Evidence-based parenting decisions: breastfeeding, vaccines & screen time (with Emily Oster)

0:00This Father's Day, do more with dad and spend less with low prices guaranteed at the Home Depot. Get him fired up with a new grill and accessories, like the Nexgrill 5 Burner for just$299, so you can spend more time together while he becomes the grill master he was always meant to be. Or build memories with savings on top brand power tools, so you can tackle projects side by side. Gift more and do more together this Father's Day with help from the Home Depot. Exclusives apply. See homedepot.com slash price match for details. so good so good so good new markdowns up to 70 off are at nordstrom rack stores now stock up and stay big on shoes tops dresses accessories and more must-haves for summer join the nordy club to unlock exclusive discounts shop new arrivals first and more plus buy online and pick up at your favorite rack store for free great brands great prices that's why you rack Welcome back to another episode of Two Parents in a Podcast.

1:00You guys, today is part two with Emily Oster. If you missed the first episode, it was last week on Monday, and what we were talking about was all things pregnancy, right? Like, can you eat sushi? Can you get Botox? What about deli meats? And she gave us all the answers. I love the way she talks. She's very direct. So if that episode applies to you or somebody you know, that was last week. This week, we are talking about all the firsts you encounter in the first couple of years when you have your baby, right? So screen time, discipline, formula versus breastfeeding was an interesting one. And so we dive into all of that with her.

1:38She's incredible. I love the way she answers questions. She's direct. And if you don't know who Emily is, even though I think she needs no introduction, she's a bestselling author. She's an economist and she's the data-driven voice behind parentdata.org where she helps parents cut through fear-based advice, understand what research actually says, and make confident decisions that work for their family without guilt or judgment. So without further ado, you guys, let's get right into this episode with Emily. Okay, guys, we're back with Emily Oster. You're welcome because I know we all have a lot of questions for her.

2:14um the first episode was all about pregnancy and birth and now we're going into debunking myths and decision making guides for early parenting years which you know a lot about i'm so excited we're gonna go screen time okay breast milk sleep child care punishment if we have time vaccines okay wow you're hitting all of the very top topics we were trying to hit that because these are all things we're genuinely interested in right i mean these are these are the topics every parent is interesting. If you're a parent, you care. Okay. Are there outstanding benefits to breastfeeding your child? Or no, the data is not.

2:54There are some small benefits to breast milk. There is some reduced risk of gastrointestinal illnesses in the first year. Some small impacts possibly on allergies or eczema. There are some benefits if the baby's in the NICU, some sort of larger digestive benefits, maybe a little bit of an effect on ear infections, and that's basically it. What about antibodies, though, to sicknesses, if you have one? So, you know, you do pass antibodies. The effects are probably smaller than most people think. This is probably part of what's going on in the gastrointestinal results, that, you know, if you have a stomach bug, you're passing the antibodies.

3:33But those antibodies are passive. so your baby is is swallowing the breast milk and it's going to their stomach where their stomach acid does all kinds of stuff to it so it's different than the kinds of antibodies that you would share if you uh got sick while you were pregnant when actually you would start your baby would have circulating antibodies so the antibodies are just they're just probably not that important and most of these long-term things you know all of the long-term things people say like breast milk makes your kid smarter makes your kid you know thinner has all kinds of other impacts those are just not supported in good data yeah so the long-term effects i can really see because like you know in this room there's five of us who knows i don't even know if i was formula or breastfed i know i was breastfed some but i don't know if i was combo fed me too no idea like i don't think anybody in the room knows and look we're all like fully functioning right um i i did see though for the first year i did feel as though breastfeeding her and i breastfed for six months And then I combo fed her And I did She never got sick She was never sick The first year And I did feel like That was cause and effect But maybe I'm wrong Was she in daycare?

