If you were to describe new motherhood in a word what would you say? Joy? Magic? Precious? Love? I’m sure all those words would pop up. But there’s also words like worry, loneliness, fear, anxious, isolation, disappointment, guilt, competition, frustration - and even anger. These are the words we don’t expect. They come out of nowhere and hit us fast, leaving us shocked and confused. No one expects to feel angry at their baby. Or disappointed...
Which is where renowned American paediatrician Dr. Harvey Karp comes in. He’s the baby whisperer who helps celebrities such as Madonna, Pierce Brosnan, Kate Hudson and Chrissy Teigen as well as the ordinary, extraordinary parents out there who are just trying to get through those hazy early months after a newborn arrives. He’s famous for his 5 S’s for babies (keep reading – they’re a highly successful method for soothing babies) as well as his book The Happiest Baby On The Block (or Baby Bliss as it’s known in Australia and the UK). But his most recent innovation is the SNOO – the world’s first smart sleeper. It’s the safest and smartest baby bed out there – or as Karp calls it, “helper”. And it’s designed to do just that – help new parents and their babies to get more sleep (most SNOO babies sleep 9 hours or more by 2-3 months). No wonder celebrity friends such as Justin Timberlake and Scarlett Johansson are investors in the SNOO (yes, even celebrities need help getting their kids to sleep, so why not back the product that does it for them?).
Here, we share an extract from our podcast with Dr Karp (listen to it here – it’s essential listening for all new parents). We ask him every single question we wanted to know about new babies. And leave feeling comforted that we’re not alone. Whatever you’re going through, you can bet so are millions of other parents around the world.
In those early days when we come home from the hospital, it's really a complete blur. I want to know what advice you have for new parents?
It’s such an amazing experience in life to have your first child. It is one of those things that’s a blur and yet at the same time, those memories will be in your mind and heart forever. It’s kind of funny how you might not remember what you ate for lunch yesterday, but little things that happen when your baby is first born is something that will just stay within your memories. I guess there are several things to think about when you’re bringing a baby home. Firstly, try to organise your support system and learn as much as you can.
Today if you have a night nurse or a nanny, you’re quite well off, but a hundred years ago and for the entire history of humanity, everyone had multiple helpers. You had your grandmother, your aunt, your older sister, your next-door neighbour – an entourage that was going to help support you. The idea that you’re going to be the one taking care of your baby and meeting every single need your baby has, is really kind of an artificial expectation. If you can line up people who can help you (even if it’s just picking up things in the house, or bringing over some food, or in some way helping to support you when the baby does come), that’s one thing that helps to prepare you.
Another thing is, of course, to learn as much as you can. And that might be going to a childbirth education class, or a class from the National Childhood Trust, or reading books, or blogs, or podcasts. There’s so much information that’s available to parents now. And it’s worth doing a little bit of work, especially if you don’t have a lot of baby experience.
Babies have an innate ability – a reflex – to be calmed. You've spoken about how this reflex disappears after four months. Can you tell me about this?
This is a really interesting area. I wrote a book and made a video called ‘The Happiest Baby on the Block’. In the UK and Australia, it’s called Baby Bliss. It’s based upon a couple of concepts. One is that in an odd sort of a way, our babies are born three or four months before they’re really ready for the world. What I mean by that is, of course, they have to be born and you’re ready probably after seven months of pregnancy, but the baby’s needs after birth are really to continue the experience that they had in the womb, holding, rocking, shushing, frequent feeding, carrying your baby, having that very close contact.
Those are the things that babies love and that nurture your baby as much as the calories that you feed your baby. By the time they get to be four months or five months of age, they can do the most important thing that a human being ever has to do, which is to have reciprocal relations with another person. Meaning that when you say, “Good morning baby.” Your baby smiles at you and there’s a little back and forth. It turns out that that silly little game is one of the most important human skills that you ever develop, which is to engage and interact with others. But for the first four months, you’re really what many people refer to as in the ‘fourth trimester’. The baby is really still a fetus, but outside of the uterus, not inside of you anymore.
