BOOKSHELF

Do you know what parents are reading?
A look at who else is molding America's children

BY LAURA A. JANA, MD

The names of well-respected, academic pediatrician-authors such as Drs. T. Berry Brazelton and Barton Schmitt are familiar to most children's health practitioners, but the fact is that they are only two of the countless "experts" who define the world of 21st century parenting. Consider Rosemond, Eisenberg, Iovine, Cline and Fay, and Gordon. Could you describe their work?

Gone are the days when parents simply showed up at the doctor's office with child-rearing questions, and left with prescriptive answers they took to be gospel. Stroll down the "child rearing" aisle in the local bookstore, browse the thousands of books in the Parenting and Families category on www.amazon.com , or pick up a copy of Ann Hulbert's new book, Raising America, and you will realize that parents are looking elsewhere for advice on everything from raising a special needs child to bringing up a financially, sexually, and emotionally healthy one. The parenting book market is booming.

Because there is such a smorgasbord of parenting topics, experts, styles, and philosophies to choose from, it's nearly impossible for children's health professionals to keep up with all of them (believe me—I've tried). That said, I'm convinced it's well worth our while to keep a finger on the pulse of the world of parenting so that we can offer our expertise and have a better idea what parents, with whom we interact, read and believe.

That is why we've chosen to stray from our customary look at pertinent children's books in this installment of Bookshelf. Although most readers of Contemporary Pediatrics are well acquainted with some of the popular, well-written parenting books—such as the American Academy of Pediatrics' Caring For Your Young Child series—the choice of books is almost limitless. To give you a running start, here are overviews of several parenting books and thoughts on what kind of parents they appeal to.

Age-based series

On Becoming Baby Wise, by Gary Ezzo and Robert Bucknam, MD, PRWIS, 2001 (238 pages, $11.95, paperback). This "classic reference guide used by over 1 million parents" entices new parents with its promise of restful nights and a predictable newborn schedule—one that comprises feeding time, waking time, and nap time (in that order). The book makes several fundamental assumptions, including: what parents do with their newborns will affect all the rest of their parenting years, and the quality of the parent-child relationship depends on the quality of the husband-wife relationship.

The authors place emphasis on the importance of routine in the typical new-parent topics of crying, feeding, and sleeping. With regard to the last subject—and in stark contrast to Dr. Harvey Karp's Happiest Baby book (discussed later)—Ezzo and Bucknam consider nursing, rocking a baby to sleep, and co-sleeping to be the three most common negative sleep props. With recommendations for infant-management strategies such as "parent-directed feeding" (PDF), in which "any time increment between 2¹/₂ and 3 hours is acceptable," and the premise that the average PDF baby sleeps through the night at 6 weeks of age, this book has the potential to be interpreted too rigidly by some parents; in fact, it has received some negative press in past years (including a statement by the AAP) when "baby wise" parents began showing up in pediatricians' offices with undernourished, dehydrated newborns.

Baby Wise appeals to parents who want a defined, structured approach to parenting (and who want to sleep through the night at the earliest opportunity). It probably will also appeal to those at the opposite end of the parenting spectrum from parents who believe in attachment parenting, the family bed, and on-demand feeding. Other books by the authors include On Becoming Baby Wise: Parenting Your Pre-Toddler—Five to Fifteen Months and On Becoming Child Wise: Parenting Your Child—Three to Seven Years.

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Secrets of the Baby Whisperer: How to Calm, Connect, and Communicate with Your Baby, by Tracy Hogg and Melinda Blau, Ballantine Books, 2002 (304 pages, $13.95, paperback). According to Tracy Hogg, a British midwife, registered nurse, and experienced baby nurse, "baby whispering" is nothing more than taking care to respect, listen to, observe, and interpret the behavior of babies. Nevertheless, her book has caused quite a buzz among parents and was listed as one of www .amazon.com's "Best of 2001."

The authors' approach is simple; it relies on mnemonics and is based on schedules. Parents are directed to consider their baby's temperament and how it fits with their own. Then they are instructed how to add structure to their daily routine using what is called the E.A.S.Y. plan. The plan states that Sleep should always follow Activity and not Eating, leaving You (the parent) time at the end of each cycle. As for figuring out what their baby wants, parents are told to take things S.L.O.W.ly—taking time to Stop, Listen to the baby's cry, Observe the baby's body language (elaborately described—from the meaning of side-to-side head movements signaling fatigue, to playing with fingers suggesting the need for a change of scenery), and then ask themselves What's up? The authors then assure parents that they will be able to figure out what their baby is saying to them.

