I felt this article blurred the distinction a bit between which schools are doing the best job at achieving their mission, vs how we as parents can tell which schools will be the best fit for our particular child. School rankings don’t do a very good job of measuring either one, to be sure.

In particular, “most improved” is a very important metric for teachers, admins, and officials to appreciate. But it’s not going to be helpful for your kid unless your kid is starting off academically behind. I am guessing that is less common among ParentData readers than average.

These may not be the most relevant factors for everyone, but we chose public school because it offered the best social opportunities (i.e. the convenience of neighborhood kids) and the widest range of neurodiversity support (e.g. single subject acceleration for gifted kids, some understanding of ADHD and autism, etc.). Being free was nice too.

The CDC reports that 10% of high school students every year attempt suicide, and rates are higher when school is in session than on break. So choosing a school that is the least bad for mental health is our top priority. Honestly, homeschooling would probably be best on that count as well as on academics; but after compromising for the mental health of us parents as well, the school with the most convenient social opportunities won.

Thank you so much for writing this article!!! I’ve made similar arguments in my writing, but I don’t have the audience you have 🙂

I really wish real estate websites would remove the GreatSchools ratings from their home listings. They are so detrimental to public school systems that serve a diverse group of kids.

Question on teacher student ratios: how do you figure out if they are directly comparable? They don’t seem to be the same thing as class size. They often see to include staffers other than classroom teachers. Are they calculated the same everywhere?

As a parent I’ve found it basically impossible to assess a school without being physically in it myself. Which makes it challenging to select a school for my kids. Just last week I was in a music class with my kid and was horrified. Our district was ranked the best in the state in music for several years running, which sounds very impressive. But by listening to my kid and then seeing it for myself, I realized that the class is horrendous and a complete waste of time. I still have no idea how to figure out things like that about schools I might potentially like to switch to, particularly if they are not hyper local to us.

I went to that 3/10 school district. My mother taught in a 1/10 district. Now my kids are going to that 10/10 school district. I have no clue why we are trying to make the lower ranked school district sound better than they are in the name of something vaguely social justice sounding. If you had an ok experience in the lower ranked school, likely you were in honors, like me and my friends were and so were already funneled in to APs and college but the rest of the students were having a different experience. I think at least half my 200+ person class did not go to college. How exactly was diversity helpful to education? Sorry but it is just a nice thing for white folks like myself to say to feel not racist and absolutely meaningless to most students. Most of the lower ranked schools are likely filled with uninterested students, future dropouts and often worse, violence. The rankings mean something, so yeah all my friends were fine but none of us send kids to the same kind of school now and that’s intentional.

Food for thought…my 1st grader is better at math than my 4th grader. He’s fast, intuitively grasps ‘new math’ concepts, does mental math quickly and loves it. His test scores for math this year say he’s below grade level. Why? He was in a bad mood that day and didn’t feel like sitting at a computer. Because, you know, he’s a smart (often bored) 7 y/o boy. So….

Thanks for bringing this up, Emily. I would say that all of this really begs the question of why we have such disparity among schools and school districts in the first place. If we look at our policies, we can find many practices that contribute to disparity and segregation. Just try to put low income housing into high income suburbs, for example, and you will see all kinds of opposition (sometimes about parking or other such things, but we all know what it is really about). Just try to increase density in areas with single family homes to try to increase home affordability (there are just a few areas doing this now). Just try to change the funding formula so that schools rely less on local real estate taxes and more on a centralized funding source, thereby spreading the funding to lower income districts. Just try to change the way that charter schools are funded right now, taking dollars away from public schools, and in some areas religious schools can take these dollars too. Just try to change the way that teachers and administrators with experience (and therefore, seniority to place transfer requests) are assigned to schools in larger districts. Just try to change the schedule to allow for parental involvement among working parents, or have effective ways to reach parents intimidated by the school system. How about the concentration of non-profit property, exempt from taxes, concentrated in the urban core of our mid-sized cities? How about the plummet in real estate assessments of our downtown properties as people work from home? And, perhaps most importantly, how do we support the stimulation and education of children from infancy on? How do we address the “word gap”, the hours spent in front of screens, and the lack of interactive play that some young children experience to the detriment of their later education? For those of the commenters here who were able to take AP and advanced courses in low-ranked schools, we should look to your districts as examples of how this was accomplished, because in too many districts it is not even possible to do this. Just saying, people, if you care about children and education, advocacy and a shift in thinking to the entirety of the problem and solutions, is sorely needed!

