pitfalls of supplementing breast milk with formula. In other words, at this point in time, we have no real knowledge regarding exactly what proportion of a child’s feeds need to come from breast only to secure the benefits it provides.
Take for example the working mother with a nine to five job and let’s examine three scenarios of possible feeding:


a) Infant is exclusively fed breast milk. Mom nurses in the morning, goes to work. Caretaker feeds infant thawed frozen breast milk the mother has stored. Mother returns and feeds infant once or twice directly from her.
b) Infant gets both. Mother’s supply and ability to pump are limited. Child nurses in AM and caretaker provides formula throughout day. Mother returns and feeds infant once or twice directly from her.
c) Infant gets formula only. Mother faced barriers (listed above) and could not nurse. Child is only fed formula.


Let’s compare them. Looking at A and C, one could make a sound scientific argument that there are a lot of benefits to to A over C. Research has continuously shown that there are health, cognitive and emotional benefits seen in children who were breastfed compared with those who were not. But there is more to that story than first meets the eye. 

Children are affected by multiple forces throughout their lives. A breastfed child that was otherwise neglected may not have better outcomes in some measurable realms as would a formula-fed child who received the attention he needed. A breastfed child who was never read to and wasn't encouraged to read, may not fare as well in school as a formula-fed child whose parents read to her every night.  A breastfed child who grows up eating fast food regularly, may be less healthy than a formula-fed child who eats a healthy diet growing up. There are so many influences in a child’s development over many years, that placing a make-or-break axiom on nursing is unreasonable. It’s hard to break the baby!

Let’s now compare A to B. Pediatricians and pediatric researchers would be hard pressed to produce data and results that could suggest that exclusive breastfeeding is vastly superior to mixed feeding. Again, while there are advantages to breastfeeding, and even though exclusive breastfeeding is recommended, the science is not so clear on this matter. There are a few issues that one should note, however.
Breastfeeding  yoga anyone?
First, part of establishing good breastfeeding is letting the newborn and the mother learn to produce and maintain a good latch. Although it is not clear in the evidence, some breastfeeding advocates assert that introducing formula in bottles too early can interfere with establishing good nursing. Probably the main reason bottles can interfere with initial breastfeeding is due to the fact that every bottle feeding session may replace a breastfeeding session. As a result, a woman’s hormonal lactation mechanism (baby sucking on nipple leads to more milk production), may be turned down and less milk may be produced.

One other issue to consider is that breastfed babies seem to grow different bacterial elements in their gut when compared to formula fed babies. Now, I’m talking about good bacteria - the kind we all have living with us every day and help our digestion and immune system. A Duke university study in 2012 showed that breast milk is more likely to produce a protective “biofilm” when bacteria such as E. Coli (good E. Coli) was grown in it. Formula milk did not promote the development of biofilms. Now biofilms are not something you watch on a big screen eating popcorn. Biofilms are protective membranes formed by thousands or millions of bacteria and act like a Saran Wrap protectant against unwanted bad bacteria. So...what does this mean? Well...you could argue that breast milk promotes better immunity in the gut and it is true that formula fed babies have somewhat higher incidences of diarrhea. But, again,  it really doesn't tell us much about babies who get both breast milk and formula.

Finally, I would like to say a word about the stress that breastfeeding and formula anxiety can confer on a family. Children are tough. They undergo a mind-boggling array of developmental, physiological, nutritional, social and physical changes within very short intervals of maturation. They can take a lot of changes and can be presented with a myriad of situations and still thrive.

Sometimes our society places pressure on parents (especially mothers) to achieve a standard of parenting that doesn't take into consideration the barriers they are facing in their lives. This pressure may ultimately end up being noxious to the family. If a woman can’t nurse and she must use formula, she is certainly not providing a lower standard of care because “care” of a child consists of so many different aspects. While there is no doubt that by itself breastfeeding is very much a positive benefit for children and their parents, there is a place and time for supplements as well. Parents should know that it’s OK to reach for help whether it’s a family member, a lactation consultant or a bottle of formula or all of the above. A child’s health and happiness is also based on so many things other than the kind of milk he or she receives in the first years of life.

