PDF Summary:Baby 411, by Ari Brown and Denise Fields

Parenting a newborn comes with many unknowns — from hygiene routines and health checkups to sleep habits and developmental milestones. In Baby 411, pediatricians Ari Brown and Denise Fields break down the essential knowledge all new parents need to care for their baby during that pivotal first year of life.

This comprehensive guide offers expert advice on everything from bathing to breastfeeding and addresses even the most niche concerns like managing preemie sleep schedules. With medically-backed practices and straightforward solutions, Baby 411 provides new parents the reassurance and preparedness they need for their infant's healthy growth and development.

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Other Perspectives

• While it's generally true that babies' appetites increase as they develop, this is not a uniform rule; some babies may experience periods of decreased appetite due to illness, teething, or other factors.
• While growth spurts are often observed at three weeks, six weeks, and three months, they can also occur at different times for individual babies, as each child's development is unique.
• Stress, poor nutrition, and dehydration can affect a parent's ability to produce milk, so simply relying on demand may not be sufficient for all individuals.

Addressing Concerns When Baby Drops On Growth Charts

Should you be alarmed if your infant's growth numbers are changing on the charts? Dr. Brown discusses why drops on the growth charts sometimes occur, and when it's necessary to worry. She advises, "Infants given solid food prior to drinking a full 25-30 oz of calorie-rich breastmilk or formula a day often see drops in their growth percentiles since they're substituting energy with lower-energy foods." This typically happens between ages four to six months, when many parents begin experimenting with solid food.

The other scenario in which a baby drops percentiles on growth charts is when they're finally showing what their true, "genetically-determined" growth patterns will be. It's very possible for a big baby to have regular-sized parents, and by nine months, they start to plateau on weight percentiles, resembling their parents more than during infancy.

Other Perspectives

• Breastmilk and formula intake can vary widely among infants, and some may thrive on slightly less than the 25-30 oz mentioned, so a one-size-fits-all approach to the volume of liquid nutrition may not be appropriate for every child.
• The timing of introducing solid foods can vary greatly from one infant to another based on individual readiness and parental choice, which means the drop in growth percentiles could occur earlier or later than the four to six-month range.
• The concept of a "true" genetically-determined growth pattern can be misleading, as it implies a predetermined path that does not account for the dynamic interplay between genetics, environment, and individual health factors throughout development.
• The idea that a big baby will plateau by nine months may not account for variations due to environmental factors, health issues, or nutritional differences that could affect a baby's growth trajectory.

Deciding Whether to Give a Baby Vitamin Supplements

Should you go to the pharmacy and buy vitamins for your newborn, or wait until your doctor recommends them? Dr. Brown and Fields advise that the only vitamins nearly all infants need during their initial year are iron and D.

Vitamin D: All babies need a daily dose of 400 IU Vitamin D supplements, beginning soon after birth. This is because human milk does not contain adequate amounts, and most babies are not exposed to enough sunlight for their bodies to generate Vitamin D naturally. The AAP suggests using the drops, not the capsules.

Iron: Determining whether your child needs iron is somewhat more complicated. Babies who drink formula receive enough iron because their the formula contains iron. Preterm babies also need iron supplements. If you’re exclusively breastfeeding and haven’t begun feeding your baby iron-rich foods by the age of four to six months, they'll also need an iron supplement.

Other Perspectives

• While Dr. Brown and Fields suggest that iron and Vitamin D are the primary supplements needed, some experts may argue that certain circumstances could necessitate additional supplementation, such as vitamin B12 for infants of vegan mothers.
• Not all babies may require the same dosage of Vitamin D; individual needs can vary based on factors such as skin pigmentation, geographic location, and the amount of sunlight exposure they actually receive.
• Breast milk is designed to be the perfect food for infants, and it naturally contains many of the nutrients that a baby needs in the first six months of life, including a form of iron that is highly bioavailable, which might reduce the necessity of iron supplements for some exclusively breastfed babies.

Recognizing Obesity Symptoms

Dr. Brown acknowledges that "babies can overeat." "If you use a bottle to feed your baby, it's critical for you to watch how you feed your baby," she says. "Hold the bottle horizontally to mimic how milk comes out of the breast. If not, your baby will gulp the milk and not self-regulate." She also says parents should limit the number of hours babies spend sitting in bouncy seats, swings, and recliners -- all these "containers" limit activity and reduce calorie expenditures.

