Basic Baby Care for Newly Adopted Babies

What new adoptive parents need to know about eating, sleeping, and pooping with a newborn. We talk with Dr. Scott Cohen, pediatrician with Beverly Hill Pediatrics and author of Eat, Sleep, Poop: A Common Sense Guide to Your Baby's First Year.

Transcript

spk_0:   0:03
* Note that this is an automatic transcription, please forgive the errors.

spk_0:   0:03
Welcome everyone to creating family. Talk about adoption and foster care. Hey, do us a favor, please let your friends know about this podcast. Most people find out about podcast podcast in general, but also specific podcast through their friends. And we would really appreciate it if you would let your friends who might be interested in adoption or foster care know about this podcast. Today we will be talking basic baby care for newly adopted babies with Dr Scott Cohen. Dr. Cohen is a pediatrician and co founder of Beverly Hills Pediatric, is the author of one of my favorite baby care books and one of the ones with the best name called Eat Sleep Poop. And he is co founder of Kids Doctors on Call, which is a telemedicine platform. And perhaps most important, he is a father of two girls, an 11 year old and a nine year old welcome Dr Cohen to creating a family. Well, thank you for having me. Yeah, well, we're going to. Not surprisingly, I really do love the title of your book, Eat sleep, poop. And so that's going to be the format for our interview today. We're going to start with eat. And so we're primarily talking about newly adopted infants, so that's kind of going to be the framework in format that we're using. So the vast majority of adoptive parents will bottle feed their baby. So one of the first questions they will have is how did they choose a formula? Is there any difference between the types of formula Is one better than another? How do you then know how to begin?

spk_1:   1:37
Well, that's really good question. There's so many formulas on the market nowadays. There are yes, And you know, the nice thing is that the FDA, you know, monitors them so they have to have the initial same components. But I always look for one with high levels of omega three fatty acids. That's your D A, which has been shown to help brain development, cognition, visual acuity. And most of them have copied each other formulas like the Meat Johnson brand of the informal formulas, the good start the Earth's best. I do think American formulas are excellent. I don't think you have to go abroad for other formulas, you know, Big sad right now is some of the European formulas, like hip and Holly and what I worry about with formulas that are coming overseas. And there's been articles written about this is you don't know how they're getting here, where the storage is in the regulations off the components in them. So I do think going to your local drug store to get a US made formula is not a bad idea. And make it easy on yourself a three in the morning when your child's hungry, you're not gonna be wanting to run around town or go on Amazon to find something. Yeah,

spk_0:   2:46
no, you certainly won't. All right, so you usually have two different formats. You've got the powdered, which you mix, or you could have the cans of the bottles or the jars that are already premixed are so wet. So is there a is one better than the other?

spk_1:   3:01
Technically, in components? No, I mean, obviously, for ease. The ready made parents of love. It's obviously mixed by a machine, so it tends to be a little smoother than the powder, which you're mixing, and Austin can have a little bit of the power in grittiness. But as far as components, no for the baby and babies take either one very well and I just make your life easy. Whatever's easier for the parents,

spk_0:   3:25
it's also cheaper. I would say the uses counter.

spk_1:   3:27
Yeah, I find that a lot of parents start with the ready made and then realize that as faras volume and price, it's just easier to get the powder. It's easier to travel with. So I find most parents end up going with the powder. Yeah, and I

spk_0:   3:40
think people have this idea that the powder is not going to be a CZ Good. Now, if you're mixing it with water, obviously what type of water do you need to use distilled water? Do you need to use bottled water? Can you use

spk_1:   3:52
just tap water? I'm gonna say something horrible you can use fresh off the tap water. Ah, you know, I live in l. A. Everybody loves fancy water and bottled water. And if you want, you absolutely can. But ah, you know, you can take it right out of the top. And actually, L a county water is actually very good. And this Florida did as well, which may come in handy when that baby starts getting Keith at six months. But whatever the parent obviously wants to do, it feels most comfortable, but tap water is absolutely fine.

spk_0:   4:21
Is there any worry about the florid ation in water for an infant?

spk_1:   4:26
No, no, not too much florid ation in the water supply. There are varying degrees of florid ation, depending on the state and the city. But there won't be too much. And if their water in a certain area does not have fluoride the child can your floor itself limitation or even fluoride varnish from their dentist when they're older. So nothing that the parent has to worry about.

spk_0:   4:47
Okay, so that's what we put in the bottle. But now let's talk about the bottle itself. There's a lot of different types of formula, but there's Maur different types of bottles, and so can you kind of. Is it possible to generalize and love the bottles into kind of groups of types? And let's talk about the different things, different types of bottles that are a bail available and which one parents either prefer. Which one do pediatricians prefer?

spk_1:   5:14
So I like to make things easy for parents. I think parents are overwhelmed and overloaded with information and things. Thank

spk_0:   5:22
you. We are, Yeah,

spk_1:   5:23
let's let's just try to make this simple. And if milk comes out of it and the baby can get at that, milk from the bottle is fine. I don't want parents spending a lot of time and a lot of money trying, Ah, lot of different bottles in general. It tends not to make a difference as far as huge amounts of gas or fussiness. But nipple size, I think, is important. And there's some different nipple sizes. You'll see slow flow nipples. You'll see primi, nipples and different levels of a 123 And I think a full term baby starting writing from the gecko can use a regular level one nipple. And the parents can paste them a little bit, meaning that if they're tilting the bottle on the baby starts, you know, gagging or choking or spending up. You dropped the bottle flow. You pull it out and you slow them down, but they don't need to work Carter to get that milk out from a slow flow or premium nipple level one nipples babies usually do well, and then the question I get asked a lot is when do we move up the speed of the nipple, and that really depends on the baby. My daughters had a level one dimple their entire first year. They could take that thing down in five minutes. I tried this. Get milk out of it. I couldn't do it in an hour. So babies are amazing doing that. They're

spk_0:   6:32
amazing. Sucking machines are

spk_1:   6:33
amazing, stuck in machines. But if they're getting frustrated and where it's taking a really long time, you could always moved to a faster flow and just paste them initially. If if it's too fast,

spk_0:   6:44
what about the shape of the nipple? There are some nipples they're supposed to more clearly a mimic. The breast and others. They don't go as deep into the baby's mouth. What about that different shapes of nipples?