Since babies are fetuses in a certain sense when they’re born, they don’t have learning abilities the way they will after five, six, seven, eight months. And in its infinite wisdom, nature has provided babies with things that we call reflexes, which are like built-in software into the baby’s brain, that gives them automatic abilities to help them survive, to suck, to swallow, to blink, to cry. Those are not things you have to teach a baby. They’re born with those abilities built-in and even a premature baby has those abilities built-in. What wasn’t known and really what my work is about, is the idea that babies also have what’s called a calming reflex, which is kind of an off switch for crying and an on switch for sleep.
What’s really curious about this in my point of view as a pediatrician, is that any book you read will say that newborn babies have to wake up every two, three hours to feed. They’re very immature, they cry and some babies have colic and we don’t know what causes that mysterious problem. But it can last for many months and then it just goes away. The main thing we tell parents is that in those first four, or five, six months, you just have to kind of suck it up and deal with it. And it’s challenging, but that’s the way it goes and that makes sense. Yet at the very same time we tell parents, “If your baby is very fussy or is not sleeping well, one way you can help them is to put them in the car seat in the back of the car and drive around for a few hours. And your baby will sleep and calm down in the back of the car.” And many parents have done that out of their desperation. They’ve seen how well it works. Even adults will fall asleep in the back of the car, or in a train, or a plane when we have those rhythms and those sounds of the rocking, and the little bit of jiggling that occurs in those environments.
When you have your baby, it’s wonderful to learn how to activate this reflex. By four months, or five months or so, the reflux disappears because by then the baby is ready to be born and has many other ways of helping themselves to sleep better and to be calmer.
This is something that you refer to as the missing fourth trimester?
Right. That’s the concept that I like people to think about. Because what people used to think about is, “Oh, my baby is born and I need to teach them to not be a cry baby, not to think that they can manipulate others by crying.” Parents kind of had this tough love attitude of letting their babies cry it out. Of course, when your child gets to be one-year-old, or two years old and you’re an experienced mother, you really have to set boundaries. But in those first six months, the goal of a parent is not to teach the child to be independent and that crying won’t get your way.
The goal of what you’re trying to teach the baby is that they should feel secure, and loved, and trusting in this environment. In fact, you want to respond to your baby’s crying relatively quickly so that the baby learns over hundreds and hundreds of experiences that this is just a good place. People here care about me and they’re here for me. And that becomes the foundation of your sense of intimacy, and trust, and confidence that you’ll carry for the rest of your life.
Going back to infant colic, because obviously, it's such a grey area for so many parents. Throughout your career, what have you learned about infant colic?
The word colic comes from the ancient Greek word meaning intestinal. In fact, we use the same root of that word in the word colon or large intestine. For thousands of years when babies cry, and they get red in the face, and they squirm, and sometimes they pass gas or poop, people have assumed that it’s intestinal pain. And we’ve tried medicines. I mean, in the UK for centuries, we used opium tincture or what’s called paregoric as a treatment for crying babies. Because that was meant to settle their stomach. So literally up until 40 years ago, you could have a prescription for opium at any apothecary, and you would use that to treat your baby’s crying.
Of course, nowadays you’d be put in jail for something like that. But the huge misunderstanding about colic is that it really is not intestinal. This is not to say that babies don’t have gas, and they poop, and they grunt, and they do all those things. Of course, they do, but that is not going to make a baby cry for an hour, or two, or three which is the definition of colic. What the problem is, is this imbalance of stimulation to a baby. If you overstimulate a baby and you’re talking in their face, and you’re not giving them a moment of peace, by the end of the day they’re overwhelmed by that. And that leads to crying that can go on for an hour or two.
In fact, we call it the witching hour at four, or five, or six o’clock in the evening. This is when babies have been awake most of the day, and by the end of the day, they just can’t take it anymore. They’re overwhelmed. What is really more of a problem than overstimulation is under-stimulation. Meaning that in the womb, babies are constantly held, constantly rocked. Every time you breathe you’re rocking your diaphragm against your uterus. The sound in the wound is louder than a vacuum cleaner 24/7. So to put a baby in a quiet room and a still bed is actually like locking you in a dark closet. It’s sensory depriving. And by the end of the day, babies are overwhelmed by overstimulation, underwhelmed by a lack of stimulation.
