Safe or unsafe?

I'm starting to get annoyed at Health Canada (HC) and the Food and Drug Administration (FDA) assessments that certain things are safe or unsafe for our infants or for the public at large. Both HC and the FDA say that trace amounts of melamine in infant formula is safe. The FDA contends that Bisphenol A (BPA) is safe, but HC says there is enough evidence that it is unsafe to pursue a ban of it in baby products. Both Canadian and American authorities contend that pesticides and genetically modified organisms are safe.

I'm not always convinced, however, that all of these chemicals are as safe as the government contends, especially when some of them disagree with each other, especially when their scientists seem to agree with the scientists of large industry rather than other independent scientists. I am starting to wonder whether we should talk about best, most likely acceptable, and unsafe when it comes to assessing the safety of various ways of feeding our families. Or perhaps some sort of sliding scale between absolutely safe and absolutely unsafe, similar to the lactation risk categories (L1 through L5) that are used by Dr. Thomas W. Hale to assess the safety of various drugs for breastfeeding mothers.

When organizations like the FDA and HC declare something safe or unsafe, the world sees things in black and white. All things that are safe must be equal. All things that are unsafe are to be avoided at all costs. Well it isn't that black and white and I would rather have more information than that in order to be able to make the best choice for my family whenever possible and to have a realistic understanding of the degree of risk when I can't make the best choice for whatever reason.

Formula, for example, is not the ideal way to feed babies whether it contains melamine or not. It has risks. Some people feel that perhaps warning labels are required on formula to advise parents of the risks so that they don't assume it is as good as any other way of feeding their baby. I don't think that is a bad idea at all. While I am supportive of Canada's proposed ban of BPA in infant feeding products, I also would have supported a proposal that perhaps didn't ban BPA outright but instead required warning labels. I think that foods that contain genetically modified organisms and pesticides should be clearly labelled as such and also contain warnings about the potential adverse effects.

A sliding scale of completely safe to completely unsafe could also apply to other products for infants and children, including medication, vaccines, toys, cribs, car seats, etc. A lot of parents seem to assume that all booster seats are made equal, but in reality belt positioning boosters are superior. We do not fully understand the safety of all vaccines and while some of them may be advisable in certain circumstances, we shouldn't pretend that there are no risks. Some parents seem to give medication to their children on a routine basis (giving tylenol before bed each night to a baby that might be teething just in case the pain wakes the baby up), but may not realize that just because a medication is safe in moderate amounts for its intended use doesn't mean you should be giving it every day.

Until the time that such a system exists and is carried out using unbiased data, we as parents need to understand that safe does not mean ideal. Safe means most likely not going to kill most people most of the time based on the information we have available at the moment. If you want to make the best choice for your kids and not just an okay choice, do your own research.

Comments

[Diana Rupert]

Melamine issues really scares most moms. I can say that any chemical that must not be include in a product is unsafe. I heard in a news that melamine can cause kidney related disease.

[Sarah V.]

Annie, I'm still trying to find time to write a response in the discussion we were having about your 'CIO: 10 reasons why it is not for us' post. But your bold-type sentence above so exactly summed up why that post angers me that I had to comment here.

People find that post when they're looking for information on CIO. You know that - you've made it clear that that's why the post's up there. And it looks like a very informative post, with all those references and all those studies cited. But it is, in fact, a very *misinformative* post, because the way you put things makes it *sound* as though those studies are into Ferber-style sleep training, when in fact they're nothing of the sort. You've concluded from them that you would prefer not to leave your baby crying for even a few minutes, and that's fine. But guess what? Plenty of other people would not draw the same conclusions from the same information *if given that information honestly* rather than in the very misleading way that it is given. And that's also fine. They have a right to make choices that are different from the choices you make for your family, and they have a right to *accurate* information in order to do so.

Now, if your post had been honest about what the evidence actually does say (that regularly leaving babies crying for long periods of time on a long-term basis is harmful) and about the big gap between what it says and about what you've concluded (that even a few nights of crying during which you would come in regularly and frequently to comfort your baby is not something you want to try), then that could have been informative for parents trying to make the choice themselves. But it isn't. Instead, it makes it sound as though the evidence says all sorts of things that it doesn't. So, *that* is what I'm objecting to - the way that you are *misinforming* parents who, guess what, might *also* like to have more (accurate) information than that in order to enable them to arrive at a realistic understanding of the degree of risk and to make the best choice for their families.