spk_1:   6:57
So I think since we're not worrying as much about breast feeding and we're focusing on bottle, that shape doesn't matter as well. I've never had a baby who couldn't get milk out of any shape nipple, so I think it tends to be a little more advertising right now, but the babies don't care. Just like ah woman's breast. The baby does isn't really isn't bothered by the different shapes of breasts. In the look of breast they take where the mill kissed. And you know, if there's moke there, the baby's going to get it. I think that's an important thing.

spk_0:   7:27
And it is their preference to using ah glass over plastic or plastic over glass and if plastic, what type of plastic?

spk_1:   7:35
So I think the majority of people nowadays use plastic just because it's easier to transport. You don't have to worry about breaking it, things like that. Most of the plastics now they're making our B p a free, which I think is important. They found that's a chemical that can, you know, possibly cause issues we don't know 100%. But if I had my choice because we're heating that plastic, then you're really looking for a B p a free plastic glasses, absolutely fine as well. But again, you know there's always that risk of breaking it and traveling it. They're heavy, so I think most people use in the refuse in plastic,

spk_0:   8:11
okay, and some adoptive parents who will face the issue of a baby either born premature or with a baby with neonatal abstinence syndrome in a s it's ah baby who is born dependent on some type of drug that their mom has has taken during pregnancy. Does the presence of let's start with prematurity this prematurity a baby born Does any of the advice you've given as to the type of formula type of bottled differ if a baby is premature?

spk_1:   8:40
Sure. So if the baby is premature or their smaller in size, for whatever reason, they may have feeding issues early on. And so that maybe a baby that the doctor in the hospital or their pediatrician does recommend a premature nipple or slower full nipple just to give them a chance to feed better. Ah, the larger flow just may be too much for them to handle feedings. Also, maybe more frequent. Or we may need to increase the calories depending on the size of the baby. And we're watching, obviously, their weight gain. So those those would be. The difference is my general rule for babies, I always say two and four answers every feeding question the 1st 4 months of a child's life. They typically take about 2 to 4 ounces off formula or breast milk, and they feed about every 2 to 4 hours around the clock. Unfortunately, we get them silly going through the night by four months. But those general rules and, you know, look, we're not robots. Sometimes you take a little less. Sometimes you take a little more. And if you start off premature, smaller, you're not gonna be taking two ounces from the get go. You're going to be working up to that bully. The nice thing about the bottle, it's there if the baby wants it. So when they're done, there's nothing you can do to make them take more. But if they want to give it to them, we never limit the volume in the bottle. They will truly stop when they're done. They won't overfeed out of given feeding.

spk_0:   9:59
Okay, so you don't need to worry that the baby is going to over feed just when they're no longer consuming. They're done

spk_1:   10:07
exactly, and one feeding. They make a four ounces in life and they make you and the two ounce feed was in a bad feet. It's just a different feet, and we all sort of vary The nice thing about again. The bottles is we tend not to worry as much about waking because we know the supplies there. And if the supply is there and it's offered and the baby can get it, healthy babies gain weight.

spk_0:   10:26
Okay, now let's go back to babies who may have been born dependent are been diagnosed with needle natal abstinence syndrome. Anything special with those kiddos?

spk_1:   10:36
Well, I think some of the same issues, you know, that baby may have symptoms. They may stay in the hospital longer. Symptoms of neonatal abstinence syndrome, which basically they're withdrawing from a drug that the mother was on could be anything from tremors. Irritability, too, you know, changing muscle tone or, you know, stuffy nose. So this could just be affecting feeding or poor feeding. And sometimes it's just a matter of timing that you have to wait, and you just have to be slower with these things. But these babies definitely have to be monitored closer for their feeding in their wake.

spk_0:   11:13
Okay? And I know that specialized formulas exist on, and they're certainly parents who think, Gosh, you know, I should just start my child off on a specialized formula, you know, lactose free or a soy, or are some type of formula just to prevent potential problems. How do we know? First of all, what type of specialized formulas exists, and number two, How do you know if your child needs it? Or should you just do it prophylactically to be careful just to be on the safe?

