Eat, Sleep, Poop, Grow!

Podcast Transcript

Dr. Richard So:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, let's talk Little Health. Hi, I'm Dr. Richard So. welcome to Cleveland Clinic Children's, Little Health podcast. Today, I'm very honored to have Dr. Hannah Spellman, pediatrician and mother at Cleveland Clinic Children's. Tell us a little bit about yourself, a little again for our, for our guests.

Dr. Hannah Spellman:

Sure. Thank you so much for having me back. So I am a primary care pediatrician, like you mentioned. I've really been in practice since July and I just finished training, um, in the last few years. And I have two children. I have a three-and-a-half-year-old son and a one-year-old daughter.

Dr. Richard So:

Yeah, at our last podcast, we talked a little bit about newborns. Today, we're gonna talk more about our journey through parenthood. We're gonna talk about, eat, sleep, poop, grow. It's a little bit about how to feed your baby, what to expect, some of the developmental milestones and growth parameters that we have with newborns. And for those new moms out there or the moms expected to be, let's... We're gonna talk about... Let's start with like some of the things about what a new mom should have in preparation for her baby.

Dr. Hannah Spellman:

Yeah, that's such a good question. Um, I'm very minimalist about what a new mom actually needs to have to care for her new baby. There's gonna be a lot of lists you'll see on the internet, on social media, and I, I would say take that all with a grain of salt. I think there's a few basic things. You need to have a car seat because you need to have a way to get the baby home from the hospital. There's a lot of car seats on the market. Most of them are pretty safe. Anything that's extra is usually bells and whistles. so having a good, safe car seat.

Um, having a place for the baby to sleep, that's a safe, firm place, um, that's outside of your bed. It doesn't have to be the fanciest bassinet. A Pack N' Play, even, you know, a cardboard box on the floor is safe. So just some safe independent space for the baby to sleep is important. I think having sleep sacks or sleep swaddles can be really helpful for baby's sleep.

And then everything else that I think is helpful comes from my experience as a pediatrician. So things like a good diaper cream is important to prevent any rashes, along with your diapers and wipes. Having some saline nose drops and a suction in case your baby gets sick, that can be important. Having a thermometer at home that you can use if you're worried about the baby's temperature. If you're breastfeeding, having some vitamin D drops is important. Everything else, you know, you need to have a little bit of clothes, You need to have some crib sheets, but you don't need a lot of that stuff, and babies usually grow out of it pretty quickly. So I think just having some basics is really enough to get through the first couple of weeks.

Dr. Richard So:

Yeah, looking at like having a new baby, it's almost like having a wedding registry. You know, there's a lot of lists online of what you need and what you need. But in my experience, I think there's a lot of what I call new baby Kool-Aid out there. They're the latest and greatest of talking about the things that you need. But I agree with you that most of the things that we need are very minimalist. One of the things that I think that's very important is like when we talk about thermometers.

Uh, I think from a standard point, every baby that's an infant until they can walk should be a rectal thermometer. I'm not a big fan of the pacifier ones or the ear ones. When the kid is sick, they're not gonna s- sit still for you to stick something in their ear, because when they... you have the ear thermometer, it actually measures the temperature of the air and you need a pretty good seal on that one. And then the, the tympanic thermometers, those new ones, those were really expensive when they first came out, and I think that works for bigger kids but not for babies.

Some other things too... Now, I'm not a big fan of, when you talk about new baby Kool-Aid. I don't like 4-ounce bottles. I think that you're gonna outgrow 'em and then you're only gonna use them for the first three to four months. I think you should just save money. Part of our practice is to give the most up-to-date care, and I think saving parents money at the same time I think is really important. And we think we should weed out some of the things that you don't need.

Uh, like for example, you don't need Motrin 'cause you can't give ibuprofen until six to nine months but it's in some of the baby kits. And I think Tylenol is always something good if you're, if you're gonna be traveling later, like a little bit Benadryl downstream. But yeah, with regards to car seats too, I think we should, we should talk about car seats a little bit. Uh, like with hand-me-downs, are, are hand-me-downs okay? You know, coming from a cold weather area, there's expiration dates on car seats, where they say the extreme temperatures of where you can be 110 degrees in the summer versus going minus 10 degrees in the winter. That does something to the plastics. There's something to be said about- about that but I'm not so sure. Um, what are your thoughts on like strollers?

