The Baby Manual

Some newborns will eat eight to twelve times a day. In this episode, Dr. Carole Keim MD talks about breastfeeding, formula feeding, pacifiers/nipple confusion, and teething/oral hygiene (also thrush). For the first couple of months, your baby should be eating at least once every 4 hours for development. Pumping can be done right after your baby is born and sometimes even before. Are you looking at formula options? She goes over different types and how to choose what’s best for your little one.

Dr. Carole Keim MD goes over the benefits of breastfeeding for both mom and baby. Eventually, your baby will start to show interest in food, so it is essential to know how to introduce solid foods and approach the risk of allergic reactions. Your baby may start teething at around six months; she talks about signs to recognize, ways to help your baby during this time, and oral hygiene practices.

The next few episodes will be a deep dive into certain topics that I get asked about a lot; these are also laid out just like this in my book, The Baby Manual, available on Amazon/Kindle

• feeding, teething - 5/4
• pee/poop, gas/colic - 5/18
• skin - 6/1
• sleep - 6/15
• illness/red flags - 6/29
• vaccines 0-6mo - 7/13

How often to feed: (0:54)

• Newborns eat 8-12x per day, need frequent feeds because their stomach is so small
  • Birth - stomach size of a cherry (5-10ml, or 1-1.5 tsp) - colostrum
  • Day 2 - walnut (20-30 ml, or 0.75-1 oz)
  • 1 week - golf ball (45-60ml, or 1.5-2oz)
  • 1 month - (80-150ml, or 2.5-5 oz)
• The stomach stretches like a balloon
• Overfeeding -> spit ups
  • The lower esophageal sphincter develops by 6-12mos of age
• 8-12 feeds aren’t exactly every 2-3 hours
  • Cluster feeding 2-6 am because prolactin is highest
  • This typically lasts about 2 weeks, then they learn the night/day difference
  • If they sleep 4 hours you MUST wake them
  • Newborn - 2 weeks: may eat more than 12x per day
  • 2weeks - 2 mos: typically eat every 2-3h
  • 2-6 mos: can sometimes go more than 4h between feeds if they are gaining weight and your doctor ok’s it

What to feed them: (4:00)

• Breastmilk or formula ONLY for 4-6 mos
  • Contains all the protein, fat, carbs, vitamins, minerals, and water your baby needs
• At 4-6 mos can start to introduce foods: will come back to this in a bit

Breastfeeding: (4:29)

• AAP recommends exclusive breastfeeding x 6 mos, then BFing + food/water until age 1 year or later
• Ok to breastfeed as long as you want
• Eat a wide variety of foods
• Vitamins:
• A prenatal vitamin that contains iron and folic acid
• Omega-3 fatty acids (200-300mg per day)
• Calcium (1000mg per day)
• Vitamin D (5,000-6,400 IU per day)
• Ok to drink alcohol because of first-pass metabolism: an 8oz drink of 10% alcohol becomes 0.04% BAC (and 0.04% breast milk concentration - 250x less concentrated). 0.08% consumed by baby makes their BAC 0.0001% (undetectable; less than BAC after a child drinks orange juice or eats an over-ripe strawberry)
  • When inside, your BAC = baby’s BAC
• Each time baby eats, they are placing an order for the next feed
  • First 3-5 days colostrum; need to nurse for 15-20 min per side per feed to stimulate milk production

Benefits of Breastfeeding: (9:53)

• Emotional: releases oxytocin, a bonding hormone, and endorphins
• Health: decreases postpartum bleeding, decreased risk of breast cancer and ovarian cancer, decreased risk of rheumatoid arthritis, decreased risk of postpartum depression, can help you lose baby weight because burns an additional 500 cal per day
• Baby benefits: decreased risk of obesity and type 2 diabetes as adults, less chance of infection due to IgA, decreased risk of SIDS, less likely to develop atopic and autoimmune diseases
• Extra benefits nobody really talks about: poop won’t smell bad and is water-soluble, you always have it on hand, the composition changes as your baby grows, it’s free

Tricky things about breastfeeding: (12:40)

• Takes babies up to 2 weeks to get a hang of it
• Can be painful for the first 2 weeks
  • Aggressively moisturize your nipples
• Tongue-tie: only class 4 needs repair. Lip and cheek ties do NOT need to be repaired.

Pumping: (14:37)

• Can start as soon as the baby is born; pumping while pregnant can induce labor
• Choosing a pump: manual vs. electric, how much suction, how portable, single or double
• Getting the best return:
  • Early morning (prolactin peak)
  • One side while baby latches on the ot...

