I hate the AAP

[Anonymous]

Anonymous wrote:

Anonymous wrote:"Hats

The final change I wanted to discuss is a new prohibition on infant hats.

In prior iterations of its guidelines, the AAP has noted concerns with overheating as a risk of SIDS. I talked about that evidence in this post a month ago. The evidence on heat overall is a bit sparse, but in this iteration, the organization has taken it one step further to express concern about the heat generated by infant hats.

The data cited is from a single paper. This is a case-control study in Australia that looked at a large number of possible relationships between clothing and bedding and SIDS. The paper finds that in 8.3% of SIDS cases, a hat (“bonnet”) was worn, versus only 5.2% of control infants. This difference is statistically significant.

However: the paper runs a lot of tests, and this raises concerns about overinterpreting any one result. The authors find, for example, a much stronger statistical link between SIDS and wearing socks than between SIDS and wearing hats. They also find that wearing a nightgown is protective, but wearing “stretch and grow” leggings is associated with an elevated SIDS risk. It’s not clear what any of this means.

In fact, the authors do not make much of any of these results. They note: “Significant differences in the type of products used by case and control infants occurred, and may be related to the difference in season of interview between cases and controls.” Basically, they may have observed more SIDS infants in the winter, when hats (and socks) are more common.

Without belaboring the point, to take from this paper the conclusion that infants shouldn’t wear hats seems … a stretch. The data would more strongly support a “no socks” conclusion. Put differently: if the AAP is convinced by this one study that hats are dangerous, it should also be convinced that socks are dangerous, and nightgowns are protective. "

https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding

The AAP addresses this : " should be noted that because there are no randomized controlled trials related to SIDS and other sleep-related deaths, case-control studies are the best evidence available."...."Physicians and nonphysician clinicians are encouraged to have open and nonjudgmental conversations with families about their sleep practices. Individual medical conditions may warrant that a clinician recommend otherwise after weighing the relative risks and benefits."....

AND YET AGAIN SHE ONLY LINKS THE ONE PAPER NOT BOTH CITED IN THE REPORT. She picked the 2008 Bristol paper and not the NICU paper that found that hypothermia was not a risk for infants who didnt have hats. The paper further goes on to say "It is unclear whether the relationship to overheating is an independent factor or merely a reflection of the increased risk of SIDS and suffocation with blankets and other potentially asphyxiating objects in the sleeping environment. Head covering during sleep is of particular concern. In 1 systematic review, the pooled mean prevalence of head covering among SIDS victims was 24.6%, compared with 3.2% among control infants.274 Although head covering usually refers to bedding or bed clothes, 1 study found significantly more SIDS cases in infants wearing hats compared with controls.321 It is not known whether the risk related to head covering is attributable to overheating, hypoxia, or rebreathing. A study on the aerodynamics of rebreathing exhaled gases demonstrated that with higher temperature and humidity, the exhaled gas is denser and does not escape the vicinity of the nostrils.429 In this in vitro model, the result was increased rebreathing of CO2-rich gas, suggesting that both overheating and rebreathing are important components in the association between head covering and SIDS." Going back to the NICU study on hats, suffocation was a concern ".

Hats have multiple risks and have no discernable benefit. Thats the equation.

What about socks?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

DP. The criticism of the AAP is not that the cite some support for breastfeeding, but that they overstate the positive benefits and completely ignore the costs. And of course, stating the support for extended breastfeeding is akin to discouraging formula. That's obvious; you're just playing ridiculous language games. If all AAP wanted to do was support autonomy in infant feeding, this would be worded MUCH differently.

It is a public health document, which specifically states that individual decisions about breastfeeding should be made by families in consultation with their pediatricians.

