Thoughts on Research on the Web (Part Two)
In Part One of Thoughts on Research on the Web I talked about information literacy, what critical thinking is, and how critical thinking is applied to research on the web. Now I’m going to search for information on the Web to provide an example of these research guidelines/principles in order to illustrate their importance.
Let’s start with a research question: Is goat’s milk a suitable alternative to breast milk or commercially available formula for an infant under the age of 12 months?
Step One: Search for “goat milk” using a search engine. In less than a half a second Google returned 7,280,000 results. That’s a lot of information to sift through. Obviously I need to pare that down by using additional search terms. Adding the word “baby” to the search yields 3,680,000. Better, but still a lot. However, in the interest of time I decide to start looking at the results from this search.
Step Two: Start reading. Here are the first few links from my search:
OK, so let’s see what they have to say.
1) Dr. Sears
The first link goes to a page on Dr. Sears’ web site about Goat Milk. Dr. Sears, for those who are not aware, is a pediatrician who has written numerous books about attachment parenting, childbirth, breastfeeding, and other topics related to infants and children. Dr. Sears’ Goat Milk page starts out with a thorough description of the contents of goat milk. Towards the bottom is the following paragraph:
Parents of babies allergic to cow’s milk and other commercial formulas often ask if it’s safe to use goat’s milk as an alternative. In theory, goat’s milk is less allergenic and more easily digestible than cow’s milk, but it should not be used as a substitute for infant formula. Like cow’s milk, it can cause intestinal irritation and anemia. If your baby under one year of age is allergic to cow’s milk-based formulas, try either a soy-based formula or a hypoallergenic formula. If your baby can’t tolerate either soy or hypoallergenic formulas, in consultation with your doctor and/or a pediatric nutritionist see the goat’s milk formula recipe below.
Below this paragraph on Dr. Sears’ page is a recipe for formula made from goat milk. The goat milk recommended in the formula recipe is the one being advertised right on the page, which, one assumes, makes it easy to find said goat milk.
Parenting.com is part of the Bonnier Group, which is a publishing company. Bonnier publishes Parenting magazine and the affiliated Parenting.com web site. Clicking the link to the Parenting.com page I discover that the information is also from Dr. Sears! Much of the same information that appears on Dr. Sears’ own page appears on this page, with the same conclusions.
FoodForKidsHealth is published by Annika Rockwell, who is, according to the About page on the site, a Certified Nutritionist. This page states:
In brief, yes, RAW goat milk can be used successfully, but it should be made according to the official, time tested and proven recipe for homemade infant formula in order for it to match breast milk’s protein/fat/water/nutrient ratios.
The page refers to the additional links available at the bottom of the page, one of which, also on FoodforKidsHealth, states:
Breastmilk is the ideal milk for baby, but if he cannot be breastfed, the second best option is clean, whole raw milk from old-fashioned cows (or goats), certified free of disease, that feed on green pasture. For sources of good quality milk, see www.realmilk.com or contact a local chapter of the Weston A. Price Foundation.
OK, so thus far we have two answers to the question:
1) Goat milk formula can be used as an alternative to breastmilk or commercially available formula if the baby cannot tolerate other formulas, but only in consultation with your child’s pediatrician or nutritionist.
2) Goat milk is the second best option to breastmilk for babies.
These two answers seem to somewhat contradict each other. From the first it would appear that goat milk alone is not a suitable alternative to breastmilk or commercially available formulas, but homemade goat milk formula might be suitable if those options are unavailable or unsuitable for a particular infant. From the second it would appear that goat milk is more suitable than commercially available formulas.
Step Three: Think about the information.
So, if we go back to A Guide to Critical Thinking About What You See on the Web and for the sake of demonstration skip the first step (which is to ask if we are seeking the information in the right place, meaning is the Web the right place to seek this information in the first place), the second step is to question the accuracy/authority of the source of information.
1) Dr. Sears
The source of the first two links is Dr. Sears, who is a pediatrician. He received a medical degree, which definitely requires a rigorous education and requires that he be licensed to practice medicine. Does this make him an expert on infant nutrition? Not necessarily. Is there anything else that should make us question the information that Dr. Sears is providing? Possibly. It seems that Dr. Sears is highly recommending one particular brand of goat milk and that that goat milk is advertised on Dr. Sears’ site, which probably results in ad revenues for Dr. Sears.
2) Annika Rockwell
In considering the source of information for the third link, the author has a BA in psychology (pre-med) and is a Certified Nutritionist. A BA in psychology doesn’t make one an expert on infant nutrition, even if it was pre-med. But, what is a Certified Nutritionist? Ms. Rockwell’s site states she received her certification from American Health Science University in Colorado. Is this an accredited institution and/or valid certification body? To answer that question I looked at the web site of the American Health Science University.
The AHSU web site contains almost no information about its academic program(s). There is nothing specific listed about the courses, programs or degrees that it grants. There is also nothing listed about the faculty. With so little information it is difficult to say whether the program has any academic rigor. In addition there is nothing listed on the site about the accrediting body.
