Re-evaluating baby ‘rules’
Pediatric experts throw wet blanket on some longheld child-rearing edicts
Attention, parents and parents-to-be. Your world is about to be turned upside down, and this time it’s not your baby’s fault. Doctors and researchers have re-evaluated recommendations for pregnancy and for feeding children, brushing their teeth — even for driving them — and they’re making changes in all categories. Get out your notebooks. Here we go. Old recommendation: Babies should be rear-facing in the car until they’re 12 months and 20 pounds. As a result of this, most parents turned the seat to face the front of the car when their child turned 1. New recommendation: The American Academy of Pediatrics now recommends that parents keep their toddlers in rear-facing car seats much longer.
Why it’s better: “The revised statements were based on the best available real-world and laboratory-based research evidence and also
reflected ever-changing trends in restraint-system technologies,” said Dr. Dennis Durbin, lead author of the revised policy statement and professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He added that no new evidence has been published since 2011, when those recommendations were first made, refuting earlier practice.
To follow the rules: Keep a toddler facing the rear until age 2 or until they reach the maximum height and weight for their car seat. The new advice also says children should ride in a belt-positioning booster until they reach 4 feet 9 inches and are 8 to 12 years old.
PEANUTS
Old recommendation: Delay eating peanut butter until age 3 if there is a high risk of allergy.
New recommendation: Introduce peanut butter and other potential allergens at 4 months.
Why it’s better: Researchers used to believe that avoiding highly allergenic foods would help keep allergies at bay, but waiting has done no good, and breast milk adds extra protection from the potential allergies, said Tiffani Hays, director of pediatric clinical nutrition, education and practice at the Johns Hopkins Hospital.
To follow the rules: Any food, with the exception of honey, can be introduced to a baby after age 4 months as long as this is done one food at a time so you can see if there’s any reaction to each food. It also should be the right texture (so make sure it’s properly pureed). You can introduce honey to 1-yearolds.
FLUORIDE
Old recommendation: Children under age 2 should stick with fluoride-free toothpaste.
New recommendation: Everyone, even infants, should be brushing with fluoride toothpaste, according to a recommendation issued in September by the American Academy of Pediatrics. This echoed recommendations made earlier in the year by the American Dental Association.
Why it’s better: Fluoride gets into the enamel and makes it more resistant to the causes of tooth decay, said Edward Moody, Tennessee-based president of the American Academy of Pediatric Dentistry.
To follow the rules: As soon as baby teeth begin erupting from the gums, parents should wipe them with fluoride toothpaste (the amount should be the size of a grain of rice) on a washcloth. Once the child reaches age 3, the amount can be increased to pea-size, Moody said.
FIRST BITE
Old recommendation: Rice cereal should be a baby’s first food.
New recommendation: There are no rules. “Parents no longer need to follow a rigid food-introduction regimen of rice cereal, orange vegetables, green vegetables, fruits, then meats,” said Atlanta pediatrician Dr. Jennifer Shu.
Why it’s better: The shift in recommendations has to do with the newfound understanding that delaying foods won’t delay the development of allergies, so there’s no reason to have such a regimented order of first foods, Shu said.
To follow the rules: Even without the old rules, Shu suggests introducing new foods early in the day so you can watch for a potential reaction. She also said to have liquid diphenhydramine (Benadryl) on hand in case of a reaction.
TAP WATER
Old recommendation: Bottled water or nursery water is better for a baby.
New recommendation: Tap water is better.
Why it’s better: Tap water has fluoride, which is good for teeth, and it doesn’t wait in warehouses full of plastic bottles before being distributed to stores. The only exception is if you’re in an area that doesn’t have safe tap water, but most cities in the United States have no worry, Hays said.
To follow the rules: Tap water doesn’t need to be filtered unless it’s from a well that hasn’t been treated and could have some bacteria. In those cases, you would need to boil the water and then cool it before giving it to your child — so parents might choose to use the bottled water, Hays said.
TOOTH CARE
Old recommendation: Concerns about potential side effects during dental work led many doctors to suggest that women avoid any dental work, including cleaning, during pregnancy.
New recommendation: In 2013, the American College of Obstetricians and Gynecologists recommended that routine oral health assessments should be done during pregnancy. Dental X-rays also are safe throughout pregnancy, they said.
Why it’s better: Physical changes caused by pregnancy can result in changes in gums and teeth, and cavity-causing bacteria can be transmitted from mother to baby. About 40 percent of pregnant women in the United States have some form of periodontal disease, including inflammation of the gums and cavities, so it’s important that they continue to have dental work done throughout their pregnancies.
To follow the rules: Routine dental care, including root canals and filling cavities, is permitted and encouraged during pregnancy.
PICKY EATERS
Old recommendation: Your child will eventually outgrow his pickiness when it comes to eating.
New recommendation: A 2014 package of 11 studies published in the journal Pediatrics found that parents noticed that taste preferences, especially for fruits and vegetables or for sweet foods, start in infancy. So it’s important to start a child on the right track by avoiding sugary foods within the first 12 months of his life and by feeding ample amounts of fruits and vegetables.
Why it’s better: The research shows that when children didn’t consume fruits and vegetables frequently as infants, they also didn’t consume them frequently at age 6 either. So the researchers suggest persuading the infants to enjoy these nutritious foods by 10 months.
To follow the rules: Try and try again. Keep offering the same fruits and vegetables, even if your baby doesn’t seem to like them. An earlier study found that even when babies don’t like them the first time, they are willing to try again.