Dr. Hannah Spellman:

Yeah, so that's a great question. So I think a stroller is super convenient because you have to have a way of moving your baby from one place to another, and you don't always have the hands available to carry them. Um, there are some... There's like, you know, the Cadillac of strollers out there that have so many different parts and pieces. And those can be great for some moms, but they're also not necessary. So I think some of it is sort of knowing what is right for your family and not feeling like, like you mentioned in the last podcast, you don't have to keep up with the Joneses in terms of having all the best products. For my family, the things that were important in a stroller was it's easy to fold up and it's light enough that we can carry it, put it in and out of the car, bring it in and out of the house. It was able to fit a baby at a pretty young size and up to a pretty big size, so we have that wide range.

Our stroller, it was convenient were we were able to get an insert so our car seat can go directly into our stroller. Again, I think that you'll see a lot online about like needing to have the best stroller. At the end of the day you need to have a safe stroller and you have that one that works for your family, and that doesn't have to always be the most expensive one.

Dr. Richard So:

Do you see a difference between a first time mom and a second time mom of the products that you buy for your kid? For example, when you've had your first baby, you wanted the system, you wanted the biggest, greatest, latest stroller, but then becoming a second time mom, you know, when we talk about new baby Kool-Aid, what are some of the things like... You could start with strollers then go for there some of the other things that you feel like you, you wasted your money on?

Dr. Hannah Spellman:

Yeah, that's a good question. So I think knowing what works for you and your family is important, and you don't know that before you have your first baby. So some things like with my first, um, he never wanted to be put down, so I needed to have a really good baby carrier. And I didn't actually have a baby carrier, I ended up borrowing from a friend, and then that didn't work and I borrowed a different one. So figuring that out, what's a good baby carrier to have so that you can carry your baby around the house while you're trying to sort of walk around or go out? That was something that was really important to me. So baby carrier was really important, and um, I sort of needed to to try one out to figure out what worked for me.

I think having a, you know, a baby swing, like I tried to get a baby swing with my first, and it was really big and bulky and in the house. And, like, we didn't really end up using it that much. And then we just got like a safe but not fancy, bouncy seat to put the baby in, and like that worked great for us. So something small and not the most expensive one, but just something that really fit in our home nicely that was easy to use for a bouncy seat once, you know, the baby was a little bit bigger was, was really helpful.

Dr. Richard So:

Yeah, I think one of the things where I wouldn't spend a lot of money on is a bassinet, because your baby is gonna eventually outgrow it. You know, 'cause like some bassinets are only good to 15 pounds, some of them are going to that, and then you're spending $150. I think that's a good hand me down.

Dr. Hannah Spellman:

Yeah, we um, we actually used a Pack N' Play for both of our kids. A Pack N' Play is kind of a fold up little crib that came with a bassinet insert. It fit right into our room right next to the bed, which was so great, and we still use it when we travel or when we have guests staying over. So it's something that, um, we were able to use for our newborn as kind of a Pack N' Play bassinet, but that has a really good kind of long-lasting purpose.

Dr. Richard So:

Yeah, bassinets, there's even ones online where you can get the box for your baby if, if expenses are tight because babies, they're expensive. They cost like three times as the mortgage. And I remember that I have three kids but I had six strollers. I think it's important for our audience to know is that you can't use a sling back stroller until about six months or when your baby developmentally can sit up straight, or tripod, or lean on their hands. I think that's important when you're looking at strollers. Also, too, you know, I don't know if I would take like a hand me down crib.

You have to be really careful with cribs because if they're the old cribs... I remember back in the day where they had the drop-down sides, and then those got all recalled because the babies would get stuck on the part that... on the drop-down. So any drop-down cribs that are out there, those are pretty much obsolete these days. So if you're gonna hear it once, you're just better off putting that one on the curb.

Again with car seats, there's a lot of systems out there, but if you're planning to have on more kids, all right, there's like the Humvee of car seats. Everyone buys the biggest, baddest, best, safest one, that's all in the books and it's rated the highest. But what I've learned is that as you have multiple kids, your family doesn't fit in the car seat because once you have your second kid, that takes up one and a half seats. Mom is in there, and then also you need a new baby seat.

So if you're looking about car seats, even just for your toddlers, I do like the narrow profile where you could fit like two or three across, you know? I think those are really, really good. Some other products, What do you think about gas drops? A lot of people-

Dr. Hannah Spellman:

Ah, that's a good question.

