Newborn Care - Transcripts

Hello and welcome to Module 3, Newborn Care. In this module, I'm going to walk you through your baby's first three months: what to expect in terms of their appearance, their development, and the best ways to look after them in the first three months.

We'll also cover the basics of feeding your baby, the basics of soothing a fussy baby, the basics of baby sleep, and I'll do a quick wrap up.

So consider this your gentle crash course on Newborn Care. First, we'll go over the most important things to keep in mind when your baby arrives and as they grow, and then we'll talk about feeding, fussing, and baby sleep, the top three topics that people ask me about the most. So let's dive in.

Okay, welcome to lesson one, your baby's development in the first three months. Here are some things to keep in mind.

Of course, to start off with, every single baby is different and normal newborn behavior encompasses a really wide variety of baby behavior. So focus on getting to know your own special baby and not so much on how your baby compares to other babies that you've met, or what the baby books are telling you your baby should be like. This is all about getting to know your baby and learning to listen to your own intuition.

All right, so I've broken this down into your baby's first week, their first month, and by three months.

So in the first week, I want you to try to remember that everything changes almost every hour. The things that are working in the first day or two might not work anymore, might need to be adjusted in the first week. Things are very fluid.

So try to go with the flow and try all of the things. And, remember, by all means, there is no such thing as a bad habit or spoiling a baby at this age. You're not setting yourself up for any kind of negative outcome by looking after your baby, by meeting their needs, by holding them, by feeding them. You, you can't… there's no such thing as a bad habit in a baby this age. Okay? So don't let anybody tell you different.

Some things to keep in mind about their appearance is that if you've never met a freshly newborn baby, you might be surprised by how little they are, or else by how chubby they are. It varies by baby, right?

They may have lanugo, which is a kind of like, a fuzzy downy hair on their shoulder or on their backs. This is perfectly normal. Most babies tend to shed it between 34 and 37 weeks in the womb. So if your baby is early, they're more likely to have lanugo. It's just something that they have in the womb.

Or milia, which is the little skin blemishes, little whiteheads that they have on their face sometimes. It's best just to leave them alone. They'll work themselves out as your baby adjusts to life on the outside.

You may find that your baby's head has an odd shape or not. My first baby had kind of a typical birthing head. His head was very elongated for the first day, whereas my second baby, her head was the most perfect little sphere, like a lovely little globe. And I don't know why that happened, but it can vary.

And it's also very common that your baby will have swollen genitals from the hormone surge that happens in you as the birthing parent. And that will also calm down in the coming days, especially in the first two weeks.

Your baby's appearance will change a lot, especially their skin color and their condition and their weight. And it will just shift and adjust and you'll have to go along with the flow.

In terms of your baby's development in the first, what did I say the first week? I want to talk about hearing, vision, and their communication, and reflexes.

So in terms of their hearing, it's completely fully developed. It's as good as it's ever going to be, but many babies still fail the newborn hearing test for several weeks after birth. And this is attributable to the fact that they were suspended in liquid for the last several months. And this is not usually something to worry about, but your labor and delivery nurses, or whoever's in charge of the hearing tests will let you know.

And a newborn’s sight is also very well developed, but their ability to focus is not yet, and their focus distance is limited to about 12 inches, which is the distance from your elbow to your face, which is great for engaging with your baby.

Their communication, your baby's ability to communicate in the first week is purely instinctual. They are not trying to communicate anything and they are not trying to get anything. Whatever sounds or attempts at communication they make are purely instinctual. So watch and learn, because there's a lot you can tell from a baby at this time.

And the important reflexes that doctors are looking for to make sure that like all parts of the brain are connected to all the parts of the body are the baby's grasp reflex, where if you put something in a baby in the palm of your baby's hand, their fingers will close on it.

Their step reflex: if you hold a baby up and set them on a table or a bed surface, they'll move their legs like they're going to walk.

The moro reflex, which is like a startle reflex. If a baby is on their back, they sometimes splay their arms out wide to catch themselves as if they were falling.

And their rooting reflex, where if you tickle their cheek, they'll turn towards the sensation, looking for something to eat, right?

And it's important to check that the reflexes are there at birth, in the first few weeks. But as your baby sort of adjusts to life on the outside, those reflexes will fade away and are replaced with other skills and abilities.

