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Kindle Notes & Highlights
by
Emily Oster
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November 26 - December 16, 2021
The results—I put them in a graph on this page—are striking. Children who were exposed to peanuts were far less likely to be allergic to them at the age of five than children who were not. In the group that didn’t get peanuts, 17 percent of children were allergic to peanuts at age five. (Remember, this figure is higher than it would be in the general population because of the way the researchers selected their sample.) However, only 3 percent of the children who were given peanuts were allergic.
For example, there is no evidence for the order of food introductions. If you’d like to start with carrots or prunes rather than rice cereal, I can find no reason in the published evidence not to. Sure, maybe your baby will be more comfortable with rice cereal, but carrots are actually objectively tastier.
An alternative, which has grown in popularity in recent years, is referred to as “baby-led weaning.” In this practice, instead of introducing pureed foods and feeding the kid with a spoon, you wait until they are old enough to pick up foods on their own and then have them more or less eat what your family eats.
Let’s assume, however, that you do care about promoting a “healthy diet.” The good news is that there is plenty of research on this question. The bad news is that a lot of it is not very good.
Related to this, once children are starting to eat solid foods, there is randomized evidence that repeated exposure to a food—say, giving kids pears every day for a week—increases their liking of it. This works for fruits, but also for vegetables, even bitter ones.9 It reinforces the idea that children can get used to different flavors and that they like familiar ones.
Before getting into these, and how you might fix them (hard), you should know that most kids become more picky around two and then slowly grow out of it in their elementary school years. This is sometimes a surprise to parents—your eighteen-month-old eats like a horse, then all of a sudden around two, they start being very selective and just generally not eating much. I have sat at many a dinner where one of my kids has taken one bite and said, “I’m done!”
The primary finding relates to how parents talk about the new food. Kids are more likely to try to eat it with what researchers call “autonomy-supportive prompts”—things like “Try your hot dog” or “Prunes are like big raisins, so you might like them.” In contrast, they are less likely to try things if parents use “coercive-controlling prompts”—things like “If you finish your pasta, you can have ice cream” or “If you won’t eat, I’m taking away your iPad!!”
These studies also show that food refusals are more common in families where parents offer an alternative. That is, if your kid doesn’t eat broccoli and then you offer him chicken nuggets instead, he may learn that this is always the reward for not eating new foods. This problem is exacerbated by parents’ concern that their child isn’t eating enough (which, see above, is probably not true).
Putting this together leads to some general advice: offer your very young child a wide variety of foods, and keep offering them even if the child rejects them at first. As they get a little older, do not freak out if they don’t eat as much as you expect, and keep offering them new and varied foods. If they won’t eat the new foods, don’t replace the foods with something else that they do like or will eat. And don’t use threats or rewards to coerce them to eat.
It is frustrating to sit at a meal that you know to be delicious with a four-year-old who screams that they hate it and will not eat anything. I don’t have a great solution for this, other than earplugs. I also tried to train Finn to say “I don’t care for pot roast” rather than “I HATE POT ROAST,” since it at least sounds more polite, even if still combined with pushing the plate away and putting on an angry pouty face. (Parenting: It’s a long game.)
The vast majority of allergies result from eight food types: milk, peanuts, eggs, soy, wheat, tree nuts, fish, and shellfish. The incidence of these allergies has grown over time, perhaps as a result of better hygiene (so less allergen exposure early on), and clearly due in part to a lack of early introduction. Milk, eggs, and peanuts make up a large share even of these. We covered the peanut evidence earlier. Other research suggests a similar mechanism is at work for eggs and milk.14 The evidence on milk isn’t as convincing as the other two, but perhaps only because large studies have not yet
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Choking hazards—nuts, whole grapes, hard candies—are also to be avoided, for obvious reasons. Babies and toddlers do choke, and these foods are more likely to lead to choking. Grapes are okay in pieces, nuts are okay in nut-butter form, and hard candies are not recommended for other reasons. Cow’s milk is probably the most complicated recommendation, partly because it interacts with the allergen issues above. It is important to introduce some milk-based foods—yogurt, cheese—to avoid allergies. But milk itself is forbidden.
The evidence says only that you shouldn’t replace formula or breast milk with cow’s milk. As an addition to, say, oatmeal or cereal, it isn’t a problem.
Early exposure to allergens reduces incidences of food allergies. Kids take time to get used to new flavors, so it is valuable to keep trying a food even if they reject it at first, and early exposure to varying flavors increases acceptance. There is not much evidence behind the traditional food-introduction recommendations; no need to do rice cereal first if you do not want to. Baby-led weaning doesn’t have magical properties (at least not based on what we know now), but there is also no reason not to do it if you want to. Vitamin D supplementation is reasonable, but don’t freak out about
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Parenting a toddler also seems somehow more consequential than parenting a baby. As you see your child’s personality come through, you also start to see what they will struggle with. And you, all of a sudden, face choices—like screen time, or what kind of preschool to send them to—that seem like they may follow your child forever. On top of this, add the issue of discipline, which, suddenly, you have to think about, and it adds up to a much more complex parenting problem.
