Christianity Today Reprint
The Brave New Baby
Does a new curriculum for families build up the parent-child relationhip, or put infants at risk?by Thomas S. Giles
See also the companion article "Are Ezzos Culturally Insensitive?".
Reprinted with permission from the August 19, 1993 issue of Christianity Today.
Medical professionals around the country are sharply questioning a new Christian education curriculum, Preparation for Parenting, which is suspected of contributing to inadequate weight gain in some newborn infants.
On the market since 1987, the curriculum has gained a significant foothold in churches. The authors, Gary and Anne Marie Ezzo, estimate that about 500 churches in the United States are currently using their program and nearly 40,000 copies of the manual were sold in 1992. A Northridge, California - based firm, Growing Families International (GFI), distributes the Ezzos' curriculum and sponsors their radio program, aired at least monthly on about 90 radio stations across the country.
Yet, the marketing success has not come without controversy. Some physicians and nurses are concerned that the rigidity of the feeding program the Ezzos' advocate may put some newborn infants at risk of inadequate weight gain, especially in the first weeks after birth. In addition, the program has caused strong disagreements in a few churches, leading at least one to drop the Preparation for Parenting program.
The Ezzos wrote Preparation for Parenting to teach parents how to use "a biblical mindset" in raising children from infancy. "Working from a biblical mindset," they say, "automatically assumes a routine that leads to order."
The Ezzos say putting babies on a "parent-controlled" feeding schedule is a major part of establishing that order. They are strongly critical of "demand feeding,", the idea that newborn infants should be fed when they signal readiness.
The Preparation for Parenting manual, which sells with audiotapes for $29, says "Demand feeding is based on a philosophy that man is made in the image of God and now exists in the condition of depravity."
What went wrong?
A Southern California woman, Lori Raders, was 35 and about to have her first child when she started using Preparation for Parenting. She recently had moved to a rural area of California and could not afford to call her friends frequently to ask them about parenting. There were only 29 people at her church and few new parents nearby.
A friend obtained the Preparation for Parenting book and tape series for her through the mail. She and her husband listened to the tapes and went through most of the book "step by step."
"The parenting skills sounded so good," she says. "They have it biblically based and it seemed really easy."
Raders followed the program and put her baby on a feeding schedule, as recommended. When the time came to schedule her son's two-week checkup, she was unable to get an appointment with her doctor. Believing the baby was healthy, she assumed it would be okay to bring him in at three weeks.
"When my doctor saw him," Raders recalls, "he said, `He needs to be admitted right away into the hospital.' "
"I wasn't developing enough breast milk," Raders says. "His weight had dropped almost two pounds since birth and his temperature was 103. He was severely dehydrated.
"I was devastated. I felt like the stupidest person in the world. I thought that if I was breast-feeding according to their plan, my baby would be okay."
Raders is one of at least five mothers whose infants have experienced significantly low weight gain while they were following Preparation for Parenting guidelines.
Some health-care professionals say Preparation for Parenting may have contributed to the health problems of the Raderses' infant. They believe some advice on feeding in the curriculum is flawed and is likely to contribute to health problems in infants whose parents follow the guidelines to the letter.
The Ezzos also forbid debate in their classes and tell parents not to initiate conversations about curriculum outside class. Some professionals fear these rigid rules may keep parents from talking about the Ezzo program with their own doctors.
Gary Ezzo, who holds a master's degree in Christian education and is pastor of family ministries at Grace Community Church, in Sun Valley, California, insists there is no basis for linking his curriculum to health problems in babies.
Enough food?
Preparation for Parenting encourages parents to schedule feed their newborn infants every three to three-and-a-half hours from the first week after birth. However, according to several health-care professionals, schedule feeding a breast-fed baby too early may interfere with a mother's production of milk.
Jeannette Newman Velez, a certified lactation educator and registered dietitian specializing in public-health nutrition, says, "It is quite possible that a mother who adheres to the Ezzos' parent-controlled feeding schedule will experience a decrease in milk production due to inadequate breast stimulation."
Nancy Williams, a certified childbirth educator and lactation consultant, says the Ezzos fail to make provisions for cases in which their approach may not work, such as "sick, small-for-gestational-age, or prematurely born infants."
A California-based registered nurse who asked to remain anonymous to protect the identity of her patient has worked with one set of parents who used the curriculum. The parents brought in the child at three days and the baby checked out fine. Between that period and the two-week checkup, the mother spoke to the nurse twice.
The nurse said, "I told her she need to feed the baby when the baby was hungry." When the mother brought the baby in for its two-week checkup, the child weighed two pounds less than at birth. The nurse says, "The baby was in poor condition... Neurologically the baby was lethargic."
Ezzo insists GFI should not be held responsible for these or other health problems. "We will not assume responsibility for someone who does not read the book and listen to the tapes.
"There are so many variables that are involved in successful breast-milk production that you simply cannot state, 'They fed every three hours - that must be the problem.' "
Robert Bucknam, a Colorado pediatrician and coauthor with Ezzo of On Becoming BABYWISE, says, "In the cases where babies have had health problems, there were probably other causes."
Making changes
Ezzo told CT that the fourth edition of Preparation for Parenting, due out this fall, will have changes and clarifications.
