Infant Feeding Advice

Babywise and Preparation for Parenting (also known as Let the Children Come: Along the Infant Way) have been criticized by hundreds of professionals in pediatric medicine, human lactation, psychology, anthropology, child development, and theology. Problems have been associated with these programs -- cases of slow weight gain, failure to thrive, depressed babies, even hospitalization. Its feeding recommendations were the subject of a warning sent out by the AAP.

The following are some of the concerns experts share :

• Lack of expertise and credentials. The primary authors of the material, Gary and Anne Marie Ezzo, are self-proclaimed experts. Gary Ezzo has no background or expertise in child development, psychology, breastfeeding, or pediatric medicine, and holds neither an associate's nor a bachelor's degree from any college; his master of arts degree in Christian ministry was granted through a program that awarded credit for life experience in lieu of an undergraduate degree. Anne Marie Ezzo worked only briefly as an R.N. decades ago. It is unclear what, if anything, Babywise co-author Dr. Robert Bucknam contributed to that book, since the earlier religious versions are essentially the same with additional material and do not have his name on the cover.
  
  
• Risks for breastfeeding mothers and babies. Breastfeeding on a parent-determined schedule (including a "flexible routine" as it is called in Babywise) may reduce a mother's milk supply and contradicts the recommendations of the American Academy of Pediatrics (AAP), which has stated, "The best feeding schedules are the ones babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration."
  
  
• Poor breastfeeding information. Although it is presented as authoritative, the breastfeeding information presented in Babywise is inaccurate and substandard (compare with the AAP Breastfeeding recommendations from the 2005 AAP Policy Statement on Breastfeeding and the Use of Human Milk).
  
  
• One Size Doesn't Fit All. All babies and mothers are treated alike without any respect given for individual differences in breastmilk storage capacity, rate of milk synthesis, rate of infant metabolism or stomach capacity.   In actuality, the number of feedings one mother's body requires in order to supply her baby with plenty of milk each day will be quite different from other mothers around her. Similarly, breastfed babies need varying amounts milk in varying numbers and sizes of feedings, and they do not feed exactly the same way from one feeding to the next in any case. Ezzo seemingly expects all babies to respond in an identical manner.  This is no more realistic than expecting adults to consume the same amounts of food on the same schedule and grow (or lose weight!) at the same rate. 
  
  
• A high-pressure presentation impacts parents' perception of what is at stake:
  
  
• Pressure to maintain the regimen. The rules for sleep, feedings and wake time are portrayed as critical to follow in order to achieve a healthy outcome, while health and behavior problems for the baby, and sleepless nights for the parents, are predicted if the program is not followed. (Flexibility is praised but is described as small, short-term adjustments to the prescribed regimen. Parents are warned against making open-ended adaptations.)
  
  
• Misplaced moral dilemmas. How well the parents and the baby adhere to the program is framed as a moral or biblical issue (e.g. permissiveness on the part of parents, uncooperativeness on the part of the baby).
  
  
• Parents are reluctant to give up on the method. Health care professionals have observed that even when their babies were doing poorly on the program, parents often wanted to stick with it.

Essential Reading:

AAP Media Alert | PDF version
This media alert was issued after the AAP evaluated On Becoming Babywise.

"Examining the Evidence for Cue Feeding" | PDF version
by Jan Barger, RN, MS, IBCLS and Lisa Marasco, MA, IBCLC

"Babywise Advice Linked to Dehydration, Failure to Thrive"
by Matthew Aney, MD, AAP News

For Further Information

Critiques, reviews and professional analyses of Babywise and Prep
Heath Care Professionals Quoted in News Reports
News reports and media coverage
Comparisons of Ezzo and AAP Advice
Personal stories of former Babywise users
Frequently Asked Questions

American Academy of Pediatrics
Parent Education Sheets on Breastfeeding:

FAQ on Breastfeeding
Common Concerns While Breastfeeding

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