Baby Whisperer is popular among parents who want to read a book on new baby care, who lean toward the side of the parenting spectrum that advocates clearly defined schedules and routines, and who won't mind the casual and quaint British style of the author (pacifiers are "dummies," moms are "mums," and readers are addressed as "darling" or, even, "ducky"). There is also a Secrets of the Baby Whisperer for Toddlers (352 pages, 2003).

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The Girlfriends' Guide to Surviving the First Year of Motherhood, by Vicki Iovine, Perigee, 1997 (272 pages, $13.95, paperback). The Girlfriends' Guide series could be classified as the humor-based reality books on parenting. After a frank (and, frankly, successful) look at pregnancy and all that it entails, this mother of four tells her readers openly (as only a true girlfriend would) about the first year of motherhood. In this—and subsequent—Girlfriends' guides, Iovine certainly isn't shy. She believes in filling her readers in on all the amusing, challenging, and even gory details.

Iovine writes in a style all her own—casual and conversational, as if she's sitting next to you, chatting. She has a wry humor and a bluntness that is not for everyone, but that many find amusing. In contrast to the comprehensive reference-book format of the What To Expect books (discussed later), the Girlfriends' guides are topic-based books. Instead of being organized month-by-month, Surviving the First Year is divided into chapters on topics such as fatigue, body image, sex after the baby comes, and how to keep everyone in the family healthy. Parents (mothers, perhaps more accurately) can easily sit down and read straight through these books.

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What To Expect The First Year, by Arlene Eisenberg, et al, Workman Publishing Company, 2nd Edition, 2003 (704 pages, $15.95, paperback). As the sequel to the best-selling pregnancy book, What to Expect When You're Expecting and billed as "one of the most comprehensive resources for new parents as they progress through their baby's first year," this parenting book (and its counterpart, The Toddler Years, weighing in at more than 900 pages) certainly speaks volumes about everything from the medical aspects of raising a child to the safety concerns, emotional sides, practicalities, and challenges of parenting. With more than 15 million copies sold to date, this series rose to the status of the Encyclopedia Britannica in pre–World Wide Web days.

Characteristic of the What to Expect series, the book includes an easy-to-recognize cover and uses a month-by-month organization of chapters (with a few topic-based chapters added on). The information is offered in short paragraphs and sections, and generally focuses on what parents can expect their child to be doing, what parents may be concerned about, and what's important for them to know for each time interval.

Although the book carries the risk of overwhelming parents with the vastness of its information, it is definitely written for those who want their questions answered factually and concisely. This book is not, however, for those interested in sitting down and reading in-depth about a particular parenting topic or philosophy.

Specific parenting topics and philosophies

From Diapers to Dating: A Parent's Guide to Raising Sexually Healthy Children, by Debra Haffner, MPH, and Alyssa Haffner Tartaglione, Newmarket Press, 2000 (240 pages, $14.95, paperback). The title might lead you to wonder why a book on sexuality is reviewed in a column on parenting books. Simple: Haffner addresses sexuality as a subject that is really about healthy relationships, family social dynamics, and open communication—all of which are unquestionably key to effective parenting and raising healthy children.

The book is about raising boys and girls from being in diapers through adolescence and dating, and shows a good understanding of their differences (which go well beyond just physical differences). As Haffner succinctly explains, most people miss the "–uality" part of the word "sexuality" and think of the word as synonymous with "sex." Not only is teaching one's children about sexuality a permeating aspect of a parent's role, it is one of the most challenging. Debra Haffner is a true expert with a distinguished career, which included many years of heading up the Sexuality Information and Education Council of the United States (SIECUS). She presents her practical approach to integrating sexuality into healthy upbringing in a readable, developmentally appropriate way.

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Parenting With Love and Logic: Teaching Children Responsibility, by Foster W. Cline, MD, and Jim Fay, Navpress, 1990 (229 pages, $21.00, hardcover). Having first established themselves as major players with their Love and Logic books, Cline and Fay now direct a Love and Logic Institute that offers seminars for parents and professionals across the country and that has a Web site featuring more than 100 books and products to help parents raise responsible children.

