Re: Infant flat skulls can be avoided: U.S. doctors

[JG]

"CBI" > wrote in message
...

> "JG" > wrote in message
> t...

> > If a child sleeps *much*
> > better on his/her stomach (falls asleep faster, stays asleep
longer), it
> > makes much better sense, IMO, to let him/her do so.

> At least (s)he will be a well rested corpse.

Why are you so averse to letting parents make a rational decision based
on *their* situation? A sleep-deprived child can adversely affect an
entire family; his/her problem usually has a domino effect.

> > There's a trade-off to be made in the case of kids whose heads
become
> > pronouncably misshapen: Are the costs (financial and other) of
having
> > the deformity corrected worth the benefit (very, very small) of
forcing
> > an infant to sleep on his/her back? Likewise (alternatively), are
the
> > costs of *not* correcting a noticable deformity (teasing,
ridiculing,
> > name-calling, ...[= bullying, these days]) worth it?

> You tell us. What is the cost of correcting these deformities caused
by BTS?

Sorry, I don't have a plastic surgeon on call. I'm sure you could get a
ballpark figure by doing a Gooogle search, however.

> Compare that to the number of lives saved. How many of these kids are
> noticibly deformed by the time they get to school age? How much
teasing
> /life is worthwhile?

That's for the individual (or, in this case, his/her parents) to decide
now, isn't it?

> > "Doomsday," IMO, is already upon us (the US). The point of my
posting
> > the article (along with my comments) was not to lament the creation
of a
> > society with weird-shaped-head kids (hell, some of the kids whom I
tutor
> > have deformities/conditions that they'd undoubtedly trade for a
> > flattened head in a heartbeat), but to deplore the existence of a
> > society in which parents apparently can't discern and resolve
problems
> > for themselves.

> Why do you assume this?

I'd say "up to 48%" of kids having misshapen heads, even if the
deformities aren't permanent, speaks for itself. The simple measures
suggested in the article (prone while awake/observed, rotating 180
degrees in the crib) are, IMO, common sense--yet apparently almost half
of "Back to Sleep" parents haven't employed them (or asked their kid's
caregiver to employ them). OTOH, maybe they ARE aware of them, and
simply think Jr.'s misshapen head is endearing, right? Uh-huh. Yeah...

Maybe they can and they just don't come tot he same
> conclusions as you.

Yup. Gee, and to think there are some parents who just can't cope with
having kids, so they come to the conclusion that they'll simply off
them.

[JG]

"CBI" > wrote in message
...

> "JG" > wrote in message
> t...

> > With all the concern
> > about "bullying" these days, I'd advise parents, especially those
> > reluctant to encourage their kids to defend themselves, to try to
have
> > their kids look as "normal" as possible.

> Interesting parenting advice. Would you have them keep their mouths
shut and
> go along as much as possible as well?

You bet, if they (the kids) are unwilling and/or unable to defend
themselves against the responses (consequences) their words or actions,
like their appearance, might provoke. Growing up, you must surely have
known one or two kids who'd throw stones (literally or figuratively) and
immediately retreat behind their mom or dad. What'd you think of them?

[CBI]

"JG" > wrote in message
t...
> "Elizabeth Reid" > wrote in message
> om...
>
> ...It should be *ZERO*. How in the world could an otherwise competent
> parent .....

JG - the fallacy of your whinings is showing through.

First you whine about the AAP treating parents like idiots.
Then you whine that some of them are idiots.

Maybe there is some connection?
Perhaps the AAP is not being so unreasonable after all?

--
CBI, MD

[CBI]

"JG" > wrote in message
t...
> "CBI" > wrote in message
> ...
>
> > "JG" > wrote in message
> > t...
>
> > > If a child sleeps *much*
> > > better on his/her stomach (falls asleep faster, stays asleep
> longer), it
> > > makes much better sense, IMO, to let him/her do so.
>
> > At least (s)he will be a well rested corpse.
>
> Why are you so averse to letting parents make a rational decision based
> on *their* situation? A sleep-deprived child can adversely affect an
> entire family; his/her problem usually has a domino effect.

Never said I was. Why do you assume that parents aren't? Maybe some value
the decreased risk over a little extra sleep. Truth be told there are very
few kids who, if put down supine right from birth, will not sleep just fine.
There is nothing int he back to sleep program that suggests parents should
force the issue. All they are told to due is to put them down face up. There
is no direction to keep checking them and flipping the kid over. We've
discussed this before yet to keep raising the same old crap over and over
again.


>
> > You tell us. What is the cost of correcting these deformities caused
> by BTS?
>
> Sorry, I don't have a plastic surgeon on call. I'm sure you could get a
> ballpark figure by doing a Gooogle search, however.

For one surgery? - Sure.

The relevant figure would be to determine how many surgeries are being
caused by the campaign. I'm betting it is low. SInce you are the one
claiming it is not worth it then I am sure you won't mind digging out those
figures.


>
> I'd say "up to 48%" of kids having misshapen heads, even if the
> deformities aren't permanent, speaks for itself.

What does it say? To me it says that a lot parents have been appropriately
counselled to try to turn the kid but not to get worked up about some mild
asymmetry.