[phdinparenting]

@Sarah V

I think we are talking on two sides of the same coin.

My post on CIO explains the 10 reasons that I am not doing CIO. I don't claim that it will kill your baby and is completely unsafe. I claim that there are enough concerns with it (10 of which I raised in that post) that have led me to decide it is not right for my child.

I could write a similar post about the risks of using formula, the risks of cribs, the risks of medicating your baby, the risks of overusing strollers, the risks of vaccines, the risks of epidurals in birth, the risks of c-sections, etc. If I did that, I would be doing it to point out that these practices are not completely "safe". That doesn't mean that they are completely unsafe. But it means that parents should be aware of the risks when making a decision.

We have in some cases chosen to do things that have risks associated with them. However, we do it with full knowledge and acceptance of the risks . We do not deny the risks and pretend that a practice is completely safe when it is not.

I don't want to tell parents that they shouldn't do CIO, that isn't my place, it is their decision. I just want them to be aware that there are risks associated with it that they should consider in making their choice.

[Marianne]

While warning labels on formula coudl be a great idea for the vast majority of mothers who simply decide they don't feel like breastfeeding, it woudl be HUGELY emotionally devastating to the mothers who have done their best to breastfeed and end up needing to supplement. I felt enough guilt and heartbreak about having to supplement my daughter and a warning label on every can reminding me of the risks to my daughter each and every time I fed her would have been more than I coudl have handled. (I had near total lactation failure, and despite trying all possible interventions was never able to breastfeed more than baout 1/4 of my daughter's daily intake over the 8 month period of our breastfeeding relationship).

What I'd like to see instead is formula being sold behind the counter of a pharmacy -- preferably by prescription only, but at the very least making it so that new moms have to ask for it and could receive counsel about it and it's possible side effects first.

[phdinparenting]

@Marianne - I think that is an interesting idea too. I guess if I had to use formula though, I'd probably deal better with a warning on the label that I could choose not to look at over time (i.e. I've read it, I understand, I have to feed my baby) rather than the chastising looks and comments that I might get from the pharmacist each time I went in. I'd feel like I had to explain myself over and over again to each pharmacist that I encountered and would dread having to go in and pick up more. That is just me though, I guess different people would react differently to different situations.

[Máire Clements]

A few things are coming up for me reading your post.

I agree that parents, and consumers in general, need to adopt a less trusting attitude and make every effort to become informed on issues that affect the health and well-being of themselves and those whom they love.

The day has passed where edicts from members of the health care system and regulatory bodies such as HC and FDA are the last word on any given topic. It is evident that there are other forces in play here, lobbying perhaps, that would prompt the FDA to raise the bar on how much melamine would be acceptable. Instead of zero tolerance they are giving manufacturers a greater margin for error!

I think your idea about labeling formula is interesting. It is my hope that it would get the attention of the doctors and nurses who encourage mothers to give formula when it isn't even necessary. They have long ago forgotten that there are risks attendant to formula. Perhaps now that Melamine is here on their doorstep and not only affecting babies in China, they might finally have to take a closer look at this issue.

Unfortunately, I doubt labeling would really have much impact. I would worry about whether or not there was a hidden agenda. Look at what the manufacturers of artificial baby milk already are doing to market their products and circumvent the Code.

I am reminded of fat-free food labels that distract you away from the fact a product may be loaded with sugar. What would these labels say? Melamine- free, but I am wondering what will be the new mystery ingredient/contaminant?

Truth be told there are no guarantees.

As you have so beautifully described in your post, safety and risk occur on a continuum. In every decision we make for ourselves or our families, we must weigh the risk/benefit ratio to find what will best suit us based upon the results of our research.

[phdinparenting]

Thanks for your thoughts Máire. I wasn't thinking of just the melamine risk, but labelling formula with all of the risks that it poses (i.e. including the ones that can't be overcome because it isn't equal to breastmilk).

