It’s been a busy week when it comes to telling new parents what they should and shouldn’t do. The American Academy of Pediatrics (AAP) released several new policies, and the US Preventive Services Task Force (USPSTF) reviewed and updated their recommendations on breastfeeding support. Even though Little Boy is well past infancy, I’m still very interested in the science of infant care (and we might decide to have another kid), so I’ve been paying attention. Let’s take a look at each of the new policies.
Kids & screen time
The general message of the AAP’s new policy statement on media use by young children is familiar: choose age-appropriate media, talk to your kids about what they’re watching, and turn off the TV (and other devices) before bed. But there are a few key updates worth pointing out:
- They’ve lowered the age of “no digital media” from 2 years to 18 months: you are now allowed to introduce “high-quality programming” to your 18-month-old if you so choose. I’m pleased with this recommendation, because it agrees with my observations of child development. Little Boy was 17 or 18 months old when he started really caring about Sesame Street. By age 2, he knew all the characters and could identify the letter C (is for Cookie) in other contexts. The old ‘kids don’t get anything out of TV before age 2’ policy seemed frankly incorrect.
- For children under 18 months, the “avoid digital media” recommendation now explicitly says video-chatting is OK. It’s a little thing—I mean, we all kind of figured that Skyping with Grandma didn’t really count as “screen time”—but it shows that the AAP put some thought into the various uses of media in modern society.
- I also appreciate that this statement is included: “…there are intermittent times (eg, medical procedures, airplane flights) when media is useful as a soothing strategy…”
Safe infant sleep
Again, most of the recommendations in the AAP’s new policy statement on infant sleep safety are things we’ve heard before. Babies should sleep on their backs. Avoid blankets and soft bedding. Don’t smoke. Offer a pacifier (nobody quite knows why, but pacifier use is associated with lower rates of SIDS). In a few cases, though, the details have changed:
- Room-sharing (baby sleeps in parents’ room but in his/her own crib or bassinet) is now explicitly encouraged for the first 6–12 months. Popular media articles seem to be treating this as a shocking new development, but the old safe sleep policy already recommended room-sharing, just without a specific length of time. The science around this is up for debate, though; it’s not clear if the references cited by the AAP really show strong support for room-sharing. (Some thoughts from educated folk here and here.)
- The AAP remains very strongly against bed-sharing; however, they now admit that parents get really fricking tired caring for new babies and sometimes falling asleep with your baby in bed is the least bad option. While bed-sharing is most definitely not for me, I appreciate their concession to reality:
However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.
The recommendation statement by the USPSTF, accompanied by an in-depth statistical analysis, addresses whether anything hospitals and medical professionals do actually increases breastfeeding rates, and if so, what interventions are most helpful. They conclude, “with moderate certainty,” that breastfeeding support has a “moderate net benefit.”
That’s not terribly surprising, but there are some really, really interesting specifics in the report, highlighted in a Journal of the American Medical Association editorial:
- There is no evidence that the Baby-Friendly Hospital Initiative (BFHI) does any good. If you’re unfamiliar with the BFHI, the idea is that hospitals can be certified if they implement a set of ten “baby-friendly” (read: breastfeeding-friendly) steps. Some of these steps are controversial; for instance, if a new mother wants to formula-feed, the BFHI requires that hospital staff “educate her about the possible consequences to the health of her infant.” Anyway, the USPSTF report determined that “individual-level interventions” (seeing a lactation consultant, attending a breastfeeding support group, etc.) were useful, while “system-level interventions” (the BFHI and other hospital policies) were not.
- There is no benefit (in terms of breastfeeding duration) to completely avoiding formula during the newborn period. Moms who supplement with formula before their milk comes in are just as successful at breastfeeding! This is a big deal, because current breastfeeding advice tends to take an “any formula ever will ruin your breastfeeding relationship” approach.
- Pacifiers are also OK! Pacifier use is not associated with breastfeeding problems. In fact, because pacifier use is associated with lower SIDS risk, the JAMA editorial goes so far as to say that
routine counseling to avoid pacifiers may very well be ethically problematic.
Interestingly, when the USPSTF posted a draft of their recommendations back in April, there was apparently some concern about their choice to talk about the “support” of breastfeeding instead of the “promotion” of breastfeeding. Because people are weird about this.