When it comes to parenting, everyone is an expert. Family, friends, random strangers, New England diner proprietors—everybody has “helpful” ideas about how you should be raising your kid. (Confidential to the woman in the mall parking lot that one time: yes, I know socks would keep my infant son’s feet warm. That’s why I tried putting them back on roughly 15 times after he pulled them off before I finally gave up. But thanks for teaching me what “cold” is.)
For parents of newborn infants, much of the advice they receive about health and safety for their babies should be coming from medical providers. According to a new study in the journal Pediatrics (PDF), many of them aren’t getting it.
Researchers from Boston University surveyed a little over 1,000 new mothers in the months following the birth of their babies, and asked where they’d been getting advice about such things as where and how to put the babies to sleep, breastfeeding, immunizations, and pacifier use. Sources of advice included medical providers, nursery nurses, family members, and the media. They then compared the advice these mothers reported receiving to the advice recommended by the American Academy of Pediatrics (AAP).
As a pediatrician myself, the numbers that jumped out at me most were of the mothers who reported getting no advice from their medical providers about such important topics as sleep position. Nearly 20 percent of mothers said they got no advice from doctors about how to put their babies to sleep, despite there being clear recommendations to put them to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). It’s such a part of my routine during new infant check-ups to talk about Back to Sleep that it’s startling to me to learn that a significant number of my colleagues are omitting it.
The authors do acknowledge the limitation that their study relied on a survey of respondents’ recollections. It could be that some of those mothers simply don’t recall advice that the providers really did deliver. But in either case, for a lot of new parents an important infant safety message isn’t getting through.
Another point of particular concern is the number of new moms who report no advice from their children’s doctors about immunizations. While the overwhelming majority did say they got the appropriate counsel, a little more than 10 percent said they heard none at all. That is quite dismaying.
I am unambiguously in favor of vaccinations. However, even the safest and most effective medications have side effects. It’s our obligation to explain to parents what immunizations we’re going to be giving, what protections they confer, and what side effects they should expect. It’s a duty I take very seriously, and I always give parents a chance to ask questions about them.
Physicians who do not educate parents about vaccines, even if they are administering them anyway, are doing them a disservice.
An unsurprising but nonetheless infuriating finding of the study was that, of mothers who said they had gotten advice about vaccines from the media, over 25 percent reported getting information that was not in keeping with AAP recommendations. Whenever a media outlet promulgates misinformation about vaccine safety, it makes its way to the people who are most in need of hearing the right thing. Unless new data actually emerge, giving people a platform (no matter how well they’re polling) to undermine public health by demonizing vaccines is irresponsible.
I wish the article offered more detail about those situations when mothers reported getting advice from doctors that deviates from AAP recommendations. The authors say that most deviations were along the lines of endorsing the recommended choices, but offering a single non-recommended alternative, as well. (For example, telling parents they could put the baby to sleep on its back or side, but not prone.) I suspect I would count as one such deviator in a couple of cases, myself.
In particular, I often differ from the AAP’s recommendation that babies nurse exclusively for the first six months of life, which I consider too doctrinaire and not as supportive of some new mothers as it should be. When I have a new mother who is struggling with breastfeeding and asks if she can supplement with formula, I give them the go-ahead without any compunction. (The authors do not comment about the recommendations per se, and acknowledge that many may deviate from them because of sincere disagreement.)
The area where most mothers reported getting no advice from their children’s doctors was regarding pacifier use. I will concede that I do not routinely bring it up, though I certainly discuss it when parents ask. Clearly I’m not alone, as 75 percent of mothers say their own providers didn’t mention it, either. The AAP does recommend their use, which may lower SIDS risk.
However, this would be another instance where I don’t quite toe the line, since their recommendation for nursing babies is to wait until one month before introducing them. I’ve always been very skeptical about so-called nipple confusion, and have given plenty of brand-new parents the go-ahead from the very beginning. Thus far, I haven’t personally heard back that it complicated breastfeeding in any perceptible way.
Yet even without discussing pacifiers routinely (and I’m going to try to make more of a point of it), the amount of information I present to parents of young infants is a lot. I try to do it in a non-overwhelming way, since having a newborn is plenty overwhelming on its own. But it’s my job to give them the best advice I can about keeping that small, vulnerable person as safe and healthy as possible.
Hopefully this new study will serve as a reminder to all medical providers that they are likely to be the most reliable source of correct recommendations these parents have. Family, friends, and Facebook will all doubtless offer up no shortage of opinions, but it’s our job to make sure the information they’re hearing from us is sound and comprehensive.