Breaking Down Babywise ~ Part III

Please read Part 1, an intro to Babywise and it's authors, and Part 2, discussing the compatibility of using Babywise while breastfeeding.

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And now we come to sleep. Babywise is subtitled "Giving Your Baby the Gift of Sleep". One of the first questions the Ezzos ask as they begin discussing the subject of sleep is: "Who wouldn't want their baby to sleep through the night?" It's meant to be rhetorical, and the answer would seem to be "I don't know, who wouldn't want their baby to sleep through the night?"

ME!

Not as early as they say anyway, and not by their definition. But first, let's talk about why babies wake up during the night.

1. Hunger. Growing babies need food. For the first 3 to 4 months, babies need to eat very frequently, they're growing like crazy, then tossing in extra growth spurts every couple of weeks, it's pretty obvious that they need calories around the clock. Around 3 to 4 months they might naturally start "sleeping through the night" something that the Ezzos and the American Academy of Pediatrics agree on. BUT, the Ezzos define sleeping through the night at 12 weeks old as 11-12 hours of sleep. The medical definition and the expectation is 5 hours.

2. Brain development. Babies have two sleep stages. Their bodies and brains rest during the deep sleep stage, but during the lighter, REM sleep stage is when the baby is forming all of their brain connections and cementing into place everything that they have learned that day. They need the lighter stage of active sleep in order to develop. As they move around they will sometimes wake themselves up. This has a purpose too, because...

3. SIDS risk reduction. Although no one knows for sure what really causes SIDS, one of the current theories is that the baby falls into the deep sleep stage and, for whatever reason, can't and doesn't return to lighter REM stage; the brain continues resting and sleep continues to deepen until the brainstem ceases to function and breathing stops. Waking during the night for some babies is a necessary part of moving from deep sleep to REM sleep.

Waking during the night is developmental issue. For the first 6 months (even longer for some babies) night waking is just what their brain does. While there are factors that play into a good night's sleep - being overtired, too much stimulation during the day - your baby will sleep through the night when he or she is ready to sleep through the night, physically and mentally.

Now, Babywise...

At first glance the Babywise method seems like just another cry-it-out (CIO) method. But when you take a closer look you find that it's more than that and can lead to some pretty serious consequences.

The Ezzos say that some crying is expected and is normal and may last anywhere from 5 to 45 minutes. This is fine, sometimes babies just need to cry. The AAP agrees to an extent saying that a baby may average about 3 total hours of crying over a 24 hour period.

Acknowledging that, some babies will cry no matter what they do, and you also have to consider what prolonged crying does to the baby. I'm not talking about emotional health here, I'm talking about physiologically. Prolonged crying raises the amount of the stress hormone, cortisol, in the baby (and parents too). Elevated cortisol levels can cause restless sleep, failure to reach a deep restful sleep state and has long term effects of high blood pressure and heart problems. Anyone who has cried themselves to sleep as an adult can describe to you exactly how well they slept that night and how they felt the next morning; like you didn't sleep at all and someone ran over you with a Mack truck. How is this productive in developing truly healthy sleep habits?

The Babywise technique takes the baby through his naptime routine, that somehow should be devoid of any sleep props (pacifiers, nursing, rocking), lays him down in his own bed and leaves him to fall asleep alone, no matter how hard he cries. It is based on the belief that any child can be trained to sleep. Whatever happens, Baby remains in his crib until his 1.5 - 2 hour naptime is up, and heaven forbid he finally fall asleep with 15 minutes to go, because he doesn't get to decide when his nap ends; he'll be up in 15 minutes when his Babywise Mom gets him up so that he stays on schedule.

If baby wakes up during his nap or during the night, parents are instructed to poke their head in the room, but don't get Baby out of his crib, let him cry and he'll figure things out, just monitor him.

Babywise does not give any credence to differing personalities, or the fact just like adults, infants are going to have their own sleep patterns. Babies have personalities that affect everything they do and how they are parented. Each child is unique.

