Monday, September 01, 2014

Babywise Feeding Concerns

Babywise Feeding Advice

BabyDoh3Babywise and Preparation for Parenting have been criticized by hundreds of professionals in pediatric medicine, human lactation, psychology, anthropology, child development, and theology. Problems have been associated with these programs -- cases of slow weight gain, failure to thrive, depressed babies, even hospitalization. Its feeding recommendations were the subject of a warning sent out by the AAP.

Summary of Concerns

The following are some of the concerns experts share :

  • Lack of expertise and credentials
    • Professional: The primary authors of the material, Gary and Anne Marie Ezzo, present themselves as experts but Gary Ezzo has no background or expertise in child development, psychology, breastfeeding, or pediatric medicine, and holds neither an associate's nor a bachelor's degree from any college. His master of arts degree in Christian ministry was granted through a program that awarded credit for life experience in lieu of an undergraduate degree. Anne Marie Ezzo worked briefly as an R.N. decades ago.
    • Personal: The Ezzos raised two daughters but have been estranged from them for nearly a decade.
    • Co-author: It is unclear what, if anything, Babywise co-author Dr. Robert Bucknam contributed to that book, since versions of the book for the Christian market are essentially the same (with added religious material) and do not have his name on the cover.
  • Risks for breastfeeding mothers and babies. Breastfeeding on a parent-determined schedule (including a "flexible routine" as it is called in Babywise) can reduce a mother's milk supply and contradicts the recommendations of the American Academy of Pediatrics (AAP), which has stated, "The best feeding schedules are the ones babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration."

  • Poor breastfeeding information. Although it is presented as authoritative, the breastfeeding information in Babywise is inaccurate and substandard (compare with the AAP Breastfeeding recommendations from the 2005 AAP Policy Statement on Breastfeeding and the Use of Human Milk).  Babywise itself contains an oblique warning that breastfeeding mothers may experience difficulties feeding their babies in the long term.

  • One Size Doesn't Fit All. All babies and mothers are treated alike without respect for individual differences in breastmilk storage capacity and rate of milk synthesis on the mother's part, or differences in metabolism, stomach capacity, rate of growth, thirst and fluid intake needs, etc, on the baby's side.  Breastfed babies need varying amounts of milk in varying numbers and sizes of feedings based on fluctuating factors. Similarly a woman's milk production is variable from day to day and differs on an individual basis from one woman to another.
  • A high-pressure presentation impacts readers' perception of what is at stake:
    • Pressure to maintain the regimen. The rules for sleep, feedings and wake time are portrayed as critical to follow in order to achieve a healthy outcome, and health, behavior problems and sleepless nights are predicted if the program is not followed. (Flexibility is praised but defined as small, temporary deviations from the prescribed regimen. Parents are warned that open-ended adaptations will cause problems.)
    • Misplaced moral dilemmas. Adherence to the program is framed as a moral or biblical issue (e.g. failure to stick to the regimen is portrayed as lax permissiveness on the part of parents, and uncooperativeness on the part of the baby.)
    • Parents are reluctant to abandon the method, even when it's not working out. Health care professionals have observed that even when their babies were doing poorly on the program, parents often wanted to stick with it.

Essential Reading:

AAP Media Alert | PDF version
This media alert was issued after the AAP evaluated On Becoming Babywise.

"Examining the Evidence for Cue Feeding" -- PDF file
by Jan Barger, RN, MS, IBCLC and Lisa Marasco, MA, IBCLC

"Babywise Advice Linked to Dehydration, Failure to Thrive"
by Matthew Aney, MD, AAP News

For Further Information

Critiques, reviews and professional analyses of Babywise and Prep
Heath Care Professionals Quoted in News Reports
News reports and media coverage
Comparisons of Ezzo and AAP Advice
Personal stories of former Babywise users
Frequently Asked Questions

 

Double Messages

  • "But Ezzo says to feed a hungry baby": Yes, but this is trumped by warnings about the baby's metabolism if feedings aren't spaced properly. I remember being worried that my baby's metabolism and everything else would be screwed up when I fed her early. How sad to RELUCTANTLY feed your baby, because you're scared that the feeding will damage her!

    --former user
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Best Practices

AAP Info For Parents:
How often to Breastfeed
Supply and Demand
Sleeping through the Night
A Message for Dads

Professional Best Practice Guidelines:
AAP Policy Statement on Breastfeeding
Best Practices Guidelines
of the Royal Women's Hospital, Melbourne AU

Also helpful:
How Does Milk Production Work?
by Kelly Bonyata, BS, IBCLC