The other problem is providing too much food to comfort a baby. "A lot of babies are fussy simply because settling down as a newborn. If you consistently offer food whenever your baby fusses, it leads to obesity." Dr. Brown advises caregivers to consider when your infant last fed and how much weight they’ve gained before offering food as a method of soothing. She also explains that "the ideal way to determine whether your baby is overweight is to watch their weight percentiles on the World Health Organization growth chart."

Context

• Recognizing a baby's hunger and fullness cues is crucial. Signs of hunger include rooting, sucking on hands, or lip-smacking, while signs of fullness might include turning away from the bottle or losing interest in feeding.
• For mothers who are transitioning from breastfeeding to bottle-feeding, this technique can make the process more seamless for the baby, as it mimics the natural breastfeeding experience.
• Babies need opportunities to move freely to develop motor skills and muscle strength. Limiting time in stationary devices encourages activities like tummy time, which promotes physical development and energy expenditure.
• Consistently overfeeding can affect a baby's metabolism, potentially leading to a higher risk of obesity later in life as their body becomes accustomed to processing excess calories.
• Caregivers can explore other soothing methods, such as rocking, singing, or using a pacifier, to comfort a fussy baby without immediately offering food.

Providing Your Baby With the Right Amount of Calcium, Iron, and Fiber

Once your baby reaches six months to a year, they'll need more nutrients than milk or formula can offer.

Calcium: Babies from birth to twelve months get enough calcium from breast milk or formula. But once they turn one, Fields suggests giving milk or other calcium-rich food sources. These include green vegetables like broccoli and plant-based dairy alternatives.

Iron: Infants need 11 milligrams of iron each day. And because our bodies take in iron more efficiently from meat than from plant-based foods. Fields suggests offering meats, eggs, or beans when possible.

Fiber: Everyone can benefit from fiber! It aids digestion (regulating bowel movement frequency) and reduces the likelihood of heart disease. How much does your baby require? Well, the authors note that no official guidelines exist for babies younger than a year old. However, it's safe to assume that if your infant becomes constipated after adding solids to their diet, you should offer more! When a child reaches one year old, that amount increases to 6 grams daily. "Offering whole grain bread, beans, and produce is the simplest way to increase fiber," advises Fields, and prune puree remains a tried-and-true option for infants.

Context

• Introducing a diverse range of foods, including potential allergens like peanuts and eggs, can help reduce the risk of developing food allergies. Current guidelines suggest early introduction to these foods may be beneficial.
• While plant-based dairy alternatives can provide calcium, they may not always offer the same levels as cow's milk. It's important to check labels for calcium content.
• The body absorbs heme iron, found in animal products like meat and eggs, more efficiently than non-heme iron from plant sources. Combining plant-based iron sources with vitamin C-rich foods can enhance absorption.
• Consistent fiber intake is associated with a lower risk of developing various chronic diseases, including type 2 diabetes and certain types of cancer, due to its role in maintaining healthy body weight and reducing inflammation.
• Babies' digestive systems are still developing in their first year, which means they may react differently to new foods compared to older children or adults. This can make it challenging to establish universal dietary guidelines for fiber intake.
• Two kinds of fiber are soluble and insoluble. Soluble fiber dissolves in water and can help lower glucose levels and cholesterol. Insoluble fiber does not dissolve in water and helps food move through the digestive system.

Switching to Solids and Managing Hunger Strikes

Once a baby turns one, they should regularly consume solid foods. Ideally, they'd join their families for dinner, eating the same meals. As Dr. Brown explains, "a baby gradually drinks less calories (from breast milk or formula) while their calorie intake increases." That's why, when infants are initially given solids, they think of those foods as snacks in between their liquid meals. And once a baby reaches nine months of age, some of those liquid meals get replaced by the solid ones.

What if your baby decides not to eat? Don't worry. Dr. Brown points out that "all humans (including your fussy toddler) experience hunger—that urge that prompts us to consume food when we need fuel." Your child is simply exercising their newfound independence. If your infant is skipping solid food meals, provide only a few choices. Avoid a power struggle— the best thing is to move on and wait for a later meal!

