Wednesday, June 6, 2012

Book Review: On Becoming Babywise

On Becoming Babywise [1] was originally written by Gary Ezzo, an Evangelical Christian who has no pediatric experience except for raising his own two children with the help of his wife, Anne Marie Ezzo. In fact, the only formal education he has is a few semesters of study at a community college and a Master's Degree from the Talbot School of Theology.[2] After that he and his wife began teaching parenting classes at a megachurch in Los Angeles, California, where they eventually published the first edition of Babywise.[3] Even at this early stage it met with resistance and engendered controversy, eventually leading to their exit from that church. Rather than treat the book as a whole, I'm going to address each chapter separately, listing things that were good, things that were bad, and things that would've been bad in our situation because of Lillian's health problems.

Chapter 1: Your Baby Needs a Family

Good things:
  • They emphasize that the family structure, especially the relationship between husband and wife, is necessary for the emotional health of the baby.
  • They emphasizes that your child will have opportunities to have many friends, but only two parents, so you should be parents first.
Bad things:
  • They overstate the effects of "child-centered parenting"—they make it sound as though the first few months of a child's life will engender behaviors and attitudes that cannot be changed or tempered. Life is much more dynamic than that. In fact, I suspect that the parents' behaviors are more in danger of becoming cemented than the baby's are.
Bad things for us:
  • They recommend that, as much as possible, your life shouldn't change after the arrival of the baby. In general this is a good idea. But we have special circumstances. We couldn't take Lillian out—not because she wouldn't like it, but because we didn't want her to end up back in the hospital with RSV.
Chapter 2: Feeding Philosophies

Good things:
  • They advocate that feeding a baby should follow a schedule, but be flexible around the needs of the mother, not just the needs of the baby.
  • They reject the post-Freudian notion that birth causes psychological trauma for a baby.
  • They associate attachment parenting for infants with helicopter parenting for adolescents and twenty-somethings.
  • They criticize other theories of parenting for lacking objective, verifiable data (but their refutations of those same theories are philosophical and lacking in objective, verifiable data).[4]
Bad things:
  • They start by debunking Sigmund Freud and then by claiming even Sigmund Freud wouldn't buy into the theory behind demand feeding (1. they wasted their time mentioning Freud at all and 2. the vast majority of demand feeding parents don't do so for philosophical or psychological reasons—they do so because their baby is expressing hunger).
  • They make the absurd claim that a baby's brain doesn't start functioning until they start breathing on their own.
  • They make the absurd claim that a baby starts wiggling and kicking because they're starting to feel confined by the womb (instead of this being a natural result of normal development).
  • They characterize on-demand feeding as feeding the baby any time it cries but don't address the fact that babies have a different cry for when they're hungry versus when they're in pain, bored, need a diaper change, etc. Feeding a baby when they're hungry is not bad parenting.
Bad things for us:
  • Since Lillian was born premature, she wasn't prepared to be outside of the womb. Treating her as though she didn't need a womb anymore wouldn't result in psychological trauma, but rather in developmental trauma. It is widely accepted practice to recreate a womb environment for premature babies to help them continue to develop as normally as possible. 
  • Lillian had Gastroesophageal Reflux Disease (GERD), so she often wouldn't finish eating because burping made her throat hurt. If we'd made her wait 2–4 hours every time this happened, she wouldn't have gotten enough to eat and would've started losing weight. Also, shorter, more frequent feedings meant she was less likely to spit up.
Chapter 3: Babies and Sleep

Good things:
  • They debunk the idea that breast-fed babies are somehow less prone to sleeping through the night than bottle-fed babies. 
  • The idea that an eat–play–sleep schedule helps babies sleep longer than an eat–sleep–play schedule is intriguing, though unfounded (see below).
  • They correctly warn that sleeping with your baby increases the risk of SIDS and also disrupts your own sleep.
Bad things:
  • They never explain why a baby on a schedule will suddenly start sleeping through the night—they just treat the idea as though it's the most obvious thing in the world. (My only guess is that a baby that falls asleep nursing may wake up because they need to burp or have gas from not burping earlier in the day.)
  • They recommend that you base your evaluation on the results experienced by families that practice Babywise and that practice other methods (one of our neighbors practiced Babywise and I often heard their baby crying at 3 am—i.e. she didn't sleep through the night, only her parents did). 
  • They present data from a study they conducted [5] but it has no statistical analysis (i.e. statistical significance), no comparable data from babies on other feeding strategies, and no peer review. 
  • They warn against the use of sleep props (rocking, singing, binkies, etc.) but don't explain why God made babies able to fall asleep more easily with said sleep props if He wanted them to fall asleep using the authors' so-called 'natural way' of putting a baby to sleep (which is just to put them down and let them cry).[6]
Bad things for us:
  • When Lillian was on an eat–play–sleep schedule we had to be careful how (and how much) we played with her, or she'd spit up—sometimes a lot, because of her GERD. 
  • We've been told that premature babies have a hard time self-regulating so they don't know how to stop crying. Thus letting her 'cry it out' would've been fruitless. The premature babies in the Babywise study took 1–2 months longer to sleep through the night, possibly for this very reason.
Chapter 4: Facts on Feeding