4:39No That's why she didn't get sick She didn't get sick Because she didn't go to daycare Maybe that's what it was I mean not that Daycare is great In many ways But I think A huge share Of the variation In illness Is exposure to other kids But she did fly 52 times Very different Than having other kids Put their hands in your mouth And pacifiers And things like that Yeah Okay Okay so maybe That's what it was And I mean this is sort of like Just in general When we look at the data The illness rates Really aren't Very different And so is there Any data that you see Formula What's it How do I ask that question Like formula Versus breast milk There's no No supporting There's no overwhelming Supporting data That shows breast milk Is better So I mean I think That's not quite right Because there are These small benefits So I think what I would You know if you sort of Summarize this I would say there are Some small short term Benefits to breast milk feeding particularly in the first year but they are nowhere near as large as people are told that they are and i think that's kind of the important point because many many women hear a rhetoric about breast milk which is like this is the opportunity to give your kid the best start and if you don't do this your kid is going to be bad in these ways and like this is like you and and you have failed and i think that's a very different message than like you know this is something that you might like a lot of people do it you know it has some sort of short-term benefits for for illness you know they aren't enormous but they're there and you might try it which is kind of the message i think we should send people as opposed to like if you don't do this you've already failed and it's day three so i the reason i like what you're saying while breastfeeding was very hard on me but i did it it's so i'm like okay well you you gotta ask yourself for what um one thing that we're huge proponents of is fed is best happy mom is the best happy mom happy baby happy mom happy baby no question and I do think that there's a lot of negative rhetoric around using formula which I don't agree with at all the main one of the main reasons I wrote crib sheet which is my second book about early parenting is the number of dads I heard from about breastfeeding and they would write and they would say you know my my wife loves your first book like she really listens to you and like she is killing herself to breastfeed our kid and isn't working and she's really sad and if you could just tell her that it's okay to stop like i think she would listen to you beautiful and i got enough of that eventually i wrote this other book i think it's a beautiful message and we try to do episodes on it too we have formula people you know we had we had a milk specialist on it and she was like no both are good both are good especially now we have more formula options just both are good yeah okay okay good all right great i mean i'm gonna do the breast milk again round two and three i thought it much easier on the second one actually okay good i was just like much easier to figure out.

7:25Like it was like, I don't know. I just like going to, cause I kind of knew what I was doing. Yeah. But I'm going to put a whole lot less pressure on myself. And I always like to say like, fed is best. Cause mom, it should not, we cannot be killing mom. Yeah. If you're a last minute shopper like me, and I know so many of you are, you know, the feeling, the shelves are running low and you're out of ideas, but you guys aura frames is the best gift because it's the gift that keeps on giving. It's a digital picture frame that you're going to give to somebody maybe they live far away from you maybe you don't live in the same house as them but you want to send them pictures and live updates of what you're doing aura frames is the best thing ever you guys you can upload unlimited photos and videos you can preload the photos before the frame ships so when they open it they already have the photos on there and you can share photos and videos effortlessly straight from your phone all year long you guys it is so simple so So for a limited time, save on the perfect gift by visiting AuraFrames.com to get$35 off Aura's best-selling Carver Matte Frames, named number one by Wirecutter by using promo code 2Parents at checkout.

8:33That's A-U-R-A frames.com promo code 2Parents. This deal is exclusive to listeners and frames sell out fast, so order yours now to get it in time for the holidays. Support the show by mentioning us at checkout. Terms and conditions apply. alcohol while breastfeeding yeah that's fine okay because so what i did was we went out one night and had i think three margaritas four probably four and i was breastfeeding at the time so i made a video i made a tiktok and i was like i'm gonna do the test of it so i had my little frita strips i tested my breast milk it came back like there's alcohol in this then i filmed myself pouring it down the drain it was a learning moment for me and all the comments they were really nice but they were just like number one most definitely never poured out use it in the bath okay obviously But a lot of nurses were in there just like They were like if you can see your baby You can feed your baby Like it's not going to get through to it Yeah it's So the I think the way to think about that Is the amount of The sort of concentration of alcohol in your breast milk Is the same as the concentration in your blood And so even So they've done these studies Where like they give people So they've done sort of studies Where you have someone have like Four tequila shots in an hour Which is too much You're not going to parent well after that No it's too much or feel good at all.

