This chapter lets you in on a trade secret that pediatricians wish weren’t such a secret: The official “Newborn Checklist.” It’s what pediatricians in the newborn nursery use to make sure you and your baby are ready to safely leave the hospital.

Dr. Phoebe Danziger, pediatrician mother and brilliant researcher into the newborn checklist, has expertly debunked vitamin K misinformation in this fantastic New York Times article. She’s my personal go-to source for pediatrician-mom insights as well, so make sure to check out all her amazing work.

This article provides an excellent overview of the evidence behind vitamin K injections for those looking for a deeper dive into the science.

This is the seminal study (from 1944!) by Swedish researcher Jorgen Lehmann and his colleagues that has inspired decades of life-saving research and intervention in preventing the horror that is neonatal vitamin K deficiency.

This paper from 2011 gives an excellent, detailed, and scientific overview of vitamin K research and the very scary things we see when vitamin K shots are missed.

Once bleeding has started due to vitamin K deficiency, giving vitamin K can’t reverse it, and the damage is devastating. A study from Vanderbilt University in 2014 found that 40% of late vitamin K deficiency bleeding survivors showed signs of serious brain dysfunction and disability.

These pediatricians at Vanderbilt University rekindled their love of vitamin K research in 2014 for a reason. In 2013, the hospital was thrust into the spotlight when six infants were diagnosed with late Vitamin K Deficiency Bleeding. The results were tragic and predictable: Four of these babies had brain bleeding, two had bleeding in their intestines, and while all survived, two needed emergency brain surgery, at least one has severe brain damage (severe cognitive delays and complete right-sided paralysis), and two have moderate brain injuries.

It’s not just Nashville. A national survey from the Better Outcomes through Research for Newborns (BORN, a network of clinicians in 34 states who treat 330,000 newborns) found that 52% of doctors and nurses now deal with vitamin K refusal.

One popular but unfounded worry is that vitamin k shots are linked to leukemia. This false claim has been thoroughly debunked—here is a study that provides a great overview.

This article provides an excellent overview of the evidence behind newborn erythromycin eye ointment for those looking for a deeper dive into the science.

The history of newborn eye ointment to prevent blindness starts at least as early as the 1800s, when doctors began to notice a common and serious problem. At the time, 1 in 10 babies born across Europe developed inflammation of their conjunctivae (the thin layer of tissue under your eyelids and over parts of the whites of your eyes) in the first few weeks of life. They called this “ophthalmia neonatorum,” and as more research was done, it turned out that 3% of these babies went on to become completely blind.

In 1879 there was a breakthrough. Dr. Albert Neisser in Germany figured out that mothers with gonorrhea had babies with ophthalmia neonatorum. It made sense, since doctors had suspected that it was related to bacteria passes from moms to babies through the birth canal. Just a year later, another German doctor, Carl Crede, decided to put silver nitrate (an antiseptic but very irritating solution) in all babies’ eyes when they were born, rather than waiting until they developed symptoms-- at which point it almost never helped. It was wildly successful, with his hospital showing a 30-fold reduction in ophthalmia neonatorum cases that year.

Any time there is a universal screening or prevention measure, public health experts have to look closely at the numbers and decide if the benefits are worth the resources, time, and yes, money. So when Australia and Great Britain decided to do away with their erythromycin-for-all newborn policy, I didn’t think twice about its safety or efficacy for my baby. I knew it was just a boring financial policy decision.

Comprehensive information and answers to all imaginable questions on the hepatitis B vaccine can be found here at the fantastic CHOP vaccine education center.

Hepatitis B is a devastating, deadly virus. Acute infection can be mild in babies and adults alike, but can also cause life-threatening liver failure. Even scarier, 9 out of 10 newborns who get hepatitis B develop a chronic infection, which leads to liver failure or liver cancer, both frequently fatal, later in life.

In 1982, when the hepatitis B vaccine was introduced in the United States, 300,000 people were infected with hepatitis each year-- including 20,000 children! By the year 2006, universal hepatitis B vaccine at birth decreased rates of vertical transmission by 98%.

The science of newborn jaundice is complex and evolving, but it’s nothing you need to worry about! Pediatricians like myself use the AAP guidelines to help with screening, diagnosis, and management.

