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.

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.

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.

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. 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.

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.

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)

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 (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.