9:49But even with that, the level, the concentration in the breast milk is very low, like comparable to what you get in juice, basically. That's what they said. And so it is, it is, it's just, the concentration is just not high. And so you should, it's fine to feed your baby with that. Some people ask me, like, can I have a glass of wine? Yes, definitely. I believe so, yes. Yes, definitely. If you put a test strip in apple juice, you're going to, it's going to be higher. Yeah, these test strips are pretty, I would not use the test strips. I think that logic is better than the test strips. Okay. There we go.

10:21Sorry, Frida. Okay, sleep. You are for the method or against the method, and what does the data show about cry it out? I think cry it out is something that should be in people's toolboxes. It's not for everybody, but the data does show that on average, it improves infant sleep. It improves parent sleep and parent happiness, and we look at long-term impacts, both short and long-term impacts on things like attachment and so on. We don't see any negative impacts. And so, you know, again, like this is not everyone is going to choose this method, but I think it should be on the table for people. So you don't see the data does not show any negative impacts.

10:59How do you get data on something like that? So there are some randomized trials of this where they bring people in and they randomize some of them to sleep train and some of them not, and they follow their kids for many years. Wow. So cortisol spikes and things like that are all Checked in this Yeah and then they you know we have some of these studies Where they sort of show like you will see cortisol You see cortisol spikes when babies cry But cortisol is not Always a It sounds like uniformly a terrible thing We have cortisol spikes and There isn't When we again we sort of look at this long term Stuff we don't see Any negative impacts which is kind of the thing you would worry about like that there is something kids look different later that there's some other negative impact that's what people are how large are these studies because this one's really surprising to me we we didn't do cry it out we were very fortunate though that we didn't really we weren't put in a position that we actually like needed to make the decision because she was a pretty we did the 5 10 15 method yeah five easy sleeper but yeah um intuitively it did um it it did make sense to us that there could be some negative effects to you know letting her cry for super long extended periods of time yes i mean but then that's but that's why we have date that's why we have dates that's why he's asking that's why i want to know like how broad like how like how big are these studies these are like several hundred you know hundreds of kids um and so they're not so i think it's not if you're sort of saying like the thing that i would need was a study with like millions of kids with incredibly detailed like we don't have that um we do have a lot of observations from the world you know the huge share of kids there people do some sleep training um there's a sort of trade-off on the other side which is they they do sleep better and we know that sleep is important for development and so if you sort of like there's almost a potential countervailing uh of the sort of like we're trading you know maybe maybe you're trading three days of a cortisol spike for you know months and months of better overall sleep hygiene yeah that's where i think it's interesting that's why that's why we want to talk to people like you because we don't know we just go off of like a a gut and so but i think what's what's interesting about this i think that for some people it's like look i you know i'm worried about this like i'm worried that you know about like i just i you know yes you told me there are these studies but the studies are not perfect and this is not for me and i think sometimes with sleep training we give people the impression like this is the only way to operate your life and i don't think that's true either and you may say like sleep training is not for me which is okay yeah i guess what i was trying to get to is um and i don't know this this may be now getting two sleep specialists but i feel like there's a commonality we have with a couple of our friends where their kids like they just cry like and and so you say three four nights um let's say our next kid is like a really really really bad sleeper

14:19like leaving them in that crib for two weeks until they figure it out is okay is okay so I think is a really hard question to answer because if you said like is that is that okay okay like do people do that and their kids aren't like yes um most of the time does not take anywhere near that amount of time to do this if you are doing consistently I think a lot of pediatricians if you went to like Tribeca Pediatrics in New York, they'd be like at 12 weeks old, close the door and don't come back no matter what. Like there are some sort of very, people are gonna tell you something very extreme about this.