With regard to extended breastfeeding, the policy statement urges support for those who choose to breastfeed beyond six months for as long as mutually desired by mother and child. Why do individual costs need to be discussed in order to support those who want to breastfeed beyond a year? Do you want them to say, this might be something you are choosing to do for your family and that you want, but here's a bunch of reasons why you are wrong and should stop? That's not the point of offering support. If you have been breastfeeding for six months to a year, you are aware of the pros and cons. If it doesn't work for your family, then stop.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

DP. The criticism of the AAP is not that the cite some support for breastfeeding, but that they overstate the positive benefits and completely ignore the costs. And of course, stating the support for extended breastfeeding is akin to discouraging formula. That's obvious; you're just playing ridiculous language games. If all AAP wanted to do was support autonomy in infant feeding, this would be worded MUCH differently.

DP but…the bolded is entirely incorrect. Breastfeeding past one has nothing to do with formula because babies older than one don’t drink formula…someone breastfeeding their 14MO isn’t choosing between breast and formula.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

Yes, of course you think only people who agree with you are capable of nuanced thought. That is the definition of not being capable of nuanced thought, ironically.

Neither of you are paying any attention at all to the concerns expressed in this thread about the AAP's statement/technical paper, or what Oster is actually arguing in her blog post. So whatever, keep think you are smart and everyone else is dumb. That will take you far in life.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

Yes, of course you think only people who agree with you are capable of nuanced thought. That is the definition of not being capable of nuanced thought, ironically.

Neither of you are paying any attention at all to the concerns expressed in this thread about the AAP's statement/technical paper, or what Oster is actually arguing in her blog post. So whatever, keep think you are smart and everyone else is dumb. That will take you far in life.

What is Oster actually arguing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

DP. The criticism of the AAP is not that the cite some support for breastfeeding, but that they overstate the positive benefits and completely ignore the costs. And of course, stating the support for extended breastfeeding is akin to discouraging formula. That's obvious; you're just playing ridiculous language games. If all AAP wanted to do was support autonomy in infant feeding, this would be worded MUCH differently.

DP but…the bolded is entirely incorrect. Breastfeeding past one has nothing to do with formula because babies older than one don’t drink formula…someone breastfeeding their 14MO isn’t choosing between breast and formula.

Exactly! The only benefit they cite is to the mother in terms of reduced risk of cancer. If you don’t agree with the evidence or don’t think the extra burden of feeding past one outweighs the benefits then don’t do it. I applaud this particular revision because those feeding past one do need more support and less judgement. There is NOTHING in the statement that criticizes those whose choose not to - in fact it basically says only do it if both baby and mother want to but should they choose to that choice should be supported and there are health benefits. No need to feed any baby (absent special needs) formula past one.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:"Hats

The final change I wanted to discuss is a new prohibition on infant hats.

In prior iterations of its guidelines, the AAP has noted concerns with overheating as a risk of SIDS. I talked about that evidence in this post a month ago. The evidence on heat overall is a bit sparse, but in this iteration, the organization has taken it one step further to express concern about the heat generated by infant hats.

The data cited is from a single paper. This is a case-control study in Australia that looked at a large number of possible relationships between clothing and bedding and SIDS. The paper finds that in 8.3% of SIDS cases, a hat (“bonnet”) was worn, versus only 5.2% of control infants. This difference is statistically significant.

However: the paper runs a lot of tests, and this raises concerns about overinterpreting any one result. The authors find, for example, a much stronger statistical link between SIDS and wearing socks than between SIDS and wearing hats. They also find that wearing a nightgown is protective, but wearing “stretch and grow” leggings is associated with an elevated SIDS risk. It’s not clear what any of this means.

In fact, the authors do not make much of any of these results. They note: “Significant differences in the type of products used by case and control infants occurred, and may be related to the difference in season of interview between cases and controls.” Basically, they may have observed more SIDS infants in the winter, when hats (and socks) are more common.

