Don't Retract Pack

‘Babywise’ Linked to Babies' Dehydration, Failure to Thrive

By Matthew Aney, M.D.

Volume 14 Number 4

Expectant parents often fear the changes a new baby will bring, especially sleepless nights. What new parent wouldn’t want a how-to book that promises their baby will be sleeping through the night by three to eight weeks?

One such book, On Becoming Babywise, has raised concern among pediatricians because it outlines an infant feeding program that has been associated with failure to thrive (FTT), poor weight gain, dehydration, breast milk supply failure, and involuntary early weaning. A Forsyth Medical Hospital Review Committee, in Winston-Salem N.C., has listed 11 areas in which the program is inadequately supported by conventional medical practice. The Child Abuse Prevention Council Of Orange County, Calif., stated its concern after physicians called them with reports of dehydration, slow growth and development, and FTT associated with the program. And on Feb. 8, AAP District IV passed a resolution asking the Academy to investigate “Babywise,” determine the extent of its effects on infant health and alert its members, other organizations and parents of its findings.

I have reviewed numerous accounts of low weight gain and FTT associated with “Babywise” and discussed them with several pediatricians and lactation consultants involved.

The book’s feeding schedule, called Parent Directed Feeding (PDF), consists of feeding newborns at intervals of three to three and one-half hours (described as two and one-half to three hours from the end of the last 30- minute feeding) beginning at birth. Nighttime feedings are eliminated at eight weeks.

This advice is in direct opposition to the latest AAP recommendations on newborn feeding (AAP Policy Statement, “Breastfeeding and the Use of Human Milk,” Pediatrics, Dec. 1997): “Newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting. Crying is a late indicator of hunger. Newborns should be nursed approximately eight to 12 times every 24 hours until satiety...”

Although demand feeding is endorsed by the Academy, WHO, and La Leche League among others, “Babywise” claims that demand feeding may he harmful and outlines a feeding schedule in contrast to it. The book makes numerous medical statements without references or research, despite that many are the antitheses of well-known medical research findings. In 190 pages, only two pediatric journals are referenced with citations dated 1982 and 1986.

Many parents are unaware of problems because the book is marketed as medically supported. It is co-authored by pediatrician Robert Bucknam, M.D., who not only states in the book that the “Babywise” principles are medically sound,” but also writes, “Babywise” has brought a needed reformation to pediatric counsel given to new parents.” Obstetrician Sharon Nelson, M.D., also warns: “Not following the principles of “Babywise” is a potential health concern.”

The book’s other author is Gary Ezzo, a pastor with no medical background. Ezzo’s company, Growing Families International (GFI), markets the book as “ideally written” for “obstetricians, pediatricians, or health-care providers to distribute to their patients.” (GFI promotes the same program under the title “Preparation for Parenting,” a virtual duplicate with added religious material).

Though “Babywise” does say, “With PDF a mother feeds her baby when the baby is hungry,” it also instructs parents to do otherwise. In a question-and-answer section, parents of a 2-week-old baby, who did not get a full feeding at the last scheduled time and wants to eat again, are instructed that babies learn quickly from the laws of natural consequences. “If your daughter doesn’t eat at one feeding, then make her wait until the next one.”

Unfortunately, the schedule in “Babywise” does not take into account differences among breastfeeding women and babies. According to one report, differences of up to 300 percent in the maximum milk storage capacity of women’s breasts mean that, although women have the capability of producing the same amount of milk over a 24-hour period for their infants, some will have to breastfeed far more frequently than others to maintain that supply. Babies must feed when they need to, with intervals and duration determined according to a variety of factors in temperament, environment, and physiological makeup. Averages may fit into a bell-shaped curve, but some babies will require shorter intervals. (Daly S., Hartmann P. “Infant demand and milk supply, Part 2. The short-term control of milk synthesis in lactating women.” Journal of Human Lactation; 11; (1):27-37).