Thursday, October 11, 2012

Are Pacifiers Evil?

  My daughter still uses a pacifier at age two and a half and my wife and I have heard numerous times that if we don't wean her soon, she will have permanent dental problems. We were also told to avoid them soon after her birth, so as to not interfere with breastfeeding. There seems to be a lot of confusion regarding whether pacifiers are helpful tolls, or just plain evil. Here's a short review.


1) Pacifier use in newborns helps prevent SIDS (crib death)

TRUE


A review of seven studies published in 2005 by the University of Virginia School of Medicine showed a clear advantage in SIDS prevention among infants under one who used a pacifier for sleep. The researchers showed that for every 2733 babies of used pacifiers, one episode of SIDS could be prevented, which, when considering the terrifying outcome of SIDS, is certainly compelling.

2) Pacifiers can interfere with establishing breastfeeding in the first month


MAYBE BUT PROBABLY NOT

Several studies from different countries have corroborated data which shows that pacifiers can interfere with nursing. Each of these studies has some flaws, but together they seem to agree that pacifier use should be delayed until breastfeeding is established.

However, a mechanism to explain exactly why it is that pacifier use blocks successful nursing has not been found. Many lactation experts speak of “nipple confusion” as an explanation. In this hypothesis, the pacifier represents a “fake” nipple, eroding the child’s ability to learn correct latch and milk expression from a real, and very differently shaped nipple. La Leche League International states “Pacifiers can be risky for breastfed babies. When it comes to comforting newborns, they are not right for the job, and mothers should avoid them until breastfeeding is well established, at least for the first three or four weeks. “
Others have postulated that pacifier use decreases an infant’s frequency of nursing and ability to empty a breast. This leads to decreased milk production through a hormonal process. (see bottom of article for explanation)*
Both the above hypotheses have not, as of today, been proven. The lack of mechanism by which pacifiers interfere with breastfeeding creates a “chicken and egg” dilemma. While there is a clear association between pacifier use and breastfeeding disruption, there is no clear causation. In other words, it is unclear whether parents who chose to use pacifiers do so because they are having trouble with nursing in the first place. So we may be blaming pacifiers for diminished nursing when the initial problem may be unrelated.
Finally, a 2001 study, published in the Journal of The American Medical Association, looked at 258 infant-mother breastfeeding pairs who either used a pacifier or did not. They found no increase in breastfeeding weaning at age three months with pacifier use. Interestingly, the perception during the experiment was that pacifiers did cause earlier weaning. But when the statistical numbers were run, no such effect was calculated.

3) Pacifiers Cause Dental Problems


FALSE BEFORE AGE THREE
An "orthodontic" pacifier

Pacifier use in the first years of life is well known to temporarily change children’s tooth alignment. However, there is some, but relatively limited data to suggest that pacifier use is responsible for permanent dental changes.
A few studies conducted in the 1970s showed no or minimal relationship between pacifiers and permanent dental alignment issues. The lack of relationship was especially true when pacifier use was stopped prior to age four.
A newer study, published in “Pediatric Dentistry” in 2005, studied 444 children. Here, researchers found an increase in the occurrence of overbite in children who used a pacifier until ages two to four. A 2004 study, published in  2006, concluded that  “Pacifier use beyond the age of 3 contributes to a higher incidence in anterior open bite, posterior cross bite and narrow intercuspid width. The greater the longevity and duration of pacifier use, the greater the potential for harmful results”
In all studies, special “orhtodontic” versus regular pacifier shapes, made no difference in dental outcomes.
The bottom line is that the data on whether pacifiers cause permanent dental changes is somewhat mixed. There seems to be pretty clear evidence that pacifiers can lead to permanent dental alignment problems, but those tend to start with use past ages two to four. Also, it seems clear that the longer a pacifier is used, the more severe the problems may become. However, based on the data available, it seems very reasonable that the AAP has recommended avoiding pacifier use beyond age three.

4) Pacifiers can cause more ear infections

TRUE (but...)