Failure to achieve these milestones at the time we expect, therefore, tends to worry parents. I think part of the issue is the focus on average ages—as in, “Most children walk around one year.” This is true, but it misses the fact that there is a wide distribution in what is typical.
Although not technically a milestone, baby’s first cold is definitely a moment for a parent. A bad one. Then there is baby’s second cold, baby’s third cold, and on and on. As the parent of a young child, you will spend the period from October to April drowning in a lake of snot. To many of us, it may seem that our child has a cold, or possibly some other illness, literally all the time. If you have two children or, god forbid, more than two, the winter months are a haze of repeated illnesses: you, kid 1, kid 2, your partner, back to kid 2, now kid 1 again. Usually there’s a dose of stomach flu
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Kids younger than school age get an average of six to eight colds a year, most of them between September and April.7 This works out to about one a month. These colds last on average fourteen days.8 A month is thirty days. So in the winter, on average, your kid will have a cold 50 percent of the time. On top of this, most kids end their cold with a cough that can last additional weeks. It adds up.
most doctors will tell you to come in if you are concerned, or if a fever lasts longer than a couple of days, or if your child gets worse after they’ve seemed to get better. Of these complications, ear infections are the most common. About a quarter of kids will have an ear infection by the age of one, and 60 percent by the age of four.9
You should also invest in a good general pediatrics book, which can do a more complete job at listing childhood symptoms than I can here. There are some references in the back; my favorite is The Portable Pediatrician for Parents by Laura Nathanson.
On the other hand, there is a tremendous amount of evidence suggesting that exposure to TV—and, more generally, to any screens—is associated with lower cognitive development. Researchers have shown that kids who watch more TV are less healthy and have lower test scores.
The American Academy of Pediatrics falls squarely in agreement with the second answer. They recommend no TV or screen time at all for children under eighteen months, and no more than an hour a day, ideally consumed with a parent, for older children. In addition, they recommend choosing “high-quality” programming, such as that featured on PBS.
Within this research, we can start to learn about the potential for infants and toddlers to learn from videos. The results are not very encouraging. In one example, children twelve, fifteen, and eighteen months old were shown either a live person or a person on TV demonstrating some actions with puppets.1 The researchers evaluated whether the children could repeat the action either in the moment or twenty-four hours later. In all three age groups, when kids watched an actual person doing the action, some of them were able to replicate it a day later. The video demonstration was much less
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The study’s authors noted that the most significant predictor of both how many words the children spoke and how fast their vocabularies grew was whether their parents read them books. Other authors have extended versions of this study to kids up to age two and found similar results.
If some quiet distraction is your goal, then your question is probably not whether TV is a learning opportunity, but whether it is detrimental. Does TV rot your child’s brain? Many studies say yes. For example, a 2014 study shows that preschoolers who watch more TV have lower “executive function”—meaning less self-control, focus, etc.9 An earlier study, from 2001, shows obesity is higher among girls who watch more TV.10 These are just exemplars—many, many research papers correlate more television with bad outcomes.
you are looking in this data for evidence that TV is bad, which is what the authors argue, high watching before age three seems to be an issue. However, watching TV at older ages doesn’t seem to matter. When the authors compared, say, the kids who watched only a little TV before age three and then a lot between ages three and five to the children who watched little TV before age three and little later, they found their test scores to be no different. If anything, the kids who watched more TV later had higher test scores than those who watched less. This throws some cold water on the idea of
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Your zero- to two-year-old cannot learn from TV. A three- to five-year-old can learn from TV. It is worth paying attention to what they are watching. The evidence is sparse overall. When in doubt, use your “Bayesian priors” to complement the data.
I was warned before I had Finn that this problem is especially acute if you have a daughter first, followed by a son. “Boys are slower with language,” warned my more delicate friends. Some less delicate ones said, “You’ll think your son is stupid.” People whose children were born in the opposite gender order told me how brilliant they thought their daughter was.
Take, for example, age 24 months. This data says that the average child—that’s the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—so, near the bottom of the distribution—has only about 75 words. On the other end, a child at the 90th percentile has close to 550 words.
One main takeaway from these graphs is the explosion of language after fourteen or sixteen months. Even the most advanced one-year-old has only a few words. At eight months, virtually no children have any words or gestures.
This problem is surprisingly common (or, rather, surprising for people who do not have children yet). Perhaps a quarter of kids will experience some degree of this during potty training.11 As weird as it might sound, a lot of kids like to poop in their diaper. Children who will successfully urinate in the toilet will nevertheless refuse to poop there, and unlike urine, bowel movements are something over which even young children do have some control.
By the age of five, 80 to 85 percent of children are dry at night (meaning not that they do not pee, but that if they do, they wake to use the bathroom).15 Doctors generally do not worry about lack of nighttime dryness until a child is six years old. Older than that, it is common to begin to consider some interventions—waking the child to pee, limiting fluids before bed, a wetting alarm. These continued issues affect perhaps 10 percent of children (mostly boys) and nearly all of them eventually resolve.
