The Baby Manual

New babies are difficult. Don't you wish they came with a manual? Well, now there is one! Hosted by a pediatrician mom, The Baby Manual will help guide you through everything you actually need to know to take care of a baby. Whether this is your first baby or your fifth, I bet you’ll hear something helpful in here that you didn’t know. Enjoy The Baby Manual podcast, and enjoy your new baby!--Dr Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode, Dr. Carole Keim MD explains what you should expect when going into labor. Why she, as a pediatrician, recommends having your baby at the hospital vs a home birth. She also goes into great detail on what to expect from a c-section or vaginal birth. It's all here in this episode to make your life easier pre and post-delivery in an unfamiliar environment where you may feel overwhelmed by your new responsibilities.Knowing the right questions to ask and having the right answers before your baby arrives will decrease your stress during your labor and delivery. Why is a vitamin K injection important and how erythromycin ointment protects your newborn from pink eye. She even gives you advice and tips for breastfeeding success.  Good luck with your new baby. You are going to do awesome!How to tell you’re in labor: (00:42)Water breaksContractionsWhen to go to the hospitalHow long you’re going to be in laborWhat happens at the hospital: (01:59)Delivery options (vaginal, c-section)Delivery staffWhat the pediatrician does, APGAR scoreNewborn screenWhat I recommend while still in the hospital: (08:41)Feeding: only breastfeed, push through the pain because it gets better.  Start pumping while in hospital.  Work with the nurses to check baby’s latch, learn how to listen for milk movement/swallowingWrite down every time your baby starts and stops eating, and every time they pee and poop.  You’re going to be asked this by everyone who walks in the room so one less thing to have to remember.Vitamin K shotErythromycin ointmentHep B vaccine: get it in the hospital if you want your baby to have it.  (explain why it’s safe for newborns)Bilirubin/jaundice checks: all babies get screened before discharge (either visually or with TCB or blood test)Blood sugar testing - for babies who are LGS or SGA; pros/consCatch up on your sleep because this might be your only chanceBuy a copy of The Baby Manual on Amazon so it’s waiting at home for youDischarge instructions: (17:49)Jaundice precautionsFeverCar seat safetyFollowup appointmentBaby development / what to expect before the next appt (weight loss and weight gain, length changes, sleep deprivation)Who to call if you need helpResources discussed in this episode:The Baby Manual - Available on AmazonDr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The first week of having a new baby is full of surprises, but it's important that you know what to expect. In this episode, Dr. Carole Keim MD talks about what she wishes she knew the first week of having a new baby. She walks you through what is normal and what can be scary for a new mom. She also goes into detail on what moms can expect for themselves after welcoming home their adorable little one!Dr. Carole Keim MD covers hormones, postpartum depression and the use of the Edinburgh Postnatal Depression Scale. From the first diaper change, breastfeeding, skin care, right up to your baby's first doctor's visit, there is a lot of information in this episode.  However, you are going to be glad to have it to make that first week less scary. Also, remember that it’s normal to feel a little sad, overwhelmed, and exhausted.At this age, your baby is doing a lot of things that seem scary but are actually normal.Emotions: (00:32)Bonding with babyBaby bluesSigns of postpartum depressionPooping: (01:33)MeconiumTransitional stool colorsSeedy yellow - what are the seeds?Number of poops: 1 in first 48h of life, a few times on days 3-4, then every feed once milk surgesPeeing: (02:35)Brick dust / rusty pipesPee once in the first 24h, 2-4x until milk surges, then by 1 week of age with each feedConcentrated urine x 3 daysNormal peeEating / breastfeeding:  (03:22)Painful x 2 weeksTakes baby 2 weeks to really learn how to do itTongue ties, lip ties, cheek ties - when to fix them, baby has to re-learn how to eatFix if W shaped tongue, can’t stick out tongue past lips, inadequate weight gain. Some people fix due to nipple painSkin:  (07:10)Bath x 9 mos, they’re going to peelCan use aquaphor/vaseline/unscented baby lotionNormal newborn rashDiaper rash: (08:32)Uncommon at first but can happenUse wipes for poop only, not for peeIf baby has a rash, could be irritation from wipes or diaper brandBaby girls vs. boys: (09:11)PseudomensesCircumcision after careIntact careBreathing patterns: (12:03)Fast then slowBelly button care and when it falls off: (12:30)The first two checkups: (13:19)Typically 2-3 days after going home, or DOL 3-5, f/up 1 week (earlier if concern for weight or jaundice)First Hep B vaccine if they didn’t get it in the hospitalCheck weight; often down from BWCheck if mom’s milk is in yet and what color poops are to assess jaundice riskCheck for signs of PPDPE: Look at skin for jaundice, rashes (some normal, some deadly). Heart, lungs, organs, eyes, genitals, sacral dimple, spina bifida, hip clicks, fontanels, sutures mobileNeuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, turns towards parents voice, communicates needs (hungry/wet), fixes briefly on faces, lift head when prone / on parent’s chestAnticipatory guidance: (18:15)Eating - nothing but breast milk or formula for 4-6 monthsMom should eat a wide variety of foods and take PNV while breastfeedingSupplement with 400 IU of vit D daily, or mom can take 6400 IUSleep: back to sleep, nothing else in the crib.  ABC = Alone, on Back, in CribFever and how to take tempJaundice precautions, why jaundice happens, when it’s dangerousNever leave baby on high surfaceRear facing car seat til age 2Avoid secondhand smokeBathing baby - wait til umbilical stump falls off; then once/wkSkin care / peeling skinTummy timeResources discussed in this episode:The Baby Manual - Available on AmazonEdinburgh Postnatal Depression Scale - Downloadable--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Your baby is now two weeks old and they are changing so fast! In this episode, Dr. Carole Keim MD walks you through what to expect during your baby’s two-week check-up. Your baby will now be keeping their eyes open longer and the nighttime feeding schedule will change. She talks about tummy troubles that usually start to pop up over the next few weeks.There is so much happening in that little body. Your baby is learning to use their muscles and oh wow that ceiling fan is so wonderful to look at. From tummy time to bicycle legs and what is safe to give your baby to help them along. Baby is starting to be awake more during the day - awkward age: (00:23)Parents / emotions: (00:53)You’re getting a little more sleep - baby’s consolidating feeds, more awake during day, sleeping at nightDon’t overstimulateNarrate your dayEating: (01:54)8-12x per 24h; formula or EBM should be 12-24 oz per day (350-700ml)Peeing/pooping: (02:20)Baby pees and poops every time they eatTummy troubles: (02:55)gas, colic, refluxGas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic dropsReflux: Explain LES, normal spit ups.  Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)Pyloric stenosis: getting progressively worse, turns green (grass green)Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillowsSkin: (08:25)Umbilical stump is off - start baths.  Once or twice per week, unscented soap or just plain water, pat them dry rather than rubbing, use lotion/cream/ointment right after the bathDiaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.Checkup: (12:42)Check weight, should be above birth weight nowAsk about any feeding difficulties; should be better nowJaundice should be goneScreen for PPDPE: same head to toe exam as the first checkupNeuro/devel: Reflexes (grasp, suck, moro), calms to parents’ voices, communicates needs, lifts head in tummy timeSafety: (15:37)Fever over 100.4 (38c)Back to sleep, alone, in a crib or bassinet. Ok to stop swaddling and start sleepsack.  NO blankets til age 1 and no pillows til age 2.Never leave baby on high surfacesAvoid secondhand smokeRear facing car seat til age 2 yearsBreastfeeding moms should be taking PNVSupplement baby with 400 IU vitamin DTummy time: 2x per day 15-30 minsWhat to expect in the next 2 weeks (before the 1mo checkup): (17:53)Awake more and more; start to notice things farther away like lights, windows, and ceiling fansDiscoordinate stoolingResources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok |instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

You are starting to get into the groove of this new parenting thing and your baby is now 1 month old. You should start to see those smiles and the super cute cooing. In this episode, Dr. Carole Keim MD talks about what to expect from the 1 month check-up along with eating, peeing, pooping, sleeping, and skincare. She goes into great detail on gas, colic, reflux, and the benefit of a probiotic. It is also a good time for you to start thinking about your relationship again and enjoying a date night.This is the peak age for discoordinate stooling, reflux, and skin issues. Knowing the difference between learning bowel control and constipation or spit up vs green projectile vomit. Knowing what to watch for is half the battle when caring for your little one.Parents: (00:25)Finally feeling in the groove of thingsBaby has nights and days figured outDon’t overstimulateStill narrate your day, take turns talking with babyFind time for a date night!Eating: (02:04)8-10x per 24 hours, 24-30oz per 24hStarting to go from q2-3h to q4-6hPeeing/pooping: (02:40)Discoordinate stoolingGas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic dropsReflux: Explain LES, normal spit ups.  Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)Pyloric stenosis: getting progressively worse, turns green (grass green)Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillowsSkin: (10:11)Bathing 1-2x per weekCan use lotion or cream or ointment after bathsDiaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.Checkup: (14:08)baby should have gained about 2 pounds from birth weight (based on 7 lb baby)Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, responds to calming actions when upset, follows parents with gaze, recognizes familiar voices, communicates needs (hungry/wet), lift head when prone / on parent’s chest, fontanels open until 1 year of agepoAnticipatory guidance:Eating - nothing but breast milk or formula for 4-6 monthsMom should eat a wide variety of foods and take PNV while breastfeedingSupplement with 400 IU of vit D daily, or mom can take 6400 IUSleep: back to sleep, no blankets, stop swaddling.  