Dr. Richard So:

A lot of people, "Oh, I want gas drops, you know, for my baby because I, I don't know why my baby is crying. They're gassy." Before we get into drops, talk about what your personal and professional opinion is on, "My baby is gassy."

Dr. Hannah Spellman:

Okay, so that's a really good question. That's something I hear about a lot in practice. So newborn babies are gassy. It's normal for babies to be gassy, be burpy, spitty, passing gas for like the first six months of life. Their, um, guts are immature, they're still developing, and that's normal. And their abdominal muscles are immature, so a lot of babies I'll hear about they're really straining to poop. They seem really uncomfortable. They're turning red in the face. They're having a hard time. That really has to do more with the fact that they're abdominal muscles are immature and a little bit discoordinated. And so it just takes them some time to figure out how to get their poops out. It doesn't mean that they're constipated. It doesn't mean that they're gassy. That's just, uh, uh, a developmental sort of part of what it means to be a little baby.

Um, in terms of gas drops, so because it is normal for babies to be gassy, I'm not a huge fan of gas drops. There's really no evidence to support that gas drops are particularly effective, and I think, I think for some families that say that it works, there might be a little bit of a placebo effect. I can't speak to every single individual family's personal experience to say whether or not the gas drops truly did or didn't work for them, but I think a lot of families end up spending money and investing a lot of energy in something that's probably not having such an impact on their baby. And it might be making them feel better that they're trying something, but it's probably not really going to be what makes a difference. Probably more just the passage of time.

Dr. Richard So:

I agree 100%. I think that, number one, when I hear someone say, "Oh, my baby is gassy, my baby is gassy." I think that parent or even that grandparent who's telling me, "Oh, that baby is gassy," they just don't know why that baby's crying, all right? And they all think it's pain and they think they have to treat. And I think the gas drops, the studies show that gas drops versus placebo, which is water, there's no difference when you look at the medical studies regarding those types of things.

So I think it's a total waste of money. With regards to like gassiness, once you learn why your baby is crying, I think that that'll be the main thing. But everyone thinks their baby is in pain. For example, what I tell my parents is that when baby is inside mom, in utero, is that baby is in that water environment. And once the baby is born, they're swallowing air and farting is normal. And then I'll always look at dad and I'll say, "Listen, dad, does it hurt when you fart?" And they go, "No, it feels good." That's because like when dad farts, he has control of his muscles, like you said, versus the baby has immature muscles. Is that they tighten their abs, they look behind them, they have control of their sphincters, and then they pass the gas.

Babies, they don't have that, so they go, "Uh, uh, uh, uh, wah." And I think they cry because it's just a new feeling, but it doesn't hurt when we fart, and I ask every dad, "Hey, when you ate chili, did you take any gas drops preventively?" And they say no. So I think gas drops are the same thing. Same thing with hiccups. That's probably the most common question that I get asked like at the three to four week, "Oh, my baby has hiccups, my baby has hiccups."

I could retire right now if I put something in a bottle and I called it, Dr. So's Hiccup Juice and I put on the label, "Compatible with breastfeeding, organic, non-GMO" and all the latest terms. And I could retire a millionaire. But like gas drops and gassiness, I think it takes some time to learn all the different cries in your baby.

Dr. Hannah Spellman:

And I think aside from that, I'd also just caution parents, I think a lot of the like gripe water and things like that, they're really, they're not regulated. So you don't actually know what's in there. You don't always know what you're giving to your baby. So I just caution parents, both from the financial aspect of it and then a lot of those gripe waters. Like they're not always 100% safe because you really don't know what it is that you're giving to your baby.

Dr. Richard So:

Gotcha. Let's talk about sleep products. Now, there's, there's a lot of things to get your babies to sleep that are very, very restricting, and I've had a couple patients lately where parents are more worried about their sleep than their baby's sleep, which is a common theme if you look at our previous podcast. When do you get your babies or your parents out of restrictive sleep wear?

Dr. Hannah Spellman:

You're talking about like swaddles and things like that?

Dr. Richard So:

Or whether it has Velcro, or zippers, or weighted.

Dr. Hannah Spellman:

Yeah, so it's hard to talk about sleep without talking about our rules of safe sleep. So just to go right there, you know, a lot of research has been done in the United States, who care a lot about sort of safe sleep rules as a way of protecting babies, from sudden infant death syndrome. And so those safe rules are having be alone, on their back, in the crib, or the bassinet. Really nothing else in there, nothing else that they could get close to their face or anything like. So a swaddle is a type of sleepwear that the baby's wrapped up really tightly-

Dr. Richard So:

Like a burrito.

