This episode is all about skincare. Dr. Carole Keim MD walks you through the ways newborn skin is different from all other babies’ skin and goes into detail on birthmarks, jaundice, baby acne, eczema, cradle cap, and diaper rash. She explains why newborn skin is prone to dryness and peeling, what milia is and how it will go away on its own, the causes and helps for jaundice, and shares much useful advice. 

One of the first things to know about newborn skin is that because they’ve basically been in a bath for nine months, their skin will be dry and peely as it adjusts to the outside world. Have you heard of stork bites, angel kisses, Mongolian spots, or port wine stains? These are all types of birthmarks that Dr. Keim explains in detail. She also details how hemoglobin from extra red blood cells converts to bilirubin in the body, and bilirubin causes the yellowish tint we know as jaundice. Dr. Keim tells exactly what to look for and what to do for your baby.

Covered in this episode: 

• Newborn skin
• Newborn rash
• Pustular Melanosis / normal rash
• Milia
• Birthmarks
• Hemangioma
• Jaundice
• Baby acne
• Seborrhoeic dermatitis / cradle cap
• Eczema
• Diaper rash

Newborn skin / newborn rash 0:33

• Dry and peely is normal 
• Newborn rash looks a little like chickenpox: red spots all over
• Newborn rash is not itchy or painful and happens usually within first 3 days of life
• No lotion or product required - only a greasy emolient if dry and cracking at wrists or ankles

Pustular Melanosis / normal rash 1:51

• Tends to happen in babies with darker skin tone
• Looks like newborn rash but tiny blisters are smaller - tiny pustules with yellowish fluid inside
• When they pop they leave behind a little freckle
• Freckles go away on their own
• Should go away in a week - if persists beyond week, talk to doctor

Milia 2:44

• Looks like pimples on nose, upper cheeks, forehead
• Is not pimples but is tiny white, pinpoint size, dots
• Do not pick or squeeze, could hurt baby or scar if you do
• It’s essentially skin cells trapped under the skin that form tiny white bumps - almost like clogged pores but not quite
• Will go away on its own and is not dangerous

Birthmarks 3:24

• Present either at birth or a few days or weeks after birth - normal
• Salmon patches - also called stork bites or angel kisses - can show up anywhere on body and usually fade within the first year of life 
• Sometimes scalp and back of head salmon patches never fade
• Sometimes when babies cry, especially with patches on forehead or eyelids, they’ll get redder and brighter - this is normal
• Mongolian spots - also called slate grey nevus or dermal melanocytosis - are light blue grey in color, almost like bruises
• They show up frequently from birth in low back area but can really be anywhere
• They tend to fade within the first five years of life
• More common in babies with darker skin tone, normal, and kids outgrow them
• Port wine stains - dark red, flat area of skin - usually on face or upper body, but not always
• Not dangerous but sometimes associated with other conditions
• If your baby has a port wine stain your doctor may want to do a genetic workout but many times it’s nothing
• Treatment is not necessary for port wine stains but some families opt for it for cosmetic reasons

Hemangioma / infantile hemangioma 6:00

• Similar looking to port wine stains but are raised and lumpy
• Are a collection of blood vessels
• If you press on it, it may go lighter colored or white then turn back to red
• Tend to grow quickly - within first 6 months of life - then start to involute or crumble within themselves and shrink back down
• Typically by age four there might be a bit of color left, might not, might be different texture to skin area or might not 
• Hemangiomas are often not treated but depending on location may require treatment - hemangioma on eyelid or near airway (“beard distribution” area) could overlay vital structures and cause baby to not see out of affected eye or close airway
• Doctor can check for internal hemangioma with ultrasound
• Treatment may be beta blocker or laser therapy - consult doctor

Jaundice 8:16

• Yellowish color of skin and eyes and is common among babies
• Reason: babies are born with extra red blood cells, some maternal red blood cells release hemoglobin when broken down which converts to bilirubin
• Bilirubin is what causes the yellow color of skin and eyes: jaundice
• Bilirubin can be checked for with tests via light and special device (transcutaneous bilirubin) or blood test (serum bilirubin)
• Phototherapy is bright light therapy that breaks bilirubin down into form that can be peed out
• Normally bilirubin just leaves the body via eating and evacuation
• You can feed them more - you can expose baby to sunlight indoors (not outside) in patch of sunlight while feeding
• Jaundice needs to be treated either at home or by doctor because high bilirubin levels can actually be dangerous
• High bilirubin (levels 20 to 25) can get into the baby’s brain and cause brain damage, seizures
• You can always catch bilirubin before it’s at that level - always watch for it, you can see the yellowish tint by level 10 or 12
• No association between Vitamin D and jaundice - sunlight breaks down bilirubin which decreases jaundice but Vitamin D does not treat jaundice, no association there
• Vitamin K shots do not treat jaundice either
• If your baby had delayed cord clamping or cord pumping, it is not related to Vitamin K or jaundice but can be related to less anemia - that is a separate thing and an OBGYN conversation
• Risk factors for jaundice - Coombs positive antibody which comes from mom and baby having different blood types resulting in baby making antibodies for mom’s blood - Coombs positive can cause bilirubin to rise
• Baby not eating well is also a risk factor for jaundice because if they are dehydrated, bilirubin can go up - preemies are also at risk

Baby acne 14:14

• Can happen on face, chest, back - looks like little red dots or sometimes pimples like regular teenage acne
• Typically related to hormones, sometimes in breast milk - not a reason to stop breastfeeding
• Baby acne is completely cosmetic, doesn’t hurt baby, doesn’t itch, and goes away by itself
• Do not use adult products on baby’s skin - no acne medications, they will dry out baby’s skin and possibly burn - just bathe normally, once or twice a week