Context

• By the age of one, most babies have developed the necessary motor skills, such as the ability to chew and swallow more complex textures, and have the hand-eye coordination to feed themselves.
• Regular family meals provide a consistent routine, which can be comforting and help establish healthy eating patterns.
• Transitioning to solids encourages the development of self-feeding skills, such as using fingers or utensils, which are important for independence.
• Parents are encouraged to offer a variety of foods to help infants develop healthy eating habits and preferences, even if the initial intake is small.
• It's normal for toddlers to assert independence by refusing food, as this is part of their cognitive and emotional development.
• Pressuring a child to eat can create negative associations with mealtime, leading to long-term aversions. Keeping mealtime positive and stress-free is crucial.
• Healthy snacks can supplement nutrition if a child skips a meal, ensuring they still receive necessary nutrients throughout the day.

Sleep

In this part, Dr. Brown and Fields explore babies' sleep, including its science and how to establish healthy sleep habits. They also cover those hot button debates like co-sleeping and the crying method, along with our favorite topic, how to get your baby to sleep.

Understanding the Biology of Sleep and Rest Cycles

First things first. Dr. Brown astutely notes that the way infants sleep differs from adults. Adults have more extended sleep cycles (about 90 minutes long) that get consolidated into a single period at nighttime. Infants have much briefer sleep cycles (about 60 minutes in duration) and can't self-soothe and calm themselves when those cycles end. They additionally have to contend with a new time zone with longer daylight and darkness than they're accustomed to. This circadian rhythm, combined with immature neurologic systems, are the main reasons why newborns sleep 14-18 hours a day but rarely for longer than three to four hours at a time.

Practical Tips

• Use a white noise machine with a feature that allows you to program changes in sound volume correlating with the time of day or night. This can help your infant associate different sound levels with day and night, aiding in their adjustment to the new time zone's daylight and darkness cycles.

Other Perspectives

• The consolidation of sleep into a single nighttime period is a cultural norm in many societies, but not universal; some adults in different cultures or with different lifestyles may have biphasic or polyphasic sleep patterns.
• The duration of sleep cycles in infants can vary, and not all infants may have sleep cycles that are exactly 60 minutes long; there is a range of normal variation in sleep cycle length.

Creating a Nighttime Routine

During your infant's first two months, it'll feel like you've entered "survival" mode, and when it comes to getting everyone some shut-eye, you'll probably use whatever works—rocking, feeding to sleep, driving around town, etc. You might not expect this, but it's perfectly endorsed by the authors. Don't worry about overindulging your baby or establishing bad habits. "Babies aren't yet capable of pulling it together and calm themselves, so you'll need to take over for a bit," explains Dr. Brown.

But, as your infant ages, you should establish a routine that allows them to fall asleep independently, using their newly acquired self-calming techniques. Dr. Brown advises starting a short, relaxing sleep ritual once the baby reaches four months old. Maintain consistency, and use a consistent routine for sleep, whether it's naptime or bedtime (that is, bath, book, rocking chair/cuddle session, lights out). And prepare to gently assist your baby in the initial weeks as they go through the transition. Being patient is critical here!

Context

• Establishing a sleep routine early can have long-term benefits, including better sleep habits in childhood and beyond, contributing to emotional and physical well-being.
• A bedtime routine can also serve as a special bonding time between parents and the baby, strengthening their emotional connection through activities like reading or cuddling.
• While consistency is key, it's also important to be flexible and adapt the routine as the baby grows and their needs change, ensuring the routine remains effective and supportive of their development.
• Parents play a crucial role in guiding their baby through this transition by providing comfort and reassurance, which helps the baby feel secure and supported.
• Establishing a routine takes time and consistency. It’s important to remember that progress may be gradual, and setbacks are normal.

Choosing to Co-sleep or Not

Few topics concerning raising children create more controversy than bedtime habits. To clarify, the authors do not pass judgment on families who choose to allow their babies to share their bed. "It's completely a parent choice," says Fields. However, the authors acknowledge that infants have a higher chance of SIDS (Sudden Infant Death Syndrome) and Sudden Unexplained Infant Death (SUID) when they're without their own safe sleep space. This is why they strongly encourage parents to follow the American Academy of Pediatrics recommendations of room-sharing, but NOT bed-sharing.

What about families that follow "attachment-based" parenting? Fields notes that Dr. Sears, the guru of attachment parenting, "feels it's focused on fulfilling an infant's needs and not dictating the sleep space." While the authors don't object to this approach, it's wise for couples to consider how they sleep when making those decisions. And putting a child in their own sleeping space can extend the period before a baby sleeps all night, which can cause marital tension. No worries. We'll help you establish those practices in a later section.

