advice linked to dehydration, failure to thrive
Matthew Aney, M.D.
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
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.
reviewed numerous accounts of low weight gain and
FTT associated with "Babywise" and discussed
them with several pediatricians and lactation consultants
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.
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."
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.
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."
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).
"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
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 make-up.
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;
of the many other unsubstantiated medical claims
in "Babywise" include:
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
"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
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."
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."
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
can 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.
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.
should be made to inform parents of the AAP recommended
policies for breastfeeding and the potentially harmful
consequences of not following them.
is an AAP candidate fellow based in Lancaster, Calif.