ABC = Alone, on Back, in Crib.Put baby to bed awake but drowsyFever and how to take tempNever leave baby on high surfaceRear facing car seat til age 2Avoid secondhand smokeSet water temp to 120 degrees to avoid scald burnsBathing baby 1-2x per weekSkin care / peeling skinTummy timeNext checkup is at 2 months:  (21:48)First round of vaccines: DTaP, polio, HiB, Hep B, PCV, RotavirusNo need to pre medicate before shots, but DO buy some infants or children’s Tylenol / acetaminophen before the visitAsk doctor for the dose of Tylenol at the 2 month visitPooping will consolidate further: rule of 7’s at this age is that anything from once a week to 7x per day is normalShould keep peeing every time they eatStill need to wake them up once every 4h to eatResources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Wow! It has already been 2 months since your baby made its way into this great big world. Now is the time to get that all-important 2-month checkup done along with mom's 6 week postpartum appointment, come find out what Dr. Carole Keim MD has in store for you today on The Baby Manual: vaccine protection against diseases like rotavirus; important questions answered about resuming pre baby activities work, etc., but don't worry she still covers eating, peeing, pooping, and skincare routines.The first vaccines: DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type B), Hep B(Hepatitis B), PCV (Pneumococcal conjugate), rota (Rotavirus). Again we cover the importance of tummy time and ways you can help your baby with their development.Parents (00:23)Starting to resume pre-pregnancy activities and interests, plan return to school or workGetting out with the baby Partner support?  Family support?Mom should have had 6-week postpartum checkupTalk with partner about family planning Hold, cuddle, talk and sing to your babyDevelop strategies for crying Eating (02:48)6-8x per 24 hours, 24-30oz per 24hCan take 4-6oz at a time and be full 4-6 hoursPeeing/pooping (03:23)They have found their pattern: typical 1-2x per day, the rule of 7’s still applies: once per week up to 7x per day is normalPeeing with each feed, 6-8x per 24hSkin (04:06) Bathing 1-2x per weekCan use lotion or cream or ointment after bathsDiaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.2 month checkup (08:27)Baby should have gained about 2lbs since last checkup (avg weight 11lb)First vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)Neuro/devel: diminishing grasp/tone/moro reflexes, attempts to look at parent, smiles, able to console self, begins to have different types of crying, coos, able to push up a little during tummy time, consistent head control while supported in upright positionAnticipatory guidance - Eating: nothing but breast milk or formula until 4-6 months; wait for our next visit before feeding anything else Sleep: back to sleep, no blankets, put baby to bed awake but drowsySafety: 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, don’t prop bottleDevelopment: tummy timeNext checkup is at 4 months of age and we will do all the same vaccines except they don’t need another Hep B at that time (17:43)Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 overallBaby is laughing and babbling, really interacting - this is when most parents fall in love with the babyStart wearing hair up / no jewelry - baby can grab objects!Development: (01:32)Social smile / laugh / happy feet Consoles selfBabblesDifferent types of cryingIndicates happy/sadResponds to affectionLift chest when prone, roll (typically front to back)Sleep: (03:02)Variable at this age; some have sleep regression, others are sleeping better than everSafe 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 yetNo blankets until 1 year, no pillows til age 2 - very high risk at this age - starting to rollStart 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, musicEating: (06:27)Primarily breastmilk or formula; starting to consider solids6-8x per 24 hours, 24-30oz per 24hCan take 4-6oz at a time and be full 4-6 hoursSigns of food readiness: showing interest in food, good head control while seated supported, loss of extrusion reflexHow 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, vomitingWhen 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 dayPeeing about 6x per 24hSkin: (17:54)Bathing 2-4x per week; wipe skin folds a few times per dayCan use lotion or cream or ointment after bathsSunscreen, 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 waterTeething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bagsMedicines: tylenol (ask your doctor for the dose), topical teething gel like orajel4-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 burnsDevelopment: 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 Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 booUse support networks, balance parent roles/responsibilities Date night with trusted babysitter Development: (02:25)Socially interactiveHappy feet Recognizes familiar faces BabblesTakes turns babbling / making sounds like squeals, blowing raspberries, rrrStarts to know own nameVisual and oral exploration to learn about environmentRolls 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 thingsRaking graspCan bring hands together, transfer hand to hand, and put objects in mouthNo object permanence yetToys: 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 ageLower crib mattress (pull to stand)No blankets until 1 year, no pillows til age 2 - very high risk at this age - rollingMaintain 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, musicNutrition: (11:48)Primarily breastmilk or formula; starting solidsHow 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, vomitinggive water (ounce per ounce with foods)Start consolidating meal timesConsider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby foodExpect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cuesGagging is normal, choking is notTeeth: (19:30)Teeth can appear anytime; brush 2x per day with water and soft toothbrushTeething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bagsMedicines: tylenol (ask your doctor for the dose), topical teething gel like orajelFluoride: 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 bottlePeeing/pooping: (24:49)Peeing about 4-6x per 24hPoop is now more solid because they are eating foods; can consider starting potty training nowSkin: (26:40)Bathing 2-4x per week; wipe skin folds a few times per dayCan use lotion or cream or ointment after baths - watch those folds for rashes thoughSunscreen, 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 morningThe 6 month checkup: (30:23)Baby should have gained about 2-3lbs since last checkup, should be more than twice birth weightThird round of vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)Anticipatory guidance: Safety: use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, no infant walkers, remember safe sleep, start baby proofing, bathroom and kitchen are most dangerous rooms (burns, sharp objects, poisons, drowning), choking hazards, avoid plastic bags / balloons, limit finger foods to those soft enough to crush easily with fingersDevelopment:  Stranger anxiety can inspire crawling/rolling with toys placed just out of reach. Anticipate sitting on their own and crawlingNext WCC in 3 mos; no vaccines (might get flu shot)Reminder: flu shot is given in 2 doses, 1 mo apart, for baby’s first flu season, then 1 annuallyPast few visits were q2mo, now q3mo (9, 12, 15, 18 mos)Resources discussed in this episode:The Baby Manual - Available on AmazonEdinburgh Postnatal Depression Scale - Downloadable--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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/Kindlefeeding, teething - 5/4pee/poop, gas/colic - 5/18skin - 6/1sleep - 6/15illness/red flags - 6/29vaccines 0-6mo - 7/13How often to feed: (0:54)Newborns eat 8-12x per day, need frequent feeds because their stomach is so smallBirth - stomach size of a cherry (5-10ml, or 1-1.5 tsp) - colostrumDay 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 balloonOverfeeding -> spit upsThe lower esophageal sphincter develops by 6-12mos of age8-12 feeds aren’t exactly every 2-3 hoursCluster feeding 2-6 am because prolactin is highestThis typically lasts about 2 weeks, then they learn the night/day differenceIf they sleep 4 hours you MUST wake themNewborn - 2 weeks: may eat more than 12x per day2weeks - 2 mos: typically eat every 2-3h2-6 mos: can sometimes go more than 4h between feeds if they are gaining weight and your doctor ok’s itWhat to feed them: (4:00)Breastmilk or formula ONLY for 4-6 mosContains all the protein, fat, carbs, vitamins, minerals, and water your baby needsAt 4-6 mos can start to introduce foods: will come back to this in a bitBreastfeeding: (4:29)AAP recommends exclusive breastfeeding x 6 mos, then BFing + food/water until age 1 year or laterOk to breastfeed as long as you wantEat a wide variety of foodsVitamins:A prenatal vitamin that contains iron and folic acidOmega-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 BACEach time baby eats, they are placing an order for the next feedFirst 3-5 days colostrum; need to nurse for 15-20 min per side per feed to stimulate milk productionBenefits 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 dayBaby 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 freeTricky things about breastfeeding: (12:40)Takes babies up to 2 weeks to get a hang of itCan be painful for the first 2 weeksAggressively moisturize your nipplesTongue-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 laborChoosing a pump: manual vs. electric, how much suction, how portable, single or doubleGetting the best return: Early morning (prolactin peak)One side while baby latches on the other side, or within 15 mins of baby finishingIf at work, look at photos/videos of babyStay hydratedCan try herbal teas, lactation cookies, dietary supplements; these are not proven to be effective and are unlikely to be harmful outside the US: domperidone Pumped milk lasts 6 mos in the freezer, 6 days in the fridge, 6 hours at room tempGiving bottles to a breastfed baby: (17:11)Allows partner and other family members to bond with baby Can allow mom a little more sleep at nightAlways pump while your baby gets a bottle to keep supply upBrush baby’s cheek and let them latch on; don’t put the nipple into baby’s mouthStart with it horizontally, angle up after 1-2 secondsUse a preemie flow nippleChoosing a formula: (19:07)All brands are fairly equal in the US; choose based on the type of formula and look at the ingredients!Regular (cow’s milk-based) - best mimics breast milkGoat milk formula is ok; goat milk is NOT (nor is any animal milk other than human)Preemie formula - has extra iron, calcium, and calories because the last month is when babies store Fe/Ca/fatSoy-based - for vegan families or babies with galactosemia; NOT for milk protein allergy because tend to cross-reactSensitive formulas - more simple sugars, corn syrup-based - I hate these but they do have their place; more info in the next episode (gas/reflux/colic/spit-ups)Anti-reflux formula - has added rice starchHydrolyzed formulas (partially digested, amino acid-based) - protein, fat, and/or carbohydrates are broken down and easier to digest; for babies with milk protein allergy To prepare the formula: (21:38)Ok to mix up to 1 day’s worth (24-30oz) and keep in the fridge Can get ready-to-feed (liquid) formula; do NOT water it downPowdered formula - follow instructions on the package exactly Can mix with drinking water if the clean source Temp should be