And here in the first week, here are some key things to pay attention to.

Notice, you don't have to track, but notice your baby's periods of quiet alertness and fussy times, and when they're sleeping. You will definitely want to track all their wet and dirty diapers, track them all. This kind of data helps your medical team, your providers, get extra information about your baby's feeding and how they're growing.

You might also want to track their feeding, the frequency, duration and amounts, if it's applicable, if they're drinking out of a bottle, for example. And again, this is useful data for your providers and for you as you learn your baby's rhythms. And your baby's weight will be tracked at every visit to their doctor but you don't have to track it at home.

The weight is an important part of the puzzle to determine your baby's health. But it's only a small piece, but it's the one that the doctors tend to lean on the most. And you should also know that most babies lose a little bit of weight in the week or so after they are born. The normal range is considered 5 to 10% of their body weight.

So if your baby is 10 pounds, they might lose up to one pound in the first week after birth. But more than that is a real cause for worry for doctors. So, just keep in mind that your baby's weight at birth may fluctuate in the first week or so, but after that, babies tend to gain really steadily and the amount becomes less important - how much they weigh becomes less important than their position on their own growth curve.

So probably about the second month of your baby's life, when they have their two month checkup. You will find, hopefully, one of the documents that you receive at the end of your pediatrician visit shows a growth curve like how your baby's weight has progressed on a graph.

And there will be a number of lines that stretch up that show what the spread of averages is for babies at that age. And wherever your baby falls, whether they're in the middle of all the babies that are weighed, and whether they're on the high end or on the low end, whatever line they're falling on, that is expected to be the line that they'll gain weight at, for the rest of their early years, which is more important.

It's more important that they stay close to that line than that you help them to gain more weight so that they're higher in percentiles.

Okay, so that's your baby's first week. What about your baby's first month?

Well, in the first month with your baby, you will start to see some sense of rhythm or predictability, but there's still a lot of uncertainty.

In the first month through the first four to six weeks, you must continue to be sensitive and responsive to your baby's needs, and there are still no bad habits or spoiling your baby.

You may find that if your baby was really sleepy at the beginning, they may be waking up more and more. Or if you have had a fussy baby through the first few weeks, then they may continue to be fussy, and that generally tends to peak around six to eight weeks.

And then after that, fussy babies tend to calm down quite a bit. This is an important time to learn your baby's rhythms and preferences and meet their needs. Hopefully your days are settling into a kind of a pattern that matches a sleep, feed, diaper change, and then another feeding, and another sleep - that kind of rhythm.

The days and nights should start to feel different between, you know, four, or five, six weeks. And you'll have a sense that your baby is growing, that they have quiet days, that they have hungry days, that they have restless days, or sleepy days.

And then by three months you'll start to feel more and more capable because you're able to better predict what your baby needs and you can start to implement a gentle routine or schedule. So by the time your baby is 10 or 11 or 12 weeks old, you might start to feel like you can make your baby wait for half an hour for a feeding. If that matches your sense of how the day is going to go. You can start to shape your days a little bit more according to what feels good for you and your family, instead of having to tend to the baby as the central engine of your day.

And at the same time, your baby will seem more sturdy and more happy. They'll be smiling more and be more engaging. Most babies are on track to double their birth weight by four months, so not by the end of three months just yet, but on track to go that way. And that's the fastest they will ever double their weight. So it's very impressive.

Many babies seem to settle down between 9 to 11 weeks. There's a lot less fussing going on, and they will start to react to you in a way that feels more deliberate, more like they're looking for your attention, and they're calling for you, which is not as instinctual as it was before.

And at that time, your focus will probably shift from feeding and fussing, because those things start to feel more normal and manageable, to things like rolling or teething or grabbing and finding a way to make your baby smile all the time.

So this is your mini crash course on your baby's development in the fourth trimester in the first three months.

And if you have any questions about these, make sure that you send me an email or make a note to ask your pediatrician or like your midwife or OB at your next appointment. All right, let's move on to the Basics of Feeding next.

Welcome to lesson two, the Basics of Feeding Your Baby, where I want you to keep in mind that what you feed your baby is not quite as important as how or, how often you feed your baby. But in this lesson I want to give you some of the practical things to keep in mind as you feed your baby, whether by breast or by bottle, with human milk or with the scientific marvel that is baby formula. Let's get into it.

