111 - Sleep

06/15/22 • 35 min

1 Listener

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...

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...

Previous Episode

110 - Skin Care

This episode is all about skincare. Dr. Carole Keim MD walks you through the ways newborn skin is different from all other babies’ skin and goes into detail on birthmarks, jaundice, baby acne, eczema, cradle cap, and diaper rash. She explains why newborn skin is prone to dryness and peeling, what milia is and how it will go away on its own, the causes and helps for jaundice, and shares much useful advice.

One of the first things to know about newborn skin is that because they’ve basically been in a bath for nine months, their skin will be dry and peely as it adjusts to the outside world. Have you heard of stork bites, angel kisses, Mongolian spots, or port wine stains? These are all types of birthmarks that Dr. Keim explains in detail. She also details how hemoglobin from extra red blood cells converts to bilirubin in the body, and bilirubin causes the yellowish tint we know as jaundice. Dr. Keim tells exactly what to look for and what to do for your baby.

Covered in this episode:

Newborn skin
Newborn rash
Pustular Melanosis / normal rash
Milia
Birthmarks
Hemangioma
Jaundice
Baby acne
Seborrhoeic dermatitis / cradle cap
Eczema
Diaper rash

Newborn skin / newborn rash 0:33

Dry and peely is normal
Newborn rash looks a little like chickenpox: red spots all over
Newborn rash is not itchy or painful and happens usually within first 3 days of life
No lotion or product required - only a greasy emolient if dry and cracking at wrists or ankles

Pustular Melanosis / normal rash 1:51

Tends to happen in babies with darker skin tone
Looks like newborn rash but tiny blisters are smaller - tiny pustules with yellowish fluid inside
When they pop they leave behind a little freckle
Freckles go away on their own
Should go away in a week - if persists beyond week, talk to doctor

Milia 2:44

Looks like pimples on nose, upper cheeks, forehead
Is not pimples but is tiny white, pinpoint size, dots
Do not pick or squeeze, could hurt baby or scar if you do
It’s essentially skin cells trapped under the skin that form tiny white bumps - almost like clogged pores but not quite
Will go away on its own and is not dangerous

Birthmarks 3:24

Present either at birth or a few days or weeks after birth - normal
Salmon patches - also called stork bites or angel kisses - can show up anywhere on body and usually fade within the first year of life
Sometimes scalp and back of head salmon patches never fade
Sometimes when babies cry, especially with patches on forehead or eyelids, they’ll get redder and brighter - this is normal
Mongolian spots - also called slate grey nevus or dermal melanocytosis - are light blue grey in color, almost like bruises
They show up frequently from birth in low back area but can really be anywhere
They tend to fade within the first five years of life
More common in babies with darker skin tone, normal, and kids outgrow them
Port wine stains - dark red, flat area of skin - usually on face or upper body, but not always
Not dangerous but sometimes associated with other conditions
If your baby has a port wine stain your doctor may want to do a genetic workout but many times it’s nothing
Treatment is not necessary for port wine stains but some families opt for it for cosmetic reasons

Hemangioma / infantile hemangioma 6:00

Similar looking to port wine stains but are raised and lumpy
Are a collection of blood vessels
If you press on it, it may go lighter colored or white then turn back to red
Tend to grow quickly - within first 6 months of life - then start to involute or crumble within themselves and shrink back down
Typically by age four there might be a bit of color left, might not, might be different texture to skin area or might not
Hemangiomas are often not treated but depending on location may require treatment - hemangioma on eyelid or near airway (“beard distribution” area) could overlay vital structures and cause baby to not see out of affected eye or close airway
Doctor can check for internal hemangioma with ultrasound
Treatment may be beta blocker or laser therapy - consult doctor

Jaundice 8:16

Yellowish color of skin and eyes and is common among babies
Reason: babies are born with extra red blood cells, some maternal red blood cells release hemoglobin when broken down which converts to bilirubin
Bilirubin is what causes the yellow color of skin and eyes: jaundice
Bilirubin can be checked for with tests via light and special device (transcutaneous bilirubin) or blood test (serum bilirubin)
Phototherapy is brig...