spk_1:   11:40
So I'm glad you brought that up. I mean, again, it goes to their so many different formulas and types of formula. So if we think about the clock vacations, the general classifications, most formulas air cow's milk protein based formulas. Breast milk is breast milk, protein and then or human milk protein. And then the main class of formulas are your cow's milk protein. There's also soy, so that's obviously a soy based protein. And then there's more broken down formulas for babies that may have irritability, frostiness with feeding or allergies. There is in betweens like gentle ease, which is made by me johnson or Good Start. And that's like a partially broken down cow's milk formula. And then there's truly hyper Jenna Hypo allergenic formulas, something called like new tram engine, or Allah Mentum, where they take that cow's milk protein. They break it down, they wash it, so it's more easily digested by the baby. So in general we start a baby without any history or any strong family history of allergies on a regular cow's milk protein formula. And that is all the ones you see in the supermarket. There's through your general formulas. Babies tend to handle it very, very well. If we see symptoms of a possible allergy, symptoms could show up as imagine, you're eating something and it disagrees with your stomach. You're thirsty. You drink a little bit, but oh, God, that hurts. So you push the bottle away, but I'm thirsty, so you drink a little bit and push it away. That's the history I hear from parents. Feedings air Very difficult. The baby goes back and forth between drinking and crying and fussy, gassy. Then we change the formula. If the symptoms are mild, we may try and intermediate one of those partially broken down formulas because we're saying they probably don't have a true allergy. Maybe they're a little sensitive and they're gonna outgrow it. But if that it was extremely Flossie, feedings are miserable. Maybe not gaining weight, maybe having blood in their stools. That's the baby. We move right to Ah, hypo allergenic formula because you don't wanna wait to see if things get better slowly. You want to fix it right away. And then that child stays on the hypo allergenic formula, usually through the first year. The good news about milk approach in allergies, the baby's outgrow them. And pretty much all babies outgrow this by a year, if not much sooner. And by the time we're starting food around, six months of age were offering dairy foods and trying those things to see if they're better. So the nice thing is intended to be transient in the first year, and we have lots of options. The key that parents need to do with their pediatrician is you don't want to keep just changing formulas just to change formulas, because then you never know. Is it really causing a problem? You want a plan of action? Here's the symptoms we're seeing. We're going to try something new. It takes three or four days to get the old protein out of their systems. You wantto do the new formula for 3 to 4 days, see if it improves it. Have a discussion and move from there. You don't wanna every time. The baby is a little gassy. Change it. Because then how do you know what's going on?

spk_0:   14:35
Yeah, okay, that makes good sense. All right, so we have other feeding options. As adoptive parents one, an adoptive mom can try to induce lactation to be able to breastfeed the baby. Or adoptive moms will sometimes use donated breast milk. Do you have thoughts on either of those

spk_1:   14:54
options? No. I mean, I think they're both good options. The one thing we should educate parents on with the donor breast milk is that one of the big advantages we always talk about with breast milk over formula is the immune benefits, right? You're getting the antibodies from the mother producing the breast milk and passing that on to the babies. Ah, lot of the other benefits of breast milk have been mitigated with the new formulas. Formulations, you know, adding the omega three fatty acids, adding some of those extra nutrients in which has been great in the last decade. Closing the gap when you do don't know breast milk because they have toe basically clear it of any infections, sort of like you would if you donated blood and you heat pasteurized this, you actually kill the immune benefits. So could be honest if I you know, a lot of people start off with donor breast milk and honestly find it very hard. You know, it's very costly. They have thio, you know, ship it. It's very difficult on both ends, and it's really should full. And they say, you know, what can we just do? Formula? And I absolutely think that is as good an option, especially cause we're losing the immune benefits, which is one of the biggest benefits. So I think again it comes down to the parents Feel uncomfortable. But I think formula is an absolute good option. I think their child will still go to Stanford or Harvard where they want to go to college. And

spk_0:   16:23
they Yeah, yeah, I'm kind of thinking if you think the formula is gonna be what gets your kid into Harvard, Good luck. But I

spk_1:   16:32
you know, I was I was breast fed from day one. My wife was formula for from day one, most of them one of the most amazing, intelligent women you ever seen. I was resting from day one and look what you're getting so you know. Yeah.

spk_0:   16:43
Yeah. There you go. Yeah, I've had I can't see much difference between my bottle fed and breast fed babies either. So there, there you have it. All right, so how do you know? And you may have already answered this, but how do you know if your baby is getting enough food? I mean, that's I think, what every parent worries about.

spk_1:   17:03
Sure, there's two ways. I mean, one is just watching your baby's cues. Babies. We'll take good volume and be very satiated. And if they're taking anywhere in that beautiful rounds range every 2 to 4 hours, they're getting the volume they need. But that has to be coupled with routine visits, their pediatrician. And we do wait check. So we see babies every two months. I see them after birth every day, there in the hospital, two weeks of age and typically every two months for the first year of life. So there's a lot of visits, and we're tracking their weight, their height, their head size, and watching that growth percentiles don't mean as much. The parents are always excited when they're babies, hide his 90th percentile or they're going to be a future basketball player in seven feet tall know their their baby's future height and weight. I have more to do with their current height weight up until the age of three, so that doesn't mean as much. But we just want to see that they're following along whatever percentile there on. So if they're smaller on the 30th percentile, they're sort of staying along the 30th percentile or alternatively, the 90th percentile. We also Comptel just, you know, asking parents questions. Parents will tell you. Yeah, the baby takes bottles, they're happy and they feed, eat, sleep, poop, right? And that's what it tells you. A baby who's not getting enough tends to push the bottle away, tends to be very fussy after the bottle, and then you see it in their weight gain as well.

spk_0:   18:23
Also, would you be looking to see how many wet diapers I mean your baby should be having? And wet and messy diapers? You know, poop, poopy diapers and messy and and P diapers is another way of today's peeing and pooping. Chances are pretty good. They're getting enough.

spk_1:   18:41
Absolutely, and and really, the urine output is the marker of good hydration pooping in Tres Lincoln really vary, So babies poop. I could prove 10 times a day in those first couple weeks, but then it can really slow down. It could be once or twice a day or once or twice a week, and that's actually very normal. So parents should be concerned if their baby skips days with pooping. As long as they're peeing, then you know they're staying hydrated. And the other thing is with bottles. Again, It's nice. Unlike the brass, you have a visual. You know the milk's being taken, so that's a good sign as well.