Now, everyone's goal in the first week, first two weeks of your baby's life will be to make sure that the baby gains weight. It will seem like your doctor's only concern is whether the baby gained weight this week. And so this is one of the important things you're going to want to try to master for yourself.

And, yeah, as I started, saying earlier, that it can seem like your doctors can get kind of obsessed about it, but especially for parents of premature or small babies, it'll feel like a lot of pressure to make sure that you're feeding your baby plenty so that they can gain weight quickly. But even parents who have sort of big babies will be cautioned against overfeeding or feeding at every cry.

And it is very easy to let your baby's weight be the one thing that proves that you're doing a good job as a parent because your baby is gaining heartily and they're plumping up or they're reaching whatever weight milestone you have. That means you're doing a good job.

But, feeding your baby is not the only thing that matters. It's really important that you watch your baby and learn their cues and meet their needs, and that is it. And that sometimes means not feeding more if they don't need it or if you think that that's not the reason that they're unhappy.

So watch your baby, learn your baby's cues, and then meet their needs.

So what are your options for feeding your baby? Well, you should choose whatever feels meaningful, important, and easy for you. Whether that's human milk or formula, which is a cow or goat milk based milk. You can get human milk from yourself, from someone you know, from a trusted source or from a public milk bank at a lactation clinic or at a hospital for example.

But store bought formula is an excellent alternative and they're all really, really similar. But when your baby is very little, you'll probably want to start, if you're going to do formula feeding, start with the pre-made liquid, the bottles that already have liquid formula inside and switch to a powder that you mix with water later, like after four months.

And this has to do with the risk of the cronobacter bacteria in powdered formula, which is technically not sterile, the way that flour that you use for baking isn't sterile until it's been cooked. So to make sure that there's a lot less risk for your baby when they're the most vulnerable, under four months, use the pre-made liquid formula if you can.

And if you can't, if you are using powder early on, make sure that you mix the powder with water that is freshly boiled, that is fresh off the boil, hot, hot water for the powder at the beginning.

Now, how often should you feed your baby? Well, the standard recommendation is to feed your baby about every two hours and if you're breastfeeding, 15 minutes per side. And this is good general info, but you must learn to watch your baby for hunger cues.

And those cues might look like that they're turning their head from side to side, they're opening and closing their mouth, making sucking noises, or smacking their lips, sticking their tongue out, or sticking things into their mouth for sucking, rooting, where they respond really quickly to anything that sort of touches their face.

And then later on if they've been hungry for a little while, fussing, wriggling, squirming a lot, and then crying. All of those can be considered hunger cues. So watch your baby to see if you can learn the patterns of their behavior when they're feeling hungry.

All right. It is possible and also normal, that your baby will eat much more often than every two hours, and this is two hours from the beginning of the last feeding, not the end of the last feeding.

So, it's pretty common that your baby might be sending these feeding cues within one hour of starting their last feeding. Or maybe every 90 minutes after the starting of the last feeding. You should, early on, especially, feed your baby when they're hungry, okay?

And you can know that they are hungry through trial and error and instinct.

Now, it's also possible, and the source of conflict, that your baby might sleep for three or four or five hours straight in the first two weeks. But you still ought to wake them up to feed them at least every two hours, maybe two and a half or three hours until they surpass their birth weight or their doctor gives you the go ahead to let them sleep.

Otherwise, there's a risk that they won't have the energy to wake up more to eat more. And it's true, really, the the biggest goal in the first two weeks is to make sure that your baby is gaining weight well, that feeding is going well, and that means in those first two weeks, you should not let your baby sleep for four or five hours at a time, even if they want to, at least not more than once a day.

If they have a four hour stretch overnight, okay, maybe, but you must feed them at least every two hours in those first two weeks until they have surpassed their birth weight or your doctor says it's okay.

And then, since breast milk is created based on demand, a baby who is suddenly cueing to eat more often is likely helping to boost your supply of breast milk for a growth spurt that's coming up.

So it's totally possible that they seem more hungry, not because you don't have enough milk, but because they are causing more milk to be produced. They're in the process of boosting your supply for themselves. So don't fear about that.