lukewarm / room tempReminder: let baby latch onto the bottle, always hold baby and bottle while feeding (don’t prop)Burp halfway through and at the endAny leftover in the bottle must be thrown away Baby cues: (9:05)Hungry - eyes open, looking around; rooting; cryingDone - falls asleep, sucks slowly, or turns awayCan offer pacifierStarting solids: (23:03)4-6 mos of age in the US; 6 mos elsewhereSigns of readiness: sit with support, loss of extrusion reflex, watching you eat, bringing hands/objects to mouthOne food every 3-4 days; watch for signs of allergyFood order doesn’t matter; can have anything other than honey and animal milkPuree method: rice cereal, green veg, orange veg, fruit BLW: give babies mashed up foods that they can swallow, or pieces too big to fit in their mouth for them to suck onStart water with solids, 1oz per each 1-2oz of foodFood allergies: (26:46)Signs - blood in stool, rash, vomitingMust discontinue food and wait until after 1st bday with your doctor’s approvalTop 8: peanuts, tree nuts, fish, shellfish, dairy, wheat, egg, soyRisk factors: family member with asthma, eczema, or allergy (likely to something different), a baby with severe eczemaIntroducing peanut proteinNipple confusion: (18:27)Not a real thing, but flow preference isIf you’re going to give bottles ever, start early Pacifiers don’t cause nipple confusion and can soothe the baby and decrease SIDS riskTeething: (29:28)Average 6 mos of age; anytime in the first yearTeeth order; 20 total baby teeth (for tooth-fairy planning)Signs: fussiness, drooling, low-grade fever, pink cheeks, chewing on hands/toys, tooth buds, diarrheaHow to help: teething toys, frozen washcloth, frozen fruit in a mesh bag, topical medications, Tylenol Oral hygiene: (33:12)Pre-teeth: don’t need anything specialAs soon as teeth emerge, brush 2x/day with water or fluoride-free toothpasteStart fluoride at 6mos of age if it’s not in your drinking water; the size of a grain of riceDentist at 1 year of ageThrush: (34:41)Yeast infectionThick white coating on the tongueDoesn’t wipe offNystatinCan spread to breasts - pills for mom The next episode will be gas, colic, spit-ups, and refluxResources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Does your baby show signs of discomfort after feeding? In this episode, Dr. Carole Keim MD goes over practices to best help your baby through peeing/pooping, gas, colic, and other tummy troubles. If your baby has colic, there are ways to help digestion and alleviate discomfort. Vomiting in infants can be a bad sign; she explains how best to keep your little one hydrated with no treatment for vomiting or diarrhea.Dr. Carole Kiem MD details different conditions your baby may experience within their first year, such as diarrhea, constipation, vomiting, and reflux. Watch out for blood in the diaper; she goes over the potential causes, from stool to urine or even a “false period” in baby girls. Check out this episode for more information about tummy troubles.We will cover: PeePoopPotty training an infantBurpingGasColic - dx and txSpit ups / GERDVomiting - gastroenteritis, pyloric stenosis, no txDiarrhea - tx, when to be concerned, signs of dehydrationConstipationBlood in the diaperPee (0:21)Allow up to 24h for the first void.A few pees for the first few days; by day 3-5, mom’s milk surges, and baby voids with each feedVolume is difficult to discern, and the color is sometimes pale - diapers with urine stripes are helpful.Rust-colored urine in the first 2-3 days (uric acid crystals)If a baby less than six mos voids less than 6x per 24h or goes more than four h between voids, they may be dehydrated (nighttime doesn’t count!). Babies >6 mos should void at least once per 6h.Poop (2:48)Up to 48h for first stoolMeconium (and what it means if passed in utero)Transitional stoolsYellow seedy stoolsOver the first 4-6 months becomes brown and toothpaste-consistencyFormula-fed babies may have brown, yellow, or green stool; tends to be smellierHydrolyzed formula -> gray stoolsRule of 7’sOnce they eat food, their poop becomes like adult poopPotty training from birth / Elimination communication / Diaper-free method (6:27)Involves reading baby’s cues and giving cues when it’s time to pottyCan start as early as birth; I recommend around 1-2mos of age after the discoordinate stooling phase.Decide on a phrase and/or hand signal to useBring your baby to the potty (over the sink, potty chair, or toilet adapter)Make a sound to indicate it’s time to go (“psss” or grunt)Easy catches: babies who go during diaper changes, right after waking up, after eating, when you see them poopingIt takes several months; ok to wait until later. Toddlers: takes about 6 mos for daytime and another 6-12mos for nighttime.I love it because there are fewer diapers, less discomfort for the baby, less diaper rash, and it is easier than toddlerhood.Burping (12:28)How toWhen to (breastfed, formula-fed)Why? Decreases gas, colic, spit-upsThey can stop when they burp on their own (around 4-6 mos)Gas (14:20)Normal to fart a lot, loudly, and have smelly gasBreastfed babies may get more gas when mom eats cruciferous vegetables, beans, garlic, and caffeineCheck with your doctor before you start eliminating foodsSimethicone - how it works, when to give it, how oftenColic (16:21)Rule of 3s: 3h per day, 3 days per week, for 3 weeksAlmost all babies get some colic symptoms at some point.Tummy TimeBicycle legsBelly massage - clockwiseBack rubs - counterclockwiseMedicines: simethicone, probiotics, gripe water; can consider chamomile, licorice, or mint tea - dilute, 1/2oz per dayAlternative health: chiropractic, acupuncture, ayurveda - I can’t formally recommend them, but they are sometimes helpful; choose your practitioner carefully.What doesn’t work - is the sensitive tummy formula. No formula will treat colic.Spit ups / GERD (20:47)Reflux = stomach contents go up into the esophagus.GERD = reflux is so bad that the baby has poor weight gain or loses weight, chokes, arches in pain, or has other problemsLESSpit-ups are not forceful.Tx: decrease volume and increase the frequency of feeds (BF vs. formula), burp baby well, anti-reflux formula/breast milk thickeners, add 1 tsp rice cereal to 2oz formula/breastmilk (this is the ONLY time we put rice cereal in a bottle), use gravity, medications such as ranitidine make the stomach produce less acid but don’t decrease the volumeCall your doctor if the baby spits up more than half of their food, if they look like they are in pain with spitting up, if they appear to choke, or if it starts to become more frequent and the baby seems hungry after spitting up.Check out healthychildren.org for more info.Vomiting (28:09)Forceful: Involves abdominal muscles and a retching movementProjectile vomiting goes about 2-3 feet, but spit-ups can tooThe baby is upset afterwardAlways a red flagNo treatment other than to keep hydratedDiarrhea (29:48)Hard to tell in newborns/infants because their poop is so soft/liquidIf you’re worried, call your doctorStool that is so watery it soaks into the diaperA marked increase over what your baby normally doesMarked increase or “blowout” poops more than twice in a rowA foul odor that was not there before, sometimes with a change of colorFever/blood - go to ER if <6 mos, call your doctor if >6mosNo treatment other than to keep hydrated​​Signs of dehydration: decreased urine output, fussy/lethargic, dry lips/tongueConstipation (34:11)Infants: the first year of life; does not apply to children >1yr. We will do that episode in a few months.1 mo: discoordinate stoolingAbout 3% of infants get true constipation: hard stools like pellets, pain with BM, and rectal bleeding.Tx: prune juice 0.5-1oz (15-30ml), once or twice per day; water if they are taking solids/purees; consider eliminating dairyBlood in the diaper (39:01)when it’s normal: pseudomensesAbnormal: any other time, call your doctor immediately! Urine = kidney problem, stool = infection or allergy. UA/ HemoccultFoods that mimic blood: watermelon, beets, tomatoesI hope this helps you guys know what’s within normal range and when to be concerned.  Remember: It is ALWAYS ok to call your doctor’s office with questions if you’re worried.  Babies are really different than adults, so it can be hard for new parents to know whether something is serious or not. I wrote the Baby Manual for that reason, and I know parents refer back to it often through the first year of life to check whether they need to be concerned.  Resources discussed in this episode:The Baby Manual - Available on Amazonhealthychildren.org--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 skinNewborn rashPustular Melanosis / normal rashMiliaBirthmarksHemangiomaJaundiceBaby acneSeborrhoeic dermatitis / cradle capEczemaDiaper rashNewborn skin / newborn rash 0:33Dry and peely is normal Newborn rash looks a little like chickenpox: red spots all overNewborn rash is not itchy or painful and happens usually within first 3 days of lifeNo lotion or product required - only a greasy emolient if dry and cracking at wrists or anklesPustular Melanosis / normal rash 1:51Tends to happen in babies with darker skin toneLooks like newborn rash but tiny blisters are smaller - tiny pustules with yellowish fluid insideWhen they pop they leave behind a little freckleFreckles go away on their ownShould go away in a week - if persists beyond week, talk to doctorMilia 2:44Looks like pimples on nose, upper cheeks, foreheadIs not pimples but is tiny white, pinpoint size, dotsDo not pick or squeeze, could hurt baby or scar if you doIt’s essentially skin cells trapped under the skin that form tiny white bumps - almost like clogged pores but not quiteWill go away on its own and is not dangerousBirthmarks 3:24Present either at birth or a few days or weeks after birth - normalSalmon 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 fadeSometimes when babies cry, especially with patches on forehead or eyelids, they’ll get redder and brighter - this is normalMongolian spots - also called slate grey nevus or dermal melanocytosis - are light blue grey in color, almost like bruisesThey show up frequently from birth in low back area but can really be anywhereThey tend to fade within the first five years of lifeMore common in babies with darker skin tone, normal, and kids outgrow themPort wine stains - dark red, flat area of skin - usually on face or upper body, but not alwaysNot dangerous but sometimes associated with other conditionsIf your baby has a port wine stain your doctor may want to do a genetic workout but many times it’s nothingTreatment is not necessary for port wine stains but some families opt for it for cosmetic reasonsHemangioma / infantile hemangioma 6:00Similar looking to port wine stains but are raised and lumpyAre a collection of blood vesselsIf you press on it, it may go lighter colored or white then turn back to redTend to grow quickly - within first 6 months of life - then start to involute or crumble within themselves and shrink back downTypically 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 airwayDoctor can check for internal hemangioma with ultrasoundTreatment may be beta blocker or laser therapy - consult doctorJaundice 8:16Yellowish color of skin and eyes and is common among babiesReason: babies are born with extra red blood cells, some maternal red blood cells release hemoglobin when broken down which converts to bilirubinBilirubin is what causes the yellow color of skin and eyes: jaundiceBilirubin can be checked for with tests via light and special device (transcutaneous bilirubin) or blood test (serum bilirubin)Phototherapy is bright light therapy that breaks bilirubin down into form that can be peed outNormally bilirubin just leaves the body via eating and evacuationYou can feed them more - you can expose baby to sunlight indoors (not outside) in patch of sunlight while feedingJaundice needs to be treated either at home or by doctor because high bilirubin levels can actually be dangerousHigh bilirubin (levels 20 to 25) can get into the baby’s brain and cause brain damage, seizuresYou can always catch bilirubin before it’s at that level - always watch for it, you can see the yellowish tint by level 10 or 12No association between Vitamin D and jaundice - sunlight breaks down bilirubin which decreases jaundice but Vitamin D does not treat jaundice, no association thereVitamin K shots do not treat jaundice eitherIf your baby had delayed cord clamping or cord pumping, it is not related to Vitamin K or jaundice but can be related to less anemia - that is a separate thing and an OBGYN conversationRisk factors for jaundice - Coombs positive antibody which comes from mom and baby having different blood types resulting in baby making antibodies for mom’s blood - Coombs positive can cause bilirubin to riseBaby not eating well is also a risk factor for jaundice because if they are dehydrated, bilirubin can go up - preemies are also at riskBaby acne 14:14Can happen on face, chest, back - looks like little red dots or sometimes pimples like regular teenage acneTypically related to hormones, sometimes in breast milk - not a reason to stop breastfeedingBaby acne is completely cosmetic, doesn’t hurt baby, doesn’t itch, and goes away by itselfDo not use adult products on baby’s skin - no acne medications, they will dry out baby’s skin and possibly burn - just bathe normally, once or twice a weekSeborrhoeic dermatitis / cradle cap 15:05Happens on the scalp - greasy, flaky, yellowish whitish plaques stuck to skinMost common in first 6 weeks of life but can be seen in two or three year oldsCosmetic; skin thinks it’s too dry so overproduces sebumTreat it by putting something greasy on top of it - olive oil or Vaseline or aquifer in petroleum - apply to scalp - tricks skin into thinking it produced enough already, stops overproduction, and loosens plaques so they can be gently brushed away with baby brushIt can come back - it’s cosmetic and not dangerousEczema 16:40Common in babiesTends to run in families that have history of asthma, allergies, and eczemaStarts as dry patch of skin, typically on areas that rub like cheeks and backs of arms and legsEczema is itchy and does bother them, they may be fussy or rubbingThey may scratch with baby nails - scratching releases more histamine which makes you more itchy which can lead to worsening and a flare upTreatment - keep skin really moisturized - only bathe them once or twice a week with unscented soap or just plain water bath - after bath put something greasy like emmalin petroleum aquifer or unscented lotion and reapply throughout dayIf eczema is really bad, check with doctor - may need medicated cream or food allergy testDiaper rash 18:28Irritation in diaper area because of moisture and frictionUse over the counter diaper creamA lot of diaper creams contain zinc oxide which helps heal the skin but if those also irritated baby’s skin - if diaper rash isn’t improving with zinc oxide diaper cream - try petroleum-based cream or calendula cream (Aqua, AMD, Vaseline)Greasy ones work by creating a barrier and preventing more moisture from getting inDiaper rashes can get infected with yeast or bacteria - candida infections are commonCandida infections look like bright pink or reddish rash in pale skin babies, and deep pigmentation or pink and through with satellite lesions in darker skin babiesFirst treatment for candida infection is dry area out - leave off diaper as much as possibleAlso antifungal cream - ringworm cream or jock itch cream, or best idea is medicated cream from doctorIf rash lasts more than two or three days or has boils or pustules, that is typically a bacterial infection - needs special treatment with ointment and if it recurs over and over, treat entire familyDiaper free time is encouraged - wipes only for poop, water wipe or wet washcloth is fine for just urineConsider potty training from birth - addressed in Episode 9 about Tummy TroublesDr. Carole Keim hopes this guide to normal baby skin care is useful and helps alleviate regular questions or concerns. All of this information is also in The Baby Manual book. But remember: it is always ok to call your doctor’s office with questions if you’re worried.  Resources discussed in this episode:The Baby Manual - Available on AmazonEpisode 9 - Tummy Troubles--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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 patternsHow to help baby fall asleep and transfer to the bedHow much crying is okSafe sleep / SIDSCo-sleepingDivision of night workTips to help you sleep betterSleep trainingBaby sleep patterns: 00:44Newborns: 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 consistentlyBy 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: 05:43Signs baby is tired: drooping eyelids, rubbing eyes, yawning, fussingSwaddle 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 overHave a wind down routineLast nighttime feed in arms / high chairBrush teeth or gumsBath (optional; they don’t need it daily, but it can be relaxing)Sway/rock with baby in armsSpeak in a quiet, soothing voiceRead a book / sing a lullabyPlace baby down “awake but drowsy” - they will get used to falling asleep in their bedAll 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 awayFor 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 awayCan 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 laterTylenol/ibuprofen at bedtime for teething infants can help them sleep betterDO 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 ageDO NOT give your infant or child sedating antihistamines or other sleep medicines, they are not safe How much crying is reasonable? 12:07Most 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 minsGenerally 5-20 mins of crying is ok, but if it is hard for you to wait that long it’s ok to pick baby up sooner.  Just make sure you give them a chance to self-soothe.This is not the same as cry-it-out or CIO; that allows them to cry until they become exhausted and fall asleep, and I do NOT recommend thatIf your baby cries to the point of breath holding, gasping, or vomiting, that is too muchSafe sleep / reducing the risk of SIDS: 13:31The ABCs of safe sleep: Alone, on their Back, in a CribAlone - no blankets until 1 year of age, and no pillows until age 2.  No toys, no crib bumpers, no loose sheets, no netting.  They CAN have a pacifier and be swaddled.Back, on their - aka face up Crib - may also be a bassinet or other safe surface.  Safe sleep surfaces are firm, have tight-fitting sheets, and baby is unable to fall out of it.  It is ok for baby to sleep in a car seat, swing, or stroller for about 20-30 mins while observed, but you must transfer to a safe sleep surface ASAP for babies less than 6 months.  Pacifiers can reduce the risk of SIDSSmoking is a big risk factor for SIDS, so smoking outside or stopping smoking will help reduce this risk Around 4-6 months when baby is rolling: No swaddlingNo blankets When they roll themselves over, you don’t have to turn them back.  still place them on their back to sleep initially though.Transition to crib in parents’ room until 1y of ageCrib in their own room at 1 yearToddler bed when you are ok with them getting out of it or if they are escaping the crib (typically age 2-3)Co-sleeping: 17:14Considered unsafe by the AAP for the first year of lifeAfter 1 yr can sleep in a bed with blankets, and at age 2 can have pillows; safe to co sleep at age 2 yearsMany parents will co-sleep at some point, often when baby is sick, which is arguably the most dangerous time To co sleep safely: firm mattress (with tight fitted sheet) on the floor, no blankets, no pillows There are safe and unsafe co-sleepers on the market.  Safe ones have 3 or 4 hard sides, and a firm flat bottom, and are sometimes also called bassinets.  Unsafe ones have soft pillow sides, or are inclined more than 10 degrees.  It is not safe to sleep in a chair holding your baby, or to sleep with your baby lying next to or on top of you in bed Tips to help you sleep better: 19:45If you have a partner: divide the nightSplit the night into shifts from 10p-2a and 2a-6a.  Keep in mind, newborns will be more awake during that 2-6am time (for the first month or so) and mom’s milk production is highest at that time.  Baby takes bottles of EBM during partner’s shift, and mom pumps.  Alternate nightsSplit the duties: one parent feeds, the other changes diapers.  I typically don’t recommend this one, because then neither parent gets any stretch of sleep longer than 2-3 hourMinimize screen time, and no screens for 2h before your ideal bedtime.  The blue light from screens decreases sleep quality.  Amber glasses and night-shift mode can help, but no devices is better. Have a wind-down routine for yourself that includes hygiene and a relaxing activity  like stretching, meditating, praying, or reading Keep the bedroom dark and quiet; consider blackout blinds and white noise machine for parents’ roomAvoid caffeine and alcohol; both will decrease sleep quality.  Drink loads of water.Eat healthy power snacks at night (plain yogurt, cottage cheese, fruit, nuts) if you are breastfeeding, rather than processed foods which provide quick energy/calories and could make it harder to go back to sleep.  Have a lighter meal in the eveningIf you are anxious about sleeping through something important, keep in mind that a baby’s cry is the very best alarm clock for moms, they tend to be in sync with mom’s sleep cycle (so you are likely to wake at the same time anyway), and you can always set a 4-hour timer to wake you both up so baby doesn’t sleep through a feed Avoid sedating medications whenever possible (especially OTC ones like diphenhydramine or melatonin) because you need to be able to wake up when your baby needs you Go to bed after your baby’s first evening feed (the one after your dinner).  It can add 2-3 hours of sleep per night, which is immensely helpful Sleep training: 27:53Cry it out / Extinction method: Leave them until they fall asleep, do not go back to check on them.  This is not recommended, babies feel neglected and very stressed with this method.Babywise: Schedule feedings, play, and sleep.  This is not recommended; has been associated with serious problems (dehydration, poor weight gain, failure to thrive, delayed development, early weaning)Dr. Sears: promotes co-sleeping and following baby’s cues; co-sleeping is not recommended.Dr. Spock: recommends following baby’s cues but suggested placing them face down, which is associated with SIDS and not recommended.Ferber method: Have a wind-down routine.  Leave the room, and allow progressively longer intervals of time before checking on baby (every 5 mins, then every 10, then every 15, etc); when you check on baby you may verbally soothe but do not pick them up.Happiest baby on the block: 5 s’s: swaddling, side/stomach position, shushing, swinging, and sucking.  Swaddling and side/stomach are not recommended, but shushing, gently swinging/swaying with baby, and allowing them to suck on a pacifier are all recommended.Closing remarks: 31:43This is one of the hardest things parents deal with (their lack of sleep due to baby’s inconsistent sleep)The first few weeks are the hardest; it gets better with time, and all people