There is strong evidence that using a pacifier increases the risk of ear infections by about 1.5 times. There are several studies that show this causation and one that even showed that the more pacifier use was reduced, the more the rate of ear infections decreased. However, breastfed babies using pacifiers had a decrease in ear infections compared to all infants who were not breastfed, regardless of pacifier use.There indeed seems to be a connection, but in general, the increase in infections may eliminated by breastfeeding.

Summary

  • Pacifiers can decrease the chance of SIDS
  • There is a chance that pacifiers interfere with nursing, but a causation has not been well proven
  • Pacifiers can permanently interfere with normal tooth development, but the likelihood of this happening is small under age three
  • Pacifiers increase the chance of ear infections but not by much and these infections can be avoided with nursing


The Verdict On Pacifiers

Pacifiers can be extremely useful to families. They can provide hard working, breastfeeding mothers with much needed breaks and fussy infants with oral soothing they require. There are significant advantages to pacifiers and they can even help save lives. An overly strict policy of no pacifier use until good nursing is established might be unnecessary as a true connection between use and breastfeeding failure has not been yet established. In situations where breastfeeding is proving very challenging, parents may want to meet with a lactation consultant when possible for a more comprehensive review. From the available data, it seems that the risk for permanent dental problems with pacifier use is minimal, if children are weaned from use before age three. Finally, while there is an increased risk of ear infections with use, parents should balance that information with the risks of SIDS and try to breastfeed if possible.




* Explanation from above: Milk is produced by lactocytes (milk cells) in the milk collecting channels of the breast. When milk is not frequently removed from the breast, a hormone called FIL (feedback inhibitor of lactation) is released. This tells the breasts to gradually produce less milk over time. Based on this, some have hypothesized that actions which decrease the number of breastfeeding sessions (such as choosing to give a crying baby a pacifier as opposed to a breast), leads to increased milk retention. This retention then triggers release of FIL and diminishes milk volume over time.


Tuesday, October 2, 2012

5 Pediatric Misconceptions: Colds and Mucus

Snot.

The matrix of existence in which a Pediatrician spends the work day. The number one culprit of mucous production: the common cold (AKA "You got a virus"). More than any other infectious disease, the common cold is responsible for missed school and work days, doctor visits and misconceptions. Here are some myths and clarifications:

1) When a child has a cold, it's important to get the mucous out

     Colds happen when a virus passes from one person to another and infects the victim's eyes, nose, mouth, throat and lungs. Viruses cause the body's defenses (its immune system) to go into battle mode. In this mode, chemicals, called interleukins, are released by the body into the bloodstream. Those interleukins reach the nose and throat area and, as part of the body's way of protecting itself, cause a flood of mucous to be released. Enter mom with tissues and a firm "blow" command as she pinches a tiny red nose.

     Blowing your nose is great for getting that annoying drip to go away for a short interval, but it will not bring a quicker end to the cold. As long as the battle between the immune system and the virus rages, interleukins, and therefore mucous, will be continuously released. When the body starts winning (usually after day 3 or 4 of illness), the snot faucets will begin to shut off. In the meantime, a nasal saline spray can really help for temporary relief.

2) Antihistamines can help a runny nose

     Allergies cause lots of mucous too and antihistamines are great for helping noses when pollen counts are high. So one would think it makes sense that those medicines can help the common cold as well. Unfortunately, those runny noses are not caused by the interleukins described above. In allergies, histamine is the chemical messenger instead. Antihistamines (Benadryl, Zyrtec, Claritin) , do what their name implies: they block the ability of histamine to do its job of making mucous. But in the common cold, caused by viruses, there is no histamine involved. So antihistamines are pretty useless.

3) When the color of the mucous changes from clear to yellow, it's time to panic

     When those pesky viruses take charge of your body and attach to the inside of your nose and throat, they cause blood vessels in that area to become leaky. Those vessels are not leaky enough to let blood out, however, white blood cells, the immune system's soldiers, can slip out of the blood stream and out to the nasal mucous. This changes the color of the mucous and makes it thicker. Changes in color and thickness do not necessarily mean the child is getting sicker, it's just part of the process. Expected mucous colors include: clear, green, yellow and whitish. Mucous that looks like pus (white or gray), merits a visit to the Pediatrician.