Dr. Hannah Spellman:

Like a burrito, exactly. I think swaddles for little babies that have Velcro on them are the best because they can stay secure in place. You're not worried about them slipping up. They can hold the baby in nice and tight. And babies have a natural starter reflex where they kind of wave their hands out, and they move a lot, and they tend to wake themselves up. So the swaddle can be helpful for keeping them all nice and snug and tight, sort of emulating that in utero environment and preventing the baby from waking themselves up.

So they're helpful for getting babies to sleep, especially for the little, little babies. Once the baby starts rolling, then it's no longer safe for them to be in that swaddle because that material could move and it can kinda get up near their faces. It's no longer safe. So I say, um, okay to swaddle really until the baby starts rolling.

Some babies might not want to be swaddled, they might want to have their hands out or their hands near their face, and that's okay too. It's not a necessity to swaddle your baby, it's really about what helps them sleep best and what's most comfortable. The swaddle can be Velcro'ed sometimes just around the belly with arms out, and that could be a good solution. Once babies are out of the swaddle, um, then I like sleep sacks, which are basically like zipper blankets, so they're blankets that, they're, they're sacks that the baby-

Dr. Richard So:

They're like a sleeping bag.

Dr. Hannah Spellman:

Like a sleeping bag, exactly, um, that really zips. So, again, we highly recommend against putting blankets in, um, in the crib or the bassinet. So, um, a sleep sack can be a good safe option to help make sure the baby is kinda snug and warm at night.

Dr. Richard So:

Yeah, I agree. With regards to like swaddles or... I, I agree for the first six weeks. As like we mentioned in our previous podcast where babies are like Vegas. Remember, when they're inside mom for 38 weeks, they're in the dark, they're partying, they're jamming, boom, boom, boom, boom. There's no clocks. They don't know what time it is. They come out a casino vagina. It like- it's like coming out of the casino at six:30 in the morning. There are bright lights. They sleep all day. And it takes six weeks from a hormonal perspective for them to figure out what daytime is nighttime.

Usually around four weeks, your... all the babies get neonatal acne. That's one of the most common calls, "Oh, my God, my baby has a rash, my baby has a rash." But then we just know that that's, uh, hormones that have passed through mom's umbilical cord to baby as baby starts making their own hormone and they're teenagers. They're mean. They have acne, and they're just really, really fussy when they have their baby acne. But we know that with baby acne, you don't even need like any benzoyl or a peroxide cream or anything like that or ac- acne wash 'cause it just goes away when the hormones re-regulate.

That's why I always think for the first six weeks since the babies are from Vegas, I think that's the best birth control after having that baby for the first six weeks. It's awful. It's painful. You're tired, you're not sleeping, you're scared, you don't know how to feed the baby. But then once you get through that first six weeks, the baby does well. And then by the two-month visit, you're not afraid anymore. You figured out all the cries. You know I'm hungry cry. You know that I'm dirty. You figure that I'm sleepy. But then I think parents get in a rut. I think parents, they need to know that once you get to the two-month, by four months your baby has better head control, gets better shoulder control. But then parents they still want to swaddle their babies because they're more worried about their sleep.

But what I've seen in my practice is that the babies were on their backs and they're basically in a straight jacket for the long time. I'm like, "Free the baby." And then I've seen babies actually get flat heads and next thing you know by the four to six-month visit, we got to get a helmet because they have a flattening of the back of their head. Have you seen some of that stuff in, in your practice as well?

Dr. Hannah Spellman:

Yeah, so, um, in my own personal experience and then in practice as well, um, I have a few comments. So the first is in terms of that, like, early stage, those first six weeks really fussy baby. I have one memory of, um, when my baby was about a month old waking up in the morning or I say waking up. I had been up all night with, you know, with my first baby and he wasn't sleeping and I wasn't sleeping, and I was miserable. And I was like, "What am I doing wrong?" And I think the answer is like you're not necessarily doing anything wrong. That might just be the, the developmental stage and it will get better with time and it's important to just remember that.