[Adrianne]

Your post is great! I love the idea of rating things "best, most likely acceptable, and unsafe". Right now I am finding it so hard to make those choices for my family. We hear so many conflicting opinions. The vaccinations, for example. My doctor realy pushes for them while our Naturopath seems to be very against them (for good reason IMO). These are both people that are respected for their knowlege about our health but, as I am learning, can't be blindly trusted. I really agree that it is up to us to do the research and to make sure that we are making informed choices.

[crammer]

i just started working with the government in risk management of chemicals (in the environment), so though I am by no means an authority (yet?), I think i can offer some insight into the risk assessment process. The canadian government is taking a "precautionary approach" which assumes something is toxic unless industry can provide sufficient evidence that it isn't (it's just recently started, and the bees are already starting to notice somebody is shaking the hive). anyway, two of the main considerations are the potential for exposure to a substance and its toxicity. I'm not sure what the folks at Health Canada use as a basis, but one of the indicators is LC50 and IC50 (lethal concentration that affects 50 percent of the target population and concentration that incapacitates 50% of the target population).

Remember, its the dose that makes the poison, and since everybody's constitution, metabolism, and genetic makeup is different, what is amply safe for some could be lethal to others. That's just too much information to put on a typical label. An insert would be ok, but it would require you to buy the product first. And what to do about trace contaminants? It would be prohibitively costly to measure let alone prevent them all at such low concentrations, with very little impact to the consumer.

That being said, my son has multiple food allergies incl egg milk soy peanuts tree nuts - and the food industry seems to have a very difficult time in controlling/preventing contamination with such common ingredients, I can't imagine they're anywhere near ready to manage all 75,000 or so known chemicals.

Anyway, if you want to know more about what we're doing on chemicals, check out http://www.chemicalsubstanceschimiques.gc.ca/en/. I'd welcome your observations and try to incorporate your concerns as I do my work! the moderator knows my email address and I'm sure she could put us in contact without posting any names/contact info publicly.

[Sarah V.]

No. You don't claim that CIO will kill your baby or that it's completely unsafe. You do, however, claim that it can cause harmful changes to babies' brains, that it can result in decreased intellectual, emotional and social development, that it can result in a detached baby, that it's harmful to the parent-child relationship, that it can make children insecure, and that deep sleep resulting from it is often a result of trauma. You claim that these are 'scientific' reasons why you are not doing it, cite studies, and make mention of researchers finding this and that. In short, you present all these statements in a way that makes them look as though they're thoroughly evidence-based claims

And nowhere during that post do you point out that, despite the fact that you specified at the beginning that when you said 'CIO' you were going to talk about the practices otherwise known as Ferberisation and/or sleep training, absolutely none of the research you cite has anything to do with Ferberisation or other forms of sleep training. Nowhere in that post do you point out that the research in question is into children who were regularly neglected on an ongoing basis during their childhood, not into children who were left on their own for short periods at bedtime with a parent coming in to check and comfort them regularly. Nowhere in that post do you point out that there is a big difference between what the research you are citing actually *says* and the conclusions you are drawing from it. Regardless of what you feel in the matter, do you really not feel that that is information that any other parents might, perhaps, want to know in order to enable them to make a realistic assessment of what *they* feel to be the degree of risk?

When you make it sound as though the evidence says something it doesn't – when you are not honest and open about the limitations of the evidence – then you are *not* giving parents full knowledge of the risks. You are *not* helping them to form a realistic understanding of the degree of risk. You are deliberately trying to make it *sound* as if you are doing so, while, in fact, not being open about important information that parents might well want to take into account when assessing the degree of risk.

I ask you again: How would you feel if you read a post in which someone claimed that they were going to write about the risks associated with safe bedsharing, and then cited a bunch of studies into bedsharing-associated deaths that you knew perfectly well were in fact about *unsafe* methods of bedsharing, without ever once pointing out that the deaths in question had not been shown to be associated with safe bedsharing? Would you consider that that post was providing people with full knowledge that would enable them to gain a realistic understanding of the degree of risk? Or would you feel that that person was deliberately presenting facts in a skewed and misleading way to further their own agenda?

[Sarah V.]