Seborrhoeic dermatitis / cradle cap 15:05

• Happens on the scalp - greasy, flaky, yellowish whitish plaques stuck to skin
• Most common in first 6 weeks of life but can be seen in two or three year olds
• Cosmetic; skin thinks it’s too dry so overproduces sebum
• Treat it by putting something greasy on top of it - olive oil or Vaseline or aquifer in petroleum - apply to scalp - tricks skin into thinking it produced enough already, stops overproduction, and loosens plaques so they can be gently brushed away with baby brush
• It can come back - it’s cosmetic and not dangerous

Eczema 16:40

• Common in babies
• Tends to run in families that have history of asthma, allergies, and eczema
• Starts as dry patch of skin, typically on areas that rub like cheeks and backs of arms and legs
• Eczema is itchy and does bother them, they may be fussy or rubbing
• They may scratch with baby nails - scratching releases more histamine which makes you more itchy which can lead to worsening and a flare up
• Treatment - keep skin really moisturized - only bathe them once or twice a week with unscented soap or just plain water bath - after bath put something greasy like emmalin petroleum aquifer or unscented lotion and reapply throughout day
• If eczema is really bad, check with doctor - may need medicated cream or food allergy test

Diaper rash 18:28

• Irritation in diaper area because of moisture and friction
• Use over the counter diaper cream
• A lot of diaper creams contain zinc oxide which helps heal the skin but if those also irritated baby’s skin - if diaper rash isn’t improving with zinc oxide diaper cream - try petroleum-based cream or calendula cream (Aqua, AMD, Vaseline)
• Greasy ones work by creating a barrier and preventing more moisture from getting in
• Diaper rashes can get infected with yeast or bacteria - candida infections are common
• Candida infections look like bright pink or reddish rash in pale skin babies, and deep pigmentation or pink and through with satellite lesions in darker skin babies
• First treatment for candida infection is dry area out - leave off diaper as much as possible
• Also antifungal cream - ringworm cream or jock itch cream, or best idea is medicated cream from doctor
• If rash lasts more than two or three days or has boils or pustules, that is typically a bacterial infection - needs special treatment with ointment and if it recurs over and over, treat entire family
• Diaper free time is encouraged - wipes only for poop, water wipe or wet washcloth is fine for just urine
• Consider potty training from birth - addressed in Episode 9 about Tummy Troubles

Dr. Carole Keim hopes this guide to normal baby skin care is useful and helps alleviate regular questions or concerns. All of this information is also in The Baby Manual book. But remember: it is always ok to call your doctor’s office with questions if you’re worried.  

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Episode 9 - Tummy Troubles

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Dr. Carole Keim MD: linktree | tiktok | instagram

Does your baby show signs of discomfort after feeding? In this episode, Dr. Carole Keim MD goes over practices to best help your baby through peeing/pooping, gas, colic, and other tummy troubles. If your baby has colic, there are ways to help digestion and alleviate discomfort. Vomiting in infants can be a bad sign; she explains how best to keep your little one hydrated with no treatment for vomiting or diarrhea.

Dr. Carole Kiem MD details different conditions your baby may experience within their first year, such as diarrhea, constipation, vomiting, and reflux. Watch out for blood in the diaper; she goes over the potential causes, from stool to urine or even a “false period” in baby girls. Check out this episode for more information about tummy troubles.

We will cover: 

• Pee
• Poop
• Potty training an infant
• Burping
• Gas
• Colic - dx and tx
• Spit ups / GERD
• Vomiting - gastroenteritis, pyloric stenosis, no tx
• Diarrhea - tx, when to be concerned, signs of dehydration
• Constipation
• Blood in the diaper

Pee (0:21)

• Allow up to 24h for the first void.
• A few pees for the first few days; by day 3-5, mom’s milk surges, and baby voids with each feed
• Volume is difficult to discern, and the color is sometimes pale - diapers with urine stripes are helpful.
• Rust-colored urine in the first 2-3 days (uric acid crystals)
• If a baby less than six mos voids less than 6x per 24h or goes more than four h between voids, they may be dehydrated (nighttime doesn’t count!). Babies >6 mos should void at least once per 6h.

Poop (2:48)

• Up to 48h for first stool
• Meconium (and what it means if passed in utero)
• Transitional stools
• Yellow seedy stools
• Over the first 4-6 months becomes brown and toothpaste-consistency
• Formula-fed babies may have brown, yellow, or green stool; tends to be smellier
• Hydrolyzed formula -> gray stools
• Rule of 7’s
• Once they eat food, their poop becomes like adult poop

Potty training from birth / Elimination communication / Diaper-free method (6:27)

• Involves reading baby’s cues and giving cues when it’s time to potty
• Can start as early as birth; I recommend around 1-2mos of age after the discoordinate stooling phase.
• Decide on a phrase and/or hand signal to use
• Bring your baby to the potty (over the sink, potty chair, or toilet adapter)
• Make a sound to indicate it’s time to go (“psss” or grunt)
• Easy catches: babies who go during diaper changes, right after waking up, after eating, when you see them pooping
• It takes several months; ok to wait until later. Toddlers: takes about 6 mos for daytime and another 6-12mos for nighttime.
• I love it because there are fewer diapers, less discomfort for the baby, less diaper rash, and it is easier than toddlerhood.

Burping (12:28)

• How to
• When to (breastfed, formula-fed)
• Why? Decreases gas, colic, spit-ups
• They can stop when they burp on their own (around 4-6 mos)

Gas (14:20)

• Normal to fart a lot, loudly, and have smelly gas
• Breastfed babies may get more gas when mom eats cruciferous vegetables, beans, garlic, and caffeine
• Check with your doctor before you start eliminating foods
• Simethicone - how it works, when to give it, how often

Colic (16:21)

• Rule of 3s: 3h per day, 3 days per week, for 3 weeks
• Almost all babies get some colic symptoms at some point.
• Tummy Time
• Bicycle legs
• Belly massage - clockwise
• Back rubs - counterclockwise
• Medicines: simethicone, probiotics, gripe water; can consider chamomile, licorice, or mint tea - dilute, 1/2oz per day
• Alternative health: chiropractic, acupuncture, ayurveda - I can’t formally recommend them, but they are sometimes helpful; choose your practitioner carefully.
• What doesn’t work - is the sensitive tummy formula. No formula will treat colic.