To recap: Babies SHOULDN'T be sleeping through the night (7-8 hours) a 7 weeks old, like Babywise says they should, they still need calories around the clock and need to wake to return to REM sleep so their brains develop correctly. Babies will sleep through the night when they are developmentally ready, "training" them to do so earlier poses risks to development and health. In allowing Baby to CIO in the Babywise manner, there is a risk of short term and long term health problems from the elevated stress hormone levels.

Even with all of that, we still haven't reached my main gripe. My biggest problem with how Babywise handles sleep is that it places the responsibility of a child's sleep patterns directly on the parent. If Baby isn't sleeping through the night, then you, as the parent, are doing something wrong. There is no other explanation, and that's what led to this story:

A few months back a Babywise parenting friend of mine posted on Facebook that for several nights her 4 month old had started waking up nearly every hour. He had been sleeping through the night. I offered the suggestions of sick, teething, growth spurt, but was drowned out by several Babywisers who encouraged her that it was just a phase and he needed to work through it. She decided to go with "tough love" and let him cry it the several times he woke that night. 

The next day, she decided to take him into the ER and found out that the baby had pneumonia and an ear infection. I was livid. I know she did what she thought was best, but her's is not the only story I've heard where illnesses have gone missed for days because the parents thought the sleep disturbances were training issues instead of recognizing them as a sign of something else.

This is my conclusion for now with Babywise (unless I get a ton of requests for a review of the Biblical/Spiritual issues). I could go on for another two weeks about discipline, older infant/toddler feeding, play time, parental roles....

For now I'll leave you with this, some babies thrive under a schedule, however, under the full schedule of Babywise there is an extremely high risk for both long term and short term health problems, if you are considering Babywise, please don't. Consider another form of baby scheduling and above all watch and listen to your baby, he or she didn't read the book...

If you'd like to read more about the Ezzos and Babywise I recommend this website and this handout.

Share your thoughts and come join me on Google+, Facebook, and/or Twitter!

Breaking Down Babywise ~ Part II

Please read Part 1 of Breaking Down Babywise, an intro to the method and the authors. It'll help explain some of the terms I use or reference in this post.
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Babywise and Breastfeeding: Compatible?

It depends. Maybe if you apply some ideas and leave out others, but then, that's not really the Babywise method. As presented in Along the Infant Way, you take it all or you're not really using the method effectively or as intended and can't be promised the same results.

It's my belief, along with the Academy of American Pediatrics (AAP), most pediatricians, all lactation consultants, and nutritionists that a child should be breastfed for at least 1 year. If you have to put them on formula then it's not time to wean! Furthermore, if milk is such a critical part of a 1 year-old's diet as the pediatricians and AAP recommend it to be, then you'd probably do best to keep that oh-so-important milk coming from within the species. At the child's 2 year old appointment, when all of the sudden the Dr is suddenly worried about them drinking too much milk, then you might think about cutting things back and moving on. (This is assuming that mom has the ability to breastfeed.)

That said, tonight I met the first person I have ever known to successfully breastfeed longer than 8 months without using formula supplements and while using the Babywise method. And I know alot of people who use Babywise. Congrats! Thank you tweeps for helping me find her! So there are a few examples out there that it can work. But I think that in making it work moms are treading on some very dangerous ground.

If you use Babywise, you might also want to check the edition of your book, the most current edition is from 2006. This newest edition does cut out some of their stricter rules and deletes some paragraphs entirely, without addressing the disappearances. This worries me in and of itself. If the method is really so great, so effective, and so irrefutably good for family and baby, then why these drastic changes? It would seem that in the face of criticism the Ezzos are much more ready to water things down to sell a few more books than stick by their original statements.

To the point.

I'm just going to work my way through Chapter 4 to begin with. "Facts on Feeding."

Right, facts. In Chapter 4 the Ezzos state that bottles are as good as the breast when it comes to feeding. Well, they get the food to the baby's mouth alright, but it is documented that feeding from the breast is necessary for the proper development of baby's jaw muscles, jaw alignment, and palate formation. So, braces anyone?

