The evidence supporting some of our most popular opinions is often not so compelling.
In 2015 31% of first time mothers were over 30 years old. In 1980 it was 8.6%, and it is safe to assume that those 2015 first time mothers got more of their parenting advice from the internet rather than from an experienced grandmother. One of those first time mothers, an economics professor at Brown, has written a book examining the presence, or absence, of real data on the conventional wisdom surrounding breast feeding, sleep training, and working mothers.
According to Emily Oster in her book Cribsheet, the current mantra is that it is best to breast feed your infant: it is easy to do, produces smarter babies with less diarrhea and ear infections, and makes “happier moms with better friendships”. In reviewing the evidence on the internet she notes that breast-fed babies in many of the observational studies of breast feeding are generally being fed by a mother with a higher IQ and in a higher educational and economically class than non-breast feeding mothers. “So which is the cause?” The difference in ear infections in one very large study was 2%. The difference in diarrhea episodes was 4%. One study of siblings, one breast fed and one not, found no difference in IQ or incidence of obesity at 6 1/2 years of age. Her conclusion: “The good news for guilt-ridden moms [who don’t breast feed their infant] is that there is very little evidence for long term effects [of not breast feeding]. Moms often feel selfish about thinking about their own wants and needs with decisions about their kids. In this case, the data gives you permission to put yourself first for once.”
The internet is apparently full of stories of the extensive long-term damage to your infant if you let them “cry it out”, the code word for “sleep training”. This is apparently based on 1980s studies in orphanages in Romania. Dr. Ferber’s careful studies of sleep training and in 1986 outlined in detail how to do it. (“Ferberizing”)(1) Many studies of sleep training show sizable improvements in maternal depression, family functioning, and no negative effects on infants. But, one small study quoted all over the internet suggested that more stress was demonstrated by the infants a few weeks after sleep training even though the mothers were less stressed. Her conclusion: “Every family is different, and you may not want to let your baby cry. But if you do want to sleep train, you should not feel shame or discomfort about that decision.” ( Since it might take two or three nights to train the infant, I suggest to apartment dwellers to let the neighbors know what you are doing.)
In our pediatric practice we use “SAH” to describe the non-working mom as “stay-at-home”. Also for the non-working dad, but Oster restricts her discussion to the moms. She notes that there is very little data about the pros and cons of mothers working outside the house except for the evidence supporting longer maternity leave which is beneficial to mother and infant in those first months. Like other working parents I have observed, Oster finds that the switching back and forth from work mode (academic research) to child-care mode and back again can be satisfying (she uses the economic term: “marginal value”) as a change of pace that can reduce boredom and fatigue. The economic value of working outside the home is clear. Her conclusion: “Do whatever fits your family best.”
Oster relates that after she had unloaded a lengthy, multi-faceted, escalating stepwise concern to her pediatrician about what to do if her non-allergenic 2 year old child was stung by a bee on an upcoming vacation trip, she responded, “Hmm. I’d probably just try not to think about it.”
That reminds me of the old story of the 100-leg caterpillar merrily progressing along a road when a fly asked him how he coordinated all those legs. The more the caterpillar thought about it the more entangled his legs became, and he ended up curled up in a ball in the gutter.
Who Are the Real Screen Addicts?
Nielsen research found that Americans aged 35 to 49 used social media 40 minutes MORE each week than those aged 18 to 34. They were more apt to pull out their phones at dinner and spend more time on multiple devices, but they peeked at their phones while driving LESS than millennials. One researcher reported that her interviews of elementary school kids about screen times sometimes indicated that “Parents are the worst.” (2)
Stand or Sit At Work?
The 2015 studies suggesting that sitting for prolonged periods increased your risk of cardiovascular disease spawned a widespread wave of popularity for “standing desks”, but repeat analysis of the data indicated that alternating standing and sitting “may be useful for some people with low back or neck pain . . .but there is no scientific evidence for improved cardiovascular health”. (3)
1. Solve Your Child’s Sleep Patterns, Richard Ferber, MD, 1986 and revised 2006
2.Wired, April 2018, pg. 67
3.This Week, December 7, 2018, pg. 20