And I think sometimes in those vulnerable moments, when you've been up all night, that's when social media and advertising hits you of like, "You need to buy this baby sleep product and that baby sleep product." And the reality is it's taking advantage of your exhausted state. And you don't necessarily need to buy all those products, you just sometimes need to wait for a time to pass. So that's, that's the first thing I'll say. I think the next thing about, um, you mentioned about skincare products.

So I didn't mention before, I, I really like fragrance-free products. I think a lot of fragrance can be super irritating for baby skin. And so just being super gentle, super fragrance-free and like letting that baby acne just kind of ride itself out. But then being, just being aware of sort of a fragrance-free baby products I think can be helpful. And then in terms of as the baby grows and develops, you know, as they get to be, you know, four months old, not only do they have better control, they, they interact with you more. They're smiling at you more, they're laughing at you more.

And there's something really fulfilling as a parent about seeing your baby smile and laugh at you more. And you know when they get to be about two months, they start smiling at you more. About to four months, they're interacting with you more. And, and seeing the baby pass through those stages can be so fulfilling. And you look back on that one-month-old baby that was screaming all night and you're like, "What is going on right now? What am I doing as a parent?" And then as they grow they start giving you those positive feedback moments of smiling, and laughing.

And, and that's just really beautiful and special to sort of get to experience as the baby grows and develops. In terms of the flatheads, we do recommend safe sleep. That's babies on their back. They're going to be lying on their back a lot. Whenever possible, when you ever have the chance, I do recommend putting babies on their tummy and doing some tummy time. I usually recommend starting as soon as the umbilical cord falls off, so that's usually a couple... within the first couple weeks of life. Put them on their tummy.

Some babies will love being on their tummy and they'll just play and look around. Give them something interesting to look at. For a newborn baby, that could just be like a piece of paper with some black lines on it. It doesn't have to be like a gorgeous landscape, um, because anything that's color contrast will be interesting for them to look at. So put them on their tummy in a supervised safe way. If baby doesn't like being on their tummy, then I recommend usually doing short periods of time every often.

So every time you change baby's diaper, just have them lay on their tummy for a few minutes as much as you can tolerate, um, to just get them to explore the world in a different way, to see the world differently, get them to stretch out their neck muscles, their head muscles, move around. Um, it's just really important developmentally for them to have the opportunity to be on their tummy, do that tummy time and to get that stimulation and development.

Dr. Richard So:

That's a great answer. I think as we're moving forward with regards to our journey through parenthood, we talk about eat, sleep, poop, grow. I think parents they get stuck on what we told them last time. Like for example as pediatricians, we see your baby every week for the first two weeks. We see you every month for the two month till six months and then every three months after that. For our audience out there, our doctor's visits, they're set up just when you figure out your baby.

It's time to visit your pediatrician. And believe it or not as your baby grows, we make you grow up as parents and we put you in a comfortable situation in your journey through parenthood. So I think around two-month visit, I think is a good time to get your baby out of the swaddle be- to prevent that flat head. I think that would be a pretty good study is like, "Okay, what is the incidence of, of flattening heads and time spent in a swaddle or something more restrictive?" Because remember aro- around two months your baby gets good head control. At four months you get good shoulder control. And if your baby is wrapped up too long, I think you can hamper your baby's gross motor development 'cause by four months a lot of them do learn to roll front to back.

That's at the four-month, they start reaching for things. And I agree my favorite part about development of a four-month baby is the laughing and giggling. What a joy of that one. And then you get to six months, they're sitting up, they're playing with their feet. And from a safety point between that four and six months, that's when I get the call once a quarter where your baby might roll off the bed. Just when you think your baby can't, uh, from a safety standard the call I get is, "Dr. So, I had to pee so bad. I put my baby on my bed. I surround it with pillows and then I heard the thump and the cry." You know? And then next thing you know they're in the ER.

Or grandma is watching the baby. I wedged the baby on our big sectional couch, wedged right where the cushions meet and then we heard and the thump and the cry. Being a second time mom, okay, what do you think are some big, safety issues that you would have between first baby and second baby? So in general in terms of baby rolling off, I think babies they're going to surprise you. Sometimes every once in a while you see that you know little newborn that just managed to get themselves in just the right angle and roll off.

So I always recommend never leave the baby alone on the changing table, the bed. It's... Put them on the floor. You know, it's safe to put them on the floor. If they can't crawl anywhere, you can just leave them right on the floor and on their back and run to the bathroom and they'll be just fine. Nothing wrong with doing that.

Dr. Hannah Spellman:

But you have that second kid.