It also assumed and implied that breastfeeding is strictly nutritional. Except that a study of basic physiology and hormones shows us otherwise. Breastfeeding is a calming and connecting event. The hormones and pheromones released during breastfeeding give physical and mental benefits to mom and baby. These particular hormones and pheromones reduce stress, promote bonding, and increase milk supply. Yes, just being near your baby and breathing his scent can encourage milk supply. If it were strictly nutritional then why would let down often occur at the very cry of a baby and not always wait until appropriately stimulated by baby at the nipple? Comfort nursing is just as important as nutritional nursing to both baby and mom at emotional and mental levels.

We have now reached a point that I have nearly over-researched. Foremilk and Hindmilk.
Page 67 of Babywise

"...snack  feeding provides baby only a partial meal consisting of the lower calorie foremilk and not the higher calorie hindmilk essential for growth."

Page 43 of Along the Infant Way

"...the lower caloried foremilk that too frequent of feedings produce."

These statements show a basic lack of knowledge about foremilk and hindmilk. These books teach a mom that her baby gets foremilk anytime he starts a new feeding. But that is not always true. Foremilk is not "made." It is the milk that is left in the ducts after the last feeding. The fat in the foremilk has risen back towards the glands and is let down as the glands contract after the baby has started nursing off the leftover, watery milk from the last feeding. The amount of foremilk is largely based on how much storage space the mom has in her breasts. The shorter the time between feedings, the LESS foremilk a mom has and the more fat and calories the baby will get in his meal.

Then we get to supply and demand.
Page 67 of Babywise

"A mother who takes her baby to her breast 12, 15, or 20 times a day will not necessarily produce any more milk than the mom who takes her baby to breast 8 or 9 times a day." 

Even the Ezzos themselves negate this when they instruct a mom struggling with supply to pump between feedings to increase her supply. One of the ways a baby signals to his mother's body that he has grown and needs more milk is to eat more frequently. More nursing sessions = more milk!

Later in Babywise (pg 103), moms with a questionable supply are told to either put the baby on a schedule or supplement with formula. Interesting.

According to the Ezzos there are only 3 "correct" ways to nurse. The cradle hold, the football hold, and side-lying. According to Babywise and Along the Infant Way, anything that varies from these positions will inevitably cause poor latch and result in poor feeding. Ladies, I'm sorry if your breasts are too small or too large for these positions to work for you comfortably, I guess you're just up a creek without a paddle.

Ideally, according to Babywise, your newborn will eat on a 2.5 - 3 hour schedule. It one part of the book they say to be flexible, but in another part they advise to let a 2 month old experience "natural consequences" of not eating enough at the previous meal and instruct the mom to force the baby to wait until the next scheduled feed. They put forth the use of a pacifier to hold off a baby until the next feeding. However, they fail to address that the act of sucking on that pacifier releases hormones in the baby that cause drowsiness. So baby is sleepy and doesn't eat a full meal, but then is forced to wait until the next mealtime by using the same pacifier. A cycle and recipe for dehydration and malnutrition.

When it comes to weaning, early editions of Babywise state "No one can say for sure what age is ideal." Except that actual doctors have determined that at least 1 year, but 2 is ideal according to the World Health Organization. Which is probably why this statement was struck from the 2006 edition.

The Ezzos also encourage moms to listen to their pediatrician's advice over that of any lactation consultant. Because we all know that pediatrician's receive years of training specifically on breastfeeding. (PLEASE read that with the sarcasm it was intended to be read with.) They also imply that you should refrain from telling an LC about the schedule the baby is on until you find that she is in support of the Babywise method; only then are moms encourage to be fully forthcoming about exactly how and when they are feeding their baby.

Some final thoughts.

The AAP has expressed concern over Babywise and the reports they've received connecting the method to dehydration, malnutrition, slow growth, and slow development.  (Here and Here) Remember the Ezzos said to trust your pediatrician over a lactation consultant...

Two quotes from page 213 of Babywise:

"Competent doctors have your best interests in mind."

"More lawsuits against obstetricians and gynecologists today are forcing them to exercise conservative, lower risk treatments."