Spit ups / GERD (20:47)

• Reflux = stomach contents go up into the esophagus.
• GERD = reflux is so bad that the baby has poor weight gain or loses weight, chokes, arches in pain, or has other problems
• LES
• Spit-ups are not forceful.
• Tx: decrease volume and increase the frequency of feeds (BF vs. formula), burp baby well, anti-reflux formula/breast milk thickeners, add 1 tsp rice cereal to 2oz formula/breastmilk (this is the ONLY time we put rice cereal in a bottle), use gravity, medications such as ranitidine make the stomach produce less acid but don’t decrease the volume
• Call your doctor if the baby spits up more than half of their food, if they look like they are in pain with spitting up, if they appear to choke, or if it starts to become more frequent and the baby seems hungry after spitting up.
• Check out healthychildren.org for more info.

Vomiting (28:09)

• Forceful: Involves abdominal muscles and a retching movement
• Projectile vomiting goes about 2-3 feet, but spit-ups can too
• The baby is upset afterward
• Always a red flag
• No treatment other than to keep hydrated

Diarrhea (29:48)

• Hard to tell in newborns/infants because their poop is so soft/liquid
• If you’re worried, call your doctor
• Stool that is so watery it soaks into the diaper
• A marked increase over what your baby normally does
• Marked increase or “blowout” poops more than twice in a row
• A foul odor that was not there before, sometimes with a change of color
• Fever/blood - go to ER if <6 mos, call your doctor if >6mos
• No treatment other than to keep hydrated
• ​​Signs of dehydration: decreased urine output, fussy/lethargic, dry lips/tongue

Constipation (34:11)

• Infants: the first year of life; does not apply to children >1yr. We will do that episode in a few months.
• 1 mo: discoordinate stooling
• About 3% of infants get true constipation: hard stools like pellets, pain with BM, and rectal bleeding.
• Tx: prune juice 0.5-1oz (15-30ml), once or twice per day; water if they are taking solids/purees; consider eliminating dairy

Blood in the diaper (39:01)

• when it’s normal: pseudomenses
• Abnormal: any other time, call your doctor immediately! Urine = kidney problem, stool = infection or allergy. UA/ Hemoccult
• Foods that mimic blood: watermelon, beets, tomatoes

I hope this helps you guys know what’s within normal range and when to be concerned.  

Remember: It is ALWAYS ok to call your doctor’s office with questions if you’re worried.  

Babies are really different than adults, so it can be hard for new parents to know whether something is serious or not. 

I wrote the Baby Manual for that reason, and I know parents refer back to it often through the first year of life to check whether they need to be concerned.  

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• healthychildren.org

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Dr. Carole Keim MD: linktree | tiktok | instagram

Some newborns will eat eight to twelve times a day. In this episode, Dr. Carole Keim MD talks about breastfeeding, formula feeding, pacifiers/nipple confusion, and teething/oral hygiene (also thrush). For the first couple of months, your baby should be eating at least once every 4 hours for development. Pumping can be done right after your baby is born and sometimes even before. Are you looking at formula options? She goes over different types and how to choose what’s best for your little one.

Dr. Carole Keim MD goes over the benefits of breastfeeding for both mom and baby. Eventually, your baby will start to show interest in food, so it is essential to know how to introduce solid foods and approach the risk of allergic reactions. Your baby may start teething at around six months; she talks about signs to recognize, ways to help your baby during this time, and oral hygiene practices.

The next few episodes will be a deep dive into certain topics that I get asked about a lot; these are also laid out just like this in my book, The Baby Manual, available on Amazon/Kindle

• feeding, teething - 5/4
• pee/poop, gas/colic - 5/18
• skin - 6/1
• sleep - 6/15
• illness/red flags - 6/29
• vaccines 0-6mo - 7/13

How often to feed: (0:54)

• Newborns eat 8-12x per day, need frequent feeds because their stomach is so small
  • Birth - stomach size of a cherry (5-10ml, or 1-1.5 tsp) - colostrum
  • Day 2 - walnut (20-30 ml, or 0.75-1 oz) 
  • 1 week - golf ball (45-60ml, or 1.5-2oz)
  • 1 month - (80-150ml, or 2.5-5 oz)
• The stomach stretches like a balloon
• Overfeeding -> spit ups
  • The lower esophageal sphincter develops by 6-12mos of age
• 8-12 feeds aren’t exactly every 2-3 hours
  • Cluster feeding 2-6 am because prolactin is highest
  • This typically lasts about 2 weeks, then they learn the night/day difference
  • If they sleep 4 hours you MUST wake them
  • Newborn - 2 weeks: may eat more than 12x per day
  • 2weeks - 2 mos: typically eat every 2-3h
  • 2-6 mos: can sometimes go more than 4h between feeds if they are gaining weight and your doctor ok’s it

What to feed them: (4:00)

• Breastmilk or formula ONLY for 4-6 mos
  • Contains all the protein, fat, carbs, vitamins, minerals, and water your baby needs
• At 4-6 mos can start to introduce foods: will come back to this in a bit

Breastfeeding: (4:29)