Anyway, stepping down off that particular soapbox for a minute to comment on the issue of what should go on the side of a formula tin - what I'd like to see on there would be a sympathetic statement that it was almost always possible to overcome breastfeeding difficulties with the right support and information, followed by a list of sources from which people could get that information (helpline numbers, URLs, and books). And maybe a link to where they could find information on the risks of formula if they wanted to go look it up for themselves. Given that the main reason women don't breastfeed is because of lack of information, support, and provision, not because they don't realise breastfeeding is better, I think that would be a lot more helpful while avoiding making other mothers feel worse.

[phdinparenting]

@ Sarah - I think that is a good idea about the formula label.

[phdinparenting]

@ Sarah - If someone wrote a post that cited research that showed that what I consider safe bedsharing was in fact harmful, I wouldn't claim that the research only showed that it is harmful when you do it frequently or when you do it during the day. I would conclude that if it is dangerous, it is dangerous. It doesn't matter what time of day you do it at. Same thing with crying. If excessive crying and not responding to your baby can be harmful, then it can be harmful both during the day and at night. It doesn't suddenly become safe or okay because the lights are off and you think it is time to sleep.

Some people resort to crying it out in desperation. Some people resort to formula in desperation. But there are risks with both and those risks increase the more of it you use. Some babies can be "trained" in a few nights, other babies persist and persist and persist and so do the parents in their "training" attempts.

Like crammer said in his comment above, not all things are equal to all human beings. What is safe for one person, may not be for another as it relates to chemical substances and the like. With things like excessive crying, bullying, physical abuse, and other things, we do not know why some people seem to come through it all with a smile while others end up depressed.

What I do know for sure is that I will not and cannot do cry it out with my children because my instincts tell me it is wrong and because the research shows me that the risks of excessive crying (which yes, CIO sometimes is) are great enough and we do not know from the research that has been done what the "safe" level of crying alone without any parent comfort is.

[phdinparenting]

@crammer:

Thanks for your comment and the insight into what the Canadian government is doing now. I think the approach sounds interesting, but regardless of what approach they use to determining if something is dangerous or not, I guess my main point is that there are varying degrees of dangerous. I would love to see them rate things on a sliding scale of 1 to 5 for example. Perhaps they decide that things that are rated L4 and L5 are not allowed on the market because they are too dangerous (great!), but I would like to be given an assessment as to the relative degree of risk in the things that they do decide are safe enough to make it onto the market (lets' say L1 to L3).

For example, as it relates to drugs and breastfeeding, I generally try not to take anything that is not rated L1. However, if I was ill enough that I had to decide between weaning and taking an L2 or L3 drug, then I would think about the risks and weigh the consequences of both options. Perhaps if I only had to take the drug for a short period, I would try to get information on how long the drug takes to make it through my system and my milk and would try to take the medication at a time when my daughter is not likely to nurse for a while (e.g. as I leave for work in the morning).

Or as it relates to food, I might make the assessment that if I cannot get organic raspberries at all times of the year but that my daughter loves them, then maybe the risk is worth it to get her to eat an otherwise healthy food. However, if there is another organic food that she will eat that has an equivalent vitamin make-up and is available when the raspberries are not, then maybe I would buy that instead. In any case, I need to understand that there is some risk in ingesting pesticides first.

Does that make any sense? I guess while I generally trust in the assessment of the government (which is more than many do!), if I can choose between "safe enough" and "safest", I would like to choose "safest", but I need the information to do that.

[Sarah V.]

No, Annie. Not what I asked. I asked how you would feel if someone wrote a post claiming that *safe* bedsharing was harmful in which all the research they cited was, in fact, about *unsafe* methods of bedsharing, and in which the author did not at any point clarify that the research they were citing was not about safe bedsharing despite having said specifically that this was what they were going to be talking about. As I recall, when the Ontario coroner did pretty much that you were not happy about it at all.

The objection to the research you've cited isn't that the crying in sleep training methods takes place at a particular time of day. It's that leaving children crying for short periods of time, a few times a day, for a few days, while coming in to check and comfort them regularly, is not at all the kind of chronic neglect situations studied in the articles that show prolonged crying to be harmful. To go back to your analogy about overeating, it's like claiming that eating some extra biscuits and treats over Christmas could result in the same kind of health problems as eating biscuits and treats all day every day for years on end. Trying to make it sound as though the two situations are the same is not providing 'full knowledge' of the available information and the actual risks.

