08 Nov

Book Review: The Happiest Baby on the Block, by Harvey Karp

The Happiest Baby on the Block, The New Way to Calm Crying and Help Your Baby Sleep Longer by Harvey Karp is an interesting book, with quite a few useful ideas both for parents and people supporting parents; but it did also raise a few concerns for me. It was recommended by a colleague and I was curious to learn about the “5 Ss.” This is Karp’s technique for calming an unsettled baby, and when he says unsettled he is referring to anything that might be even loosely described as colic. Karp believes that babies have an innate calming reflex, and certain activities will trigger this. I haven’t found any further research on this matter, and think he might be over-sciencing what is basically a set of instructions to cuddle and comfort a baby.

As with most parenting books, Karp uses an Expert Voice and includes many quotations from parents to demonstrate how great his method is. There must be a fascinating PhD topic in exploring the way parenting authors instil their authority; for example by referring to research (but in this case giving absolutely no references at all), and developing catchy acronyms. Interestingly, he warns at one point that his method may not work immediately (sound familiar, Ms Ford?) and parents may need to commit to it over several days before they see results. This supports my own theory that a bad situation will nearly always start to get better soon.

The good stuff in this book includes a detailed section on the evolutionary and physical reasons why babies cry, some really nice stuff on babies’ reflexes, and a logical debunking of the Top Ten Theories of Colic (p29). Unfortunately most of his information about breastfeeding is fairly inaccurate, compounded by the fact that this is the fifth “S;” he refers to this as the “icing on the cake” but in effect it comes across as the last resort, even after pacifier use.

I might offer this book to parents, perhaps after a method of feeding has been established; I would certainly recommend it to colleagues as it inspired some interesting thoughts for antenatal education. I would dispute whether cuddling and feeding are really “new” ways to calm a baby.

24 Apr

Regression to the mean

Most weeks, someone will tell me they ‘swear by’ some remedy for one of the many woes of early parenting, and assure me that it has worked wonders. And then they will turn and tell the mum sitting next to them, who [unless healthily sceptical] will unquestioningly accept the recommendation without asking two very important questions:
1. Is there any evidence that it works?
2. Is there any evidence that it does harm?

Infacol is a prime example of a medication recommended widely and unscientifically by mums everywhere, but more worryingly, by GPs and Health Visitors, who must surely know that there is no evidence that it works. Breastfeeding Network has a useful paper [pdf] on colic which discusses Infacol and other remedies, concluding the research is a bit thin on the ground and there are various things you can try; and particularly for the breastfed baby, getting some support with breastfeeding may be key.

Here’s another one: Lansinoh prevents nipple pain. It doesn’t. Its only function is to heal damaged tissue. Nipple pain is almost always prevented (and resolved) by good attachment, and no amount of lanolin cream will facilitate good attachment. In fact, large amounts of it, making the breast slippery, will make it harder for the baby to stay comfortably latched on. In addition, the heavy marketing of Lansinoh reinforces mums’ certainty that breastfeeding will hurt, and is therefore a barrier to doing it at all.

Blogger Scepticon takes a look at amber teething beads and basically demolishes them as a remedy for the pain of teething. Teething is a tough time for parents as well as babies, and parents may feel helpless to alleviate the pain and misery, so it’s no wonder there’s such a market in remedies that are only anecdotally effective.

And when we are talking about our babies’ health, anecdotal is just not good enough. There is an ethical obligation on health professionals not to recommend something just because they have no other answers, but the fact is that few health professionals have the time to sit with an anxious parent and help her to work through her worries and gain confidence in what she is doing. Hence the quick fix: a formula top-up, controlled crying, dummies, all of which can be shown to cause harm.

But the anecdotes of one mum to another seem to carry even more weight at this vulnerable time, and is an inevitable result of the peer-support that we encourage. It’s hard to take that away from new parents, but it’s equally important to encourage them to ask those questions rather than accept at face value the claim that something works.

Regression fallacy.