Not to confuse things: There quite simply is a long list of things that can kill an infant and we get increasingly better evidence for what's on there and what is not. Avoiding death at all cost is ludicrous, but for a child born in the 1950s in high income countries the mortality rate was ~5%. 1 in 20 kids dead before the age of 5. For contrast, now it's closer to 1 in 300. That's not a coincidence but a lot of compounding things we understand better today.

Are there missteps? Certainly. Figuring out what is effective, what has bad secondary effects (fragility, allergies etc) and what is simply wrong is an ongoing effort and that's great, but less dying is a pretty nice baseline and progress on that front is inarguable.

"What doesn't kill you makes you stronger" makes for a fun little statement. It's not actual natural law though, right? I feel like it's fairly well documented that good hygiene is a win for humanity as a whole, so I have some skepticism for generally saying "well let the kids eat dirt". We did that for centuries already!

The thing I'm a bit curious about is how the research on peanut allergies leading to the sort of uhhh... cynic's common sense take ("expose em early and they'll be fine") is something that we only got to in 2015. Various allergies are a decently big thing in many parts of the world, and it feels almost anticlimactic that the dumb guy take here just applied, and we didn't get to that.

Maybe someone has some more details about any basis for the original guidelines

I have a great example of this. For our first kid, we had created a Sterile Field in our kitchen for pacifiers, baby bottles, etc. The sanctity of the Sterile Field was never violated. We would wash things by hand and then BOIL them and place them into the Sterile Field. This kid is allergic to tree nuts and a few other things.

For baby number 2, soap and water is enough. There's no time for Sterile Field nonsense. This kid isn't allergic to anything.

There was a local mom who had 4 thriving kids. When their baby dropped the pacifier in the dirt, it just got brushed off and handed back to the baby. I don't think those kids had any allergies.

It seems like all it's done is make people more vulnerable as adults.

In 2000, the American Academy of Pediatrics recommended not allowing your kids peanuts until they were 3 years old. It was just parents following doctor's (bad) advice.

I’d argue that the fear you speak of spread because it was profitable. I hit the 90’s in my mid-teens and boy howdy did it seem like every news outlet, especially the local ones, had their sites set on making us terrified to eat or drink things we previously consumed without much thought. Fear gets viewers, which is how revenue is generated, so there’s an arguable conflict of interest there.

The real problem is some of those claims and reports were true, but we were so inundated with the rhetoric that everything was going to kill us that many of us sort of lapsed into apathy about it. Stepping back, the food industry in the US clearly does not have consumer health at heart and we struggle to find healthy options that avoid heavy processing or synthetic fillers. Those parents who sheltered their babies back then may have been on to something when it came to stuff we consume and we should have been on the path to demand better from our food sources had more of us been more diligent with our grocery choices (myself included, at the time), but instead we ended up with bread that lasts unnaturally long and has an allowable amount of sawdust as an ingredient.

Sheltering kids from lead paint flakes is certainly beneficial

I'll wager that more children and adults have been killed by assault rifles and oversized vehicles over the past few decades than have died from a peanut allergy.

That kind of assumes they are sheltering kids, but to be honest peanuts aren't really that common a food, certainly not in foods you would commonly give a four month year old child.

You might be confusing bouncing back with survivor bias. A lot of them used to not bounce back. They had funerals.

The Hygiene Hypothesis has been around for a long time.

It will be interesting to see what happens with allergies for those who were born in the 2020-2023 timeframe.

> where parents sheltered their kids from everything. It seems like all it's done is make people more vulnerable as adults.

I don't agree that this is "all" that it has done.

There are many cases where reducing exposure as much as possible is the correct thing to do. Lead is the best-known example.

As the other reply pointed out, the second-order effect, the nuance that comes later is that sometimes this isn't the right thing to do.

But it would be basically incorrect to reduce it to blanket, binary, "all good" vs "all bad" black-or-white conclusions, just because the there is a smaller course correction when it's found out to be not entirely good. Concluding that "all it's done is cause problems" is a knee-jerk reaction.

