MaryAnn,

Your topic of study is a very interesting one.  I'm glad you are looking at
this.

In my experience, pediatricians feel qualified to advise parents on many
issues for which they are not truly educated or experts, but go by their
own personal experience or philosophy.  These include night waking, place
where child sleeps, discipline (many pediatricians seem to be strong
advocates of behavior modification and time-outs), weaning, dependency and
separation.  There seems to be a very paternalistic concern that mothers
not allow babies to "manipulate" them ("don't let him use you as a
pacifier"), and that mothers need time away from their babies and babies
need to learn to deal with separations.  Also, a concern that mothers not
be made to "feel guilty" in the face of their baby's needs for them.  In my
experience, family practice physicians have less rigidity in their advice
in these areas.  And certainly not all pediatricians fit into one category.

I do not believe that much time in medical school is devoted to these
topics, or that research underlies many of the recommendations given.  Yet
it has become common for parents to turn to the pediatrician as the expert
for advice on all these aspects of child rearing.  One physician, (I
believe her name was Naomi Bluestone), in an article many years ago,
pointed out that physicians tend to suffer from what she labeled a
"generalization of expertise."  By dint of their expertise in medicine,
they feel qualified to speak with authority on all topics, even those
outside their range of knowledge.  In addition, physicians, like all of us,
have a stake in getting people to make the same personal choices as they
(we) have made themselves (ourselves).  This influences advice on lots of
topics (cotton vs disposable diapers, pacifier use, work outside the home
vs stay-at-home mothering, bottle vs breast, type of schooling, meat-eating
vs vegetarianism).  When others make the same decision as we do, it
validates our choices and helps soothe our own anxieties.
Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, Wisconsin
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