An Open Letter to the parenting babies and children's expo

In 2014 The Pregnancy Babies and Children's Expo decided to cut one of their scheduled exhibitors/speakers, Dr Bryan Symon from Adelaide. This decision was in response to parent backlash as he holds some extremely controversial views about newborn sleep and breastfeeding.

Later in the year they held a debate with "experts" from both the pro-sleep training camp and the anti-sleep training camp. The outcome of which was that they (PBC Expo) decided that there was no reason to prevent Dr Symon from speaking at the 2015 expo.

I attended his talk in Brisbane, which included some very interesting "facts", such as the claim that Red-Haired women can not breastfeed. A nurse who had never heard of him before and had been happily agreeing with everything he said, ending up standing up and asking how he could possibly spread such dangerous misinformation. This talk also saw Dr Pamela Douglas from The Possums Clinic being escorted out by security, after disagreeing with Dr Symon.
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This was my letter to the PBC Expo coordinators in the aftermath of the Expo and the stir Dr Symon's attendance caused online in the lead up.

First of all I would like to say that I have enjoyed your event over the last few years. I was also impressed that range of exhibitors at this weekend's Brisbane expo included a lot of small WHAM, and local business as well as a large number of businesses with Eco-friendly products.


It should not however come as a surprise that I was concerned to discover that Dr Brian Symon - The BabySleep Doctor was presenting.  

It did however come as a surprise to me. By which I mean that, last year it was all over the Internet and the media for weeks before the Melbourne Expo that this doctor was scheduled to speak, you responded within a day to parents concerns and petitions, and removed him from the speaker list. This year I guess everyone assumed we had already dealt with the issue, and that PBC expo would not be booking him again. So I was actually sceptical when I first saw the post in my newsfeed saying that there was a petition to stop him speaking. I assumed it was the petition from last year being re-shared for some reason. Unfortunately I was wrong.


My concern has only deepened since yesterday after seeing your company's response, or in most cases lack of response, to the hundreds of concerned voices that asked why you were featuring him again. 


Your social media team saw fit to delete comments asking why he was featured such as this one:

replied to concerns by posting an article about the "Mummy wars" and frequently stating that cyber bulling would not be tolerated, nor would personal attacks - despite no evidence of cyber bulling. 

Ignored questions that asked what your response would have been if someone had informed you that a product one of the exhibitors was showing was dangerous, and refused to answer anyone who questioned your team about your duty of care towards your customers.

Stated that you had Dr Symon's work checked by other health professionals (great), But would not elaborate on this when asked. You did state that you will be sharing the podcast of your May debate, in the coming weeks, whilst that may be helpful for patrons of your Melbourne event, it has not been helpful for those attending the Brisbane event.

Commented that you had a balance of speakers at the Expo.

​Whist there was a second talk about Breastfeeding, Dr Symon was the only speaker about baby sleep (in the context of behaviours not safety). That isn't particularly balanced. 


Stated that You received many letters of support for Dr Symon - well of course you did. Any parent who has paid large amounts of money to see him and has then implemented his strategies willingly is going to support him. They have an emotional and financial investment in him and his practices. They most certainly do not want to hear people speak out against him because to admit that his critics have a point means questioning their own actions and the way they have parented their child. No one wants to believe that they have done something that could be harmful, especially if a doctor advised them to do it. They are employing backfire effect bias in order to avoid having to face the possibility that an action they took could have harmed their child. In fact they are displaying multiple cognitive biases (Confirmation bias, post purchase rationalisation, Bayesian conservatism, Semmelweis Reflex, system justification, rosy retrospect.)


Repeatedly said that your Facebook page is not a place for a "war of opinions", which is completely fair, except this has nothing to do with opinion and everything to do with the scientific validity of this doctors techniques. 

Made multiple comments stating that you as an organisation believe in presenting parents with information so that they can make a choice, and that information empowers parents to make their individual choices, having weighed up all the options and their situation. Again, that is completely fair, except, this isn't a situation where parents have been presented with all the information so that they could weigh it up and make empowering choices. This is you choosing to allow a Doctor who holds highly controversial views, to speak and exhibit without any alternative views presented by speakers, and without informing your customers that his views are controversial and contested. Additionally when concerned citizens voiced the fact that his views are not supported by major child health bodies, you accused people of attacking Dr Symon. ​

I truly hope that you would never choose to have a speaker or exhibitor who told parents that smoking in pregnancy is not harmful, and is in fact beneficial. Or that it was appropriate and useful to put Cola or Milo in babies bottles. Yet these are both things that doctors advised only 50-60 years ago.