4) A child who gets too many colds must have a broken immune system

     On average, kids will experience 6-8 common colds a year! And that's with a fully working, healthy immune system. When someone has a broken immune system (immunocompromised), they not only get many infections, but often they will have "weird" infections. In other words, common colds are common, so there's not much to worry about. But when children experience infections with germs that are very uncommon and experience severe or unusual symptoms (infections needing hospitalizations, brain infections, never healing infections) then we worry about their immune systems.

5) My child has had a cold for 3 months

Some Prolonged Colds Are Really Many Colds In Tandem
     Some viruses, like RSV can hang around for a long time, even as long as three weeks. But most viruses last about 5-7 days, with the first 3 to 4 days being the worst for the patient (feeling lousy, fevers, etc...). If your child seems to be having cold symptoms for more than 3 weeks, something else is likely going on. Allergies can mimic colds and last for months. Very prolonged colds can sometimes (but not always) be sinus infections. But, it is very common for children to get what's known as "back-to-back colds". In other words, virus A comes along, makes you sick. As soon as you start feeling better, virus B attacks. As soon as you start feeling better, virus C attacks. So when you look back, it feels like your child has been sick for many weeks. If your child has been sick for more than 2-3 weeks, or if fevers persist for five days or longer, go see your Pediatrician. He or she will help you figure out which of the above patterns your child is dealing with.

Thursday, September 13, 2012

Do "Ferberizing" and "Cry-It-Out" Kill Brain Cells?

      Are you killing your baby's brain cells? According to Dr. Darcia Navarez and Dr. Bob Sears, if you use a "cry it out" (CIO) technique to get your baby to sleep through the night, you may be doing just that. In an article published in Psychology Today titled "Dangers of Crying It Out", Dr. Navarez outlines her case against the popular methods, sometimes known eponymously as "Ferberization." Navarez joins Sears and many parents in criticizing CIO to be, as an NPR reporter put it: "...just short of barbaric."

"I just felt so wrong with letting my child cry for any length of time." - a mother on "Circle of Moms" site
      On his webpage, Dr. Sears uses his family's MO for proving a point: using referenced studies that are not really about his theory as if they are directly corroborating it. In his web page "Science Says: Excessive Crying May Be Harmful," Dr. Bob references no less than 19 pieces of writing regarding children and crying. Shockingly (or maybe not so shockingly), Sears qaulifies such writings  as someone's non-published master's thesis and an interview transcript as "science." Actual peer-reviewed studies are referenced but most do not directly discuss crying and sleep. Some are rat or ape studiesSears cobbles pieces of data about extreme situations in which infants and young children cry excessively and has magically linked them to CIO. One of the citations: "Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence,” is a well written chapter regarding the effects of repeated violence on children. This is what Sears is trying to pawn off as evidence for brain damage due to CIO. Does he really think parents are that stupid?


Dr. Richard Ferber
      Navarez implements similar techniques to Sears. By using data from studies looking to elucidate other questions, she creates the illusion of a problem. It becomes evident from her article that she is merely postulating a hypothesis and not actually proving a point. For example, regarding neuron death in stress situations: "when the baby is greatly distressed, the hormone cortisol is released. In excess, it's a neuron killer. A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth...Who knows what neurons are not being connected or being wiped out during times of extreme stress? What deficits might show up years later from such regular distressful experience?"

      

Here's the strategy

Step 1: Make big, scary statements: 
  • Brain cells grow rapidly in infants
  • Cortisol is released when the baby is "greatly distressed"
  • In excess, cortisol can kill brain cells

Step 2:  Ask a scary question: How will this affect babies' brains?

      The question is absolutely valid. But Navarez neglects to present counter points:

  • The fact that infant brain cells grow rapidly, does not necessarily increase their vulnerability
  • There is no evidence that CIO constitutes "great" distress
  • There is no evidence that cortisol is released in excess during CIO
If crying is so detrimental, why are Sears and Navarez insisting on letting infants cry ad-infinatum?
 Both Sears and Navarez use animal and human trials to show that stress-related physiological changes (increased blood pressure, elevated cortisol levels) occur in children while crying. They even extrapolate from extreme examples (prolonged neglect) which show how brain cells may be altered and even die under such circumstances. Two obvious problems with this line of thinking are left unaddressed: 

1) There are huge differences between CIO for a few days and prolonged child neglect or abuse. This is especially true when using Ferber's method, in which parents enter the room, remind the child they are there and can tell them " I love you, I'm right here", before they leave. 

