Wednesday, May 8, 2013

Science, Schmience, and SIDS

I analyze research articles for the EAL, lecture on evidence analysis, and generally love the regimented science process. But I am in a profession (nutrition & public health) where we still know very little about so much. As a parent, there is also so little we know about how to prevent SIDS and Food allergies despite research. Nothing makes sense. Put babies on their backs, put babies on their stomachs, feed your child solid food at 6 months, no, make that 4 months. Use sunscreen, but make it the non-nano kind, and oh yeah also get some "safe" sun time without sunscreen.  Plastics are safe but not when heated, except certain types of plastics, those are safe. Oh wait, maybe they aren't.  No wonder parents are confused!

I have been thinking about both issues a lot lately, mostly because I have a 2 month old and I am "maternity leave."  I spend some of her nap time helping to develop evidence-based guidelines for The Academy of Nutrition and Dietetics's Evidence Library.  That word, EVIDENCE. A strong word but unfortunately the more articles I review, the more disenchanted I become with the quality of the research and the press that promotes it. Research articles that are neutral or even poor quality get published in very reputable science journals and are followed by snazzy headlines in papers around the world. In the years between 1978-1985 there were 5,000 peer-reviewed journal articles. In the years between 1994- 2001 there were 25,000 peer-reviewed articles!!! What doctor or professional organization can possibly keep up with that? Or worse, conducting a very high quality study cannot be done due to ethical concerns for the human subjects involved, so tons of poorer quality studies get published instead, each with a different result, and a different snazzy headline. Or even worse, the high quality study cannot get not funded or published due to political reasons. Yes, that happens.

Before the medical world was fixated on evidence-based guidelines, we used common science sense about what was biologically plausible. Of course, it's great if rigorous scientific studies back us up but sometimes that takes years.

For example, I took one of my older children to the doctor and as part of a blood workup, I requested that we check his Vitamin D level. It came back in the normal range. It was just at the end of winter. What happened after that was very strange:

Doctor: "Wow, I have never seen a child with a vitamin D level in the normal range, they are all deficient."

[By the way, I live in very sunny Israel]

Me: "Well, I supplement my children with vitamin D in the winter."

Doctor: "Why do you do that? The guidelines only recommend it until one year."

Me: "Because in my holistic nutrition training (through the Institute for Integrative Medicine), we look at a lot of research that points to the fact, that for whatever unknown reason, we are deficient in Vitamin D, especially in the winter."

Doctor: "Well I cannot recommend that you do that because we don't have guidelines that recommend that you do that just yet."

Meanwhile....we have doctors telling patients not to worry about their child's broken bones from a simple fall or legs getting caught behind their parent's bodies on slides in parks. "It's normal, we see them all the time," can often be heard after a concerned parent questions why the child broke a bone so easily. This article is a perfect example!

Another example, we have pretty good evidence that when you put babies to sleep on their back, Sudden Infant Death Syndrome (SIDS) is reduced.  So public health professionals started campaigns to promote "Back to Sleep."  We don't exactly know why this works, there are many theories. One theory is that babies breathe in toxic air when they sleep on their bellies, either from re-breathing their own air or from toxins in indoor air. I, and others, think it's perhaps toxins from all the new furniture and mattresses in their rooms. Indoor air quality is always worse that outdoor air quality. This theory is bolstered by the fact that research shows that fans in a baby's room can further reduce SIDS. But this hasn't made it into the "Guidelines" yet so no moms know about it unless they read research articles or followed the small flurry of articles, such as this one.

And don't even get me started about food allergies and starting solid food recommendations, we have "Guidelines" that were based on professional opinions, and now the American Academy of Pediatrics clearly states that they don't know when exactly or what to feed babies.  More on that another time.

So what to do when we don't have supporting guidelines?

In the meantime, use the "precautionary principle," gets your kids vitamin D levels checked once a year, earlier if you see any signs of deficiency (bow legged, teeth coming in uneven, other bone deformities, delayed motor development, muscle weakness, aches and pains, and fractures. And put a fan in a room where a baby is sleeping. And in a future post, I'll hopefully get to baby-feeding "guidelines".

A good example of the precautionary principle in use regarding plastic safety can be found here: NPR's "Is Better Safe than Sorry Reason Enough for Law?"

In good health, Debra


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