These two quotes were referring to C-sections and how having one should be seen as a possible and even probably birth outcome; but it reflects a knowledge that doctors will do what they have to to protect themselves and either ignorance or naivete that those same doctors will still have the patients best interest in mind. Ummm, right.

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Monday I'll break down "The Gift of Sleep" that Babywise promises. Find Part III here.

Share your thoughts, positive or negative, and come join me on Google+, Facebook, and/or Twitter so you don't miss when the rest of the series is published!

Breaking Down Babywise ~ Part I

Well, it's here. I've read, I've researched and I can't put off the writing any longer. This was supposed to be a single post, but after everything I've read and started writing in my head, there will be at least 3 parts to this and possibly 4. So here we go....

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The first time I heard of Babywise was when I was pregnant with Aedyn. The former pastor of our church at the time and his wife swore by the method. Most of my friends were dead set on using it. If the pastors were doing it and recommending it, it must be the right thing!

It didn't sound right to me then, but I didn't stir the pot. I stuck very much to "Well, if it feels right for your family, then that's your choice." Now I feel quite a bit different. Now I hope that EVERY SINGLE ONE of my friends reads this and stops using this method of parenting; and I'm not going to keep my mouth shut anymore if I hear someone considering it.

For those of you who haven't heard of the Ezzos, they are a "Christian" couple who conduct classes on parenting. Among the books that they have written or co-written are: Let the Children Come: Along the Infant Way and On Becoming Babywise (Commonly called just "Babywise"). These are the two that I'll be referencing the most. Babywise is essentially Along the Infant Way with all the church words taken out. Neither have had any training in child development, pediatric medicine, breastfeeding, or psychology. Gary Ezzo has no associate's or bachelor's degree, but somehow has a M.A. in Christian Ministry (credited due to "life experience"). Anne Marie Ezzo worked as a RN many years ago and to my knowledge has not kept her credentials up to date.

For the first 3 parts of this series I'm going to leave out all of the Christian principles and guidelines. They wrote Babywise for a non-religious group, so we're going to handle it that way. Depending on how I feel and the response I get I'll tackle things from a Biblical standpoint next week in the possible part 4.

A few weeks ago I came across an article that opened up a whole new section of the internet to me. I don't remember if it was tweeted, shared, liked, or posted, but somehow I found out that I wasn't the only one not drinking the Ezzo kool-aid. Not only was I not drinking the kool-aid, my gut feelings about Babywise were backed by quite a large population, including the American Association of Pediatrics.

Much of what moved me from quiet disagreement to outright condemnation was not their inaccurate breastfeeding information or questionable sleep strategies. It was what I found out about the author. Gary Ezzo has been asked to leave two different churches and positions of leadership. Grace Community Church, where he served under John MacArthur, and Living Hope Evangelical Fellowship. Further, Grace Community and MacArthur have formally withdrawn any support and affiliation with the Ezzos and their parenting program, they have also issued a waring to their congregation and others about the Ezzos and their teaching. Living Hope not only asked them to leave but excommunicated the couple. Both churches cited lack of truthfulness and refusal to be held accountable. (You can find more details about that here and here.)

If you read the second article all the way through, you'll also notice that the Ezzo's daughters and their families cut ties and remain estranged from the couple. Ummm, if their parenting philosophy has resulted in that, do you really want to try and do things their way?

To my knowledge, the Ezzo's have never answered any of these issues directly. Instead they play the politician's game of dancing around the question and painting themselves as victims. They try to throw dirt on a laundry list of respected Christian leaders, Lactation Consultants, and Pediatricians, plus they attack their accounting firm (who dropped them due to "ethical concerns") and their publisher (who could not verify medical claims made in their books). And while MR. Gary Ezzo maintains that he doesn't call himself "Dr." he hasn't corrected others who do call him that, even when the error occurs on public, national television. Hmmm, maybe they should run for government office! They'd fit right in...

If their character and professional history hasn't been enough for you to question the credibility of Babywise, then maybe tomorrow's post will give you a bit more to think about. Find Part II here and Part III here.

Share your thoughts in the comments and come join me on Google+, Facebook, and/or Twitter! Make sure you don't miss any posts in this series!