spk_0:   19:12
Okay, excellent. And if your baby spit on me, baby spit up. And so if your baby is spitting up, a lot of parents worry. Well, you know she's spitting up so much, you know she's not getting that. This is not supposed to be. I was supposed to be going into her body, and she's getting it up. So should you. At what point should you worry that your kids fitting up so much that they're not getting the nutrition?

spk_1:   19:36
So it's surprisingly, even babies that spit up 10 times a day after every feeding. If there were we call, I call them happy Spitters. I had one. Yeah, it tends, not too surprisingly affect weight, even though sometimes it looks like an exorcism, and there's more on the floor than went in the bottle. So, really, we judge it on one, monitoring their waking, but to mainly symptoms. So babies who take their bottles and with the birth they spit up, but they're happy otherwise, in they're gaining weight. We don't worry babies who spit up and they're very fussy there, arching their screaming. That could be a sign of reflux that we want to look more into and treat. Reflects. Actually, in babies is extremely common because their G I tract is not strong to hold things down. The plumbing isn't great, so things tend to come up. Ah, lot. But most babies, they spit up. They know they're happy. They're gaining weight nonissue, and that's 2/3 of babies. 1/3 will have what we call painful spit up painful reflux and those of the babies we consider other treatment options for reflux.

spk_0:   20:39
Okay, so the happy spitter uppers are usually just going to be fine, and the other one's the Children who might have reflux. It's less of an issue of not getting food and getting nutrition and more of an issue that there's something wrong in there in pain.

spk_1:   20:52
They're in pain. Exactly. It's funny. Even the worst reflectors often are gaining weight. Okay, it's usually the pain we're treating more than anything. Yes, it's possible they're not gaining. Wait a cz well, but surprising majority. Babies who spit up and spit up a lot are gaining weight. Absolutely fine.

spk_0:   21:08
Very good. All right, let me remind everyone that this show is brought to you by the jockey being Family Foundation. They have been under arriving a show for a number of years, and their mission is to strengthen adoptive families through post adoption service is. And one way they do that is through their free, which provides newly adopted Children with her own personalized backpack. It has their initials on it. It's a really cool back. That's a nice backpack. Inside, they have a stuffed bear and a blanket and a tote bag with ferreting resource is this backpack would make a great diaper bag. So for those of you who are adopting babies, you also are eligible for this backpack. What you need to do is your adoption agency. Our adoption attorney needs to sign up at the jockey being family dot com website and you sign up there and they become It's free to your agency or attorney. It is free to you. But you do have your agent. Your attorney has to sign up, so have them. You need to need to tell him that pop over there that you would like to be able to get your child a free, personalized backpack are you could save it for when they start free school. Our Mother's Day. Ouch or whatever. It's adorable. All right, so now we've talked about eating. It's time to move on to the number one bugaboo of all new parents. Sleep? Yes, So I mean, you know, as soon as you bring a baby home that the first question people way asking is how many times a night? So is that baby getting up? So what is the typical wait sleep pattern for a newborn?

spk_1:   22:49
So typically they are up and feeding every 2 to 4 hours around the clock. Um, typically, that's the schedule. And definitely in the first couple weeks, we ask parents not to let the baby sleep more than four hours any time because they're just learning the fee. They're just increasing their volumes, and we want to make sure they regain their birth way. And that can take even with bottles of babies. Up to two weeks is when we should see that milestone of regaining their birth weight. Once we see that they're regaining their birth way, they're taking good volumes and gaining weight. I'd like to tell parents no waking a sleeping baby at night. So during the day and during the day, we never want babies. Let's leave four more hours for obvious reasons. If they're sleeping longer stretches during the day, I guess who's gonna be up all night? But at night, I like parents to pick the feeding that naturally falls between seven and 9 p.m. And make that feeding different bath of it's bath night pajamas lights out feeding and down to bed so that child sees This is day. This is night, and that feeding separates it so hopefully they get in the the idea. There's something new that should be happening, which is hopefully sleeping longer, and hopefully that baby does give the parents a longer stretch, and again babies will wake up when they're hungry. So healthy, baby, that's gaining weight. If they're sleeping longer stretches at night. Your pediatrician gave the okay, of course. That is a wonderful, wonderful thing. And then by four months, if the baby is not sleeping longer stretches, we can help train them. Toe, hopefully go. A 10 hour stretcher sleeps through the night, which all parents are like Who? Hey, let's make that happen.

spk_0:   24:25
What about the idea of what we called in our house, topping him off when we would go to bed at 10 or 11 We I would go in and feed the baby, or my husband will go in and feed the baby. And with the idea that we were, top them off and maybe just maybe get some more sleep. Is that Does that work?

spk_1:   24:46
Well, you know, people do. What's called what I think you're describing is a dream feeds to the baby's sleeping, but the parents on a sleepy at So they go and give some volume. Yeah, that may push him another three or four hours. From that point, it won't nationally push him the whole night. And especially with bottles, that baby, since they're always getting the volume they need, you know, typically, they can do a really good 304 hour stretch, but the top off doesn't actually make it go longer. Just makes it go longer from that point in time.

spk_0:   25:14
Yeah, but that's all I care about because I'm going to see you. No offense, but this is all about me. That's all I care about that point

spk_1:   25:22
right? But then if we're going to sleep, train I tend to get rid of that dream feed either way, because I'm the goal is to get that baby to go a an hour stretch from that last feeding. So if that last feeding falls in that 7 to 9 p.m. Time period, we're getting them to go from 8 to 6 or 7 to 5. You know, it was somewhere in that range, which is life changing rather than waking up once or twice tonight.