Your baby is now super cute at 4 months old and are laughing, smiling, and doing happy feet. In this episode, Dr. Carole Keim MD talks about weaning your baby and the difference between the traditional purees method and baby-led feedings. With new foods comes how to handle food allergies and brushing your baby's teeth. She also talks about protecting your baby while outside and safely using sunscreen or bug spray. Bookmark this episode! This information will apply for the next two months.

Just like previous episodes Dr. Carole Keim MD will go into detail about your baby’s development, sleep patterns, peeing and pooping, skin care, and what to expect at their 4-month check-up. As a new parent, you should be feeling a lot more confident about the overall care of your baby. Also a reminder those little hands are stronger than they look so if it is in grabbing distance be prepared.

Parents: (00:24)

• Feeling more confident overall
• Baby is laughing and babbling, really interacting - this is when most parents fall in love with the baby
• Start wearing hair up / no jewelry - baby can grab objects!

Development: (01:32)

• Social smile / laugh / happy feet
• Consoles self
• Babbles
• Different types of crying
• Indicates happy/sad
• Responds to affection
• Lift chest when prone, roll (typically front to back)

Sleep: (03:02)

• Variable at this age; some have sleep regression, others are sleeping better than ever
• Safe sleep: alone, on their back, in a crib. (Time to move to a crib!)
• Crib should be in parents’ room until 1 year of age, new studies show babies sleep better in their own room starting at 4mos but it’s not an official recommendation yet
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - starting to roll
• Start a bedtime routine; feed, brush teeth/gums with water, read, sing, set down awake but drowsy
• Things that can help, but only if they need it: blackout blinds, white noise machine, music

Eating: (06:27)

• Primarily breastmilk or formula; starting to consider solids
• 6-8x per 24 hours, 24-30oz per 24h
• Can take 4-6oz at a time and be full 4-6 hours
• Signs of food readiness: showing interest in food, good head control while seated supported, loss of extrusion reflex
• How to start solids:
  • Baby-led weaning vs. purees (traditional)
  • rice/oat cereal optional (pros/cons)
  • progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
  • one new food every 3-4 days
  • signs of food allergy: rash, vomiting
• When to start water (ounce per ounce with foods)

Peeing/pooping: (17:11)

• They have found their pattern: typical 1-2x per day, the rule of 7’s still applies (until they start solids): once per week up to 7x per day is normal; after starting solids should be 1-3x per day
• Peeing about 6x per 24h

Skin: (17:54)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths
• Sunscreen, insect repellant: any baby sunscreen is ok but not fully protective til >6mos, citronella works for insects and is safe
• Diaper rash and drool rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.

Teething: (22:25)

• Teeth can appear anytime; brush 2x per day with water
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel

4-month check up: (26:19)

• baby should have gained about 2-3lbs since last checkup, or should be about twice their birth weight (avg weight 14lb)
• Second round of vaccines: DTaP, Polio, Hib, PCV, rota (2 shots, one oral)
• Anticipatory guidance:
  • Safety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns
  • Development: tummy time (30 mins twice a day), anticipate rolling, laughing, babbling. Can inspire rolling with toys placed just out of reach. They’re not sitting on their own yet or crawling (those are at 9 mos).
  • Next WCC in 2 mos; same vaccines as the 2mo visit
...

Dr. Carole Keim MD talks you through everything about sleep in this episode. Your baby’s sleep and yours as well. She addresses sleep patterns, helping your baby fall asleep and stay asleep, crying, safe sleep and reducing SIDS risk, and how to consider nighttime work division with a partner so both of you can get your own sleep.

Sleep is vital for both you and your baby. For the first months of your baby’s life, they will sleep a lot in two or three hour increments, and wake to feed often, while you don’t really sleep at all. Dr. Carole offers suggestions on how to help your baby learn the difference between night and day so you can teach that nighttime is for sleep. Develop a nighttime routine for your baby that will help them be ready to fall asleep faster in their crib. Dr. Carole also explains why she’s pro-pacifier and swaddling and cautions about other ideas that may not be safe for your baby. Learn all about your baby’s sleep health so you can get back to your own night rest.