Dr. Richard So:

Right.

Dr. Hannah Spellman:

So that's when it becomes-

Dr. Richard So:

Or a pet.

Dr. Hannah Spellman:

... tricky.

Dr. Richard So:

Or a pet.

Dr. Hannah Spellman:

Like if you have a pet that's going to come over. I think with second kids you know to some extent the biggest safety thing was making sure my toddler didn't do anything to hurt the infant. You know, they're curious. They want to poke them in the eye. They want to breathe their snotty boogers right in their face. I hear a lot about parents being worried that their older child is going to get their younger baby sick. So that's definitely something that I'm really mindful of. Some things that I've tried is I tried to teach my toddler that we always kiss the baby's feet.

We don't go near the face. We always... And just really emphasize, like, "Stick near the feet, be near the feet. Let's be close and cuddly near the feet." Sometimes I would take... Honestly, just take my toddler into the bathroom with me so that I know at least he's not getting close to the baby. If the baby needs to be somewhere on their own, like, have one child with me so that they're not kind of two by themselves together without direct parental supervision. Because that definitely can be the biggest safety hazard.

Dr. Richard So:

I bet you if, if we did a survey how many moms have actually held their baby why have they have to use the bathroom. What do you think? I think about 97%.

Dr. Hannah Spellman:

I mean, you have to do what you have to do.

Dr. Richard So:

And, and probably, and probably-

Dr. Hannah Spellman:

(laughs)

Dr. Richard So:

... 75% of dads have held the baby in a football hold and go to the baby to protect the child from the older sibling, like, in the toddler on that part.

Dr. Hannah Spellman:

Yeah.

Dr. Richard So:

But I, I agree that the biggest safety hazard for a second baby is the first baby especially if they're two years old.

Dr. Hannah Spellman:

Yeah.

Dr. Richard So:

Because learning right from wrong, that's four. So you never trust a two or three-year-old with, with the newborn around.

Dr. Hannah Spellman:

Right. And like you want to encourage that bonding. You want, you don't want it to be like, they can't touch the baby. They don't have anything close to the baby. You want to find a way to encourage them to, to encourage the toddler to love the baby, but it has to be in a safe way. And they just really don't know what that means at that age.

Dr. Richard So:

Yeah, even with the second baby, I think like, like the biggest anxiety with that second time parent is, "Oh my God. My, my, my first one is not going to love me as much because I have the other one." But what I tell my mom is usually in, in those cases is usually a two-year-old developmentally, they've learned how to take turns. So when mom is expecting the second one and they're in the office and they, they give me the, the joyous news that, "We're having another one," I tell them, you know, there's a lot of good books out there like, "I'm a big brother now."

But I always give them this term, so if you have a two-year-old and you're expecting a new one, when the new baby comes and the new baby actually does fall asleep, you're supposed to go to the second one and you say, "Now, it's your turn for special time with mommy." And I think that empowers the second time mom to say, okay, when you say that to the second child, it takes away the guilt and the feeling of doing that, where, okay, when baby cries you can always go to the first one and you say, "Well, you've had your turn for special time with Mommy. Now it's baby's turn for special time with mommy." And I think that empowers new moms of that guilty feelings of splitting their time.

Dr. Hannah Spellman:

Yeah. There are a few things that I think can be helpful. One is, like you mentioned getting books. I think it's important to prepare the older child in advance. Like, you can't just come home from the hospital with a new baby that you haven't talked about before. So reading books, talking about it, those can be helpful ways to prepare the child in advance. I think number two is that it's okay for the older child to have a little bit of her aggression and to want to be your baby.

So I would say try to, try not to be like, "Oh no, you're the big kid now." Like, let them be the baby. Give them that special time that attention. Baby them a little bit when you have the opportunity to because they're going to want their mommy. They're going to want that close connection and you want to still let them feel like they're, they're a child. They're not being neglected now. You know, you don't have this new special toy. You want to give them that love and attention.

And then the third thing is try to whatever extent not to blame the baby for things you can't do with a toddler. Like if the toddler wants to go to the park don't say, "Oh, we can't go because the baby is sleeping." Try to leave that kind of blame of the younger baby out of it and just sort of say, "Oh, we're not going to the park right now. We could go in a half hour," or whatever it is to sort of separate the newborn from the things that the older child is not able to do anymore.