spk_0:   25:43
No, definitely. We'll circle back. Could you talk about sleep training here in just a minute? All right. So, roughly, when would you be expecting your baby to sleep? 5 to 6 hours.

spk_1:   25:57
It really varies typically between two and four months of age. Those nighttime stretches start to get longer. So you cross your fingers and you hope you get one longer 4 to 6 hour stretch. But then they tend to cluster early morning for you, like every two hours. And then, really, at four months is where we expect to get much longer stretches.

spk_0:   26:18
Gotcha. Okay. And just this seems seems obvious. But the reality is, if your baby is going down for what it is, they're nighttime at nine. You should be doing that as well. Least for the first couple of months to try to maximize that. Your greatest sleep is gonna be when their greatest

spk_1:   26:36
Lee. Yeah. You need to sleep when your baby sleeps. Good

spk_0:   26:38
point. Yeah, All right. Does the sleep wake cycle? Is it impacted by the neonatal abstinence syndrome? Yes,

spk_1:   26:48
yes, absolutely. I mean, your sleep cycle could be totally off, and babies could be more irritable and fussy, and their sleep cycle could be office. Well, so again, sometimes it's a matter of timing. Sometimes, you know, you're finding soothing ways, but a lot of times it's waiting. Obviously, until the drugs are out of the baby system.

spk_0:   27:06
Yeah, which is brilliant. Takes a relatively short period of exactly Yes. Oh, OK, Now, to talk about what you're calling sleep training, it would get also college. No, introduce stab, wishing healthy sleep habits. So what is your approach on? First of all, when you should even be considering this in second, how do you do it?

spk_1:   27:27
So I am a big African asleep training. I think most parents are as well. But I will tell you as a parent is not easy. If you look a all sleep training books out there, whether they have nice names, no cry or bad names like Ferber let them cry very similar. And they're honest spectrum in that you're basically teaching your child how to self soothe. And the reason we do this starting around four months is because pride of four months, you can't spoil the child If they cry, you want to fix it. They're learning from your, you know, fixing the you're changing the diaper. You're picking them up your soothing that, but it four months they can start learning to self soothe, which is the idea of waking up crying, looking around the room and say, You know what? I'm actually not hungry. I'm gonna put myself back to sleep. The other thing, we know what four months of age is that starting at that point. Ah, baby doesn't need to feed nutritious Lee in that 10 hour period at night. So any feedings that are happening are really comfort feedings there. They don't need them to gain weight and grow. So for those two reasons, starting at four months is a safe time. You know, again, if the baby has been growing and house, they too start sleep training. So what we talk to parents is about is I define what I call my book ends, which are my 10 hours. So if their bedtimes been around, let's say, for argument's sake, around eight o'clock, we say your bookings or a P m the 6 a.m. And that is our goal. If your baby sleeps longer wonderful. If you have a 12 hour sleeper, you would brag about it like everybody else. Yeah, actually. Sit, though. But the goal is 10. So basically, we're gonna say from eight to sex, and this is very difficult. We're going to do the two things that have taught your baby to wake up. We're not going to pick them up. And we're not gonna feed that because those are the two things that are reinforcing them, waking up and crying for you. Now, how are you going to do that? It's difficult. You're gonna go in and you're gonna check on them. You can touch them, you can talk to them. But you want to spend a minimal amount of time in the room and you want to maximize your response time to them. So it's taking longer and longer for you to respond. So the baby's saying, Wait a second. Mommy's not coming in as much. Daddy's not coming as much and I'm not hungry. I'm gonna put myself back to sleep. So I used sort of a modified Ferber method, and I call it the 5 10 15 So if they go down eight o'clock and they start crying at midnight, you're gonna wait five minutes before you go in there, you're gonna go in and you're really it's more for you than them. You're gonna make sure they're not hurt. They're not sick. They're not stuck. There is a problem of course you want to fix it. Usually there's not. You can touch them. Mommy and Daddy love you, and then you're out of there. Very likely when you leave that room, they're still crying because you didn't do the two things they wanted you to dio pick them up and feed them. So if they're still crying now, you're gonna wait 10 minutes before you go in there. Touch, talk, leave If they're still crying 15 minutes and then I sort of waited 15. Every time you leave that room and they're still crying, you're gonna wait 15 minutes before you go back in there. If they fall asleep, they wake up at three. In the morning. You're gonna keep it 15 15 15 until they fall asleep. And then any time after 6 a.m. that they cry. It's been 10 hours. Now you should pick him up and feed him and go on with the day the next day instead of 5 10 15 15 15 I up into 10 15 2020 20 the next night. 15 2025 25 35. The point is, the intervals don't matter. It's just easy to remember 5 10 15 And I know if you can start that which, as a parent is difficult but doable. It takes two or three rough nights and then by the third or fourth night, honestly, they're sleeping through the night. But listen, my wife and I did this. We fought all night. We aborted it the first couple of nights. It did not go well. And then by the third night we got into, Ah, rhythm. And my daughter's been a great sleeper, every person, so it does work as a parent. Emotionally, it is not easy, but I can promise you two things. You are not emotionally damaging them by letting them cry a little bit, and you are not starving them. You're actually doing something much more important developmentally, you're teaching them how to self soothe that problem. Solved where, when they looked at infants who were slept, trained and extrapolated that data, those kids actually did better later on in some developments, self soothing in problem solving tests, then kids that weren't so. I actually think it's it's a really good thing if you choose not to do it. It's absolutely fine. You can do it any time but parents love it If it works,

spk_0:   31:58
you know, the other thing I would throw in there is that during the period prior to sleep training the 1st 4 months, and this is particularly easy. If the baby is bottle fed, it's to switch off every other night if you're partnered and let's and in if you're not partner, to get your mom to come over once or twice a week or our friend a very good friend. Thio, come over and handle the night so that every if you're partnered every other night, and if you're single, you know at least twice a week are three times a week you're getting, you know you will get sleep, and to do that, you've gotta move to another. At least for me, it's simply never worked. If I could possibly hear the baby, I would. So I had Thio sleep in a different room, a lot of closed doors and earplugs, and that way you're not. At least you know every other night or every couple of nights you're going and the same with sleep training because it is hard and it's hard. It was for me to go back to sleep, Uh, the And so I was being like, Darn. I mean, I'm already awake. I might as well go in there, you know, because, you know, now I'm wide awake and I'm worried. And so anyway, that's Ah hint from the been there, done that crowd.