And at the same time, don't be in a hurry to get your baby on a feeding schedule. Instead, watch your baby and learn their cues and meet their needs. And again, this is mostly through trial and error and instinct. Yep.

All right. How much should you feed your baby? Well, babies start out needing very, very small amounts because their stomachs have never had food in it before, right? So for the first three days or so, they might drink an ounce or less at every feeding.

By the end of the first month, they might be drinking, if they were drinking from a bottle, four ounces at a time. And if they're feeding every two to three hours, especially in those first two weeks, that means they need 8 to 12 feedings per day, roughly. And that means that by the end of the first month, you're working your way up to about 32 ounces or one liter of milk per day.

Breast fed babies tend to nurse more frequently than formula fed babies. But when breast fed babies are fed by bottle, the biggest bottle that they receive at a time is almost always four ounces all the way through six months. And this is different from formula fed babies.

Typically, formula fed babies go longer between feedings. So even a bottle fed baby who's receiving breast milk will probably want to eat between every two to three hours, whereas a formula fed baby who is getting milk from a bottle can probably wait more like four or sometimes five hours between a feeding.

And on top of that, the amount of milk in a bottle, the amount of formula in a bottle increases as the baby grows. So this can go up to eight ounce feedings up to six months. Whereas if a baby is drinking breast milk from a bottle through six months, they will probably top out at four ounces and will not drink six or eight ounces of breast milk at a time.

All right, let's talk about how to feed your baby. This is mostly for breastfed babies. These first five bullets are for breastfed babies, for nursing, especially, when feeding by bottle is the last one.

Okay. So there's five very common positions for feeding your baby and you might very naturally and normally adopt one of these.

And so some of these alternatives are really good if you've had a c-section, for example, you might want to use one of the alternatives. Or if you find that your baby swallows a lot of air, you might want to try a different position.

So in the cradle hold: prop your baby's head on your elbow and you feed your baby that way.

For cross cradle: your hand on the one side is supporting your baby's head on the other, and your other arm is supporting your baby's back and bum.

For the football position, the football hold, you hold their legs out behind you and their belly is facing your ribs and their face is next to your breast to feed them. And that can be really good for parents who are recovering from a c-section.

For laid back feeding, you recline way back in your bed or on the sofa or whatever, and you lay the baby on their belly on top of your belly and you feed them when they're more upright.

And for the side lying position, you lay down on your bed, on your side and lay with your baby belly to belly, on your side, on their side so that they can feed there.

But when you're bottle feeding your baby, the best position for your baby is a more upright position versus a more laid back feeding. So don't lay your baby way back until they're lying down flat and feed them because the flow of the milk might be too fast and you might not even really be able to tell.

So it's better to help your baby learn to signal to you when they need a pause or not, by keeping them more upright when they're feeding.

So how do you offer your baby a feeding session? Well, when nursing, when you're starting a nursing session with your baby, you can offer your nipple first on their lip or on their cheek and insert when your baby's mouth is open wide, like really, really wide, because you want the nipple to go way at the very, very back of their mouth. And you can sometimes help this when you're holding your baby by pulling their chin down so that their mouth opens really, really wide.

To help them get a really good latch, it's also helpful to flange your baby's lips out so that their lips are all the way out and not squished in.

And a deep latch for breastfeeding is vital for less pain, maybe no pain, when you're nursing.

When you're bottle feeding, it's very similar. Offer your baby the nipple first by tempting them, I guess, on their lips, and try to hold the bottle of formula or bottle of breast milk horizontal while your baby is more or less upright and then lower the bottle every minute or two to check in with your baby if they'd like more. It's a nice way to communicate with your baby and give them a little bit of control.

So I've included this note to pause and burp your baby about halfway through and again at the end. But this common advice is shifting.And we're not sure where that's going just yet. So I've left it in here.

And then after a feeding, it's very common that some babies immediately need a clean diaper. It's like the feeding cues, the need to void, and then you need a clean diaper. But many other babies also just settle down for a nap right away.

Just follow your baby's lead and help provide their needs.

All right. And then the last part of this lesson, I want to focus on troubleshooting some common feeding problems. And, we're going to start with the baby struggles and then we'll talk about parent struggles.