As I pointed out in my other post - the real joke here is that for ages you
have been screaming about how the advice the AAP gives should be obvious to
any idiot. Now you are claiming that 48% of parents are idiots. You can't
have it both ways. If so many parents are so stupid then the AAP is
justified in giving such obvious advice.


> The simple measures
> suggested in the article (prone while awake/observed, rotating 180
> degrees in the crib) are, IMO, common sense--yet apparently almost half
> of "Back to Sleep" parents haven't employed them (or asked their kid's
> caregiver to employ them). OTOH, maybe they ARE aware of them, and
> simply think Jr.'s misshapen head is endearing, right? Uh-huh. Yeah...

No - maybe they are employing them but they don't work 100%. I hear about
kids that prefer to sleep with their heads to one side all the time but you
and Roger are the only two parents I have ever heard claim their kids would
not sleep well supine. Perhaps that is because I counsel my patients from
early on and so the kids become accustomed to supine sleeping from early on
whereas you and Rog never really bought into the whole concept (and probably
took a perverse pleasure in not following the standard advice).

Remember, you still have not shown that there is a significant problem. The
48% figure indicates nothing since that does not tell us how many of these
kids will even have a noticeable asymmetry when older, much less undergo
surgery or teasing. Before you lambaste 48% of the parents for their poor
choices/parenting you need to show that they are doing something wrong.


>
> Maybe they can and they just don't come tot he same
> > conclusions as you.
>
> Yup. Gee, and to think there are some parents who just can't cope with
> having kids, so they come to the conclusion that they'll simply off
> them.

I'm not sure I see the connection. Surely you abnit that it is possible for
a well adjusted, sane intelligent parent to come to different conclusions
than you did?

--
CBI, MD

[Jeff Utz]

"Roger Schlafly" > wrote in message
...
> "JG" > wrote
> > Another article for the "Well, DUH!" file. Amazing how some people
> > manage to walk without someone else (a physician?) telling them
>
> It seems obvious, but a lot of people have trouble distinguishing
> the good pediatrician advice from the ungrounded goofy opinions.

Can you tell me what about advice that prevents kids from dying from SIDS is
"goofy?"

Am J Epidemiol. 2003 Mar 1;157(5):446-55. Related Articles, Links


Infant sleeping position and the risk of sudden infant death syndrome in
California, 1997-2000.

Li DK, Petitti DB, Willinger M, McMahon R, Odouli R, Vu H, Hoffman HJ.

Division of Research, Kaiser Foundation Research Institute, Kaiser
Permanente, Oakland, CA 94612, USA.

To assess the association between infant sleeping position and risk of
sudden infant death syndrome (SIDS) in an ethnically diverse US population,
the authors conducted a population-based case-control study in 11 counties
in California from May 1997 through April 2000. The authors conducted
in-person interviews with the mothers of 185 SIDS cases and 312 randomly
selected race/ethnicity- and age-matched controls to collect information on
sleeping positions. Infants who had last been put down to sleep in the prone
or side position were at greater risk of SIDS than were infants who had last
been put down on their backs (adjusted odds ratio (AOR) = 2.6 (95%
confidence interval (CI): 1.5, 4.5) and AOR = 2.0 (95% CI: 1.2, 3.4) for the
prone and side positions, respectively). The risk of SIDS was especially
high for an unstable side position in which an infant was placed on its side
and found prone (AOR = 8.7, 95% CI: 3.3, 22.7). Infants who were usually
placed on their backs to sleep but had last been put down in the prone or
side position (an unaccustomed position) had a significantly high risk of
SIDS (AOR = 8.2 (95% CI: 2.6, 26.0) and AOR = 6.9 (95% CI: 2.3, 20.6) for
the prone and side positions, respectively). Infants placed in an
unaccustomed prone or side sleeping position had a higher risk of SIDS than
infants who were always placed prone or on the side.

PMID: 12615609 [PubMed - indexed for MEDLINE]

> There are other drawbacks to putting babies on their backs. Nowadays,
> a lot of babies never even learn to crawl.

Better learning to walk in the wrong way (without crawling first) than being
in a coffin.

[Roger Schlafly]

"JG" > wrote
> I'd say "up to 48%" of kids having misshapen heads, even if the
> deformities aren't permanent, speaks for itself.

Yes. Plus delayed development, less sound sleep, less sleep for
the moms, etc. The BS campaign was a bad idea.

[Jeff Utz]

"JG" > wrote in message
t...
> "Roger Schlafly" > wrote in message
> ...
> > "JG" > wrote
> > > Another article for the "Well, DUH!" file. Amazing how some people
> > > manage to walk without someone else (a physician?) telling them
>
> > It seems obvious, but a lot of people have trouble distinguishing
> > the good pediatrician advice from the ungrounded goofy opinions.
>
> Apparently: "Up to 48 percent of infants develop the deformity." This
> certainly doesn't bode well for our country's future, does it? It looks
> like we have a generation ("GenX"?) that hasn't been taught to question
> "expert" advice and to think, *at all*, for themselves. No wonder so
> many didn't even blink at WJC's "It depends what 'is' is," or when
> Congress passed the USA Patriot Act.

