Part One: In the Beginning
1. The First Three Days
- Newborn baths early on are unnecessary, but not damaging. Tub baths are better than sponge baths.
- Circumcision has some small benefits and also carries some small risks. The choice is likely to come down largely to preference.
- Rooming in doesn’t have any compelling effects on breastfeeding outcomes either way. It is worth being careful about falling asleep with your infant if you choose to keep them with you at all times.
- Infant weight loss should be monitored and compared with expectations; you can do this yourself at www.newbornweight.org.
- Jaundice is monitored with a blood test and should be treated if outside the normal range; you can monitor this yourself at www.bilitool.org.
- Delayed cord clamping is likely recommended, especially if your baby is premature. Vitamin K supplements are a good idea. Eye antibiotics are likely unnecessary for most babies but are mandated in some states and have no known downsides.
2. Wait, You Want Me to Take It Home?
- Swaddling has been shown to reduce crying and improve sleep. It is important to swaddle in a way that allows the baby to move its legs and hips.
- Colic is defined as excessive crying. It is self – limiting, meaning it will stop eventually. Changing formula or maternal diet, treatment with a probiotic, or both have shown some positive impacts.
- Collecting data on your baby is fun! But not necessary or especially useful.
- Exposing your infant to germs early on risks their getting sick, and the interventions for a feverish infant are aggressive and typically include a spinal tap. Limiting germ exposure may be a good idea, even if just to avoid these interventions.
3. Trust Me, Take the Mesh Underwear
- It takes time to recover from childbirth.
- You’ll bleed for several weeks.
- You may have vaginal tearing, which takes a few weeks to heal.
- A caesarean section is major abdominal surgery, and it will take significant time for you to be mobile again afterward.
- Return to exercise depends a bit on your birth experience, but you can typically start within a week or two, and most women could be back to their pre – pregnancy routine by six weeks.
- There is no set waiting time for sex, although you should wait until you’re ready (and are on birth control if you’re not ready for another child).
- Postpartum depression (and related conditions) is common and treatable. Get help as soon as you need it.
Part Two: The First Year
4. Breast Is Best? Breast Is Better? Breast Is About the Same?
Benefits of Breastfeeding (claimed vs. actual; strikethrough means no evidence)
- Short – Term Baby Benefits
Fewer colds, infections
- Fewer allergic rashes
- Fewer gastrointestinal disorders
- Lower risk of NEC
Lower risk of SIDS
- Fewer ear infections (maybe)
- Long – Term Child Benefits: Health
Less diabetes
Less juvenile arthritis
Lower risk of childhood cancer
Lower risk of meningitis
Lower risk of pneumonia
Lower risk of urinary tract infections
Lower risk of Crohn’s disease
Lower risk of obesity
Lower risk of allergies, asthma
- Long – Term Child Benefits: Cognitive
Higher IQ
- Benefits for Mom
Free birth control
More weight loss
Better bonding with your baby
Save money
More stress resistant
More sleep
Form better friendships
- Lower risk of breast cancer
Lower risk of osteoporosis
Lower risk of postpartum depression
- Benefits for the World
- Lower methane production from cows
- Breastfeeding can be very hard!
- On early interventions:
- Skin – to – skin contact early on can improve likelihood of breastfeeding success.
- On latching:
- Nipple shields work for some women, although they can be hard to quit.
- There is very limited evidence that fixing a tongue tie or lip tie can improve nursing.
- On pain:
- Fixing a tongue tie can improve pain for Mom.
- There isn’t much evidence on how to fix nipple pain but focusing on the latch may help.
- If you are still in pain a few minutes into a feeding, or a few weeks into nursing, get help; it could be an infection, which would be treatable, or some other problem with a solution.
- On nipple confusion:
- Not supported in the data.
- On milk supply:
- The majority of women will have their milk come in within three days after the baby’s birth, but for about a quarter, it will take longer.
- The biological feedback loop is compelling: nursing more should produce more supply.
- Evidence on the effectiveness of non – drug remedies (e.g., fenugreek) on supply is limited.
- On pumping:
- It sucks.