So one of the common struggles that babies face is that they can't seem to stay latched. And you'll notice this is happening if there's a clicking sound when your baby is nursing. This is usually a sign, maybe a sign of a tongue tie. It's often accompanied by more pain for the nursing parent. And sometimes your baby seems to be slow to gain weight because the feeding isn't as efficient. Your baby's not getting as much milk as they could be for the amount of time that they're spent latched.

Sometimes babies seem uninterested or too sleepy to nurse, and a good solution for this is to spend some time with no clothes in the bed with your baby. And that will generate a lot of oxytocin for your baby and for yourself. And usually that inspires a baby to start nursing more.

if your baby struggles to keep up with a strong letdown, if your breasts eject a lot of milk very quickly, consider pumping or hand expressing before feeding so that you have a letdown, catch the extra milk, and then offer your baby a chance to nurse after that letdown has slowed down

And sometimes babies struggle with spitting up, and normal amounts can vary quite a lot.

Like cute wet burps to spit ups that are caught by a burp cloth, or even copious spit ups, where like the milk seems to come out of your baby's nose and you have to change their outfit several times a day. This too can be considered normal. And you know, if your baby's gaining weight well and seems otherwise happy during or after a feeding it might not impact their health at all, but definitely bring it up with your doctor if you're worried about it.

Now for parents who are breastfeeding, the struggles are slightly different that you might be dealing with.

One of the common ones is engorgement, where your breasts feel very swollen and very hard, and this is usually a sign of an abundance or perhaps an overabundance of milk. And you can ease the pain of engorgement either by feeding your baby right away, maybe it's been a little while, or by hand expressing a little, or pumping a little bit to replace a nursing session.

But when your breasts are full, like even when they're very engorged, this slows milk production. So you've got to decide, are your breasts engorged because, like your milk has finally come in, because you are only starting out on your breastfeeding journey, or are they continuing to be engorged for many weeks after you've sort of gotten into a good rhythm with feeding your baby?

Because every time you empty your breasts, there are signals sent to your body to produce more and more milk, which is useful for your baby. But if you empty your breasts more often, than your baby is fed, like if your're pumping in between, then your body will continue to make more and more milk until you're producing enough to feed twins, for example.

And if that's not what you're after, then you want to try to give yourself some extra time with a full breast on one side maybe, to slow the milk production. And I think that usually the strategy that's recommended for that is called block feeding. But if you're dealing with engorgement and it's really, a serious struggle for you, definitely get in touch with a lactation specialist

Here on this side, I also mentioned leaking or a forceful letdown, just like on the baby's side, and this is much more common early in postpartum. And you can use burp cloths or reusable or disposable nursing pads or even milk collection devices like a haakaa pump to catch the leaking milk. It should ease off several weeks in.

And then, pain is the most common, I think, of parents' struggles when they're breastfeeding. There are some breastfeeding experts that insist there should be no pain when your baby's latch is good, but I would estimate that like 98% plus of parents describe some kind of nipple pain in the first week or two of breastfeeding, but that it usually lasts just for the first minute or two after latching.

If you have persistent or lasting nipple pain, that would be a sign, a clear sign that your baby's latch is not efficient, that it may be shallow, or that maybe there's a lip tie or a tongue tie that's keeping your baby from getting a really like a tidy deep latch, and the best way to treat your sore tender or cracked nipples is with fresh air, with breast milk some people claim, lanolin, or silverettes. Silverettes are little… they're like little disks made of pure silver, with antibacterial properties, and they can be nice and cold and soothing on your damaged and tender nipples.

Another kind of pain that you may experience when you're breastfeeding, if you have sharp or hot breast pain that might indicate a yeast infection or thrush on your nipple, which is usually also in your baby's mouth, or a plugged duct, or worst case, mastitis.

Make sure that you get in touch with your care provider right away if you've got red breasts, hot patches, or sharp pain because you definitely need to get some medical care right away, especially in the case of mastitis. Usually that's followed by a very sudden fever and intense fatigue, so you don't want to put off getting help for that.

I also wanted to mention the much less common, aversion to nursing called D-MER, which is also known as the dysphoric milk ejection reflex.