When I misbehaved as a small child, my mother’s solution was to ask me to “sit on the stairs and think about it.” I would toddle off to the stairs, sit for a while and contemplate my wrongs, and then return to explain what I did wrong and that I would not do it again. My mother congratulated herself on being an amazing parent who was deeply in touch with her child and didn’t need to resort to the kind of “Go to your room!” discipline that others practiced. Then my brother, Stephen, arrived. He did not want to sit on the stairs and think about it when he misbehaved. In fact, he loudly refused.
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Of course, once a child is in a tantrum, there is really no helping. Toddlers act out in other ways as well. They can almost seem like scientists—experimenting with what is possible. If I throw this half-eaten cauliflower stem at Mom and say, “I don’t LIKE IT!,” what will happen? If I hit my sister on the head with a book, will she hit back? Will an adult stop me? The constant experimentation can be exhausting and confusing, especially as your kid gets to the point where it is harder to physically restrain them.
This is the discipline-as-education philosophy espoused by French parenting (thanks, Bringing Up Bébé!). Discipline is not the same as punishment. Yes, there is a punishment component. But it’s in the service of raising better humans, not punishment for its own sake.
First, recognize that children are not adults, and you usually cannot improve their behavior with a discussion. If your four-year-old is taking their shirt off in the museum, they will not respond to a reasoned discussion about how you actually do need to wear a shirt in public places. The flip side of this—more important—is that you shouldn’t expect them to respond to adult reasoning. And as a result, you should not get angry the way you would if, say, your spouse was stripping in the museum and didn’t stop after you explained why they shouldn’t. All these interventions emphasize not getting
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Toddler discipline is, really, parental discipline. Breathe. Take a second.
An extension of this your-child-is-not-an-adult observation is that it is probably not a good use of your time to think a lot about why your small child is having a tantrum. There is a strong temptation to try to figure out what exactly is the issue—to try to get them to articulate the precise problems they are having. Even if they can talk, this is likely to be fruitless, since they probably do not know. Tantrums happen for all kinds of reasons. Working on disciplining the tantrum behavior is the goal. If they do not think of a tantrum as a way to react, they can work on developing other,
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Finally, there is a strong emphasis on consistency. Whatever the system you use, use it every time. If the consequence of counting to three is a time-out, then there needs to be a time-out every time,
As an extension, if you say no to something, you stick to no. If your kid asks for dessert and you say no, you cannot then later say yes if they whine for long enough. This basically makes sense—what do they learn from that? That whining will sometimes work. Let’s do more of it! And similarly, do not make threats you cannot carry out.
These approaches are helpful through older ages, but can be used as early as two. The books have some specific guidelines for time-outs—for example, they should be shorter at younger ages and do not start until after a tantrum has ended. And they do outline some key components that are useful for very small children. For example, do not let your child use a tantrum to get what they want. The evidence that these work is based on a number of randomized controlled trials.
In this way, these programs are not unlike sleep training. Many of the benefits are to the parents: lower stress, better relationship with your child, etc. (In this case, there may be some benefits at school also.) If what you are doing is working for you, great. If not, this might be worth a try.
One of the main tenets of these parenting approaches is that discipline should be reserved for actual bad behavior, not for things that are merely annoying. At least one of the books I read on this suggested earplugs. It is worth noting that for an older kid, if they know you are annoyed, they’ll probably do whatever annoying thing they’re doing more.
Spanking has not been shown to improve behavior and, indeed, has been associated with worse behavior in the short term and even through adulthood.
We can begin with a well-established fact. There is a large body of literature showing that children whose parents read to them as babies and preschoolers have better performance on reading tests later.
The results show large positive impacts of reading on children’s achievement. Children who are read to more as young children achieve greater reading success in school. One concern is that these kids just generally get more attention; this is a possibility, but the effects do not extend to math, so the authors argued that it does seem to be something about reading in particular.
In this particular study, the kids were put in the fMRI machine and then were read stories. What the researchers found was that children who were read to more at home showed more brain activation in the areas of the brain thought to be responsible for narrative processing and imagery. Basically, it looked like kids who were read to more were processing the story more effectively. How this links to later reading is unclear, and the study was small (fMRI scans are really expensive to run). Nevertheless, it provides some further evidence on the mechanisms that might drive effects.
This literature goes further and actually provides some guidance on how to read to your child. In particular, researchers have found that the benefits are bigger with more interactive reading.6 Rather than just reading a book, kids benefit from being asked open-ended questions:
A related question is whether you should favor one preschool “philosophy” over others. The three philosophies you will most commonly encounter in your preschool exploration are Montessori, Reggio Emilia, and Waldorf.
Montessori education focuses on a particular classroom structure and a set of materials. There is an emphasis—even in young children—on the development of fine motor skills. These schools generally refer to children’s play as “works.” Young children are typically exposed to letters and numbers and writing them in sand, counting blocks, and so on.
