CHICAGO - Recent media reports have focused on the issue of whether scheduled feedings or demand feedings are best for babies. In response to these reports, the American Academy of Pediatrics (AAP) reaffirms its stance that the best feeding schedules are ones babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration.
The AAP has always advocated breastfeeding as the optimal form of nutrition for infants, and in December 1997, the AAP issued its latest recommendations about breastfeeding infants. The policy statement says, "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 ... In the early weeks after birth, nondemanding babies should be aroused to feed if 4 hours have elapsed since the last nursing."
AAP Media Alert on Scheduled Feeding PDF file
Rosemary Shy, MD, FAAP
Director, Children's Choice of Michigan Ambulatory Pediatrics
Assistant Professor of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
"It is dangerous to do it the way he describes," Pediatrician Dr. Rosemary Shy says of Ezzo's technique. "It puts these babies at risk for jaundice, at risk for dehydration, and at risk for failing to thrive, all of which we’ve seen."
Wilson, Steve, "Baby Care Controversy," WXYZ-Detroit, November 14, 2004
Arnold Tanis, MD, FAAP
1999 recipient, John H. Whitcomb Outstanding Pediatrician Award, presented by the Florida Pediatric Society and the Florida Chapter of the American Academy of Pediatrics (AAP)
"There is no scientific basis whatsoever in their philosophy....It is contrary to what nature intended. It can be very dangerous.
Michael Sonenblum, MD, FAAP
"Just as a three-meals-a-day diet is not right for every adult, no schedule is right for every baby, says Dr. Michael Sonenblum, pediatrics chairman at West Boca Medical Center. Some may need to eat every 90 minutes. Babies go through growth spurts, and their nutritional needs may change daily, he says."
La Mendola, Bob, "Feeding schedule for babies causes debate," ORLANDO SENTINAL, June 28, 1997,
Marianne Neifert, MD, FAAP
Clinical Professor of Pediatrics at University of Colorado Health Sciences Center and Co-Founder and Medical Consultant for the HealthONE Alliance Lactation Program
Author, Dr. Mom
"Scheduled feedings are a risk for a breast-fed baby" said pediatrician Marianne Neifert, author of the popular "Dr. Mom" parenting books. The risk is present but lesser for bottle-fed babies, she said, because a bottle-fed infant's intake is easier to observe.
"We've documented, by weighing babies before and after breast-feeding, what's consumed. I can tell you that some babies, particularly brand new babies learning to breast-feed, may go through the motions of a feeding, and the clock says they've had a feeding, but the scale tells us they've taken a teaspoon or two. A breast-fed baby can be hungry in a half hour.
"A home health nurse has come to me whose clients follow this schedule, and she says it does not serve breastfed babies well. They lose weight, or don't start a proper pattern of weight gain. For three decades the medical literature has shown cases of breastfed babies who suffer failure to thrive, dehydration, problems with electrolyte balance -- and the thing you find is that they're on an inappropriate feeding schedule."
"One of the biggest obstacles to parenting is not understanding child development, like mislabeling age-appropriate behavior as misbehavior, " Neifert said...."This is not an empathetic approach to caring for a newborn. Many parents who've followed this said their hearts told them to meet the baby's needs, but the book told them to wait. Some babies that are large and robust, vigorous feeders, they could handle the schedule. But a small baby with a mother who's got a marginal milk supply --some breasts can't provide a huge amount at a time -- needs to be fed more often. Those babies could be put in jeopardy on a schedule."
Nancy Krebs, MD
Professor of Pediatrics
Chairman, Committee on Nutrition, American Academy of Pediatrics
"Just because we don't hospitalize the baby doesn't mean there's not a problem, " said Children's Hospital pediatrician Nancy Krebs, who is conducting a research project of 60 breast-fed infants in the Denver area. "We've seen a couple of cases of breast-fed babies who were small and then lost weight instead of gaining it when the mom was following this book." In one case, the baby started with an average birth weight -- 7 pounds -- but had trouble gaining weight. By three months, she was losing weight, and finally, as Krebs put it, "bottomed out," dropping below the fifth percentile in weight. The mother was devastated. She thought, because she'd been following the book so closely, that she was doing the right thing."