Because I am a librarian working in higher education I happened to know that the US Department of Education has a database called The Database of Accredited Postsecondary Institutions and Programs that allows you to search for accreditation information about all types of postsecondary institutions and programs. By searching this database I found that American Health Science University was accredited by Distance Education and Training Council (DETC), but resigned from accreditation in 2008. I could find no other verifiable details about AHSU’s DETC accreditation or lack thereof online. It is also not listed on the Colorado State Department of Higher Education’s list of accredited institutions.
The certifying authority listed on the AHSU web site, the National Institute of Nutritional Education (NINE), appears to be inseparable from the AHSU. That is, it does not exist separately from AHSU. I could find very little other information online about NINE. It is very unclear to me from the little information that is available what authority NINE has that validates its existence as a certifying authority. Even with a past DETC accreditation this is questionable due to potential conflict of interest when the educational institution and the accrediting body are one and the same.
What does all of this mean about Ms. Rockwell? It means that Ms. Rockwell received her education from a distance education program and her certification from an authority that is essentially one and the same with the educational institution, and that the institution from which she received said education and certification are now, apparently, defunct according to the state of Colorado and the national accrediting body.
I would not consider Ms. Rockwell to be an authoritative source of information in regard to infant nutrition. There is no evidence to indicate that she has appropriate education, training or certification to label her as such.
OK, so what does this mean?
This means that we do not have a definitive answer to our research question. There are also 3,679,997 more pages to look at in our Google search results. But, looking at that many pages is going to be very time consuming. Maybe we better take a different approach.
Step Three: Seeking Information from Other Sources
Instead of using a search engine this time I am going to look for information from other sources.
Kellymom.com is a very well known site for parenting and breastfeeding information. Kelly Bonyata, the site’s author, is an International Board Certified Lactation Consultant (IBCLC) with undergraduate education in mathematics and physics from Mercer University (a higher education institution that has been accredited since 1911). The IBCLC program requires rigorous training, testing and continuing education for certification and the certifying authorities (the IBCLCE) are separate from the educational bodies. Kelly also has an extensive list of her own continuing education available on the Kellymom site.
This is what Kellymom has to say about goat milk:
Using goat’s milk before 6 months or regular use between 6 and 12 months is not recommended. Goat’s milk is no more appropriate to give baby than cow’s milk. If you need to supplement and breastmilk is not available, formulas are a more nutritionally complete product. There are several comparisons of goat vs. cow vs. human milk in the links below. Using this information, goat milk is much closer in composition to cow milk than human milk. Goat’s milk is high in sodium (like cow’s milk) and is very high in chloride and potassium, which makes the renal solute load too high for babies. This can cause gastrointestinal bleeding and can result in anemia and poor growth (these problems are usually undetected until months later). Goat milk is also deficient in folic acid, which can lead to megaloblastic anemia. Also, infants who are allergic to cow’s milk protein are often allergic to goat’s milk too.
2) The American Academy of Pediatrics
The American Academy of Pediatrics (AAP) is the professional organization for pediatricians in the United States, and according to their web site has about 60,000 pediatrician members. AAP publishes policy statements, books and journals on topics related to pediatrics. The official journal of the AAP is called Pediatrics. In a search of Pediatrics I found an article about the use of goat milk for infants that was published in March 2010. The article entitled Fresh Goat’s Milk for Infants: Myths and Realities–a Review concludes with the following statement:
An exclusive, unmodified goat’s milk diet can cause significant morbidity and even mortality in infants, including electrolyte imbalances, metabolic acidosis, folate deficiency, and species-specific and nonspecific antigenicity. Unpasteurized goat milk has its additional infectious risks. However, information supporting this practice abounds on the Internet and in specific cultures. Our case report and literature review support the need to strongly advocate against this practice.
The case report referred to in this citation was that of an infant who was admitted to the pediatric intensive care unit with metabolic acidosis and hypernatremia (elevated sodium levels), and the baby had suffered strokes from severe hypernatremic dehydration. For 3 to 4 weeks prior to admission to the hospital the baby was exclusively fed raw goat milk as his mother was unable to pump enough breastmilk for him (he was tube fed due to birth defects). Just prior to his admission he suffered several days of diarrhea. Essentially, the baby’s kidneys were unable to adequately process the higher (than breastmilk) levels of protein and very high sodium levels in the goat milk, which was compounded when he developed diarrhea. As the authors of the article state,
infants fed fresh goat’s milk are at substantive risk for hypernatremia and azotemia, particularly in the face of dehydration (as in the case described here), which may in turn result in major central nervous system pathology, including diffuse encephalopathy, intraparenchymal hemorrhage, or thromboses10 as manifested in our patient
It should be noted that this article is considered both a case study and a review of the literature. What does this mean? This means that the authors researched the published literature in regard to the use of goat milk as an alternative to breastmilk (or commercially available formula). They cite the first instance of a case report in the literature when they refer to an article from 1906 that describes the case of a 7 month old baby boy who weighed 4lbs (yes, FOUR) when he died as a result of being fed raw goat milk as an alternative to breastmilk.
At this point I do not feel it is necessary to pursue this research question any further for the purposes of this blog post. The answer to the question according to more reliable resources is:
No, goat milk is not a suitable alternative to breastmilk or commercially available formula for infants under the age of 12 months.