• AAP recommends exclusive breastfeeding x 6 mos, then BFing + food/water until age 1 year or later
• Ok to breastfeed as long as you want
• Eat a wide variety of foods
• Vitamins:
• A prenatal vitamin that contains iron and folic acid
• Omega-3 fatty acids (200-300mg per day)
• Calcium (1000mg per day)
• Vitamin D (5,000-6,400 IU per day)
• Ok to drink alcohol because of first-pass metabolism: an 8oz drink of 10% alcohol becomes 0.04% BAC (and 0.04% breast milk concentration - 250x less concentrated).  0.08% consumed by baby makes their BAC 0.0001% (undetectable; less than BAC after a child drinks orange juice or eats an over-ripe strawberry)
  • When inside, your BAC = baby’s BAC
• Each time baby eats, they are placing an order for the next feed
  • First 3-5 days colostrum; need to nurse for 15-20 min per side per feed to stimulate milk production

Benefits of Breastfeeding: (9:53)

• Emotional: releases oxytocin, a bonding hormone, and endorphins 
• Health: decreases postpartum bleeding, decreased risk of breast cancer and ovarian cancer, decreased risk of rheumatoid arthritis, decreased risk of postpartum depression, can help you lose baby weight because burns an additional 500 cal per day
• Baby benefits: decreased risk of obesity and type 2 diabetes as adults, less chance of infection due to IgA, decreased risk of SIDS, less likely to develop atopic and autoimmune diseases 
• Extra benefits nobody really talks about: poop won’t smell bad and is water-soluble, you always have it on hand, the composition changes as your baby grows, it’s free

Tricky things about breastfeeding: (12:40)

• Takes babies up to 2 weeks to get a hang of it
• Can be painful for the first 2 weeks
  • Aggressively moisturize your nipples
• Tongue-tie: only class 4 needs repair. Lip and cheek ties do NOT need to be repaired.

Pumping: (14:37)

• Can start as soon as the baby is born; pumping while pregnant can induce labor
• Choosing a pump: manual vs. electric, how much suction, how portable, single or double
• Getting the best return: 
  • Early morning (prolactin peak)
  • One side while baby latches on the other side, or within 15 mins of baby finishing
  • If at work, look at photos/videos of baby
  • Stay hydrated
  • Can try herbal teas, lactation cookies, dietary supplements; these are not proven to be effective and are unlikely to be harmful 
  • outside the US: domperidone 
• Pumped milk lasts 6 mos in the freezer, 6 days in the fridge, 6 hours at room temp

Giving bottles to a breastfed baby: (17:11)

• Allows partner and other family members to bond with baby 
• Can allow mom a little more sleep at night
• Always pump while your baby gets a bottle to keep supply up
• Brush baby’s cheek and let them latch on; don’t put the nipple into baby’s mouth
• Start with it horizontally, angle up after 1-2 seconds
• Use a preemie flow nipple

Choosing a formula: (19:07)

• All brands are fairly equal in the US; choose based on the type of formula and look at the ingredients!
• Regular (cow’s milk-based) - best mimics breast milk
• Goat milk formula is ok; goat milk is NOT (nor is any animal milk other than human)
• Preemie formula - has extra iron, calcium, and calories because the last month is when babies store Fe/Ca/fat
• Soy-based - for vegan families or babies with galactosemia; NOT for milk protein allergy because tend to cross-react
• Sensitive formulas - more simple sugars, corn syrup-based - I hate these but they do have their place; more info in the next episode (gas/reflux/colic/spit-ups)
• Anti-reflux formula - has added rice starch
• Hydrolyzed formulas (partially digested, amino acid-based) - protein, fat, and/or carbohydrates are broken down and easier to digest; for babies with milk protein allergy 

To prepare the formula: (21:38)

• Ok to mix up to 1 day’s worth (24-30oz) and keep in the fridge 
• Can get ready-to-feed (liquid) formula; do NOT water it down
• Powdered formula - follow instructions on the package exactly 
• Can mix with drinking water if the clean source 
• Temp should be lukewarm / room temp
• Reminder: let baby latch onto the bottle, always hold baby and bottle while feeding (don’t prop)
• Burp halfway through and at the end
• Any leftover in the bottle must be thrown away 

Baby cues: (9:05)

• Hungry - eyes open, looking around; rooting; crying
• Done - falls asleep, sucks slowly, or turns away
• Can offer pacifier

Starting solids: (23:03)

• 4-6 mos of age in the US; 6 mos elsewhere
• Signs of readiness: sit with support, loss of extrusion reflex, watching you eat, bringing hands/objects to mouth
• One food every 3-4 days; watch for signs of allergy
• Food order doesn’t matter; can have anything other than honey and animal milk
• Puree method: rice cereal, green veg, orange veg, fruit 
• BLW: give babies mashed up foods that they can swallow, or pieces too big to fit in their mouth for them to suck on
• Start water with solids, 1oz per each 1-2oz of food

Food allergies: (26:46)

• Signs - blood in stool, rash, vomiting
• Must discontinue food and wait until after 1st bday with your doctor’s approval
• Top 8: peanuts, tree nuts, fish, shellfish, dairy, wheat, egg, soy
• Risk factors: family member with asthma, eczema, or allergy (likely to something different), a baby with severe eczema
• Introducing peanut protein

Nipple confusion: (18:27)

• Not a real thing, but flow preference is
• If you’re going to give bottles ever, start early 
• Pacifiers don’t cause nipple confusion and can soothe the baby and decrease SIDS risk

Teething: (29:28)

• Average 6 mos of age; anytime in the first year
• Teeth order; 20 total baby teeth (for tooth-fairy planning)
• Signs: fussiness, drooling, low-grade fever, pink cheeks, chewing on hands/toys, tooth buds, diarrhea
• How to help: teething toys, frozen washcloth, frozen fruit in a mesh bag, topical medications, Tylenol 

Oral hygiene: (33:12)

• Pre-teeth: don’t need anything special
• As soon as teeth emerge, brush 2x/day with water or fluoride-free toothpaste
• Start fluoride at 6mos of age if it’s not in your drinking water; the size of a grain of rice
• Dentist at 1 year of age

Thrush: (34:41)

• Yeast infection
• Thick white coating on the tongue
• Doesn’t wipe off
• Nystatin
• Can spread to breasts - pills for mom 

The next episode will be gas, colic, spit-ups, and reflux

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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Dr. Carole Keim MD: linktree | tiktok | instagram

Did you know you can potty train your six months old infant? Dr. Carole Keim MD talks about potty training, babyproofing, routines, and stranger anxiety. Your six-month-old should be recognizing familiar faces and reacting to their own name. Now is also a good time to use your support network to help with tasks, get a babysitter and go on a date. It is ok to leave your infant for a few hours and ask for help when overwhelmed. 