This episode will cover:

• Baby sleep patterns
• How to help baby fall asleep and transfer to the bed
• How much crying is ok
• Safe sleep / SIDS
• Co-sleeping
• Division of night work
• Tips to help you sleep better
• Sleep training

Baby sleep patterns: 00:44

• Newborns: about 18h per day, in 2-3h increments, and MUST be woken up to feed if they have slept 4 hours. NB are only awake to feed/pee/poop/cry.
• Around a month they learn the night-day difference, and will start to sleep longer stretches at night and shorter ones during the day. They still wake at least 1-3x per night and nap throughout the day.
  • You can help by interacting more during the day, and keeping the lights dim and a quiet voice at night
• Around 2 months they are allowed to sleep more than 4h at a time; check with your doctor to make sure they are gaining weight consistently
• By 6 months some babies may sleep through the night, but most will still wake up at least once. They are also typically taking 3 naps per day at this age, then 2/day at 9 mos, and 1/day at 1 year.
• It is normal even for the first few years of life to wake 1-2x per night. Can make it less appealing by adding water to the bottle after 1y of age.
• The 4-6mo sleep regression - not a medical thing, may be due to teething. Many babies actually start to sleep better at this age - this is not due to starting solid foods, but more likely due to their ability to consume larger amounts of breastmilk/formula at a time.
• Total hours of sleep: 18h per 24h for newborn scattered throughout the day, 14-18h per 24h for 6 mos old (12-14 at night, then 2-3 naps 1-2h each), 12-14h per 24h for 1 year (11-12 at night, 1 nap for 1-2h)

Help baby fall/stay asleep: 05:43

• Signs baby is tired: drooping eyelids, rubbing eyes, yawning, fussing
• Swaddle baby for the first month or until they bust out of it; can go longer if baby loves it, but MUST stop when baby can roll over
• Have a wind down routine
  • Last nighttime feed in arms / high chair
  • Brush teeth or gums
  • Bath (optional; they don’t need it daily, but it can be relaxing)
  • Sway/rock with baby in arms
  • Speak in a quiet, soothing voice
  • Read a book / sing a lullaby
• Place baby down “awake but drowsy” - they will get used to falling asleep in their bed
• All babies hate their bed!
• If baby falls asleep in arms, transfer quickly to bed, place a hand over them for 10-20 seconds or until they seem settled in, then walk away
• For babies who seem to want more, can sit in a chair near the crib and move the chair progressively farther away each night, eventually stand in doorway while they fall asleep, then you should be able to walk away
• Can try adding in blackout blinds, white noise machine, lotion, etc - keep in mind that baby will get used to this and it can make sleep harder later
• Tylenol/ibuprofen at bedtime for teething infants can help them sleep better
• DO NOT put rice cereal in the bottle for sleep, or start solids early; these actually contain less calories per ounce than breastmilk/formula and will make them get hungry sooner
• DO NOT use melatonin in babies less than a year, or for more than 2 nights in a row after 1 year of age
• DO NOT give your infant or child sedating antihistamines or other sleep medicines, they are not safe

How much crying is reasonable? 12:07

• Most babies will wake up a little as you set them down, and many will cry
• It’s ok to put a hand on them, rock them gently in their bed, pat them gently, talk to them, sing, etc. but try not to pick them up for a few mins
• Generally 5-20 mins of crying is ok, but if it is hard for you to wa...

You are starting to get into the groove of this new parenting thing and your baby is now 1 month old. You should start to see those smiles and the super cute cooing. In this episode, Dr. Carole Keim MD talks about what to expect from the 1 month check-up along with eating, peeing, pooping, sleeping, and skincare. She goes into great detail on gas, colic, reflux, and the benefit of a probiotic. It is also a good time for you to start thinking about your relationship again and enjoying a date night.

This is the peak age for discoordinate stooling, reflux, and skin issues. Knowing the difference between learning bowel control and constipation or spit up vs green projectile vomit. Knowing what to watch for is half the battle when caring for your little one.

Parents: (00:25)

• Finally feeling in the groove of things
• Baby has nights and days figured out
• Don’t overstimulate
• Still narrate your day, take turns talking with baby
• Find time for a date night!

Eating: (02:04)

• 8-10x per 24 hours, 24-30oz per 24h
• Starting to go from q2-3h to q4-6h

Peeing/pooping: (02:40)

• Discoordinate stooling
• Gas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic drops
• Reflux: Explain LES, normal spit ups. Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)
  • Pyloric stenosis: getting progressively worse, turns green (grass green)
• Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillows

Skin: (10:11)

• Bathing 1-2x per week
• Can use lotion or cream or ointment after baths
• Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
  • Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID. Treat the whole family - nails and nose.