As scientific knowledge changes, things that used to be considered perfectly acceptable, are no longer. Where would we be today if in the 1970's people had claimed that smoking in pregnancy is a legitimate parenting choice, or that the sharing of information proving smoking to be dangerous was "a war of opinion"?


I would hope that you would want the exhibitors at your expo to use up to date knowledge in infant psychology, biology and neuroscience to underpin their practices. Yet in Dr Symon's speech yesterday he talked about restricting friends and family from holding or even visiting your baby so as not to cause the baby over tiredness or to learn sleep cues such as rocking or  singing. He practically relayed this advice from 1913 (yes, an entire century ago) word for word.


I would hope that you would never support any exhibitor promoting or even selling books by Michael Pearl, who details instructions for how to select the right size and weight of switch to hit your baby with.  


What about Gary Ezzo, who's original edition of his book had to be recalled after the AAP issued warnings about it causing infants dehydration, failure to thrive?  This happened all the way back in 1998, and yet Dr Symon is advising that a newborn baby should only be fed (their only source of both food and hydration - as well as the nutrients needed for growth and brain development) a of maximum two times in the 12hrs he "expects his babies to sleep at night". this is despite the fact that a newborn baby has a stomach with a maximum capacity of 60mls at one week, and 150mls at one month. He clearly said in his talk yesterday that "there may be one or two feeds in that 12hr period". This goes against recommendations by La Leche Legue, Australian Breastfeeding Association, World Health Organisation, Baby Friendly Hospitals Initiative and all the paediatric associations who all state that babies should be fed on demand, even if formula fed, and that until they have regained their birth weight they must be fed at least every four hours or they will be at risk of dehydration and not gaining weight. 


He claims that his only issue with breastfeeding is the push for exclusive breastfeeding. Thus he recommends not only mixed feeding, but introducing solid foods at 8-12 weeks. This is a strange stance to take as regardless of breastfeeding or formula feeding status the 'exclusive' caveat still applies. Breastmilk and formula are the only foods that should be given before 4-6months.


Dr Symon also stated the following (proven to be) incorrect beliefs about breastfeeding, presenting them as if they were fact.


Up to 95% of women are unable to exclusively breastfeed


actually as any LC will tell you the true statistics are the reverse - only around 5% of women are biologically incapable of producing enough milk.  Whilst 96% of Australian women initiate breastfeeding, the fact that by 3 months only 39% will be exclusively breastfeeding has far more to do with the type and quality of support/advice they receive than the mother's biology. 


That supplementing with formula is helpful in the breastfeeding relationship, and allows mothers to increase their milk supply (by up to 50%) as they are less stressed about meeting their baby's nutritional needs. Therefore formula should be given in the first few days whilst waiting for the milk to come in, and mothers can rest assured that giving formula top ups whenever they feel their supply is low will help their supply to grow.


La Leche Leauge's myths article, Best For Babes Foundation and any IBCLC will quiclky dispel this claim. 


when speaking about the variable nature of supply, He also only talked about mothers not being able to produce enough, or enough high quality milk. There was no mention of issues that can masquerade as or cause low supply such as tongue tie, lip tie, high palate, cleft palate. No mention of issues that can make baby appear to be hungry, such as cluster feeding. Or of issues that stop them from gaining weight such as reflux and allergies. There was not even a passing comment that suggested he investigates the cause of a "supply" issuebefore advising formula top ups. There was also no mention of the WHO's guidelines that donor milk should be considered before formula. How to increase supply, or how mum's can tell if their baby is getting enough milk. ​
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I fail to see how this is giving parents the information they need, to empower them to make the choice that is best for them. 

​In fact he made the blanket statement that all babies should have formula top ups, starting from a few days old, and his website says that  babies will require complimentary feeding of solids by 12 weeks. 

Which brings up yet another area in which Dr Symon's advice shows a lack of knowledge of current research. The Humam Micro-Biome project has made multiple findings in the last couple of years that suggest that gut health has a direct impact on the future health of not only the individual, but also their ancestors through hereditary factors and epigenetics.  Advising all clients to introduce formula without an actual medical need for it, completely ignores and flies in the face of this research. (Microbiome Journal, The Milk Meg)

He states in his response to our concerns, that the research shows it is best to introduce allergens between 4-6months of age. This is true, but he clearly tries to use this fact to support his recommendations to introduce solids from 8 Weeks.
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How is it evidence based medicine to introduce solids two whole months before the earliest time recommended in the scientific literature?