Dr. Carole Keim MD goes into great detail about the power of routines. Routines for feeding, winding down, sleeping, and leaving the house. Your infant will start to recognize these patterns and know what you are doing. Check out this episode for more information about your six-month-old infant. 

Parents: (00:43)

• For many this is a “golden” age - you’ve got a good handle on things, sleeping fairly well, have routines down, parents show confidence with infant (it’s ok if you’re not! But also keep postpartum depression in mind.)
• Establish routines 
• Interact with baby, respond to cues 
• Talk/sing, read, play peek a boo
• Use support networks, balance parent roles/responsibilities 
• Date night with trusted babysitter 

Development: (02:25)

• Socially interactive
• Happy feet 
• Recognizes familiar faces 
• Babbles
• Takes turns babbling / making sounds like squeals, blowing raspberries, rrr
• Starts to know own name
• Visual and oral exploration to learn about environment
• Rolls over both ways 
• Tripod sit / sit with support (baby seat, high chair)
• Stands and bounces (johnny jump up / activity center)
• “Swims” on land (pre-crawling)
• Turns while sitting to look at things
• Raking grasp
• Can bring hands together, transfer hand to hand, and put objects in mouth
• No object permanence yet
• Toys: soft toys, crinkly toys, rubber/silicone toys, rattles no hard eyes/noses, no small parts (choking hazard)

Sleep: (09:14)

• Safe sleep: alone, on their back, in a crib. 
• Crib should be in parents’ room until 1 year of age
• Lower crib mattress (pull to stand)
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - rolling
• Maintain a bedtime routine;  feed, brush teeth/gums with water, read, sing, set down awake but drowsy 
• Things that can help, but only if they need it: blackout blinds, white noise machine, music

Nutrition: (11:48)

• Primarily breastmilk or formula; starting solids
• How to start solids: 
  • Baby-led weaning vs. purees (traditional)
  • rice/oat cereal optional (pros/cons)
  • progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
  • one new food every 3-4 days 
  • signs of food allergy: rash, vomiting
• give water (ounce per ounce with foods)
• Start consolidating meal times
• Consider 3-5 “meals” of breastmilk/formula with 1-3 “snacks” of baby food
• Expect them to eat about 1-2oz of food at a sitting when starting out; soon will go up to 4oz, watch cues
• Gagging is normal, choking is not

Teeth: (19:30)

• Teeth can appear anytime; brush 2x per day with water and soft toothbrush
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel
• Fluoride: check if it’s in tap water, if not, can consider using fluoride toothpaste (grain of rice sized amount)
• Avoid laying them down with a bottle, never prop a bottle

Peeing/pooping: (24:49)

• Peeing about 4-6x per 24h
• Poop is now more solid because they are eating foods; can consider starting potty training now

Skin: (26:40)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths - watch those folds for rashes though
• Sunscreen, insect repellant: any baby sunscreen is ok, citronella works for insects and is safe 
• Diaper rash and drool/food/skin fold rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
• Cradle cap - olive oil / vaseline / aquaphor at night, soft baby brush in the morning

The 6 month checkup: (30:23)

• Baby should have gained about 2-3lbs since last checkup, should be more than twice birth weight
• Third round of vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)
• Anticipatory guidance: 
  • Safety: use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, no infant walkers, remember safe sleep, start baby proofing, bathroom and kitchen are most dangerous rooms (burns, sharp objects, poisons, drowning), choking hazards, avoid plastic bags / balloons, limit finger foods to those soft enough to crush easily with fingers
  • Development:  Stranger anxiety can inspire crawling/rolling with toys placed just out of reach. Anticipate sitting on their own and crawling
  • Next WCC in 3 mos; no vaccines (might get flu shot)
  • Reminder: flu shot is given in 2 doses, 1 mo apart, for baby’s first flu season, then 1 annually
  • Past few visits were q2mo, now q3mo (9, 12, 15, 18 mos)

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Edinburgh Postnatal Depression Scale - Downloadable

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Dr. Carole Keim MD: linktree | tiktok | instagram

Your baby is now super cute at 4 months old and are laughing, smiling, and doing happy feet. In this episode, Dr. Carole Keim MD talks about weaning your baby and the difference between the traditional purees method and baby-led feedings. With new foods comes how to handle food allergies and brushing your baby's teeth. She also talks about protecting your baby while outside and safely using sunscreen or bug spray. Bookmark this episode! This information will apply for the next two months.

Just like previous episodes Dr. Carole Keim MD will go into detail about your baby’s development, sleep patterns, peeing and pooping, skin care, and what to expect at their 4-month check-up. As a new parent, you should be feeling a lot more confident about the overall care of your baby. Also a reminder those little hands are stronger than they look so if it is in grabbing distance be prepared.

Parents: (00:24)

• Feeling more confident overall
• Baby is laughing and babbling, really interacting - this is when most parents fall in love with the baby
• Start wearing hair up / no jewelry - baby can grab objects!