6. Sleep Position and Location
- There is good evidence that infants who sleep on their back are at lower risk for SIDS.
- There is moderate evidence that bed sharing is risky.
- These risks are much higher if you or your partner smokes or drinks alcohol.
- There is some less – good evidence that room sharing is beneficial.
- The benefits to room sharing die out in the first few months.
- Infant and child sleep may be better if your child sleeps alone after the first few months.
- In the crib:
- Wearable blanket: check!
- Bumpers: very small risk, although small benefits as well.
- Sleeping on a sofa with an infant is extremely dangerous
7. Organize Your Baby
- There are some broad guidelines for sleep schedule.
- Longer nighttime sleep develops around two months.
- Move to three regular naps around four months.
- Move to two regular naps around nine months.
- Move to one regular nap around fifteen to eighteen months.
- Drop napping around age three.
- There is tremendous variability across children, which you mostly cannot control.
- The most consistent schedule feature is wake – up time between six and eight a.m.
- Earlier bedtime = longer sleep.
8. Vaccination: Yes, Please
- Vaccinations are safe.
- A very small share of people has allergic reactions, which are treatable.
- There are some extremely rare adverse events, most of which occur in immune – compromised children.
- The only more common risks are fever and febrile seizures, which are also rare and do not do long – term harm.
- There is no evidence of a link between vaccines and autism, and much evidence to refute such a link.
- Vaccines prevent children from getting sick.
9. Stay-at-Home Mom? Stay-at-Work Mom?
- Babies benefit from their mothers taking some maternity leave. However, there is little evidence suggesting that having a stay – at – home parent after the parental leave period has either good or bad consequences for children.
- Decisions about whether to have a parent stay home should consider your preferences, along with consequences for your family budget in both the short and long term.
- Stop judging people!
10. Who Should Take Care of the Baby?
- With any childcare arrangement, quality matters. For day care, in particular, you can use some simple tools to try to do your own quality evaluation.
- On average, more time in day – care centers seem to be associated with slightly better cognitive outcomes and slightly worse behavior outcomes.
- The positive effects of day care present more at older ages, the negative ones more at younger ages.
- Kids in day care get sick more but develop more immunity.
- Parenting quality swamps childcare choices in its importance, so make sure you pick something that works for you as a parent as well.
11. Sleep Training
- “Cry it out” methods are effective at encouraging nighttime sleep.
- There is evidence that using these methods improves outcomes for parents, including less depression and better general mental health.
- There is no evidence of long – or short – term harm to infants; if anything, there may be some evidence of short – term benefits.
- There is evidence of success for a wide variety of specific methods, and little to distinguish between them.
- The most important thing is consistency: choose a method you can stick with and stick with it.
12. Beyond the Boobs: Introducing Solid Food
- Early exposure to allergens reduces incidences of food allergies.
- Kids take time to get used to new flavors, so it is valuable to keep trying a food even if they reject it at first, and early exposure to varying flavors increases acceptance.
- There is not much evidence behind the traditional food – introduction recommendations; no need to do rice cereal first if you do not want to.
- Baby – led weaning doesn’t have magical properties (at least not based on what we know now), but there is also no reason not to do it if you want to.
- Vitamin D supplementation is reasonable, but don’t freak out about missing a day here and there.
Part Three: From Baby to Toddler
13. Early Walking, Late Walking: Physical Milestones
- Delayed motor development can be a signal of more serious issues, the most common of which is cerebral palsy.
- Variation in motor development within the (very wide) normal range is not a cause for concern.
- There are many approaches to evaluating motor skills; your pediatrician is your best partner in doing so.
- Children get many, many colds — about one per month for the winter, at least until school age. Lotion tissues. Lots of lotion tissues.
14. Baby Einstein vs. The TV Habit
- Your zero – to two – year – old cannot learn from TV.
- A three – to five – year – old can learn from TV.
- It is worth paying attention to what they are watching.
- The evidence is sparse overall. When in doubt, use your “Bayesian priors” to complement the data.
15. Slow Talking, Fast Talking: Language Development
- There are some standard tools to determine child vocabulary size, which you can use on your own. There are also some metrics you can compare.