> the risks of honey, which can actually spawn camp infants with botulism

I hadn't heard of this. Very intriguing that only camp infants would be affected.

> There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything.

The hygiene hypothesis is not impossible, but evidence for and against it is questionable. But anyway, for peanuts it's not the hygiene.

It's a much more complex mechanism that retrains your immune system from using the non-specific rapid-response allergic reaction to the T-cell-mediated response.

The same method can be used to desensitize yourself to poison oak or ivy. You need to add small amounts of them into your food, and eventually you stop having any reaction to urushiol contact with the skin.

> There was a period of a few decades (I guess still ongoing, really) where parents sheltered their kids from everything

Not just parents sheltering kids. Take a look at this (in)famous tweet https://x.com/d_spiegel/status/1271696043739172864 from *June 2020* ...

"[eg] women aged 30–34, around 1 in 70,000 died from Covid over peak 9 weeks of epidemic. Over 80% pre-existing medical conditions, so if healthy less than 1 in 350,000, 1/4 of normal accidental risk"

Running experiments is really really hard due to regulations. Difficult to blame doctors for that.

https://www.astralcodexten.com/p/book-review-from-oversight-...

The fun part is realizing that any and all exercise comes with risks, and running probably is bad for your knees in the long term - but maybe the long term health benefits to the rest of your body of running outweigh the risk of damage to your knees.

Your personal health profile or family history may also put you at higher risk for cartilage degeneration from running, which would shift the balance in the other direction.

Blanket statements about medical outcomes like that are useful for medical practice in general, but can be misleading for individuals making health decisions if they ignore other relevant factors. There's also plenty of doctors who will not take those other relevant factors into account and just go by whatever the last training or research they were exposed to (which, incidentally, is also why big pharma companies invest in salespeople to target doctor offices - because it works).

Not what this conversation is about but anyone running and worried about their knees should consider doing a little cycling. Dooesn't have to be fast or high resistance, but it does supposedly "massage" your joints without impact and help cartilage recovery. I definitely noticed a difference with myself and about 2 dozen clients with knee issues from running intensely (military, athletes etc)

The question seems really poorly formed! Like there’s never going to be a binary answer to a question like that. The answer is always going to be “it depends” on for example the volume, your physical attributes, recovery, genetics, age etc

We're you allowed to not reject all the null hypotheses and thus come to no conclusion?

For example say 3 papers are rediculous, could you say "they are all rediculous, there is nothing learned, we know nothing new from them"

The problem is there are always exceptions, like honey for infants.

How long did you delay for? It's not like there's some tiny window of opportunity before 10 months or whatever. Consider that the Spanish conquistadors who literally never saw a peanut as a child and tried their first peanuts as adults all survived long enough to make peanuts a globally accepted food. You can't blame yourself. To think that somehow not delivering peanut exposure was a sure cause of the allergy is nonsense.

Sounds more likely that she was just bound to get the allergy anyway. Giving the children exposure to the allergens early decreases the risk. It does not eliminate it 100%. Doubt not feeding her everyday peanuts was what made the difference.

You don't need to let them 'eat' it. just introduce it to her body by putting a tiny amount in her mouth is enough to trigger the immune system.

>>I highly recommend being very rigorous about giving them the peanut exposure every single day

I honestly can't tell if this entire post is some kind of parody or what. That cannot be real - I don't know anyone or have ever heard of anyone basically force feeding their child peanuts to maybe avoid peanut allergy later in life. It sounds insane, just like the presumption that because you missed some imaginary time window in their development your daughter has developed peanut allergy. That cannot possibly be real.

Is the joke that they are respectful with regards to allergies? Or am I reading a bit much of an attitude into your comment? Because it comes off as rude and tone deaf.

With a child that has PA on anaphylaxis-level and has had such an reaction a couple of times, and she has thusly built up a fear and anxiety, not being able to casually just let her attend b-day parties etc etc etc, I can assure you it's not a joke to us.