Development: (01:32)

• Social smile / laugh / happy feet 
• Consoles self
• Babbles
• Different types of crying
• Indicates happy/sad
• Responds to affection
• Lift chest when prone, roll (typically front to back)

Sleep: (03:02)

• Variable at this age; some have sleep regression, others are sleeping better than ever
• Safe sleep: alone, on their back, in a crib.  (Time to move to a crib!)
• Crib should be in parents’ room until 1 year of age, new studies show babies sleep better in their own room starting at 4mos but it’s not an official recommendation yet
• No blankets until 1 year, no pillows til age 2 - very high risk at this age - starting to roll
• Start a bedtime routine;  feed, brush teeth/gums with water, read, sing, set down awake but drowsy 
• Things that can help, but only if they need it: blackout blinds, white noise machine, music

Eating: (06:27)

• Primarily breastmilk or formula; starting to consider solids
• 6-8x per 24 hours, 24-30oz per 24h
• Can take 4-6oz at a time and be full 4-6 hours
• Signs of food readiness: showing interest in food, good head control while seated supported, loss of extrusion reflex
• How to start solids: 
  • Baby-led weaning vs. purees (traditional)
  • rice/oat cereal optional (pros/cons)
  • progression green veggies - orange veggies - fruits; ok to give anything other than honey and cow’s milk (dairy products are ok)
  • one new food every 3-4 days 
  • signs of food allergy: rash, vomiting
• When to start water (ounce per ounce with foods)

Peeing/pooping: (17:11)

• They have found their pattern: typical 1-2x per day, the rule of 7’s still applies (until they start solids): once per week up to 7x per day is normal; after starting solids should be 1-3x per day
• Peeing about 6x per 24h

Skin: (17:54)

• Bathing 2-4x per week; wipe skin folds a few times per day
• Can use lotion or cream or ointment after baths
• Sunscreen, insect repellant: any baby sunscreen is ok but not fully protective til >6mos, citronella works for insects and is safe 
• Diaper rash and drool rash - might be infected if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor)
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.

Teething: (22:25)

• Teeth can appear anytime; brush 2x per day with water
• Teething toys, frozen washcloths, frozen fruit/breastmilk/formula in mesh bags
• Medicines: tylenol (ask your doctor for the dose), topical teething gel like orajel

4-month check up: (26:19)

• baby should have gained about 2-3lbs since last checkup, or should be about twice their birth weight (avg weight 14lb)
• Second round of vaccines: DTaP, Polio, Hib, PCV, rota (2 shots, one oral)
• Anticipatory guidance: 
  • Safety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns
  • Development: tummy time (30 mins twice a day), anticipate rolling, laughing, babbling. Can inspire rolling with toys placed just out of reach. They’re not sitting on their own yet or crawling (those are at 9 mos).
  • Next WCC in 2 mos; same vaccines as the 2mo visit 

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

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Dr. Carole Keim MD: linktree | tiktok | instagram

Wow! It has already been 2 months since your baby made its way into this great big world. Now is the time to get that all-important 2-month checkup done along with mom's 6 week postpartum appointment, come find out what Dr. Carole Keim MD has in store for you today on The Baby Manual: vaccine protection against diseases like rotavirus; important questions answered about resuming pre baby activities work, etc., but don't worry she still covers eating, peeing, pooping, and skincare routines.

The first vaccines: DTaP (Diphtheria, Tetanus, Pertussis), Polio, Hib (Haemophilus influenzae type B), Hep B(Hepatitis B), PCV (Pneumococcal conjugate), rota (Rotavirus). Again we cover the importance of tummy time and ways you can help your baby with their development.

Parents (00:23)

• Starting to resume pre-pregnancy activities and interests, plan return to school or work
• Getting out with the baby 
• Partner support?  Family support?
• Mom should have had 6-week postpartum checkup
• Talk with partner about family planning 
• Hold, cuddle, talk and sing to your baby
• Develop strategies for crying 

Eating (02:48)

• 6-8x per 24 hours, 24-30oz per 24h
• Can take 4-6oz at a time and be full 4-6 hours

Peeing/pooping (03:23)

• They have found their pattern: typical 1-2x per day, the rule of 7’s still applies: once per week up to 7x per day is normal
• Peeing with each feed, 6-8x per 24h

Skin (04:06) 

• Bathing 1-2x per week
• Can use lotion or cream or ointment after baths
• Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
  • Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.

2 month checkup (08:27)

• Baby should have gained about 2lbs since last checkup (avg weight 11lb)
• First vaccines: DTaP, Polio, Hib, Hep B, PCV, rota (2-3 shots, one oral)
• Neuro/devel: diminishing grasp/tone/moro reflexes, attempts to look at parent, smiles, able to console self, begins to have different types of crying, coos, able to push up a little during tummy time, consistent head control while supported in upright position
• Anticipatory guidance - 
  • Eating: nothing but breast milk or formula until 4-6 months; wait for our next visit before feeding anything else 
  • Sleep: back to sleep, no blankets, put baby to bed awake but drowsy
  • Safety: never leave baby on high surfaces, use rear-facing car seat until age 2, avoid secondhand smoke, set water temp to 120'F to avoid scald burns, don’t prop bottle
  • Development: tummy time

Next checkup is at 4 months of age and we will do all the same vaccines except they don’t need another Hep B at that time (17:43)

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

--

Dr. Carole Keim MD: linktree | tiktok | instagram

You are starting to get into the groove of this new parenting thing and your baby is now 1 month old. You should start to see those smiles and the super cute cooing. In this episode, Dr. Carole Keim MD talks about what to expect from the 1 month check-up along with eating, peeing, pooping, sleeping, and skincare. She goes into great detail on gas, colic, reflux, and the benefit of a probiotic. It is also a good time for you to start thinking about your relationship again and enjoying a date night.