You mean like people who have, say a Ph.D. in mathematics and have "FAQs"
about vaccines? Or about people who claim to be experts in nutrition while
trying to sell a vitamin drink or other useless concoction.

Or, how about a group of physicians who went to college for 4 years, then
med school for 4 years and then 3 or more years of residency. And base their
beliefs largely on information that has been published in peer-reviewed
journals?

Gee, so whom should one believe for expert advice on the care of children?
Someone who is a board-certified pediatrician or an outstanding mathematical
theorist?

All the best,

Jeff

> > There are other drawbacks to putting babies on their backs. Nowadays,
> > a lot of babies never even learn to crawl.
>
> Yeah, something else a whole generation won't learn...
>
>

[Jeff Utz]

"JG" > wrote in message
t...
> "Mark" > wrote in message
> om...
>
> > "JG" > wrote in message
> >...
>
> > > Another article for the "Well, DUH!" file. Amazing how some people
> > > manage to walk without someone else (a physician?) telling them
> > > (headphones?) how ("Left foot...right foot...left foot...right
> > > foot...left foot...").
>
> > Is a slightly flattened back of the head (aka: positional
> > plagiocephaly) dangerous to brain development?
>
> Overwhelmingly, no. Some flattened-head cases, however (e.g., those
> severe enough to require corrective helmets), could conceivably hamper
> *social* development if allowed to go unchecked. With all the concern
> about "bullying" these days, I'd advise parents, especially those
> reluctant to encourage their kids to defend themselves, to try to have
> their kids look as "normal" as possible.

What is normal?

And what percent of kids does this affect?

All the best,

Jeff

[Jeff Utz]

"Elizabeth Reid" > wrote in message
om...
> "JG" > wrote in message
>...
> > Another article for the "Well, DUH!" file. Amazing how some people
> > manage to walk without someone else (a physician?) telling them
> > (headphones?) how ("Left foot...right foot...left foot...right
> > foot...left foot...").
> >
> > How many fights do you imagine this one little piece of advice--"Back to
> > Sleep"--has caused? Husband: "Aaah, honey? The back of Bubba's head
> > is gettin' as flat as a pancake. Whaddaya say we let him sleep on his
> > belly for a while to see if it helps?" Wife (in a high-pitched, panicky
> > voice): "NO! !! No, no, no, no, NO! He'll DIE of SIDS if we do that!
> > Dr. Imdeexpert said babies should sleep on their BACKS! So what if
> > Bubba looks like some sorta weird doofus; at least he's ALIVE!!")
>
> Right. How ridiculous. I'd much rather my son live fast, die
> young, and leave a beautiful corpse. A round head would look so
> much nicer in the last pictures I'd ever have of him. (As it happens,
> he never had any flattening problems, although he did have a bald
> spot on the back of his head for a while. The horror!)
>
> From what I've read, in the majority of cases the flattening resolves
> itself over time. Even if it didn't, though, what possible implications
> would this have for 'our country's future'?

We have more kids grow into adults?

> Millions spent on
> hat redesign, plunging us into an economic crisis?

Hat redesign? If hats were flexible enough to fit around a kid's ears if he
pulls it a little to far, I am sure they will conform to the shape of the
skull well enough.

But it does sound like a good niche market.

> Increased
> incidence of mosquito-borne illness because the little vampires have
> a nice flat surface to fasten upon? Round-headed aliens arrive and
> exterminate us all because they think we look silly? What's the
> doomsday scenario here?

An imagined problem, flat back of heads.

> I think there are decent reasons to ignore the recommendation, and
> obviously the risk to any one child is probably low. Fear of
> flat-headedness is silly though.

I think Roger should call this fear "goofy", at least when compared to real
fears, like increased risk of death.

All the best,

Jeff
>
> Beth
> Sam 8/16/2002

[Roger Schlafly]

"Jeff Utz" > wrote
> Gee, so whom should one believe for expert advice on the care of children?

Not someone who thinks that deformed heads, poor sleep, and delayed
development are all ok.

[PF Riley]

On Wed, 9 Jul 2003 00:05:34 -0400, "CBI" > wrote:
>
>No - maybe they are employing them but they don't work 100%. I hear about
>kids that prefer to sleep with their heads to one side all the time but you
>and Roger are the only two parents I have ever heard claim their kids would
>not sleep well supine. Perhaps that is because I counsel my patients from
>early on and so the kids become accustomed to supine sleeping from early on
>whereas you and Rog never really bought into the whole concept (and probably
>took a perverse pleasure in not following the standard advice).

I'd say I see about one family a year where the infant is put to sleep
prone because of a dramatic difference in quality of sleep. I
appropriately counsel the parents, who are generally well aware of the
risk, and they make the decision, sometimes with great difficulty, to
continue to allow the patient to sleep prone. The vast, vast majority
of infants, on the other hand, who have any preference, hate being
prone, and in fact many infants have to be coached to tolerate "tummy
time."

PF

[PF Riley]

On Tue, 08 Jul 2003 18:22:47 GMT, "JG" > wrote:

>"PF Riley" > wrote in message
...
>
>> I'd say 48% sounds about right in my experience. What you fail to
>> realize is that for most of them, the deformity resolves with time.
>> Back to Sleep started in full force around 1994. Do you know many
>> 9-year-olds with misshapen heads?
>
>I know a couple of teenagers with rather severe craniofacial
>abnormalities, but not because of supine sleeping. What I have
>difficulty understanding is why the parents of the 48% with misshapen
>heads either didn't notice the problem developing (!) or didn't take
>corrective action (e.g., the suggestions in the article) sooner...