spk_1:   33:14
Yeah, Aaron's have to take care of themselves. Happy parents, Happy babies. You're exactly right. And think of it as you know, it may seem difficult for a couple nights, but long term gain for

spk_0:   33:25
sure. A lot of parents are tempted because they will. They will hear from their parents or from friends that if they will introduce solid foods, even like water down Or are you know, like the rice cereal. That's with a lot of formulas to put a little rice, little rice cereal in that bottle and that will help the baby sleep through the night. And I'm gonna fess up that when I had my six month over, she was probably five months old and started waking up again. All my friends were like, You just got to give her some rice cereal and she will sleep through the night and I tried it. So anyway, tell me about that work. It actually didn't. But, you know, I don't

spk_1:   34:05
have so I would agree with that. I don't find it works. There's a couple things, you know. Yes, Adding a little rice cereal or food may make them a little fuller, but it's not the difference between sleeping three hours and 10 hours. That may be the difference between three and four hours. It also is adding passive calories the baby doesn't need. And when we're offering food, we want to teach them something as well, which we'll talk about. We teach them how to use a spoon with the simple motor coordination. We don't want to just put it in a bottle where they suck it down. So for nutritious reasons and the fact that it doesn't help a baby necessary sleeps through the night. I don't recommend.

spk_0:   34:41
Okay, so it doesn't work, and it's not particularly effective. Okay. All right. So I just thought I would mention it, because I guarantee they're gonna hear is right. All right, So is the recommendation. Still sleeping on the back? No pillows, no blankets, no bumpers, no stuffed animals. Kind of that. That approach

spk_1:   35:00
100%? Yes, because of citizens was to sudden infant death syndrome, which we've decreased dramatically since the back to sleep campaign, which is basically putting all babies to sleep on their back. That is this state, this position. So we want to make sure they're on a firm surface. There's no bumpers, no pillows, no blankets, nothing that could go over the head. We want to make sure that they're sleeping on their back until they can roll over on their own. The majority of SIDS, it peaks between two and four months. 80% is before six months of age. Then it really drops off because the developmentally they can lift their head better. They could roll over more neurologically that we're more advanced. But we definitely want to do back to sleep, sleeping no matter what,

spk_0:   35:43
and as far as a baby in the parent's bed, I know that there are a lot of a different differences of opinion there, But what is yours?

spk_1:   35:52
We really don't want to do that. I mean, it is not safe. And all parents, you know, where well intentioned then, you know, sometimes it feels easier, but there is a huge risk, you know, as a parent, you're already overtired, God forbid you will. Over there's a suffocation risk with pillows and your body, so we heavily It's a big no no co sleeping with the baby, which means the baby is in your room. But in their own device, whether it's a bassinet or crib is absolutely fine. And that actually made decrease Sid's because they hear the breathing going on in the room. But we do not want them. Event.

spk_0:   36:29
Okay, right? This show is underwritten by the jockey Being Family Foundation, but it is also supported by our partner agencies and these air agencies that believe in our mission of providing unbiased, accurate information both pre and post adoption or fostering one. Such a partner is adoptions from the heart. They have helped build over 6000 families since 1985 to domestic infinite options. They worked with people all across the U. S. And her license in Pennsylvania, New Jersey, New York, Delaware, Virginia and Connecticut. Way also have Vista del Mar. They are a license, not profit adoption agency. With over 65 years of experience helping to create families. Now they have home study only service is and They also have a full service infant adoption program, as well as international and Foster to adopt. So both of those are partners who put their money where their values are, and we really appreciate it. All right. We have talked about eating and sleeping, and now it's time to talk about pooping. So how often our baby's supposed to poo

spk_1:   37:42
so initially they may not prove a lot. They, you know, when your firstborn you're producing meconium meconium is a black Tory looking poop. And then, as they're taking more volume, they're pushing out that poop and its training to a transitional grooming color. And then what? We typically think of baby proof that yellow mustard CV poop once they're taking, you know, within the first couple of days, the proofs increase in volume and frequency greatly. Ah, baby may prove 10 to 12 times a day, and that's absolutely normal. Not uncommon for parents to say Wow! Every time they feed, we see a little poop or smear and the diapers, so there's a lot of diaper changes. But after two weeks of age, as we mentioned, the pooping may stay very frequent or could slow down and both are equally normal.

spk_0:   38:27
Okay? And yeah, I will say that I had with my first child. She went almost a week one time, and I absolutely panicked about the pediatrician wasn't overly worried. So it's just probably thrilled that I just mentioned this on here s O. So you said that typical baby poo is kind of ah, yellowish cup color. This could fall under the T m I category, but, uh, bottle fits, baby. Would it still be kind of a yellowish color? Or is it going to be more of a brown? Is that the normal colored are just color, even matter should you worry about?