​He also makes the bold statement that boys tend to need solids earlier than girls. He doesn't even attempt to prove this claim with evidence, it is merely based on his anecdotal assumptions. So is his stance that the vast majority of babies he sees are interested in solid food by 8-12weeks. His claim that sudden night waking around 8 weeks old is proof that baby requires solid foods, has been disproved many times, by many scientists, and completely ignores the growth spurts and developmental leaps that occur at this stage. This also ignores the chocking/aspiration risk of introducing solid foods before baby can hold their head independently, as well ignoring as other well established signs of solid food readiness. (double their birth weight, can sit unaided, can pick up objects and put them in mouth, has lost the tongue thrust reflex, is able to open and close their mouth and swallow with conscious control and can turn their head away or clamp their mouth shut to indicate disinterest)


As for his claims on sleep:


He stated that his goal is to have babies sleeping 12hrs a night by two-three months old. This goal, is the crux of his approach. All his advice on feeding, behaviour modification and interaction with the baby is designed to support this goal. A goal that is completely incompatible with everything we know about infant biology, anthropology and evolution/history. He correctly stated that infants have short sleep cycles, and will arouse at the end of these cycles. What he failed to mention is that this is biologically normal for all babies throughout the world, and only western parents in the last 200 years try to "fix" it. It is most likley a protective evolutionary trait, and SIDS research shows that  a baby sleeping for longer and deeper stretches increases their risk of SIDS death.  The whole point of the baby having short sleep cycles is to keep them alive, by ensuring they wake up and thus breathe. 


Whilst he did not explicitly state that he expects babies to sleep in their own bed, in their own rooms, he did however make the incredibly fanciful claim that babies expect and require a flat stable surface to sleep on. I would really love to see his evidence for that that claim, since even in 2015 the majority of babies worldwide spend their day sleeps napping in arms or in a carrier and their night sleeps on or beside a parent or sibling. I am quite sure that the mothers in the entire continents of Africa and Asia as well as large parts of Europe would be very willing to disprove his claim. Even accounting for modern western parenting, it is a strange leap of logic to claim that babies are unable to sleep adequately unless on a flat stable surface. 


This insistence on a flat stable surface,  his  disapproval of in arms settling, his desire to see babies sleep for 12 hours straight, and his belief that there is no need to feed the baby more than a maximum of twice; suggests that he requires parents to put their baby in a cot or bassinet in it's own room from birth.  (Note I did not say, lock babies in their own room, or anything about crying. Just that he encourages them to be in a separate room to the parents.) This goes against SIDS guidelines which state that the safest place for your baby to sleep is in the parents room, in sensory proximity. 


Considering that he has already urged parents to give formula top ups, and encourages parents to teach their child to sleep for extended periods at a time, his clients' babies are now exhibiting three separate potential SIDS risk factors.


I am sure that if you had someone speaking about water awareness and they told parents that they could and should have an unfenced pool, not to worry about designating an assigned adult to watch the children, and that there is no need to teach children to swim; you would kick them out immediately, ban them from your events for life, and report them for child endangerment.
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Yet you seem to believe that following safe sleep practices is 'Parental Choice' and that it is perfectly okay for a man in a position of power and authority to tell pregnant and sleep deprived women that they should put their baby in a situation that is increasing their risk of death from SIDS. 

​Other claims:

On his websites Research page and his blog he states that in a 5year follow up there were no divorces amongst the parents who followed his program. The insinuation is clear, that following his advice is important not only for your baby, but also for your marriage. Blaming babies for ruining marriages, and inferring that safeguarding your marriage requires you to follow his advice: classy. (Yes, that is sarcasm. I was trying to avoid using any, but really!? That is baffling)


Dr Symon states that his methods reduce maternal stress and depression. This may be true, but there are plenty of other ways that such reductions can be achieved. He also makes numerous claims that his work is based on the highest level of evidence and that his own research is one of only two accepted by the Cochrane review. Dr Pamela Douglas, disagrees. 