Context

• Ongoing research aims to better understand the causes of SIDS and SUID, with studies focusing on genetic, environmental, and developmental factors. Statistics show a decline in SIDS rates with increased awareness and adherence to safe sleep practices.
• In some cultures, bed-sharing is a common practice and is integrated into traditional child-rearing methods. However, the AAP's guidelines are based on studies primarily conducted in Western contexts, where different sleeping environments and practices may influence risk factors.
• While attachment parenting has many supporters, it also faces criticism for potentially placing too much pressure on parents to be constantly available, which can lead to burnout. Advocates argue that it fosters a deep, trusting relationship between parent and child.
• Each partner may have different sleep needs or preferences, such as one being a light sleeper and the other a deep sleeper, which can influence the decision to co-sleep.
• Guidance could include how to create a safe sleep environment for the baby, such as using a firm mattress, keeping the crib free of soft toys and loose bedding, and ensuring the room is at a comfortable temperature.

Dealing With Unique Sleep Issues in Infants

Lack of sleep can be truly torturous, particularly with a newborn who sleeps for only a few moments, eats for an hour, and then needs walking around, bouncing, and singing to go back to sleep for another few moments. While Fields advises new parents to "relax and not stress" about spoiling the baby with constant holding and attention, it's useful to keep a few quick tricks up your sleeve for those early days. She says, "swaddling, using a front carrier to carry your baby, taking a car ride, or allowing them to suck on a finger or pacifier will all encourage self-soothing."

Other Perspectives

• The use of the word "torturous" could be considered insensitive to those who have experienced actual torture, as the challenges of parenting, while difficult, are not equivalent to the severe physical and psychological pain associated with torture.
• Not all newborns require an hour to eat; some may complete feeding more quickly.
• Some parents may find that their own stress levels are reduced when they are more attentive to their baby's needs, as it can decrease the frequency and intensity of the baby's crying.
• While swaddling can be comforting for many infants, some babies may actually feel restricted and become more agitated when swaddled, preferring more freedom of movement.

Developing Sleep Patterns for Your Growing Child

Newborns, with their developing nervous systems and dependence on their mom's body, are the exceptions to the "rule" of letting your baby drift off to sleep independently—but as they age, their sleep needs decrease and they develop the ability to self-regulate (finally). When your baby reaches four months, it's an ideal time to teach them how to doze off (and return to sleep after each sleep cycle) without your help.

Follow your sleep schedule and lay them down while they’re calm and awake. Expect some initial pushback! They've grown accustomed to specific habits that involve you. Dr. Brown says, "give them about ten minutes to see what they can do. You will use the monitor to hear them chatting with their stuffies. And they might even fall asleep. If they can’t relax, do a quick check-in -- try patting their back or singing -- but avoid those sleep crutches, like nursing to sleep." This will become easier as your infant ages. By 6 months, your infant should be capable of self-soothing, with some assistance from you, their caregiver.

Context

• The presence of the mother provides a sense of security and bonding, which is crucial for emotional development and can influence sleep patterns.
• Developing self-regulation skills early in life can lead to better emotional and behavioral outcomes as children grow, impacting their ability to handle stress and interact socially.
• Approaches to teaching self-soothing can vary widely across different cultures, with some emphasizing more parental involvement and others encouraging independence earlier.
• Ensuring that babies are calm before laying them down helps prevent overstimulation, which can make it harder for them to fall asleep. A calm environment supports the natural winding down process necessary for restful sleep.
• Babies cannot verbally express their discomfort or confusion about changes, so they may cry or resist as a way to communicate their feelings.
• Around six months, babies begin to develop better emotional regulation, which helps them manage minor distress and settle themselves back to sleep.

Avoiding Common Mistakes That Disrupt Sleep Patterns

Dr. Brown emphasizes creating the CORRECT routine from the start -- "otherwise, sleep training will involve breaking bad habits, and it's a more emotional challenge for both babies and parents."

Which parental errors are most significant? The three biggest mistakes are:

1. Sneaking baby into bed. If your infant always dozes off in your embrace and is then put in bed, they'll be disoriented when they wake in a different location.

2. Drifting off to sleep during a feeding. Having a baby rely on nursing or taking a bottle in order to drift off to sleep will once more lead to problems when they wake and need that crutch.

