The American Academy of Pediatrics and On Becoming BabywiseRecommendations and Comparisons

The following comparisons are compiled from: The American Academy of Pediatrics, Caring for Your Baby: Birth toAge Five - The Complete and Authoritative Guide, Steven P. Shelov, M.D., F.A.A.P. (Editor-in-chief), and Babywise byGary Ezzo, MA, and Robert Bucknam, M.D., F.A.A.P.

Topic American Academy of Pediatrics On Becoming Babywise Caring for Your Baby, Shelov Ezzo/Bucknam

Feeding Recommendation

1 . Nursing after delivery

2 . Time Between Feeding

3 . Frequency of Nursing Minimum

4 . Feeding hungry babies

The first hour or so after birth is a good time to beginbreast-feeding because your baby is very alert andeager (pg. 29).

Some newborns need to nurse every two hours;others, every three. As they get older, they are ableto go longer between feedings... (pg. 87).

Newborns should be nursed approximately 8 to 12times every 24 hours. Ref: AAP Policy Statement,Pediatrics Vol. 100, Number 6, Dec. 1997, pg.1037. (No reference found in Caring for Your Baby.)

Newborns should be nursed whenever they showsigns of hunger... Ref: AAP Policy Statement,Pediatrics Vol. 100, Number 6, Dec. 1997, pg.1037.

If possible, nurse your baby soon after birth. This will besometime within the first hour-and-a-half, when new-borns usually are most alert (pg. 77).

As a general rule, during the first two months, you willfeed your baby approximately every 2 1/2 to 3 hours fromthe beginning of one feeding to the beginning of thenext. Sometimes it may be less and sometimes slightlymore, but this time frame is a healthy average. In actualpractice, a 2 1/2-hour routine means you will nurse yourbaby 2 hours from the end of the last feeding to the startof the next, adding back in 20 to 30 minutes for feedingto complete the cycle (pg. 74).

With these recommended times you can averagebetween 8 to 10 feedings a day in the early weeks (pgs.74, 112).

With PDF, a mother feeds her baby when he is hungry,but takes advantage of the first few weeks to guide thebabys hunger patterns by a basic routine (pg. 38). Ifyour baby is hungry, feed him or her. If the child routinelyshows signs of hunger before the next scheduledfeeding, then find out why, rather than letting the babycry it out (pg. 145). Hunger cues, not the clock,determine feedings (Page 112).

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5 . Infant Feeding and Crying

6 . Defining Demand Feeding

Infant Crying

1 . Crying and Naps

2 . Crying and Mothers

Infant Sleep

1 . Helping Your Baby Sleep

It is best to start nursing the baby before cryingstarts. Crying is a late sign of hunger (pg. 87).

...responding promptly to a cue of hunger (apractice called demand-feeding)... Once yourefinally home, it may take several days for her to resether internal clock, so in the meantime try demandfeeding her every two to three hours even if shedoesnt cry for nourishment (pg. 87). (Emphasisadded.)

Many babies cannot fall asleep without crying andwill go to sleep more quickly if left to cry for a while.The crying shouldnt last long if the child is truly tired(pg. 36). Newborns routinely cry a total of one tofour hours a day (pg. 37).

All babies cry, often without any apparent cause.Newborns routinely cry a total of one to four hours aday... No mother can console her child every time hecries, so dont expect to be a miracle worker withyour baby (pg. 37). Pay close attention to yourbabys different cries and youll soon be able to tellwhen he needs to be picked up, consoled, or tend-ed to, and when he is better off left alone (pg. 34).This statement is quoted in Babywise on page 137.

Initially, your infant doesnt know the differencebetween day and night... But even at this age, youcan begin to teach her that nighttime is for sleepingand daytime for play (pg. 37).

Waiting on the babys signal for food may alsocompromise the childs health. Some newborns may notcry to signal hunger readiness for five to six hours, andcrying is not always a signal of hunger. Weak and sicklybabies may not have the energy to cry... (pg. 65).

Responding promptly to a newborns hunger cue isreferred to as demand feeding. Responding promptly toa newborns hunger cues is also a central part of ParentDirected Feeding. Yet, in reality both approaches areparent-directed. Parents always decide when a baby willeat regardless of what you call it. But there is a subtle andsignificant difference between the two approaches.Demand feedings more standard, moderate approach...instructs parents to feed their babies every two to threehours based on the babys hunger cues: putting fisttoward mouth, making sucking motions, or whimpering.Crying is a late signal of hunger. On the other hand, PDFparents will feed their babies on a flexible routine everytwo to three hours based on the same cues (pgs. 64-65).

Some children cry fifteen minutes before falling asleep.Others vary the duration of their cry from five minutes atone naptime to an off-and-on thirty-five-minute cry atanother. If your baby cries longer than fifteen minutes,check on the baby (pg. 147).