[Sarah V.]

BTW - just wanted to mention that there are also some other important problems with the way you're interpreting the research. For example, the study that showed lower IQs in babies with prolonged crying in infancy didn't even look at parental levels of responsiveness to crying. Nor did the study that showed increased levels of ADHD. This means that it's perfectly plausible that the actual explanation is that cause and effect are the other way round from what you're claiming - in other words, that children with ADHD or lower IQs are more likely to cry as babies.

[phdinparenting]

@ Sarah V - I think part of the trouble I'm having with figuring out what you're asking or what you're debating is that I don't understand where you draw the line between safe crying and unsafe crying. If I understand you correctly, you say that a few nights of crying with the parents checking in every once in a while is okay whereas chronic neglect is not. There is a lot in between those two.

At what point, in your educated opinion based on the research that you've read, does leaving a child to cry become potentially harmful? If you could enlighten me, perhaps I would find it easier to address what you are actually saying rather than dancing around the issue.

For example, I know of parents that put their baby down at 7:00pm every night and close the door and don't go in again until 7:00am no matter what. I know people whose baby has to cry for 30 minutes to get to sleep every nap and every night and it didn't stop after a few nights (they continued it for over a year). I know some babies that cried and cried for hours when their parents were doing CIO and some that cried for 30 minutes. Some people do CIO at 3 months, some not until a year. Some people go in after 5 minutes of crying, some go in after 15 minutes of crying, some go in only if there is vomit and then only clean it up quickly and leave right away again without saying a word or comforting their child.

With regards to bed sharing, I can be very clear about what is safe and what is unsafe (and in fact I plan to write a post about it when I get a chance).

If you could tell me what you consider safe crying and unsafe crying (not just the extremes, tell me where the line is between the two or at what point it becomes possibly harmful in your mind), that would help me to better respond to your questions and better interpret the research in light of your comments.

[Sarah V.]

Annie, the fact that you're asking that question suggests to me that you still have no idea what it is I'm actually trying to say here. Where I 'draw the line' is completely irrelevant. What I'm talking about is how the information should be fairly presented to other people in order to enable them to, as you put it, make the best choice for their families and have a realistic understanding of the degree of risk.

We know that children who are regularly neglected are at risk of suffering terrible harm as a result. We have no such data showing harmful results from controlled crying (and some to the contrary). Faced with the information I've just summarised in those two sentences, some people decide – as I've done – that controlled crying's OK, and some people decide – as you've done – that it's a risk they're not happy with. That's fine. What is *not* fine, in my book, is when someone is scared away from controlled crying because posts like yours have *misled* them into thinking that studies have directly shown harmful effects from controlled crying techniques. Because that isn't informed choice. That is *misinformed* choice. I am objecting to the misleading, and sometimes downright inaccurate, information in that post. Not because I want anyone to do controlled crying if they're not happy with it, but because I think people should be able to make that choice based on accurate information and not scare stories. Presenting the information in the way you did does *not* allow people to come to a realistic understanding of what they feel the degree of risk to be.

By the way, do you even understand what the terms Ferberisation/controlled crying mean, or were they just terms you picked up somewhere and decided to fling in there? Leaving a child alone for twelve hours no matter how distressed they are certainly isn't Ferberisation. In fact, it's just the sort of scenario that Ferber intended the controlled crying method to avoid.

[Sarah V.]

By the way, the lines for safe bedsharing are actually not all that clear. There are certainly behaviours that we can clearly state to be unsafe, such as bedsharing if you're a smoker or sleeping with your baby on a sofa. However, a thornier issue is that of whether there's any increased risk in bedsharing in the first few months of a baby's life. Some studies say there is, others haven't found this. So, is there or isn't there? And, if there is, where do we draw the line? Accepting that this is a grey area doesn't stop me from saying that the evidence clearly shows some other behaviours to be unsafe. More to the point, it doesn't mean that I try to mislead people as to the risk level by making it sound as though the studies that show increased risk with unsafe bedsharing practices are actually about bedsharing according to guidelines when they aren't.