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. EmergentAbnormal Temperature - emergencyApnea/Cyanosis - emergencyAspiration/Choking - emergencyBlood in the Diaper - urgentBulging Fontanel - emergencyCough - emergencyCOVID/flu/RSV exposure - urgentDiarrhea/Vomiting - urgentHead injury - emergent if signs of concussion/fx, otherwise urgentJaundice - urgentSeizure - emergencyUmbilical Cord Infection - urgentUmbilical Granuloma - urgentWhat is a red flag? - 00:24A red flag is a sign that something MIGHT be wrong and you should run it by a doctor.  Urgent vs. Emergent - 00:37Urgent = 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 - 1:15You 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 - 4:10Signs 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 - 4:46If 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 - 5:30If 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 - 6:33Hiccups 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 - 8:47Call 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 baby.  If you’re breastfeeding and you have COVID/flu/RSV, keep breastfeeding!  You’re giving passive immunity to your baby that way.  Just wear a mask so you don’t cough onto the baby.   Breastfeeding babies: mom can take Vitamin C, Vitamin D, echinacea, and zinc to pass through breastmilk to baby.If baby develops cough or fever, go to the ER if under 6 mos, or call your doctor if over 6 mos.  Diarrhea/Vomiting - urgent - 12:09Babies can get dehydrated very quickly from diarrhea and/or vomiting.  Call your doctor if baby has vomiting or diarrhea 2-4x in the same day; go to the ER if it is more than 4x in a row or if baby is showing any signs of dehydration: dry lips/tongue, sunken fontanelle, irritable, lethargic.It’s ok to rehydrate babies over 6 mos by giving water or an electrolyte solution (pedialyte, ORS) to replace losses, but only in small volumes - check with your doctor about how much is ok to give.  Remember they are on a primarily liquid diet, and giving electrolyte solution can cause them to be protein/fat/calorie depleted.  Head injury - emergent if signs of concussion/fx, otherwise urgent - 14:22Any time your baby falls off a surface (couch, changing table, bed, etc.) you need to call a doctor to make sure your baby did not sustain a concussion.Signs of concussion include:Losing consciousness / faintingVomitingChange in personality - persistent crying, acting strange, trouble sleeping/eating, etc.Pupils unequal sizeSeizure Weakness of the entire body or parts of the bodyIf you feel skull crepitus (a crunchy sensation under the skin) or if baby’s fontanel is raised, that is an emergency.  Crepitus = skull fracture, bulging fontanel = bleeding around the brain. Jaundice - urgent - 18:07If your baby’s skin and eyes appear yellow, you should call a doctor.  Most babies will have jaundice at some point, and your doctor can do a test to determine the level of bilirubin in the blood to see whether the jaundice needs treatment or not.  If the level of bilirubin is too high and is not treated, it can cause brain damage.Seizure - emergency - 20:02Infantile seizures may be the whole body (generalized shaking and tremors), or may only involve part of the body.  Some signs of seizures are:The whole body or part of the body makes repetitive jerking movementsSucking when there is nothing in the mouthFast blinkingEyes deviated to the sideIf you think your baby might be having a seizure, remove anything that might be in baby’s mouth, make sure your baby is not left unattended on a surface, and call an ambulance.If you are able to take a video of the seizure, it can be very helpful for the doctors to see that!Umbilical Cord Infection - urgent - 22:35If the skin around the umbilical cord is red, swollen, warm to touch, and tender, these are signs of infection.  Umbilical Granuloma - urgent - 23:42When the umbilical cord falls off, it’s normal to have a little bit of bleeding and what looks like yellowish goo.  After the cord has fallen off, clean the area gently with a wet washcloth or a cotton ball with rubbing alcohol.  The bleeding should stop immediately, and much of the yellow goo will come off.  If the umbilicus is still bleeding, or there is too much yellowness, there may be an umbilical granuloma in there.  This can be treated easily at the doctor’s office with a chemical called silver nitrate.  The chemical cauterizes the granuloma, and the process is completely painless for your baby.All of this information is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Carole Keim MD takes listeners through vaccines in today’s episode. She explains everything from how vaccines are created to common myths and misconceptions about them. She then details each baby and childhood vaccine, and what disease each prevents.Dr. Keim breaks down how vaccines work and what criteria they must meet in disease to be effective. She explains the four main types of vaccines and lays each vaccination out in a clear manner, covering what age your baby or child will be when they receive the vaccine and how the immune response works. These vaccines are proven to protect your baby against everything from tetanus to mumps to pertussis and more.This episode will cover: How vaccines workCriteria to create a vaccineThe 4 different types of vaccinesCommon myths or misconceptions about vaccinesSpecific vaccines (all routine childhood vaccines)Total number of vaccinesCommon side effects and red flags, how to treat How vaccines work: 00:44The purpose of vaccines is to trigger an immune response faster and with less harm than the original disease.The immune system is a lot like a microscopic team of superheroes, made up of white blood cells, antibodies, the complement system, and a few others.  These superheroes fight villains such as bacteria, viruses, and other pathogens.  If they cannot fight them fast enough, the villains will multiply and cause symptoms of disease.  Vaccines give your superhero team information about what the villains look like, so they can recognize them as soon as they enter the body, and fight them off quicker and easier.Vaccine criteria: 01:26In order to make a vaccine, certain conditions must be metIt has to be effective.  We must be able to become immune to the pathogen; diseases like RSV and HFM are ones we can catch multiple times.  Chickenpox is one that you become immune to after catching it once.The pathogen must not be able to mutate faster than the vaccine can be given - we do flu boosters annually because the flu virus mutates about that often.  HIV and common cold mutate too fast for a vaccine to be developed.The vaccine must be cost-effective; it has to be cheaper to prevent the disease than to treat itThere are 4 main types of vaccines: 02:31Inactivated (killed pathogens)Live attenuated (weakened pathogens)Toxoid (a piece of what’s inside the pathogen)mRNA vaccines Inactivated vaccines 03:44Most common typeThe bacteria or viruses in the vaccine are killed, so your immune system can safely learn to recognize the pathogen that it is trying to fight off.  These vaccines do not have the potential to cause actual disease.  What they do is cause the immune system superheroes to practice fighting the villains, kind of like practicing on dummies, which may cause mild signs of illness - fever, sore muscles, crankiness, or other symptoms.  Examples: IPV (polio), HPV (human papillomavirus), HiB (Haemophilus influenzae B), pneumococcus (Streptococcus pneumoniae), meningococcus (Neisseria meningitidis), and Hepatitis A and B vaccines.Live attenuated vaccines 04:02Made from bacteria or viruses that have been exposed to chemicals that make them weaker than the natural or “wild type” bacteria or virus.  Since these pathogens are not killed completely, your superheroes aren’t just practicing on dummies, they are actually fighting the weakened villains.  So it is possible to have symptoms of the disease, but milder.  Some people with weakened immune systems may not be able to fight them off, and can get the actual disease.  People taking steroid medications or immune suppressants, or who have HIV or other immune deficiencies should consult a doctor about whether it is safe to receive these vaccines.  Examples: oral polio vaccine, MMR (measles, mumps, and rubella), Varicella zoster (chickenpox), and rotavirus vaccines.Toxoid vaccines 04:55Made from just part of the pathogen, and protect against the kinds of bacteria that cause symptoms after the toxins inside them are released.  These toxin-carrying bacteria are like villains carrying around a bottle of poison, and the toxoid vaccine gives the superheroes the poison to sample and build up resistance to it.  Example: DTaP (diphtheria, tetanus, and acellular pertussis).MRNA vaccines 05:23Newest typemRNA is like a copy of instructions. These give your immune system something like a sewing pattern to print out and make the dummies for your body to fightExample: some COVID vaccinesMyths and misconceptions about vaccines: 05:45Many parents have concerns about vaccinating their children.  It only takes one serious reaction to call into question the safety of vaccines.  And it has been so long since the vaccine-preventable diseases have run rampant that we in the United States don’t fully understand the scope of what is being prevented.  Here are some of the top concerns that I have heard from parents, and the truth behind them.Aluminum.  There is aluminum in vaccines, but the amount is far less than babies get from other sources.  The total amount of aluminum that babies get from vaccines in the first 6 months is 4.4mg.  Breastfed babies consume 7mg, formula-fed babies consume 38mg, and babies on soy formula consume 114mg of aluminum in the first 6 months of life.  Consuming aluminum vs. having it injected in a vaccine looks the same to the body, so the tiny amount of aluminum in vaccines will not harm your babyAntigens.  An antigen is any microscopic substance that has the possibility to elicit an immune response.  Babies are exposed to over a trillion antigens in the first year that naturally occur in the environment.  The entire vaccine series that children receive today contains just over 150 antigens.  A young baby’s immune system can easily recognize these few antigens and make antibodies to the diseases without getting sick.Autism.  It has been proven that vaccines do NOT cause autism.  The age that children first start showing signs and can be tested for autism is 15-24 months.  