14:53I think what I would say there is like, that's not sustainable. It's not sustainable to be exhausted all the time. This isn't the only solution to that. So, you know, depending on the age of your baby, another solution that many people find more palatable is co-sleeping. So a lot of kids who won't sleep well alone in the crib will sleep fine with their kids in the bed. Co-sleeping is not for everybody either. But after, you know, several months, it's pretty safe. And it works for a lot of people. And I often, like, I think if for many families, they find kind of you sort of either need to, if your kid is not a great sleeper, you kind of need to either sleep train or co-sleep because the sort of middle option of getting up every hour for two years is like infeasible for people.

15:39Yeah, that makes a lot of sense. Yeah, I agree with that. Okay. Child care. A lot of people will say, you know, if you have child care during the day, if your kid goes to daycare or if you have a nanny that has a negative effect on the child, that is not supported by the data. The data shows what? The data shows that high-quality child care, meaning responsive caregivers, not watching television all day, safe environment, shows outcomes very similar to being home. You see more time in child care before school slightly improves kids' school readiness. More time in child care slightly worsens their behavior early in school.

16:20those differences basically all wash out by kind of early elementary age and so really the decision about like what kind of child care to have should be about what works for your family what works for your budget what works for you logistically uh kids do get the first time your kid goes to a child care setting they will get sick pretty often and whether that's when they're a baby whether that's when they're two whether that's when they're five the first time they're around a lot of other kids they will get that first like winter season they will get sick a lot and that's just worth knowing interesting totally totally but and if they get and it's like one so if they get sick a lot when they're two then you know when they show up in kindergarten at five they're not going to get as sick as somebody who didn't have all this illness when they were two okay so get it get it they're gonna have they're gonna pay their dues they're gonna pay their dues okay um yeah i love this take because i think like number one working parents like you have no other option And so the worst thing you can hear is like, that's bad for your kid.

17:14But number two, I think like it makes for happier parents. If it's what you choose, there are stay at home moms who probably would love, love doing it. Right. But I do think like different things are working for different people. And I think the way that people should approach this is much closer to like, what do the adults in the family want? What is the right work hours for all of the adults in the household? What is going to make this work as a family? as opposed to like how can we you know obsess about what's best for our kid and and not think about everybody else which is not helpful right and so i think this is i think this is very helpful i also think yeah i think everything you're saying is very helpful because i think a lot of parents are overwhelmed they want to sleep train but they don't know if they can they want their breastfeeding is mentally destroying them they need some they some people need a bit of permission to know like you can lean into formula so I think this is really helpful I think people need permission to like think about these decisions carefully make the decisions that work for them knowing that there are many good choices and then try hard because you have thought like try hard to tell yourself I thought about the right decision for me and that may not be the right decision for someone else and that doesn't mean that my decision is wrong or their decision is wrong I think there's like that's very hard yeah no I agree with that um punishment what do you think about spanking i do not think that spanking is good i think we have reasonable data that spanking is associated with uh worse long-term outcomes for kids including worse behavior which which once you really start reading into it makes complete and total sense but what are some supporting causes for that so i i mean i think this is just this is a thing we see in the data you can sort of track uh kind of kids and look at spanking and not spanking and track them over time and it doesn't seem like kids who are spanked improve their behavior more.

19:01And in fact, if anything, it seems to worsen behavior. There is also a lot of good evidence about alternative approaches to discipline, which seem to work in terms of improving behavior and family functioning, which do not involve physical violence. And so what are, it feels like as a society, we have reached a consensus now that spanking is bad. About half of American families spank their kids. Oh, wow. We did a poll. We did this. I was going to say, we did our audience. We have not arrived at that. And we were like, huh. We're non-spankers, for the record. But what are alternative parenting methods that the data shows works well?

