What is evidence-based parenting?
Sometimes research doesn't have all the answers (she says, crying into her laptop)
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6 min read
I recently stumbled on a Reddit forum called Science Based Parenting.It describes itself, somewhat defensively, as a community for anyone who prefers to base their parenting choices on actual, evidence-backed scientific research. The forum is home to over 60,000 members with questions ranging from the basic (Pumping vs. breastfeeding - any differences?), to the specific (Does anyone…know of studies that discuss the benefits to using fingers vs forks for infants and young toddlers?), to the surprisingly niche (Woodstove is our main source of heat…we have a HEPA filter continuously in the same room. How dangerous is this?).
What ties these forum posters together, though, is a singular mission: trying to do what scientific research shows is best for our kids. In other words, they’re self-proclaimed evidence-based parents.
But a strange thing happens when you dig into the comments beneath these posts. Despite the forum’s explicit rules (Do not attempt to state your opinions as facts) and clearly-tagged requests (Evidence-based input ONLY), there are a lot of, well, opinions. Not to mention, those opinions differ from one another. In fact, you rarely get a single, clear answer. You get links to scientific articles about the microbiata composition of breastmilk, yes, but also personal stories about cleaning pump parts, a four-week-old baby’s tongue tie, and postpartum depression.
How can this be? Why can’t we simply post a question, get a single, science-backed answer, and be on our merry way to light up the old wood-burning stove?
What is evidence-based parenting, anyway?
The term evidence-based parenting has trended in recent years, perhaps buoyed by a hashtag-infused desire to label our parenting styles and select into various parenting camps (see: #gentleparenting, #positiveparenting, #respectfulparenting).
The concept of evidence-based practices, however, has a long history in medicine (and, more recently, clinical psychology). It also happens to be the approach we like to take here at Techno Sapiens.
The mandate of evidence-based practices seems obvious: to make decisions—whether in medicine or parenting—based on science. We have a simple mental model for how this would occur: we have a question, we find some scientific studies that gives us the answer, and voila! Evidence-based.
The truth, as usual, is a bit more complicated.
So, what does it mean to be evidence-based?
Let’s first talk about the premise behind evidence-based medicine. Then we’ll discuss how it applies to evidence-based parenting.
An oft-cited 1996 article in the British Medical Journaldescribes three essential components of evidence-based medicine (EBM). This approach has since been adopted by the field of clinical psychology, too.
Each of these components is considered necessary for optimal clinical care:
The best available research evidence, prioritizing high-quality randomized controlled trials (RCTs) and meta-analyses.
A medical provider’s clinical expertise
A patient’s characteristics, values, preferences, and circumstances
To illustrate, imagine you go to the doctor with some kind of ailment. Here are a few ways your doctor could approach it: 1) They prescribe X medication, because the latest research suggests that it is effective for treating your condition. 2) They prescribe Y medication, because they recognize your symptoms as similar to other patients’ they’ve seen, and they know that Y medication helped those patients. 3) They describe a few options for medications, and ask for your opinion.
Which is best? The answer is some combination of all three.
We need #1, of course. Prior to the adoption of evidence-based medicine, doctors would often just, kind of, guess. Relying on intuition and what they learned in medical school, we’d end up with treatments like blood-letting and—much more recently—the suggestion to avoid peanuts in order to prevent nut allergies in kids.
But why can’t we rely on #1 alone? Well, maybe you’re allergic to X medication. Maybe you have an underlying health condition that makes you different from the patients in the X medication clinical trials. Maybe X medication isn’t the right option for you.
We need research to inform our decisions, but it can’t get us all the way there.
The standard metaphor for evidence-based medicine is a “three-legged stool.”Each of the three components represents a leg of the stool. If any of the three is missing, the stool falls down.
When we think of something as “evidence-based,” the stool that comes to mind is often one-legged. We know we need #1, the research, but we forget about the others.
So, how do the principles of evidence-based medicine apply to parenting? It involves a similar, three-pronged approach:
The best available research evidence
Our experience, values, and expertise as parents
Our kids’ characteristics, circumstances, and needs
We can—and, I’d argue, we should—rely on the research to inform our parenting. Intuition alone can lead us astray. When my son grabs a fistful of yogurt from the bowl on his highchair tray and flings it to the ground, my intuition tells me to gasp, yell NO, and enter a long discussion with him on yogurt etiquette.The research on effective behavioral consequences, however, would suggest this isn’t a good idea.
And yet, the research alone can only get us so far. Even in cases where high-quality scientific studies are available, these studies address averages. They can point us in a direction, but they often cannot address exactly what you, specifically, should do in a very specific situation with a very specific child.
