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AAP News prints article questioning Babywise

© Matthew Aney, M.D.

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 be 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."

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