It’s Q&A Friday! 

The first question today is available to all subscribers (about activities and babies’ intelligence), and there are a few bonus ones behind the paywall (about ear tubes and infections, the safety of sleepovers, and baby sign language and speech development).

Enjoy! And remember, you can submit questions for future weeks here.

How can I make my baby smarter? I worry my six-month-old is not getting the same experiences as, say, kids in day care because I don’t do as many activities with her. I don’t take her places, because it’s easier to go by myself while someone watches her. We don’t walk outside much in the stroller, well, because I’m lazy. I don’t do all those creative activities like putting things in bags for her to squish, like I see on Instagram. I do obviously play and read with her during the day, but she also sits in the stroller I roll around inside or I carry her around doing household stuff a lot too. I do try to talk to her and narrate what I’m doing. Am I sacrificing IQ points because she’s not building as many neural connections or something like that because we’re not doing Montessori activities all day?

—Worried Mom

I would like to give you a hug and tell you you are doing a great job and please, please, please be less hard on yourself.

First of all: there is absolutely no evidence that doing things like baby music class has any impact on babies. I realize that baby music classes will tell you they do, but I assure you that it’s not supported by any rigorous data. Same goes for baby gym class, baby yoga, and all the rest. The reason to do these things is that it’s something to get you out of the house to see other adults! Which is great if that’s what you want to do, but it is not a requirement.

Second: there is also no evidence showing that enrollment in day care at these young ages is important for cognitive development (there is maybe a bit of evidence on preschool around ages 3 or 4, but nothing at this age). There also isn’t any evidence that day care is bad. There are many great care environments, but your child is not missing some evidence-based bump.

Third: about the only parental behavior where we do see some evidence of positive impacts on kids is reading to them. Which you are doing. 

But what I think is much, much more important to say here is that this is so emblematic of the pressure we put on parents, especially moms. Re-reading what you write: I do obviously play and read with her during the day, but she also sits in the stroller I roll around inside or I carry her around doing household stuff a lot too. I do try to talk to her and narrate what I’m doing.

You are spending your day doing fun stuff with your baby, talking to her, reading to her, rolling her around the house in a stroller. This is all awesome. And you’re being hard on yourself because of a squishy bag Instagram video!  

I am sending you a hug. And a reminder that you’re doing great. 

Hi Emily! I’m curious about what you see in the data with respect to ear tubes. We have a 15-month old who’s had about four ear infections since he started day care in September. We recently saw an ENT who recommended ear tubes, but it’s not clear to me whether the data shows that ear tubes have significant success in reducing recurrent ear infections. I’m trying to weigh the potential upside of ear tubes and reduced ear infections with the risk of our son developing antibiotic resistance if we do nothing and we keep having to periodically treat him with antibiotics. What’s your take? 

—Laura

This is a tough problem, and when one reads medical approaches to it, they heavily emphasize the importance of parent choice and of taking circumstances into account. Frequent ear infections are more concerning if they seem to be interfering with language development. They are also more concerning if a child is otherwise immunocompromised. 

There are also a variety of changes that families will be encouraged to make before ear tubes are discussed, such as avoiding exposure to tobacco smoke and getting the flu and pneumococcal vaccines. 

In a case with multiple ear infections (like yours), there is then a question of how to deal with it, and there are really three options. 

• Expectant management: what you are doing now — just wait it out and treat the infections when they come

• Prophylactic antibiotics: treat a child with antibiotics daily for a longer period — perhaps six months — to get ahead of an infection

• Ear tubes

None of these is an obvious choice. Expectant management is non-invasive but is likely to mean more ear infections. 

The approach of prophylaxis with antibiotics has been shown in randomized trials to have an impact on infections, reducing them by about half. This is a large reduction, but there are risks — if your child does get an ear infection, they will need stronger antibiotics. And continual use of antibiotics can disturb digestion. 

There is relatively little evidence on the efficacy of ear tubes. In 2021 a randomized controlled trial of 250 children was published in the New England Journal of Medicine, and the results were underwhelming. There was no impact of ear tube placement on ear infections. One complication is that, like many trials of this type, the authors didn’t require people to adhere to their assigned group (this is a style of randomized trial called an “encouragement design” — the treatment is encouraged but not mandated). So some of the control group got ear tubes, and some of the treatment group didn’t. This could explain some of the null results, but it seems very unlikely based on this that the results could be large.

