Friday, February 27, 2015

Parents' Intuition: It Can Harm As Well As Help

    After my children were born I was very surprised by the degree to which emotional rather than rational thinking influenced our parenting decisions. Even simple choices seemed complicated: Should we wake the baby to feed or allow her to sleep? Was the injury risk from contact sports greater than the benefits of team play? Should the kids stay home when they have a cold but miss their math test? Were we setting boundaries that were too strict or not strict enough? The list was endless and intuition quickly earned a prominent place in our parenting tool kit. We came to realize that there was simply no other practical way to make these choices.
     The concept of intuition is quite mysterious. We understand that it is not rational and use vague descriptive terms like “gut feeling” and “sixth sense” but we don’t quite understand how intuitive feelings get into our heads in the first place.  Even more disquieting is the notion that we have to use intuition to know when to trust our intuition. Intuitive thoughts allow us to make predictions that might seem to be based on absolutely nothing, but the most valuable intuitions occur when we unconsciously compare past experience to what is happening in the present. They can warn us away from serious danger, “I don’t want my daughter travelling in that boy’s car,” and they can address the more trivial concerns of a mother who asks through the bathroom door, “Are you okay in there?” Despite its limitations, most of us agree that a parent’s intuition has real value and it is easy to recall situations where potentially terrible mistakes were prevented by responding to a seemingly unexplained anxiety. It is quite possible, however, that we exaggerate its accuracy and minimize its failures because we are more likely to remember those times when we discovered a toddler about to drink furniture polish than when we rushed to the kitchen and found our child happy and safe. 

     There is usually a complimentary relationship between intuitive and rational thought.  But when there isn’t, bad things can happen.:When rational thinking tells us one thing and intuition another, parents can become so immobilized that they can't make any decisions at all. And there are times when parents were absolutely certain that something is true but intuition tells them to ignore it anyway. It is counterintuitive, but very confident parents who believe that “no one knows my child better than I do,” are at extra risk for making mistakes because they are so certain they know what will happen next.
     Group intuition can also lead us astray.  Most recently, it is playing a role in vaccine refusal. Vaccinating against infectious disease is one of the few times a parent can knowingly lessen their child’s chance of developing permanent brain damage and even death. But the strong power of negative intuition might cause a parent to delay or miss this opportunity - especially when it is reinforced by like-minded friends, relatives and pundits. The statistical evidence is very clear that the risk of developing brain inflammation from measles illness is one thousand times greater than from the vaccine: One per thousand vs one per million. Even when we exclude parents whose religious beliefs don’t allow vaccination and those who think that vaccination is a conspiratorial plot, we might reasonably wonder why an informed parent would hesitate to vaccinate against this disease. The answer is that a fairly large group (including some parents who did vaccinate their children) have a strong intuitive feeling that it is the wrong thing to do. They are aware of the benefits and the risks to their child and others, but it just doesn't feel right. Some have understandable but irrational concerns about giving too many shots, tinkering with the immune system, injecting a "foreign" substance, or the discredited association between vaccines and autism. Often, they will not or cannot articulate why they are so wary. But once this feeling of dread has been planted in their heads, a rational discussion with the doctor is unlikely to make it go away. Unfortunately, we pediatricians can be part of the problem. We often tell parents to trust their intuition but then we don’t address their non-rational fears in a respectful or meaningful way. 
We can and should  agree with parents that their iintuition is a very powerful tool ,but then we can offer them some additional advice: First, be certain that the information you are relying on is current and comes from a reliable source. Be especially wary of “junk science,” anecdotes, and unsubstantiated claims that are found on the internet. Next, try to keep rational thinking and intuitive thinking separate. Don't try to rationalize one in terms of the other; we will make better decisions once we can say, “I know that the evidence says this, but my intuition tells me that…,”  Third, get another opinion – preferably from the child’s other parent. In the vaccine example, I was surprised to learn how often parents in stable relationships have never discussed this issue with each other.  (That is why I frequently made both parents sign our refusal to vaccinate form; it is not legally necessary but it forces both parents to have a conversation.). And last, suggest that they give more weight to the best available information and rational thinking when making those decisions that are most important; vaccination is one of them. Life events are unpredictable, but over time, we are more likely to guess right by playing known odds than by betting on a hunch.

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