This is the same age that children receive booster vaccines, so it is understandable that some parents think they are related. Long-term protection.  Vaccines will protect a person for just as long as if they got the original disease.  So a person who had chickenpox as a child is just as protected from getting it again as a person who has received the chickenpox vaccine.  Some people do not seroconvert (develop antibodies to that disease) - that depends on their immune system and is not a failure of the vaccine itself.Mercury.  There used to be a preservative called thimerosal in vaccines.  That preservative (which contains mercury) has been removed from all vaccines in the US that children receive.  The only vaccine that still contains thimerosal is the adult flu vaccine.Unnatural exposure.  Some people worry that getting exposed to a disease through an injection is not the same as getting it “naturally” by being exposed to a sick person.  This is not true; any disease will get into your bloodstream, which is where it is recognized by the body, and once in there the body has no idea how it got in.  So getting an injection looks exactly the same to your immune system as getting the disease from a sick person.Doctors DO NOT get paid to vaccinate childrenVaccines are NOT a punishment for children who are behaving badlySpecific vaccines: 10:47Hep B - 0, 2, 6 mos.  Hepatitis B is a viral infection that can be passed from mom to baby through the placenta or during delivery.  90% of babies born with HepB will develop chronic infection and are at risk of liver cancer later in life.DTaP - 2, 4, 6, 15 mos, 4 years.  Tdap - age 11, every 10 years.  DTaP has more diphtheria, Tdap has more tetanus. Bacterial infections.  Diphtheria causes severe sore throat and enlarged tonsils, and can block the airway from swelling/tonsils being so enlarged.  Tetanus makes spores that live in soil; any penetrating wound could have tetanus in it (nail/thumbtack, dog or cat bite) and tetanus is not killed by antibiotics so it must be prevented.  Pertussis is whooping cough and causes babies less than a year old to stop breathing.  Everyone who takes care of the baby should be current on their TDaP (within 10 years).  Polio - 2, 4, 6 mos, 4 years.  Polio is a virus that attacks nerves and causes paralysis.  Sometimes it’s minor, and sometimes it’s the diaphragm that’s affected and they stop  breathing.  There is no specific treatment for polio.HiB - 2, 4, 6, 12-18 mos.  HiB (haemophilus influenzae B) bacterial infection that affects children less than 5 years, and especially those under 1 year of age.  It used to cause severe infections like epiglottitis, sepsis, pneumonia, and meningitis.  PCV - 2, 4, 6, 12-18 mos.  PCV = pneumococcal conjugate vaccine, pneumococcus is another name for streptococcus pneumonia, which is a kind of strep that gets into the bloodstream and causes sepsis, pneumonia, and meningitis.  PCV has 13 strains of strep in it right now.Rotavirus - 2, 4, 6 mos. Viral infection that causes severe diarrhea and dehydration in babies. Hep A - 12 and 18 mos. Hep A is a type of food poisoning, there’s no specific treatment.  MMR - 1 and 4 years.  Measles causes high fever, rash, and can cause brain damage, hearing loss, and death.  Mumps causes parotitis (infection of salivary glands), but in boys also causes orchitis (inflammation of testicles) and can lead to sterility.  Rubella is a fever and rash; more dangerous to unborn babies, causes miscarriages and birth defects.VZV - 1 and 4 years.  Varicella Zoster virus (chickenpox) causes cold symptoms, fever, and an itchy and painful rash in children, and shingles in adults.  VZV in pregnancy causes miscarriages and birth defects.MCV - 11 and 16 years.  Meningitis A, C, W, Y are viruses that cause inflammation around the brain that develops quickly and can be fatal.  HPV - 11 years.  Human papilloma virus causes warts and dysplasia and can lead to cancer of the mouth, throat, anus, cervix, and penis.  Currently 9 strains of H

Dr. Carole Keim MD takes parents through all the different developmental milestones that babies go through from newborn to one year of age. She details the types of development, how to play with your baby to enhance development, and how much screen time is okay for babies.Dr. Keim explains how your baby’s grasp will develop as they age through their first year and when they’ll be able to use their thumb and forefinger to pick up small objects, for example. She explains how far they can see when they’re newborn, when they start to recognize voices and then faces, when they develop object permanence (which is the same time they start to love playing peek-a-boo). She covers reflexes, speech patterns, tummy time, stranger anxiety, helpful play, and everything you need to know about how your baby is absorbing their world.This episode will cover: Types of developmentDevelopmental milestones by ageHow to play with your babyScreen timeTypes: 0:42Gross motor skills - use large muscle groupsFine motor - small muscle groupsVerbal/social - their interaction with family / peersIsolated delays are often benign; delays in 2-3 areas are red flagsThere is no advantage to pushing motor skills, but there is advantage in encouraging verbal/social skillsNewborn: 2:11Brief periods of wakefulnessEqual limb movementsResponds to parents voice/touchLooks briefly at parentsMoves in response to visual or auditory stimuliReflexes: grasp, rooting, moro1-2 weeks old: 4:20turns and calms to parents voiceCommunicates needs (wet diaper, hungry, tired) but has the same cry for allAble to fix briefly on faces or objectsFollows to midlineLift head briefly while prone 1 month: 5:36Responds to calming actions when upsetFollows parents with eyes; follows past midlineRecognizes familiar voicesResponsive smileAble to lift head during tummy time or while on parent’s chestCommunicates needs2 months: 6:57Start losing grasp/rooting/moro reflexes Looks at parentSocial smileStarts to comfort selfDifferent types of cryingCoosCan show signs of boredomLift chest briefly during tummy timeHead control while sitting supported4 months: 8:41Elicits social interactionsLooks at parents / watches them walk aroundAble to comfort/console selfStarts babbling / cooing expressively, squealing, and laughingResponds to affectionIndicates happy/sadAble to push up onto elbows (lifts chest fully while prone)Good head control Start rolling (front to back)Start reaching for objectsCan hold a bottle6 months: 10:52Socially interactive with parents - takes turns babblingMature babbling (consonants and vowel sounds)Recognizes familiar faces; beginning of stranger anxietyStarts to recognize own nameRolls over both waysSits (tripod)Starts showing pre-crawling behaviors (getting to knees, rocking, army crawl)Turns while seated Brings objects to mouthTransfers objects hand to handRaking graspGets distracted while eatingDiaper changes get more difficult because they try to roll9 months: 13:40Stranger anxietySeeks out parentsUses repetitive consonant and vowel soundsPoints at objectsObject permanenceInteractive games (responds to peek-a-boo)Explores environment with eyes, hands, and mouth3-finger graspPulls to stand3D diaper changes1 year: 17:07Imitates activitiesHands books/toys to parent to play with themWaves byeStrong parent attachment; separation anxietyProtodeclarative pointingImitates sounds/words (animal sounds)Speaks 1-2 wordsJabbers with inflectionIdentifies people when askedBangs two objects togetherStands alone2-finger graspFollows simple directions How to play with your baby and boost their development: 19:46All ages: talk and sing to your baby, narrate your dayNewborn up to 1mo: Help baby develop sleep and feeding routines; swaddle baby and place them face up to sleep in a crib or bassinet in parents’ room, use dim lighting and a quiet voice at night; help baby wake for feeding by picking them up, undressing, can use a wet wipe; tummy time on parents’ chests1 month: Awkward time because they are awake more.  Develop consistent routines for sleep and eating, cuddle and talk to baby often, do tummy time 15-30 mins 1-2x per day; let them look out windows, at ceiling fans, or at bold patterns2 months: Continue routines; hold baby, cuddle them, sing or talk to them; start to learn their likes and dislikes; continue tummy time 30 mins 1-2x per day4 months: as above, but also can let them sit supported; watch for signs of food readiness; can play music for baby6 months: Play time on the floor, let them sit in high chair (for meals and also to watch you / play), interactive/reciprocal play, make funny sounds, read to baby, hand them objects to put in their mouth, babies start to notice screens at this age (front camera feature, video chatting).  Officially no screen time til age 2 other than this.  Babies start to notice patterns and cause/effect at this age, can develop habits.  Start baby proofing at 6 months.9 months: Consistent positive discipline (one pickup rule for thrown objects, have cause-and-effect toys, have a “yes” space), expect them to explore the environment, read together, hand them toys that make noise when you squeeze or shake them12 months: Use distractions for discipline, verbally acknowledge good behavior, consider playgroups (they often won’t interact with other babies other than to point them out), encourage self-feeding, can help them start walking by holding onto hands or using rolling toys, say the name of objects they point to, name their emotions, tell them what’s ok to do instead of using ‘no’ Screen time: 33:10Officially, ONLY video chatting is ok up until age 1.5-2 years, age 2-5 years up to 1 hour per day, 5+ years up to 2 hours per day of recreational screen timeAt 18 months, ok to start educational programs, but you need to watch with themPBS kids, Pocoyo, Baby Bus, CocomelonChildren are affected by sounds on TV - avoid anything scary or violent while baby is in the roomScreen time is associated with developmental delays; it’s like overhearing a conversation as opposed to being engaged in oneYou (and other people) are your baby’s primary entertainment source for the first 2 years There are plenty of ways to entertain your baby that don’t involve screens: singing, talking, playing with them, reading to themIf you need a few minutes: keep preferred toys in a “yes” spaceComing up, Dr. Keim will go through the checkups and advice for the next several visits. Now babies are being seen every three months, so the next few visits will be 9 months, 12 months, 15 months and 18 months. Carole Keim is also working on a third edition of The Baby Manual coming out soon. And another book called The Baby Manual Step By Step which will go chronologically, a one chapter at a time guide. You just need to read one chapter that will go with whatever age your baby is and the closest checkup to your baby's age.All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Dr. Carole Keim MD introduces everything to know about babies at 9 months of age in this episode. She details developmental milestones and safety considerations for the 9 to 12 month age range and lets you know what to look for.Dr. Keim encourages parents to have date nights at this stage, to leave your baby with a trusted sitter, and also to start