Dive into the complete episode list for The Baby Manual. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.
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Pub. Date
Title
Duration
11 Oct 2023
301 - Overview of supportive and alternative care
00:19:20
Welcome to Season 3 of The Baby Manual podcast with Dr. Carole Keim - pediatrician, mom, author of The Baby Manual and the upcoming Holistic Mamas Handbook. In this new season Dr. Keim will take parents through things like teething, colic, constipation, and allergies. This first episode explores what types of modalities are available, from Western medicine to acupuncture to naturopathy and more.
In visiting alternative practitioners, interviewing them, and going through the research, Dr. Keim has learned how many things are available to parents to help children feel better when they’re ill. Western medicine, our traditional medical system in the US, has great advantages but is not always the best at improving quality of life. So Carole explains the options for a multifaceted approach, what to look for, and how each can help children thrive.
In this episode:
Why CAM? 00:26
Many modalities of healthcare
Western medicine does a lot of things well, but nobody does everything the best
Kids under age 3 can’t take most OTC medications, but still suffer from many ailments
A multifaceted approach is often the best one
Treat symptoms and underlying disease at the same time
Important to know which ones might interfere with others, and what’s safe for babies
Writing HMH to help parents through this time; let you know what’s safe, what will actually help
Stay tuned because this season we will cover teething, colic, constipation, allergies, and more
Practitioners
Western
Chiropractic
Acupuncture
Nutrition
Massage
Homeopathy
Aromatherapy
Naturopathy
These are in the Holistic Mamas Handbook
The most common ones used in the US are chiropractic, acupuncture, homeopathy, and naturopathy
Western med 02:03
Philosophy: Body = collection of independent systems. Treat the underlying cause when possible. Prolong life.
Tools: Physical examination, lab testing, imaging, medications whose direct action is well understood
Training: 4 years of college, 4 years of medical school, 3-5 years of residency, additional years of fellowship to subspecialize
How to spot a good one: MD or DO, open minded, offers more than one solution, works with you on the treatment plan
Acupuncture 04:19
Philosophy: stimulating points along specific channels can affect nerves and muscles, releases chemicals into the bloodstream, and triggers the body’s natural healing mechanisms to bring about homeostasis. Shonishin dates back to the late 1600s
Tools: shonishin is the technique used for children - observe the child, ask questions, feel pulses, and treat. Blunt tools are used to stroke, tap, and press on the points. Should be painless and not scary. Sometimes also use cupping and/or indirect moxibustion. Moxa is made from mugwort.
Training: 4 years of college, plus 3 years of acupuncture school for LAc, 4 years for DACM.
How to spot a good one: certified in shonishin, has pediatric experience, DACM vs LAc.
Chiropractic 07:21
Philosophy: body has an innate ability to heal itself. Nerves control everything, and pressure on those nerves from bones being out of alignment causes dysfunction.
Tools: adjustments - manual, clicker, drop table vs flat
Training: 3-4 years undergrad, 3-4 years of chiropractic school, earn DC
How to spot a good one: Webster certified, icpa4kids.com, gentle, listens to the child
Naturopathy 09:40
Philosophy: the body has the inherent nature to heal itself, the whole person is treated (mental, emotional, genetic, environmental, and social components), first do no harm, identify and treat the cause (not just the symptoms), prevention is the best cure, and the ND is a teacher whose main role is to educate, empower, and motivate patients to take responsibility of their own health
Tools: nutrition, homeopathy, herbal remedies, hydrotherapy, massage, fascial manipulation, acupuncture, fasting, breathing. Since naturopathy is so broad, few studies have been done on it as a discipline, but there are many studies about the specific techniques used.
Training: 4 years of undergrad, 4 years of ND school. Curriculum includes many of the same classes as western medical doctors, but less pharmacology and more training on herbal and alternative remedies and modalities.
How to spot a good one: certified by AANMC, knows when to refer to western medicine for pharmacologic interventions
Homeopathy 12:54
Philosophy: like cures like, and the more dilute a preparation is, the stronger it is.
Tools: observation of a person’s constitution, remedies that are made from an herb or pathogen and are diluted until no longer detectable and made into pellets with sugar
Training: 2-4 years undergrad, 3-4 years homeopathic school
How to spot a good one: CCH = certified classical homeopath
Essential oils / Aromatherapy 15:05
Philosophy: strengthen the self-healing process by stimulating the immune system. Inhaled scent molecules travel along the olfactory nerves to the amygdala (emotional center of the brain)
Tools: essential oils are extracted by steam distillation or cold pressing. Oils are either inhaled, ingested, or applied topically. Children should not ingest essential oils because they’re not regulated and very concentrated. If you’re using them on your child’s skin, always use a carrier oil to dilute them so they don’t get irritation or a chemical burn.