2) If crying is so detrimental, why are Sears and Navarez insisting on letting infants cry ad-infinatum? If parents can prevent children from crying every single night for months or years by allowing them to learn to self-sooth over a few days...wouldn't that lead to less episodes of those bad physiological changes? I suppose their retort would be "when the parent soothes, those changes get better"...but there is absolutely no science to tell us what duration a cry should be to be "safe."
     
      And here's Navarez and Sears' biggest problem: an Australian study published this month in Pediatrics, which actually did look at children exposed to CIO. After five years of monitoring, the researchers showed no increase in cognitive or behavioral problems in two groups of children who underwent a form of CIO. They concluded:
"Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can con´Čüdently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression."
     There is another issue Sears and Navarez forgot to mention: there is a significant increase in cases of maternal depression when children cry and do not sleep at night. What is the impact of that fact on the health of the infant-mother dyad?

      What is most striking to me are the outrageously exaggerated descriptions of  the supposed turmoils involved in the CIO process. Anti-CIO advocates make it seem like family hell. For the most part we're talking about a process that lasts 2-4 days. Sure, every child is different, some may take longer (some may stop crying after one day), but for many parents the experience is nowhere near as bad as they imagined. The process takes a few nights, those nights can be quite difficult and stressful, and then...it's over. The baby goes to sleep, the parents go to sleep and they all wake up in the morning. Some babies regress and wake up at night every once in a while, but for the most part, it is a tremendous de-stressifier for the whole family. Reading Sears', Navarez's and some parents' diatribes about the evils of CIO, makes one believe it is the Pediatric equivalent of Trial by Ordeal. In reality, parents are trading  months and possibly years of minimal sleep-related crying, for a few nights of extra crying. As new data directly testing CIO's influence on the Pediatric brain emerges, maybe we can all finally put unfounded fears to bed.

     

   

Thursday, August 30, 2012

Your Baby's Smart, She Just Can't Read



Can your 3 year old read Harry Potter? No? Well parents in a Your Baby Can Read infomercial claim theirs can. For around $150 , kits containing “...multi-sensory learning techniques popular with families all around the world” can be purchased on Amazon. The kit can no longer, however, be purchased from the company’s website. That’s because the Federal Trade Commission recently filed fraud charges against the corporation, indicating that marketing of their product constituted false and deceptive advertisement. The company immediately shut down, citing insurmountable legal expenses.


Surfing to www.yourbabycanread.com runs you into this message:

“Your Baby Can, LLC has shut down all operations and is no longer in business. The developer of Your Baby Can Read!, Robert Titzer, Ph.D. has decided to take over maintenance of the Your Baby Can Read! website and of the Facebook page going forward. Your Baby Can, LLC, is no longer connected or affiliated with Robert Titzer, Ph.D. or his company the Infant Learning Company. We would like to take this final opportunity to thank all customers who supported Your Baby Can, LLC over the years.”
Robert Titzer
Dr. Titzer, the product's founder, possesses a Ph.D in human performance, a discipline unrelated to the study of pediatric acquisition of language and reading skills. While he does have three scientific publications to his name, in 1998 he admitted to the Los Angeles Times that the “main study for this theory, and for the book and video he sells via his website, is based on his own daughters.” The business took off, riding on the lift provided by an intense marketing engine. Commercials and infomercials, Facebook and Twitter were all used to promote the now defunct company. Featured in the campaign were infants and toddlers performing abilities usually expected at a minimum of ages 4 or 5. A two year old girl was featured in one commercial, reading an excerpt from “Charlotte’s Web.” 


The company reportedly sold over a million units in its more than a decade of existence, grossing approximately $185 million in sales. That is the exact amount the FTC has levied against them in fines.