So if you happen to feel like, instead of calm and peace and sweet, lovely feelings when you're nursing your baby, you feel your skin crawl, your toes are curling, or if you feel kind of ragey when you're breastfeeding your baby, this is a sign of the dysphoric milk ejection reflex, where nursing leads to a huge drop in dopamine instead of a huge boost in oxytocin. And if this happens, please don't feel guilty. Don't try to wait it out. Don't force yourself to breastfeed, talk to your doctor and make a new plan because it is a real thing.

I hope I've given you a pretty good overview here of what to expect, and how to handle feeding your baby.

Please do make sure you talk to your doctor and your partner. Gather your supplies and talk to your birthing team, and reach out to me if you've got any other questions about feeding your baby. I look forward to chatting with you at the Q and A about this.

Welcome to Lesson Three, the Basics of Soothing. Now, it is totally possible that you'll have a super chill baby who sleeps for 14 or 16 hours per day. But if you happen to have a normal baby, here's all my best advice for keeping yourself calm and soothing your fussy baby. I myself had a fussy baby for my first born, and so I hope that this helps you.

All new parents need help looking after their babies. But parents of fussy babies especially do so if you have a baby that seems to cry or fuss or be restless a lot more than the average baby, try to find a way to get comfortable with saying “Yes, please!” when someone offers help and book people in to help you.

So firstly, how much fussing is normal? Well, most babies have predictable periods of normal fussiness where your baby will communicate some kind of discomfort. You fix the problem and the baby is happy.

It's also normal that your baby fusses and squirms and cries, and that you do like active soothing to make your baby feel better for 30 minutes or 60 minutes or 90 minutes, and then your baby will settle down.

It's also normal that you have evenings that are filled with this fussy period, which is called the witching hours. Usually this peaks between six to eight weeks and then fades away.

Another way that, providers have started to sort of categorize or label this peak fussy period, which is still normal and not considered outside of normal is to call it PURPLE crying. PURPLE stands for Peak. The P stands for Peak, where the fussiness seems to Peak around eight weeks, that the crying is Unexpected, that it Resists soothing, that it looks like your baby is in Pain. The crying Lasts a long time and it tends to usually happen in the Evening.

And this PURPLE crying is a label that has been applied more and more lately as an alternative to colic, which is also unexplained, long-lasting crying, somewhere between two to four months, lasting two to four months, and this has largely replaced the 3-3-3 framework where if your baby cries for more than three hours a day for more than three days a week for three weeks or more, then usually we would say, your baby probably has colic and you can try some of these, I don't know, solutions, I guess, but there's no cure. There's no fix for colic because it doesn't describe a medical problem as far as we know.

But even this three hours a day, three days a week for three weeks or more is the far end of what is considered normal. Fussing that is beyond normal usually comes with other symptoms, along with your baby's fussing.

And when I say fussing, I usually mean crying, and like restless tension, squirming, unhappiness. If this is also accompanied by frequent or violent, spitting up, if your baby shows signs of discomfort during or immediately after feedings, like they have an arched back, or you notice that they have a gassy belly, if there is blood in their stool, in their diapers, or if they're very slow to gain weight, then this is a fussing that needs to be dealt with with your doctor right away.

If you've got a normal fussy baby, some of the most common tips for soothing a fussy baby are Harvey Karps, five S's. These are five techniques that you can use to sooth your fussy baby, but try to commit to each one for about 10 minutes. Use them in combination if you can, but don't switch them out too often or you'll just confuse and frustrate your baby.

So the five S's are:

swaddle your baby

swing your baby, like motion rocking them

shushing, sh sh sh, sh. Or use a, like a white noise machine, or you might hear, use a hair dryer or a vacuum cleaner or set them next to the, like the dryer, some kind of white noise seems to sooth normal, fussy babies

side lying or stomach lying, but I want to emphasize in your arms only! If you lay your baby on their belly on top of your forearm, sometimes that pressure on their stomach can soothe their fussing, but do not, do not put them on their belly, in their bed.

And sucking is one of the soothing techniques that seems to work, which is why we have pacifiers, right?

But here's some more ideas. So get creative. Do what works in the early weeks with your baby,

You should consider hanging out outside or go near a window in your house.

Wear your baby in a baby carrier. Baby wearing is one of the most common ways to soothe a fussy baby because your baby wants to be, usually, held by you.

You could take a long warm bath together if your baby seems to like that.