The newborn screen is awesome and saves lives. While some diseases that we look for will be different depending on which state your baby is born in, most are the same. All of them are genetic conditions that, if found in the first days of life, can be treated in a way that either saves an infant’s life entirely, or has such a meaningful impact on their health that waiting even one day more to find it would have horrible consequences.

The critical congenital heart disease (CCHD) screen is one of the least invasive newborn tests (it’s literally placing a sticker on your baby’s fingers and toes) but saves thousands of lives each year. In the United States, about 7,200 babies are born with a type of heart condition that we describe as critical congenital heart disease.

The AAP recommends avoiding baby walkers and I agree. You can find the full statement here.

Some claim that baby wearing devices are bad for hip development, but the data is shaky. This is why pediatricians like myself agree that any possible risks pale in comparison to the real, enormous benefits of safe baby wearing.

Once a baby holder has earned its seal of approval from Consumer Reports or JMPA, it’s really just as safe as the premium models.

Vendors do, however, still sell certain types of products—in-bed sleepers, crib bumpers, and baby walkers, to name a few—that pediatricians disapprove of altogether.

Until the past few decades, it was standard practice that any infant under three months old with a temperature above 38 degrees Celsius or below 36.5 degrees Celsius needed a full “septic rule out.” But recently, research has confirmed what pediatricians already suspected—we worry about way more babies than we need to.

There is a large, national, ongoing study that is guiding which lab tests and risk factors can help pediatricians better identify which babies we actually should be worrying about.

Masks are a great tool for giving newborns safe snuggles. During the 2020 covid surges, pediatricians saw an enormous drop in infant infections, notably flu and RSV. These viruses are two of the biggest culprits in giving newborns those fevers and serious breathing problems that earn them a trip to the hospital, so watching these bad bugs take a break was a true pandemic silver lining.

Babies aren’t great at regulating their temperature—their big heads, low body fat content, large amount of exposed skin compared to their body size, and developing brains all make it hard for them. This is part of why we worry more about their exposure to the elements.

Here’s a quick overview of how baby poop changes colors and textures in the first months of life.

We tend to worry more than we need to about babies being constipated or having diarrhea, since diagnosing these stool patterns is about more than just frequency. As always, you’ll be able to call your pediatrician with any questions or concerns!

Here are the latest, official American Academy of Pediatrics safe sleep guidelines.

Placing babies on their back to prevent SIDS is based on many scientific findings. An important one is from 1985, when Davies et al demonstrated with hard data that in Hong Kong, where babies were routinely put to sleep on their backs, the rates of SIDS was much lower.

There are many biological mechanisms that are proposed to be responsible for babies being protected from SIDS when placed on their backs. This includes laboratory research showing that when babies sleep on their backs, their sleep brain waves act differently

The “back-to-sleep” campaign is one of the most successful public health movements in modern history. From 1992 to 2002, there was a dramatic decline in SIDS cases, usually estimated to be at least 50%.

Bed-sharing is extremely common. A CDC survey from 2009 to 2015 found that 61 percent of U.S. parents reported bed sharing.

Peter Blair of the University of Bristol has spent decades comparing the sleeping habits of infants who died of SIDS from their healthy counterparts. He found that having a parent who gets less than four hours of sleep in a row actually increases the chances of SIDS more than bed-sharing does.

In 2018, this NPR article summarized the latest data, including Dr. Blair’s research, which shows that bed sharing becomes much less dangerous if you remove larger risk factors such as having a parent who smokes or drinks alcohol or using a duvet or comforter in bed. Dr. Blair explains to NPR, "We recognize and acknowledge that bed-sharing happens. We don't promote it, but neither do we judge people about it. By doing that, you can open up a conversation with the parents about the really dangerous circumstances when you shouldn't do it." The results are impressive. In the United Kingdom, SIDS rates are down 40% since 2003.

Ed Mitchell of the University of Auckland is among the group of doctors in New Zealand who focus on helping parents understand their personal risk factors for SIDS. Similar to the UK, this country has seen a 30% decrease in SIDS deaths since 2010.

The reality is that there are currently no bed-sharing devices that have even been tested by the Consumer Product Safety Commission. Dock-a-tots, in-bed sleepers, and other crazy bed-sharing contraptions are untested and unproven. From 2012 to 2018, 12 cases of SIDS were tragically linked to “safer” bed-sharing devices.