I talked about this on Instagram recently, and I got a huge number of people basically telling me that ear tubes saved their sanity. It raises to me some interesting – and unanswered – questions about how we reconcile these randomized data with experiences. 

I wish this was more helpful! There is no obvious solution. 

A recent hot-button topic for parents that I’ve been hearing a lot about: sleepovers. Many parents opt not to allow sleepovers due to the potential for risky decisions, loss of sleep, as well as bullying or abuse — especially sexual abuse. A child psychologist recently came on TikTok and said he has a hard-and-fast rule against sleepovers for these reasons. I was wondering if there is any data on the subject that could lead to evidence-based conclusions. Thanks so much!

—Ally

There is no direct data on either the risks or benefits of sleepovers. In part, this isn’t a well-defined question, since it would be hard to even define “sleepover.” If your child stays over at their cousin’s house, is that a sleepover? Or are we just talking about slumber parties with other kids? At any rate, there is no good data.

What we can do is try to put together some auxiliary data and use it in decision-making.

One piece of relevant data: sleep. We know sleep is important, and we also know that kids do not sleep as well at sleepovers versus otherwise. Having said that, we also know that people can catch up from limited sleep disruptions. Our kids get jet-lagged and recover. Once I accidentally gave 10-year-old Penelope highly caffeinated tea at 6 p.m., and she didn’t go to sleep until 2 a.m. She was very cranky the next day and did not do well on a math quiz, but a day or so later she was fine. My point being: sleep is very important, but you could weigh a night of missed sleep against the possible benefits of a sleepover.

Sexual abuse is a very real concern for many people. Unfortunately, by far the most common perpetrators are family members. This does not mean that it could not happen at a sleepover, but it is not the highest-risk environment children face. The advice here is more general: keep the  lines of communication open with your children, and make sure that any environment they are in is one where you feel comfortable with the supervision.

Finally: bullying can happen at a sleepover, or it can happen in any other environment. When I wrote about it in The Family Firm, what I found most helpful was the data on what generates resilience. We cannot fully protect our kids from bullying, but evidence suggests that supportive family environments can make them more resilient to the bad mental health effects. 

Sleepovers can be disruptive, and, yes, they can be hard. Some kids feel homesick. They can be a challenge. But they can also be really fun! And challenges are not all bad; fostering some independence in kids, having them feel like this is something they can do is potentially empowering.

Bottom line: as a parent, you may decide sleepovers are a pain in the butt. Or you may not. There is no concrete data to point you in either direction, so you’ve got to make your own mind up. 

Hi Emily, do you have any good data on baby sign language and its impact on speech development? I find lots of opinions about it online — some that it delays speech and some that it improves speech — but not much data. It’s hard to believe no one has done a randomized controlled trial. (I’m asking specifically about children under age 2, i.e. not about its use in older children who are non-verbal.)

—Caitlin

It is hard to believe, but, no, there are no randomized controlled trials of this. I find that very surprising! Not so much because I think this is a medically crucial question, but just because it seems of significant interest to many parents. It seems like it might tell us something about baby language development.

In the absence of a randomized trial, we could imagine comparing children whose parents used sign language with them to those who did not. But because the use of baby sign language is associated with other characteristics (like parental education), these comparisons would not likely be causal. 

This is a case where we know basically nothing despite enormously strong online claims. In looking into it, I found a paper whose abstract answered this question far better than I could. So I will defer to them, the authors of a paper entitled “Evidence for Website Claims about the Benefits of Teaching Sign Language to Infants and Toddlers with Normal Hearing.” Here is a (slightly condensed) version of their abstract: 

A popular trend gaining national media attention is teaching sign language to babies with normal hearing whose parents also have normal hearing. Thirty-three websites were identified that advocate sign language for hearing children as a way of promoting better developmental outcomes. These sites make several claims about the positive benefits of teaching hearing infants and toddlers to sign, such as earlier communication, improved language development, increased IQ, reduced tantrums, higher self-esteem, and improved parent–child bonding. Without endorsing or disparaging these claims, the purpose of this article was to evaluate the strength of evidence cited on websites that promote products to teach young children to use sign language. Cumulatively, 82 pieces of evidence were cited by the websites as supporting research. However, over 90% of these citations were opinion articles without any supporting data or descriptions of products and only eight were empirical research studies relevant to the benefits of teaching sign language to young children with normal hearing. Unfortunately, there is not enough high-quality evidence cited on these websites to draw research-based conclusions about whether teaching sign language to young children with normal hearing results in better developmental outcomes.