Ultimately that kind of makes some babies go over the edge. And so if you give your babies rhythmic calming stimulation, hold them skin to skin, carry them in a carrier, take a walk for a couple of miles, let them hear white noise, use something like SNOO, which is this automated rocking bed that can help fill babies with a lot of this rhythmic stimulation. You counterbalance the overstimulation, and you allow them to be able to deal with this crazy new world that you brought them into.
I want to go back to something that you talk about in your books, which is the five S's. Many of our readers will know what the five S's are. But for those who don't, can you take me through what they are?
If you accept the concept of the fourth trimester, and you accept the concept that babies have this calming reflex, the question is how do you on the reflex? It turns out you do it by imitating their experience in the womb. Or parts of the sensory experience that they had. And it turns out that there are five easy steps that parents have used for thousands of years, and grandparents have used in every culture around the world to settle their babies. And these are what I call the five S’s. It’s just an easy way to remember these five steps. The first is swaddling, and that’s with the arms down, and very snug around the arms. Loose around the hips but very snug around the arms. And that’s the way that parents have swaddled babies for thousands of years in cultures all around the world.
The second is the side or stomach position. The back is the safest position rather for a baby’s sleep. But it’s the worst position for calming a crying baby or a fussy baby. On the back, babies feel like they’re falling, it makes them feel more insecure. So on the stomach for calming crying, and then on the back for sleep. The third S is shushing or white noise. And shushing is also done in cultures all around the world. The fourth S is swinging or rhythmic motion. And the fifth S is sucking which is kind of like the icing on the cake. It helps calm babies get even more profoundly calm.
99% of babies do better with swaddling with their arms down. Even babies who fight it and seem not to like it, do better with the swaddling but they often fight it. That’s just the first step. Then you have to layer on the other S’s to calm the swaddled baby. The swaddling keeps the baby calmer longer and some babies love swaddling and white noise. For other babies, the white noise doesn’t really help very much. But the rhythmic motion is very powerful. For other babies, it’s the side stomach position that’s most helpful. And other babies it’s sucking. And then some babies need combinations of those S’s to really be the magic formula that is going to work in a minute to get your fussy baby soothed. And you don’t really know what your baby’s going to prefer, so you have to learn how to master these S’s.
I have a friend who is considering having a third baby. She said to me the other day: "I'm not going to have a third baby unless I can buy a SNOO." So for our readers who haven’t yet discovered the SNOO, can you tell me about it?
Ultimately when you have a baby, there are three jobs you have to be good at. Feed your baby, calm the crying, and get sleep. Everything else kind of works its way along. You’ll learn how to take care of the baby’s belly button, and how to bathe your baby, and how to change a diaper. Those aren’t the things that really kind of break us when we’re failing at our job as caregivers. What can break us is when you’re not feeding your baby successfully. If your baby is crying and crying and you don’t know how to calm your baby. And if your baby is only giving you short periods of sleep. And you’re ultimately so sleep deprived that you’re developing postpartum depression, and anger, and irritation, and those things.
There’s very little that teaches parents about how to calm crying and get sleep. In fact, most people tell you there’s nothing you can do, so just abandon them in one room, close the door, and put cotton in your ears, and gin and your stomach to try to deal with it. As we started teaching the five S’s, what became apparent is that, well, that’s great, that can help you all day long but what do you do all night long? Because as I was alluding to before, we do a very strange thing to babies when we put them to sleep. We put them in a sensory-deprived environment. You probably have your bed that you like, the sheets that you like, the pillow that you like, the duvet that you like. And that’s the way you sleep every night, you have customary cues that help you to fall asleep more easily.
You could sleep on a cement floor if I took everything away from you, but you wouldn’t sleep very well. Babies have cues from nine months in the womb where they have constant sound, constant holding, constant motion, and they’re cuddled up in this little ball. When they’re born, we do this crazy thing, we take everything that the baby is used to away from the baby. We put them on the back, in a still bed, in a quiet room unswaddled. And then we scratch our heads and go, “Why isn’t our baby sleeping better?” Well, it’s because you’ve taken everything away. Ultimately what babies need is to feel envelop, they need to hear these rumbly sounds that they’re used to, and they need to have rhythms. And that is what everybody has known since the beginning of time. Because when you hold and rock your baby and shush them in your arms, they fall asleep so beautifully and so gently.