In multiple places on his website it states That if a baby is well fed and not overtired there is no reason for them to cry. In his talk on Sunday he also stated that babies "wake up" to love  in The second month of life. This makes it quite clear that Dr Symon believes that a brand new baby has no concept of love, or any possible reason to cry other than hunger or tiredness. 


In his blog post titled "preparing for the birth of your child" Dr Symon's says:

I offer the final few tips to help mothers and new children get the very best start in life:

• After the delivery, if it is possible offer the baby a breast feed (this feed may be quite short – 3-4-5 minutes per side). Then put the infant down before he or she becomes tired. We want to avoid the baby being overtired within the first 60 minutes of life.
• From the first feed, offer the breast anywhere between two to four hourly – on demand – followed by a top-up of formula from a bottle. We are avoiding hunger while waiting for your milk to come in. Milk often comes in about day 3 after giving birth.
• The length of breast feeds increases by about two to three minutes per feed per day. Aim to feed something like 10 minutes per breast by day 3 or 4. Most babies can empty a breast in about 10 minutes and prolonged feeds will increase the risk of both an overtired baby and sore nipples.
• Once your breast milk arrives the baby will have less interest in the bottle. This technique protects the baby from hunger and INCREASES breast feeding success rates (while protecting your nipples from trauma and pain).

​None of these tips are supported by the Baby Friendly Health initiative, La Leche League, the ABA, or research on the "magical hour"

In his blog post titled "Response to Facebook post on starting solid foods" Dr Symon says: ​
So let me start with the basics which are well established.

• The best evidence to-date states that allergenic proteins and in particular peanut should be started by 4-11 months.
• To do so decreases the risk of peanut allergy by about 70-86% for high and medium risk infants. Please see the LEAP study published in the New England Journal of Medicine in February 2015.
• Approximately 3% of Australian children have peanut allergy. This converts to approximately 9,000 children per annum who develop this important allergy per annum. In the large majority of these children it could have been avoided by earlier exposure to peanut protein.

The risks of starting solids early are not at all well established. The only evidence which I have been able to find relates to wheat protein which if offered too early (i.e. before about 4 months), is associated with an increased risk of coeliac disease. As a result, I do not introduce wheat protein before 16 weeks.
The solids which I introduce include potato, apple, pear and pumpkin. There is no suggestion in the literature that these food products cause any health issues in humans.
So if there is no risk to using these solids the focus then moves back to the issue of breast feeding exclusively.

​I honestly don't even know where to begin with this. It is truly 'Jumping the Shark' territory. 


His whole premise revolves around the presumption that if a food is not a known allergen then it is safe for everyone and can be introduced at any age. This however is simply not true.


1. Any food can be an allergen for an individual child. I for example, am allergic to balsamic vinegar, caffeine, broccoli, Pasito/passion fruit flavouring and Lebanese eggplants. You won't find any of those thing listed in the literature because they are not common allergens, but that doesn't make me any more able to tolerate them.


2: Cow's milk is one of the 8 most common allergens, yet Dr Symon encourages the use of formula top ups with no mention of the potential for this to cause allergies.


3: Allergy prevention is not the only reason for the 4-6month old minimum age recommendations. Once again, developing research on the Micro-Biome backs up the recommendations to wait as the introduction of solid foods alters the make up of bacteria in the gut (drastically in the case of mix-fed and formula fed babies). Thus the timing of solid food introduction has potential impacts on future long term health and even epigenetics. 


4: the CDC, FDA, AAP, NHS, ABA, La Leche Leauge, WHO, APS, ESPGHAN, ASCIA, EFSA and EU all state that solid foods should be introduced after 4 months of age. Most agree on 6 months.


In summary, despite his frequent ascertains that his work is highly proven and research based, his techniques go against research, recommendations and position statements by key bodies Internationally. They put babies at an increased risk of SIDS, dehydration, and chocking. Ignore evolving research about the effects of gut health and development on future health outcomes. Makes strange leaps in logic such as; if a food is not a proven common allergen it can be introduced at 8 weeks without any impact, or, that boys are less tolerant of hunger than girls. Makes statements that parents in the majority of the world would find laughable. Overstates the acceptance of his research, and completely ignores the possibility of any fixable causes for breastfeeding issues. 


Once again, I fail to see how highlighting this Doctor as a speaker and your continued stance that anyone who raises concerns is entering into a war of options, allows your customers to make informed choices.


Regards
Nicole - Integrity Calling