Checkup: (14:08)

• baby should have gained about 2 pounds from birth weight (based on 7 lb baby)
• Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, responds to calming actions when upset, follows parents with gaze, recognizes familiar voices, communicates needs (hungry/wet), lift head when prone / on parent’s chest, fontanels open until 1 year of agepo
• Anticipatory guidance:
  • Eating - nothing but breast milk or formula for 4-6 months
  • Mom should eat a wide variety of foods and take PNV while breastfeeding
  • Supplement with 400 IU of vit D daily, or mom can take 6400 IU
  • Sleep: back to sleep, no blankets, stop swaddling. ABC = Alone, on Back, in Crib.
  • Put baby to bed awake but drowsy
  • Fever and how to take temp
  • Never leave baby on high surface
  • Rear facing car seat til age 2
  • Avoid secondhand smoke
  • Set water temp to 120 degrees to avoid scald burns
  • Bathing baby 1-2x per week
  • Skin care / peeling skin
  • Tummy time

Next checkup is at 2 months: (21:48)

• First round of vaccines: DTaP, polio, HiB, Hep B, PCV, Rotavirus
• No need to pre medicate before shots, but DO buy some infants or children’s Tylenol / acetaminophen before the visit
• Ask doctor for the dose of Tylenol at the 2 month visit
• Pooping will consolidate further: rule of 7’s at this age is that anything from once a week to 7x per day is normal
• Should keep peeing every time they eat
• Still need to wake them up once every 4h to eat

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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Dr. Carole Keim MD: linktree | tiktok | instagram

Dr. Carole Keim talks about the all-important subject of sleep in this episode. Sleep is a frustrating thing as a new parent which is why there is so much sleep advice and so many sleep books available. Dr. Keim will break down what sleep patterns are normal at different ages and give information on different ways to help babies (and parents, by extension) sleep well.

All babies are different and what works for one baby’s sleep may not work for another. But there are normal sleep patterns for different ages and Dr. Keim clears up confusion around those necessary patterns. She explains why babies crave the rocking and contact of being held as opposed to being laid in a bed to sleep and offers advice on how to slowly get them accustomed to the change. From night feeding to sleep positions to not using your phone in your baby’s room to all the different alternative healing modalities that have been shown to be helpful in promoting sleep, Dr. Keim gives the key information parents need on the topic of sleep.

In this episode:

Sleep (00:27)

• Intro: helping babies sleep at night is one of the most difficult and frustrating things as a new parent. All babies are different. What’s normal at different ages:
  • Newborns cluster feed and wake at least once every 2-3 hours
  • For the first 2 months of life, a baby can’t sleep more than 4 hours
  • From 2-6 months it’s ok to let them sleep longer, but most still wake 2-3x at night to feed
  • From 6-9 months, allowed to sleep as long as they want, typically wake 1-2x per night, worse when teething
  • From 9-12 months, can start offering water at night. Feeding higher fat/protein meals at dinner time can help them sleep better.
  • After 12 months, they don’t need milk at night, only water if they wake up, and reassure for night waking. Cosleeping will make you both get worse sleep, and remember a thin blanket is ok, but no thick blankets and no pillows til age 2. Sleeping with a tight shirt can help curb breastfeeding at night.
• Western - graduated or progressive extinction method. “Cry it out” is not recommended due to emotional trauma. Melatonin is not recommended on a regular basis; can be used intermittently when traveling (jet lag) but not more than 2-3 days. Also a consistent bedtime routine helps - run/play, brush teeth, bath, reading/singing, low lighting, avoid screens x 2h before bed.
• TCM - pediatric acupuncture (shonishin) and Chinese herbs can both help with sleep. Speak to a pediatric acupuncturist for specific recommendations.
• Chiro - pediatric chiropractic and craniosacral therapy can help your baby or child sleep better. Chiropractic is built around relaxing and resetting the nervous system, so regular adjustments tend to be really helpful for sleep.
• Nutrition/supplements - Eating a dinner high in fat and protein and low in sugar at least 2 hours before bedtime, magnesium supplements (check with a doctor for dosing), chamomile tea over age 1 or for breastfeeding moms; can give a spoonful of chamomile tea under age 1 (no honey!)
• Homeopathy - aconitum napellus, arsenicum album, belladonna, china officinalis, chamomilla, calcarea carbonica, and pulsatilla. Note: not supported by western science; speak to a CCH for specific recommendations.
• Aromatherapy - Can diffuse oils or dilute in a carrier oil and rub onto baby’s back and feet. The best oils for sleep are Roman chamomile, German chamomile, neroli, tangerine, pettigrain, and lavender. Lavender can be stimulating in children; if this seems to be the case, try chamomile oil instead.

End of season; stay tuned for more in the future!

Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, which can be ordered here. Her first book, The Baby Manual, covers year one of your baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.

Resources discussed in this episode:

• There is more information like this in the Holistic Mamas Handbook. You can order the Holistic Mamas Handbook on Amazon
• The Baby Manual is also available on Amazon
• Dr. Keim’s Supplement/vitamins link for 10% off

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Dr. Carole Keim MD: linktree |

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