I worked with leading engineers in the United States and leading designers to create this caregiving bed called SNOO. It’s a smart bed because it rocks and shushes the babies all night long, the way you would if you were sitting in a rocking chair with the baby, or driving them all night in the car. And then the bed also senses when the baby is upset and it rocks and shushes more briskly. It has four different levels of increasing rocking and shushing to imitate when an experienced nurse or caregiver would do if they were holding the baby.
We call it a bed, but it’s really not a bed. It’s a helper that comes into the house and when you have to take a shower, or fix a meal, or play with your five-year-old, or get some sleep, or get on a Zoom call because you have to work. The bed is there as an extra pair of hands. And we introduced this bed in the United States four years ago, we’ve now measured about 150 million hours of infant sleep. And what we’ve demonstrated on well over 10,000 babies… I mean, we’ve had over a hundred thousand babies use the bed. But we did a study of 10,000 babies and we demonstrated that the bed pretty quickly adds one to two hours to the baby’s sleep.
It can calm crying 50% of the time in under a minute. And if it doesn’t calm the crying in under a minute, it means the baby is hungry or needs something from you. So it’s not a magic bed that is just always going to calm the baby, but it’s a helper. And then it also secures the baby on the back so that the baby can’t roll to an unsafe position. And we actually were just recognised by the American FDA as a breakthrough device, meaning that we have the potential to be life-saving. And we hope and we believe that we’ll be able to prevent 90% or more incidents of cot death. We’re doing studies to demonstrate our ability to prevent postnatal depression, reduce obesity, improve breastfeeding outcomes, reduce stress on the parents, reduce even car accidents.
I want to talk about professionals who warn that children could become addicted to soothers. We’re told to not rock your baby - let them cry it out. And there's a lot of contradictory advice. What are your thoughts on things like rocking children? Or babies becoming addicted to soothers?
I’m so glad you asked. That’s the number one question we get about SNOO. Parents are worried that they’re going to set bad habits of some sort. And interestingly it’s so funny. Babies have been with us for thousands of years. You would think we would just know everything now. Yet there are so many of these controversies about how to take care of a baby, how to feed a baby. All these things that you would think would be just resolved. Anyway, when it comes to addicting your baby to these crutches or comforts, there’s some truth to that. In other words, babies are learning once they’re born, and you’re teaching your baby what to expect in the sleep experience.
So if you always rock your baby to sleep, and then you gently kind of lower them into the bassinet, or the Moses basket. When they wake up in the middle of the night, which they’re going to do, they suddenly look around and go, “Wait a second, everything’s missing. Where did you go? You with the long hair, come back here.” And they will need that rocking and shushing again. And remember, that’s what they had 24/7 in the womb, so that’s what they’re expecting anyway. With SNOO it’s different, however. And the reason it’s different is because when you rock your baby to sleep, and you put them in SNOO and you turn it on, the baby is being rocked and shushed.
When they wake up in the middle of the night, their eyes open up, they’re being rocked and shushed. They look around a little bit and they’re very likely to fall right back to sleep. Kind of the way you would if you were in a long airplane flight and you fall asleep, and when you wake up, you look around a little bit, your eyes roll around in your head and then you fall back asleep. If the baby doesn’t fall back asleep, it usually means they’re hungry and they need to be fed anyway. The interesting thing is by the time the baby gets to be five months or so, their brains are much more mature and developed. They’re able to stay in a sustained sleep state without the need of rocking. By that point in time, they don’t need it anymore.
You can wean their arms out of the swaddle. You can wean them off of the rocking. I still recommend the white noise. And I’d still continue to SNOO because I want to keep babies on the back for that full six months, so I can reduce their risk of cot death. And then after six months or so, there’s a weaning setting in our app that gives them sound but no motion. But the motion comes back if the baby fusses, so they get that little extra rocking if they need it. But usually, after five, or six, or seven days on that weaning setting, the baby’s sleeping perfectly and you just move them to a crib. And that’s the end of their need for the SNOO.