Dr. Richard So:

Oh, that, that's a fantastic answer. I never used that one before. I like that one. With safety wise in that second one, another developmental milestone of the second one is like they're learning how to share. So you got to be really careful. Not, not only they're going to poke them in the eye, but if you're at the dinner table and you're making dinner what are they going to do? They see the baby and the bassinet, and they're throwing their goldfish and their crackers. "Oh, I want to give my food or I want to share my toy," and they're banging them in the head. So, yeah, your biggest safety hazard for that new baby is the first baby. Excuse me on that one.

Dr. Hannah Spellman:

Yeah. My older child was constantly trying to put stuffed animals, like, on top of the baby's face in the bassinet. And like it was... he's like, "Oh, she needs her, she needs her stuffy. She needs her stuffy." And it's like it's so sweet and so loving and also not safe. So then we would just, you know, be like, "Oh, that's so lovely." Now, we're going to take that stuffed animal right out of the bassinet. Like... (laughs)

Dr. Richard So:

Oh, if they don't like the crying, if they don't like the crying what they do is they take the blanket and they put it over the baby's head-

Dr. Hannah Spellman:

Yeah. (laughs)

Dr. Richard So:

'Cause they, they don't like the loud noises. We talk about our journey through parenthood, eat, sleep, poop, grow. Talk about normal pooping in a baby.

Dr. Hannah Spellman:

Oh, that's a great question. So we talked about this a little bit that baby's pooping can be a little bit discoordinated sometimes and that's normal. So baby poop is usually soft and soft can be anything from like really loose and liquidy to kind of like peanut butter consistency. Anything on that spectrum is normal. CD is normal, like, little mustard seeds in it or cottage cheesy. That's all normal consistency. Normal colors, anything that's kind of yellow, light brown, green, can all be normal colors. Anything that's red, white, or black we want to know about.

Um, call the pediatrician. Those are not normal. But anything that's on that spectrum of yellow, brown, green, all normal. And baby poop can change. So if it looks like one thing one day and looks different another day, it might just be something that you ate or something that the baby ate. Some babies poop all the time. They're going to poop every time they eat throughout the entire day and some babies might poop every couple of days, every two, three four days.

And then I hear about this a lot that parents get worried that their baby is constipated because they went a day without pooping. Some babies just aren't going to poop every day. Sometimes formula fed babies, sometimes breastfed babies, they might go a few days without pooping. And when they do poop, they might look like they're working really, really hard. Scrunching up their face, scrunch up their legs, maybe even just crying, that usually has more to do with their muscles being immature.

Newborn babies will kind of try clenching their stomach muscles, but they're also clenching their butt at the same time and they're working against these opposing forces. So they just haven't figured out how to coordinate pooping while lying flat on their backs. And so they seem really uncomfortable. But it doesn't mean they're constipated. As long as that poop comes out nice, and soft, and loose that's just normal and that's something that will kind of, um, improve over time.

Dr. Richard So:

Yeah, I agree with, with regards to pooping and what's normal and what's abnormal. I think a lot has to do with the difference between being a first parent and a second parent. First parents especially like accountants, they're charting everything, "You need the poop, I need the poop." But a second time parent, like, if a baby doesn't poop for a day they're like, "Sweet." (laughs)

Dr. Hannah Spellman:

Yeah, or sometimes I'll get like the, the first baby pooped all the time and then the second baby maybe went a day. And the first and the parent is like, "Well, my first child pooped all the time and now my second baby is, you know, not pooping all the time." And that just could be they have different guts and they're different babies and that it's still within the range of normal.

Dr. Richard So:

Yeah. I, I agree. And there's a difference between breast milk poop and formula poop, you know, with consistency and smell. But what we tend to see in our offices is that breastfed kids, it's not uncommon for them to poop every three days. I... My record is once a week how about you?

Dr. Hannah Spellman:

Um, yeah, it was a baby that usually pooped once every five days but they went a week without pooping. And I was like, "Well, if they haven't pooped by tomorrow, give us a call." And then of course they pooped. I always say like put them in a fancy white outfit and stick them in a car for a long ride and they'll, they'll go. (laughs)

Dr. Richard So:

Yeah, breast milk, it's, it's the most pure food and a lot of times there's no waste. And sometimes you'll just get like a little smear in there and that counts. But it's not uncommon for a breastfed baby to poop once every five days. And believe it or not, to those new parents out there, that's a gift.