Built on 23 truisms about parenting referred to as "Love and Logic Tips," Cline (an adult psychiatrist by training) and Fay (an educator and a former school principal) propose that "the challenge of parenting is to love kids enough to allow them to fail," and in so doing, let them learn from their mistakes. In Love and Logic language, these SLO's (significant learning opportunities) are key to helping "build" our children and helping them grow into responsible teenagers and adults.

In contrast to Dobson's philosophy (The Strong-Willed Child, discussed later), these authors believe that allowing children to make choices (and living with the consequences within a safe environment) works far better than punishment, such as spanking. The authors believe consequences are often punishment enough and that the "the real world by and large doesn't operate on punishment."

While books on parenting philosophy tend to be too abstract for some parents, Parenting With Love and Logic is grounded in reality. Not only are concrete examples and anecdotes interjected throughout, but parents will surely relate to the many specific (and accurately portrayed) parenting challenges discussed in the second half of the book—from lying, allowances, peer pressure, and school issues to discipline, whining, and teeth brushing.

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The Happiest Baby on the Block; The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer, by Harvey Karp, MD, Bantam Doubleday Dell Pub., 2003 (288 pages, $13.95, paperback). One of the newest experts on the block, Dr. Karp is nevertheless in a league of his own with this expertly written book for new and expectant parents. The premise of the book is Karp's "fourth trimester" theory, which hypothesizes that much of what parents do to successfully calm and care for their infants in the first few months of life is, in essence, an attempt to recreate in-utero existence.

Dr. Karp's five fundamental calming techniques—conveniently referred to as the five S's (swaddling, sucking, side/stomach, shushing, and swinging)—aren't novel concepts in and of themselves. The way he assembles them as ingredients in a well-explained, well-tested recipe for calming success is what is new and different in his book. And lest you worry that some of his advice might go against conventional (read: AAP) wisdom—such as his suggestion of side or stomach positioning—rest assured that the author takes great care in appropriately explaining positioning the baby for sleep and other recommendations to ensure that, when followed, they will not conflict with current safety recommendations.

In short, Dr. Karp's approach to crying and colic along with his overall understanding of what makes newborns tick is both simple and enlightened. His depth of knowledge and experience on the topic is impressive, and his ability to distill it all into a realistic, practical book for parents is masterful. It's not hard to imagine why The Happiest Baby on the Block has recently come to publication with an impressive range of endorsements—from well-respected pediatricians and health professionals to parents and celebrities alike.

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The Strong-willed Child: Birth through Adolescence, by James C. Dobson, PhD, Tyndale House Publishers, 1992 (335 pages, $7.99, paperback). Dr. Dobson's book is geared to traditional, married parents who believe that raising a child will inevitably bring a contest of wills between generations, and that it is the parents' objective to shape the will of their offspring during the formative years of early childhood.

This popular parenting book argues for using corporal punishment as a "teaching tool by which harmful behavior is inhibited" and as an "act of love." A quick scan of the book's table of contents will give you some idea of what the book is about. It has such chapters as "The Wild and Wooly Will" (followed by one on how to shape it), "Protecting the Spirit" (a chapter that describes how to shape the child's will "without breaking it"), and "The Scourge of Sibling Rivalry." Using biblical quotations throughout, the author offers his readers many illustrative stories to reinforce his approach to child rearing.

It is fairly safe to say that Dr. Dobson's overall philosophy may not sit well with all pediatricians. But whether or not you subscribe to the author's underlying philosophies and scripture-based beliefs is not the point. It is important for all children's health professionals to familiarize themselves with this best-seller—especially because it has sold close to two million copies, and some of those copies will, inevitably, find their way into your patients' families' homes and influence the way they raise their child.

DR. JANA is a practicing pediatrician with Physicians Clinic in Omaha, Neb. She is co-founder of The Doctor Spock Company, a national parenting media company, and maintains special interests in early childhood literacy and in childhood safety and injury prevention. Dr. Jana is the mother of three young children and an avid collector of children's books.

Bookshelf.

Contemporary Pediatrics

November 2003;20:121.