Hi Emily – some of the writing in the article on screen time seems to really over simplify things…primarily the section on content. You note content doesn’t matter much beyond age appropriateness, and note that violent video games and shows don’t lead to more violence. What about cultural messaging though? What about the data on how racism, sexism, objectification of women’s bodies, glorification of thinness, etc. influence a child’s perception of themselves and others? There seems to be this huge reckoning going on for millennial women right now about how distorted body image messaging was for us growing up, and the long-term damaging effect of consuming content that disparaged bodies that were anything other than very skinny, able bodied, light skinned, etc. Content seems so much bigger an issue than violence, swearing, sex and nudity.

Question for Gillian Goddard on the bioidentical hormone article: most of what I hear about bioidentical hormones is actually about synthetic progestins vs bioidentical progesterone, but the article didn’t cover this. For example, in this article on CEMCOR (https://www.cemcor.ca/resources/progesterone-not-progestogenprogestin%E2%80%94-it%E2%80%99s-estrogen%E2%80%99s-unique-biological-partner):

“Progesterone is a hormone integral to women’s whole reproductive system and is essential in the milieu of an adult woman. Progesterone works in partnership with estradiol in every system, tissue and cell. However, sometimes progesterone and progestogens have opposite effects! For example, progesterone acts in breast cells to decrease estrogen-related cell growth/proliferation and to make cells more mature [2]. We only recently learned this—activation of the progesterone receptor by progesterone in breast cells decreases the proliferation that is normally produced by stimulation of the estrogen receptor [3]. Progesterone’s breast actions through the progesterone receptor have breast cancer-reducing effects. The opposite is true for medroxyprogesterone, the progestogen most closely chemically related to progesterone. When medroxyprogesterone is used in combination with estrogen, this treatment increases breast cancer risk [4]. Sufficient research now combined shows that progesterone with estrogen treatment significantly decreases menopausal women’s risk for breast cancer compared to progestogens with estrogen therapy [5](Asi et al. Systematic Reviews (2016) 5:121 DOI 10.1186/s13643-016-0294-5 2016). It turns out that medroxyprogesterone acts in breast cells through a glucocorticoid rather than through the progesterone receptor; stimulation of that stress hormone receptorincreased the breast cell proliferation that, with estrogen, increased breast cancer risk [6].”

I have no idea if this source is legit or not, but curious about your take on the whole synthetic vs bioidentical topic when it comes to progesterone.

Very disappointed in the answer to a very specific question from Casey regarding any available research about the accuracy of a potential prenatal diagnosis percentage. What followed seemed to be a non-answer explaining that doctors really try to get these things right, which of course we all understand and then a patronizing description about how to discuss a potential diagnosis with the doctor. That was not her question. Her question was…how often does research show these diagnosis percentages are accurate. With the prevalence of more prenatal screening, stories like Casey’s are more and more common and I believe the impact of stress on a pregnant mother in these situations cannot be overstated. What I do think is lacking is thorough counseling prior to administering some of these tests, which seem now to be standard, without explaining what they are testing for and why, and consideration on the part of the parents how they might USE this information. My midwife, counseled me by saying “it’s helpful to know what you might feel comfortable doing with this information, and how it might change your decisions”. I neglected any testing other than the 20 week ultrasound bc I knew that was right for me. I realize all issues don’t present as a result of testing…but a lot do. I have several friends who had genetic screening results flagged, sometimes for the possibility of very severe anomilies, only to result in severe anxiety, further expensive work up, and at the end of the day, a healthy baby. It’s a legitimate question to ask about the accuracy of some of these test results or doctor’s analyses given how expensive and life-impacting our care is. IS there research indicating accuracy of potential diagnosis percentages?

As an AYA breast cancer survivor I was glad to see Tamoxifen discussed (April is AYA Cancer awareness month too!). Here to add that many of us with er/pr+ breast cancer that are premenopausal are now being prescribed Lupron (shuts down ovaries) and Letrozole (decreases other estrogen made by the body) instead of Tamoxifen. Of course this is all dependent on your type of cancer and risk so this is not to say that Tamoxifen is bad, it’s not, but there are multiple treatment types. It’s a huge adjustment to be put into medical menopause and I’m glad to see more resources available to navigate it.

