McAlpine’s Law: Quacks rush to fill a vacuum

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NewbornScience doesn’t have all the answers but the money-making quacks are quick to fill the vacuum, writes MedicalBrief columnist Alastair McAlpine. The unique dependency of human infants on their caregivers makes the field of fussy and uncooperative babies irresistible to the pseudo-scientists.

McAlpine writes:

Human infants are fairly unique in how helpless and dependent upon their caregivers they are. The evolutionary price that had to be paid in exchange for our ever-expanding brains and heads, which began struggling to find a way through the limited pelvic circumference of our mothers, was high: we come out relatively ‘early’ and in a pretty functionless state from a survival perspective. In the animal kingdom, most other mammalian species are fully mobile within hours of birth; human infants only achieve stable ambulation at around 18 months of age. What all this means is that for the first few years of life, we are not only uniquely vulnerable, but unable to fully articulate our laundry-list of needs.

It’s a cliché, but nature abhors a vacuum and will rush to fill it. McAlpine’s Law states that pseudoscience will always rush to fill vacuums in scientific knowledge, and infancy is no different. Science doesn’t have all the answers, but the quacks sure do, and are more than willing to present you with ‘answers’ for your fussy or uncooperative baby. So, let’s look at some of the more common claims and see if there’s anything to them.

Placentophagy: Back in the 1970s, when ‘natural birth’ was all the rage, some of the proponents began advising mothers to eat their placentas. This was presumably based on the idea that many other species do it, so why not us? The notion seemed to die down a bit in the 90s but has come roaring back recently. Gone are the days when you had to eat it raw: now you can blend it into a smoothie, or have it lightly sautéed with some olive oil, or macerated and processed into easily-digestible capsule form.

Fans of the practice claim that there are a number of benefits, including unspecified ‘hormones’ that could help with postpartum depression. They also state that the placenta is rich in iron, which may offset the usually mild anaemia that accompanies pregnancy and labour. Is there any truth to these claims? Should you be contacting your local placentophagy service and forking over R3,000 for them to process your afterbirth?

The answer is: no. The idea that because other species do something, we should mimic them, is an odd one: dogs and rabbits engage in coprophagia (eating their faeces), but I doubt there’s much of a market for that, regardless of any slick marketing. Modeling our behaviour on male lions, who kill the offspring of other males when they move into a new pride, would certainly make divorces more dramatic, but would probably not be great for society in the long run.

In addition, there are simply no studies to back up the claims about effects on iron stores or post-partum depression. There is evidence, though, that eating your placenta could be a bad idea: they are not sterile and may be colonized by dangerous bacteria. Case reports of infants developing life-threatening Group B Streptococcal (GBS) infections in mothers who were negative for the infection during their pregnancies, have been described.(1)

Bottom line: there is simply no reason to pay someone a lot of money for the privilege of eating the placenta.

Reflux: Babies reflux. A lot. The mechanism is complex, but is due to a combination of anatomical and physiological factors, together with the fact that babies ingest their entire caloric requirements in the form of milk (the equivalent of an adult drinking 14 litres of milk daily).

In thriving, healthy tots, the odd bout of reflux is normal and nothing to be concerned about. As paediatric registrars, we would frequently refer to these babies as ‘happy refluxers’. There is evidence that normal babies reflux up to 30 times per day. The only time doctors become concerned is if there is evidence of reflux into the lungs, which is usually indicated by a failure to thrive, and repeated episodes of wheeziness, termed gastro-oesophageal reflux disease (GORD – or GERD for our North American friends).

Because parents don’t like to see their babies ‘spit up’, and unscrupulous pharmaceutical companies are always looking to make a quick buck from your fear, you may see advertisements exhorting parents to switch to special ‘hydrolized’ formula feeds for refluxing babies, which taste awful and are usually completely unnecessary. In addition, some doctors advise anti-reflux medication in the form of proton-pump inhibitors (PPIs). Worryingly, the trend towards prescribing these drugs has increased sharply in recent years.(2)

To be clear, for babies with true GORD, medication is warranted and necessary. But these patients are uncommon, and this should only be done when proper modalities have been employed to make the diagnosis.(3) Routine administration of drugs to infants with reflux-type symptoms is unnecessary, and may be harmful, because they radically alter the intestinal flora of the gut.(4)

Unless your baby is actually unwell, and has had a confirmed diagnosis of GORD made by a competent doctor after appropriate tests, the use of unusual formula feeds and powerful medications for a normal physiological process is simply not warranted.

Teething Beads: A common sight around the necks of teething babies, necklaces sporting brown Baltic beads make a frequent appearance at local custom-coffee shops on a Saturday morning. The idea is not, as I originally assumed, that the infants would chew on the beads to alleviate their gum irritation. Rather, the makers state that beads help by doing one or more of the following (depending on which manufacturer you ask): activating the chakras in the body, providing a powerful antioxidant effect, acting as an electromagnet, and (my favourite) that they ‘melt’ when in contact with the warm baby, releasing a small amount of succinic acid (a mild analgesic, apparently) through the skin.

