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...

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...

Dr. Carole Keim MD congratulates all parents on making it through the first year. She reminds everyone how much babies have developed in that year and then goes through what to expect at 12 months and beyond. From development to parenting decisions to skin and teeth care, Dr. Keim covers what you need to know.

Dr. Keim addresses how best to engage with your baby once they’re a year old. She details how they’ve developed and exactly how much they can understand and accomplish. She talks about nutrition and all the things your baby should be eating at this age. Teeth brushing should be a regular part of the bedtime routine and Dr. Keim explains what your baby’s sleeping arrangement should look like. She covers safety and childproofing your home, skincare, and what exactly to expect from their 12 month checkup.

In this episode....

• Parents
• Development
• Sleep
• Nutrition
• Teeth
• Elimination
• Skin care
• Safety
• 12mo checkup

Parents: 00:23

• Engage with child often by speaking with them, tell them the names of objects
• Baby should be able to separate or move away from parent for moments, but will check back to look at them
• Have a “yes” space
• Have regular date nights with a babysitter watching baby
• Make time for yourself
• Hang out with friends
• Use consistent positive discipline (notice/comment on good behavior, avoid using the word “no” and instead tell them what they CAN do, use distraction, be a role model)
• Give your child regular down time during the day
• Look for parent-toddler play groups
• Congratulate yourself on making it through the first year! Think of how much you have grown and changed, and your baby too!
• Birthday party planning: it’s mostly for the parents. Kids can have cake for the first time. Expect your baby to be done after an hour or two, and allow downtime afterwards.
• This is the time that parenting expectations start to come to the surface. Talk them over with your partner. Consider taking a Love and Logic class or other parenting class together.

Development: 09:21

• Stranger anxiety / apprehension goes away
• Might have a preferred parent
• Starting to talk - says mama, dada, and one other word (typically hi), imitates sounds, jabbers with inflection
• Points out objects and brings objects to show parents
• Plays interactive games (responds to peek-a-boo, pat-a-cake)
• Hands parents a book or toy
• Follows simple directions (put this away / hand me a toy)
• Waves bye
• Starting to walk/cruise along furniture, stand alone for a few seconds
• Identified people upon request
• Wean pacifier and bottle - switch to a cup for drinks

Sleep: 14:28

• 10-12h at night, 1 nap per day. Sometimes takes a few weeks to transition from 2 naps to 1 nap.
• Bedtime routine established: brush teeth together, quiet time, reading, singing
• In crib in own room; consider moving to toddler bed when it’s ok for them to get out of bed (walking independently, able to safely get to your room and wake you up)
• Blankets ok; no pillows til age 2
• No bottles in bed; if you need to wean bedtime bottle, can start progressively watering it down until it’s only water

Nutrition: 16:29

• 3 meals and 2-3 snacks per day at the same time as the family
• Offer a variety of foods and textures
• Encourage self feeding
• Can stop breastmilk or formula (use up what you have); ok to breastfeed as long as you want
• Use a cup for water; offer water with all meals and snacks
• Cow’s milk and honey are ok now
• Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
• You determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze)

Teeth: 20:03

• Brush teeth BID with fluoride-free toothpaste; if there is no fluoride in water source can use a grain-of-rice sized amount of fluoride toothpaste
• If no teeth yet, brush gums BID with plain water and toothbrush
• Schedule first dentist checkup now or when first tooth is in

Elimination: 20:53

• Can start potty training by putting baby on potty after eating and upon waking
• Typically voiding at least 6x per day, stooling 1-2x per day
• If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day. If not enough, talk to your doctor about miralax.

Skin care: 22:56

• Bathe as often as they get dirty (2-3x per week)
• Can use lotion
• Use sunblock if spending more than 30 mins outside
• Insect repell...

Did you know you can potty train your six months old infant? Dr. Carole Keim MD talks about potty training, babyproofing, routines, and stranger anxiety. Your six-month-old should be recognizing familiar faces and reacting to their own name. Now is also a good time to use your support network to help with tasks, get a babysitter and go on a date. It is ok to leave your infant for a few hours and ask for help when overwhelmed.

Dr. Carole Keim MD goes into great detail about the power of routines. Routines for feeding, winding down, sleeping, and leaving the house. Your infant will start to recognize these patterns and know what you are doing. Check out this episode for more information about your six-month-old infant.

Parents: (00:43)

• For many this is a “golden” age - you’ve got a good handle on things, sleeping fairly well, have routines down, parents show confidence with infant (it’s ok if you’re not! But also keep postpartum depression in mind.)
• Establish routines
• Interact with baby, respond to cues
• Talk/sing, read, play peek a boo
• Use support networks, balance parent roles/responsibilities
• Date night with trusted babysitter

Development: (02:25)

• Socially interactive
• Happy feet
• Recognizes familiar faces
• Babbles
• Takes turns babbling / making sounds like squeals, blowing raspberries, rrr
• Starts to know own name
• Visual and oral exploration to learn about environment
• Rolls over both ways
• Tripod sit / sit with support (baby seat, high chair)
• Stands and bounces (johnny jump up / activity center)
• “Swims” on land (pre-crawling)
• Turns while sitting to look at things
• Raking grasp
• Can bring hands together, transfer hand to hand, and put objects in mouth
• No object permanence yet
• Toys: soft toys, crinkly toys, rubber/silicone toys, rattles no hard eyes/noses, no small parts (choking hazard)

Sleep: (09:14)

• Safe sleep: alone, on their back, in a crib.
• Crib should be in parents’ room until 1 year of age
• Lower crib mattress (pull to stand)
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - rolling
• Maintain 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

Nutrition: (11:48)

• Primarily breastmilk or formula; starting solids
• 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
• give water (ounce per ounce with foods)
• Start consolidating meal times
• Consider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby food
• Expect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cues
• Gagging is normal, choking is not

Teeth: (19:30)

• Teeth can appear anytime; brush 2x per day with water and soft toothbrush
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel
• Fluoride: check if it’s in tap water, if not, can consider using fluoride toothpaste (grain of rice sized amount)
• Avoid laying them down with a bottle, never prop a bottle

Peeing/pooping: (24:49)

• Peeing about 4-6x per 24h
• Poop is now more solid because they are eating foods; can consider starting potty training now

Skin: (26:40)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths - watch those folds for rashes though
• Sunscreen, insect repellant: any baby sunscreen is ok, citronella works for insects and is safe
• Diaper rash and drool/food/skin fold 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.
• Cradle cap - olive oil / vaseline / aquaphor at night, soft baby brush in the morning

The 6 month checkup: (30:23)

• Baby should have gain...

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
...