[phdinparenting]

Please enlighten me Sarah on what the terms Ferberisation/controlled crying mean (I assume that is what you consider "safe" cry it out). I get confused about which "experts" say you should check on your child and reassure your child and which ones don't. I forget which ones say to check back after 15 minutes and which ones say 30 minutes. I forget which ones say not to talk to your child and which ones say that hearing your reassuring voice can be beneficial. I forget which ones say not to go in unless your child vomits and even then just clean it up and get back out without reassuring your child.

My posts are about "cry it out" which IMO includes *any* technique that involves leaving your child alone to cry themselves to sleep (my understanding is that Ferberisation involves some element of this). But again, they are about *my* reasons for not doing it and they explain what some of the consequences *can* be. Others are welcome to look at the research and come to different conclusions. It would be an awfully tedious post that noone would read if I listed the full results of every study that I look at. It was intended as a summary of my reasons with the detailed sources I used listed for people to review at their own leisure. I am not a government regulator and do not have the obligation to provide people with "a realistic understanding of the degree of risk". Even if I wanted to do that, there are not sufficient studies for me to quantify the degree of risk, so instead I have extrapolated from the available studies the information that I used to make my decision.

The studies that you insist show that controlled crying is "safe" have significant limitations too (http://phdinparenting.com/2008/08/11/cry-it-out-cio-is-it-harmful-or-helpful/#comment-1000" rel="nofollow">as I pointed out in my other post), most notably that it only looks at the short term results and not the long term ones. Many of the negative effects of spanking, for example, are only seen later in life.

Even if studies did prove that it is "safe" (which they don't), I still think it is mean, so I wouldn't do it.

[Alison]

Before I had my children, I assumed that the CryItOut method was what everyone should do, as it seemed that all the moms I knew were doing it.

I couldn't do it. At all. It went against every cell in my body.

As it turned out, my first child, in addition to being only 4 1/2 pounds at birth (only 3 weeks early--I had pre-eclampsia and hyperemesis), also had not one but 2 Ventricular Septal Defects (holes in his heart).

CryingItOut might very well have caused him physical harm.

I slept with him at night, and wore him all day, and nursed him for 2 1/2 years.

He had open-heart surgery at age 2, not to close the holes, because, against the odds, they closed on their own. But he developed a rare condition called Anomolous Muscle Bundles inside the heart, which had to be removed.

He was also diagnosed with autism at age 3, but now, at age 13, has "lost" the diagnosis.

I often wonder what has happened to us as a society, that we mothers are bombarded with marketing, telling us that it's not only safe but desirable to have our babies sleep in a cage (come on, that's what a crib really is), that we should not respond to them when it's not convenient for us, and that formula is at least as good as breastfeeding, and should be the norm for feeding a baby. Even breast-feeding mums are told that they should wean their baby--to a bottle???

And if you really want to open up a can of worms, try researching vaccine safety outside the propaganda of the pharmaceutical/medical industry...(www.nvic.org is a good place to start)

[Andrea]

Frankly, after seeing your tweet last week that claimed that 83% of babies in slings were securely attached and 38% of babies in carriers were insecurely attached w/o making any mention of the ridiculously low sample size (49) of the ONE study of *low-income inner-city American moms* with that result makes me think you don't understand risk very well at all. If you did, you might understand that, given that studies consistently find that 60% of American infants of one year of age are securely attached to their mothers and that for this fact to gibe w/ that ONE study as generalized to the entire population would mean that half of American mothers must be using slings instead of plastic carriers--which is clearly not true. You might also understand that the author of that ONE study clearly intended her report to be research into a potential intervention amongst mothers who were at high-risk of having insecurely attached infants--that is, a targeted treatment towards a particular population at high-risk, not something that can be generalized to mothers in other populations.

As far as the interesting CIO debate is concerned, you do realize--having read the original research, and not simply reports on the research, I am sure; and having been *thorough*--that studies of responses to infant crying are decidedly mixed, and while some find that infants w/ prompt responses to cries then cry less at one year of age, others cry more, and other studies find no relationship.