Dr. Hannah Spellman:

You know, the poop doesn't smell quite as strong as adult poop, but it can have a little bit of an odor kind of like a, you know, a mild sour milk type of smell and that can be normal too.

Dr. Richard So:

When, when do you start feeding the babies in your practice, like, regular food or, like, baby food? And what are your thoughts on that?

Dr. Hannah Spellman:

Yeah, that's a great question. So, um, a little bit, it, it depends on whether they're exclusively breastfed or taking formula. Babies who are exclusively breastfed, a lot of the studies, um, with a lot showing the health benefits, um, is exclusive breastfeeding up to six months. So I generally recommend babies who are exclusively breastfeeding to really go up to about six months, um, all taking breast milk before introducing complimentary foods. Babies who are taking formula already, um, usually between four and six months is when I say, "You can start thinking about introducing complimentary foods."

And I, I say complimentary because the main calories and the main nutrition is still really coming from that formula or that breast milk. And everything else at that age is really extra. It's for exploring taste and flavors and just getting used to the skills of feeding. There are a few developmental things that I look for between four and six months that tells me it's time to offer the baby some complimentary food. So one is, um, how well is the baby able to sit up independently?

So they need to be able to sit up pretty independently and have good head control because otherwise it's not safe. It could be a choking hazard if they're flopping all over the place while you're trying to feed them something more solid. So sitting up while having good head control. Babies are born with the reflex where they push things out of their mouth to their tongue. So we have to make sure that they're able to keep the food into their mouth. If every time you put something in their mouth, they just push it right out as an automatic reflex, might not be time to give them something extra and you might need to wait a little bit of time.

So getting rid of that tongue thrusting reflex. And the baby should be interested in what you're eating. If you kind of have them at the table and they're looking at your food and they're trying to grab for it and they're watching you put things in your mouth, that could be a sign that they're interested in feeding too. And if they're not really showing those signs, it might be a little bit young to start thinking about feeding them. So usually either between four to six months for formula or breastfed babies depending on their developmental milestones or at about six months for exclusively breast-fed infants.

Dr. Richard So:

Yeah, I'm going to tag on that a little bit because I agree, number one, that the main caloric source of all babies from 0 to 12 months is breast milk or formula. Breastfeeding may not be for everybody. Don't feel guilty if it didn't work for you. But I usually start foods around four months in my practice. Some moms will pick six. But I think if they say, "Oh, I'm going to wait till six," I think that's the old data because I think it was like in 2009 in Penn State, like, we used to wait to start food. I remember it was table food at one. It was eggs at 18 months and peanuts at two.

But then what we... but we saw like in the Israeli studies where they didn't have kids at the peanut table in preschool because they had early introduction of peanut powder through those peanut butter flavored puffs called Bambas. So when do you start the, like, peanuts or eggs or some of the a- allergenic foods?

Dr. Hannah Spellman:

Yeah. That's a great question. So, um, in terms of what foods to start with, so early introduction of allergens has like you mentioned has been really well studied to decrease the chance that a child will develop allergies later in life. Um, so I recommend when babies are starting to take solid foods to start with those early introduction of allergenic foods. So things like peanut, egg. If a baby hasn't had been introduced to cow's milk yet, cow's milk, sesame, soy, fish. Um, those tree nuts, high risk of allergy foods to introduce them earlier on. And it has to be obviously a way that's safe for the baby.

So if you just gave a baby a spoonful of peanut butter, they probably wouldn't be able to swallow that easily. So doing something like a Bamba which is a puff that might be easier for the baby to take or mixing a little bit of peanut into some baby cereal, or, uh, loosening it down with some formula or some breast milk can be a good strategy. They do make like powders you can buy online that have all those different allergens that you can introduce at different stages.

And I think for some families, those are helpful. They want to be really controlled over it, but they're not necessary. You can also just kind of look for those foods in the environment and things that you're kind of have in your house already, find ways to safely incorporate those into the baby's diet.

Dr. Richard So:

Wow, what great information. You sound like a fantastic pediatrician and mother. It was such a pleasure of having you today and talking about these new things. How can we get a hold of you?

Dr. Hannah Spellman:

Thank you so much. Um, so it was great to be here. I work at the Cleveland Clinic Children's Lakewood practice. So you can reach out with email or with phone, and I would be happy to be in touch.

Dr. Richard So:

Thank you so much.

Dr. Hannah Spellman:

Yeah, thank you so much for having me.

Dr. Richard So:

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.