This is the peak age for discoordinate stooling, reflux, and skin issues. Knowing the difference between learning bowel control and constipation or spit up vs green projectile vomit. Knowing what to watch for is half the battle when caring for your little one.

Parents: (00:25)

• Finally feeling in the groove of things
• Baby has nights and days figured out
• Don’t overstimulate
• Still narrate your day, take turns talking with baby
• Find time for a date night!

Eating: (02:04)

• 8-10x per 24 hours, 24-30oz per 24h
• Starting to go from q2-3h to q4-6h

Peeing/pooping: (02:40)

• Discoordinate stooling
• Gas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic drops
• Reflux: Explain LES, normal spit ups.  Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)
  • Pyloric stenosis: getting progressively worse, turns green (grass green)
• Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillows

Skin: (10:11)

• Bathing 1-2x per week
• Can use lotion or cream or ointment after baths
• Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
  • Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
  • Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.

Checkup: (14:08)

• baby should have gained about 2 pounds from birth weight (based on 7 lb baby)
• Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, responds to calming actions when upset, follows parents with gaze, recognizes familiar voices, communicates needs (hungry/wet), lift head when prone / on parent’s chest, fontanels open until 1 year of agepo
• Anticipatory guidance:
  • Eating - nothing but breast milk or formula for 4-6 months
  • Mom should eat a wide variety of foods and take PNV while breastfeeding
  • Supplement with 400 IU of vit D daily, or mom can take 6400 IU
  • Sleep: back to sleep, no blankets, stop swaddling.  ABC = Alone, on Back, in Crib.
  • Put baby to bed awake but drowsy
  • Fever and how to take temp
  • Never leave baby on high surface
  • Rear facing car seat til age 2
  • Avoid secondhand smoke
  • Set water temp to 120 degrees to avoid scald burns
  • Bathing baby 1-2x per week
  • Skin care / peeling skin
  • Tummy time

Next checkup is at 2 months:  (21:48)

• First round of vaccines: DTaP, polio, HiB, Hep B, PCV, Rotavirus
• No need to pre medicate before shots, but DO buy some infants or children’s Tylenol / acetaminophen before the visit
• Ask doctor for the dose of Tylenol at the 2 month visit
• Pooping will consolidate further: rule of 7’s at this age is that anything from once a week to 7x per day is normal
• Should keep peeing every time they eat
• Still need to wake them up once every 4h to eat

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

--

Dr. Carole Keim MD: linktree | tiktok | instagram

Your baby is now two weeks old and they are changing so fast! In this episode, Dr. Carole Keim MD walks you through what to expect during your baby’s two-week check-up. Your baby will now be keeping their eyes open longer and the nighttime feeding schedule will change. She talks about tummy troubles that usually start to pop up over the next few weeks.

There is so much happening in that little body. Your baby is learning to use their muscles and oh wow that ceiling fan is so wonderful to look at. From tummy time to bicycle legs and what is safe to give your baby to help them along. 

Baby is starting to be awake more during the day - awkward age: (00:23)

Parents / emotions: (00:53)

• You’re getting a little more sleep - baby’s consolidating feeds, more awake during day, sleeping at night
• Don’t overstimulate
• Narrate your day

Eating: (01:54)

• 8-12x per 24h; formula or EBM should be 12-24 oz per day (350-700ml)

Peeing/pooping: (02:20)

• Baby pees and poops every time they eat

Tummy troubles: (02:55)

• gas, colic, reflux
• Gas/colic: belly rubs, bicycle legs, up and downs, tiger in a tree pose, tummy time, simethicone drops, probiotic drops
• Reflux: Explain LES, normal spit ups.  Signs of severe reflux: weight loss, spitting up more than half of their feed every time, arching back and screaming, aspirating (choking/coughing/sputtering)
• Pyloric stenosis: getting progressively worse, turns green (grass green)
• Reflux tx: smaller and more frequent feeds, hold upright for 20-30 mins after feeding, sleep in a reclined position (tilt the crib or bassinet with a phone book), NO pillows

Skin: (08:25)

• Umbilical stump is off - start baths.  Once or twice per week, unscented soap or just plain water, pat them dry rather than rubbing, use lotion/cream/ointment right after the bath
• Diaper rash - if it lasts more than 2-3 days despite normal diaper cream (zinc-oxide-based like Desitin or petroleum-based like Vaseline or Aquaphor) it might be infected.
• Candida (yeast/fungal) - solid pink area with tiny pinpoint-sized pink dots around it (satellite lesions). Can try mixing apple cider vinegar and water 1:1, OTC antifungal cream, or call a doctor for a prescription for Nystatin.
• Bacterial infection: pimples or boils, often MRSA, can try applying Neosporin TID but if it doesn’t help, they need mupirocin TID.  Treat the whole family - nails and nose.

Checkup: (12:42)

• Check weight, should be above birth weight now
• Ask about any feeding difficulties; should be better now
• Jaundice should be gone
• Screen for PPD
• PE: same head to toe exam as the first checkup
• Neuro/devel: Reflexes (grasp, suck, moro), calms to parents’ voices, communicates needs, lifts head in tummy time

Safety: (15:37)

• Fever over 100.4 (38c)
• Back to sleep, alone, in a crib or bassinet. Ok to stop swaddling and start sleepsack.  NO blankets til age 1 and no pillows til age 2.
• Never leave baby on high surfaces
• Avoid secondhand smoke
• Rear facing car seat til age 2 years
• Breastfeeding moms should be taking PNV
• Supplement baby with 400 IU vitamin D
• Tummy time: 2x per day 15-30 mins

What to expect in the next 2 weeks (before the 1mo checkup): (17:53)

• Awake more and more; start to notice things farther away like lights, windows, and ceiling fans
• Discoordinate stooling

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

--

Dr. Carole Keim MD: linktree | tiktok |instagram

The first week of having a new baby is full of surprises, but it's important that you know what to expect. In this episode, Dr. Carole Keim MD talks about what she wishes she knew the first week of having a new baby. She walks you through what is normal and what can be scary for a new mom. She also goes into detail on what moms can expect for themselves after welcoming home their adorable little one!