Without belaboring the point, to take from this paper the conclusion that infants shouldn’t wear hats seems … a stretch. The data would more strongly support a “no socks” conclusion. Put differently: if the AAP is convinced by this one study that hats are dangerous, it should also be convinced that socks are dangerous, and nightgowns are protective. "

https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding

The AAP addresses this : " should be noted that because there are no randomized controlled trials related to SIDS and other sleep-related deaths, case-control studies are the best evidence available."...."Physicians and nonphysician clinicians are encouraged to have open and nonjudgmental conversations with families about their sleep practices. Individual medical conditions may warrant that a clinician recommend otherwise after weighing the relative risks and benefits."....

AND YET AGAIN SHE ONLY LINKS THE ONE PAPER NOT BOTH CITED IN THE REPORT. She picked the 2008 Bristol paper and not the NICU paper that found that hypothermia was not a risk for infants who didnt have hats. The paper further goes on to say "It is unclear whether the relationship to overheating is an independent factor or merely a reflection of the increased risk of SIDS and suffocation with blankets and other potentially asphyxiating objects in the sleeping environment. Head covering during sleep is of particular concern. In 1 systematic review, the pooled mean prevalence of head covering among SIDS victims was 24.6%, compared with 3.2% among control infants.274 Although head covering usually refers to bedding or bed clothes, 1 study found significantly more SIDS cases in infants wearing hats compared with controls.321 It is not known whether the risk related to head covering is attributable to overheating, hypoxia, or rebreathing. A study on the aerodynamics of rebreathing exhaled gases demonstrated that with higher temperature and humidity, the exhaled gas is denser and does not escape the vicinity of the nostrils.429 In this in vitro model, the result was increased rebreathing of CO2-rich gas, suggesting that both overheating and rebreathing are important components in the association between head covering and SIDS." Going back to the NICU study on hats, suffocation was a concern ".

Hats have multiple risks and have no discernable benefit. Thats the equation.

What about socks?

I cant access the full article. But as I stated above- socks were in the article she choose but she didnt talk about the NICU paper or other papers r/t hats and suffocation risk AND she emphasized in her article that the AAP recommendation was based on one article- not true.

Further, if there are papers on socks and suffocation risk then yes the AAP should be consistent. The hat is 3-fold risk- overheating, suffocation, and rebreathing risk. Socks may only be an overheating risk, which makes them less risk. That would also imply that footed pajamas should be avoided.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

Yes, of course you think only people who agree with you are capable of nuanced thought. That is the definition of not being capable of nuanced thought, ironically.

Neither of you are paying any attention at all to the concerns expressed in this thread about the AAP's statement/technical paper, or what Oster is actually arguing in her blog post. So whatever, keep think you are smart and everyone else is dumb. That will take you far in life.

What is Oster actually arguing?

I don't know why you are asking me, since you don't believe I am capable of nuanced thought.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

Yes, of course you think only people who agree with you are capable of nuanced thought. That is the definition of not being capable of nuanced thought, ironically.

Neither of you are paying any attention at all to the concerns expressed in this thread about the AAP's statement/technical paper, or what Oster is actually arguing in her blog post. So whatever, keep think you are smart and everyone else is dumb. That will take you far in life.

What is Oster actually arguing?

I don't know why you are asking me, since you don't believe I am capable of nuanced thought.

I am not the nuanced thought poster but glad to know you can back up your arguments!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

Yes, of course you think only people who agree with you are capable of nuanced thought. That is the definition of not being capable of nuanced thought, ironically.

Neither of you are paying any attention at all to the concerns expressed in this thread about the AAP's statement/technical paper, or what Oster is actually arguing in her blog post. So whatever, keep think you are smart and everyone else is dumb. That will take you far in life.

What is Oster actually arguing?

I don't know why you are asking me, since you don't believe I am capable of nuanced thought.

I am not the nuanced thought poster but glad to know you can back up your arguments!

Why would I continue to talk in circles with people who ignore what I've already written?

