What is best for your kids is what works for you
April 19, 2019 6:35 PM   Subscribe

"Many of the benefits cited do have some basis in evidence, just not always especially good evidence. And even when the evidence is good, the benefits are smaller than many people realize." An economist looks at the statistical evidence for three hot-button "best practices" in baby-rearing.
posted by drlith (33 comments total) 35 users marked this as a favorite
 
Huge fan of Emily Oster's prior book, Expecting Better, which really looks at the studies (or lack of studies) behind pregnancy guidelines. It doesn't prescribe specific courses of action (except in really clear-cut cases) but lays out the evidence so you can make your own decisions, based on your own risk tolerance. Can't wait to read Cribsheet!
posted by peacheater at 6:57 PM on April 19 [11 favorites]


I expect this thread to be full of Emily Oster stans and I am fully one of them. +1 pre-ordered her new book months ago and am so stoked it'll be out in time for my third kid.
posted by potrzebie at 7:02 PM on April 19 [5 favorites]


"One day, your child will have a temper tantrum. How on earth do you deal with that? Exorcism? And what about potty training?"

I enjoy how these sentences read completely differently, and delightfully, if you treat them as a list of three common parenting problems, or as two common problems and a suggestion.

Anyway I'm some ways off being a parent but I quite liked this article.
posted by Merus at 7:44 PM on April 19 [5 favorites]


Great article, it's funny I think, you're so anxious with your first, and then your second comes along and you're basically "welp, it's in god's hand now, cause nothing we do seems to have had any traceable outcome!"

Less judgment around parenting is a great idea full stop
posted by smoke at 7:51 PM on April 19 [23 favorites]


I read “baby-rearing” as “baby-wearing” but despite that error was glad to learn from the article that our failed baby-wearing attempts did not leave my baby at a deficit. I had such hopes of living a beautiful life with a baby wrapped to my chest but instead ended up with so, so, so much baby puke down my cleavage.
posted by Maarika at 7:57 PM on April 19 [30 favorites]


When my first was born, we went with a midwife rather than an on (a midwife who'd spent 25 years as an RN first). She was amazing, but one of the best things she did was contextualize the recommendations the province gave us for things like how baby should sleep. Along with the laundry list of rules, she also gave us the studies they were based on, which really equipped us to make on our decisions.
posted by Reyturner at 8:26 PM on April 19


Don't read the comments! Here, I'll sum them up for you: "I know this article just presented a bunch of evidence, but we all know that the most important thing is common sense and intuition! Which coincidentally say that the way I did it is right and the way the article suggest is okay to do it is wrong."
posted by soren_lorensen at 8:26 PM on April 19 [27 favorites]


I actually thought one or two of the earlier comments which questioned the premise of having an article about the pros and cons of breastfeeding or not doing cry-it-out without doing more to acknowledge that those are privileges were good.
posted by lab.beetle at 8:29 PM on April 19 [1 favorite]


Why is it about economics, tho? Isn t this just regular scientific literacy, or at most, the mathematical statistics you learn in many disciplines?

Anyway, it s nice to have someone deflate the overheated rhetoric around parenting. 6 months paid leave or bust!
posted by eustatic at 8:43 PM on April 19 [1 favorite]


Economists tend to worry more than average about the subtleties of inferring causation from observational data and natural experiments, which is exactly what the article discusses.
posted by vogon_poet at 9:34 PM on April 19 [8 favorites]


Kids are flexible and resilient. They have to be, while learning and growing and absorbing and sifting information. I think the details matters less than overarching trends: Are my parents there for me when I need them (really need them)? Do they love me and keep me safe?

Get those right and everything else will sort itself.
posted by lubujackson at 11:10 PM on April 19 [11 favorites]


Yesterday I treated a 4-year-old with a broken pinky who kept screaming for a mother who "went out for a cigarette" and returned about 3 hours later with shopping bags.

I've been dealing with mothers like this for 18 years.