3. Using a pacifier to fall asleep. Having a binky in the mouth during sleep creates a situation where your baby awakens at night when that pacifier is gone. You’ll have to replace it!

To avoid these pitfalls, Dr. Brown advises being a proactive parent. This means placing the infant in the crib when they're sleepy but not yet asleep. Offer soothing words and pats, and exit before they drift off to sleep.

Other Perspectives

• The emotional challenges of breaking bad habits can be seen as a natural part of parenting and child development, rather than something that must be avoided at all costs.
• The disorientation upon waking in a different location might be a temporary phase that babies can quickly outgrow as they develop spatial and environmental awareness.
• Rigidly avoiding feeding to sleep may not be practical for all families, especially if the baby has a strong suck-to-sleep association and other soothing methods are not effective.
• The risk of waking due to a lost pacifier might be outweighed by the benefits of pacifier use, such as reduced risk of SIDS (Sudden Infant Death Syndrome) as suggested by some studies.
• It may not be practical for parents who have multiple children and cannot dedicate the time to wait for each child to fall asleep independently.
• The method assumes that all babies can self-soothe when this might not be developmentally appropriate for younger infants or those with specific needs.

Breaking Problematic Patterns and Addressing Sleep Challenges

If your six-month-old baby still needs help to fall asleep, or you are bringing a nine-month-old into bed with you out of desperation (not by choice), this part will help you get things on track.

"The first step is to acknowledge there's an issue," states Fields. She advises that parents "often perpetuate those bad sleep habits without even realizing it." The longer you wait, the more difficult it will become to finally break the cycle. The good news is that healthy, full-term babies can sleep at least six hours in a row when they're 4–5 months old, and 10–12 hours a night by 6 months. Regardless of how much guidance parents receive from sleep consultants, though, the single method for reaching that magic place is to break the cycle.

Context

• Factors such as teething, growth spurts, or changes in routine can disrupt sleep. Identifying these can help in understanding the root of the problem.
• Various sleep training methods, like the Ferber method or the "cry it out" approach, are often used to help babies learn to sleep longer. These methods vary in terms of parental involvement and philosophy.
• Gradual changes, such as slowly reducing the amount of time spent rocking or feeding before sleep, can help ease the transition to independent sleeping.

Understanding Napping and Wakeful Intervals

To truly master sleep, you must understand naps, how long they should be, and when to slot them into your day as your baby grows. Babies go from four to five naps a day as newborns, down to just a couple by the time they begin celebrating their first birthdays. The more naps they take, the shorter the duration -- some babies love to catnap and others like to hibernate (the afternoon nap usually lasts one to three hours).

Dr. Brown and Fields introduce the concept of "wake windows" once an infant develops a regular sleep schedule. A wake window refers to the amount of time a baby is awake and interacting with their world before getting tired and needing a nap. Wake windows can range from a couple of hours for babies four to six months old, to three to four or more for kids over a year old. "The key point here is to be practical," says Fields. "If your baby is cranky, bored, and tired, it's time to encourage them to have a rest."

Context

• By the end of the first year, many babies start consolidating their sleep into longer stretches at night, reducing the need for multiple daytime naps.
• The environment can impact nap preferences. A quiet, dark room might encourage longer naps, while a stimulating environment could lead to shorter, more frequent naps.
• Wake windows often align with feeding schedules, as babies typically eat after waking up. Understanding this connection can help in planning daily activities around feeding and sleeping times.
• Babies often communicate their needs through non-verbal cues. Recognizing signs of tiredness, such as rubbing eyes, yawning, or fussiness, can help caregivers decide when a nap is needed.

Managing Sleep Issues With Preemies or Multiples

"Preterm infants have an increased likelihood of experiencing sleep problems simply because they are developmentally behind," explains Dr. Brown. They might continue needing some nighttime assistance with getting to sleep, even after reaching those typical sleep milestones (that is, four months of age). Other considerations for preemies include requiring more frequent feedings to achieve that all-important catch-up growth. So, if your baby is four months old and was born two months prematurely, don't expect them to sleep all night long. They're essentially only two months old, developmentally.

However, twins present different challenges. The important thing is to attempt to synchronize nighttime feedings when possible. Fields notes, "if you rouse a twin who's asleep within half an hour of their sibling waking up, then eventually they will be getting up (and hungry) at nearly the same time." It will allow all the household members, including the twins, to sleep more.