19:44So spanking doesn't work. What does work well? Yeah. So I think the thing we have the most evidence on is sort of behavior modification programs with systems of rewards and punishments. So like one, two, three magic is the one that I like the best that I think works for. We have the most evidence. And so this is like a kind of fairly simple approach. There's a book. But it's like your kid is doing a behavior that is not good. You count, you know, that's one, two, three. And then there's a consequence, which is typically a timeout, although you could do something else. But the idea of sort of staying consistent Having a consistent system And having some Some like warnings And then punishments That is what works Basically all school based Programs are like this too You remove them from the actions Yeah remove them from the action You know in these generally Kids are given an opportunity to remove themselves First And then ultimately You remove them and if they don't stop you remove them and take them into someplace else and there's a rest period and that's it that's it yeah i mean i think the main thing we learn from this is that that you need to be consistent you need to be able to consistently do the same thing every time okay so a successful a successful like discipline behavior program is one that you can always implement and that's and it could be kind of like there are a lot of different versions of that but it needs to be something you can implement the same every time because that's what kids respond well to is the idea of like I know what's going to happen if I do this and I know that it's going to follow through the example I always give is I once was on an airplane and the kid was kicking the back of some kid behind was kicking the back of someone's chair and their parents said to them you know if you keep doing that we're going to leave you on the airplane that's actually a very poor discipline approach because you're not going to do that you're not going to leave them on the airplane and so don't say things that you're not going to be able to do.

21:43Right. Don't threat. Okay. I did read this once. Like, um, the, the dad had said, if you don't do X, Y, Z, then we're not leaving the house. Right. We're going to, I'm going to turn the car around. You better be prepared to turn. He missed work. He was like, well, I should never have threatened this thing that I can't follow through with, which makes a lot of sense. Empty threats. No guys, let's talk about neutrophil because there is nothing more frustrating than wanting thicker, longer, healthier hair. And I I have taken the women's balance and their postpartum, and I am telling you they are incredible.

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24:46What's the question? Well, screen time is top of mind for us. We haven't done it yet. We've read The Anxious Generation. Sure. That book really landed, but would love to hear your thoughts on screen time. Where do you think we have it right as society? We don't. Things parents should be focused on, not focused on, and we can share how we're thinking about it. Yeah. So let me say sort of two broad things. So one, I would really separate like the kind of passive screen time, you know, shows that you're going to be thinking about for your baby, for your 14 month kids, for your toddler, from the like anxious generation stuff because you know Instagram TikTok this this is a set of things you are going to be dealing with maybe I don't know what it's going to be like when your kid's 14 but it's a pretty different set of set of questions for now when I talk to parents about the kind of passive screen time of small children I think that rather than thinking telling people to think about this as like good or bad you want to think about what is it substituting for so what thinking about screen time as something that probably your kid will do some of but if they're watching nine hours of television a day they're not doing any of the other things we know they should do we know kids need some outside time they need some time playing with the parent they need some you know looking at book time they need some they want to sit at a meal with them whatever is the things you want to kind of scaffold in your day that you know are important and then there are probably some times in there where you'd be like yeah it's okay to have a little bit of screen time because it is not substituting for something else that's good so the thing I'll often tell people is like if this if it's 30 minutes of Miss Rachel or 30 minutes while you're trying to cook dinner and they're screaming at you and you are screaming back at them it would be better for them to watch Miss Rachel because what it's substituting for is conflict and what it's giving you with that break is the opportunity to like reset and get to you know sitting down as a family and doing something good.

26:45So I guess that's where I am on screens. So when it comes to screen time for toddlers, what do you think about new age screen time that's been created, the Coco Melons of the world that are highly overstimulating? There really is no evidence of that idea. So this idea that like old screens moved slower, et cetera, the shows are different. Coco Melon is better, but it is not worse. Okay, so this is interesting for a couple of reasons. One, because anecdotally what we hear from our friends is when they're putting shows like Cocomelon on in front of their kids, their behavior after is wonky and all over the place.

27:26When they pull the screen. Versus like when they're putting past time Disney movies a la, you know, whatever, Mighty Ducks. Secondarily, do you want to talk about some of the dopamine stuff? well okay what we have read about with coco melon and things like that oh no no sorry yes the the coco melon study the coco melon study was not whatever it's not a study it was uh my bad we watched a tick talk about how it was made yeah all right that's where you get your information sometimes so they put um a mom doing mundane house chores unloading the dishwasher washing dishes on one screen and coco melon on the other and they lined up x amount of kids and they had them watching Cocomelon.