Some crying is normal. You need to expect it. However,you also need to stay alert to certain identifiable cries...(pg. 142). Unless you sense your baby is in danger,take a moment to listen and assess his crying. After abrief assessment, take the appropriate action (pg. 150).

For better or worse, parents are the greatest influenceon a childs sleep ability. Expecting babies and youngchildren to sleep through the night is very realistic. Butthis all-important life skill is rarely achieved apart fromparental guidance (pg. 43).

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2 . Sleep and Crying

3 . Sleep Positioning

4 . Bedsharing and Risk of SIDS

Sometimes you may think your baby is waking upwhen shes actually going through a phase of verylight slumber. She could be squirming, startling,fussing, or even cryingand still be asleep. Or shemay be awake but on the verge of drifting off again ifleft alone. Dont make the mistake of trying tocomfort her during these moments; youll onlyawaken her further and delay her going back tosleep. Instead, if you let her fuss and even cry for afew minutes, shell learn to get herself to sleepwithout relying on you. Some babies actually needto let off energy by crying in order to settle into sleepor rouse themselves out of it. As much as fifteen totwenty minutes of fussing wont do your child anyharm. Just be sure shes not crying out of hunger orpain, or because her diaper is wet. Though it may bedifficult just to let her cry for even a minute or two,you and she will be much better off in the long run(pgs. 188-189). This statement is quoted inBabywise on pages 145-146.

Recent information however indicates that the backis a safer position particularly as it relates to theSudden Infant Death Syndrome (SIDS). Therefore,the American Academy of Pediatrics recommendsthat healthy infants be placed on their backs forsleep... The exact reason for this finding is notcertain, but it may be related to the stomach-positioned infant getting less oxygen or eliminatingless carbon dioxide because she is rebreathing airfrom a small pocket of bedding pulled up around thenose (pg. 37).

While bed sharing may have certain benefits...there are no scientific studies demonstrating thatbed sharing reduces SIDS. Conversely, there arestudies suggesting that bed sharing, under certainconditions, may actually increase the risk of SIDS.Ref: AAP Policy Statement, Pediatrics Vol. 100,Number 2, Aug. 1997, pg. 272.

You cant stand to hear baby cry? Join the club, butremember whats truly important. Theres a purposehere. Without a goal in mind, i.e., teaching healthy sleephabits, letting your baby cry before falling asleep atnaptimes makes little sense. The absence of anattainable and measurable goal breeds doubt andconfusion. Why are you doing this uncomfortable thing?Who needs all the added stress? With the goal ofteaching good sleep habits, some temporary crying ispreferable over long-term poor sleep skills. Somechildren cry fifteen minutes before falling asleep. Othersvary the duration of their cry from five minutes at onenaptime to an off-and-on, thirty-five minute cry atanother. If your baby cries longer than fifteen minutes,check on the baby. Pat him or her on the back, possiblyholding the child for a moment. Then, put the baby backdown. Remember, you arent training your child not tocry, but training him or her in the skill of sleep. This maybe the only time in your babys day that the practice ofnonintervention is best (pgs. 146-147).

Today, research strongly suggests, and the AmericanAcademy of Pediatrics recommends, that putting a babyon his or her back for sleep, rather than on the babystummy, reduces the risk of SIDS. What is not conclusivein our opinion is whether back sleeping is the primary orsecondary factor in the reduction of risk. Does thesupine position (wholly on the back) remove the childfrom soft surfaces and gas-trapping objects (mattresses,pillows, crib liners), which could be the actual risk factor,or is it actually the bio-mechanics of tummy sleeping?(pg. 195).

Does bedsharing with your infant really reduce thepossibility of SIDS? The American Academy of Pediatricssays no to that question. The AAP, in collaboration withan NICHD subcommittee (National Institute of ChildHealth and Human Development), concluded there wasno evidence that shared sleep reduces the risk of SIDS,and indeed, it may increase the risk (pg. 196).

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Bonding

AAP Breast-feeding Goals

The first exchanges of eye contact, sounds, andtouches between the two of you are all part of aprocess called bonding, which helps lay thefoundation for your relationship as parent and child...If your baby must be taken to the nursery right awayfor medical attention, or if you are sedated during thedelivery, dont despair. You neednt worry that yourrelationship will be harmed because you didntbond during this first hour. You can and will loveyour baby just as much, even if you werent able towatch his birth, or hold him immediately afterward.Your baby also will be fine, just as loving of you, andconnected to you (pg. 27).

Although breast-feeding rates have increasedslightly since 1990, the percentage of womencurrently electing to breast-feed their babies is stilllower than levels reported in the mid-1980s and is farbelow the Healthy People 2000 goal, says the AAP.In 1995, 59.4% of women in the United States werebreast-feeding exclusively or in combination withformula feeding at the time of hospital discharge;only 21.6% of mothers were nursing at six months,and many of these were supplementing withformula. The goal of Healthy People 2000 is toincrease the number of breast-feeding mothers to75% and 50% who will continue breast-feeding untiltheir babies are 5 to 6 months old. Ref: AAP PolicyStatement, Pediatrics Vol. 100, Number 6, Dec.1997, pgs. 1036-1037.