You can go for a drive. I have a friend who took their very fussy baby for a long, slow drive around their neighborhood and somebody called the police and said, “There's a stranger driving circles around my house” and it was my poor friend, trying to soothe his fussy baby.

But a nice slow drive might be just what your baby needs.

You can make or play music. Your baby might like that.

And aim for shorter awake times. So sometimes fussy babies are fussy because they've been awake for too long, and you should try to aim for about an hour of awake time. Definitely less than 90 minutes in the first 10 weeks.

And it might seem like there's nothing you can do to make your baby go to sleep, but keeping them awake longer probably won't help either. So I wouldn't use that as a fallback.

So To Do here at the end of this lesson: make sure that you have or have plans to acquire a swaddle, a white noise machine and a baby carrier so that you can soothe your fussy baby when they're having normal, fussy times.

All right, see you in the next lesson.

Hello and welcome to lesson four, the last lesson in the Newborn Care Module, the Basics of Baby Sleep. I'm going to run you through, real quick, what's normal, what's possible, how to plan for safe baby sleep, while you hear my daughter enjoying her playtime upstairs.

Okay, so what's normal for baby sleep?

It is very easy to wonder what you could possibly be doing wrong when your newborn never sleeps more than two hours straight at night, if they'll only nap for 20 minutes at a time during the day, if they wake up the moment you put them down in their crib or bassinet, if they will really only sleep after they've been fed, or if they’ll only sleep on you.

But all of the above are totally normal newborn sleep behaviors. And it's true that some babies do sleep more, and there are parents who insist they've done things that help their babies sleep more. But the truth is that newborns don't sleep like adults. And this is why you will need help during the earliest weeks with your baby.

So in this lesson, I'm going to run you through, real quick the characteristics of newborn sleep and how that changes in the first 10 weeks or so. And then I'm going to give you a quick look at what's considered safe for baby sleep and how to practice safe baby sleep.

Okay, so newborn sleep at the beginning is very chaotic. Babies have very immature circadian rhythms. That means they have no concept of a 24 hour day, and in fact, their bodies don't produce any melatonin. And this means that their sleep can consist of long and short periods, and they can be awake for a long time or not, and there just doesn't seem to be any rhyme or rhythm to it.

That's normal. You should still, however, offer an opportunity for your baby to sleep about 60 minutes after they wake up, much through the first six weeks or so of their life.

The sleep environment for a newborn is irrelevant. Wherever your baby's safe sleep happens is almost certainly fine. It's possible that your baby is not affected by light or dark, by noise, or by any kind of motion. So take whatever sleep you can get.

In terms of sleep shaping it, that, it's very ambitious. At this stage, I don't think there's much you can do to shape your baby's sleep. You should do what feels sustainable to you and not worry about any kind of bad habits that you're setting through the first eight to 10 weeks.

But there are, nevertheless, some newborn care specialists or night nannies who will promise that they can get your baby on a proper nap schedule and get you 12 hours of uninterrupted sleep by 12 weeks of age. But this is not realistic for the majority of parents, and it's not realistic or even healthy for the majority of babies. So this is not something to aspire to and feel like you're failing if your baby doesn't sleep 12 hours overnight by 12 weeks.

By 10 weeks, however, by the time your baby is about like 10 to 12 weeks old, the timing of your baby's sleep should be much more predictable. You'll start to notice your baby's sleepy cues.

Their naps may still be long or short, and hopefully by now your overnights include a long sleep stretch of four to six hours. You should continue to offer your baby an opportunity to sleep about 60 to 75 minutes after they wake up. Not really 90 minutes until after four months of age.

In terms of their sleep environment, you can support their developing circadian rhythms now by offering them sleep in a dark room with white noise, probably.

Keep your nighttime wakeups dark and boring when they need to eat. Change a diaper for example. Don't take them out into the light, and don't offer them an opportunity to play during the night. You want to start separating day and night for sure.

And you can start working toward a simple sleep routine that consists of something like a feeding, a diaper change, wrapping up in a swaddle, having a snuggle together, singing a song - whatever feels natural for you, but try to keep it in the same place before the every sleep so that the place itself becomes a cue for sleep for your baby.

And after 10 or 12 weeks or so, sleep shaping becomes possible depending on your energy and comfort levels, but you should do what works through this time as well.

