There’s new advice for new parents

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.

Supporting breastfeeding

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.

Our evolving toddler TV policy, part III

I have a confession to make: Little Boy’s been watching more TV.  Daniel Tiger’s Neighborhood and Curious George have permanently joined Sesame Street (still his favorite) in rotation, with an occasional smattering of Mighty Machines and Reading Rainbow.  There are two main drivers of this increased screen time.

The first reason is that Little Boy has been sick a lot.  And I mean A Lot.  Just this week, for example: he came down with pink eye on Tuesday and is running a fever today.  Books and friends warned us that the first year of daycare would be bad, but we didn’t realize just quite how much illness it would involve.  I’ve been hoping that it would taper off as cold and flu season ended, but no such luck yet.

Anyway, as I’ve mentioned before, the rules get relaxed when people are sick.  When Little Boy is uncomfortable and cranky, you can bet that we’re going to try to distract him from that discomfort however we can.  We also read, and go for walks, and snuggle, but yeah, TV is a big part of sick time.  After all, what do I do when I’m sick?  I lay on the couch and entertain myself with screens of the TV or tablet variety.

The second reason for the additional TV is that Little Boy has grown to be highly mobile and curious.  He’s also becoming increasingly social and, I think, gets frankly rather bored stuck at home with his mom and dad.  This combination means that he can get into lots of mischief.  Now, that normally isn’t too big of an issue, since we offer plenty of supervision, but sometimes as a parent you have to get things done that require your attention, and that’s where TV can help.

Do I feel guilty about this?  Of course.  I’ll always feel guilty about something.  But Little Boy has made recent leaps in verbal development, and he loves to read books and stack blocks and chase bubbles.  Television isn’t stunting him in some kind of terrible way.  In the end, I suspect it’s like most things: use thoughtfully and in moderation.

I wasn’t quite expecting this topic to turn into a series, but hey.  Here are parts I and II.

Our evolving toddler TV policy, part II

Following up on my post about our evolving toddler TV policy, I have a few other thoughts on kids and screen time that I wanted to share:

  • The original post was in no way meant to cast aspersions on parents who let their toddlers watch more or less TV than we do.  Rather, it was intended to be a “here’s one approach and why we take it” post.  Just an example.  As with most parenting choices, there’s a wide range of options that are perfectly fine.  Unless you’re letting your two-year-old watch Game of Thrones, you’re probably OK.
  • When we’re sick, the rules largely go out the window.  I was feeling awful yesterday and Little Boy was getting over a bad cold, so we pretty much just camped in the living room and watched a rotation of Daniel Tiger’s Neighborhood, Curious George, and Sesame Street (for him), and Property Brothers and House Hunters (for me).  Except for when Sesame Street was on, Little Boy got bored and played with his toys instead.  I guess we technically weren’t violating our house rule against unsupervised TV, come to think of it.
  • The American Academy of Pediatrics’ policy against screen time starts by telling us that children aren’t learning from TV before age 2.  Which is fair, if a little conservative in my opinion.  Baby Einstein isn’t going to make your infant a genius.  The second part of the policy, though, warns us that parents speak fewer words when the TV is on, depriving kids of valuable interaction.  Here’s the thing, though: In reality, it’s not a choice between TV and a pair of ideal, chatty, energetic parents.  It’s a choice between TV and Little Boy’s real parents, who are sometimes tired, quiet, and introverted.  If the TV wasn’t on at times, we’d probably be watching Little Boy play while scanning the news on our iPads.  We do plenty of talking and reading and playing, but we’re real human beings and we don’t do those things 100% of the time, TV or no.

That last point is one that’s always worth bearing in mind, I think.  In parenting, you’re rarely making choices between something perfect and something not.  You’re making choices between two imperfect options and looking for the one that works best for your family.  And that’s going to depend a lot on who you are, and who your kid is, and what your circumstances are.  Anyone who says there’s One True Way is full of crap.

Our evolving toddler TV policy

Last month, nicoleandmaggie (well, one of the two) over at Grumpy Rumblings asked their commenting community about TV policies for kids.  I wrote:

Our policy for now is no unsupervised TV. It’s either a family thing (like watching the Rose Parade), or we’re snuggled on the couch with a sick/tired Little Boy.

That has since changed.  Why?  Sesame Street.

The kid lo-o-o-o-oves Sesame Street.

I have a feeling that I did too, back when I was small.  I have no specific memories of watching it (just what my mom has told me), but I know we wore out the cassette with “The Rubber Ducky Song” because we played it so much, and I know that to this day I occasionally blurt out, “Cookie, cookie, cookie starts with C.”

The American Academy of Pediatrics, of course, recommends no screen time of any kind before age two.  I can think of only one person I know in real life who actually followed that.  It was certainly never going to be an option in our house.  Mommy and Daddy sometimes watch TV, and sometimes we watch TV when Little Boy is awake.  I’m also a big believer in the power of vegging out when you’re sick or tired.  Little Boy works hard all day learning how to be a human; he deserves some time when he doesn’t have to think very hard, too.

Our goal was always that TV not be used as a babysitter, hence the “no unsupervised TV” mentioned above.  I’ve also tried to keep TV time to limited chunks—we don’t leave it on all day.  And it’s only for days when Little Boy doesn’t attend daycare.  (By the way, the reason I’m only talking about TV and not any other screens is that we keep the laptops and iPads away from Little Boy.  We’d rather they stay in one piece!)

Up until very recently, Little Boy didn’t show any particular interest in anything specific that came on the screen.  Home renovation shows, superhero movies, Reading Rainbow—it was all pretty much the same to him.  And then one day he recognized Cookie Monster and suddenly he was following us around the living room absolutely begging us to put on more Sesame Street clips.  I’m 99% sure he thinks the word “please” means “that big blue monster who stuffs his face with cookies.”  Not joking.

I know the experts say kids don’t get much out of TV at this age, but Little Boy heads over to his toy box and grabs his stuffed Big Bird when that character appears on-screen.  He knows, at least a little bit, what he’s seeing.  It’s not a completely passive experience any more.  Given that, the rules have changed.  Little Boy is now allowed to watch an episode as “babysitting,” i.e., while his parents keep an eye on him but do something else.

This new policy has brought its own challenges; namely, that Little Boy does not believe one episode of Cookie Monster per day is nearly enough and can become quite perturbed when we tell him it’s time to play blocks instead.  Oh, well.  I guess saying no is what parenting is all about.