What’s New Since Dr. Spock

Has parenting advice changed that much?

By Anatoly Belilovsky, M.D.

I’ve been a pediatrician for more than two decades, and even during this relatively short time, I’ve seen numerous standards in parenting advice change due to fads or improved medical knowledge. As a result, parents from different generations can have very different ideas on the do’s and don’ts of caring for children. In this series of articles, I will discuss what is fad and what is fact when it comes to best practices for new parents – and new grandparents.

Sleeping Positions: Back vs. Stomach

In the 1958 edition of his parenting guide, Dr. Spock told parents not to place infants on their back when sleeping, explaining that the baby could choke on his or her own vomit. This advice was supported nearly across the board by parents and doctors, but later empirical studies in the 1990s found that there is a significantly increased risk of SIDS associated with infants sleeping on their abdomens. Parents are now told to let infants sleep on their backs.

Feeding an Infant: Bottle vs. Breast

No discussion of the changing trends in parenting advice would be complete without addressing the question of bottle feeding versus breastfeeding. The tail end of the “bottle is just as good, and easier” trend came in the late ’80s, but prior to that, formula was touted as the solution to many problems. It allowed parents to know exactly how much their babies were eating, and jaundice was less of a problem with the bottle. Then the weight of evidence – allergies, asthma, infection and developmental disparities – came down heavily in favor of breastfeeding. As a result, the medical advice has been in favor of breastfeeding ever since.

Feeding a Child: Meals vs. Snacks

Urging for more flexibility, Dr. Spock spoke out against the rigid ideas of strict mealtimes and no snacking, instead suggesting parents let their children graze when hungry. Of course, this point is still a debatable issue. I would have no problem with grazing if snacks were made with good nutrition in mind. Unfortunately, they are not, and even whole fruits and vegetables are imperfect; their high carb and/or fat content delays onset of hunger past the mealtime at which more protein and fiber may be eaten.

Learning How to Parent: More Info vs. Less Info

Spock told parents to trust their instincts and not go crazy reading too many manuals. However, it can be argued that many instincts are counterproductive in the 21st century; for example, bed sharing no longer protects infants against hyenas or cold but, instead, exposes them to suffocation. It’s important for parents to have a good relationship with a pediatrician they trust so that when a question comes up, they don’t just have to trust their instincts.

The Circumcision Debate: Health vs. Preference

Spock was one of the first doctors to say that circumcision is medically useless, although he accepted its use in religious settings, unlike later opponents such as Paul Fleiss. The last word is that it has some preventive effect against several diseases, and appears to have a favorable risk/benefit ratio. Pain is controlled with topical anesthesia in medical circumcisions.

The two illnesses that circumcision appears to protect against are urinary tract infection and cancer of the penis. Penile cancer is infrequent, but more common than serious complications of circumcision. Circumcision remains a personal decision, incorporating cultural and religious factors, and its use is not without medical indications. It is particularly indicated for boys with phimosis [tight foreskin], but its risk/benefit ratio does not justify its use in all male infants.

Anatoly Belilovsky, M.D., is a renowned New York City-based pediatrician with more than 20 years experience in treating children and advising parents. He is a Princeton graduate, a former clinical instructor at Cornell University and a recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients. More information about Dr. Belilovsky and his practice, Belilovsky Pediatrics, is available at www.belilovskypediatrics.com.

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