And yet again we revisit a common theme from you, JG. Either by
arrogance or ignorance (or both?) you seem to way overestimate the
average intelligence and common sense of the American public. As CBI
has pointed out, your problem in this case is not with the AAP
dispensing the advice, but with your perception that it shouldn't be
necessary.

I would say about half of the families to whom I point out the typical
occipital flattening and even occasional rhomboidal deformity
(unilateral occipital with contralateral frontal flattening) of
positional plagiocephaly during the 4 month check-up genuinely had not
noticed it themselves. How, then, would you expect these parents to
have begun taking corrective action?

PF

[Elizabeth Reid]

"Jeff Utz" > wrote in message >...
> "Elizabeth Reid" > wrote in message
> om...

> > Millions spent on
> > hat redesign, plunging us into an economic crisis?
>
> Hat redesign? If hats were flexible enough to fit around a kid's ears if he
> pulls it a little to far, I am sure they will conform to the shape of the
> skull well enough.
>
> But it does sound like a good niche market.

Uh, Jeff? These were deliberately silly examples intended to
illustrate my belief that head-flattening is not a major crisis.
I understand that hat redesign will not be necessary. You may
want to turn your sarcasm meter up a notch or two.

Beth

[Tsu Dho Nimh]

"Roger Schlafly" > wrote:

>Yes. Plus delayed development, less sound sleep, less sleep for
>the moms, etc. The BS campaign was a bad idea.

Can you show evidence of the supposed delays in development, and
less sound sleep?

Tsu

--
To doubt everything or to believe everything
are two equally convenient solutions; both
dispense with the necessity of reflection.
- Jules Henri Poincaré

[Tsu Dho Nimh]

"Jeff Utz" > wrote:


>Really? How is one going to tease a kid for a flat head when that part of
>the body is covered by hair and not visible from the front?

When he goes totally bald at 70, of course. Or shaves his head
and becomes a pro athlete or rap musician.




Tsu

--
To doubt everything or to believe everything
are two equally convenient solutions; both
dispense with the necessity of reflection.
- Jules Henri Poincaré

[Jeff Utz]

"Roger Schlafly" > wrote in message
. ..
> "Jeff Utz" > wrote
> > Gee, so whom should one believe for expert advice on the care of
children?
>
> Not someone who thinks that deformed heads, poor sleep, and delayed
> development are all ok.
>

When did anyone say that poor sleep, delayed development or deformed heads
are ok?

How about dead babies? Are they ok?

Jeff

[Roger Schlafly]

"Tsu Dho Nimh" > wrote
> >Yes. Plus delayed development, less sound sleep, less sleep for
> >the moms, etc. The BS campaign was a bad idea.
>
> Can you show evidence of the supposed delays in development, and
> less sound sleep?

Try this:

The pattern of early motor development is affected by sleep position.
(Stomach sleepers) attain several motor milestones earlier than (back
sleepers).
http://www.kids-md.com/Tipsheets/21_may2301/crawling.html

[CBI]

"Roger Schlafly" > wrote in message
. ..
> "Tsu Dho Nimh" > wrote
> > >Yes. Plus delayed development, less sound sleep, less sleep for
> > >the moms, etc. The BS campaign was a bad idea.
> >
> > Can you show evidence of the supposed delays in development, and
> > less sound sleep?
>
> Try this:
>
> The pattern of early motor development is affected by sleep position.
> (Stomach sleepers) attain several motor milestones earlier than (back
> sleepers).
> http://www.kids-md.com/Tipsheets/21_may2301/crawling.html

OK - they walk a little later. That is not quite the same thing as any
meaningful delay. As we have pointed out before - the kid who were born as
the campaign took effect are now 9. Do you have any evidence of long term
motor or cognitive defects?

The sleep problems are rare and those parents do have a legitimate choice.
Still not a common problem.

Your whole argument is sound and fury signifying nothing.

--
CBI, MD

[Jeff Utz]

"Roger Schlafly" > wrote in message
et...
> "JG" > wrote
> > > It seems obvious, but a lot of people have trouble distinguishing
> > > the good pediatrician advice from the ungrounded goofy opinions.
> > Apparently: "Up to 48 percent of infants develop the deformity." This
> > certainly doesn't bode well for our country's future, does it?
>
> My kid always slept face down. She slept much better that way.
> The Back to Sleep campaign never made much sense to me, as
> they didn't even seem to look at problems like misshapen heades.
>

I don't know who they are, but the American Academy of Pediatrics seems to
take the problem seriously (Pediatrics is one of the journals published by
the Academy):

Pediatrics. 2003 Jul;112(1 Pt 1):199-202. Related Articles, Links


Prevention and management of positional skull deformities in infants.

Persing J, James H, Swanson J, Kattwinkel J; American Academy of Pediatrics
Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery
and Section on Neurological Surgery.