As a professional who makes her salary assessing risk, I'm curious to know what courses and materials you have studied in risk assessment and risk management, statistics, sampling methods, statistical significance, and so on.

[phdinparenting]

@Andrea:

What my tweet last week about secure attachment means is that I was sharing things of interest that I read in the book "Attached at the Heart" while tweeting from my Blackberry while having my hair done, without the benefit of the Internet to check the sources that were listed. I see now that it was a small sample study and that the conclusion based on that limited sample was that "for low-income, inner-city mothers, there may be a causal relation between increased physical contact, achieved through early carrying in a soft baby carrier, and subsequent security of attachment between infant and mother." I also think it is too bad that only 60% of American infants of one year of age are securely attached to their mother (I'd be interested in reading those studies if you'd be kind enough to point me in the right direction) and could imagine (although I don't have a statistically valid study at my fingertips at the moment) that increased babywearing would be one practice (of many possible practices) that could help increase the incidence of secure attachment.

With regards to "cry it out", I'm interested in a lot more than just whether infants cry more or less at one year of age. http://www.phdinparenting.com/2009/01/15/another-academic-weighs-in-on-cio/" rel="nofollow">Unfortunately, most studies on cry it out look only at whether it "worked" or not and don't fully address other consequences of this method of getting babies to go to sleep. Everyone can make their own decision about whether they think there is enough evidence that it is safe or not.

In terms of my own background in the areas that you mentioned, I have taken graduate level courses in statistics, sampling methods, statistical significance and so on and have written and published guidelines that are used by the government on statistical validity for public opinion research. In terms of risk assessment and risk management, I am familiar from my work with various government agencies of the approaches that they take to risk assessment and risk management and I am enjoying learning from @crammer about how it is evolving. I have also read and am reading the work of other researchers that criticize the approaches taken by the government and industry self-regulation as insufficient and potentially dangerous. I watch with fascination and fear as government agencies start banning or increasing regulation of and restrictions on substances that they were bending over backwards to claim were completely safe not too long ago (be that BPA, pesticides, tobacco, etc.).

As a "professional who makes her salary assessing risk", I'd be interested in your professional opinion about whether perhaps the agencies that are assessing risk should be taking a more precautionary approach or doing more to inform people that there is a difference between something that is ideal/completely safe and something that has "acceptable" levels of risk when used in a specific fashion. The point I was trying to make in this post is that a lot of people assume that because something is "approved" that it must be 100% safe. I think that is naive.

[Andrea]

I appreciate that you (and I, and everyone else) are very busy and that checking sources etc. is time-consuming and a pain in the ass, but in the contentious field of parenting practices I think it is incredibly important to give people that info. Especially w/ twitter, where the necessity of reducing complex thoughts to 140 characters creates an impression of certainty and universality that is, most often, not supported by the evidence.

Thanks for your background info. That should make the rest of this easier....

Nothing is 100% safe. Anyone who concludes that whatever is approved is 100% safe is indeed naive, but anyone who is looking for 100% safety is also naive. As for communicating risk to the public, that quickly devolves into how, when, and in what detail. As I'm sure you know, even trained professionals react quite differently to the same information when presented in positive (this treatment is 80% effective) vs. negative (this treatment fails 20% of the time) terms. It is impossible to structure information in such a way so as not to bias outcomes.

Let's look at that tweet as one example:

83% of babies in slings are securely attached vs. 38% in carriers

or

17% of babies in slings are insecurely attached at one year (and isn't that interesting?)

or

even amongst low-income inner-city mothers, 38% of babies not worn in slings were securely attached at one year

That's not even getting into the whole quagmire of expressing risk in percentage vs. absolute terms, which completely alters the tone of the debate. Let's say there's a baseline risk of 2% of death from SIDS in the first year, and that formula increases that 2% risk by 50%, and bedsharing increases it by 25% (I'm making those numbers up). So your potential messages are:

Formula increases the risk of SIDS by 50%.

Formula increases the risk of SIDS to 3%.

Formula means the death of one extra baby out of every hundred.

Bedsharing increases the risk of SIDS by 25%.

Bedsharing increases teh risk of SIDS to 2.5%.