[Anonymous]

"Anti-breastfeeding poster" here (I'm not against breastfeeding, I EBFed for 6 months and kept it up until 14 months). Here's a quote from the NYTimes about the new guidelines. The AAP has messed up before (we know this because they have previously retracted guidance that severely harmed some children) and they have messed up again. It is not uncommon for subject matter experts to know a lot about their subject but very little about how to interpret data, and there is no doubt in my mind that this is a BIG issue at the AAP.

"The new guidelines suggest that in the first week after birth, “pediatricians should discourage the use of nonmedically indicated supplementation with commercial infant formula.” The 2012 A.A.P. statement was more subtle, advising that pediatricians encourage “support of practices that avoid nonmedically indicated supplementation with commercial infant formula.”

The difference may seem like a minor point — supporting breastfeeding practices versus discouraging formula use — but it matters. “Nonmedically indicated” is subjective, and the updated admonition concerns me. There are reports, such as this one from The Atlantic and this one from CNN, about mothers who’ve been pressured by lactation consultants, nurses or pediatricians to reject formula in the early days of their children’s lives, and as a result their babies lost a dangerous amount of weight and, in rare circumstances, became gravely ill."

These New Breastfeeding Guidelines Ignore the Reality of Many American Moms https://nyti.ms/3am1C5s

[Anonymous]

Anonymous wrote:"Anti-breastfeeding poster" here (I'm not against breastfeeding, I EBFed for 6 months and kept it up until 14 months). Here's a quote from the NYTimes about the new guidelines. The AAP has messed up before (we know this because they have previously retracted guidance that severely harmed some children) and they have messed up again. It is not uncommon for subject matter experts to know a lot about their subject but very little about how to interpret data, and there is no doubt in my mind that this is a BIG issue at the AAP.

"The new guidelines suggest that in the first week after birth, “pediatricians should discourage the use of nonmedically indicated supplementation with commercial infant formula.” The 2012 A.A.P. statement was more subtle, advising that pediatricians encourage “support of practices that avoid nonmedically indicated supplementation with commercial infant formula.”

The difference may seem like a minor point — supporting breastfeeding practices versus discouraging formula use — but it matters. “Nonmedically indicated” is subjective, and the updated admonition concerns me. There are reports, such as this one from The Atlantic and this one from CNN, about mothers who’ve been pressured by lactation consultants, nurses or pediatricians to reject formula in the early days of their children’s lives, and as a result their babies lost a dangerous amount of weight and, in rare circumstances, became gravely ill."

These New Breastfeeding Guidelines Ignore the Reality of Many American Moms https://nyti.ms/3am1C5s

That is untrue. There are highly publicized guidelines for what percentage of dropped birthweight indicates supplementation with formula in the days and weeks after birth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:"Anti-breastfeeding poster" here (I'm not against breastfeeding, I EBFed for 6 months and kept it up until 14 months). Here's a quote from the NYTimes about the new guidelines. The AAP has messed up before (we know this because they have previously retracted guidance that severely harmed some children) and they have messed up again. It is not uncommon for subject matter experts to know a lot about their subject but very little about how to interpret data, and there is no doubt in my mind that this is a BIG issue at the AAP.

"The new guidelines suggest that in the first week after birth, “pediatricians should discourage the use of nonmedically indicated supplementation with commercial infant formula.” The 2012 A.A.P. statement was more subtle, advising that pediatricians encourage “support of practices that avoid nonmedically indicated supplementation with commercial infant formula.”

The difference may seem like a minor point — supporting breastfeeding practices versus discouraging formula use — but it matters. “Nonmedically indicated” is subjective, and the updated admonition concerns me. There are reports, such as this one from The Atlantic and this one from CNN, about mothers who’ve been pressured by lactation consultants, nurses or pediatricians to reject formula in the early days of their children’s lives, and as a result their babies lost a dangerous amount of weight and, in rare circumstances, became gravely ill."

These New Breastfeeding Guidelines Ignore the Reality of Many American Moms https://nyti.ms/3am1C5s

That is untrue. There are highly publicized guidelines for what percentage of dropped birthweight indicates supplementation with formula in the days and weeks after birth.