28:10Anytime they looked away from Cocomelon to the other TV, they went in and added more lights, more pop-ups, more music, more sound. So it's overstimulating and more addictive was the term we saw. What do you think about that? Do you think there's any truth to that or no? I don't think that it's really possible to say, like it's more entertaining. So I think there's a question of like what you mean by sort of addictiveness. Like both of these things Are just saying like This show is something people like They like It's hard to get them to stop Because they like it They look at it Because they like it You don't think there's any Behavioral issues Tied to screens That is not what I'm saying What I'm saying is Because I think we don't I think part of this is like We are in a We are in a Largely Evidence-free environment Like it's very hard To measure these things What I will say is I think that it is It is true that it is possible to have some amount of screen time and many kids have some amount of screen time and it is completely fine but as a parent our job is to think about what else could they be doing and when is this going to fit in and maybe your job is to then also think about for my particular kid you know what is kind of scaffolding behavior that I like you know if you show your kid cocomelon every time you pull it away it's a half an hour of screening screaming then that's not a good activity for your kid whether it's the right activity for other kids or not you know maybe your kid needs mighty ducks and so you also like guardrails around it not at the table not an hour before bedtime not before bed for sure you want to like not before bed not at the not at the dinner table not in lieu of outside time but saturday morning cartoon time which i never understood until we were prepping for this episode and i always there were saturday morning cartoons and of course there was because we weren't at school so that gave us our parents a time to like make breakfast or something yeah i mean i think that there is a way to combine this with your life but you do want to deliberately think about what that way is in advance and i think part of what happens is because people are like screens are bad screens are bad screens are bad screens are bad screens are bad they don't think about okay well we are going to introduce some screens and like how are we going to do that so when they finally introduce screens they give their kids screens and it's just like screens screens for all at all you know like we haven't actually made a plan i would much rather people say screens are going to be part of our lives let's think about where they fit in rather than let's never have screens and all of a sudden just do whatever so that's where we are can i talk through our plan yeah okay because we'd love to hear we'd love to hear your thoughts um and i guess i do want to kind of tie back to the anxious generation because i think a lot of the way we're thinking about this is why i alluded to it was the skyrocketing rates of anxiety, depression, and suicide amongst teenagers post-2010.