It's how I know any mother consumed with the question “am I a good mother?” already is.
posted by BadgerDoctor at 12:05 AM on April 20 [48 favorites]


I'm so excited to read Emily Oster's new book. I love Expecting Better, it's been the reassuring, actually-informative read that I've returned to again and again throughout my pregnancy. It is wild how often guidelines are thrown at you and how difficult it is to find out the reasoning behind them if you're not already well-versed in healthcare stuff and comfortable reading (let alone have access to) the research that informs them.
posted by the cat's pyjamas at 12:28 AM on April 20 [1 favorite]


Really, really enjoyed the article. Glad we're finally trying to make parenting less weird. What I mean is, stop making parenting a religious experience that converts people into zealots for whatever they happen to do. It's all cart before the horse anyway, so people just do what they're going to do then justify it after the fact. That's fine for yourself, but no need to push that on other people and get all holier than thou.

Which does bring me to a few points. I think Dr. Oster's points about the merits of RCTs over observational studies are broadly true, but it's also easy to make generalizations about quality of evidence. Well-designed observational studies could have a lot more to say than poorly designed RCTs. (Loads of caveats, I know.)

I'd say public health folks think more about disentangling causation from observational data than do economists. I mean it's pretty much the main point of any MPH program. At the very basic level, peruse the Bradford Hill Criteria for establishing causality. (Or just wikipedia if that's easier.) Nobody tortures themselves more than public health folks trying to design cohort studies. Also, we're just not going to get RCTs for most things because the set up would be unethical, also RCTs tend to favor interventions like pharmaceuticals and aren't so good at complex, behavioral issues anyway. Life is complicated and not everything can be reduced to one variable.

Anyway, that's not the main point of my comment. I've harped on this before, but it's an important concept that needs to burrow its way into public conversation.

Though normally synonymous, in public health we use the terms efficacy vs effectiveness differently. The concept was first articulated by Archie Cochrane (of Cochrane review fame) like 50 years ago, so it's one of the basic frameworks that public health practitioners use. It's not unique to economics.

Efficacy: Can it work? Extent to which an intervention does more good than harm under ideal circumstances.
Effectiveness: Does it work in practice? Extent to which an intervention does more good than harm under usual circumstances.
Cost-Effectiveness: Is it worth it? The effect of an intervention in relation to the resources it consumes. (Definitions from here.)

Basically, efficacy measures if an intervention has the potential to work in perfectly regulated clinical settings. IE An HIV treatment that requires 16 different pills at specific intervals throughout the day with access to GP support and a steady supply of drugs might appear better in a clinical setting.

Effectiveness measures how well an intervention works in the real world. The above intervention might look 50% more effective than the current intervention on paper, but when you try to apply it to a rural African village, the actually effectiveness might be statistically worse than the current treatment. (Because it's really hard to follow the prescribed doses and maybe you run out of pills and maybe it wasn't explained to the patients properly, and maybe there's a social stigma againsy HIV so you have treat yourself secretly etc.)

Finally cost-effectiveness measures if something is worth it. Public health people might use concepts like patient number needed to treat. IE if we start using this intervention how many people would it take to see any sort of benefit. So if we tried this new intervention on 10,000 people it might save the equivalent of one life.

On an individual scale we can look at the purported benefits of the intervention (say exclusive breastfeeding for 6 months) and compare it to the perceived inconvenience or mental stress or marital stress or whatever.

Basically most interventions aren't worth the mental effort as long as we're covering the big things like handwashing, not eating your own poo and drinking less than a bottle of whisky a day. (A big step up from the 19th century.) It's basically Pareto principle. Cover your bases and don't sweat the small stuff.

If it works for you, it works for you. Stop guilting other parents because whatever you think is correct is probably mostly wrong for reasons you haven't even considered and you're probably not interpreting the research correctly anyways and the human race has survived for millions of years without parenting books, we'll be fine until we all die of climate change.
posted by Telf at 3:16 AM on April 20 [34 favorites]


Why is it about economics, tho?

The part that comes after
This is where being an economist comes in handy.
explains some of this. Economics is a big tent. So are most academic disciplines these days. I know biologists who insist on calling themselves physicists simply because the got their degree from a physics dept. and now work in one. I know geographers that are essentially economists. If you spend time at any big state U in the USA, you’ll see hundreds of people who’s work may be classified in ways that might seem surprising at first, but makes total sense when you learn a bit more detail.