Debunking each of these ideas, in detail, one by one, would probably take up an entire column. So Digitial Clubbing will be super quick: they don’t activate chakras because chakras have never been shown to exist, and even if they did, it is unclear how amber beads would affect them; they don’t have an antioxidant effect because they’re not ingested and antioxidants can’t pass through the skin; they have no measurable magnetic properties whatsoever; and succinic acid has never been shown to be an effective analgesic, but even if it were, there’s no evidence the beads ‘melt’ at skin temperature, and even if they did, there’s no evidence succinic acid can be absorbed through the skin.

The truth, though, is that parents don’t use these beads because they think they’re the epitome of scientific wizardry. They use them because they think ‘Why not? What’s the harm?’ The problem is that the beads pose a significant choking and strangulation hazard.(5) Like the infamous Power Bracelets, you’re paying a lot of money to watch confirmation bias in action (the discomfort from teething usually passes on its own).

Gripe Water: Invented in the 1800s by William Woodward to treat the rigors associated with malaria, gripe water contains a combination of herbs, sodium bicarbonate, sugar, and alcohol. Like all good pseudoscience, it has evolved with the times, and when malaria in infancy became rare outside of endemic areas, it morphed into a cure for ‘colic’.

It is perhaps worthwhile to have a brief digression about infantile colic. It is poorly understood and can be enormously stressful for new parents because endlessly crying babies are supremely upsetting. Parents will look for anything to settle their child, especially because science has few answers for them beyond the fact that colic is common and will resolve in 90% of infants by 4 months of age. Despite good evidence that gripe water has no effects on infantile colic,(6) it remains a popular choice for exasperated parents.

As a result, shelves in pharmacies are lined with various preparations of the stuff. It probably works because of the concept of ‘regression to the mean’: people seek interventions for health issues when they are feeling their worst, but were about to turn the corner, and would have improved regardless of the treatment. So whatever they happen to take gets the credit.

It also works because alcohol. And sugar. Both of these have sedating and soothing effects on infants. But whether you want to expose your baby to a concoction high in sugar and alcohol content (neither of which are particularly healthy) so early in life is an important consideration. Although many preparations of gripe water no longer contain alcohol, their manufacture is not regulated, so some still do, with concentrations as high as 9% (which is close to that of a bottle of wine).

At the hospital, we regularly see children with hypernatraemia (high sodium content in the blood) because of gripe water. This is a condition with potentially devastating consequences to the brain if severe and improperly managed. On the milder spectrum of side effects, gripe water may cause vomiting and constipation.(7)

Bottom line: it is highly unlikely that gripe water is beneficial to babies with colic, and there are legitimate concerns that it may be harmful. Best avoided.

Craniosacral Therapy (CST): Digital Clubbing has written about chiropractic before, and emphasised that under no circumstances should healthy babies have their necks or spines manipulated. So along comes CST, which is essentially ‘chiropractic-lite’. The idea is that gentle and subtle manipulations of the skull and sacral areas improve the flow of cerebrospinal fluid (CSF) through the central nervous system (CNS), thereby providing all manner of profound health benefits. Furthermore, many practitioners claim that child-birth itself impinges upon the bones in the skull and sacrum, which conveniently means that ‘most’ babies will benefit from the practice.

Now, straight off the bat, we run into a problem: the mechanism of CST makes little sense. We know that the flow of CSF is not influenced by the bones on the skull, but mostly by respiration.(8) And if there were a bony obstruction of the CSF, the infant would be unwell and would require emergency neurosurgery, not gentle touching of the scalp (which has been shown to have no effects on the bones whatsoever(9)).

When we actually look at the evidence, even journals of complementary medicine (which are generally kinder to alternative practices than mainstream journals) find little benefit, with a systematic review showing no evidence of efficacy.(10)

Having your head gently touched and massaged is very pleasant. But beyond the usual effects of touch therapy, there is no reason to pay someone to do this to your infant.

Summary: Raising a baby is hard work, rendered even more difficult these days through constant advertising and Facebook groups that declare that unless you are doing X or Y, you’re an inadequate parent. But at the end of the day, you need to be aware that what your beautiful infant needs, in no particular order, is: breastmilk (if possible), vaccines, lots of love, and patience. If you are even trying to implement the above, you’re doing great! Digital Clubbing salutes you.

Have a merry Christmas everyone. Thanks for reading. It’s been a privilege to write for you and I have been humbled by the overwhelming and generally positive responses.

Digital Clubbing will return in the new year.

References
A Human placentophagy: a review.
Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux.
Gastroesophageal reflux in preterm infants:
Streptococcus agalactiae meningoencephalitis associated with gastroesophageal reflux disease and chronic proton pump inhibitors use, in a 9 month-old infant: a case report.
&page=2&Chemical_display=1&Disease_display=1&tax=”][Infants wearing teething necklaces].
Colic in infants.
Gripe Water Administration in Infants 1-6 months of Age-A Cross-sectional Study.
Inspiration is the major regulator of human CSF flow.
Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement.
A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness.

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