As A Mom And Pediatrician, This Is What I Want Parents To Know

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newborn baby at the doctor

Congratulations on your tiny bundle of joy! There are enough parenting books out there to fill an entire nursery from floor to ceiling. If, in your sleep-deprived haze, you don’t have the time or inclination to read them, here are some hard-earned pearls to help you along the way.

Feed the baby.

This is almost every pediatrician’s mantra. Yes, breast is great, but fed is best. Breastfeeding may be “natural,” but it’s not always easy or pain free. Forget the National Geographic-style videos of newborns magically rooting to the breast, and the lactation consultants’ admonishments that if you’re sore you’re doing something terribly wrong. Having breastfed for a cumulative 61 months and counting, I can say that the properties of breastmilk are remarkable, and there’s not much sweeter in the world than a fuzzy little nursling. But I’ve also been through the cracked, bleeding nipples and the fear that baby wasn’t gaining enough weight. If you’re breastfeeding, put them to breast early and often. Baby’s stomach is the size of a marble the first day. The tiny amount of colostrum (“liquid gold”) you’re making is normal. If you supplement with formula, it’s not the end of the world.

Don’t worry too much about nipple confusion.

If you want to introduce a bottle, start early or risk ending up with a very stubborn bottle-refuser who makes up for it by nursing all night long. If you’re having breastfeeding issues, it’s probably not because of tongue tie. Some buy into tongue tie more than others, but there’s minimal high-quality evidence to suggest that intervening makes any real difference. Don’t waste your money on unproven interventions like craniosacral massage and chiropractic adjustment — these are expensive placebos at best, and harmful at worst. If you’re worried, see a board-certified pediatrician or otolaryngologist, or someone else who is properly trained. But with time, practice, and expert breastfeeding advice, most breastfeeding problems get better without putting a scalpel or a laser in baby’s mouth.

At first, baby will poop a lot.

Like, every time they eat. That’s normal. At first it will be black, tarry, and sticky. Then it will turn yellow, seedy, and liquidy. That’s normal. After a while, baby might go for days, a week, ten days without pooping, especially if they’re breastfed. That’s normal. Unless the poop is colorless or has blood in it, it’s probably normal. Unless your baby didn’t poop at all in the first 24 hours of life, or has an actual medical problem like Hirschsprung’s disease, it’s exceedingly unlikely that they’re constipated. Yes, they might get gassy or uncomfortable. It will pass. Try bicycling their legs, or comforting them in other ways.  Gas drops or gripe water probably won’t hurt, but probably won’t help.

All babies have reflux.

This is due to normal, physiologic laxity of the lower esophageal sphincter. Some babies are “spittier” than others. If they’re gaining weight, we generally don’t worry about it. It’s not dangerous. Reflux medications are pretty benign, but all medicines have side effects, and there’s no good evidence that it helps. Fussy and colicky babies can be really, really challenging, but resist the urge to pathologize and medicalize. If you’re breastfeeding, don’t worry too much about your diet. Drink plenty of fluids and try to eat healthfully. Yes, it’s possible baby may do better if you eliminate dairy, or chocolate, or spicy foods, but often things get better with time alone. If you’re formula feeding, pick one and stick to it. Resist the temptation to change from formula to formula, unless there’s a compelling or medical reason to do so. Don’t bother with the different formulations for “gassy” babies or breastfed babies. These are marketing ploys and the composition is usually the same.

Baby sleep is an eternal mystery and also pretty predictable.

For the first twenty-four hours they’re usually pretty sleepy. After that, all bets are off. Some babies sleep a lot, some don’t. You can spend a small fortune on state-of-the-art robotic bassinets and “magic” sleep suits, but in the end, it is what it is. Babies like to sleep while being held. That’s okay. It won’t “spoil” them or ruin their sleep forever. Get familiar with the classic moves: “figure eight” rocking, the carnival pirate ship deep swaying move, the “bomb defuser” when you’ve laid baby down and try to extract your hands.

When not being held, place baby on the back to sleep.

Place them on a firm, flat surface with nothing else in it, like baby jail. No blankets, no pillows, no stuffed animals, no nothing. No bumpers means no bumpers, not even the mesh “breathable” ones. Swings and soft “positioners” aren’t safe sleep surfaces, despite the cute marketing pictures. No matter how tired you are or how cozy it is or how “natural” you perceive it to be, bed-sharing dramatically increases a baby’s risk of dying of suffocation, even if you haven’t been drinking or smoking or using drugs. For every anecdote about co-sleeping that turned out fine, there’s a pediatrician who can tell you about babies who have died or been neurologically devastated from bed-sharing. If you still choose to bed-share, don’t be glib about it. Baby sleep can be exhausting, but there’s no magic solution. It gets better. Eventually they will sleep, and you will too.

When they start to eat, remember this.

The only firm rules are no honey, avoid choking hazards, and space out the introduction of new foods so that if there’s a bad reaction you know what caused it. You don’t have to start with a grain cereal. Baby’s taste buds won’t be ruined forever if you start with a fruit or sweet vegetable. “Baby-led weaning” is just a fancy way of saying that baby eats safe versions of regular food, like chunks of soft banana or avocado that they can gum and taste and explore for themselves. “Finger foods” marketed for babies, like puffs and biscuits, are nutritionally worthless but can be fun for babies to practice their pincer grasp. Some babies eat a lot of solids right away and some don’t. That’s okay. Don’t force it. Keep offering.

Get the vaccines.

All the vaccines. For you, for baby, for dad, for grandparents, for anyone who will be in close contact with baby. They’re safe, and they work. They prevent babies from dying. Period.

If you’re worried, trust your gut.

Seek out advice or evaluation from trustworthy sources who are familiar with current evidence and guidelines, who can have honest conversations with you about the limits of evidence and medical knowledge, and who can help you forge a thoughtful, reasonable approach that aligns with your values. Take care of yourself so that you can take good care of them. Remember that this too shall pass. Love them. Love them to pieces. Hold them and nuzzle them and kiss them and tell them that they are a miracle. That they are beautiful, and wanted, and special, and loved. That the world is a better place with them in it.

Disclaimer: As a pediatrician, future neonatology fellow, and mother of four wild and sweet girls, this is written as a light-hearted perspective on some of today’s parenting trends. This is not medical advice. These statements don’t apply to everyone, particularly children with medical conditions. I recommend that parents always trust their instincts and seek evaluation from a board-certified physician or other appropriate source for questions or concerns about their individual child’s health and development.


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