Yet there are babies who have been denied formula despite needing it. Is it really necessary to double down against formula, as these guidelines clearly do, despite the outright lies from previous posters on this thread?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For the Emily Oster haters, here is her blog post on the new breastfeeding (and other) AAP guidelines and why they are not evidence-based and potentially harmful (https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding ). If you have an actual rebuttal, feel free to share it. If you want to bash her credentials, of course you are free to do so, but know that that will just show you don't actually have a real argument.

I find some of these changes frustrating (obviously). This is true for two reasons.

First: in many cases, these guidelines (new and old) fail to acknowledge other family considerations. Breastfeeding for two years has practical costs and may have mental health costs, or physical downsides. Sharing a room with a child may have negative impacts on both child and adult sleep. There is little, if any, help given to families in navigating these trade-offs. Even when there is acknowledgment of the existence of a trade-off, the framing is often set up to imply that there is a “best” choice, and then some other worse choices if you cannot do that.

This is especially problematic when the benefits are so tentatively supported in the data. People are being told to make choices that may be very costly to them because of some theoretical risk, or some risk demonstrated only in very biased samples. It’s hard to see how this is a good trade.

A second issue is that as more and more restrictions on behavior are added, it becomes less and less easy to prioritize. There are some behaviors that are important for safe sleep — putting a child down on their back, for example. And then there are some, like not giving your kid a hat, that do not matter. When these are all presented together as a package, it can be challenging for parents to identify which things are important (I’ve written more about that here). And as the list gets longer and longer and starts to include things that seem ridiculous (like hats), it makes the good recommendations seem less important.

I believe it is possible to create a more coherent, more data-based set of guidelines that would help parents prioritize better. For now, what we have is flawed.

I am confused by your post. Are you suggesting someone who doesn’t agree with Emily Oster is incapable of a real argument? Because she herself has said otherwise, which is one of the reasons I like her…

I'm referring to the fact that lots of posters here like to bash her without offering any arguments as to why or how her conclusions are wrong.

Why is Oster, a trained economist, better source than the two people who wrote the AAP technical report and paper (Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC; Lawrence Noble, MD, FAAP, FABM, IBCLC) ? Literally the announcement objective for the AAP statement is : AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding. Does Oster negate this statement? No, but then she goes on to undermine the AAP.

In the article you linked she references a paper on HTN risk and only talks about the 2011 but the technical report lists two papers in 2018 and 2019.

I think she likes to be controversial and whatever gives her the most clicks.

Ahhh. A person who is capable of nuanced thought. I said this earlier in the thread, and it is clearly lost on the anti-breastfeeding poster, but the AAP did not recommend extended breastfeeding as the best option. They SUPPORT it, note studies showing health benefits, especially to the mother, and advocate for the elimination of barriers for those who choose to breastfeed beyond six months. That's it. Nowhere in the paper does it say that they recommend extended breastfeeding for everyone.

DP. The criticism of the AAP is not that the cite some support for breastfeeding, but that they overstate the positive benefits and completely ignore the costs. And of course, stating the support for extended breastfeeding is akin to discouraging formula. That's obvious; you're just playing ridiculous language games. If all AAP wanted to do was support autonomy in infant feeding, this would be worded MUCH differently.

It is a public health document, which specifically states that individual decisions about breastfeeding should be made by families in consultation with their pediatricians.

With regard to extended breastfeeding, the policy statement urges support for those who choose to breastfeed beyond six months for as long as mutually desired by mother and child. Why do individual costs need to be discussed in order to support those who want to breastfeed beyond a year? Do you want them to say, this might be something you are choosing to do for your family and that you want, but here's a bunch of reasons why you are wrong and should stop? That's not the point of offering support. If you have been breastfeeding for six months to a year, you are aware of the pros and cons. If it doesn't work for your family, then stop.

