Baby care book could be dangerous (Child magazine, August 1998).
Babywise advice linked to dehydration, failure to thrive ("AAP News," April 1998).
A Tough Plan for Raising Children Draws Fire: Babywise Books Worry Pediatricians and Others (Washington Post, February 27, 1999).
These startling headlines refer to the top-selling and highly controversial childcare guides On Becoming Babywise and Babywise II, written by Gary Ezzo, a self-described Christian pastor, and endorsed by Robert Bucknam, a pediatrician. Chances are you've heard of these books; since it was published in 1995, On Becoming Babywise reportedly has sold more than 290,000 copies. Babywise is recommended for parents of babies up to 5 months old, and Babywise II addresses parents of children 5 to 15 months old. Soon to be released is On Becoming Childwise, a guide for toddlers through 8-year-olds.
Ezzo, who has no formal theological or medical training, is executive director of the for-profit organization Growing Families International (GFI). With his wife, Anne Marie, Ezzo runs church-based classes for parents who wish to give their children a rigid religious upbringing. Although few readers know it, the Babywise books are the secular versions of Ezzo's original parenting program, which includes guides such as "Preparation for Parenting" and "Growing Kids God's Way" (GKGW). The content of these guides is based on GFI's own unpublished self-conducted studies. The studies have not been subjected to peer review, which means there has been no independent, professional evaluation of the studies or their findings, the usual method of verifying the worth of scientific studies.
Despite the fact that Ezzo has a large and growing following — reportedly more than a million families in 93 countries, with his books translated into 17 languages — distress over his program is also growing. What are doctors, lactation specialists, and child development experts — some of whom are Christians — concerned about? Ezzo's self-designed, strictly regimented feeding program, called Parent-Directed Feeding (PDF), which has a parent put their newborn on a strict feeding / waking / sleeping schedule. Rather than feed a baby when he shows signs of hunger — a technique known as demand feeding — parents are instructed to feed by the clock. The goal? Ostensibly to establish routine in your baby's life from day one and stick to it no matter what.
A recent outcry from medical and child development experts persuaded Ezzo to revise his 1998 version of Babywise to say that babies should be fed when they're hungry. However, the book still instructs otherwise: Parents are told that if their baby doesn't eat at a scheduled feeding, he must wait until the next one.
Distress among doctors and childcare professionals
About six years ago, alarm bells went off when doctors began seeing more and more infants who were showing signs of failure to thrive, poor weight gain, and dehydration. When questioned about their feeding practices, many of the parents admitted they were following Ezzo's PDF program. And though they could see something was drastically wrong with their infants, the parents found it hard — sometimes impossible — to blame PDF. After all, they were following the advice of a Christian pastor and a pediatrician. How could such experts be wrong?
Members of the American Academy of Pediatrics (AAP), the highly respected body of primary care pediatricians, have found a great deal wrong. In fact, in April 1998, after receiving a letter signed by a hundred doctors, lactation specialists, and childcare professionals exposing a number of Ezzo's statements as unsubstantiated and false, the AAP issued a Media Alert. In it, the AAP directly contradicted Ezzo's advice on scheduled feedings, and instead advised parents that "newborns should be nursed whenever they show signs of hunger, such as increased alertness or activity, mouthing, or rooting. Crying is a late indicator of hunger. Newborns should be nursed approximately eight to 12 times every 24 hours until satiety."
The AAP is currently reviewing several parenting programs, including Gary Ezzo's, and within the next couple of years will publish guidelines to help parents evaluate the programs. For more information, visit the AAP Web site.
Doctors and Christians part company with Babywise
Matthew Aney, M.D., a Christian pediatrician and member of the AAP, worries that the advice in Babywise doesn't allow for individual differences among breastfeeding mothers and babies. He points out that while some parents may be able to follow the PDF method, Ezzo offers no alternative for those who can't. It's a one-size-fits-all prescription that can leave parents who "fail" the program feeling guilty and filled with doubt about their parenting skills. Aney found parents were often reluctant to admit they were following the PDF schedule, especially if they had a strong religious commitment to the program.
Aney points out at least 35 unsubstantiated medical "facts" in Babywise. Here are three examples:
"Demand-fed babies don't sleep through the night."
"A mother who takes her baby to her breast 12, 15, or 20 times a day will not produce any more milk than the mom who takes her baby to her breast six to seven times a day."
