The Truth About Studies

Time To Get Your Preschooler Plastered?

Editor’s note: Originally written August 15th, 2021. Due to technical difficulties, unable to be posted to the blog hosted by my practice, so I’m posting it here instead.

A pediatrician’s duty is to advocate for the health of his patients. While the parents may be the ones setting up the appointments, asking the questions, and paying the bills, they are not our true clients – their children are. We as doctors owe it to the children to stand up for them and do what we can to help them, even if in some circumstances that may hurt the parents’ feelings. For example, it would be a violation of my duty to tell a parent what she wants to hear, that snuggling together overnight with her newborn in their king bed is a safe and wonderful bonding experience; I am morally and professionally obligated to tell her the truth, that co-sleeping is dangerous and may put her child’s life at risk.

              Many of these health and safety issues arise from experience, common sense, and wisdom. Not all of them have rigorous studies to back them up. Some people may look at that absence of studies and view it as an absence of evidence. In fact, if you understand how studies are designed and funded, it is very often the absence of any relevant studies that is the most overwhelming evidence there is. The lack of studies of something being harmful is proof that something is harmful? That doesn’t seem to make sense! Let me illustrate. Suppose a person wanted to prove that drinking a few cans of Miller Lite after dinner is the best way to get a 5 year old to go to sleep on time. I hope you can all appreciate why such a study would never, ever get funded or approved. So, when a dad comes to me and says, “you know, I never fail to fall asleep after a few brewskis, I was thinking of trying it out on my kindergartner,” I can firmly and confidently dissuade him from the notion, even though I know there is no relevant research on the matter.  

              Which brings me at long last to the mask debate. Look, I’m on Nextdoor too, I see the long angry threads, I know I’m not going to change anyone’s minds on the larger issue by now. However, when I see deliberately misleading information being put out by fellow doctors, I feel it is my duty to speak out on behalf of the children I am sworn to protect. Last week, The American Academy of Pediatrics put out a very carefully worded statement on masks for young children, saying “there is no evidence that use of face masks prevents or delays speech and language development.” I agree that there is no evidence on this, for the same reason there is no evidence that Natty Light harms pediatric sleep rhythms. The idea of perpetually masking toddlers is so self-evidently harmful to their development that no research board on the planet would ever have permitted such a study to proceed. Of course your babies need to see the smiles, frowns, and countless other facial expressions of their loved ones, teachers, and classmates if they are to have any chance at normal development. The American Academy of Pediatrics statement is like saying, “well, folks, there’s no evidence that chaining teenagers to a radiator in the basement for a year will significantly harm their mental health.” Again, sometimes the very absence of evidence is all the proof you need of the severity of the harm.

              I know some parents out there understandably want me to tell them what they want to hear. They would love for me to tell them that masking their young children and the adults who care for them for hours and hours each day will provide all the supposed safety benefits of masking without any significant social/developmental downside whatsoever. But I can’t tell you that. I can’t tell you what you want to hear. I have a duty to advocate for your children, even if that means telling you hard truths. After all this time, no matter what I think about the lack of danger to children from Covid, I cannot make the masking decision for you. I understand these are very difficult decisions that every parent has to make these days. I just want you to know that the pro-masking decision is not without consequences, regardless of whatever carefully worded statement you may hear from other doctors. Any doctor out there who tells you what you want to hear, instead of telling you the hard truth, is a doctor you should not trust. Our job is not to soothe guilty parents’ consciences, it is to protect their children. Mask or don’t mask your kids, that’s up to you, but do so knowing the full truth: I will stake everything I have, my career and reputation, on the long unstudied truth that little ones have a profound developmental and social need to see uncovered faces. Thank you for taking the time to read this, and good luck in the vicious Nextdoor arena. In closing, since I’m writing this on a beautiful Sunday, let me end with the words my pastor quotes to end our services every week: “The Lord bless you and keep you; the Lord make his face to shine upon you and be gracious to you; the Lord lift up his countenance upon you and give you peace."

Update: Since writing the above, it has come to my attention that the AAP, until this month, used to have info sheets on its website telling parents of the importance of face time for their babies. The day before they came out with the above statement, they scrubbed that completely uncontroversial developmental guidance from their website. Archived versions of it can still be found around the internet, including here.

Update 2: This fair summation of the science around masking children, from New York magazine, is well worth reading. I would like to call your attention to one quotation in particular:

“There are very good reasons that the World Health Organization has repeatedly affirmed their guidance for children under 6 to not wear masks,” said a pediatrician who has both state and national leadership roles in the AAP but who wished to remain anonymous because they did not want to jeopardize their roles in the organization. “Reading faces is critical for social emotional learning. And all children are actively learning language the first five years of life, for which seeing faces is foundational,” the pediatrician said.

If you are wondering why more pediatricians aren’t speaking out about the AAP’s absurd new guidance, re-read the above paragraph. This is apparently a prominent pediatrician, stating basic developmental knowledge that all pediatricians agreed on wholeheartedly for the past several decades, yet she is requesting anonymity out of fear of what the AAP will do to her for stating the obvious truth. Is this what you, as a parent, want in the organization that is supposed to help guide and heal your children? Is that what open scientific inquiry looks like? Feels a lot like something else to me.