31:04And tying that back to habit development and hobby development. And so, you know, in these early stages, really encouraging a lifestyle for our children that isn't just behind screens and is outdoors, interacting with other people, exercising, so on, reading, so on and so forth. So I get like the difference in gap, but just kind of wanted to tie it all together. So she hasn't, so our daughter has not been put in front of a screen yet. The game plan there is for the first two years of her life when she doesn't really know what's going on to avoid screens altogether. then when we eventually do introduce them at around the two-year mark do it one for travel two for like treats and special occasions so as Alex alluded to you know Saturday morning cartoons or Christmas or holiday movies and then limitations on where the screens can and can't be so not in the bedroom not in the bedroom not in the bed not at the table um and am i missing anything no i mean in past that we don't know but we we are with you on the on the school of thought of like screens are going to be a part of our world it's like we we love ai because we're like it's just going to be here sure so like understand how you're going to implement that into your kids lives and i think that's really important i like that you say that broadly i think your plan is great what i would say is before you start doing this you need to get like a lot more specific about the second part of it when you were like it's a treat it's the Saturday morning like Saturday morning cartoons is different from holiday movies holiday movies is like three times a year Saturday morning cartoons every week and so like I think just sitting down and being like here are the blocks of time where screens are going to be allowed like and literally like writing that down and agreeing the two of you like what are the screen time rules and exactly what is the schedule and then like you want to revisit that every you know six months because your kid's going to adapt into things and then i like that yeah um makes a lot of sense and then what do you think about uh like minimums where no screens unless so it's like saturday morning cartoons on the back end of you know an hour of cartoons because you did an hour walk beforehand is that you're not yeah i mean like do we don't know that much about that i think if it were me i would much like rather than thinking about those as linked because then your kid like what does your kid learn from that it's a bit similar to nutrition like if you say you know unless you eat your broccoli you're not going to get ice cream yeah they're gonna they're gonna more likely to eat their broccoli in the short term what have they learned like eating broccoli sucks and it's only a thing you do for rewards yeah i would like for us like we do a lot of hiking with Our kids we did a lot when it was little it wasn't like you have to go on this hike so you can have Screen time it was just like we're going on a hike there's the activity that we're doing on Saturday morning is first is we're going to go on a hike then it also happens that there's like a Half an hour of tv time before lunch but it's not linked to the hike like you have to go on the hike There's no option it's not like you you can't say like I'm not going on the hike and then I don't Get my screen time you have to go on the hike the hike is an activity we're doing the hike I love what you just said like the broccoli to the ice cream is so easy like so then you just Learned broccoli sucks like you're You're teaching them like this is you Have to do this but then you get to do this That's really but I think one thing people have done this Sort of related that I have heard Is kind of like you Is using is When this is a little kids are A little older but like sort of using Behavior to earn screen time on So you say like there's screen time on the weekends And you can earn up to An hour of it in This is like can work for some kids for Behavioral modifications as like a kind of like if if that's like one we have never tried that what does the data say on the best time to introduce screens to kids we don't have a lot of data on this what i will say is that after sort of sometime between the ages of two and three your kid starts to be able to learn some things from screens um so that doesn't necessarily mean that's the right age but if you said like you know we actually have some evidence that kids who are like exposed to sesame street between the ages of three and five did better in school and like these early cohorts Sesame Street turns out teacher kids letters um and so after sort of sometime after the age of two they're going to get more like they will get more engaged by screens but also be able to learn more from them but there isn't if you're looking for like kids who have screens introduced when they're under two do worse or better like we don't the data on that is all pretty garbage and so do you have a personal view no i mean i you know i like for us the most valuable thing about screens was the travel was like the first time that we could go on a flight for six hours and my kid watched tv for like a couple of the hours that was great i was glad we introduced tv before that yeah that's what i'm looking forward to i do think that flights are flights are really tough right now when they want to run around right yeah it's like the worst possible age for flights it's yeah we worst it.

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37:30So we've got one more, which is what? Vaccines. Let's spend the next six minutes on vaccines. And so if we look at the standard vaccine schedule, what does the data tell you about it? should you be following it? Are there certain vaccines that parents should be opting out of? Where do we stand? So in general, the standard vaccine schedule has been used for many decades and has saved literally hundreds of millions of lives. I think it's worth remembering that a lot of people used to die of measles. Not just one person every year, but a lot of people every year, a lot of kids, actually there's a bunch of deaths from whooping cough still every year, even in the US.

38:07So like, when we talk about vaccines, it is somehow we have moved away from an understanding of what the purpose of the vaccines is, which is to not get deadly illnesses, which used to kill a lot of people. So let's just like, say that there's a lot of evidence for safety of vaccines, a lot of the concerns about vaccines that are raised, like that they cause autism, but also others really are not supported in the best, in the best data. So I generally think people should feel completely comfortable doing the standard childhood vaccine schedule because it makes sense and then your kid is less likely to get deadly illnesses.

38:46And are there any that should be opted out of? Generally, no. I think what I would say is that there are some which are more important than others. So if you told me, like, tell me what's one vaccine that, like, you would, like if if I told you I'm definitely not doing all of them which one I will would would you remove um you know the there's been a lot of discussion about the birth dose of hepatitis b if mom is not a hepatitis b carrier then pushing off the first dose of hepatitis b to say two months is totally fine and what about spacing the the vaccines out spacing the vaccines out is is like not effect it's not helpful you know you're you're so people have this idea that like your kid is going to be exposed to too many like shocking things at the same time okay so in a given day your kid is exposed to vastly greater numbers of like things that are shocking their system good then in the vaccine.