Martin, Claire, "Let 'em Cry Technique Criticized by Doctors,", DENVER POST, September 14, 1997
Jan Barger, RN, MS, IBCLC
Past President of International Lactation Consultants Association
"I have seen computer printouts of 'the schedule' in the hospital room with parents trying to follow it with babies less than 24 hours old--the baby left to cry in the bassinet because it was 'not time to feed yet.'"
Lawrence Gartner, MD, FAAP
Professor of Pediatrics and Obsetrics, University of Chicago
Chairman, American Academy of Pediatrics Section on Breastfeeding
"...The Ezzos state that colic, or extreme fussiness, is "vary rare" in babies who are put on strict feeding schedules, but is "intensified" in babies who eat when they wish.
"Garbage," says Lawrence Gartner, professor of pediatrics and obstetrics at the University of Chicago and chairman of the academy's breastfeeding study group. "There is no such data."
Curtis, Barbara, "Striking Behavior," WALL STREET JOURNAL, February 17 1998
Jane Bradshaw, RN, IBCLC
"I've seen three cases I can trace to Ezzo use," said Jane Bradshaw, a registered nurse and lactation consultant in Lynchberg, VA. Bradshaw, a Lutheran, recalled a case "where a six month old hadn't gained anything in two months. While I talked with his mother, the baby just sat there, not making any noise or moving -- just looking straight ahead -- for 30 minutes. This baby was depressed, " she continued. "He had learned that there was no use in crying or trying to communicate hunger or his need for interaction. The bond between mother and child is destroyed in this program."
Aquilina, Mike, "Do the Ezzos Know Best?" OUR SUNDAY VISITOR, Volume 86, NO. 49, April 5, 1998
Brian Donnelly, MD, FAAP
"Do they [the authors of Babywise] know of the medical data that shows prolonged crying is physiologically detrimental to infants?"
Donnelly, Brian, MD, "Raising Children 'God's Way'? Oh, Baby!" OUR SUNDAY VISITOR
Susan Baker, MD, Ph.D, FAAP
Past Chairman, Committee on Nutrition, American Academy of Pediatrics
"Parents shouldn't try to put their healthy infants on feeding schedules....Babies' feeding needs are extremely variable. You should nurse your baby when she's hungry or shows signs of being hungry, no matter when she last ate."
Richard Ferber, MD
Director, Center for Pediatric Sleep Disorders at Children's Hospital, Boston
Author, "Solve Your Child's Sleep Problems"
"'Parents shouldn't expect babies to sleep that long that early, although a very few will on their own and in that case, you may sometimes need to actually wake them to feed them,' says Ferber. 'There is no good evidence that babies that young can go that long without a feeding.' "According to Ferber, any ill-informed child-care advice that suggests that very young infants should be sleeping through the night has the potential to leave new parents frustrated as they wonder what's "wrong" with their own baby."
Kathleen Auerbach, Ph.D., IBCLC,
Author, Breastfeeding and Human Lactation and Current Issues in Clinical Lactation
"This is completely out of keeping with how infants sleep and eat. An 8-week-old infant gets approximately 30 percent of all food volume in the hours between midnight and 8 a.m. To deny babies fully one-third of their total food volume by 2 months of age is asking for trouble," says Auerbach.
Kathleen Huggins, R.N., M.S., IBCLC
Author, The Nursing Mother's Companion and The Nursing Mother's Guide to Weaning
"'The more often a woman feeds her baby, the more milk she will make. The less often she feeds her baby, the less milk she will make. This is an established aspect of human physiology,' says Huggins, who has herself worked with several families who saw their infants lose or fail to gain weight after following the feeding advice in Babywise, including one pair of twin newborns who were diagnosed with 'failure to thrive.' Huggins says that she was able to convince the babies' mother to respond to their cues and feed them more frequently, leading to a quick recovery. 'Some women may be able to maintain a good milk supply with a feeding schedule, but many, many will not, particularly after the first few months,' adds Huggins....'What Ezzo is saying 'works' in that many babies do eventually stop crying as they become resigned to taking only small amounts of milk. In that way, you could say it works,' says Huggins."
