Pediatricians -- as specialists in the health and development of children -- are the primary resource that parents rely upon for accurate information when they have questions or concerns about their children's health. Is it possible that pediatricians believe in some of the same health myths that parents and other caregivers believe in?

To answer this question, my colleagues and I undertook a study, the results of which are now available here.

Pediatric Pearls and Perils:
Gaps in Basic Knowledge of Pediatricians
That Pose Potential Health and Safety Risks to Children

A. Adesman, MD (1), R. Milanaik, DO (1), N. Kohn, MA (2), H. Papaioannou, MD (1), A. Cohn (3), and R. Pritzker (4)

(1) Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY; (2) Biostatistics, Feinstein Institute for Research, Lake Success, NY; (3) Washington Univ., St. Louis, MO; and (4) Univ. of Pennsylvania, Philadelphia, PA


Background:

Pediatricians are expected to be the “go-to experts” for parents regarding children’s health and development. Nonetheless, preliminary data from a pilot study of 35 local pediatricians suggested that many pediatricians also subscribe to common parenting myths. Although many parenting myths are relatively benign “old wives’ tales”, some out-dated medical beliefs or parenting practices pose a risk to the safety or well-being of young children. To better assess the magnitude of this problem, a study of 5,000 board-certified American pediatricians in primary care practice was undertaken.

Study Objectives:

•  Objective 1: To assess to what extent pediatricians subscribe to out-dated pediatric beliefs or parenting practices that pose a true risk to a child’s safety or well-being.

•  Objective 2: To assess to what extent pediatricians subscribe to commonplace and more benign “old wives’ tales”.

•  Objective 3: To determine if certain demographic sub-groups of pediatricians are more likely to subscribe to parenting myths.

Methods/Design:

The Pediatric Health Beliefs Questionnaire (PBHQ) was developed to assess pediatricians' knowledge about common parenting practices and beliefs. The PBHQ contains 48 statements regarding child care, first aid, and treatment of common conditions in children. Pediatricians were asked to identify to what extent statements were true, likely true, unsure, likely false, or false. Twelve of these health belief statements would put a child at risk of illness or injury if this information were relayed to a parent by a pediatrician. In addition to these “dangerous dozen” beliefs, the PBHQ asked about 16 relatively benign “old wives’ tales”. The PBHQ also included questions regarding the physicians' personal and professional demographics. The PBHQ was mailed to a random sample of 5,000 American-born board-certified pediatricians in primary care practice.

Results: Objective #1:

Responses were received from 1,002 pediatricians. Only 24% percent correctly answered all 12 items that posed a potential health or safety issue, and 13% of doctors got 3 or more items wrong.

Pediatricians’ Scores: # Correct Items for the 12 Beliefs that Pose a Risk to Child Health or Safety

# of Items Correct
(Max = 12)

# of Pediatricians

% of Total Sample
(N=1002)

12

239

23.9

11

389

38.8

10

238

23.7

9

99

9.9

8

22

2.2

<8

15

1.5

Pediatricians Reponses for the “Dangerous Dozen” Health Beliefs
(The 12 beliefs that may pose a risk to child health or safety)

Health Belief
(Each is incorrect as stated below)

# Wrong

# Not Sure

% Right

Honey may be given to babies under 6 months of age.

2.8

-

97.2

Aspirin may be used to treat a fever in children above the age of 5 years.

5.2

2.0

92.7

Teething sometimes causes high fevers.

2.4

0.7

96.9

Ice baths can be used to bring down a high fever in young children.

5.3

1.2

93.0

Chicken pox is not contagious before the rash appears.

6.0

0.4

93.6

Since colds are respiratory viruses, they are not often spread by contact with infected body parts or surfaces.

8.2

0.8

91.0

It is safe to put a infant to sleep on his side.

32.6

3.8

63.6

If a child has a seizure, place a soft object (such as a wallet) into his mouth to prevent choking or biting of the tongue.

4.6

0.8

94.6

To prevent earwax build-up, parents should carefully clean the ear canals with a cotton swab after a bath, when the wax is softest.

4.7

1.8

93.4

Rubbing alcohol is not absorbed through a baby’s skin.

31.5

10.8

57.7

The best way to stop a bloody nose is to tilt the head back.

1.9

0.7

97.5

Foods such as raw vegetables, whole grapes and hot dogs do not pose potential choking hazards for children 3 and younger.

1.7

0.2

98.1

Results: Objective #2:

Pediatricians’ Scores: # Correct Items for the 16 “Old Wives’ Tales”

# of Items Correct
(Max = 16)

# of Pediatricians

% of Total Sample
(N=1002)

16

175

17.4

13-15

536

53.5

10-12

308

30.7

8-9

49

4.9

<8

32

3.2

Do Pediatricians Endorse Old Wives Tales?

Old Wives' Tale

% Correct

% Wrong

% Not Sure

Sugar causes hyperactivity.

84

11

5

Reading in dark causes visual problems.

88

7

5

Eating chocolate causes acne.

90

8

2

Wait 30 minutes after eating to swim.

82

15

3

Drinking milk causes an increase in phlegm.

88

8

4

Carrots improve vision.

74

16

10

Wounds heal quicker when exposed to air.

52

33

15

Vitamin C helps ward off colds.

71

17

12

Playing Mozart will make babies smarter.

74

12

14

Sitting too close to TV will damage vision.

86

7

7

Sleeping with a night light causes nearsightedness.

84

9

7

Caffeine can stunt growth.

82

8

10

Iron in formulas causes constipation.

93

6

1

Adding rice cereal at bedtime helps babies sleep through the night.

90

7

3

A child with diarrhea should not be given dairy until the diarrhea resolves.

78

19

3

Results: Objective #3:

Chi-square analysis identified several demographic differences:

•  Population density:

“Dangerous dozen”: No differences

Old Wives’ Tales: Pediatricians in an urban setting were more likely to subscribe to old wives’ tales

•  # of children raised by the pediatrician:

“Dangerous Dozen”: No differences

Old Wives’ Tales: Pediatricians who have not raised children were more likely to subscribe to old wives’ tales.

•  Gender:

“Dangerous Dozen”: Male physicians were more likely to subscribe to myths that might pose a safety or health risk to young children.

Old Wives’ Tales: Female physicians were more likely to subscribe to old wives’ tales.

•  Number of years in practice:

“Dangerous Dozen”: Pediatricians in practice less than 5 or more than 30 years or more were more likely to subscribe to parenting beliefs that might pose a safety or health risk to young children

Old Wives’ Tales: No differences

•  Time teaching medical students and pediatric residents:

“Dangerous Dozen”: No differences

Old Wives’ Tales: No differences

Conclusions:

The majority of pediatricians (76%) endorsed one or more parenting practices that could pose safety or health risks to children. Pediatricians also subscribed to many “old wives’ tales”. In the future, pediatric residency programs and continuing education programs must address these gaps in pediatrician knowledge, some of which threaten the safety and well-being of young children.

A copy of these results is available by clicking here for the results report.

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