Disney, Toys R Us and Nickelodeon all provided shelf space or airtime for the highly criticized product. Disney is no stranger to such controversy. In 2009 the company offered refunds for all purchases of its “Baby Einsteins” products. The company claimed at the time that those videos and audio CDs promote early learning despite clear indication from the American Academy of Pediatrics that prolonged screen exposure may delay normal development. Despite this history, Disney did not seem apprehensive about selling TV time to a company whose lack of evidence to support their product mirrored their own failure.

So, what has been actually shown to promote learning and skill acquisition in young children? Foremost: direct interaction between parents and their children. Hearing a parent or family member speak and spending one-on-one time is what helps brains develop. Reading to or with your child is very effective. Also important: routine interventions such as regular family meals, adequate sleep and breastfeeding have all been scientifically linked to improved learning and cognition. It is greatly lamentable that entrepreneurs hand out promises based on anecdotal or non-existent evidence to blindly promote products which do little to increase brain power and much to decrease wallet size.

Wednesday, May 16, 2012

Dr. Bill Sears' Dangerous Advice

Time's Clever Cover
Over four decades, Dr. Bill has accumulated a large body of personal experience which led him to deliver a message of mother (and somewhat father)-child bonding. Over time, previously theorized ideas by a British psychoanalyst combined with observations of South American mothers “wearing” their infants, gave rise to Sears’ blockbuster brand. The pillars of this theory, proposed as a way to raise happier, healthier children are: breastfeeding, babywearing and co-sleeping.
Dr. "Bill" Sears
-Where science exists, all doctors are ethically  mandated to present their advice in a risk-versus-benefit format-

Last week’s cover of Time Magazine, featuring the instantaneously famous image of a mother nursing a toddler with the headline  “Are You Mom Enough?” is designed to sell. The image and title, a supermarket checkout line impulse-buy machine, is a bit misleading. The actual article focuses very little on breastfeeding. For the most part, it is about Pediatrician Bill Sear’s version of the parenting philosophy known as “attachment parenting.”

 The article, with photos of Dr. Sears leaping with a granddaughter off a trampoline, or tan and smiling with his wife in their living room, may seem to be promoting his ideas at first. But on further reading, Time has taken a commendably careful look at the Pediatrician’s methods. Specifically, while they give him a chance to explain his rationale, the authors reveal what science has actually found regarding his claims. He is often just plain wrong.

         Dr. Sears, respected and loved has created a world which delivers 
parental advice based on “experience.” In the past, when little science existed regarding parenting issues, this was in essence, the only way to do it. Pediatricians are expected not only to diagnose and treat medical conditions, but also to be parenting coaches. The topics covered in a typical session can range from which pacifier to buy, to how to talk with teenagers. In the past, most of the Pediatric research had been focused on physical pathology such as infections and chronic disorders. But in the last few decades, more behavioral and social hard data have emerged. There are still many gaps in knowledge  however, and Pediatricians still have to fill those with personal experience and anecdotes. But where science exists, all doctors are ethically  mandated to present their advice in a risk versus benefit format.
For example, while co-sleeping with young children is hailed as emotionally healthy by Sears, when put in up against the cold hard reality of SIDS, it should be discouraged. To boot, there is no evidence that co-sleeping with children benefits them emotionally in any way. So what you are left with is Sears’ empty-bag: no known benefit, some risk. And folks, that’s the end of the story until further research states otherwise.
Sears’ forty years and thousands of patients of experience can’t even come close to the statistical value of population research. Would you rather take one doctor’s advice, based on a narrow geographic, socioeconomic population, uncontrolled and unmonitored - or would you trust a more robust, controlled study where the results are actually tracked?
I’ll admit, I would love to tell parents it’s OK to sleep with their babies. It’s a sweet and loving thing to do. But I can’t. It doesn’t matter what my personal philosophy is. I must have the humility to accept that my personal beliefs and instincts may be wrong. If even one baby died because a parent accidentally rolled over them at night, or the infant wiggled herself under a sheet or pillow...it would have never been worth it. And if anecdotal evidence is more important to some people, then I can tell you about the two beautiful infants who arrived dead while I was working in the Pediatric ER. Both times, the parents, who swore they could never possibly roll onto their sleeping babies, did.