Context

• Preterm infants often reach developmental milestones later than full-term infants. This includes the ability to self-soothe and sleep through the night, which are typically achieved as the brain and body mature.
• Preemies have higher nutritional needs because they missed out on the final weeks or months of nutrient transfer from the mother during pregnancy. This means they require more calories and nutrients to support their rapid growth and development.
• A synchronized schedule can contribute to a calmer household environment, as all members can anticipate and adapt to the twins' needs more easily.

Development

This chapter delves into the various types of child development, how to recognize developmental milestones, and when you need to feel concerned. It also discusses recognizing the signs of autism and the best toys/books for every stage of childhood.

Understanding What Development Means

Child growth is a complicated subject—encompassing many different topics—but boils down to how children's minds work and how they learn and acquire various skills. Dr. Brown advises against making comparisons between your kids and others (easier said than done!). And hold back from voicing your opinions when you notice a kid who appears slow on the playground. She says, "each child develops at a unique pace, and children who appear to have problems may not face any challenges when they enter kindergarten."

Context

• Proper nutrition is essential for brain development and overall health, affecting cognitive abilities and physical growth.
• Parents who frequently compare their children to others may experience increased stress and anxiety, which can affect their relationship with their child.
• Labeling a child as "slow" can negatively impact their self-esteem and motivation. It can also influence how others perceive and interact with them, potentially leading to social isolation or bullying.
• The brain's ability to adapt and change, known as neuroplasticity, allows children to catch up in areas where they may initially lag. This adaptability is especially pronounced in early childhood.

Recognizing and Responding to Milestones in Development

Although creating a comprehensive list of developmental milestones here can't be done, Dr. Brown points out that motor, speech and social/cognitive progress are the primary areas caregivers and medical professionals will be following, year by year. The authors have included a helpful checklist for year one, covering the skills that babies should be achieving. But remember that these checklists don't take into account that children vary widely. These developmental stages are provided as a tool to assist you in identifying any potential delays—not create anxiety. If you are concerned about something your child is (or isn’t) doing, discuss it during your upcoming wellness checkup.

Context

• Regular communication with healthcare providers is crucial for addressing any concerns and ensuring that the child receives appropriate care and support.
• The checklist is intended to be a supportive tool rather than a source of stress, emphasizing that variations in development are normal and expected.
• Identifying potential delays early can lead to interventions that support a child's development, such as speech therapy or physical therapy, which can be more effective when started early.
• Availability of educational and developmental resources, such as books and toys, can enhance or hinder a child's developmental trajectory.
• Children develop at their own pace, and there is a wide range of what is considered "normal." Some children may reach certain milestones earlier or later than their peers.

Observing Developmental Delays and Seeking Early Intervention

Delays happen in children for many reasons but can be classified into three broad categories: limited, global, and autistic. Certain children have isolated delays—for example, with motor skills—while their social, language, and cognitive skills are all on track. In those cases, with a little help from parents or therapists, they'll catch up in time. For children with "global" developmental delays, the situation is different. These kids are behind in one or more areas, for example, motor and verbal skills), and this might suggest an underlying, more serious diagnosis.

Practical Tips

• Create a visual tracking chart to monitor your child's developmental milestones, focusing on the areas of limited, global, and autistic development. By plotting your child's progress on a chart, you can visually see which areas they are excelling in and which might require additional attention or intervention. For example, if you notice a lag in language skills (a potential sign of limited development), you could introduce more interactive reading sessions.
• Use household items for impromptu motor skill activities. For instance, set up a mini obstacle course using cushions, chairs, and blankets to encourage crawling, climbing, and balancing. This turns practice into a fun game and seamlessly integrates skill development into daily life.

Recognizing Autism Symptoms

Autism is a neurological disorder that is now classified broadly along a range of severity. Dr. Brown cautions that "autism cannot be detected during infancy." But she notes, "there are some signs caregivers can watch for—failure to smile back, poor eye contact, failing to mimic, or exhibiting atypical reactions to auditory and visual stimuli." She also advises, "if you're concerned about autism, discuss those concerns with your kid's pediatrician—your doc can do an evaluation in the clinic and recommend further testing if needed."

Practical Tips

• Create a sensory-friendly space in your home or workplace to accommodate those with sensory sensitivities, a common characteristic among individuals with autism. This could involve using soft lighting, minimizing background noise, and providing quiet zones, which can make environments more inclusive and comfortable for everyone, not just those with autism.
• Volunteer at an organization that supports individuals with autism to gain firsthand experience with the spectrum of severity. Through volunteering, you can learn to adapt your approach to suit the needs of each individual. For instance, you might assist in a classroom setting and observe how educators use different strategies to engage students with varying levels of autism.