Bedsharing means the death by SIDS of one more baby out of every 200.

Formula is twice as dangerous as bedsharing.

97% of babies on formula will not be affected by SIDS.

And so on. Every one of those is technically accurate. Every one of them has a completely different connotation. There is no way to neutrally communicate risk, and every audience carries its own biases in: that's the difference between qualitative and quantitative risk judgments, and you can argue numbers until the ice caps melt, it will still be impossible to shift the unconscious biases underlying qualitative risk judgments. (Your own choices here are the same. You could have chosen to present the information in your last breastfeeding post as absolute rather than percentage risks, or even to use both--but you chose, whether consciously or not, to present it in the most frightening way possible. A 200% increase sounds really terrifying until you know that the baseline risk is only 1/1000 or 1/10000.)

Is this the government's job? I would say no. It is the government's job to minimize extreme risks (you must do up your seat-belt) and to protect us from known hazards (car manufacturers must provide seatbelts) but not to tell us the risks of everything we do all day (every time you get into your car you have an x% chance of dying in a car accident; your peanut butter has a y% chance of being contaminated; there is a z% chance of being struck by a passing car when waiting for the bus). The precautionary principle is lovely in theory, but in practice, progress means making decisions based on incomplete information, moving forward, and learning from our mistakes. Nothing can ever be proven to be 100% safe--because nothing is 100% safe--and nothing can ever be proven to be more safe than not. We can only believe that things are more safe than not until proven otherwise. Risk communication is a role properly undertaken by the press, who can juggle and present competing views and values. And yes, that leaves research and decision-making up to each of us as individuals, as it should.

Ultimately this is not a numbers debate. You will believe, emphasize, and accept certain risk quantifications because of your underlying values and beliefs about family, safety, risk tolerance, and so on; I will believe, emphasize, and accept other risk quantifications because of my underlying values and beliefs.

Anyway. Try this for the attachmetn security numbers. http://books.google.ca/books?hl=en&lr=&id=EcA5_dyFaIYC&oi=fnd&pg=PA135&ots=9OIf0iMssT&sig=_GA83q2o1FiEVMa_CZmr1dp_xm4#PPA136,M1 I did a bit of skimming of new psychological journals this morning, and found nothing about specific parenting practices and attachment, unless you count the one meta-study that dismissed the role of breastfeeding in forming secure attachments. I did find studies that both found and did not find a link between maternal sensitivity and attachment, and several intriguing studies about the transmission of attachment styles between generations (that avoidant mothers have avoidant infants, etc.). This seems the most reasonable assumption--that regardless of parenting style, kids will pick up on the cues of their parents and learn similar models for approaching other people. You can force an avoidant mother to breastfeed her kid, pick her up when she cries, and sleep in the same bed, but you can't force her to be close or affectionate, and parenting styles are just window-dressing.

[Babies Health Naturally]

Whew! You go girls! I love passionate mommies!

My feelings in a nutshell...
"FDA Approved" is a completely meaningless statement to me. Really, meaningless.
I do my own research and look for independent, unbiased sources of information and then I make an educated decision. I will not allow a label to make the decision for me.
Unfortunately, the majority of parents still allow that "FDA" label to make the decision for them.

[Alisha]

I completely agree with this comment. I *wish* formula was behind the counter. :/

[Alisha]

Annie, a couple things. :)
Do people not realize that this is your personal blog and the CIO post was about why *you* don't CIO with your *own* kids?!
Also, about the stats etc...no one is asking you to be an expert, if you write something that I find interesting..I do my own research and make choices that work for my family. :)
I love your posts and while I don't agree with every single one I dont have the time (because I am parenting 24/7) to argue and argue with you on something that you have your own opinion about. People can have differing opinions and that is okay! :)
Lastly, the times are so off on this page...2008 and 2010...its messing with my mind.
Keep up the awesome work. You are appreciated.

[phdinparenting]

Alisha:

You probably came to this post via my facebook page. On facebook, I often post links to posts I wrote one or two years ago, as a way of introducing my new readers to some of my older content. When I do that, I usually put "(from my archives)" in the description, which I did in this case. So yes, this post is from 2008, but posted a link to it yesterday (in 2010) on my facebook page.