While maternal-infant bonding is an interestingpsychological idea, research has not substantiated thecause-and-effect relationship this theory speaks of inhuman beings. And although nonrational animals showsome instinctive tendency of this sort, speculating thatrational man responds similarly is scientifically unac-ceptable. Anthropology, the study of mankind, is verydifferent from zoology, the study of animals. There isnothing wrong with a newborn cuddling with his or hermother right after birth or having a close time togetherwith his or her new family. If its possible, we encourageyou to do that. Take time to acknowledge the wonderfulcreation of a new life. But dont think those first minutesare more binding or important than all the hours and daysthat will follow. Building a healthy parent-child relation-ship doesnt take place in a moment of time; its a long-term process. Your baby will not be permanently impairedif there is a lack of physical contact with mom right afterbirth (pgs. 192-193).

A convenient sampling of over 240 mothers followingthe PDF principles demonstrated that 88% of motherswho start with the program breast-feed, and 80% ofthose moms breast-feed exclusively with no formulasupplement. And while the national average was 21.6%of mothers breast-feeding into the fifth month, a full 70%of PDF mothers continued into the fifth and six month.On average PDF moms breast-feed 33.2 weeks. Add tothese statistics the benefits of uninterrupted nighttimesleep and you will better appreciate the wonderfulbenefits of a flexible routine (pg. 63).

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Healthy Growth Indicators

Weight Gain Concerns

Your babys diapers will provide clues aboutwhether he is getting enough to eat. During the firstmonth, if his diet is adequate, he should wet six toeight times a day and have at least two bowelmovements daily (usually one little one after eachfeeding) (pgs. 89-90).

Once your milk supply is established, your babyshould gain about 2/3 ounce a day during his firstthree months. Between three and six months, hisweight gain will taper off to about 1/2 ounce a dayand after six months, it will drop even further (pg.91).

After the first week, some of the healthy growthindicators begin to change. Here is the check list for thenext three weeks.

1. Your baby is nursing at least eight times a day.2. Your baby over the next three weeks has two to five,

or more, yellow stools daily. (This number will probablydecrease after the first month.)

3. Your baby during this period should start to have six toeight wet diapers a day (some saturated).

4. Your babys urine is clear (not yellow).5. Your baby has a strong suck, you see milk on the

corners of his mouth, and you can hear an audibleswallow.

6. Youre noticing increased signs of alertness duringyour babys waketime.

7. Your baby is gaining weight and growing in length. Werecommend your baby be weighed within a week ortwo after birth. Weight gain is one of the surestindicators of growth (pgs. 91-92).

In 1997, our retrospective studies tracked andcompared the weight gain of 200 Babywise infants(group A) and 200 demand-fed infants (group B). Weightand length of each infant was charted at birth, 1 week, 2weeks, 1, 2, 4, 6, 9 months, and 1 year. Statisticalcomparisons were made between five weight groups.Babies born between 6.50 and 7.0 lbs, 7.1 and 7.50 lbs,7.51 and 8.0 lbs, 8.1 and 8.50 lbs, and 8.51 and 9.0 lbs.Two methods of analysis were used to compare growth:weight gain ratios (comparing weight gained at each visitas a percentage of birth weight) and Body Mass Index(BMI). Conclusion: 1) While there was no significantdifference between the two groups, group A did gainweight slightly faster than group B at each weightcategory. 2) Even when group A began sleeping 7 to 8hours at night, there was no significant change in weightgain performance. 3) While breast-feeding initially wasthe preferred method for both sets of parents, group Bmoms gave up breast-feeding significantly sooner thangroup A (pgs. 93-94).

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At Home Parent Monitoring ToolsHealthy Baby Growth Charts

Warning Signs of Failure to Thrive

Caring for Your BabyNone found.(It does contain four sample graphs from the NationalCenter for Health Statistics illustrating what a doctormay use to assess normal height and weight growthon pages 122-125, but there is no place for parentsto assess their babys health on a daily basis.)

Caring for Your BabyDiscussion of FTT was notfound, but a few guidelines designed to helpparents determine if the baby is starting to loseweight are located on page 149.

Ten specific, individual charts for parents to monitor andassess healthy and unhealthy growth by recording theirbabies daily feeding and diaper activity are located at theback of the book. These charts include healthy normsand advise parents to call their pediatrician immediately ifthere is any two-day deviation from what is listed asnormal, thus significantly reducing the possibility ofundetected health problems.

An entire chapter (Chapter Five) is dedicated tomonitoring a babys growth, with a special emphasis onsigns of adequate and inadequate nutrition and potentialfailure-to-thrive conditions and signals (pgs. 87-104).

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