Re maternal mortality data: I read that the US is actually on par with other developed countries. But from reading your article I can see that too might be an oversimplification. Any insight into what counting method other developed countries use and how the US compares?

Comment re: CDC Maternal Mortality Data.

Is there any way to access data on Severe Maternal Morbidity (SMM) and how it has been trending over time in the U.S.? SMM is defined as “health-impacting and life-threatening events that occur during hospitalization for childbirth.”

Is there a way to access this data by hospital system?

I ask because during my first healthy, normal pregnancy at 36, I had a bad outcome classified as SMM. Hospital says this is “rare” and a “freak thing” but the more I read about this, the less rare it seems (36 hours of induced labor, 4 hours of pushing, urgent but NOT emergent c section, doctor tore artery, didn’t realize it, sewed me up, 6L hemorrhage, Hysterectomy).

It seems that there are many near-misses with lifelong health implications like mine that are not being reported. It has been very hard for me to get answers about this and find data.

Curious if anyone has any tips on how to get these answers? I have yet another meeting with the hospital in May. Thank you!

Thanks!

I wouldn’t rely on death certificates for this information. They are an afterthought typically in health care, and not particularly standardized. When my grandmother died in 2021, the doctor filled one out without having been present or examined the patient or done an autopsy or tested for covid. It was probably roughly correct, but it was no gem of data accuracy. And it was absolutely typical. It’s paperwork that doctors have to do but often rush through, and it’s not done in the interests of data or science.

Re: Maternal mortality. I feel like this is a good topic for a qualitative evaluation. Since the numbers are not large, a researcher could get a good sample of the death certificates that were included in one definition and excluded from the other definition.
Also, the increasing trend is during covid, which Emily noted. While the increase may or may be from covid itself, mothers may not have received the care they would have otherwise. People were avoidant of hospitals, and medical facilities were at capacity.

“Skin Care During Pregnancy”

I truly appreciate this article! I would be forever grateful to see the follow up piece on all these with breastfeeding.

Great article on skincare! I was hoping to see commentary on the use of retinol products while breastfeeding. Are they all banned? Anything similar allowed?

I’m curious about the research behind the claim “In the data, there are a couple of school-level inputs, or characteristics, that do seem to be causally linked to student learning. One is student-teacher ratio: fewer students per teacher has been shown to increase learning (it’s true that richer districts have a smaller number of students per teacher, but other analyses that are able to isolate causality also show this).”

As someone who works in school leadership, I’ve heard a lot of different claims on this topic – and I expect there is some nuance (what age ranges causality is most impactful, at what number a smaller student:teacher ratio is no longer casaully impactful, etc.) and I’d love to be directed to some studies you think highly of to better inform my decision making.

In response to the newsletter item about breastfeeding and food allergies, I have a child with FPIES who is reactive to his triggers through my breastmilk. I’ve read that triggers are undetectable in milk in 12 hours or less (https://www.freetofeed.com/post/truth) and in my experience, this seems to be true — my baby will react within a few hours after I’ve consumed his trigger, but is usually fine the next day. I think the longer time frames mentioned (72 hours, or 2-4 weeks) are about how long it takes for your baby’s gut to heal. The reaction caused inflammation that makes them sick and so it may take some time to notice the healing effects of removing the trigger from your diet. But if you slip up and accidentally consume some of the trigger(s), you do not need to dump your milk for weeks after — evidence seems to suggest dumping milk for the next 8-12 hours or so and then you’re in the clear to continue breastfeeding.

To Katie from the Q&A email on April 18th asking about preterm labor: look up Lauren Hefez on YouTube/Instagram. She is a Boston-area Pilates/barre instructor and big part of the community. She has lived a very similar experience with her pregnancies and might be a helpful anecdotal reference for you. Her classes are great!

Wanted to add my personal experience of dairy allergy. Firstly, I hope your child outgrows it as mine has (now he has a intolerance which means he can have dairy, just only half as much as most children in one sitting and also the type of milk matters). Secondly, while severe dairy allergy does present in bloody stools etc., my child’s dairy intolerance/ allergy presented as jacquet’s dermatitis due to the constant watery and apparently incredibly acidic poos (a diaper rash so severe it has its own name – images on google are painful and graphic, you have been warned). And yes second that all dairy needs to be eliminated including anything cooked with butter and that’s pretty much 80% of every (non raw food) you can buy in a store or in a shop, including things you wouldn’t initially think has dairy, like bread.