Other Perspectives

• Technological advancements and ongoing research into early brain development may lead to the discovery of biomarkers for autism that could be detectable in infancy, even if such methods are not widely available or recognized at present.
• It's important to consider the consistency and context of these behaviors; an isolated instance of poor eye contact or not smiling back may not be indicative of autism.
• Some parents may benefit from doing their own research or reaching out to autism advocacy groups for support and information in addition to speaking with their child's pediatrician.
• A single evaluation in a clinical setting may not provide a complete picture of the child's behavior across different environments and situations.
• Further testing can be expensive or not covered by insurance, which might discourage caregivers from pursuing it even if recommended by a pediatrician.

Understanding how Babies Learn and Process Information

In the early 1900s, a Swiss psychologist named Jean Piaget developed the most widely accepted theory on intellectual/cognitive development. He described various phases of how an infant's brain learns, based on what age a child is. Fields explains, "knowing that your infant's reasoning and thinking are totally different from yours, might make some of those seemingly bizarre behaviors slightly less frustrating to handle."

Context

• Subsequent research has highlighted the role of cultural and social factors in cognitive development, areas that Piaget's original theory did not extensively address.
• Piaget emphasized the importance of play in cognitive development, as it allows children to explore, experiment, and understand their world in a hands-on manner.
• Recognizing developmental milestones can help caregivers understand what behaviors are typical at different ages, reducing frustration by setting realistic expectations.

Fostering an Infant's Social-Emotional Development

Erik Erikson (another early 20th century psychologist) is the guru on social-emotional development. His popular theory suggests that people progress through eight life stages that all affect their personality. Dr. Brown explains, "the early stages of development, based on trust versus mistrust and autonomy versus doubt, aid kids develop confidence in themselves."

Context

• Young adults form intimate relationships. Success leads to strong relationships, while failure results in loneliness and isolation.
• Different cultures may emphasize various aspects of autonomy and trust, influencing how these stages are experienced and expressed by children.
• Early success in these stages influences later stages of development, such as initiative vs. guilt and industry vs. inferiority, which further build on a child's self-esteem and competence.

Choosing Developmentally Appropriate Toys and Managing Screen Time

Dr. Brown and Fields strongly convey this message: "parents do not have to buy a roomful of expensive toys, nor enroll their baby in a specialized early childhood program to promote development." They suggest "the time a parent shares with their child is the most important developmental stimulation."

As your infant grows, they'll enjoy experimenting and investigating their surroundings with both fine and gross motor play. For this reason, they have a love/hate relationship with things like sandboxes (they're enjoyable to play in, but attract various kinds of nasty stuff). The playground can often be a magnet for harm, too!

But the bigger question now, in their opinion, is: "How much screen time should your baby have?" The answer: very little! Dr. Brown feels strongly about limiting screen time (TV, videos, smartphones) especially for babies. The American Academy of Pediatrics advises NO screen time at all for infants under 18 months (except for video chatting with Grandma)." That's because watching TV or being parked in front of a smartphone is passive," explains Dr. Brown, and kids that young aren't old enough to appreciate the educational content of these shows. She notes, "It's different if you watch together." Toddlers can gain knowledge from educational content when an adult interacts and engages with them throughout the experience.

Context

• Simple household items, like pots and pans or cardboard boxes, can be used creatively to stimulate a child's imagination and problem-solving skills.
• When parents engage in activities that require decision-making, children learn to approach challenges and develop solutions, fostering independence and resilience.
• Infants use their senses to explore their environment, which is a key part of their development. This includes touching different textures, listening to various sounds, and observing colors and movements, all of which help in cognitive and sensory development.
• Sand can contain allergens or dust that might trigger allergic reactions or respiratory issues in sensitive children.
• Surfaces can become dangerously hot in the sun or slippery when wet, increasing the risk of burns or falls.
• Exposure to screens, especially before bedtime, can interfere with a baby's sleep patterns due to the blue light emitted, which can disrupt the production of melatonin.
• The recommendation is based on ongoing research and understanding of child development, reflecting concerns about the potential negative impacts of screen exposure on young children.
• Passive screen time can affect a child's attention span. Engaging with fast-paced, overstimulating content may lead to difficulties in focusing on slower-paced, real-world activities that require sustained attention.
• Adults can provide context to the content being watched, helping toddlers understand complex ideas or situations that might not be immediately clear to them.

