High Anxiety: American Baby Care Advice Over the Past Century

Howard Markel, MD, PhD

Disclosures

January 20, 2005

I can still recall the time and place I heard a wise piece of advice to offer new parents about child rearing. A favorite professor of pediatrics offered this clinical pearl to me while I was an intern on the fabled infant's ward of the Johns Hopkins Hospital. His words ring as true today as they did more than 2 decades ago: "No matter how you rear your child, he or she will probably grow up to tell you what you did wrong."

Nevertheless, American parents continue to search in vain for definitive answers on how to raise their children, and the line of baby and childcare gurus -- always clutching the latest edition of their newest tome on the topic-- willing to accommodate their needs grows logarithmically with each generation. But when reviewing the parade of children's experts who have held forth over the last 100 years or so, one cannot help but be struck by an unintended consequence of the modern child-rearing movement: many parents today seem remarkably worried about their ability to parent.

To be sure, the specific situations or threats that worried parents of the past may not worry parents of the 21st century. But over the past 100 years or more, there has been a constant quest for the "perfect baby" -- and, in essence, a desire to be the perfect parent -- and this quest would be recognizable to any pediatrician in practice today.

Perhaps the greatest changes over this period have to do with precisely which problems have made parents most nervous about their children's health. For example, during much of the 19th century, 1 of every 5 babies died before their first birthday - - typically of a contagious disease -- and the experience of an infant or young child dying was a real possibility that most of us today cannot fathom. Today, most American pediatricians spend much of their days focusing on what sociologists call "low morbidity, low mortality" issues, ranging from providing anticipatory guidance to mothers of healthy babies and children to treating learning disabilities, attention deficit disorders, and an expanding list of behavioral syndromes.

By the end of the 1890s, baby care manuals became as common a staple in the middle class American nursery as diaper pins. One of the most successful was written by the New York City physician, L. Emmett Holt,[1] who divided his time between running Babies Hospital, developing intricate modifications of cow's milk to resemble breast milk (hence, the term formula), and serving as personal pediatrician to the city's wealthiest families (including the John D. Rockefeller, Juniors). In 1894, Dr. Holt published The Care and Feeding of Children, a perennial bestseller that went through 12 editions and 75 printings. In it, he prescribed a strict regimen of feeding that resembled a railway schedule, warnings not to kiss or cuddle infants, and toilet training by the age of 4 months. Indeed, it was precisely this list of prescriptions for absolute control over the baby's daily routine and the scrupulous prevention of deadly infections that attracted his millions of readers.

As pediatricians began to conquer many of the contagious scourges of childhood, they transformed into family counselors. Between the 1920 and the late 1940s, a gaggle of psychologists and child study experts produced a flurry of contradictory and often dogmatic treatises on child rearing and behavior. But the job of calming the apprehensions of post-World War II parents fell most famously to Dr. Benjamin Spock,[2] a pediatrician whose mother raised him on the precepts of Dr. Holt. Throughout the pages of his Baby and Child Care, first published in 1946 and second in sales only to the Bible, Dr. Spock sagely told parents: "Trust yourself. You know more than you think you do."

Dr. Spock's beautifully written blend of medicine and psychology emphasized a partnership between the child and parent, but it also reminded parents they were, ultimately, in control. Yet Dr. Spock was often misinterpreted and eventually derided as being too soft on discipline.

In the years since Spock's eclipse, child-rearing advice has splintered along lines of specific problems, developmental stages, philosophies, and even political ideologies, but the frantic search for the singularly correct way to rear children has only intensified. Some experts have theorized that the current level of parental anxiety may be increasing because most Americans are having fewer children and are becoming parents later in their lives. Others wonder if the advent of long-distance families and the lack of daily contact with one's own parents for advice might be a factor.

Dr. T. Berry Brazelton, the famously genial pediatrician whose more than 30 books have collectively sold tens of millions of copies, believes that the obsession to be a perfect parent and the guilt that can arise from the inevitable failure is "a reflection of how passionate parents are about raising children and I admire that. The trouble is that most parents don't realize that failure is really the best way to learn how to parent. They ought to embrace these failures rather than dread them," he said.[personal interview, 2004].

Dr. William Sears, a pediatrician who has written several popular baby care manuals, including The Baby Book, recommends that all parents take a deep breath and acknowledge that what "the experts" know about their babies is constantly changing. "Don't take any expert's philosophy too seriously, even mine," Sears said [personal interview, 2004].

Which reminds me of the important lessons my own experiences as both a pediatrician and a parent have taught me time and again. Too often, the joys of having a child are needlessly dampened by concerns over the things you should not do with and for your child. But we can all take heart in the age-old truth that the things you should do as parents far outnumber those you should not. Do trust your instincts. Do allow yourself to ask questions when you are puzzled by something. Do love your child unconditionally. Do be consistent. Do set limits. Most important, do get to know your child and his or her daily habits and routine. No one knows more about a child than his or her parents. And, of course, we can all relax with the comforting thought that the vast majority of our children grow up to become parents themselves!

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