Training: none required
How to spot a good one: someone with a range of experience who isn’t tied to one brand in particular. Good oils will come in dark glass bottles, will list the plant name in latin, and won’t have other chemicals added.
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her book, The Baby Manual, covers the first year of baby life and is the subject of the first two seasons of this podcast. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
101 - Essential Information Before The Baby Arrives
00:25:02
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)
In Episode 6 of Season 2, Dr. Carole Keim walks us through what to expect from three year olds. This can be a difficult age because children experience a lot of emotional growth and often become oppositional. Dr. Keim offers guidance on what to expect and how to handle it.
Three year olds have a lot of big feelings and drama, they often ask “why” a lot, they do the opposite of what is asked to test boundaries. They are trying to see exactly where the boundaries lie and that they’ll still be loved if they push limits. They have more refined motor skills, are more independent, and their speech has become more coherent. Dr. Keim advises on everything from behavior to nutrition and how best to handle certain patience-testing behaviors.
In this episode:
Social development
Motor skills
Behavior
Parenting
Nutrition
Potty training
Safety
3 year checkup
Social development 02:04
Imaginative play, often elaborate
Can put on a shirt, coat, or jacket by themselves
Plays with others and can share
Able to follow a multi-step command (when they want to!)
3-word sentences
Speech 75% intelligible to strangers
When they speak, repeat back with correct grammar and pronunciation
Tells you a story from a book or TV; make up great stories
Can compare things with words like bigger/smaller
Understands simple prepositions like on/under
Asks “why” repeatedly
Many children start preschool around age 2-3
Types of preschools - Montessori, Waldorf, Reggio Emilia
Preschool vs daycare
Motor skills 05:51
Eats independently
Typically potty trained for urine - can enter bathroom and pee by themselves
Pedal a tricycle
Climb on and off chairs, couches
Jump forward
Draw a circle
Draws a person as a face with arms or legs
Can cut with scissors
Behavior 08:31
Test boundaries
Lots of defiance
Praise/notice good behavior
Offer two reasonable choices as often as possible
Teach them what is ok to do when they are angry
Parenting 12:17
Maintain routines and limits - meals, bedtime
Encourage fantasy play
Play games that require taking turns
Teach your child about empathy (but don’t expect them to fully grasp it yet)
Rhyme together
Let your child pretend to read books to you
Limit TV to 1 hour of high quality programming that you watch together
Avoid TV during meal times and in bedrooms
Be aware of your own screen use around child
Nutrition 16:51
Pattern: eat 1 meal, skip 1 meal, pick at 1 meal
Often picky at this age; try to offer a variety and avoid falling into the trap of beige foods and sweets. Have healthy snacks ready to go for them - cut up fruit/veggies, healthy dips like hummus / soy sauce
Water is the best thing they can drink and can/should be the only thing they drink; limit milk to 24oz per day and juice to 4oz per day
Potty training 17:42
Daytime dryness comes 6-12 mos before nighttime
Encourage frequent sitting to avoid constipation; can become a vicious cycle when they have a painful BM
Dress them in clothing that is easy for them to remove
Safety 18:35
Car seat - can be forward facing
Use helmet for anything with wheels
Remove firearms from home
Supervise around dogs, cars and start teaching them about safety
Touch supervision near water - pools, toilet, bathtubs
Move furniture away from windows
Use door locks and window locks
3-year checkup 20:22
No vaccines other than flu/covid until age 4
Ok to allow child to answer questions, but expect that they will give wrong answers
They typically feel comfortable during the physical exam; time to start talking about safety around adults / private parts
Ask your doctor if you have any specific questions about preschool, behavior, tantrums, nutrition, vitamins, potty training, constipation, and sleep routines
Regular dental visits 1-2x per year
This guide aims to help you with your “threenager”, guiding you through the three years old development stages. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
Dr. Carole Keim talks about the all-important subject of sleep in this episode. Sleep is a frustrating thing as a new parent which is why there is so much sleep advice and so many sleep books available. Dr. Keim will break down what sleep patterns are normal at different ages and give information on different ways to help babies (and parents, by extension) sleep well.
