Pediatric mythology: Can pediatricians separate fact from fallacy?

Most pediatricians spend a good deal of our “quality time” with parents debunking the many “facts” they’ve learned about fever, immunizations, medications, foods, and a variety of childhood illnesses. I wrote about this in an article that was published in Contemporary Pediatrics almost a decade ago (Pediatric urban legends: Debunking common myths, March 2001) that detailed and discussed more than a dozen myths that were perpetuated by parents as well as by some pediatricians.

Recently, pediatrician Andrew Adesman, MD, asked 35 pediatricians in the New York metropolitan area to respond to a questionnaire that contained 52 health statements-12 of which were true and 40 that reflected health myths or misperceptions. None of the pediatricians correctly identified all of the 40 myths as being false. Twenty of the 35 pediatricians (57%) failed to recognize 10 or more of the 40 health myths as being false, and 4 of the pediatricians (11%) failed to recognize at least half of the myths as being false.

Based on this pilot study, Adesman sent a similar questionnaire to a random sample of 5,000 American-born, board-certified pediatricians in primary care practice to determine how many myths pediatricians believed. The results were striking. Most of the more than 1,000 pediatricians who responded to the survey (76%) endorsed 1 or more parenting practices that could pose safety or health risks to children, and 13% got 3 or more questions wrong.

These myths included:
• Honey may be given to babies under 6 months of age.
• Teething sometimes causes high fevers.
• Ice baths can be used to bring down a high fever in children.
• Since colds are respiratory viruses, they are not often spread by contact with infected body parts or surfaces.
• Foods such as raw vegetables, whole grapes, and hot dogs do not pose potential choking hazards for children aged 3 years and younger.

The survey also revealed that many pediatricians subscribed to some “old wives’ tales.” Only 17% achieved a perfect score, and 39% got 4 or more questions wrong. The old wives’ tales included:
• Sugar causes hyperactivity.
• Reading in the dark causes visual problems.
• Eating chocolate causes acne.
• Wait 30 minutes after eating to swim.
• Drinking milk causes an increase in phlegm.
• Carrots improve vision.

When Adesman looked at the demographics of the respondents, he found that pediatricians who endorsed practices that could pose health or safety risks were more likely to be male and tended to be in practice either less than 5 or more than 30 years. Those who subscribed to old wives’ tales tended to be female, to practice in urban settings, and to not have raised children of their own.

WHY DO THESE MYTHS PERSIST?
So why do pediatricians continue to perpetuate medical myths that have no scientific basis or have actually been proven to have no merit at all? There are likely many reasons, but key among them is that despite our interest in “evidence-based medical practice,” only a fraction of core medical knowledge is based on solid scientific evidence. The majority of our medical “truisms” are derived from logical assumptions derived from our understanding of anatomy and physiology.

Pediatricians also tend to accept the sage advice given to us by our mentors as gospel and pass unsubstantiated pearls of wisdom along to younger generations. So in effect many medical old wives’ tales are really “old pediatricians’ tales” that have never been disputed.

JUST THE FACTS
Adesman is a developmental and behavioral pediatrician. He has written a delightful book, Baby Facts: The Truth About Your Baby’s Health From Newborn Through Preschool. It’s available as a digital download via your Kindle, iPhone, or iPad and is a great read, discussing more than 150 pediatric myths. The Web site, www.babyfacts.com, has an online quiz that allows pediatricians to test their knowledge of medical myths. I suggest that you take the Babyfacts Quiz to determine your proficiency at myth busting. If your scores are similar to the pediatricians’ who responded to Adesman’s survey, you may need to revise the advice you give to your patients’ parents.