Examples of the many other un- substantiated medical claims in “Babywise” include:

• “Lack of regularity [in feeding intervals] sends a negative signal to the baby’s body, creating metabolic confusion that negatively affects his or her hunger, digestive, and sleep/wake cycles.”

• “Demand-fed babies don’t sleep through the night.”

• “A mother who takes her baby to her breast 12, 15, or 20 times a day will not produce any more milk than the mom who takes her baby to breast six to seven times a day.”

• “Mothers following PDF have little or no problem with the let down reflex, compared to those who demand-feed.”

• “Colic, which basically is a spasm in the baby’s intestinal tract that causes pain, is very rare in PDF babies but is intensified in demand-fed babies.”

• “In our opinion, much more developmental damage is done to a child by holding him or her constantly than by putting the baby down. In terms of biomechanics alone, carrying a baby in a sling can increase neck and back problems, or even create them.”

• “Some researchers suggest that putting a baby on his or her back for sleep, rather than on the baby’s tummy, will reduce the chance of crib death. That research is not conclusive, and the method of gathering supportive data is questionable.”

My review of the low weight gain and FTT accounts associated with “Babywise” revealed several disturbing trends. Parents were often adamant about continuing with the feeding schedule, even when advised otherwise by health care professionals. They were hesitant to tell their physicians about the schedule, making it difficult to pinpoint the cause for the weight gain problems. Many elected to supplement or wean to formula rather than continue breastfeeding at the expense of the schedule. The parents’ commitment call be especially strong when they are using the program for religious reasons, even though numerous leaders within the same religious communities have publicly expressed concerns.

Pediatricians need to know about “Babywise” and recognize its potential dangers. History taking should include questions to determine if parents are using a feeding schedule, especially before advising formula supplement to breastfeeding mothers or when faced with a low-gaining or possible failure to thrive baby. Lactation consultants also should be instructed to probe this area.
Efforts should be made to inform parents of the AAP recommended policies for breastfeeding and the potentially harmful consequences of not following them.

Dr. Matthew Aney is an AAP candidate fellow based in Lancaster, California.

For more on Babywise, the Ezzos and Growing Kids God's Way methods see:

The Case for Cue Feeding (rather than PDF - "parent directed feeding")

Parents Against Babywise (Facebook page)

Moms Against Babywise (Facebook group)

Piercing Expert, and Father, on Ear Piercing Babies

Matt Sanders' original post here

More from Matt:
Instagram/online portfolio: @modified_florida

Another father, Adam, demonstrates the honoring of consent, personal choice, and agency with his 8 year old daughter on the topic of ear piercing. Original post.

Related Reading: 

The Perils of Piercing Guns:

One Regret:

Peaceful Parenting Community:

Peaceful Parenting on Facebook:

Her Body. Her Choice.
Infant ear piercing is painful, risky, and has no benefits for any baby. Allow your child to choose body modifications when she is fully informed and able to consent.

She is just as much your baby girl without body modification. Say NO to infant ear piercing.

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Why You Should Stop Yelling at Your Kids

By Stephen Marche, New York Times
Leer en EspaƱol:
Shared at Peaceful Parenting with permission.
Read more from Marche:

Why you should stop yelling at your kids. It doesn’t make you look authoritative. It makes you look out of control to your kids. It makes you look weak.

The use of spanking to discipline children has been in decline for 50 years. But yelling? Almost everybody still yells at their kids sometimes, even the parents who know it doesn’t work. Yelling may be the most widespread parental stupidity around today. Households with regular shouting incidents tend to have children with lower self-esteem and higher rates of depression.

A 2014 study in The Journal of Child Development demonstrated that yelling produces results similar to physical punishment in children: increased levels of anxiety, stress and depression along with an increase in behavioral problems.

 How many times in your parenting life have you thought to yourself, after yelling at your kids, “Well, that was a good decision...”? It doesn’t make you look authoritative. It makes you look out of control to your kids. It makes you look weak. And you’re yelling, let’s be honest, because you are weak. Yelling, even more than spanking, is the response of a person who doesn’t know what else to do. But most parents — myself included — find it hard to imagine how to get through the day without yelling.