Health and Medical Care

Visiting the Pediatrician

Finding good healthcare for your infant is as important as finding the right stroller or crib. This section outlines the essentials of choosing a healthcare professional and what will happen during your doctor visits.

Choosing a Doctor and Scheduling an Appointment Before Birth

The authors strongly advise new parents to choose a pediatrician prior to giving birth. "There are multiple good reasons to do this," explains Fields. "First and foremost is finding someone you feel comfortable with. They'll be the ones who'll be answering your questions about your infant's wellbeing and giving you guidance on how to manage illnesses."

Secondly, your potential pediatrician should help with decisions about your newborn during the early days after birth. "This could include things like circumcision and banking cord blood," she notes. "And having these conversations is much simpler before delivery, while you're not sleep deprived!"

Another key reason for booking a prenatal visit is to inform your pediatrician of your family's medical history, enabling them to anticipate any potential health issues. Many pediatricians (if not most) offer these consultations before birth without a fee—but it's smart to inquire about pricing when booking the appointment.

Other Perspectives

• Parents might rely on recommendations from their obstetrician or birthing center after delivery, which can be just as effective in finding a suitable pediatrician.
• Some parents may prefer to rely on evidence-based parenting books, reputable online resources, or support groups for information and guidance, especially for common and minor illnesses, reserving pediatric consultations for more serious concerns.
• In some cases, parents might find that their views on procedures like circumcision change after the birth of their child, making pre-delivery discussions less relevant.
• Some parents may not feel the full impact of sleep deprivation until several weeks after birth, which could still allow for meaningful conversations with a pediatrician in the early postpartum period.
• Genetic testing and screening can sometimes provide more accurate information about potential health issues than family history alone.
• Pediatricians offering free prenatal visits might have longer wait times for appointments due to higher demand, which could be inconvenient for some parents.
• Asking about pricing upfront might be uncomfortable for some parents, and they may feel it implies a transactional approach to what they consider a relationship built on trust and care for their child.

Building a Relationship With Your Physician and Their Staff

Maximizing those office visits requires more than showing up and getting some shots. "It's really about building a long-term relationship with an office staff who are invested in the health and physical and mental progress of your child," says Dr. Brown, "and that means beginning with the initial prenatal consultation."

She advises being a well-informed patient. In this era of crowded offices, delayed appointments, and less personalized care, it's helpful for parents to understand what factors affect how your chosen provider operates. "What's your procedure for booking appointments for well-child visits and visits for when your child is sick?" she asks. "How long will it take to get a call back, and what's the optimal method for accessing the after-hours call system?" These are issues that should be addressed before having a child.

Other Perspectives

• In some cases, frequent changes in office staff may make it difficult to establish long-term relationships, suggesting that adaptability and clear communication might be equally important.
• Being well-informed is important, but it should not replace trust in a physician's judgment, which is based on years of training and experience.
• Overemphasis on understanding operational factors might lead to unnecessary anxiety or stress for some patients, detracting from the focus on health and wellness.
• In some healthcare systems, the booking process is managed by third-party services or automated systems, which can limit the impact of knowing the procedure if the system itself is inefficient or impersonal.
• In some cases, the emphasis on call back times and after-hours access might not be as relevant, especially if a patient has a condition that requires regular, scheduled visits rather than emergency or unscheduled care.

Understanding the Timeline for Pediatric Checkups

The AAP has created suggested protocols for regular well-child visits, which most pediatricians and providers in family medicine follow. According to Dr. Brown and Fields, "these visits aren't only for your infant's vaccinations—they also allow the doc tor to evaluate your infant's growth and development, administer any necessary screening tests, and address any health concerns you could have." So, bring your list of questions with you to those appointments, and don't hesitate to ask!

Context

• Most health insurance plans, including Medicaid, cover the cost of well-child visits as part of preventive care services.
• The protocols include specific age-related checkups, starting from infancy and continuing through adolescence, to address the changing health needs as a child grows.
• Regular checkups can help detect chronic conditions such as asthma or allergies early, allowing for timely intervention and management.
• Inquiries about safety measures, such as car seat guidelines or home safety tips, can help parents create a safer environment for their child.