I touch briefly on the complexities of breastfeeding history and how it’s impossible to have conversations on this topic without delving into the systemic racism involved. Here are a few articles that give an expert introduction, and I encourage everyone (myself included!) to keep learning and seeking out information.

Dr. Melissa Glassman is an expert Columbia University pediatrician, IBCLC lactation consultant, and personal hero of mine who introduced me to the entire world of breastfeeding medicine.

This chapter also relies on the wisdom of Dr. Cristina Fernandez, an incredible Columbia University pediatrician colleague who specializes in newborn medicine. She conducts research on pregnancy and early life stress, nutrition, and social determinants of health and their effects on child eating, growth and development.

I talk about some of the physiological benefits of breastfeeding for parents and infants in this chapter. This includes providing context into how the early introduction of cow’s milk and solids before the age of 4 months can mess with the infant microbiota.

I also discuss how the early introduction of solids is linked to obesity risks between 2 and 6 years old, but this is a very limited, correlational finding.

Breast milk does seem to help babies’ immune systems, with breastfed babies experiencing fewer serious illnesses, ear infections, and allergies in the first year of life. It makes sense, since there are so many immune-supporting, bioactive substances (more than just antibodies!) in breastmilk. There is also a lower risk of sudden infant death syndrome (SIDS), and breastfeeding seems to protect moms and babies from certain types of cancer.

This chapter reviews the history of infant formula and how the development of modern infant formula has affected breastfeeding. This article discusses Nicholas Appert and the preservation technique he invented in 1810. This article reviews the work of Justus von Liebigl, who patented the first infant formula specifically engineered to mimic human milk.

Infant formula marketing was so effective that it was common in the early 20th century for manufacturers to market directly to doctors—even partnering with the American Medical Association to earn their seals of approval. By the early 1970s, over 75% of babies were formula-fed, almost all with commercially made products.

Attention to the infant formula vs. breastfeeding debate was augmented by international tragedy. Manufacturers marketed commercial infant formula in nations where clean water wasn’t always guaranteed, leading to infants dying from formula made with contaminated water. These stories led to effective, pro-breastfeeding lobbying from religious groups whose pro-breastfeeding advocacy aligned with a vision of traditional domesticity.

I review in this chapter how this sparked the “breast is best” movement, and how the pendulum swung too far in the other direction. By the early 2000s, the medical community had put so much pressure to provide zero formula to their babies that some stopped giving it to babies who truly needed this additional food and fluid.

Infant massage and gentle craniosacral therapy may be reasonable to try in some cases. But high velocity chiropractic manipulation is always a big NO. These manipulations are unproven, dangerous, and messing around with a baby’s spinal cord can (of course!) even be fatal.

While the intention is to support parents who would like to practice extended breastfeeding, official American Academy of Pediatrics recommendations can feel like undue pressure, especially when they mention exclusively breastfeeding through 1 year, or even 2 years, as a goal.

Here’s a nice overview of atopic dermatitis (eczema) from the Society of Pediatric Dermatology.

The American Academy of Dermatology website is a helpful resource in how to choose products for children with atopic dermatitis.

Here is some background and practical tips on newborn bathing and diaper rashes from the AAP that echo the guidance in my chapter.

There are no fancy lab tests to diagnose colic; instead, modern pediatricians rely on symptoms—namely, patterns of crying. The organization The Period of Purple Crying coined the mnemonic PURPLE to explain that a baby with colic demonstrates three or more of the following signs: P (crying that peaks when they are around 2 months old); U (crying that is unexpected and can come and go without any apparent reason); R (crying that resists soothing; P (a look indicating that the baby is in pain when they cry); L (crying that can last a long time, up to 5 hours each day); and E (crying that usually happens most in the late afternoon and evening).

While the definitive cause of colic remains elusive—most evidence points towards differences in the “good” bacteria, hormones, and other changes in some babies’ intestines—there is plenty of data available that guide safe and effective solutions. We can start by crossing some definite “nos” off the list. These include drops that work to fight the cramp-inducing gut hormones we know are elevated in colicky babies. Drops with ingredients like hyoscine, scopolamine and dicyclomine definitely make these babies cry less—but don’t work any better than reducing light and noise in the home. They also have real side effects including constipation, sleepiness, and even serious breathing problems. Another “no” is baby acupuncture, which some researchers have found actually makes babies cry more.

Some studies point to probiotics as a possible treatment. In Italy, a group of researchers found that using certain lactobacillus probiotic supplements does seem to help babies with symptoms of colic. However, not all studies have found the same result.

The data behind dietary changes to help infant colic remains too limited to make a firm recommendation, as is nicely explained in this thorough metanalysis. But some studies have found evidence to suggest that removing cow’s milk may be helpful. The evidence for dietary changes is evolving and mixed: This study by found that moms who removed cow’s milk, nuts, wheat, soy and fish also saw less crying in their colicky infants.

Baby reflux/spit up is super common. By one month of age, half of babies routinely vomit after eating, and by 2 months this number increases to 80%. But it goes away. By 7 months, only 6% of babies have daily spit-ups, and by their first birthday the rate of routine vomiting is negligible.

The most effective GERD treatment is just giving smaller amounts of milk at a time and holding babies upright for longer than usual after they feed. Other remedies—like thickening feeds with rice cereal or commercially sold “thickeners,”— aren’t needed, and they can have side effects like gut infections, especially in premature babies.

If these methods don’t work, the next step is asking your pediatrician if having mom (if your baby is breastfeeding) eliminate cow’s milk from her diet (or use a special formula without cow’s milk if your baby takes any formula) makes sense. It’s not because getting rid of cow’s milk actually treats GERD, which is a very common misconception that’s prevalent among parents and novice pediatricians alike. It instead, intuitively, treats something called cow’s milk protein intolerance.

If a baby has blood in their poop, won’t grow, or has pain with eating that doesn’t go away with giving smaller, upright feeds, trying specialized formulas (and changing mom’s diet if your baby is breastfeeding) are absolutely the way to go.

There is more misinformation on vaccines than I could ever address. Good thing that the Children’s Hospital of Philadelphia Vaccine Education Center has done all the work for me! This is a truly incredible resource that is worth looking over, then reviewing, then re-reviewing whenever vaccine doubts creep in. They even have an app!

I do address some specific antivaccine lies in my chapter. I debunk the false link to autism, made famous by the measles-mumps-rubella (MMR) vaccine and the now thoroughly disgraced and debunked claims of Andrew Wakefield, one of medicine’s greatest frauds. Wakefield had multiple conflicts of interest, including financial gain from a competing vaccine maker, and created a fake report to make it look like the MMR vaccine du jour was linked to autism. To put things in perspective, Wakefield’s report was a series of case reports (not even a study or trial) stating that twelve children who received the MMR vaccine later were diagnosed with autism. Let’s compare that to a more recent analysis in 2014 that included data from over one million (yes, I mean million) children and found zero relationship.

The best theories to explain increasing rates of autism in recent years point towards factors such as parental age at conception (older people are having more kids these days), maternal nutrition (our diets have changed significantly in the past decades), infection during pregnancy (some of which vaccines can prevent!), and prematurity (we’re much better than we used to be at helping babies who are born early survive and thrive). In addition, there has been a dramatic increase in recognition of the disease, as well as huge changes in how we diagnose it.

Parents often hear that there are just “too many” vaccines these days. But this is a great thing! We have more vaccines these days because science is awesome and we’ve been able to invent amazing life-saving immunizations at a fairly rapid rate. What’s more, even though we now have vaccines for more diseases, we’ve been able to engineer them better, using fewer antigens, which is the part of the vaccine that mimics a virus or bacterium and triggers an immune response.

Spacing out vaccines doesn’t make sense. New studies show that giving all of the vaccines at once is actually less stressful for a child because it’s fewer separate instances of giving shots. And children who receive several vaccines at the same time don’t have any more side effects or complications compared to children who got only one shot at a time.

All vaccine-preventable diseases are worth preventing. Polio, tetanus, diphtheria—now essentially eliminated in our country due to uptake of their very effective vaccines—claim the lives of tens of thousands of infants each year around the world due to a lack of access to timely vaccination.

There’s a long-standing obsession with natural immunity, a fear of so-called toxins, and thinking that if something grows in nature it contains some sort of positive moral value. (Psychologists call this the “naturalistic fallacy.”) Anti-vaccine, pro “natural” sentiments are a great example of the naturalistic fallacy in action.

The CHOP vaccine education center has every single vaccine ingredient listed and explained, making those “just read the inserts” campaigns seem pretty silly. I also break down all the types of vaccine ingredients in this chapter in accessible, scientific detail.

All vaccine ingredients are safe, and sometimes we had to learn this the hard way. We know antigen inactivation works, for example, from an extremely and famously horrible historical incident when this process went wrong. In 1955, hundreds of thousands of the brand-new, life-saving polio vaccines managed to leave the factory after a defective inactivation process. About 40,000 children contracted polio from the vaccine, 200 were seriously ill, and 10 died. It’s an incredible tragedy that happened very, very early in our nation’s vaccine manufacturing process. It’s one of the many reasons the FDA is so strict about vaccine oversight, and there have been exactly zero cases of faulty inactivation since then.

The most famous preservative, thimerosal, became a topic of great controversy when Wakefield’s acolytes proposed it was the ingredient linked to autism. Extensive research has proved this to be false, but even so, in 1997 the FDA decided to remove thimerosal from all childhood vaccines in the United States with the exception of the multi-dose vial of the influenza vaccine in an attempt to end the vaccine “debate” once and for all. By caving to anti-vaccine lobbies, scientists believed they could close the conversation. Instead, the anti-vaccine propaganda machine used this decision as ammunition to claim a victory, stating that thimerosal had been dangerous all along.

There’s lots of evolving and emerging information about the covid vaccine. I wrote about my own enthusiasm for the covid vaccine for kids (while acknowledging just how predatory the antivaccine propaganda is) in this Washington Post piece. I also continue to share the most up to date scientific information and answer parents’ questions on Instagram.

The flu vaccine saves lives. I’ve never considered it to be “optional” and I always recommend getting it every year (which is what I do for my own family!).

Much of the modern anti-sleep-training advocacy comes from those who subscribe to something called “attachment parenting,” a movement that touts near-constant physical contact between a mother and infant as the optimal way to promote bonding. While the idea of restoring snuggle-time seems like a great idea, “attachment parenting” has deep flaws. Its origins remain problematic, with Dr. Sears (the main founder of the modern movement) basing his approach on less-than-scientific studies on the parenting habits of native cultures in Bali and Zambia. He used these anthropological observations to justify his approach, glorifying the “natural” parents he observed without actually caring to learn much about their cultures. His philosophy is also heavily founded in a particular Christian model of traditional female domesticity. Even modern variations on attachment parenting—remain steeped in religious identity and the promotion of a woman’s primary role as a homemaker.

Unfortunately, but unsurprisingly, attachment parenting advocates have found that equating sleep training with child abandonment is an excellent way to convert parents to their approach—and to monetize their “free advice” by selling countless products to help parents constantly cuddle their little ones. The “scientific” harms that attachment parents use to support this claim originated from this outrageously irrelevant study. It showed that infants in orphanages, where they were largely ignored, had minimal interaction and nurturing, and were allowed to cry for hours on end, later developed severe behavioral and emotional problems.

The Attachment Parenting International group has modernized a bit, and its website has now replaced the Romanian orphanage study with a study from 2011. This one, led by University of Texas Dr. Wendy Middlemiss, showed higher cortisol (a stress hormone) levels in babies whose parents did strict “cry-it-out” sleep training (which is a very specific, extreme technique).

The science we do have supports the assertion that sleep training is totally safe. Studies have found no differences in baby’s behavior, development, stress regulation, or bonding to parents.

One of the only randomized trials studying sleep training was done back in 1989, and demonstrated that gradual sleep training not only worked, but also helped marriages.

Child and behavioral psychologists have posited that sleep training could help build distress tolerance—a psychological term that simply means a person’s ability to manage stressors—which is now known to be a key part of why some people have fewer mental health issues than others. This is a theoretical benefit without any evidence.

One of the earliest scientists to advocate for sleep training was Dr. James Watson, whose teachings were exceedingly popular as early as the 1890s. Watson and others ascribed to a very strict (and incorrect) theory that every aspect of a child’s development is based on learned behaviors. To them, this meant that it was in fact necessary for infants to cry overnight, and that ignoring this crying was the only way a baby could ever learn how to sleep through the night. This is actually where the “cry it out” philosophy originated, with Dr. Emmett Holt’s 1894 (!) book outlining how tolerating unlimited crying (without any amount of comforting) was the only way to go.

After Watson et al burst into the sleep training scene, the next decades saw an explosion of parenting guides, books, and an entire new class of “parenting experts,” many of whom—most famously Dr. Spock—fought back against strict infant scheduling, including “cry-it-out.” The pendulum swung back and forth until 1985, when that definitive sleep-training authority, Dr. Richard Ferber, published his first edition of Solve Your Child’s Sleep Problems.

There are a few caveats when considering which sleep-training method is right for you. For example, while the pea-sized newborn stomach grows quickly the first few months, many babies remain truly hungry for an overnight feed until they are 4 months old. This means that some of the most popular systems—some of which even promise an uninterrupted 12 hours of sleep by a baby’s three-month birthday—face an uphill battle.

In 2005, the American Academy of Pediatric looked at nine of the decade’s best studies. They found that these studies, which compared babies who died of SIDS with healthy counterparts, all showed that fewer babies in the SIDS group were put to bed that night with a pacifier in their mouth.

I spoke with Dr. Burton Edelstein, Professor of Dental Medicine at Columbia University, to get his expert opinion on the connection between pacifiers and dental health. He explained to me that pacifier use only leads to tooth decay when parents give babies binkies sweetened with sugar or juice. As for unsweetened plastic? The latest data has consistently shown that sugar-free pacifiers only lead to cavities and gum disease when used for a very long time. Most studies don’t see any significant risk until age three years, and many not until age five! Furthermore, it seems that any changes in tooth alignment from early pacifier use are likely reversible if weaning happens before permanent teeth come in—usually around kindergarten.

The dentists I spoke to in researching this chapter explained that they actually prefer pacifiers to the often-inevitable thumb-sucking that replaces it after weaning. This is because it’s easier for a parent to control when and how much a baby chews on a pacifier than a finger, and much easier to wean a binky addiction than a thumb sucking habit. The true baby teeth experts routinely give pacifiers to their own children for these exact reasons. As pediatric dentist Steven Chussid explained, “It’s better to give a baby who has a strong sucking habit a pacifier before they develop a thumb-sucking problem that is much harder to break, and that can cause more damage.”

A frequently cited risk of early pacifier use is an association with ear infections. The American Academy of Family Practitioners continues to cite this risk as the main reason for promoting a pacifier wean at 6 months old.

Some studies do, in fact, suggest that babies who use pacifiers have more ear infections than those who don’t, but the underlying data is shaky. For example, in 1995, Finnish researchers divided around 900 babies in daycare centers into two groups. They counseled parents in one group that pacifiers could be harmful and didn’t tell the other group anything. Later, they found that the families who were counseled on pacifier risks actually were less likely to enforce an outright pacifier ban—but the parents in this “counseled” group didn’t give pacifiers as frequently. They also saw that this group of babies was a little less likely to get ear infections than the group that had received less counseling. Their conclusion: Using pacifiers more frequently leads to ear infections.

I talk about the Baby Friendly Hospital Initiative in this chapter, which is a big and complex topic that has been a mixed blessing in my personal and professional opinion. There are some interventions that make a lot of sense: The initiative requires keeping babies with their mothers for the first few hours after birth, providing universal lactation support, and letting babies stay in the same room as their mothers for as much as possible while they are in the hospital. But some of the rules are essentially nonsense, none more so than the complete pacifier ban for all babies in the newborn nursery.

Studies linking breastfeeding and ear infections are limited. One Quebec study had a similar design to the convoluted ear infection study above, leading to similarly confusing and very limited results– which the authors openly acknowledge and use to strongly suggest that pacifier use is likely a marker of early breastfeeding weaning, not a cause of it. Other studies do show that using binkies is related to decreased breastfeeding, but they are all those basically useless observational ones. The current body of evidence, including gold-standard meta analysis of randomized controlled trials, does not support a link between pacifier use and breastfeeding cessation.

Early literacy is a fun, easy way to engage in normal growth and development. The complex process of reading-—including holding (or even chewing) a book, turning a page, following a story, repeating sounds, bringing attention to objects on a page, and following a narrative—enhances fine motor, social, and problem solving skills.

Dr. Ellie Erickson, Assistant Professor of Pediatrics at Duke University and the Medical Director of Family Connect Durham works closely with Reach Out and Read, a national organization that promotes early literacy. She explains that reading is “so different from anything we do with our kids. All senses—touch, smell, hearing, seeing—are engaged when kids share a book with their parents.”

There are many studies that demonstrate positive and lasting results from programs like Reach Out and Read, with improvement in reading behavior, language development, and cognitive performance later in life.

The AAP policy statement on screen time guidelines can be found here. Some of the updates included no longer restricting video chat, which provides more benefit than harm.

Evidence behind restrictions is mixed, complicated, and something I go through more in the book chapter. One cited study shows that young children who are exposed to screens beyond AAP recommendations have been shown to have differences in brain structure, changes in language development, and sleep, for example.

The WHO screen time guidelines are similar but a bit more restrictive, and are based largely on very limited observational studies—like this one, which links sedentary behavior (including but not limited to watching screens) to childhood obesity.

One day in July, as I doom-scrolled through social media, I read this New York Times piece in which a parenting expert and former screen-time abstinence evangelist repented her ways. Newly faced with the task of being the primary caretaker of her children (while working from home, of course, and without nannies or preschool to provide engagement and entertainment), she saw immediately how the benefits of some screen indulgence outweigh any risks, pandemic or none.

There is some evidence for improved cognitive ability in bilingual children compared to monolingual children. As is so often the case, it’s a complex topic with near-constant emergence of evidence and so many confounding, contributing factors. Whether or not there is a true or significant advantage is debatable, but it is clear that bilingualism doesn’t pose any disadvantage to cognitive development.

There is also emerging evidence that bilingualism may even protect against dementia in older age, with researchers finding biological and functional changes in bilingual patients with Alzheimer’s compared to monolingual counterparts.

Many parents worry that exposure to multiple languages will lead to a meaningful speech delay, but the data don’t support this.

Determining the exact cut-off age for each degree of language fluency is actually quite complicated, and something that’s been debated for centuries. There’s evidence from the lab that important stuff is happening in those first weeks of a baby’s life, with connections between sounds, words, meaning all at their most malleable. But while there may be theoretical benefits to exposure right from the newborn period, we know that the majority of those positive, brain-shaping effects can still take place later on.

Language learning is complex, dynamic, and there is even a brain-imaging study that showed adolescents had similar changes in brain structure whether they started learning a language at birth or later in childhood.

This article provides an excellent overview on the science of multilingualism and is worth a read for those wanting a nerdier, deeper dive into the topic.

Researchers in the Netherlands recently published a study looking at the dozens of developmental milestones that pediatricians track in the first four years. They found that out of 75 milestones measured, delays in only 9 of them predicted problems functioning later on. The ability to predict problems was significant but small. What was more significant? Combining milestone measurements. A single delay is truly unlikely to predict a real problem. It’s when a baby has multiple delays—generally the delays that cross different domains, like social, speech, fine motor, and gross motor—that cause seasoned pediatricians to actually worry.

A major issue with developmental screening is that the tools we use are not based on appropriately diverse samples.

Professional organizations (like the CDC, WHO, and AAP) do their best to use science to define “normal” pediatric development. The way most milestones are established is by having experts take years of experience (and whatever data they have available) to come up with cut-offs. Where data is limited or lacking altogether, there’s been some good faith effort to conduct studies with large groups of children to see if the milestones these organizations put forth are backed more directly by science.

In the first months, babies don’t have the motor skills to eat solid food, which requires some basic physical ability that nursing or bottle-feeding does not.

Dr. Cristina Fernandez is a pediatrician colleague and brilliant researcher. She works as a newborn hospitalist and health disparities and health services researcher in the Department of Pediatrics at the Columbia University Irving Medical Center. Dr. Fernandez's research focus is in food insecurity, nutrition, prenatal health behavior, and childhood growth and development. Her research highlights how complex the relationship between solid food introduction, formula feeding, breastfeeding, and later childhood complications like obesity really is. There are links, but it’s not a black-and-white connection– factors like food insecurity, socioeconomic status, and parental feeding styles carry huge influence.

In 2003, the World Health Organization published guidelines based on studies showing that exclusive breastfeeding through 6 months of age correlates with substantial health benefits including lower obesity rates and fewer infections. It’s unclear whether this correlation is directly related to introducing solid foods later, or if it instead has more to do with the positive effects of breast milk.

The evidence on baby led weaning is emerging. This article (by former colleagues of mine!) does an excellent job summarizing the theoretical and data-based risks and benefits. They conclude that, “Baby-led weaning is an alternative approach to the introduction of complementary foods that is rooted in a strong theoretical framework around autonomy promotion in the realm of feeding. Current evidence is equivocal with regard to the potential health benefits in terms of eating behaviors, dietary intake, and weight outcomes. There is also little-to-no current evidence to support an increased risk of choking, anemia, or growth faltering associated with BLW, especially when BLW is done in a modified way.”

The idea that infants can only have a very limited number of “baby approved” first foods is relatively new, and coincides with—surprise—a booming baby food market (estimated at $53 billion dollars in 2018!). When the first patented baby food came on the market in 1921, the idea was to take advantage of canning and preserving technologies to provide a product that would free American mothers from manually boiling, mashing, and pureeing their infant’s meals. Commercial baby food soon became ubiquitous, championed as a product that wasn’t just as safe, but in fact superior to homemade infant meals.

This article digs into how babies explore new foods. It relies heavily on the expertise of Dr. Susan Johnson, who runs The Children’s Eating Lab at the University of Colorado and has done prolific research demonstrating just how adventurous infants are in their culinary exploration.

I’ve learned from experts like Dr. Burton L. Edelstein, professor of pediatric dental medicine at Columbia University, that childhood cavities are almost always completely preventable. The most important action you can take to keep your baby’s pearly whites happy and healthy is to focus on what she eats. “As with so many pediatric health concerns, sugar is the culprit,” Dr. Edelstein says. “Complemented with appropriate twice-daily usage of fluoridated toothpaste, provided under supervised brushing until the children are old enough to assume responsibility, dietary control will keep almost every child free of tooth decay and its consequences.”

I still see a huge amount of outdated advice online suggesting that fluoride-free toothpaste is the only safe way to go until your baby can spit out toothpaste on their own. But this is definitely not true. A rice-grain-sized dab of toothpaste that you brush onto your infant’s teeth is completely safe, even if they swallow a good amount of it. And it’s really effective at preventing cavities, especially for babies who are at higher risk.

Fluoride tablets, on the other hand, are going out of fashion, even if you use water from a well or other fluoride-free source. When compared with judicious and dentist-directed topical fluoride administration, the benefits are shown to be similar.

Teething tablets, drops, and necklaces are an absolute no-go. There are serious risks including known fatalities. It’s just no worth it.

The sleep needs and patterns are different for each baby (just like each human!). There’s no one-size-fits all best schedule.

Instead, we can only use the averages from available data to make best-guess tables and charts detailing what you can expect as a new parent.

Some quick perspective: History is chock-full of certified geniuses who never went to school or a single enrichment class as a baby or toddler.

The basic ingredients of infant develop are basic. Science shows that providing babies with nutrition and a caring environment (and reducing societal stressors/inequalities however we can) is really what matters.

The AAP takes a relatively hardline stance against unregulated, alternative treatments, an instinct I understand based on the harms I’ve seen (and share in my chapter.)

My chapter ultimately empowers you to explore some alternative treatments, making sure you are holding them to the same high standards you would any other medication. Remember, any treatment is a medication. You can learn more about naturalistic fallacy in my vaccines chapter (and the resources listed for chapter 9 above.)

In the end, it’s okay to want to explore “natural” remedies, just remember to bring a healthy dose of skepticism to any product. “Big Nature” is just as corrupt as “Big Pharma,” (if not more so), and far less regulated or transparent.

This article gives important background on the supplement industry, including how an increasingly anti-scientific national climate culminated in passage of the 1994 Dietary Supplement Health and Education Act. This act granted unprecedented legitimacy to “dietary supplements” that had not been scientifically proven to be effective and/or safe. In part, this was facilitated when professional pharmacy magazines and journals published advertisements and articles promoting these unproven medications.

This review discusses toxicity-related issues and major safety concerns arising from the use of herbal medicinal products. It also highlights some important challenges associated with effective monitoring of their safety.