T. Berry Brazelton, MD, FAAP
Professor Emeritas, Harvard Medical School
"'Telling parent that there is one simple way to get kids to behave is, well, let's just put it like this: This type of parenting is part of this whole swing to the right all over the country,' says pediatrician and Harvard professor T. Berry Brazelton, known to millions of American parents and grandparents as the author of "Touchpoints" (Addison-Wesley) and numerous other bestselling books on parenting and child development. 'I feel bad for young parents who are being told that if they follow this program or that program they won't have problems. You have to look below the surface to see what's going on with each individual family...Parenting like this shows very little respect for children...It's very adultamorphic and not sensitive to the baby. Although parents should gently set limits, punitive discipline for very young children and babies is repressive and can quash exploration and excitement in the first two years of life. It will be interesting to see some follow up on these kids in later years. I suspect that they'll have a lot of inner rebellion.'"
Don Elium, MA, MFT
Author, Raising a Family, Raising a Daughter, Raising a Son
'All isolating a baby or a young toddler teaches them is that the world is not a safe place to be in...Let a baby be a baby so that she can be an adult when it's time to be an adult.'
Jeanne Elium, MA
Author, Raising a Family, Raising a Daughter, Raising a Son
"'Leaving a baby alone to cry in order to punish or to train them to sleep can create a sense of rage that comes from abandonment and hopelessness,' agrees Jeanne Elium. 'These children will probably pay an expensive price in therapy later.'"
Granju, Katie Allison, "Getting Wise to Babywise," SALON, August 6 1998
Barry Zuckerman, MD, FAAP
Chief of Pediatrics, Boston Medical Center
Joel and Barbara Alpert Professor of Pediatrics, Boston University School of Medicine
Pamela Zuckerman, MD
Associate Clinical Professor of Pediatrics, Boston University School of Medicine
"On Becoming Babywise by Gary Ezzo and Robert Bucknam, M.D., contains information that is not only inaccurate but also has the potential to harm infants....while we certainly agree with [the authors' childrearing goals] the authors' recommendations about how to achieve them are harsh and punitive....the book might be attractive to parents who are unaware that some of the information and advice is physically and emotionally dangerous to children. Because the Ezzos appeal to widely held childrearing goals, the book may fool some parents."
Zuckerman, Drs. Barry and Pamela, "Pediatric News: Baby-care book could be dangerous," CHILDMAGAZINE, August 1998
William B. Carey, MD
Children's Hospital of Philadelphia
Clinical Professor of Pediatrics at the University of Pennsylvania
Member, Institute of Medicine, National Academy of Science
Author, Understanding Your Child's Temperament
"'At least 50 percent of a baby's temperament is genetic,' said Dr. William Carey, a pediatric behavior specialist at Children's Hospital. He read the Ezzo/Bucknam book and found it disturbing.... 'Some children will fall in line,' Carey said. 'But what happens to the ones who don't? There is no way to know, he said. 'No one has been brutal enough to study this.'"
Barbara Medoff-Cooper, PhD, CRNP, FAAN, RN
Ruth M. Colket Professor in Pediatric Nursing, University of Pennsylvania School of Nursing
Director of the Center for Biobehavioral Research
"Barbara Medoff-Cooper, director of the Center for Nursing Research at Penn, has been studying infant feeding patterns under a grant from the National Institutes for Health for 10 years. Here's what she thinks of On Becoming Babywise: "It contradicts much of what has been learned about infant development since the 1950s. It creates unrealistic expectations, makes wild claims about the connection between eating and sleep cycles, and could damage the relationship between parents and children. "Both Medoff-Cooper and Carey said they worried that, followed zealously, the program could even lead to child abuse. Parents who become frustrated when the regimen doesn't work might blame the child for being willfully diobedient."
Dribben, Marsha, "Babies Aren't for Breaking," PHILADELFHIA INQUIRER, June 23, 1997
Matthew Aney, MD
Pediatrician, private practice
"After writing an editorial criticizing Babywise in a magazine of the American Academy of Pediatrics, Matt Aney said he was flooded with calls from nurses and other pediatricians complaining about Babywise parents who would not give up strict feeding schedules against medical advice. In eight months, Aney has collected about 300 summaries of medical files of babies with diagnoses of low birth weight or "failure to thrive."
Rosin, Hanna, "A Tough Plan for Raising Children Draws Fire," WASHINGTON POST, February 27, 1999
Dr. Nancy Wight, MD, FAAP, IBCLC, FABM
Attending Neonatologist, Children's Hospital, San Diego
Attending Neonatologist, Medical Director, Lactation Service, Sharp Mary Birch Hospital for Women
Assistant Clinical Director, Neonatal - Perinatal Division, Department of Pediatrics, UCSD Medical Center
"[Parents] are honestly trying to provide direction for their children's achievement, but the Ezzo programs are the antithesis of all the research we've done on biology, anthropology and history,' Wight says. "'What really concerns me is their strict feeding schedule and expecting babies to sleep through the night,' she says. 'It's just not normal infant behavior and it is a direct sabotage of healthy breast-feeding because it may limit a mother's ability to provide adequate nutrition."