What Sears Says What The Scientific
Consensus Says
Co Sleeping (bed sharing) Infants who sleep with
parents are 4 times less
likely to die of   SIDS
.
Bed sharing may increase
the risk of SIDS.


Based on a few studies
almost exclusively
conducted on
Japanese families,
SIDS rates are
lower in bed
sharing families.
In looking at the entire
body of evidence, some data show
a decrease in SIDS with
bed-sharing,but many others show
significant increases.
Japanese families often
sleep on  mattresses on
the floor. Hard surfaces
are known to decrease
SIDS. Most families
in the US tend not to sleep
this way. There is evidence
for both theories. In these
situations, it is better to
avoid potentially fatal behavior
until more data is obtained.
A recent review of 11
studies showed that bed
sharing may increase
SIDS death by 2.88 times.
Note: room sharing, without
bed sharing has been
shown to decrease the
rate of SIDS. It is always recommended that infants
sleep in the same room
as parents.

Babies who share beds
have more "stable
physiology" and
experience better
"long term
emotional health."
Stable Physiology - described by
Sears as "more stable
temperatures, regular heart
rhythms, and fewer long pauses in breathing ." Such findings are
medically meaningless. They have
no known link to outcomes such
as SIDS. However, a 2010
British review of autopsies of infants
who died of SIDS showed higher
levels of hypoxia (low oxygen due to asphyxia) in those who bed-shared.
Better long term emotional health
- As the Time article states,
the research does not agree
 with this. Sears is quoting
animal (rat) research, a far
cry from human data.
Bed sharing facilitates breastfeeding. Bed sharing does facilitate
breast feeding. This is the only
point Sears makes which is
corroborated by good
science. However, parents
can easily use
a "co-sleeper" side bassinet
without bed sharing, significantly
diminishing the risks of SIDS.
Conclusions Bed sharing is better for children. There is no good evidence,
other than its role in promoting breastfeeding, that bed sharing is beneficial in any way to children.
There are, however, documented
risks. The risks outweigh the
benefits. Bed sharing is not recommended.










Thursday, April 26, 2012

Hi, I'm Your Pediatrician and I Don't Respect Your Opinion


Last week, at my new practice, I was told by a patient’s mother that I seemed like a “lovely individual” but I was not practicing as “open mindedly” as she hoped I would be. She complimented me on my  bedside manner and listening skills, but ultimately felt that I was not respecting her opinions. I told her that in all honesty, she was right.
I replaced her previous Pediatrician who had been in charge of the practice for over ten years and moved. In looking back at her children’s charts, I found several correspondences between the previous doctor and her. The mother had raised concerns over a decade regarding vaccines and the previous doc documented several hours worth of visits, phone calls and emails on the topic.
Her opinions, the ones I apparently did not respect, were a selected few from vaccino-phobia’s greatest hits. The MMR causes autism. Too many too soon. HPV vaccine is dangerous, etc...etc...So, I calmly and gently put it to her that all of these theories have been powerfully disproven. She calmly and gently responded that there was not enough research. I calmly and gently told her that there is so much science at this point, that there are very few other things a Pediatrician can recommend that are so supported.
There were pauses and smiles and overall disagreement. Finally she responded “I know you have a lot of training and schooling. but I’m smart too.” I smiled and said “I have no doubt you are.” I meant that. But the problem is, intelligent as we may be, the science is smarter than all of us. No matter how smart we may be, as Richard Feynman once said: “It doesn't matter how beautiful your theory is, it doesn't matter how smart you are. If it doesn't agree with experiment, it's wrong.”
I consider myself open-minded. But as James Randi would say “not so open minded that my brain falls out.” In her defensive stance, this mother extrapolated my disrespect for unproven, disproven and dangerous theories to mean disrespect of her as a person. It did not. She and her children have moved on to a new Pediatrician, maybe one who accepts her refusal to vaccinate. Maybe that doc makes her feel more respected. But for me, the disrespect of science is a spit in face of all our at-risk children.