The concept of modern medical lore specific to pediatric care has been on my mind a lot lately. In fact, I’m pretty sure it will be the focus of my talk at the upcoming Northeast Conference on Science and Skepticism this summer. The addition of “modern” is meant to differentiate what I’m addressing from folk medicine, but the distinction isn’t clear.

Folk medicine, as defined in the William A. Wilson folklore archives at BYU, doesn’t sound all that much different from some of the claims I encounter regularly practicing conventional modern medicine:

Folk medicine could be considered any sort of medical treatment that is part of a cultural tradition that emphasizes anecdotal evidence and tradition rather than any kind of scientific authority.

I encounter modern medical interventions that fulfill this criterion on a daily basis. And I’m not talking about standard SBM fare like acupuncture and the usual irregular medical suspects. There are numerous examples of widely accepted pediatric medical beliefs that are utterly lacking in plausibility and non-anecdotal evidence and that are passed down from one generation of medical professionals to the next, adrift on the currents of their cultural inertia.

Teething results in teeth

I’ve discussed a few examples of this in previous posts. Teething is one of them and it’s a particular source of frustration. The end result of this week-long process is a tooth, not the myriad symptoms, such as fever, diarrhea, and significant pain, commonly attributed to it. Parents and pediatricians alike are unable to successfully predict when a child is teething until the tooth is visible erupting from a child’s gums.

The false belief that teething results in anything other than teeth and at most some mild discomfort, although even this is questionable, can be harmful. And it is often enabled by pediatric medical professionals. At least our interventions tend to be safe. We may no longer recommend dangerous “treatments” such as lancing of the gums in an effort to ease the tooth’s transition, but children are still exposed to treatments where risk outweighs benefit by orders of magnitude.

Burping advice is full of hot air

Another example of pediatric medical lore, and one which I have not discussed in a previous post, is burping. Burping is the almost ubiquitous and bizarre practice of taking a recently fed baby, or interrupting an actively feeding baby, and slapping them on the back until they burp. It’s so stupid even a chiropractor can do it.

Babies, their parents are frequently told by pediatricians, swallow concerning amounts of air during feeding. This swallowed air supposedly becomes trapped against its will in the stomach, resulting in discomfort, and increases the likelihood that a baby will have problems with reflux. Parents are advised to burp after every feed even if the baby shows no signs of discomfort, and sometimes 2 or even 3 times during a feed if a child is prone to spitting up or colic, whatever that may be.

The problem with this advice, and the belief it is based on, is that it is entirely made up. First off, the concept of swallowing large amounts of air during feeding is suspect. The esophagus, unlike the trachea, is not propped open by cartilage. It is compressed except during swallowing, when the cartilaginous epiglottis falls into place over the trachea and the esophagus is the path of least resistance. Air in the oral cavity during swallowing is more likely to escape through the nasal passages than to enter the esophagus.

A baby does not take air into their esophagus any more readily than readers of this post do when swallowing. Sure babies may swallow a small amount air while feeding but there is absolutely no plausible reason to blame fussiness or spitting up on this other than the desire to blame something, anything for what is essentially a random process in the vast majority of infants. Also babies don’t need help burping.

There is nothing about an infant’s physiology that prevents them from burping on their own. In fact, their physiology probably makes it easier for them to burp than older children. Infants, because of a general immaturity of the nervous system and gut, are prone to what have come to be labelled as “transient lower esophageal sphincter relaxation events” where the muscular valve between the esophagus and the stomach relaxes for no good reason. This tends to happen after feeds and it is the primary reason why babies spit up as much as they do.

So babies will burp regardless of whether or not we whack them on the back after feeds. The common anecdotal observation that burping helps babies to burp is understandable however…because human brain. Babies are typically burped after every feed, but if a parent were to keep a strict burp log and, for example, only burp their baby after every other feed, they would likely see that burping tends to occur regardless.

But is there a downside to burping? There actually appears to be one. In addition to wasting time and potentially agitating a calm or sleeping infant, burping may actually increase the likelihood that a baby will reflux after a feed. There is grand total of one study addressing the practice of infant burping in the medical literature, and it shows that burped babies are significantly more likely to spit up and no less likely to have episodes of fussiness.

For a different perspective, here is a 2007 study published in Medical Hypotheses that explores the potential role of infant burping as a means of reducing the risk of SIDS. This is absurd. Just for the record, the AAP may recommend burping all babies after every feed, proving that even they aren’t impervious to acting sans evidence, it does not include gas as a modifiable SIDS risk factor.

Conclusion: More science!

Medical lore is commonplace in modern pediatric medical practice. I focused on teething and burping in this post as just two of many possible examples of false beliefs passed down from generation to generation. The factors that promote the continued belief in modern medical lore, such as cultural inertia and confirmation bias, are essentially no different than the factors that play a role in the acceptance of so-called alternative medical practices such as acupuncture and chiropractic.

The harm caused by belief in entities like teething and burping, and perhaps most examples of modern pediatric medical lore, is thankfully minimal. But they serve as excellent examples of how vulnerable we are when it comes to belief in nonsense, even when there aren’t financial incentives or the bias that comes from an unscientific worldview. Is it truly any wonder that even the most prestigious academic institutions are now promoting abject pseudoscience?

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician practicing at Newton-Wellesley Hospital in Newton, MA, and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @skepticpedi and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey.