Bringing home a newborn is scary. You have to figure out breastfeeding and nutrition, diaper changing and dressing, bathing and hygiene, sleeping patterns and needs, all on limited amounts of sleep. Even little things, like getting a onesie over their head or clipping their itty-bitty but razor-sharp nails are fraught with uncertainty and fear.
Coincidentally, I received Baby Comes Home, a new book by pediatric specialist Dr. Paul Roumeliotis while on maternity leave. I’ve read plenty of parenting books over the past six months, but what I like about Dr. Paul’s approach is his public health background and belief in how much influence you can have on your baby’s developing brain simply by loving her and fostering a nurturing relationship. He calls it the "Science of TLC.” The book is not so much a manual but an overview of all the things you should know and be prepared for. Here, Dr. Paul responded to a few of my personal questions.
I love your approach of a loving home being the foundation for a healthy baby. Can you explain a little about the “Science of TLC”?
TLC—tender loving care—is not a new concept; we always suspected it was important, and now we have the science to prove it. Studies on the effect of brain development (the wiring or sculpting of the brain) by the lack of bonding, healthy relationships, and nurturing during the first few year of life have shown rather worrisome results. Up until now, it was very clear that lack of bonding and nurturing in babies can result in long-term psychological and mental conditions. It is now apparent that this neglect can exacerbate or even cause chronic physical illness such as diabetes and heart disease even decades later.
In addition, the aspects of a child’s development that are interfered with, play a role in a child’s future learning and socializing skills, and ultimately their ability to reach their full potential as adults. So, investing in a child’s early support not only assures proper mental, emotional, and psychological development at the time, but is also a form of chronic disease prevention. The reason I purposefully chose to cover the first 18 months is because this is the period during which the brain growth and development is very active and, consequently, vulnerable.
What are the simplest ways of expressing love so you know your baby is benefiting from your internal feelings?
It does not cost anything to respond to, nurture, caress, and give your baby as much attention as you can. Connecting and interacting with baby and establishing a relationship are easy to do and the pleasure you will get back is priceless. At the same time, baby’s brain is feverishly developing and growing well. Soothing baby when upset is one of the most important things to do. Reading to baby, making eye contact, playing, and giving loving attention are quite easy to do, virtually anywhere, anytime, and under any circumstances. So remember: infant-parent and infant-caregiver relationships and connections do not cost anything, yet there is so much return!
In the four months I’ve been home with Parker, I’ve probably had 18,162 nightmares flash through my mind of all the terrible things that could happen. What do you think are actually the most overlooked safety issues and the ones that can be most easily avoided?
Accidents can happen in an instant and, at times, a baby's stage of development takes us by surprise. For example, although a 4-month-old baby cannot yet crawl or walk, she can roll over and fall off a changing table and even down nearby un-gated stairs. So it's important not to assume that baby cannot get into an accident, and to NEVER leave a baby unattended. It is a good idea to baby-proof your home before baby arrives and to ensure that there are no hazards. One of the other places where accidents can happen is when visiting a friend or relative's house who does not have kids and thus is not baby-safe.
I live in Brooklyn. What safety issues are different for city babies than those in the suburbs or country?
I have lived and worked in both city (including suburbs) and rural or country areas. For children under two, I think the safety issues are the same because most are indoor risks. However, we do know from epidemiologic studies that motor vehicle, pedestrian and work-related accidents tend to occur more in rural areas. So as a children get older and spend more time outdoors, parents need to be particularly attentive on the roads and around the home. Having said that, in busy city streets, there is also a real risk for car and pedestrian accidents.
I’m in the middle of trying to get Parker on both feeding and sleeping schedules, and it seems every resource I go to offers conflicting advice. What do you think the best thing I can do to get her to sleep through the night? What’s the soundest approach?
For feeding, I talk about a simple approach, which is the 4 by 4. It means that by 4 months of age, a baby should have 4 feeds per 24 hours. This is a good routine to aim for. In older children, I do believe that there should be 3 meals and 2 snacks per day and nothing in between. This is a great way to prevent picky/fussy eating habits.
Sleep routines are more difficult to establish because no two babies are alike and there is no "magic” or “normal” age at which a baby sleeps through the night. I think the best way to establish a bedtime routine is to start as early as possible with a calm and uninterrupted, nightly pre-bedtime ritual, like giving baby a bath, then reading and then putting her to sleep.
Also, because baby's brain sleep stages are immature, shifting from one sleep phase to another may temporarily awaken the baby during the night. In most cases baby will fall back asleep on her own so do not pick her up right away as this may teach her that every time she fusses, she gets picked up. Of course, I do not mean to let baby cry inconsolably.
The American Academy of Pediatrics has some recommendations that I describe in my book to help baby develop good sleep habits, which include:
- As soon as baby is tired put her to bed immediately.
- Rocking or holding a baby until she falls asleep creates a habit. Soon the baby will need to be held and comforted back to sleep every time she wakes in the middle of the night.
- Avoid putting baby to bed with a pacifier.
- Do not put the baby to sleep in your bed.
A good portion of your book is devoted to common illnesses. Do you want to weigh in on the immunization debate? What do you think of the recent measles outbreak?
This is a very important issue as we are in the midst of multiple Measles outbreaks in North America largely due to unvaccinated children, so, yes, I definitely want to weigh in.
In short, I do not think it is a debate. Clearly, vaccines save lives and represent one of the most important advances in medicine over the last century. We are hearing a lot about vaccine resistance in the media, yet only 1-2% of parents refuse vaccines and about 10-15% are hesitant. There is a lot of misinformation on the Internet, and this a challenge.
I would recommend that parents discuss vaccination with their health care provider and to look at credible sources for information before making any decisions. Personally, when I was training as a pediatrician in the 1980s, I lived through the era when a severe bacteria (Hemophilus Influenza B) was causing illness and even death in many young children. Since the vaccine was released in 1985, this infection has almost completely disappeared. Immunization is by far one of the most important medical advances, yet many in North America take vaccines for granted because, thanks to vaccines, infections that used to kill or maim millions have been virtually eradicated.
I also believe that if parents refuse vaccinations, they not only put their children at risk, but also can potentially expose others in the community, like young babies and people with weak immune systems. My approach is that when baby comes home, we do the best for optimal wellness. This "wellness package" includes TLC, home/car safety, proper nutrition and, in the same preventative spirit, I include vaccination as another thing we can do to protect baby and help ensure optimal health and wellness.
What has surprised or delighted you the most in your 25 years of pediatric research?
What really pleases me is that thanks to vaccines and new antibiotics, we have been able to significantly prevent infectious diseases that once killed and injured countless children. However, what fascinates me the most is the tremendous amount of knowledge that we are getting from our understanding of the human genome. It is not inconceivable that in the near future, we will be able to identify genes that cause lifelong debilitating diseases such as Cystic Fibrosis, Muscular Dystrophy and then correct them so that the children will grow normally without these diseases. This potential is very exciting and I can't wait until we are able to stop these terrible diseases before they even begin!
For any other new parents out there, I'm delighted to offer a Baby Comes Home giveaway. For a chance to get a copy, let me know what special TLC act or routine you've instilled at home in the comments box by Wednesday, March 4.
Thank you for taking the time to share your enlightening advice, Dr. Paul!