"Mothers following PDF have little or no problem with the letdown reflex compared to those who demand-feed."
Aney says that Ezzo simply throws out these statements without offering data to support them. He is also disturbed by Ezzo's questioning of recent research that shows that putting a baby to sleep on his back will reduce the chance of Sudden Infant Death Syndrome (SIDS). Ezzo says that the research is not conclusive, and that experts used questionable methods of gathering data. In fact, research conclusively shows that back sleeping has reduced the incidence of SIDS by about 30 percent.
BabyCenter's sleep expert Jodi Mindell says that while babies thrive on schedules and routine, she doesn't know of a single medical expert who supports using a PDF system. "Babies should be fed when they are hungry. Limiting a baby's feeding times is physically and emotionally dangerous," Mindell says.
James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame in Indiana, agrees. "The Ezzos appear to be the masters of the 'one-size-should-fit-all' school of childcare," he says. "Their simplistic, judgmental, and utterly self-serving program confuses personal and religious values with science, and strictly controlled infant care with successful parenting. The two are anything but compatible."
It's not just doctors and researchers who have parted company with Gary Ezzo and GFI. The board of elders of Grace Community Church in Sun Valley, California (the church where Ezzo first developed his parenting guides), issued a public statement ending all association with Ezzo and his GFI ministry. In their statement, they express concern about GFI's rigid feeding schedule and the organization's "blurring of the line between that which is truly Biblical and simple matters of preference." The elders worry that GFI's parents tend to isolate their children from those outside the GFI community. They also feel uncomfortable about Gary Ezzo's practice of responding "with exaggerated and even false accusations against his critics."
Another respected Christian organization that does not support the use of Ezzo's materials is Focus on the Family. The group has received numerous letters from parents, pastors, midwives, physicians, and lactation professionals reporting cases of failure to thrive in infants subjected to the PDF program. In a letter to Matthew Aney, one member of Focus expressed concern that parents who follow Ezzo's "controlled feeding proposals" could even wind up abusing their children.
The Child Abuse Prevention Council of Orange County, California, expressed similar fears. In a public document, council members reported their concerns about the risk of physical abuse to children when parents follow "Growing Kids God's Way." They note that "although the Ezzos advocate several alternatives to corporal punishment, they include the use of a strip of firm rubber to strike children." The council worries that condoning corporal punishment could lead some parents to abuse their children.
With so many people speaking out against it, what is the continuing appeal of Babywise?
"The appeal of Babywise is that everyone wants a good night's sleep, and everyone wants their kids to turn out well," says Kathleen Terner, a research associate at the Christian Research Institute who has spent several years investigating GFI and its programs. "Ezzo promises both if you follow his book faithfully. His information is very specific and is presented as foolproof. Sadly, many parents believe that if something is in print, then it has to be true."
In an article in the Christian Research Journal (Spring 1998) called "More than a Parenting Ministry: The Cultic Characteristics of Growing Families International," Terner, who is herself a Christian and a mother of a young child, and co-author Elliot Miller, acknowledge that GFI has some good things to contribute to the subject of Christian parenting, such as teaching children to be responsible, obedient, and respectful of others. But Terner feels the potential dangers of the program far outweigh the benefits. Jan Barger, an International Board Certified Lactation Consultant, agrees. "The overarching goal of Babywise is to shape children who are outwardly compliant, sleep a lot, and don't interfere with their parents' lives, rather than teaching parents how to develop happy, healthy, contented, intelligent babies."
So what's a parent to think?
"Do your homework before deciding what's best for your children," says Kathleen Terner. When it comes to choosing a childcare guide, check the author's credentials. Is he trained in medicine and child development? Does she back up her statements with medically proven facts? Who has endorsed the book? Get advice on choosing a guide from your pediatrician, lactation consultant, religious leader, or other parents. You also can contact the American Academy of Pediatrics or read the organization's own series of childcare books and brochures.
As a general rule of thumb, keep in mind that some babies don't need to be fed more than every three hours, but many need to be fed more often. Especially in the first few months, when your baby is growing rapidly, you should feed him when he shows signs of hunger. As he gets older, he will require less frequent feeding and will sleep for longer periods between meals. Above all, trust your baby to communicate his needs — and trust yourself to satisfy those needs.