All babies are different and what works for one baby’s sleep may not work for another. But there are normal sleep patterns for different ages and Dr. Keim clears up confusion around those necessary patterns. She explains why babies crave the rocking and contact of being held as opposed to being laid in a bed to sleep and offers advice on how to slowly get them accustomed to the change. From night feeding to sleep positions to not using your phone in your baby’s room to all the different alternative healing modalities that have been shown to be helpful in promoting sleep, Dr. Keim gives the key information parents need on the topic of sleep.
In this episode:
Sleep (00:27)
Intro: helping babies sleep at night is one of the most difficult and frustrating things as a new parent. All babies are different. What’s normal at different ages:
Newborns cluster feed and wake at least once every 2-3 hours
For the first 2 months of life, a baby can’t sleep more than 4 hours
From 2-6 months it’s ok to let them sleep longer, but most still wake 2-3x at night to feed
From 6-9 months, allowed to sleep as long as they want, typically wake 1-2x per night, worse when teething
From 9-12 months, can start offering water at night. Feeding higher fat/protein meals at dinner time can help them sleep better.
After 12 months, they don’t need milk at night, only water if they wake up, and reassure for night waking. Cosleeping will make you both get worse sleep, and remember a thin blanket is ok, but no thick blankets and no pillows til age 2. Sleeping with a tight shirt can help curb breastfeeding at night.
Western - graduated or progressive extinction method. “Cry it out” is not recommended due to emotional trauma. Melatonin is not recommended on a regular basis; can be used intermittently when traveling (jet lag) but not more than 2-3 days. Also a consistent bedtime routine helps - run/play, brush teeth, bath, reading/singing, low lighting, avoid screens x 2h before bed.
TCM - pediatric acupuncture (shonishin) and Chinese herbs can both help with sleep. Speak to a pediatric acupuncturist for specific recommendations.
Chiro - pediatric chiropractic and craniosacral therapy can help your baby or child sleep better. Chiropractic is built around relaxing and resetting the nervous system, so regular adjustments tend to be really helpful for sleep.
Nutrition/supplements - Eating a dinner high in fat and protein and low in sugar at least 2 hours before bedtime, magnesium supplements (check with a doctor for dosing), chamomile tea over age 1 or for breastfeeding moms; can give a spoonful of chamomile tea under age 1 (no honey!)
Homeopathy - aconitum napellus, arsenicum album, belladonna, china officinalis, chamomilla, calcarea carbonica, and pulsatilla. Note: not supported by western science; speak to a CCH for specific recommendations.
Aromatherapy - Can diffuse oils or dilute in a carrier oil and rub onto baby’s back and feet. The best oils for sleep are Roman chamomile, German chamomile, neroli, tangerine, pettigrain, and lavender. Lavender can be stimulating in children; if this seems to be the case, try chamomile oil instead.
End of season; stay tuned for more in the future!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, which can be ordered here. Her first book, The Baby Manual, covers year one of your baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
There is more information like this in the Holistic Mamas Handbook. You can order the Holistic Mamas Handbook on Amazon
Dr. Carole Keim is a pediatrician, mom, and author who helps new parents all over the world understand their babies and navigate the challenges that arise daily. The first year of a baby’s life is the focus of Season 1 of this podcast, ages one to three is the focus of Season 2, and holistic and supportive care is the focus of Season 3. Now Dr. Keim welcomes listeners to Season 4 where she will focus on talking about baby items that are actually needed. She will guide listeners in sorting through pregnancy, baby, and toddler items that are useful versus those that are a waste of time and money.
In this first episode, Dr. Carole Keim shares a list of items that should be bought while they’re on sale. Black Friday is just around the corner and sales tend to pop up close to major holidays. These items are divided into categories from things for pregnant moms, items useful to have before a baby is born, items for toddlers, and general household items. Dr. Keim takes listeners through the basics to let us know which things should be purchased when they’re on sale, which things to get secondhand, which things to buy new, and which things the brand actually matters.
As an Amazon Associate, I earn from qualifying purchases.
Dr. Keim has extensively researched the information presented in this episode. She is pulling on the knowledge of hundreds of thousands of new parents, other pediatricians, doctor moms, the Academy of Pediatrics, and breaking pediatrics news sites. Her insight and knowledge on alternative and holistic treatments can be found in her book Holistic Mamas Handbook, and her first book, The Baby Manual, covers year one of a baby’s life. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers.
Resources discussed in this episode:
The Holistic Mamas Handbook is available on Amazon
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
Dr. Carole Keim MD takes parents through all the different developmental milestones that babies go through from newborn to one year of age. She details the types of development, how to play with your baby to enhance development, and how much screen time is okay for babies.