Ezzo has asked Nancy Williams to write part of the new edition. He says she is "one of the top lactation consultants" in La Leche League. Ironically, in his third edition, Ezzo frequently refers to the La Leche League in negative terms, saying, "La Leche League International has led the charge" toward demand feeding, which he asserts is based on unbiblical principles.
While writing the current edition, Ezzo did not actively consult any lactation experts or other health-care professionals, except his wife Anne Marie, a registered nurse with a background in pediatric nursing.
Ezzo says health-care professionals have been exposed to his curriculum and "raised no red flags." CT also has contacted several doctors who use and endorse Preparation's principles.
Still, Ezzo is clarifying information regarding the amount of time parents should wait between feedings.
Desensitizing parents?
For some, the problem with the Ezzos' materials is not merely a matter of scheduled feeding. They also fear that Preparation's teachings on crying and its emphasis on "control" might lead to some parents being insensitive to some of their babies' other needs.
Preparation for Parenting tells parents to "learn how to assess your baby's cry in order to respond properly." It tells parents, when their baby cries, to "take time to listen, think, and pray."
At the same time, it includes statements like: "The mother or father who picks up the baby every time it cries lacks confidence in decision-making."
William Sears, a pediatrician and professor at University of Southern California School of Medicine, says, "They tell the mother that you do not respond until it's time. In time, that's going to develop a distance between that mother and baby. Those parents could miss medical problems."
Cliff Penner, a clinical psychologist who holds a master's degree in theology and writes a column for Marriage Partnership, says the materials overemphasize putting parents "in control."
"Psychologically, it sets up an adversarial system right from the start. There is an emphasis on discipline, law, punishment, judgment, on our position of power, and on control."
Focus on the Family conducted an evaluation of Preparation for Parenting and another book by GFI. A letter sent in May to Lisa Marasco, a concerned mother, says, "Although the Ezzos' work contains many worthwhile thoughts and suggestions... we believe there is reason to fear that some of their proposals - notably those having to do with controlled feeding schedules for infants - could actually result in child abuse if applied legalistically, inflexibly, and without regard for circumstances and the special needs of children."
The only way?
Jenni Beeman, a mother in Montana, had been demand-feeding her infant through his first two months. But then, she says, "he began to get a little hungrier and started to thin out, and I thought, I must be doing it wrong.
"I had similar problems with my first child and was beginning to receive pressure from family members to do something."
Members from her mother's church shared Preparation for Parenting materials and encouraged her to schedule feed her baby. Beeman also contacted GFI and received an introductory tape and newsletter. "They use compelling Scriptures in the newsletter," Beeman says, "to inspire families to raise children according to the Ezzos' program." After a month on the program, her baby lost two pounds. The parents discontinued scheduled feeding and began supplementing feedings with formula.
Scott Bauer, Church on the Way's executive director of ministries, says, "The printed materials were very dogmatic about a schedule-fed baby. Parent-directed feeding is the way, the Bible way, children are fed."
The Focus on the Family letter on the program notes, "The authors' claim that their particular program represents the one and only correct and biblical approach to parenting seems to us unnecessarily narrow."
Ezzo says he did not want to create the impression that his is the only biblical approach to parenting. "There's no biblical issue governing feeding babies. It's an area of freedom."
However, Preparation for Parenting paints another picture, saying, "Working from a biblical mindset and practicing demand-feeding can never be harmonized since the two are incompatible philosophies."
Use of Preparation for Parenting has led to strong disagreements in some churches. The curriculum was discontinued in one prominent Southern California church, and teachers in at least one other church toned down its language and modified some of its principles.
Preparation for Parenting was formerly taught through the Pasadena, California, Lake Avenue Congregational Church. But according to pastoral assistant Ray Syrstad, "strong differences of opinion among members of the children's ministry staff" led the church to discontinue using the materials in 1991.
The material currently are taught in other prominent Southern California churches, including Church on the Way, in Van Nuys, Calvary Church Santa Ana, and Grace Community Church.
Some of these churches endorse the curriculum provided that flexibility is strongly emphasized, something they say the curriculum itself does not do. At Church on the Way, Preparation for Parenting is taught in a modified format. "The principles of the Ezzos' material are biblical and practical," says Bauer. "We needed to modify the harshness and the dogmatic approach."
At Grace Community, where Ezzo is on staff, John MacArthur, senior pastor and well-known author, issued a "no comment" through his secretary, when asked his opinion of Preparation for Parenting.
Joan Wagner, former director of early childhood ministries at Lake Avenue Congregational Church, says that in person, the Ezzos encourage flexibility in their approach. "[But] their written materials do lend themselves toward a formula approach.
"I wouldn't want [Preparation for Parenting] just out there in the community because of the chance for excess and no chance to monitor those that might be given to that excess."
Ezzo claims that by the end of the year, 200,00 parents will have gone through Preparation for Parenting and that "99 and three-fourths of a percent" of the people who use his materials are "extremely successful."
However large the number of current or future users and however high their success rate, Preparation for Parenting may not be the choice for everyone.
Indeed, evidence suggest in some cases it may be the distinctly wrong choice. But, to borrow advice from Focus on the Family's letter, "[I]ts principles should be implemented only in conjunction with generous measures of common sense, intuition, and natural parental affection."
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