We can go on and on about ‘what is science’, but the only real answer is ‘what scientists do’, and I think that applies pretty well to economics too.
posted by SaltySalticid at 4:06 AM on April 20 [2 favorites]


Why is it about economics, tho? Isn t this just regular scientific literacy, or at most, the mathematical statistics you learn in many disciplines?

Economists consider doing proper literature reviews of other scientific disciplines' work an allocative inefficiency in the free market of ideas.
posted by srboisvert at 4:38 AM on April 20 [7 favorites]


I think the overlap between this topic and economics is that amongst other things, economics is the study of cost-benefit analysis and rational decision making. So the article is not just, 'how do I evaluate the scientific merit of existing studies on child rearing', but also, 'how do I make decisions given the more or less weak evidence for these various claims'? I don't think it's very central to the article, but that's the angle.

Anyway, I've always been frustrated the way much of the parenting advice I encounter so completely de-emphasizes the well being of the parents. I mean, if the parents are deeply stressed out and unhappy, that's going to have a pretty negative effect on the kids. So yah, the title of this post speaks to me. I guess in light of BadgerDoctor's anecdote above, this advice could also probably go too far in the other direction, but balance in all things, I guess.
posted by Alex404 at 6:08 AM on April 20 [7 favorites]


The evidence is a bit cherry-picked to support her experience.
posted by Mom at 6:29 AM on April 20 [5 favorites]


She may be a very good economist, but this is a very poor literature review. She may have done more work if this is an excerpt from a book, but this does not show that work.
posted by chiquitita at 6:41 AM on April 20 [2 favorites]


I mean, she may be correct, I have not done those literature reviews and I don't want to specifically get into a fight about sleep training.

But if she's selling herself as science-based, method matters.
posted by chiquitita at 6:44 AM on April 20 [5 favorites]


posted by Mom

Eponysterical!
posted by hwyengr at 7:12 AM on April 20


I recently read The Science of Mom by Alice Callahan, based on her blog of the same name - and it's a really great book (despite the annoying title).

She's a research scientist and takes you through the systematic reviews, RCTs, and observational studies on various practices. She tends to avoid giving specific advice (vaccination excepted), but lays out the evidence about the safety/benefit of practices for the reader to decide. I learned a lot about things like vitamin k shots, chances of anemia for breast-fed children (reduced if you delay clamping the umbilical cord) - and why the evidence on the safety of co-sleeping is mixed (tldr; Japanese co-sleeping is safer than American, because the beds are harder and have less bedding). also: all the benefits of breast milk versus formula seem to be limited to the first year, it's all a wash after that, so do what you need to do to keep the kid fed and yourself sane. And there is one major benefit of formula: it's iron-fortified, so you have a much lower chance of anemia (breast milk has very little iron).
posted by jb at 7:55 AM on April 20 [9 favorites]


I also loved “Expecting Better” - finally a rational explanation of the long list of Pregnancy Don’ts!
I am very excited to read cribsheet.
posted by natasha_k at 9:53 AM on April 20


She may be a very good economist, but this is a very poor literature review. She may have done more work if this is an excerpt from a book, but this does not show that work.
Yes, this is only a excerpt from the book, so I really wouldn't judge based on that.
posted by peacheater at 5:48 PM on April 20 [4 favorites]


I will choose to judge on her poorly nuanced discussion of RCT vs observational study, which is completely oblivious to the fact you can't really do an RCT on formula vs breastfeeding as it would probably be unethical.
posted by chiquitita at 11:13 PM on April 20


I will choose to judge on her poorly nuanced discussion of RCT vs observational study, which is completely oblivious to the fact you can't really do an RCT on formula vs breastfeeding as it would probably be unethical.
The PROBIT study she mentioned was an RCT where they randomized whether they offered advice to encourage breastfeeding or not. Here is a paragraph about it from an article in 538 also by Emily Oster:
In the first camp — the randomized trial camp — we have one very large-scale study from Belarus. Known as the PROBIT trial, it was run in the 1990s and continued to follow up as the children aged. The study randomized women into two groups, one in which breastfeeding was encouraged and another in which it wasn’t, and found that the encouragement treatment increased breastfeeding rates. The trial has studied all sorts of outcomes, including infant and child health and cognitive development.
Yes of course, there is an issue with requiring women to either breastfeed or formula feed, but you can get around that by randomizing whether you provide encouragement to breastfeed or not which is not unethical.
posted by peacheater at 4:24 AM on April 21 [5 favorites]