really talking out any parenting differences that may have appeared. She talks about all the ways in which your baby will have developed, from object permanence to repetitive sounds, and covers sleep, nutrition, and teeth as well. This is the age to really start baby proofing your home with outlet covers and stairway gates, and Dr. Keim also shares advice on skincare and the 9 month check up.This episode will cover: ParentsDevelopmentSleepNutritionTeethEliminationSkin CareSafety9 Month check-upParents: 00:26Typically have routines downEngage with child often by speaking with/to them, waiting for them to respondInfant should be able to separate or move away from parent for moments, but will check back to look at themHave a “yes” spaceHave regular date nights with a babysitter watching babyMake time for yourselfHang 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) Development: 03:00Stranger anxiety / apprehensionSeeks out parentUses repetitive consonant and vowel sounds while babblingSays mama or dada (not specific)Points out objectsHas object permanenceInteractive games (responds to peek-a-boo, cause-and-effect toys)Explores environment with eyes, body, and mouthSome movement across floorCan start weaning pacifier Sleep: 05:2010-12h at night, 2 naps per dayBedtime routine established: quiet time, reading, singingIn crib in parents room; consider moving to own room when 1 year oldStill no blankets until 1 year oldNo bottles in bedNutrition: 06:213 meals and 2-3 snacks per day at the same time as the familyOffer a variety of foods and textures Should be consuming 24-30oz of breast milk or formula dailyCan have water; can start using a cupNo cow’s milk or honey until 1 year of ageShould be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per weekLots of oral exploration at this age; they might get into dog food/water, eat crumbs off the floor, eat rocks/sticks/dirt outside Teeth: 09:59Brush 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 toothbrushFirst dentist visit will be at 1 year of ageElimination: 11:10Can start potty training by putting baby on potty after eating and upon wakingTypically voiding at least 6x per day, stooling 1-2x per dayIf 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: 13:29Bathe as often as they get dirty (2-3x per week)Can use lotion Use sunblock if spending more than 30 mins outside Insect repellant for babies (citronella based is best)Safety: 14:54Baby proof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach Keep baby in arms or a high chair or playpen in the kitchen and bathroom; never allow baby to be alone in those roomsSet water temp to 120’F Avoid secondhand smokeRear facing car seat until age 2Don’t leave heavy objects or hot liquids on tablecloths or coffee table Save poison control number in your phone 9mo Checkup: 18:40Expect them to tear up and try to eat the exam room paperThey try to eat my stethoscope and badge Full head-to-toe examPostpartum depression screeningNo vaccines this visit, other than flu and covidNext checkup is at 1 year of age (after first birthday); will do vaccines at that visit Reminder that after 1 year of age should have their first dentist visit and eye exam at ophthalmologist All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

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….ParentsDevelopmentSleepNutritionTeethEliminationSkin careSafety12mo checkupParents: 00:23Engage with child often by speaking with them, tell them the names of objectsBaby should be able to separate or move away from parent for moments, but will check back to look at themHave a “yes” spaceHave regular date nights with a babysitter watching babyMake time for yourselfHang 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: 09:21Stranger anxiety / apprehension goes awayMight have a preferred parentStarting 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 byeStarting to walk/cruise along furniture, stand alone for a few seconds Identified people upon requestWean pacifier and bottle - switch to a cup for drinks Sleep: 14:2810-12h 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, singingIn 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 2No bottles in bed; if you  need to wean bedtime bottle, can start progressively watering it down until it’s only waterNutrition: 16:293 meals and 2-3 snacks per day at the same time as the familyOffer a variety of foods and textures Encourage self feedingCan stop breastmilk or formula (use up what you have); ok to breastfeed as long as you wantUse a cup for water; offer water with all meals and snacksCow’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 weekYou determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze)Teeth: 20:03Brush 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 toothbrushSchedule first dentist checkup now or when first tooth is inElimination: 20:53Can start potty training by putting baby on potty after eating and upon wakingTypically voiding at least 6x per day, stooling 1-2x per dayIf 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: 22:56Bathe as often as they get dirty (2-3x per week)Can use lotion Use sunblock if spending more than 30 mins outside Insect repellant for babies (citronella based is best)Safety: 23:43Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of themKeep baby in arms or a high chair or playpen in the kitchen and bathroom; never allow baby to be alone in those roomsSet water temp to 120’F Avoid secondhand smokeRear facing car seat until age 2Don’t leave heavy objects or hot liquids on tablecloths or coffee table Save poison control number in your phone Remove guns from the home or keep them locked and unloaded in a safe12mo Checkup: 27:54Typically able to sit alone on the table; stay within arms reach so they don’t fall offFull head-to-toe examRoutine vaccines at this visit and the next two: a total of 5-7, plus flu/covid Next checkup at 15 mos Reminder that after 1 year of age should have their first dentist visit and eye exam at ophthalmologistAll of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram  Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Welcome to Season 2 of The Baby Manual with Dr. Carole Keim MD. This first episode of Season 2 is all about your baby at 15 months of age. From parenting to nutrition to skin care, Dr. Keim covers all the major developments of the 15 month age group. Dr. Keim discusses the developmental progress of your baby at 15 months and notes that they understand the word no, they have preferences, and they also feel upset if those preferences aren’t met. They quite like to help and mimic your actions. She addresses what children should eat and drink and how toddlers like trying things at this age, and explores how often to brush their teeth, when to see a dentist, making your home safe for their exploration, and what to expect at the 15 month check up. A lot of information is here to help you feel confident in navigating everything from tantrums to health. In this episode….ParentsDevelopmentBehaviorSleepNutritionTeethEliminationSkin careSafety15mo checkupParents: 00:31Engage with child often by speaking with them, tell them the names of objectsSupport toddler’s need for safety and reassuranceBoundaries are reassuring to themBaby should be able to separate or move away from parent for moments, but will check back to look at themLook for parent-toddler play groups - Parallel play 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; might still be napping  Development: 05:14Stranger anxiety comes backMight have a preferred parentPoints out objects and brings objects to show parents Hands parents a book or toy to play withFollows simple directions (put this away / hand me a toy) Imitate parent behavior (talking on the phone, taking pictures, feeding dolls, etc)Look around when asked questions like “where is your ball?”Stoop and recoverCrawl up stairsStart to runVocabulary starts to explode; should know at least 3 words and jabber with inflection  Scribble with a crayon or marker (and not just eat it)Feed themselves well with hands, drink from a cup without spillingBehavior: 08:28Terrible two’s start now - they learn how to use “no”Offer 2 suitable choices as often as possible throughout the day.  Let them choose how things get done.They have a hard time expressing preferences; pretty good with needs Modify their environment to avoid conflict Hitting and biting are attempts to communicate - teach them how to communicate effectively Sleep: 10:4110-14h at night, 0-1 nap per day.  Bedtime routine established: brush teeth together, quiet time, reading, singingIn crib in their 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)Night waking is normal; reassure briefly, offer stuffed animal or blanket so they can self-consoleLifehack while potty training: layer sheets and chucks Blankets ok; no pillows til age 2No food or drinks in bedNo electronic devices in the bedroom (TV, tablet)Nutrition: 13:253 meals and 2-3 snacks per day at the same time as the familyOffer a variety of foods and textures Encourage self feedingUse a cup for water; offer water with all meals and snacksShould be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per weekYou determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze).  They are typically not picky and want to try new foods at this age.Teeth: 16:48Brush teeth BID with small smear of fluoride toothpaste; if there is no fluoride in water source can use a grain-of-rice sized amount of fluoride toothpaste They should see a dentist 1-2x per yearElimination: 17:31Typically voiding at least 6x per day, stooling 1-2x per dayIf 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.Can start potty training by putting toddler on potty after eating and upon wakingIf toddler is resistant to potty training, can start with sitting while clothed and entertain them with a book or toy, then sitting with pants and diaper offCan keep the potty in your bathroom and try going at the same time - they love to mimic adults at this ageSkin care: 20:09Bathe as often as they get dirty (daily)Can use lotion Use sunblock if spending more than 30 mins outside Insect repellant that is safe for babies (citronella based is best)Safety: 20:52Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of themKeep baby in arms or a high chair in the kitchen, keep the bathroom door shut and bring them in with you; never allow baby to be alone in those roomsSet water temp to 120’F Avoid secondhand smokeRear facing car seat until age 2Don’t leave heavy objects or hot liquids on tablecloths or coffee table Save poison control number in your phone Remove guns from the home or keep them locked and unloaded in a safeMake a fire escape plan with the family, check smoke detectors often 15mo Checkup: 24:32Typically able to sit alone on the table; stay within arms reach so they don’t fall offFull head-to-toe examRoutine vaccines at this visit and the next oneNext checkup at 18 mos Reminder that after 1 year of age should have their first eye exam at ophthalmologistAll of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.  