Mother knows best

BMJ 1996; 312 doi: (Published 22 June 1996) Cite this as: BMJ 1996;312:1616
  1. Tony Smith

    This year is the 50th anniversary of the publication of Dr Benjamin Spock's Baby and Child Care, which in successive revised editions has sold over 43 million copies. Single handed, Spock transformed the way that parents brought up their babies, giving them confidence to make their own decisions about feeding, soothing, loving, and training their children.

    In the first half of this century advice on the care of babies was dominated by psychologists who asserted—with the confident arrogance of evangelists—that mothers should use the discoveries of behavioural science to condition their babies. They should feed them by the clock at six o'clock, ten, two, six, ten, and two; and babies should be picked up only to be fed or have their nappies changed. Picking up a crying baby would only encourage it to cry more so that he or she would be picked up more often. Babies should stay in their cots.

    Similar unbending advice was given about toilet training and the importance of starting it early. Here in Britain professional nannies would tell miserable mothers that “Mr Gladstone was clean and dry by 9 months” without speculating about the effects this may have had on his sometimes bizarre behaviour as an adult. Dr Spock turned all this teaching upside down with his advice to “leave bowel training almost entirely up to your baby…a child will completely train himself sooner or later if no struggle has taken place.”

    In a recent interview for the New Yorker Spock explained that his prime concern had been to give parents confidence to trust their instincts. When teaching young paediatricians he had emphasised the importance of their being nice to parents. Reassurance was more important than elaborate explanations of variations in child development and their psychological basis.

    The various editions of the book showed changes in emphasis: the first edition was the most child centred, leaving everything to nature and good intentions, but later editions were more sympathetic to parents who complained that they felt guilty if they did their best to follow the doctor's advice but the child turned out less than perfect in its behaviour. As the years and editions rolled by Spock became seen himself as a traditionalist, putting on parents the responsibility to rear children with strong values of cooperation, honesty, and tolerance. Eventually he became attacked as “an oppressor of women in the same category as Sigmund Freud.”

    Nevertheless, Spock's revolution in thinking had paved the way for patients of all ages as well as parents to take greater responsibility for decision making. Few parents in the 1990s believe that there is only one way to bring up children: they pick and choose from the shelves of child care manuals until they find one that sits easily with their own beliefs.— TONY SMITH, associate editor, BMJ

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