Cranial asymmetry may be present at birth or may develop during the first
few months of life. Over the past several years, pediatricians have seen an
increase in the number of children with cranial asymmetry, particularly
unilateral flattening of the occiput. This increase likely is attributable
to parents following the American Academy of Pediatrics "Back to Sleep"
positioning recommendations aimed at decreasing the risk of sudden infant
death syndrome. Although associated with some risk of deformational
plagiocephaly, healthy young infants should be placed down for sleep on
their backs. This practice has been associated with a dramatic decrease in
the incidence of sudden infant death syndrome. Pediatricians need to be able
to properly diagnose skull deformities, educate parents on methods to
proactively decrease the likelihood of the development of occipital
flattening, initiate appropriate management, and make referrals when
necessary. This report provides guidelines for the prevention, diagnosis,
and management of positional skull deformity in an otherwise normal infant
without evidence of associated anomalies, syndromes, or spinal disease.

PMID: 12837890 [PubMed - in process]

It seems Roger is making things up. Again.

All the best,

Jeff

[Jeff Utz]

"Roger Schlafly" > wrote in message
. ..
> "Elizabeth Reid" > wrote
> > I tend to agree that the risk for a healthy term infant who has
> > no other risk factors is pretty low. I also agree that if a child
> > sleeps much better on his stomach, it may be worth considering. I
> > had a co-worker whose child would literally only sleep thirty minutes
> > at a strtech if put on his back. In that situation, I'd put a child
> > on his stomach too.
>
> Tell the pediatricians. The AAP seems to lack common sense in
> this area.

The NIH did: http://www.nichd.nih.gov/sids/sids_qa.htm: "Health
professionals need to consider the potential benefit when taking into
account each baby's circumstances." Sounds like the real professionals in
health have already addressed the issue.

All the best,

Jeff

[Tsu Dho Nimh]

"Roger Schlafly" > wrote:

>"Tsu Dho Nimh" > wrote
>> >Yes. Plus delayed development, less sound sleep, less sleep for
>> >the moms, etc. The BS campaign was a bad idea.
>>
>> Can you show evidence of the supposed delays in development, and
>> less sound sleep?
>
>Try this:
>
>The pattern of early motor development is affected by sleep position.
>(Stomach sleepers) attain several motor milestones earlier than (back
>sleepers).
>http://www.kids-md.com/Tipsheets/21_may2301/crawling.html

It doesn't back up your argument that sleeping supine is bad for
children:

“ ... now about a third of babies skip the step of crawling and
go right to walking,” says Dr. Dewling. “The babies in the study
that skipped the crawling stage,” says Dr. Dewling, “all learned
to walk at the same time as the babies who crawled"

" The study’s conclusion?
The pattern of early motor development is affected by sleep
position. (Stomach sleepers) attain several motor milestones
earlier than (back sleepers). However, all infants achieved all
milestones within the accepted normal age range. Pediatricians
can use this information to reassure parents. This difference in
milestone attainment is not a reason to abandon the American
Academy of Pediatrics’ (APA) sleep position recommendations.”

So is they are all learning to walk, what's the problem?

Tsu

--
To doubt everything or to believe everything
are two equally convenient solutions; both
dispense with the necessity of reflection.
- Jules Henri Poincaré

[Jeff Utz]

"JG" > wrote in message
t...
> "Elizabeth Reid" > wrote in message
> om...
>
> > "JG" > wrote in message
> >...
>
> > > "Elizabeth Reid" > wrote in message
> > > om...
>
> > The risk of having a misshapen head that's severe enough to
> > be noticed or need correction is also very small.
>
> ...It should be *ZERO*.

The number of children dying of SIDS should be ZERO, too. Unfortunately, we
don't live in a perfect world.

> How in the world could an otherwise competent
> parent let his/her child's head deformity get to the point that it's
> noticeable (and likely commented upon by family/friends) without at
> least questioning/investigating why and taking some common-sense
> measures (e.g., the suggestions mentioned in the article)?

How do some parents let their kids get obese?

> We all
> wonder about those parents who, on summer days, "forgot" that their
> (sleeping?) kids were strapped in their car seats and, upon returning to
> their cars hours later, found them dead, or those parents who left young
> kids alone in a bathtub for "just a second" and then returned to find
> they'd drowned, or (my favorite) those parents who've run over their
> kids with a lawn mower. These are all "instantaneous" accidents
> (problems); they didn't develop gradually. (Of course, other negligent
> behavior also occurs over longer time periods; e.g., some parents are
> apparently oblivious to their kids' obesity or anorexia.)

That is one thing that is not true about SIDS. It is not a problem that
develops gradually. One minute you have a live kids sleeping, the next
minute, you don't have a live kid.

I guess you think a little head deformity is worse than a cold kid.

> Why do parents of kids whose heads have become misshapen due to their
> (parents') rigid adherence to the "Back to Sleep" rule view it as
> immutable? Are they just plain dumb, or are they afraid to question the
> advice-giver's (physician's) supposed expertise? Physicians have been
> sued for not giving their patients enough information--for not doing
> enough to "help" their patients (e.g., not explaining "well enough" the
> consequences of detrimental, avoidable behaviors); will a pediatrician
> now be sued for advice he/she HAS dispensed ("We recommend putting
> babies face-up; it's been shown to decrease the risk of SIDS") by the
> parent(s) of a kid with a deformed skull? (Don't laugh; who'd have
> thought, a decade ago, that people would actually file lawsuits against
> fast-food restaurants and food manufacturers for "making" them obese?)