It's possible to slowly and gently offer less help when your baby is falling asleep and see what happens. Your baby might be willing and ready to pick up on those cues.

In terms of safe sleep, the AAP recommends using a firm flat sleep surface that's free of blankets, bumpers, toys, and strings in the parent's room for the first six months.

But there is some bed sharing that is considered safe. After all, a majority of families who are not white, Western, or affluent use a family bed. So if that's something that appeals to you, that like calls to you, consider the following information as a way to prepare for whether or not you'd like to bed share with your baby.

The book Safe Infant Sleep by Dr. James McKenna and La Leche League International's Safe Sleep Seven are both excellent resources to explore. And I want you to understand that Dr. McKenna's research shows that intentional, thoughtful, and prepared bed sharing eliminates almost all of the risks that are associated with unintentional, unprepared, or chaotic bed sharing.

And both sources, Dr. McKenna's research and also La Leche League emphasize that you should bed share only with a willing and aware parent, on a safe sleep surface, so not with older siblings or pets, not with your auntie, and that since formula feeding does continue to be a risk factor for SIDS, Sudden Infant Death Syndrome, to only bed share if your baby is all or mostly breastfed.

I want to wrap this baby sleep section up with a quick chat about SIDS and suffocation because the data for SIDS and the data for suffocation deaths used to be combined for a long time, and this has led to the more like really narrow, restricted, safe sleep recommendations from the AAP.

But I want to emphasize that SIDS or sudden unexplained infant death syndrome is unexplained. It is not well understood at all. There's some suspicion that it has to do with how deeply babies sleep, or their ability to wake up maybe, or oxygen levels. But there are no clear causes. There's nothing concrete connecting SID'S deaths with any kinds of behaviors.

But there are risk factors. That means this small list of factors are found in pretty much all households where there is a SIDS death and almost always in some combination.

And these are the things that you may be able to control or not, right?

Usually there is smoking in the household. Almost always the baby is formula fed. Babies younger than four months old are much more vulnerable and then the risk declines very steeply after four months. The baby is almost always sleeping on their belly, and there's usually a little bit of overheating, like the room is too warm, or the baby's overdressed.

We don't know how these factors lead to baby's inability to wake up. All we know is that these factors almost always seem to be present.

What we do understand though, is suffocation, and these are the things you absolutely can control.

Do not fall asleep with your baby on an armchair or a sofa. That's a huge risk factor for suffocation. Avoid gaps or spaces in your baby's sleep surface, like between their mattress and their crib. Or if you're a bed sharing between the mattress and the wall, for example, or your bed frame. Avoid loose sheets or blankets or swaddles that can get tangled around your baby. Don't use crib bumpers and don't leave any stuffed animals or lovies or anything like that in your newborn's, bassinet or sleep space.

Avoid using Dock-a-tots or padded co-sleepers or infant loungers or like baby nests for sleep. They're fine for awake, active, alert time, but not for sleep. And also avoid using swings, bouncers, baby rockers, or car seats that aren't clicked into their car seat base for sleep. And this has to do with the incline on the car seat.

Okay, so these are some things to keep in mind for safe baby sleep. Do accept though that your newborn’s sleep will feel very chaotic for several months. So make sure you set yourself up for some help and talk to everyone who will look after your baby about safe sleep. And for sure, shoot me any questions that you have and remember that there is help for you and your very restless baby. Chat soon!

All right, let's wrap up the newborn care module by going over the to-dos from each of the lessons to make sure that you feel totally ready to meet your baby and look after them. There's a lot that we covered, but you can come back to look at this section any time.

What you should try to do before we hop into the next module is find a pediatrician, talk to your doctor's office about whether you need to connect with a pediatrician before you give birth. Make a plan for how to feed your baby. Gather the supplies that you're going to need for feeding your baby. And grab your basic baby soothing supplies like a baby carrier, white noise machine, that kind of thing. Set up your baby's safe sleep space and discuss safe baby sleep with all your baby's caregivers, yeah?

And then attend our next Q and A call. You can go to the website to find out when the next call will be. I'd love for you to join us so you can ask your questions and share your stories and make sure that you are feeling totally ready to meet your baby in the next couple of weeks.