Studies Change “Best Practices”.

In one of the groups that I frequent, there was a long thread about the introduction of solids. One of the most common things to hear on any of these threads is “Well when my first child was a baby”… “When *WE* were kids, my parents..” and “We all are healthy and managed to survive”. I used to think that this was simple defensiveness. People tend to do what they’ve always done, and habits are hard to change.

Today, though, I read something that was a bit of a wake-up call for me.

“When my older daughter was a baby, WIC and the doctor recommended starting cereal at 3-4 months and baby food at 4-5months. Now when the WIC people give me grief about solids I just tell them that and they shut up because we all know babies digestive systems didn’t change in the last 3 years.”

Studies change what is considered “best practice”. As we get new information, as we see the effects of a formerly recommended practice, as new studies are done on the development of the bodies and digestive systems of our children, the “best practices” recommendations evolve.

It used to be recommended that babies be put to sleep on their bellies so that if they spit up, they would not choke on the spit-up. Now it’s recommended that babies be put to bed on their backs. The bodies of our babies haven’t changed in the past 20 years, however groups have been founded to investigate the causes of SIDS, to study the similarities between cases, and to attempt to minimize the lives lost. These studies say that the best practice is to place our babies on their backs to sleep.

The introduction of solids, rice cereal in bottles, and rice cereal in general are another thing that has been investigated.

We now know that introducing cereals before 3 months of age is “at or near the top of the list for potential triggers of Type I Diabetes” later in life: http://www.kellymom.com/nutrition/solids/solids-diabetes.html

We also know that while adding cereal to the infant’s bottle can in some cases decrease spitup, it does not significantly decrease the real problem, which is REFLUX. It simply causes the reflux to become silent. This means that the baby is no longer spitting up, however the acid is still coming up and causing the baby distress, pain, and physical damage. A study done in December of 2008 showed that thickened feeds “had no effect on the reflux index, number of acid gastroesophageal reflux episodes per hour, or number of reflux episodes lasting >5 minutes”, and declared thickened feeds to be only
“moderately effective” (http://pediatrics.aappublications.org/cgi/content/abstract/122/6/e1268 ) Since the thickened feeds are only “moderately effective” at decreasing the damaging effects of reflux but highly effective at decreasing the cosmetic signs of reflux (spitting up), babies are at risk for suffering from damage from the continued effects of reflux that the parents think they have effectively eliminated with thickened feeds.

In addition to that, babies that are receiving thickened feeds gain weight much more rapidly, are much more likely to suffer from childhood and adult obesity, potentially more likely to suffer from Type I Diabetes later in life, are exposed to allergens and may be more likely to develop food allergies and other life-threatening conditions such as FPIES.

Not only that, but one of the main contributing factors to reflux is delayed gastric emptying. Thickened feeds delay gastric emptying. It seems counter-intuitive to treat a problem with something that is known to contribute to the problem itself.

For a baby with severe reflux, a medication is much more effective at preventing long-term physical damage from reflux and reducing the amount of pain that your baby experiences.

For a baby with mild reflux, breastfeeding and keeping the baby in a more upright position after feeds can often resolve the problem.

Yet, doctors continue to recommend thickened feeds. Why? Many doctors seem to fall into the same patterns of “I recommended this last year, I’ll continue recommending it again this year”. These doctors continue to ignore the current recommendations of the American Academy of Pediatrics and the World Health Organization. They’re human, after all. They learned one thing in college, or in their own parenting experiences, and there doesn’t seem to be any “continuing education” requirement that demands that they stay up to date on the current “best practices” recommended by the AAP, or studies being done.

So the question is simply: Knowing the new information that has been released- do we care more about simply diminishing some of the more inconvenient (for us) symptoms of the condition while leaving the harmful symptoms virtually untouched and drastically increasing a lot of other risk factors for our children.. Or do we want to modify our actions to follow the recommendations of current studies that point to other solutions being more effective with potentially less of a risk of serious long-term side effects? Do we want to try methods with no side effects such as keeping our infants upright, modifying mom’s diet to try to reduce the effects of reflux, or look into the physical causes of why the child has reflux?

That’s a personal parenting decision, and IMO one that should be made fully informed rather than having it be based on the mistaken idea that old information is still correct just because the digestive systems of babies haven’t changed in the past few years.