Part of the well child check is to look at every square inch of body,
including the skull.

It sounds as if you think that letting kids get a mishapen skull for short
period of time is worse than about 1 kid in 1200 dying unnecessarily.

> Especially since,
> > as the article you quoted points out, there are ways to avoid those
> > problems without placing a child in the marginally riskier face-down
> > position. Is it really all that tough to take the recommendations
> > mentioned in the article, such as shifting the child's head and
> > making sure she/he doesn't spend all waking hours on his/her back?
>
> Apparently it is, for some parents (up to 48%!), that "tough."
>
> > If a parent takes a little care, both risks can be minimized.
> > Problem(?) solved!
>
> The problem of misshapen heads, perhaps. NOT the problem of parents who
> are dolts, however...

So which is better, 1 dead kid or 1200 kids who have slightly mishapen
skulls for a period of time?

> > > "Doomsday," IMO, is already upon us (the US).
>
> > You may or may not be right, but I can safely say that
> > the conviction that civilization has finally and irretrievably gone
> > to hell in a handbasket is about ten minutes older than
> > civilization itself.
>
> Not civilization per se. Just the US.
>
> It'd be nice if common sense and skepticism
> > were thicker on the ground, but I'd take some powerful convincing
> > that things are demonstrably worse now than any other point in
> > history.
>
> A topic that could be debated ad nauseam <g>.
>
>

[PF Riley]

On Wed, 9 Jul 2003 08:59:43 -0400, "Jeff Utz"
> wrote:
>
>"Roger Schlafly" > wrote in message
. ..
>> "Jeff Utz" > wrote
>> > Gee, so whom should one believe for expert advice on the care of
>children?
>>
>> Not someone who thinks that deformed heads, poor sleep, and delayed
>> development are all ok.
>
>When did anyone say that poor sleep, delayed development or deformed heads
>are ok?
>
>How about dead babies? Are they ok?

Yes, Roger, tell us. Would you sacrifice 2,000 American babies a year
to prevent this scourge of head deformity, sleep deprivation, and
developmental delay we all should be seeing?

PF

[PF Riley]

On Wed, 09 Jul 2003 16:43:58 GMT, "Roger Schlafly"
> wrote:

>"Tsu Dho Nimh" > wrote
>> >Yes. Plus delayed development, less sound sleep, less sleep for
>> >the moms, etc. The BS campaign was a bad idea.
>>
>> Can you show evidence of the supposed delays in development, and
>> less sound sleep?
>
>Try this:
>
>The pattern of early motor development is affected by sleep position.
>(Stomach sleepers) attain several motor milestones earlier than (back
>sleepers).
>http://www.kids-md.com/Tipsheets/21_may2301/crawling.html

This is the same as citing, in defense of a position against
seatbelts, a study that shows more people get wrinkles on their
clothes if they wear seatbelts.

PF

[Tsu Dho Nimh]

Brian Edmonds > wrote:

>"Roger Schlafly" > writes:
>> There are other drawbacks to putting babies on their backs. Nowadays,
>> a lot of babies never even learn to crawl.

>I can certainly see how this would become very limiting later in life.

It would be a serious problem for plumbers, electricians and IT
staff ... they all spend a lot of time crawling under things
doing installations.

Tsu

--
To doubt everything or to believe everything
are two equally convenient solutions; both
dispense with the necessity of reflection.
- Jules Henri Poincaré

[LSU Grad of '89]

Ha, my baby started getting the flattened head and we were alarmed as son as
we noticed - at about 3 months. We got a positioner and put him on his side
to sleep.

I daresay most intelligent folks will figure it out - that is, if they are
not overwhelmed by life (too many children, work, etc.) to notice

L.

P.S. I find the lot of you rather arrogant ans silly. I do not know a single
"doctor" that has TIME TO WRITE silly accusations. "> And yet again we
revisit a common theme from you, JG. Either by
> arrogance or ignorance (or both?)" To what parents are you dispensing
advice ? People in the grocery line in front of you ?

This is a very strange group.

"PF Riley" > wrote in message
...
> On Tue, 08 Jul 2003 18:22:47 GMT, "JG" > wrote:
>
> >"PF Riley" > wrote in message
> ...
> >
> >> I'd say 48% sounds about right in my experience. What you fail to
> >> realize is that for most of them, the deformity resolves with time.
> >> Back to Sleep started in full force around 1994. Do you know many
> >> 9-year-olds with misshapen heads?
> >
> >I know a couple of teenagers with rather severe craniofacial
> >abnormalities, but not because of supine sleeping. What I have
> >difficulty understanding is why the parents of the 48% with misshapen
> >heads either didn't notice the problem developing (!) or didn't take
> >corrective action (e.g., the suggestions in the article) sooner...
>
> And yet again we revisit a common theme from you, JG. Either by
> arrogance or ignorance (or both?) you seem to way overestimate the
> average intelligence and common sense of the American public. As CBI
> has pointed out, your problem in this case is not with the AAP
> dispensing the advice, but with your perception that it shouldn't be
> necessary.
>
> I would say about half of the families to whom I point out the typical
> occipital flattening and even occasional rhomboidal deformity
> (unilateral occipital with contralateral frontal flattening) of
> positional plagiocephaly during the 4 month check-up genuinely had not
> noticed it themselves. How, then, would you expect these parents to
> have begun taking corrective action?
>
> PF

[JG]

"CBI" > wrote in message
...