And no, we are not overly clean, in fact love going outdoors into the woods and getting dirt under our fingernails. Nor did we hold her off peanuts when small, her first reaction came when she just had learned to walk at about 10 months and ate a tiny piece found on the floor. And we as parents work very hard on trying to have a casual attitude towards life and work on her anxiety, and not let the PA define who she is or does. But then something like last week happens - those who make the food for school messed up her box of food and she ate mashed pea pattys and got really, really bad, worst in years. Boom, all her confidence in school down the drain.

It's heartbreaking, really. To find her have all that fear and pain, and we can only do so much to help her with that. And it's heartbreaking to see it being a joke to some. When I see such attitudes, I try to think that it comes from someone who is living a happy-path life, and well, good for you.

Thanks for coming to my TED talk, and smash that bell button.

Who are you making the joke to?

You seem to be suggesting that doctors should not suggest any health precautions until controlled experiments have found them effective. That is the position taken by the highly-cited paper "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials", which you must read immediately, because in a peculiar way it is a paper about you: https://pmc.ncbi.nlm.nih.gov/articles/PMC300808/

Lots of things kill infants that harm children, so keeping them away from things that harm some children probably seemed correct. The mechanism for allergy development wasn’t well known and it seems reasonably to avoid it in case it was genetic or something and would cause a hard to treat allergic reaction in the infant.

If people are developing allergies to food, isn’t a logical first step to not expose babies to the allergens? It seems logical. It turns out to be exactly backwards.

People did understand what to do, it just turns out their understanding was wrong. We might still be wrong though, one study isn't definitive proof of anything. We have to make decisions with the knowledge we have at the time, and it's normal for those decisions to look dumb in hindsight.

Bad advice that has a very long return on investment is quite sticky.

For instance the "cry it out method" did massive amounts of psychological damage to more than one generation, but it seemed to work in the short term as the babies eventually learned to "self-soothe".

Even now I still see parents and grandparents suggesting it in parenting groups; and taking extreme umbrage at the idea that it might have damaged them/their children.

The 2000 guidance was based on expert opinion because there were no studies. Leap was published in 2015 and it gave the first level 1 data on peanuts.

Anaphylactic shock is scary and peanut fear was a big deal in the late 1990s but actual risk of harm was very low. The guidance was more about the psychosocial burden placed on parents when there was no guidance. Anxious parents have been studied, that mechanism is reasonably well understood and that harm can be quantified.

Hindsight is 20/20. The fact is that thousands of children were dying and public health officials were set to task to identify interventions that help.

They know that skin and mucosa sensitization can occur in response to allergens.

A reasonable hypothesis is that there’s some boot-up process with the immune system that needs to occur before anything happens. The kids are dying today. “Avoid the thing that can cause sensitization” is a conservative position.

It is unusual that it should have been opposite and that oral exposure induces tolerance. It’s the fog of war.

The standard conservative intervention has helped in the past: I’m pretty sure seatbelts didn’t have strong mortality data before they were implemented. If it had turned out that more people were killed by seatbelts that trapped them in vehicles it would make for a similar story. I think they also got rid of all blood from donors who were men who have sex with men during the initial stages of the HIV pandemic (no evidence at the time).

Edit for response to comment below since rate-limited:

Wait, I thought it was on the order of ~150/year people dying from food anaphylaxis though I didn’t research that strongly. It was off my head. If you’re right, the conservative advice seems definitely far too much of an intervention and I agree entirely.

You do not know what you don't know.

I think people seek out these restrictions on their own. Almost everyone I know has some sort of belief about what's healthy and what isn't.

Some people become vegetarians, some people become vegans, some people believe eating big steaks of red meat is healthy, some people avoid pork, others do not eat cooked food on some days of the week, others eat only fish on special holidays, some people tell you that yoghurt is good for your gut, others tell you to avoid dairy at all cost, some tell you to avoid carbohydrates, ....

Some of these are backed by science, some are batshit crazy, some are based on individual preferences.

I don't think this is a new phenomenon. People just love coming up with rules, and even if our society allows you to eat pretty much whatever you want, people still seek out restrictions for themselves (and their kids...)

You really think a sense of embodiment can be lost voluntarily?