The new research on yelling presents parents with twin problems: What do I do instead? And how do I stop? Yelling to stop your kids from running into traffic is not what we’re talking about here. We’re talking about yelling as a form of correction. Yelling for correction is ineffective as a tool and merely imprints the habit of yelling onto the children. We yell at our kids over the same stuff every day, and we yell at them some more because the original yelling doesn’t work. Put your clothes away. Come down for dinner. Don’t ride the dog. Stop hitting your brother.

The mere knowledge that yelling is bad, in itself, won’t help, said Alan Kazdin, a professor of psychology and child psychiatry at Yale. Yelling is not a strategy, it’s a release. “If the goal of the parent is catharsis, I want to get this out of my system and show you how mad I am, well, yelling is probably perfect,” Dr. Kazdin said. “If the goal here is to change something in the child or develop a positive habit in the child, yelling is not the way to do that.” There are other strategies, and they don’t involve screaming like a maniac.

Many think of positivity as a form of laziness, as if parents who are positive aren’t disciplining their children. But not yelling requires advance planning and discipline for the parents, which yelling doesn’t. Dr. Kazdin promotes a program called the ABCs, which stands for antecedents, behaviors and consequences. The antecedent is the setup, telling a child, specifically, what you want them to do before you want them to do it. Behaviors are where the behavior is defined and shaped, modeled by the parent. And the consequence involves an expression of approval when that behavior is performed, an over-the top Broadway-style belt-it-to-the-back-row expression of praise with an accompanying physical gesture of approval. So instead of yelling at your kid every night for the shoes strewn across the floor, ask him in the morning if he can put his shoes away when he comes home. Make sure when you come home that you put your own shoes away. And if your child puts his shoes away, or even puts them closer to where they’re supposed to be, tell him that he did a great job and then hug him. 

The ABC method of praise is a highly specific technique. You have to be effusive, so you actually have to put a big dumb smile on your face and even wave your hands in the air. Next thing is you have to say, in a very high, cheerful voice, exactly what you’re praising. And then the third part is you have to touch the child and give him some kind of nonverbal praise. The silliness is a feature, not a bug. It makes the kid notice the praise that accompanies correct behavior. And that’s the point. “We want to build habits,” Dr. Kazdin said. “The practice actually changes the brain, and in the process of that, the behaviors that you want to get rid of, having all kinds of temper tantrums and all the fights, all that just disappears.” Furthermore, he noted, “as a side effect, when you do these things, the parents’ depression and stress in fact go down and family relations pick up.” If our kids behave better, then we won’t feel like yelling. And if we don’t yell, our kids will behave better.

The beauty of having a system is that instead of reacting after your kids do something bad, instead of waiting for them to mess up and then getting angry, you have a conscious plan. But planning requires discipline on the part of the parent, and it’s tough. “We know that humans have what’s called a negativity bias,” Dr. Kazdin says. “The technical term for that in psychology is ‘normal.’ This is something in the brain, in which through evolution we are very much sensitive to negative things in the environment.” We are hard-wired to yell. It’s an evolutionary survival instinct that has turned on those it was meant to protect. It’s hard to abandon yelling, because it gives us the impression that we’re parenting.

In the 1960s, 94 percent of parents used physical punishment. A poll in 2010 found the number had declined to 22 percent. There are probably many reasons, including the influence of a number of childhood development educators. But surely one reason has to be that the reason to spank your kids evaporates if there’s a more effective way to change their behavior that doesn’t involve violence. Why spank if it doesn’t work? The same applies to yelling: Why are you yelling? It isn’t for the kids’ sake. Ultimately, techniques of discipline have to be about effectiveness, about getting through the day while trying to get your kids to do what you want and not do what you don’t want. Praise works. Punishment doesn’t.