> "JG" > wrote in message
> t...

> > "Elizabeth Reid" > wrote in message
> > om...

> > ...It should be *ZERO*. How in the world could an otherwise
competent
> > parent .....

> JG - the fallacy of your whinings is showing through.

> First you whine about the AAP treating parents like idiots.
> Then you whine that some of them are idiots.

> Maybe there is some connection?
> Perhaps the AAP is not being so unreasonable after all?

Many parents ARE idiots (incompetent). I believe the number, and
percent, of
"idiot parents" is increasing. A few reasons are obvious: Many
parents these days have (or had) less-than-ideal (and/or often absent)
parents
themselves ... A crappy (*overall*) public education system that turns
out future parents (and some teenagers who are *already* parents!) who
can't think (but who *think* they can think and who feel good about
themselves!) ... A culture (read: media) that continues to endorse and
encourage/promote self-centeredness--ME first, kid second ...
Politicians (and bureaucrats), intent on keeping their jobs, giving (or
trying to) all things to all people (even those who
neither need nor want to partake of gubmnt's largesse!), and have
thereby instilled a sense of both dependency and entitlement among much
of
the populace (why think for yourself when there's someone--some
bureaucrat--all too ready and willing to do it for you?) ... A federal
gubmnt that's made a habit of bailing out/subsidizing all sorts of
entities, including other gubmnts (e.g., cities) and corporations (e.g.,
Amtrak) as well as individuals (e.g., farmers) who DO screw up ... In
short, can you honestly deny that personal responsibility is a waning
virtue? But I digress...

As I've asserted before (previous threads), it's simply not possible to
educate a lot of idiots (the "uneducable"), no matter how hard one might
try. You can lead a horse (parent) to water...

The AAP apparently believes *all* parents are idiots, and thus
recommends pediatricians treat them as such (e.g., by asking MYOB
questions such as whether there are any guns in the house). As far as
head-flattening is concerned, if it's to the point where it's noticeable
(i.e., of medical concern) you'll have a hard time convincing me that
the parents themselves don't/haven't noticed it and taken some "common
sense"--intuitive--measures (such as those recommended in the article)
to alleviate/correct it.

If a pediatrician wants to cover his/her ass (against "failure to warn"
lawsuits), I'd suggest he/she simply put all his/her (i.e., the AAP's)
"advice" in a "new parent" booklet that can be given to all
new/expectant moms. Hand out an addendum regarding the importance of
repositioning infants to avoid smushed heads, if you wish.

[JG]

"CBI" > wrote in message
...

> "JG" > wrote in message
> ...

[...]

> > The AAP apparently believes *all* parents are idiots, and thus
> > recommends pediatricians treat them as such.

> I've seen no examples of this.

Read some of the AAP's "policy statements"
(http://www.aap.org/policy/pprgtoc.cfm); those recommending that
pediatricians "advise" or "counsel" parents *never* state "when
appropriate" (or words to that effect), let alone "IF asked for
guidance." I guess the AAP doesn't believe pediatricians should (are
competent to?) discern which parents need what "advice."

> Do you get ****ed off when you see an exit sign and you already knew
where
> the exits are?

Of course not. Exit signs provide information (e.g., an exit number
and/or a street/highway name); they don't advise/recommend (state) "get
off here (to get to XXX)." Using lawn mowers (still my favorite example
:-D), the exit sign is analagous to the piece of information, "lawn
mower blades are sharp." I can do with any piece of information what I
want, i.e., either ignore it or use it in some way. In the case of the
mower blades (and being a rational individual <g>), I'll think, "Okay;
I'll be careful when I am (or my child is) around lawn mower blades."
In the case of the exit sign, I'll also either ignore it or use it
(either to exit or to estimate how much farther it is to the exit I
want). Now, when a pediatrician says, "Be careful with sharp lawn mower
blades; Buffy and Biff could get hurt if they're nearby while you're
mowing," he/she is dispensing more than information (that mower blades
are sharp)--he/she is giving advice. If I wanted/needed advice about
how to be "careful with sharp lawn mower blades," I'd *ask* (likely the
lawn mower manufacturer; NOT a pediatician). Likewise, if I
wanted/needed advice about exits (e.g., which ones to take to get to my
destination), I'd ask (either someone at my destination, an "expert" in
the vicinity [e.g., a gas station attendant], or a service [e.g.,
Mapquest] that provides advice/directions); the exit sign itself is not
"advice," "guidance," or "counselling."

> Why do you think that some of those idiots don't own guns? Or do you
think
> that nothing should be said to them?