Good things:
  • They correctly point out that there are more health benefits from breastfeeding over bottle feeding. 
  • They give a good layout of what to expect from a newborn and breastfeeding.
Bad things:
  • They mention different positions for breastfeeding but don't clearly describe how to hold the baby in those positions (though they do a better job of describing burping holds).
Bad things for us:
  • None.
Chapter 5: Monitoring Your Baby's Growth

Good things:
  • This section was probably primarily the work of the pediatrician author. It describes normal behaviors and growth during the first few months of a baby's life and also points out areas of concern. I suspect this was added in later editions in response to criticisms that Babywise babies are at higher risk for malnutrition.
Bad things:
  • They present another study [7] but once again they only tell you what they want you to know, not how non-Babywise babies fared in comparison. There is no statistical analysis offered. There is no peer review.
Bad things for us:
  • None.
Chapter 6: Establishing Your Baby's Routine

Good things:
  • They encourage you to keep your newborn awake long enough to get a full feeding—they need calorie-rich hindmilk.
  • They tell you not to let a newborn go too long between feedings (even during the night).
  • They acknowledge that premature, underweight, and/or jaundiced babies may need to feed more often than the schedule they recommend for healthy babies.
Bad things:
  • Within a week of birth they encourage you to keep your newborn awake for "playtime" after feedings, even though during this sleep important growth and neural development is taking place. 
  • They claim that babies want a schedule from you and if you fail to give them one, they will become emotionally unstable. 
  • Mothers whose babies sleep too long at night may not get enough stimulation to produce the needed amount of milk. 
  • After a few weeks they have you start dropping feedings, trusting that the baby will know what is going on and naturally compensate by taking more at each of the remaining feedings.
Bad things for us:
  • None.
Chapter 7: Waketime and Naptime

Good things:
  • They give good suggestions for activities with the baby.
Bad things
  • In one paragraph they imply that demand feeding and responding to a baby's cry by picking them up will lower their IQ and "leave him manic-depressive at age thirty."[8]
Bad things for us:
  • Lilli would often wake up fussy because she had gas. Letting her cry it out wouldn't have solved the problem and only would've left her in pain and without consolation.
Chapter 8: When Your Baby Cries

Good things:
  • They finally acknowledge that babies use different cries to signal different needs. Furthermore, they describe types of crying that might indicate the need for a visit to the pediatrician (injury, sickness, etc.)
  • They cite a more reliable work at several points in this chapter.[9] The most important quote, for their purposes, was a statement that some babies need to cry for a while before falling asleep.
Bad things:
  • They still pretend that demand feeding means nursing the baby every time it cries, regardless of what type of cry it is.
  • They claim that crying releases stress hormones from the body. However, this idea stems from the Hippocratic notion of bodily humors and hasn't been confirmed by modern science. Furthermore, the amount of hormones that could be secreted by tears would be negligible.
  • They speculate that on-demand feeding contributes to obesity and stress eating.
  • They make the tenuous claim that their strategy for raising babies produces children that naturally know how to delay gratification.[10]
  • They incorrectly deny that most persistent, unexplainable evening crying is colic, preferring to arbitrarily assign that label only to babies who cry with their fists clenched.
  • They imply that demand feeding predisposes parents to child abuse.
Bad things for us:
  • As I mentioned before, because of being born premature Lilli couldn't self-regulate, so if she was crying before a nap sometimes we needed to help her calm down before resuming putting her to sleep. We did this using the method described in The Happiest Baby on the Block.[11] We also used it to deal with her colic (which she was diagnosed with).
Chapter 9: Multiple Births—The Endless Party (written by a guest author, Dr. Eleanor Womack)

Good things:
  • She tells you to seek and/or accept help from others when you have multiples.
  • She identifies some of the unique problems associated with multiples (e.g. one baby waking up the other(s)) and suggests ways to cope with them. 
  • She warns against treating multiples as the same person—they each need individual time with their parents.
Bad things:
  • Supposedly written by a mother of one set of triplets and two sets of twins, this chapter must've been heavily edited by Gary Ezzo since the tone and use of buzz words is exactly the same as the rest of the book.
  • She tells you that you can't do it by yourselves—enlist the help of a third person—then she uses the inability to rock all three babies to sleep at the same time as evidence that you must put them down to put themselves to sleep.
  • She declares that a one-every-three-hours feeding schedule is the reason babies sleep through the night—again without providing any justification.
Bad things for us:
  • We didn't have multiples but Lilli was in the NICU (as many multiple births are). She did plenty of sleeping, but that didn't improve her feeding at all (of course, we were competing with the full feedings she was getting through the feeding tube.)
Chapter 10: Problem Solving