Resources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this second episode of Season 2, Dr. Carole Keim discusses what to expect at the 18 month stage. Your baby is a toddler now, and showing ever more personality, and Dr. Keim has advice on everything from tantrums to sleep.Dr. Keim addresses what social and motor development looks like at this age. Your baby will want to play with you and they understand a lot more language than their few words would have you believe. She talks about the “terrible twos” and shares ways to avoid tantrums. She addresses sleep and what bed your baby should sleep in at 18 months. How should teeth brushing go? How do you navigate potty training? What are major safety concerns to address? Dr. Keim has insight on all these questions and more in this episode.In this episode….Social development and languageMotor developmentBehaviorDigital mediaSleepNutritionTeethEliminationSafetySkin care, bathing, sun protection18mo CheckupSocial development: 00:40Engaging with others for playHelp with dressing and undressingPoints at pictures in booksShows things to parents by pointing or bringing objectsLooks at parent if something new happensCan scoop with spoonStarts using words to ask for helpCan identify 2 body partsCan name 5 objects Stranger anxiety starts getting better, but separation anxiety starts getting worseFollow simple instructions and love to help outParents: encourage use of language by naming what you see, talk and sing to child, use words to describe feelings and emotionsMotor development: 04:30Can run, kick a ballWalks up stairs by doing step-together and while holding a handCan sit in a small chairWalks around with toysScribbleThrow a ball Behavior: 06:10Terrible two’s start now - they know how to use “no”Offer 2 suitable choices as often as possible throughout the day.  Let them choose how things get done.They have a hard time expressing preferences; pretty good with needs Modify their environment to avoid conflict; plan ahead for new and difficult situationsHitting and biting are attempts to communicate - teach them how to communicate effectively Anticipate anxiety/clinging in new situationsSpend at least 10-15 minutes in child-led playPrepare child for new sibling by reading books, getting them a dollDigital media: 14:14Promote reading, physical activity, and play with non-electronic toysMake time for play every dayNo screens for at least 2 hours before bedtime; instead plan on tech-free play, bath, readingUse methods other than screens to calm them down: distraction, removing trigger, going outside, addressing needs like hunger/sleepIf you do use digital media, choose high quality programs/apps and use them together: PBS kids, Daniel TigerLimit viewing to less than 1 hour per dayBe mindful of your own screen use; make a plan for family media useAvoid having TV on in the background, especially during meals Sleep: 17:5510-14h at night, 0-1 nap per day.  In crib in their 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)Night waking is normal; reassure briefly, offer stuffed animal or blanket so they can self-consoleLifehack while potty training: layer sheets and chucks Blankets ok; no pillows til age 2No food or drinks in bedNo electronic devices in the bedroom (TV, tablet)Nutrition: 20:573 meals and 2-3 snacks per day at the same time as the familyOffer a variety of foods and textures Encourage self feeding and use of utensils Use a cup for water; offer water with all meals and snacksShould be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per weekYou determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze).  They are typically not picky and want to try new foods at this age.Less than 24oz of milk per day, less than 4oz juice (ideally NO juice)Teeth: 25:10Brush teeth BID with small smear of fluoride toothpasteThey should see a dentist 1-2x per yearElimination: 26:09Typical age to start potty training - start noticing them hiding to poop or anticipate when they will go, they know and tell you when they’ve peed/pooped, they can pull pants up/downTypically voiding at least 6x per day, stooling 1-2x per dayIf 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.Can start potty training by putting toddler on potty after eating and upon wakingIf toddler is resistant to potty training, can start with sitting while clothed and entertain them with a book or toy, then sitting with pants and diaper offRead books about using the pottyCan keep the potty in your bathroom and try going at the same time - they love to mimic adults at this ageStart boys sitting on the toilet; they can stand later.  Standing too early can lead to constipation.  Potty signal: songsSafety: 33:13Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools, small and sharp objects out of reachDon’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of themSet water temp to 120’F Avoid secondhand smokeRear facing car seat until age 2, make sure everyone in the car is using a seat beltDon’t leave heavy objects or hot liquids on tablecloths or coffee table Save poison control number in your phone Remove guns from the home or keep them locked and unloaded in a safeMake a fire escape plan with the family, check smoke detectors often Skin care: 37:38Bathe as often as they get dirty (daily)Can use lotion; many have started outgrowing eczema by nowUse sunblock if spending more than 30 mins outside, apply 30 mins before you go outside, and use SPF 30 or higher.  Also use a hat, sun protection clothing (long sleeve swim shirts)Insect repellant that is safe for babies 18mo Checkup: 39:05Expect them to be clingy and sad if you leave them on the tableFull head-to-toe examRoutine vaccines at this visit; should be all caught up now until age 4!Next checkups at age 2, 2.5, and 3 yearsResources discussed in this episode:The Baby Manual - Available on Amazon--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode, Dr. Carole Keim talks all about potty training. While potty training usually involves toddlers - the common age is between two and four years - it can be started as early as infanthood with what’s called elimination communication. Dr. Keim walks parents through all the major questions and issues about potty training. Dr. Keim first explains how to identify when your toddler is ready to start training. She then talks about how to potty train and explains various methods of working with a reluctant toddler or what she calls “secret poopers”. In addition she addresses various things that could go wrong, such as constipation or diarrhea, and how to take care of your toddler if one of these issues should arise. Dr. Keim imparts sound and thorough advice to prepare parents for the journey of getting toddlers to use the toilet.In this episode….Elimination communicationSigns your toddler is readySecret poopers Resistant childrenConstipationDiarrheaUTIsElimination communication 00:42Can start at any agePre-verbal childrenYou indicate when it’s time to potty and make noises while holding them over a potty, adult toilet, or sinkTimes to take them : after they eat, when they wake upToddler potty training 01:45Dry for 2+ hours at a timeThey indicate when they’ve gone or you can tell when they’re goingStart anticipating these times (after meals, upon waking) and/or use a scheduleSit them on the potty / toilet seat with adapter They don’t have to be fully independent with moving/removing clothing, pulling up pants, getting on and off the toilet, and washing hands.  Use scaffolding.It can take a while for them to get the hang of itDon’t punish them for accidentsDon’t use treats unless you need to Daniel Tiger episode Children who don’t mind sitting in a dirty diaper 04:51aka “secret poopers” Can try the “oh crap” bookAllow them to run around without diaper or pants on, especially outsideTry nature pees/poopsCan try the potty training in a weekend methodHave a potty in each room so it’s easyChildren who fight using the potty 05:56Try nature pees/poopsHave a potty in each room to get them used to itLet them sit on the potty fully clothed and play while siting thereHave fun potty time - read a special book together, play with a toy on the pottyIf using potty treats: sticker charts are often too delayed of a reward except in children 4 and up.  I suggest a treat for trying, and a treat if anything comes out.  Food treats tend to motivate children more but are also associated with more performance anxiety.  It is ok to praise attempts to use the potty and success in using it, but excessive praise can also cause performance anxietyBecoming angry at child for refusing to use the potty can backfire on parents, as this is one of the only things a child can controlConstipation 09:17Decrease in frequency or size of bowel movements, harder stools, pain with stoolingCan be acute or chronicHow chronic constipation happensAvoiding it: choose high fiber and low processed foods - fresh fruit and veggies for more than 50% of each meal / 10 fistfuls per day.  Avoid dairy products.  Make sure child is drinking 1/2oz per pound of weight in water each day (so a 25 lb child should drink at least 12.5oz of water).  Try to establish positive associations with sitting on the toilet.Treating it when it’s acute: can try prune juice as a laxative, a glycerin suppository if stool is very hard, or an enema for a one-time cleanout.Chronic constipation: first disimpaction - enema of hypertonic saline or a suppository x1, followed by a stimulant laxative x 2-3 days, and a stool softener for several weeks.  At the same time, increase fiber and water, decrease processed foods, and eliminate dairy.  Encourage frequent and prolonged sitting on the toilet.How stimulant laxatives work and why they are addictive and shouldn’t be used more than a few daysHow miralax and psyllium work as stool softeners and why they can be used long termDiarrhea 16:32Teething - symptoms, why it happensViral - tend to have no or low-grade fever, no blood, can be foul smelling and green Bacteria - can have fever, can have blood, can have it for over a week, can be profuse or just a few times per day.  Requires test to determine type of bacteria to guide treatment; sometimes antibiotics help, sometimes they make it worse.After antibioticsFrom juiceFrom foodWhen to be concernedTreatment - more water, BRAT diet x 1 day, bland foods, avoid dairy, probiotics, avoid dehydration Why we can’t use diarrhea medicines in childrenAvoiding spread to family membersRotavirus vaccineUTIs 19:48Symptoms: pain with urination, urinary frequency, urgency, accidents in a potty trained child, sometimes bad smell of urine. Fever is a late sign.Caused by constipation, staying in wet clothing/swimsuit too long, poor hygiene (not bathing enough, staying in dirty diaper too long), tight clothing/sweat, bubble baths Treatment: antibiotics.  Prevention in those who get more than 1 UTI: increase water intake, more frequent voiding, avoid risk factors, decrease sugar intake.  Also they should get an ultrasound of the kidneys to determine risk for pyelo.These are the major things to do with potty training. For additional tips and advice on babies and toddlers, follow Dr. Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.   Resources discussed in this episode:The Baby Manual - Available on AmazonDaniel Tiger’s Stop & Go Potty--Dr. Carole Keim MD: linktree | tiktok | instagram Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.