spk_1:   39:01
That's a good point. So it shouldn't matter. So we spend so much time looking at poop. Any little changes. Parents get concerned. It turned green. It's peanut butter. It's, you know, consistency. It's watery. So I always say, There's four things that I'm concerned about with poop. Everything else should be ignored. There are three colors it should never be. It should never be black and Tory like the meconium. After the meconium disappears, it should never be. Never had red blood in it, of course, and should never be plain white, white, perfectly white Could be a sign of Oliver issue. Extremely, extremely rare. Any other color Yellows, greens, browns, blue if they ate a blue crayon? Uh, Thea other color is not concerning in any consistency from watery too soft. Serve ice cream to peanut butter to Plato. I don't know why we name it after foods. I don't know either. Yeah, right are all normal as well, but it shouldn't be a hard rock. So parents always worried, as you probably were with your daughter about constipation. Constipation is defined by consistency, not frequency. So a baby who poops once a week but it comes out soft, is absolutely normal. Ah, baby, who proves every day. But it's a hard rock. They're constipated, and, you know babies tend not to get constipated. So you're looking for that hard rock. Babies turn red and grunt and strain every time they poop, and it doesn't mean they're constipated. Doesn't even mean they're in pain. They just don't know how to get it out of their truck trying different muscles. And then it finally comes out and it's a blowout, and it's normal.

spk_0:   40:36
Okay, so three colors to worry about other than that, any other color of the rainbow is okay. And any consistency other than hard rock is okay. Yes. And I agree with you. Let us avoid the food analogies when we're talking about our kids. All right, so how do you know if there is a problem? You're saying that grunting is not a, you know, a problem. What about a child who seems to be crying when they're have trying to have passed about movement? Yeah,

spk_1:   41:07
I think lying basically straining with crying or pain could be a sign they're having difficulty. The consistency of the poop, if it is a hard rock, is a concern. Or obviously, if there's blood in the stool, that would be a concern. But you know, a little grunting and pushing. And then the poop comes out and they're gaining weight. That's a good sign. Another sign, maybe, you know, their belly is very distended and seems like they're in pain. But I caution even saying that because babies do tend to look like they always have bellies, Buddha bellies, and that's an absolutely normal thing. So I really go like you said that on their demeanor. More than anything else.

spk_0:   41:47
So the only way to know if your child is constipated is by the consistency of the not so much frequency but the consistency of their poop. But they're really it's It's hard and pebble like

spk_1:   42:01
yep, and and painful

spk_0:   42:03
and painful. So what should you do if your child is displaying constipation?

spk_1:   42:09
So it really depends on the age, so constipation in the newborn period is not common. So if there was true constipation, which again we don't see a lot of really needs to be investigated by a pediatrician to make sure there's nothing anatomically going on constipation as they get older, you know, we can try simple dietary things like, you know, and we're talking when they're, you know, six months old. You know, a little prune juice in the bottle produced works better than a laxative, you know, a little water. And then there are, you know, stool softening agents that we can use under a year of age things like a milk of magnesia and may relax. But this would be that they're really having, ah, lot of trouble. We try and dietary things first. Ah, baby, who he's starting solids often gets a little constipated, and I always try to do dietary things first I was a P. Fruits help you poop. So prunes, pears, plums, peaches, apricots. Second letter. Close enough and I add more of those in the diet. I hold off on the more constipated, starchy foods and add water. And usually those dietary things really help.

spk_0:   43:13
Okay, so what type of diaper is the best? There's a lot of varieties, actually. Not that many, really. But you've got disposable, you've got cloth and other disposables. You usually have a couple of different types and, quite frankly, for coffee, about a couple of different types, too. So what type of diaper is best?

spk_1:   43:31
I think it really comes down to a personal preference. I mean, personally, we use disposable. I thought it was very easy, you know, quick on. Quick off. We didn't have to worry about washing. I know they have. Service is now that make it easier for parents to send the cloth diapers, too. I think that when they looked at environmental resource is thinking that cloth is you know, better for the environment. I think when they looked in and saw, you know, the amount of water used for washing and things like that. They were pretty close. I really think it comes down to a personal preference, and then this forest type. You know, it's up to the parent. What cute design they want on the diaper. Think my girls used Pampers, but I think there's so many brands out there. And if it holds in the poop and pee, I think that's the most important thing.

spk_0:   44:16
Yeah, it's been a while now, but a long time ago I did the research, and if you use a diaper service, it's kind of arguable whether there's an environmental benefit. But as you wash your own, I think they're clearly is. But if you're using a diaper service on, this is old information, so it may be different now. Okay, so let's talk about diaper rash. Another thing that parents worry about, and it's certainly uncomfortable for babies. What qualifies, first of all, as a diaper rash,

spk_1:   44:45
any readiness in the diaper area? I mean, babies poop and pee so often, and obviously you could be parent of the year. The baby's going to be in it. You can't, you know, avoid that poop and pee is gonna come in contact with their skin. So because of the contact with the skin and the irritation, it turns the area around the butt and the Penis in the vagina anywhere in that diaper area red. And that usually constitutes diaper rash in and easy fixes any type of diaper creams, you know. Usually those thick white creams there is decimated and bomb Max and Andy and aka for you name it. And what you're doing, really is just creating a barrier so that that raw red skin can heal as they're pooping and peeing more. And that's really the key of plain old diaper rash. Now some kids get a second there. Yeast infection, which sounds horrible. My God, how did my baby get a yeast infection? It's probably the second most common rash we see in babies. Any waste environment grows yeast, and sort of a hallmark of this is that when you start seeing that those that redness in the creases of the skin like their folds or little red dots around the periphery that typically is yeast. And then there's different over the counter ye screams that we can use to take care of that

spk_0:   45:58
in the yeast. Usually in my experience is that the use trashes looked angry or they were not a gentle red. They seemed they looked like they would be more uncomfortable.