At the risk of being slightly unfair to practitioners of the dismal science, the big thing separating economists from many other disciplines is they get paid more to make predictions based on interpretations of quantitative data. So if you're into not-particularly-difficult math and painstakingly generating executive summaries of conclusions based on having run a few linear regressions, it's not a bad career choice. Especially compared to other fields where you have to actually follow IRB and read field studies and messy shit like that.

On a micro level it seems obvious that the most cost-effective method of baby rearing would have something to do with condoms, 'cause our delightful little progeny are a total money pit.
posted by aspersioncast at 5:56 AM on April 21 [1 favorite]


The first thing that struck me is that an article subheaded "What Science Tells Us" is categorized as opinion. Still, I have to wonder about the studies that produced this data. I'm going to assume that the choices the parents under study made about each of these "agonizing decisions" were not made with goals of science in mind but were determined by the "free will", financial context, and culture of the decider, and that the primary means of gathering the data is asking the parents to report what they did. To me, this means that the number of confounding variables will be enormous. Just for a single example, how does the parent (who reports) "sleep training" their child feel about doing so and what does this say about their relationship with the child outside of this activity? Did they experience it as a struggle of wills? As "I'm doing this for your own good and you'll thank me later?" Or as "I feel bad that I have to let you cry it out," and expressing an apologetic attitude when doing it or the following morning. Or some days, one of these and a different day another? And did the activity make it easier to let the child cry on other occasions without responding/"giving in"? Could they distinguish between different types of crying? Fearful? Angry? Manipulative? Despairing? Perhaps researchers felt that all these other variables will cancel each other out if they're not under consideration?
posted by Obscure Reference at 6:39 AM on April 21 [1 favorite]


As she notes, it's always hard to get direct causality out of observational studies, but

To me, this means that the number of confounding variables will be enormous.

This is why God gave us multiple regression (and analogs). It's extremely unlikely that the studies asked about all of those specific factors, but it's hard to think that at least studies from the US wouldn't control for SES, race, ethnicity, religion, and (degree of) nativity.
posted by GCU Sweet and Full of Grace at 7:11 AM on April 21 [3 favorites]


The first thing that struck me is that an article subheaded "What Science Tells Us" is categorized as opinion.

It's pretty common for the Times to run pieces by scientists explaining their own studies in the Sunday opinion section, which is appropriate since it's not a straight news article, so I wouldn't read too much into it.
posted by ultraviolet catastrophe at 7:15 AM on April 21 [1 favorite]


I actually thought one or two of the earlier comments which questioned the premise of having an article about the pros and cons of breastfeeding or not doing cry-it-out without doing more to acknowledge that those are privileges were good.

The article not only acknowledges that breastfeeding is a privilege but even goes so far as to say that privilege has skewed the results of scientific studies on breastfeeding:
Most studies of breast-feeding are biased by the fact that women who breast-feed are typically different from those who do not.
posted by ultraviolet catastrophe at 7:23 AM on April 21 [8 favorites]



I recently read The Science of Mom by Alice Callahan, based on her blog of the same name - and it's a really great book (despite the annoying title).


I read the Science of Mom blog a lot back when Soren Jr. was a newborn (before she had a book deal and it was just a personal project.) It changed my mind about several issues that wound up being really key to my and my baby's health and well-being in the first couple years. I think of myself as a very analytical, skeptical thinker, and I realized just how much "well it's just common sense/your intuition is infallible" nonsense I'd absorbed. In no other area of my life do I accept "intuition" as evidence, so it was humbling
posted by soren_lorensen at 10:20 AM on April 21 [3 favorites]


More from Emily Oster in Slate "When You Give Birth, Your Body … Rips. That Might Suck a Little Less if We Talked About It More."
posted by Homo neanderthalensis at 2:38 PM on April 22


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