If it’s a public health document, it needs to take into account the costs and benefits of its recommendations, and it needs to base recommendations on very strong evidence.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:"Hats

The final change I wanted to discuss is a new prohibition on infant hats.

In prior iterations of its guidelines, the AAP has noted concerns with overheating as a risk of SIDS. I talked about that evidence in this post a month ago. The evidence on heat overall is a bit sparse, but in this iteration, the organization has taken it one step further to express concern about the heat generated by infant hats.

The data cited is from a single paper. This is a case-control study in Australia that looked at a large number of possible relationships between clothing and bedding and SIDS. The paper finds that in 8.3% of SIDS cases, a hat (“bonnet”) was worn, versus only 5.2% of control infants. This difference is statistically significant.

However: the paper runs a lot of tests, and this raises concerns about overinterpreting any one result. The authors find, for example, a much stronger statistical link between SIDS and wearing socks than between SIDS and wearing hats. They also find that wearing a nightgown is protective, but wearing “stretch and grow” leggings is associated with an elevated SIDS risk. It’s not clear what any of this means.

In fact, the authors do not make much of any of these results. They note: “Significant differences in the type of products used by case and control infants occurred, and may be related to the difference in season of interview between cases and controls.” Basically, they may have observed more SIDS infants in the winter, when hats (and socks) are more common.

Without belaboring the point, to take from this paper the conclusion that infants shouldn’t wear hats seems … a stretch. The data would more strongly support a “no socks” conclusion. Put differently: if the AAP is convinced by this one study that hats are dangerous, it should also be convinced that socks are dangerous, and nightgowns are protective. "

https://emilyoster.substack.com/p/new-aap-guidelines-on-breastfeeding

The AAP addresses this : " should be noted that because there are no randomized controlled trials related to SIDS and other sleep-related deaths, case-control studies are the best evidence available."...."Physicians and nonphysician clinicians are encouraged to have open and nonjudgmental conversations with families about their sleep practices. Individual medical conditions may warrant that a clinician recommend otherwise after weighing the relative risks and benefits."....

AND YET AGAIN SHE ONLY LINKS THE ONE PAPER NOT BOTH CITED IN THE REPORT. She picked the 2008 Bristol paper and not the NICU paper that found that hypothermia was not a risk for infants who didnt have hats. The paper further goes on to say "It is unclear whether the relationship to overheating is an independent factor or merely a reflection of the increased risk of SIDS and suffocation with blankets and other potentially asphyxiating objects in the sleeping environment. Head covering during sleep is of particular concern. In 1 systematic review, the pooled mean prevalence of head covering among SIDS victims was 24.6%, compared with 3.2% among control infants.274 Although head covering usually refers to bedding or bed clothes, 1 study found significantly more SIDS cases in infants wearing hats compared with controls.321 It is not known whether the risk related to head covering is attributable to overheating, hypoxia, or rebreathing. A study on the aerodynamics of rebreathing exhaled gases demonstrated that with higher temperature and humidity, the exhaled gas is denser and does not escape the vicinity of the nostrils.429 In this in vitro model, the result was increased rebreathing of CO2-rich gas, suggesting that both overheating and rebreathing are important components in the association between head covering and SIDS." Going back to the NICU study on hats, suffocation was a concern ".

Hats have multiple risks and have no discernable benefit. Thats the equation.

What about socks?

I cant access the full article. But as I stated above- socks were in the article she choose but she didnt talk about the NICU paper or other papers r/t hats and suffocation risk AND she emphasized in her article that the AAP recommendation was based on one article- not true.

Further, if there are papers on socks and suffocation risk then yes the AAP should be consistent. The hat is 3-fold risk- overheating, suffocation, and rebreathing risk. Socks may only be an overheating risk, which makes them less risk. That would also imply that footed pajamas should be avoided.

The evidence linking SIDS and hats was just one (very confounfed) article. The other article was about babies’ temperature in the NICU.