spk_1:   46:09
They can be. And when you think about it, you know diaper rash. What's the mechanism? It's the contact off that diaper with the skin, so that rash is usually the areas that touch the diaper, not inside the creases. When it's inside the creases, you have to sort of think what crawled in there and that's usually the East.

spk_0:   46:27
Okay, and do they still recommend two babies go without two diaper, lay him in the stun, let him get some liniment, a bright window and let him get the sun on their on their little high knees to help it clear up? Or is that old fashioned? No.

spk_1:   46:43
I mean you could do that. I think that's very difficult, because any time you have a diaper off a baby, they end up pooping and peeing on something. So I just think logistically it's hard. And I think you could just put diaper cream and keep their diaper on, and it will work well,

spk_0:   46:56
Okay, Yeah, So this is not unnecessarily pooping related, but I didn't want to talk about colic. Uh, we hear a lot about colic, and it seems to be a mechanism that was not well understood. So first of all, tell us what colic is and when we usually see it. At what age?

spk_1:   47:17
Sure, So colic is sort of this indescribable fussiness that babies have. They sort of called the Rule of Three. So starts around three weeks of age to about three months of age. Thankfully, kids outgrow it. It can be fussy, crying for up to three hours, usually around early evening time for at least three nights a week. But you know any basically indescribable fussiness that a baby has usually in the evening time, and you're exactly right. We don't know exactly what causes colic. It's not that I can say Do this and colic goes away, it's been hypothesized. Is their g I upset? But they've looked in that not everybody has. It is it's a certain bacteria that's in the baby's stomach will not 100% of the time. So the key is that if your baby has colic, no, a couple of things. I know that it's going to get better and you know it does. But it could be very trying and we try soothing measures first. You know, small on the baby, stretching the baby, rocking that gently. You can try different, you know, white noise. People try going where the dryer is, you know, just depends on what sounds the baby likes. We also try homeopathic things because they're not medically proven. But they're safe. You know, things like camel melty and colic drops in tabs, which have mixtures, you know, fennel and cam a meal because they can't hurt and maybe they'll help probiotics. I've actually only been the only medical thing that's been shown to decrease colic and Fosse NSO I'm a big fan of baby probiotics for babies. And then, you know, I think the biggest thing for parents is to take a deep breath and know that it's gonna get better. Sometimes they just have to hand the baby off to somebody else, like you said, and go into another room and and get some down time. But when a pediatrician sees colic, we want to obviously make sure that there are other reasons. The baby's fussy like we mentioned before, like reflux or something's bothering them. But typically the babies that are gaining weight healthy, happy all day long and then sort of have what we call that witching hour at night. That's colic.

spk_0:   49:16
Yep. I had one with colic and actually from me. It really did help to know that this is going to be relatively short term. That if he was really uncomfortable. I mean, yes, he he isn't happy. But there's nothing that I could do that's going to be making it any better. So cuddling him. And it just somehow took some of the sting away that I didn't feel like. I that I responsible for solving the problem. I just need to be there with him. And, um and eventually, fortunately, he his was didn't last the full three months of thinking this. Yeah, all right. And I thought we would save one. The more controversial things to the end. And that is what is the current thinking on circumcision I talk about If you want to see any parent group explode introduced the idea of circumcised, just pick a topic of circumcision and people have very strong opinions, so Yeah, Well, what's the current thinking.

spk_1:   50:11
You know what I tell parents is, whatever you decide, I'll help you take care of it.

spk_0:   50:16
But that's a weenie out. Come

spk_1:   50:18
on, people's community, you're right, has gone back and forth with this, you know, over a decade ago, everybody should be circumcise that have flipped to, you know, Aaron Choice, and now it's moving back toward that. It's recommended to do, and the reason is the studies are sort of six of 1/2 dozen the other. So a circumcised baby has decreased risk of urinary tract infections, but you're in a tract. Infections tend to be easily treatable on babies, so they called a wash. Certain decision decreased to the risk of penile cancer, but not cancer is extremely rare, so they call it a wash. Circumcision decreases the risk sexually transmitted diseases like HIV, but not initially others, so they call it a wash. And then the chance of getting a circumcision and needing a revision or having an uncircumcised Penis and needing to be circumcised surgically is also a wash. So that's why they've sort of gone back and forth, though I still think those things that were calling a washer still a positive toward being circumcised. So that's why the recommendation is there. I think if I had a son, but I only make girls, you know, I would choose to circumcise him for non religious reasons. But I do really believe it's, you know, it's a parental choice. They should be. Do what they feel comfortable ass. And, yes, I will tell them how to take care. Okay?

spk_0:   51:37
And And I think the assistant point out the thing that's not a washes the complications from circumcision, which is also relatively rare, but non existence. So yeah. So mean? Those are the That's the So there you have it. All the things you need, Thio. Think about to figure out what's the best thing for your kiddo. Well, thank you so much for talking with us today. Dr. Scott Cohen, author of Eat Sleep Poop Book. I think not poop poop that works. Yeah, it all works. Thank you so much. This has been great. I really appreciate it. And let me remind everyone that the information presented in this show is the opinion of the guests. Not necessarily the opinion of creating a family. Our partners are underwriters and keep in mind that the information given is general advice. To understand how it applies to your specific situation, you need to work with your adoption professional or, in this case, your pediatrician. Thank you, everyone. And I will see you again next week.