Coburn, Jennifer, "The Gospel according to the Ezzos," SAN DIEGO UNION-TRIBUNE, March 5, 1999
Loraine Stern, MD, FAAP
Associate Clinical Professor, Department of Pediatrics, UCLA School of Medicine
"a new mother came to me confused and upset. She was breastfeeding her 3-week-old infant on a strict, every-three-hours schedule because she had read a book advocating that babies be taught from the beginning to fit into their families' routines. At first, things were fine. But all of a sudden, Patrick was demanding to be fed every two hours, and it was breaking his mother's heart to let him cry until three hours had passed. I explained that infants sometimes go through growth spurts and it's perfectly normal for them to need more frequent feedings. Strictness and discipline have their place, I told her, but not with infants."
Stern, Loraine, "Should Parents be Stricter?" WOMAN'S DAY, October 1999, p. 202
Robert Mendelson, MD, FAAP
Chair, Committee on Medical Liability, American Association of Pediatrics
Past Chair, Committee on Communications, American Association of Pediatrics
"When trying to address feeding problems, find out what parents are reading or hearing. One of the problems we have faced recently is parents who are convinced of the unchallengeable truth of the On Becoming Babywise dogma of Gary Ezzo. He advises that for such "offenses" as dropping or playing with food, trying to hold the spoon that a parent is using, or banging on the tray, a child must first be swatted on the hand, then isolated in the crib if it recurs. This is supposed to establish early manners and self-control. This self-styled "expert" on childrearing has gotten a lot of press and sold a lot of books, but has also caused a lot of problems. Restricting the natural curiosity that impels a toddler to explore the texture of food and the best way to get it to his mouth can incite rebellion and food refusals."
Mendelson, Robert, MD, "Putting Research into Practice," PEDIATRIC BASICS, Number 89, Fall 1999
James Dobson, Ph. D., licensed psychologist and marriage and family counselor,
past Associate Professor of Pediatrics, USC School of Medicine
Author, The New Dare to Discipline
Founder, Focus on the Family
"There is a rigidity to it [Growing Kids God's Way] that worries me about young children. Children differ tremendously in temperament, as you know. They come into the world differently. And some of them are easy to raise and some of them are tougher than nails. And you try to take one of those ADD kids or one of those very aggressive youngsters and try to put them in a box like they recommend, and I think you can create some problems.
Dobson, James, Ph. D., Focus on the Family Radio Broadcast, August 25, 1999
John Rosemond, MA, psychologist
Author, New Parent Power!
"I've heard from many parents who claim that the recommendations put forth in Babywise resulted in babies who slept through the night, or most of it, by age 2 months. That's fine and good, but I am convinced there are more benevolent means of accomplishing this than ignoring a crying baby that has been fed and put to bed. If periodic reassurances (which I've recommended since 1978) mean the child doesn't sleep through the night until 4-6 months of age, so be it. A secure baby is more important than one who sleeps the night at 2 months. "
Rosemond, John, "Ezzo Parenting Can Be Dangerous", syndicated newspaper column, Dec 7, 2000
Barbara Francis, Ph. D., MFCC
"My first exposure to [the Ezzos' parenting materials] came through clinical experience. A "rebellious and disobedient" 3-year-old was receiving constant corporal punishment for behaviors that were healthy and appropriate for a preschooler. In another case, a young mother expressed pride for allowing her 3-month-old infant to cry for 45 minutes. In yet another, a pastor heard verbal chastisement by one parent toward teh other for her lack of spirituality for demand-feeding her infant....Concern led to a personal examination of the material; I was struck by the legalistic tone and lack of concern for developmentally appropriate psychological growth and health....Newborns are to be taught self-discipline by learning they are not the center of the universe. This is done primarily through exclusively parent scheduled feedings and sleep times."
Francis, Barbara, Ph.D., MFCC, "Growing Families International: An Extreme Response to Attachment Parenting", CAPS West Newsletter, August 1998