Let’s take, for example, one of the most basic—and, somehow, complex—of all tech parenting questions: how much screen time should we allow our kids? The best available research evidence would suggest that extremely high levels of screen time can be problematic, but that moderate amounts are fine, and that the content they’re watching probably matters more than then the time itself. Great. But now we enter a specific situation: it’s a Sunday in December, and should you let your 5 ½ -year-old watch another episode of Bluey, knowing that they’re tired from an earlier holiday party, and also that you need a few minutes for last-minute, online Christmas shopping?
We need the research, but we also need to factor in what we know of our kids and ourselves.
To be truly evidence-based, we need to look to the science for answers, but we also need to recognize that the science will never have them all.
Life imitates art (and science)
While writing this post over the weekend, I was interrupted by my son suddenly waking up from his nap. He was crying hard, which is unusual for him.He has COVID, and despite what I knew from the research—that he’s very low risk, based on his age and recent vaccination—I was worried.
What should we do? My husband and I looked at each other. Enter the room, and we risked waking him up further, losing any chance at him falling back to sleep and getting needed rest. Stay out of the room and he might just continue to lie there, uncomfortable and sick.
I went in first. I picked him up, rocked him, sang to him, shushed him. As soon as I put him back in the crib, he was sobbing again. I was ready to exercise the nuclear option—calling off the nap altogether—when my husband entered the room. I backed slowly out the door, doubtful.
A few minutes later, an eerie quiet had settled back over the house. I glanced at the video monitor. My son was sleeping peacefully in his crib. My husband, inexplicably, was lying on the floor next to the crib (I wanted to get out of his field of vision!). He was holding his phone up at crib-level, playing wave-crashing sounds in my son’s direction from a white noise app.
Just trial and error, he later explained.
We need research to build a foundation, to guide us in the right direction, to test our assumptions and teach us when our intuitions are misplaced. But it can only get us so far. No scientific study exists to tell us just how worried to be when our COVID-positive son wakes up crying from his nap. No RCTs have tested the efficacy of lying on the floor next to our son’s crib, playing wave-crashing sounds, to get him back to sleep.
Sometimes, evidence-based parenting just means doing the best we can.
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For the uninitiated, Reddit houses millions of chat forums called “subreddits” or “subs,” of which Science Based Parenting is one (i.e., r/ScienceBasedParenting). Communities of people gather on various subs and chat about everything from r/FormerPizzaHuts, dedicated to photos of former Pizza Hut locations, to r/BreadStapledtoTrees, dedicated to photos of…you guessed it. Reddit is one of the top 20 most visited sites on the Internet.
I think Emily Oster has also played a big role in bringing evidence-based pregnancy and parenting advice to the (science-minded) masses. I loved her books (Expecting Better is essential reading during pregnancy), and I’m now an avid reader of her newsletter, ParentData. To all the new sapiens who’ve joined us from ParentData, welcome! To those who haven’t yet signed up, you can (and should) subscribe here.
At the time, the journal’s formal name was actually BMJ. According to the website: “…in January 1857, [the journal] became the British Medical Journal. The title was shortened to BMJ in 1988, and then changed to The BMJ in 2014.” I want to know who was part of the committee that campaigned (successfully) for the addition of “The” in 2014. Academics, man.
The three-legged stool metaphor has come under scrutiny in recent years due to its implication that each of the three legs holds equal weight. This is, obviously, often not the case. Our doctor shouldn’t prescribe us a medication just because they kinda feel like it would work, even though there’s no research to support it. We shouldn’t let our toddler play with the stove just because they really want to, despite considerable research to suggest it is dangerous. Perhaps a better metaphor is something like mixing paint colors. For example, let’s imagine that evidence-based parenting is a nice shade of light green. We’re going to need three colors (the three pillars of evidence-based practice): blue, yellow, and white, but not necessarily in equal amounts. Some of us are going to be going for a Sea Foam, and others, maybe, a Pistachio or Peppermint. Depending on the question at hand, or the phase of life we’re in, we may want a slightly different shade.
Recently, the culprit is often soup, rather than yogurt. Extremely detail-oriented techno sapiens may remember from a previous footnote that I love soups of all kinds. I seem to have passed this onto my son. He has started asking for soup (“schoop”) at most meals. A few days ago, I asked him his favorite color, and he responded “bean soup.” I now fear we may be pushing the soup agenda a bit too hard.
He is actually a great sleeper. I credit a combination of luck and Taking Cara Babies newborn class.
He is doing fine, and luckily, seems to have had a mild case.
Thanks! This is a very helpful and timely post for me. Also, I did find out about you and your newsletter from Emily Oster/ParentData. Love all her books. And love both of your newsletters! Thank you for all you do!