Dr. Carole Keim MD covers hormones, postpartum depression and the use of the Edinburgh Postnatal Depression Scale. From the first diaper change, breastfeeding, skin care, right up to your baby's first doctor's visit, there is a lot of information in this episode.  However, you are going to be glad to have it to make that first week less scary. Also, remember that it’s normal to feel a little sad, overwhelmed, and exhausted.

At this age, your baby is doing a lot of things that seem scary but are actually normal.

Emotions: (00:32)

• Bonding with baby
• Baby blues
• Signs of postpartum depression

Pooping: (01:33)

• Meconium
• Transitional stool colors
• Seedy yellow - what are the seeds?
• Number of poops: 1 in first 48h of life, a few times on days 3-4, then every feed once milk surges

Peeing: (02:35)

• Brick dust / rusty pipes
• Pee once in the first 24h, 2-4x until milk surges, then by 1 week of age with each feed
• Concentrated urine x 3 days
• Normal pee

Eating / breastfeeding:  (03:22)

• Painful x 2 weeks
• Takes baby 2 weeks to really learn how to do it
• Tongue ties, lip ties, cheek ties - when to fix them, baby has to re-learn how to eat
  • Fix if W shaped tongue, can’t stick out tongue past lips, inadequate weight gain. Some people fix due to nipple pain

Skin:  (07:10)

• Bath x 9 mos, they’re going to peel
• Can use aquaphor/vaseline/unscented baby lotion
• Normal newborn rash

Diaper rash: (08:32)

• Uncommon at first but can happen
• Use wipes for poop only, not for pee
• If baby has a rash, could be irritation from wipes or diaper brand

Baby girls vs. boys: (09:11)

• Pseudomenses
• Circumcision after care
• Intact care

Breathing patterns: (12:03)

• Fast then slow

Belly button care and when it falls off: (12:30)

The first two checkups: (13:19)

• Typically 2-3 days after going home, or DOL 3-5, f/up 1 week (earlier if concern for weight or jaundice)
• First Hep B vaccine if they didn’t get it in the hospital
• Check weight; often down from BW
• Check if mom’s milk is in yet and what color poops are to assess jaundice risk
• Check for signs of PPD
• PE: Look at skin for jaundice, rashes (some normal, some deadly). Heart, lungs, organs, eyes, genitals, sacral dimple, spina bifida, hip clicks, fontanels, sutures mobile
• Neuro/devel: grasp reflex, rooting/suckling reflex, moro reflex, turns towards parents voice, communicates needs (hungry/wet), fixes briefly on faces, lift head when prone / on parent’s chest

Anticipatory guidance: (18:15)

• Eating - nothing but breast milk or formula for 4-6 months
• Mom should eat a wide variety of foods and take PNV while breastfeeding
• Supplement with 400 IU of vit D daily, or mom can take 6400 IU
• Sleep: back to sleep, nothing else in the crib.  ABC = Alone, on Back, in Crib
• Fever and how to take temp
• Jaundice precautions, why jaundice happens, when it’s dangerous
• Never leave baby on high surface
• Rear facing car seat til age 2
• Avoid secondhand smoke
• Bathing baby - wait til umbilical stump falls off; then once/wk
• Skin care / peeling skin
• Tummy time

Resources discussed in this episode:

• The Baby Manual - Available on Amazon
• Edinburgh Postnatal Depression Scale - Downloadable

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Dr. Carole Keim MD: linktree | tiktok | instagram

In this episode, Dr. Carole Keim MD explains what you should expect when going into labor. Why she, as a pediatrician, recommends having your baby at the hospital vs a home birth. She also goes into great detail on what to expect from a c-section or vaginal birth. It's all here in this episode to make your life easier pre and post-delivery in an unfamiliar environment where you may feel overwhelmed by your new responsibilities.

Knowing the right questions to ask and having the right answers before your baby arrives will decrease your stress during your labor and delivery. Why is a vitamin K injection important and how erythromycin ointment protects your newborn from pink eye. She even gives you advice and tips for breastfeeding success.  Good luck with your new baby. You are going to do awesome!

How to tell you’re in labor: (00:42)

• Water breaks
• Contractions
• When to go to the hospital
• How long you’re going to be in labor

What happens at the hospital: (01:59)

• Delivery options (vaginal, c-section)
• Delivery staff
• What the pediatrician does, APGAR score
• Newborn screen

What I recommend while still in the hospital: (08:41)

• Feeding: only breastfeed, push through the pain because it gets better.  Start pumping while in hospital.  Work with the nurses to check baby’s latch, learn how to listen for milk movement/swallowing
• Write down every time your baby starts and stops eating, and every time they pee and poop.  You’re going to be asked this by everyone who walks in the room so one less thing to have to remember.
• Vitamin K shot
• Erythromycin ointment
• Hep B vaccine: get it in the hospital if you want your baby to have it.  (explain why it’s safe for newborns)
• Bilirubin/jaundice checks: all babies get screened before discharge (either visually or with TCB or blood test)
• Blood sugar testing - for babies who are LGS or SGA; pros/cons
• Catch up on your sleep because this might be your only chance
• Buy a copy of The Baby Manual on Amazon so it’s waiting at home for you

Discharge instructions: (17:49)

• Jaundice precautions
• Fever
• Car seat safety
• Followup appointment
• Baby development / what to expect before the next appt (weight loss and weight gain, length changes, sleep deprivation)
• Who to call if you need help

Resources discussed in this episode:

• The Baby Manual - Available on Amazon

Dr. Carole Keim MD: linktree | tiktok | instagram