Next Episode

112 - Illness and Red Flags

In this episode Dr. Carole Keim MD covers baby illnesses and red flags. A red flag is a sign something could be wrong with your baby. Dr. Keim explains abnormal temperatures, choking, diarrhea, head injuries, seizures, and more to guide you in identifying red flags and what they might mean.

Not all red flags are emergencies that require immediate attention. Some are, but some are identified as urgent, which means your baby should be seen by your doctor within the next week or two. Dr. Keim shares this list of major red flags to watch for in the hopes it helps you, and ideally saves you and your baby a trip to the ER.

This episode will cover:

What is a red flag?
Urgent v. Emergent
Abnormal Temperature - emergency
Apnea/Cyanosis - emergency
Aspiration/Choking - emergency
Blood in the Diaper - urgent
Bulging Fontanel - emergency
Cough - emergency
COVID/flu/RSV exposure - urgent
Diarrhea/Vomiting - urgent
Head injury - emergent if signs of concussion/fx, otherwise urgent
Jaundice - urgent
Seizure - emergency
Umbilical Cord Infection - urgent
Umbilical Granuloma - urgent

What is a red flag? - 00:24

A red flag is a sign that something MIGHT be wrong and you should run it by a doctor.

Urgent vs. Emergent - 00:37

Urgent = should be seen by their doctor at the next available appointment, ideally within a week or two.

Emergent = they need to be seen that day (sometimes immediately) - go to the ER or call emergency services. If you are traveling, look up the phone number for emergency services before you go. It’s 911 in the US but different in other countries.

It is ALWAYS ok to call your doctor or emergency services if you are concerned!

Abnormal Temperature - emergency - 1:15

You should have a rectal or temporal artery (TA) thermometer at home. Go buy one if you don’t have one yet.

The rectal temperature is the most accurate in babies, since their skin doesn’t hold heat very well. If your baby is acting strange, or feels especially warm or cool to the touch, you can check a rectal temperature.

Underarm temps and infrared forehead temps are inaccurate after the first few days/weeks of life - they can read either too high or too low by as much as 2 degrees. They are ok as a screening, but they are measuring surface temperature and not core temperature, so if you are concerned and want an accurate read you need to do a core temperature - either rectal or TA.

A core temperature higher than 100.4 degrees Fahrenheit (38 degrees Celsius) is considered a fever. A rectal temperature less than 96 degrees Fahrenheit (35.5 degrees Celsius) is considered to be hypothermia.

Babies who are less than 6 months old have immature immune systems, and an abnormal temperature (either high or low) can be a sign that they have an infection.

Apnea/Cyanosis - emergency - 3:29

If your baby appears to stop breathing for several seconds (apnea), or starts turning blue (cyanosis), it’s time to call a doctor. Cyanosis is most apparent on and around the lips, fingertips, and toes.

Aspiration/Choking - emergency - 4:10

Signs of aspiration/choking include gagging, coughing, arching the back, vomiting, and turning blue. Call your doctor if your baby is experiencing these symptoms, or 911 if it’s severe.

Blood in the Diaper - urgent - 4:46

If you see blood in your baby’s diaper, and you think it is coming from the urine or stool (and not from pseudomenses), call the doctor. This is urgent but not emergent.

Bulging Fontanel - emergency - 5:30

If the anterior fontanel (soft spot) seems to be higher than the rest of the skull, this is a sign that the pressure around your baby’s brain is too high. The fontanel will often raise during crying, straining to poo, and other normal maneuvers. That is nothing to worry about. But when the fontanel is bulging when your baby is calm, you need to see a doctor.

Cough - emergency - 6:33

Hiccups are normal, sneezing is normal, but cough is not. Clearing their throat after eating doesn’t count as a cough. Any baby less than 6mo with cough needs to go to the ER - they are at risk of apnea and may need to be admitted depending on how they are doing.

OTC cough medicines are NOT to be used in children less than 6 years of age - they can cause them to stop breathing, and the safe ones (like antihistamines) just don’t work.

COVID/flu/RSV exposure - urgent - 8:47

Call your doctor or check the CDC website for current guidelines.

Everyone in the house should wash hands often. Anyone with cough or runny nose should wear a mask and try to stay away from ba...