- Girls develop language faster than boys, on average, although there is a lot of overlap across genders.
- The timing of language development does have some link with later outcomes — test scores, reading — but the predictive power is weak for any individual child.
16. Potty Training: Stickers vs. M&M’s
- Age at toilet training has increased over time, very likely as a result of parents choosing to train later.
- Starting training earlier leads to earlier completion on average, although it generally takes longer; starting intensive training before twenty – seven months does not seem to lead to earlier completion.
- First, there is the parent – led, “endpoint – oriented” potty training. 6 These methods are discussed in books like Oh Crap! and 3 – Day Potty Training.
- There is little evidence on the efficacy of child – led training versus more intensive, goal – oriented methods.
- Refusal to poop on the toilet is a common complication with some limited solutions.
17. Toddler Discipline
- There are a number of evidence – based parenting interventions. These include 1 – 2 – 3 Magic, the Incredible Years, Triple P — Positive Parenting Program, and so on.
- First, recognize that children are not adults, and you usually cannot improve their behavior with a discussion. If your four – year – old is taking their shirt off in the museum, they will not respond to a reasoned discussion about how you actually do need to wear a shirt in public places. The flip side of this — more important — is that you shouldn’t expect them to respond to adult reasoning. And as a result, you should not get angry the way you would if, say, your spouse was stripping in the museum and didn’t stop after you explained why they shouldn’t
- All these interventions emphasize not getting angry. Don’t yell, don’t escalate, and definitely don’t hit. Controlling parental anger is the first central part of the intervention.
- Second, these approaches all emphasize setting up a clear system of rewards and punishments and following through on them every time. For example, 1 – 2 – 3 Magic develops a system of counting (to three, obviously) in the face of disruptive behavior, and if three is reached, there is a defined consequence (a time – out, loss of a privilege, etc..). Finally, there is a strong emphasis on consistency. Whatever the system you use, use it every time. If the consequence of counting to three is a time – out, then there needs to be a time – out every time, including, say, in the grocery store.
18. Education
- Your baby cannot learn to read.
- Whether your two – or three – year – old can is unclear, but it would be very unusual for them to be a fluent reader.
- Evidence on the value of different preschool philosophies is limited.
- Rather than just reading a book, kids benefit from being asked open – ended questions
- “How do you think the Cat in the Hat is feeling now?”
Part Four: The Home Front
19. Internal Politics
- Marital satisfaction does decline, on average, after children.
- These declines are smaller and briefer if you’re happier before children, and if the kids are planned.
- Unequal division of labor and less sex probably do play some role, although it is hard to get a sense of how important these are.
- There is some small – scale evidence suggesting marital counseling and “marriage checkup” programs can improve happiness.
20. Expansions
- The data doesn’t provide much guidance about the ideal number of children or birth interval between them.
- There may be some risks to very short intervals, including preterm birth and (possibly) higher rates of autism.
Appendix:
Evaluating a Daycare
- Safety
- No exposed outlets, cords, fans, etc.
- Safe cribs
- Written emergency plan
- Disposable towels available
- Eating area away from diaper area
- Toys washed each day
- Teacher knows about infant illnesses
- Fun
- Toys can be reached by kids
- Floor space available for crawlers to play
- 3 different types of “large – muscle materials” available (balls, rocking horse)
- 3 types of music materials available “
- Special activities” (i.e.., water play, sponge painting)
- 3 materials for outdoor infant play
- Individualization
- Kid has own crib
- Each infant is assigned to one of the teachers
- Child development is assessed formally at least every 6 months
- Infants offered toys appropriate for their development level
- Teachers have at least 1 hour a week for team planning
- Books on Sleep Training:
- Weissbluth, Healthy Sleep Habits, Happy Child
- Ferber, Solve Your Child’s Sleep Problems
- Ezzo and Bucknam, On Becoming Baby Wise
- Pantley, The No – Cry Sleep Solution
- Hogg, Secrets of the Baby Whisperer
- Waldburger and Spivack, The Sleepeasy Solution
- Mindell, Sleeping Through the Night
- Giordano, The Baby Sleep Solution
- Turgeon and Wright, The Happy Sleeper