Say something to them IF they solicit your advice/opinion (though why
they'd ask a pediatrician, rather than someone who sells devices
[lockboxes, gun locks] intended to reduce accidental gun
injuries/deaths, or even the police, is beyond me). While your concern
for your patients' welfare is understandable, it's really NONE of your
business whether there are guns in their homes. Do you ask if they have
a bathtub and, if the answer is "yes," *automatically* (invariably)
proceed to advise them on drowning prevention?

You can't have it both ways. If you
> admit that there are some fools at them then there is nothing wrong
with
> issuing advice to them.

And just how, Chris, do you identify, with TOTAL accuracy, the "idiot
parents"? Do you give prospective patients' parents a quiz? (Now how
insulting would THAT be--how many prospective patients would you lose?
....Q1: Lawn mowers (A) have very sharp blades and my child could be
injured if I'm not extremely careful when he/she is around one; (B) make
a great substitute for my kid's go cart when it's not available or out
of gas; (C) what's a lawn mower?...)

Making assumptions about a parent's intelligence/level of "common sense"
is risky, but the answer is certainly not to treat *every* parent
condescendingly, as if he/she is an idiot in need of nannying.

[JG]

"PF Riley" > wrote in message
...
> On Tue, 15 Jul 2003 23:23:44 GMT, "JG" > wrote:

> >"CBI" > wrote in message
> ...

> >> "JG" > wrote in message
> >> ...

> >> > The AAP apparently believes *all* parents are idiots, and thus
> >> > recommends pediatricians treat them as such.

> >> I've seen no examples of this.

> >Read some of the AAP's "policy statements"
> >(http://www.aap.org/policy/pprgtoc.cfm); those recommending that
> >pediatricians "advise" or "counsel" parents *never* state "when
> >appropriate" (or words to that effect), let alone "IF asked for
> >guidance." I guess the AAP doesn't believe pediatricians should (are
> >competent to?) discern which parents need what "advice."

> Wrong. You failed to notice that every single Policy Statement ends
> with the following:

> "The recommendations in this statement do not indicate an exclusive
> course of treatment or serve as a standard of medical care.
> Variations, taking into account individual circumstances, may be
> appropriate."

Thank you for pointing this out. I guess I've either (1) gagged or (2)
had my eyes glaze over before reaching the end of one. I stand
corrected.

[CBI]

"JG" > wrote in message
.. .
>
> > > The AAP apparently believes *all* parents are idiots, and thus
> > > recommends pediatricians treat them as such.
>
> > I've seen no examples of this.
>
> Read some of the AAP's "policy statements"
> (http://www.aap.org/policy/pprgtoc.cfm); those recommending that
> pediatricians "advise" or "counsel" parents *never* state "when
> appropriate" (or words to that effect), let alone "IF asked for
> guidance." I guess the AAP doesn't believe pediatricians should (are
> competent to?) discern which parents need what "advice."

In general the AAP assumes that neither the parent nor the pediatrician are
omnicient.


>
> > Do you get ****ed off when you see an exit sign and you already knew
> where
> > the exits are?
>
> Of course not. Exit signs provide information ...... I can do with any
piece
> of information what I want, i.e., either ignore it or use it in some
way.......
> ... Now, when a pediatrician says, "Be careful with sharp lawn mower
> blades; Buffy and Biff could get hurt if they're nearby while you're
> mowing," he/she is dispensing more than information (that mower blades
> are sharp)--he/she is giving advice. If I wanted/needed advice about
> how to be "careful with sharp lawn mower blades," I'd *ask*

1) I think you are splitting hairs between giving information and giving
advice. It is nonsense to say that it would be OK to inform you of the
hazzards of lawnmower use but not to admonish you to be cautious of them.

2) When you go to the doc you are, in effect, asking for his advice (like it
or not).



>
> > Why do you think that some of those idiots don't own guns? Or do you
> think
> > that nothing should be said to them?
>
> Say something to them IF they solicit your advice/opinion

But the idiot is the one least likely to do so. You are setting up a
catch-22.


> (though why
> they'd ask a pediatrician, rather than someone who sells devices
> [lockboxes, gun locks] intended to reduce accidental gun
> injuries/deaths, or even the police, is beyond me).

The pediatrician is an expert (or should be). The gun dealer is a saleman.
The stated policies of the police largely agree with the AAP.



> While your concern
> for your patients' welfare is understandable, it's really NONE of your
> business whether there are guns in their homes.

Concern for the wellfare of the patient is the business of the doctor.
Whether there are guns in the house (and ths issues such as storage and
supervision that stem from the question) affects that welfare.


> Do you ask if they have
> a bathtub and, if the answer is "yes," *automatically* (invariably)
> proceed to advise them on drowning prevention?

I routinely discuss drowning prevention. Part of the discussion mentions
short unsupervised periods and shallow water such as is found in bathtubs.


>
> You can't have it both ways. If you
> > admit that there are some fools at them then there is nothing wrong
> with
> > issuing advice to them.
>
> And just how, Chris, do you identify, with TOTAL accuracy, the "idiot
> parents"?

You can't - that is my point.


> Making assumptions about a parent's intelligence/level of "common sense"
> is risky, but the answer is certainly not to treat *every* parent
> condescendingly, as if he/she is an idiot in need of nannying.

Only an insecure person would feel that they are being treated like an
idiot.

--
CBI, MD