39:51I mean, your kid is being exposed to viruses and all this stuff all the time. There's viruses everywhere. There's like hundreds of many viruses and other pathogens are all around and your kid is constantly being exposed to them. So this is not there's not some kind of like overexposure of stuff. Some people like to to space out their vaccines and really any reason to do it. There's not really any strong reason not to do it if you do it sort of quickly enough that you get them basically in time. And so what's the data that people are pointing to that is on the other side of the argument, like tying the vaccines to autism?

40:27Yeah. So there's a couple of kinds of data that have tied vaccines to autism. So one is there was a very famous paper from the late 1980s in The Lancet in which a guy named Andrew Wakefield had 12 cases that he had largely made up the details of. It turned out the paper was totally fraudulent and he linked the MMR vaccine to autism development in these kids. Again, most of the cases had a lot of details fabricated. So that is, although that is still widely cited, that is totally not credible. There are then some more recent papers that will look at, you know, kids who have more vaccines versus fewer vaccines and then different kinds of diagnoses.

41:11The issues with most of those papers is that kids who don't have any vaccines in the U.S. also tend to have a pretty limited exposure to the medical system. So if you sort of think about the characteristics of families who are not vaccinating their kids at all, they also are not often doing other things at the doctor. And so with something like autism, which is largely diagnosed at medical visits, so there's like screening for autism for every three-year-old. So if you have a group of people who are getting vaccinated to doctors or getting vaccines, then they're much less likely to show up as diagnosed with autism.

41:50But that's not the same as saying they don't have those symptoms. They're just not getting the diagnosis because they're not showing up at the doctor. So a lot of the studies that people point to here have that very basic problem, that the set of people who are getting vaccinated are also seeing doctors for other things like diagnosis of autism i think that yeah there's an anti-vax movement happening that is for sure it's you know it's happening yeah it's happening and i'm watching it and i i don't i think what we when we became parents we tate has all of her vaccines she's up to date we're nervous about it and uninformed people are and you're the second person we've now talked to about vaccines and i And I just think it's worth saying Like it's important to vaccinate your kid Because I think what happens If we don't vaccinate them Is we're going to be waking up in five years With people that are really sick And hopefully Not hopefully Perhaps dying Yeah I think that's right I agree with that But I also want to say Like I think we need to give people A tremendous amount of grace That they are asking these questions Yes I think too often In the public health establishments Like what do you mean You don't trust vaccines Like just get your vaccines I told you and I think much I would much rather have us say like hey I hear you of course you're confused there is a lot of information about there out there you know let's try to understand like what is the reason for these vaccines why do we know the details I would love if people could engage more if like the sort of experts on the pro vaccine side could engage more with the things that people are afraid of I agree I think it's the only way to bridge a gap it's the only way to bridge again with this type of of rhetoric because if your feed is all anti-vax it's all you know and so you do need somebody to to start to bridge it i think that that's um confirmation bias that happens a lot of times online that we all we all get echo chambers you totally totally and you're someone who's who's shown that that you have no problem going against um the status quo and and against the way things have been done.

43:50And so it does really mean a lot coming from you when you say, hey, these are the things definitely to do versus these are the things to avoid. Because I think one of the challenges that we have, right, as we alluded to before, we love taking a data-driven approach to our life. But when it comes to the sciences, we just don't understand them. And so you can put all the data in front of me, but I can't dissect a good study from a bad study. Yeah, and I think in public health, there's sort of so much of the way that that communication happens is people just being like, well, trust me, I'm an expert, but I'm not going to explain why.

44:27And I think we need, you know, one of the things I've tried to do, I would love other people to do more of is just to be like, hey, you actually need to figure out how you can explain to someone why, even if they're not a person with a PhD and, you know, whatever field this is. And that should be possible. We should be able to engage with people's concerns and help them understand the the evidence like that's the job of communication about health totally totally and you do a very good job of it um okay i'm gonna ask you to plug yourself again so you can find me on instagram at prof emily oster uh you can find my books in stores expecting better and crib sheet uh and you can find a lot of my writing at parentdata.org amazing um thank you so much thank you we we loved both of our chats um you guys if you're listening to this episode and you want to go to the pregnancy episode, it's the one before.