Good things:
  • They emphasize that the baby's health is more important than the schedule.
  • They warn against letting your baby sleep too long.
  • They warn against practices that will decrease milk supply in breastfeeding mothers.
  • They acknowledge that in certain cases you should make exceptions to the Babywise routine.
Bad things:
  • In discussing fussiness and colic they mention that it's easy to become frustrated, but don't warn against shaking the baby.
  • For them the solution to almost every problem is to get the baby into the Babywise routine—a veritable panacea.
Bad things for us:
  • None.
Chapter 11: Parenting Potpourri—Topics of Interest to New Parents

Good things:
  • They debunk the idea that if you fail to bond with your baby in the first few minutes after birth that your relationship with them will be destroyed forever.
  • They recommend you not be tyrannical with day care workers and church nursery volunteers about your baby's schedule since there are lots of other babies there, too, and that's too many schedules to keep track of.
  • They point out that circumcision isn't as traumatic for an infant as it is sometimes portrayed to be. 
  • They warn that soft or flimsy mattresses may contribute to SIDS.
  • They advocate immunization.
  • They counsel strongly against co-sleeping.
Bad things:
  • They make sure to put in a plug for On Becoming Babywise II.
  • They make the unfounded claim that most cases of post-partum depression can be eliminated by practicing the Babywise method.
  • They recommend heavy use of an infant seat (so Mom can do other things than hold the baby) but fail to warn that overuse can lead to the baby having a 'pancake head' (positional plagiocephaly).
Bad things for us:
  • None that haven't already been addressed in my review of prior chapters.
Chapter 12—Principles for Starting Late

Good things:
  • While we considered the ideas laid out in the book we took our pediatrician's advice and didn't start sleep training until she was 9 months old. Eventually you have to stop picking your baby up every time they cry in the night or fuss during the day. Otherwise they are always fussy because they know that eventually you'll give them what they want. This also leads to out of control toddlers who throw temper tantrums. I felt like this was a good time to start because Lilli was old enough to understand what we were doing and to regulate herself, but young enough to learn and adapt. So I would actually recommend starting late (as the authors of On Becoming Babywise define it).
Bad things:
  • They say it's okay, but then strongly imply that you shouldn't check on your baby while they're crying it out. But what if they've hurt themselves while thrashing around or got a limb caught in the bars of the crib?
  • They say it's okay, but then strongly imply that you shouldn't comfort your baby—even if they're crying out of control. But it's precisely this abandonment that can possibly lead to attachment disorders. There's no harm in letting your baby know you're still there but that you're not going to pick them up.
Bad things for us:
  • None. Lilli is pretty bright and she caught on pretty quickly. Sometimes she wakes up because her teeth are bothering her. We could let her cry it out, but we prefer to give her some children's acetaminophen or ibuprofen.
My verdict: In general I felt like there was a lot of bad information in On Becoming Babywise. Of what was good, most (if not all) can be found in more reliable books. The take away message, that you can teach your baby to put itself to sleep by putting him or her to bed while they're still awake and letting them cry it out, is sound but they recommend you start this way, way too early. And they are oblivious to the fact that though they recommend avoiding 'sleep props' like singing, rocking, pacifiers, etc. for putting your baby to sleep, 'crying it out' is also a prop—it just happens to be the one they prefer.


[1] Ezzo, Gary and Bucknam, Robert. 1998. On Becoming Babywise. Multnomah Publishers, Inc. Sisters, Oregon. ISBN 1576734587.

[2] See

[3] Ibid.

[4] Ezzo, op. cit., p. 32.

[5] Ibid., pp. 50–52. They also make unsupported claims about their method lowering ADHD on p. 54.

[6] In an earlier edition of the book, they compare leaving your baby crying at night with God not intervening while Jesus Christ was suffering on the cross. I think that's a gross misinterpretation of Scripture.

[7] Ezzo, op. cit., pp. 93–94.

[8] Ibid., p. 131. This was probably not their intent since they usually ascribe some sort of attachment disorder as being the result of never letting your baby cry. If that's the case, they should've worded the paragraph (and its sentences) a little more carefully.

[9] The American Academy of Pediatrics. 1998. Caring for Your Baby and Young Child—Birth to Age Five: The Complete and Authoritative Guide. Bantam Books. New York, New York. ISBN 0553379623. Note, however, that there is an updated edition of this book, published in 2009. ISBN 0553386301.

[10] This is in reference to the subject of Professor Daniel Goleman's book, Emotional Intelligence. To learn more, see this Times article from 1995. They assume universally high 'EQ' scores for Babywise babies since they did their own version of Goleman's test with 20 children and without any experimental controls.

[11] See Or you can skip the purchase and read the technique here, on Wikipedia.

No comments:

Post a Comment