Something that parents debate about is crying it out. What are your thoughts on letting a baby cry it out?
Of course, it’s against every instinct you have as a parent, to just allow your baby to scream and not go to them. It’s as tough on the parents as it is on the babies. However, it can work if it’s done correctly. If it’s not done correctly, it actually makes things worse. So you do want to make sure that you’re using the right technique. But the times that I would recommend that as a pediatrician, is when parents are falling apart. If a mother is anxious and depressed and the parents are at each other’s throats. And they’re getting in car accidents and things like that, they have to do something to take control of the situation.
Doing a cry-it-out routine is one way of accomplishing that. SNOO is another way of accomplishing that, using white noise sometimes is a quick fix. And you’d be surprised at how well it can work, just by giving babies the right types of sounds to help them fall back asleep when they wake up in the middle of the night. Cry it out is kind of the ultimate technique that you might use if the baby just isn’t responding to all these other things. And I would say I would definitely use that if I felt that was necessary to keep parents from killing each other and getting depressed.
What are your thoughts co-sleeping with your baby?
Co-Sleeping was not very common 20 years ago. And over the last 20 years, it’s become more and more common. And people say, “Well, it’s to help breastfeeding and all this sort of stuff.”
Now about 70% of cot death occurs with the baby in bed with the parent, which is the worst nightmare you could possibly imagine. You will never recover from that as a parent. If you have the baby in bed with you and the baby rolls into a pillow, or you accidentally put your arm over the baby’s face. Or anything that can happen when you’re sleeping. Because ultimately when you’re exhausted, it is the equivalent of being drunk. That’s why drivers get into car accidents when they’re very sleep deprived.
Instead of having the bed with you, have the baby right next to your bed. That way you can meet your baby’s needs, you can breastfeed as much as you want. But you’re not taking that risk with this most important treasure in your life. I strongly recommend to parents not to bed share for their first nine or 10 months. After that, if you want to have that baby in bed with you, fine, that’s great, do it. Families in many cultures have the baby in bed with them for years. I don’t have a problem with that if that’s what the parents want to do. For the first nine months, it’s just not safe and you’re taking a terrible risk. That’s my position on that.
You have also written a book called The Happiest Toddler on The Block – can you share what it’s about…
I teach a very different technique starting at eight months of age. Earlier than you think you should be using or thinking about your child as a toddler. But one of the great burdens on children today, and on parents is to teach their children values. And to help them with emotional resilience, and emotional strength, and learn to be patient, and cooperative, and communicative, and to learn to have delayed gratification.
All of those things are what we call executive function. They’re part of the brain that helps you to do well as you go through life. Those are things that we can help babies or toddlers learn. And much of that is counter-intuitive to parents. Unless you’re a preschool teacher or you’ve really had a lot of experience taking care of babies, a lot of these techniques are actually the opposite of what you think you should do. It turns out that there are very simple techniques, 10 or 15 of them in this book that allow you to be really the best, almost like a pied Piper of toddlers. That you can help them to feel smart, and strong, and brilliant. And to recognise that they’re loved and appreciated. And yet still set the limits that you need to be able to set as a parent of a toddler.
I thought babies were hard and then I had two toddlers…
It’s so true, but there are tricks. There are hacks that within a day or two will make you much more successful with a one, and two, and three, and four-year-old. Here’s one that I think is interesting. I call it gossiping. When we want to praise our children, we say good job. It turns out that our brains are built to believe more that we overhear than what is told directly to us. So if I’m with you and I say, “Hey, Georgie, you look great today.” You’re saying, “Oh, well, thank you very much.” But you feel that I’m just being polite or whatever. However, if you hear me whispering in the hallway to someone else, “Hey, Georgie looks great today.” For some reason, we believe that more. There’s no ulterior motive involved. The same thing is true for little children. You can reinforce your positive message, or for that matter, your negative message by using a gossiping technique. And the gossiping is literally five times more powerful at shaping a baby’s behavior, than telling a message directly to a child.