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

--

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

--

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

New babies are difficult. Don't you wish they came with a manual? Well, now there is one! Hosted by a pediatrician mom, The Baby Manual will help guide you through everything you actually need to know to take care of a baby. Whether this is your first baby or your fifth, I bet you’ll hear something helpful in here that you didn’t know. Enjoy The Baby Manual podcast, and enjoy your new baby!

--

Dr Carole Keim MD: linktree | tiktok | instagram