Dr. Keim explains how your baby’s grasp will develop as they age through their first year and when they’ll be able to use their thumb and forefinger to pick up small objects, for example. She explains how far they can see when they’re newborn, when they start to recognize voices and then faces, when they develop object permanence (which is the same time they start to love playing peek-a-boo). She covers reflexes, speech patterns, tummy time, stranger anxiety, helpful play, and everything you need to know about how your baby is absorbing their world.
This episode will cover:
Types of development
Developmental milestones by age
How to play with your baby
Screen time
Types: 0:42
Gross motor skills - use large muscle groups
Fine motor - small muscle groups
Verbal/social - their interaction with family / peers
Isolated delays are often benign; delays in 2-3 areas are red flags
There is no advantage to pushing motor skills, but there is advantage in encouraging verbal/social skills
Newborn: 2:11
Brief periods of wakefulness
Equal limb movements
Responds to parents voice/touch
Looks briefly at parents
Moves in response to visual or auditory stimuli
Reflexes: grasp, rooting, moro
1-2 weeks old: 4:20
turns and calms to parents voice
Communicates needs (wet diaper, hungry, tired) but has the same cry for all
Able to fix briefly on faces or objects
Follows to midline
Lift head briefly while prone
1 month: 5:36
Responds to calming actions when upset
Follows parents with eyes; follows past midline
Recognizes familiar voices
Responsive smile
Able to lift head during tummy time or while on parent’s chest
Communicates needs
2 months: 6:57
Start losing grasp/rooting/moro reflexes
Looks at parent
Social smile
Starts to comfort self
Different types of crying
Coos
Can show signs of boredom
Lift chest briefly during tummy time
Head control while sitting supported
4 months: 8:41
Elicits social interactions
Looks at parents / watches them walk around
Able to comfort/console self
Starts babbling / cooing expressively, squealing, and laughing
Responds to affection
Indicates happy/sad
Able to push up onto elbows (lifts chest fully while prone)
Good head control
Start rolling (front to back)
Start reaching for objects
Can hold a bottle
6 months: 10:52
Socially interactive with parents - takes turns babbling
Mature babbling (consonants and vowel sounds)
Recognizes familiar faces; beginning of stranger anxiety
Starts to recognize own name
Rolls over both ways
Sits (tripod)
Starts showing pre-crawling behaviors (getting to knees, rocking, army crawl)
Turns while seated
Brings objects to mouth
Transfers objects hand to hand
Raking grasp
Gets distracted while eating
Diaper changes get more difficult because they try to roll
9 months: 13:40
Stranger anxiety
Seeks out parents
Uses repetitive consonant and vowel sounds
Points at objects
Object permanence
Interactive games (responds to peek-a-boo)
Explores environment with eyes, hands, and mouth
3-finger grasp
Pulls to stand
3D diaper changes
1 year: 17:07
Imitates activities
Hands books/toys to parent to play with them
Waves bye
Strong parent attachment; separation anxiety
Protodeclarative pointing
Imitates sounds/words (animal sounds)
Speaks 1-2 words
Jabbers with inflection
Identifies people when asked
Bangs two objects together
Stands alone
2-finger grasp
Follows simple directions
How to play with your baby and boost their development: 19:46
All ages: talk and sing to your baby, narrate your day
Newborn up to 1mo: Help baby develop sleep and feeding routines; swaddle baby and place them face up to sleep in a crib or bassinet in parents’ room, use dim lighting and a quiet voice at night; help baby wake for feeding by picking them up, undressing, can use a wet wipe; tummy time on parents’ chests
1 month: Awkward time because they are awake more. Develop consistent routines for sleep and eating, cuddle and talk to baby often, do tummy time 15-30 mins 1-2x per day; let them look out windows, at ceiling fans, or at bold patterns
2 months: Continue routines; hold baby, cuddle them, sing or talk to them; start to learn their likes and dislikes; continue tummy time 30 mins 1-2x per day
4 months: as above, but also can let them sit supported; watch for signs of food readiness; can play music for baby
6 months: Play time on the floor, let them sit in high chair (for meals and also to watch you / play), interactive/reciprocal play, make funny sounds, read to baby, hand them objects to put in their mouth, babies start to notice screens at this age (front camera feature, video chatting). Officially no screen time til age 2 other than this. Babies start to notice patterns and cause/effect at this age, can develop habits. Start baby proofing at 6 months.
9 months: Consistent positive discipline (one pickup rule for thrown objects, have cause-and-effect toys, have a “yes” space), expect them to explore the environment, read together, hand them toys that make noise when you squeeze or shake them
12 months: Use distractions for discipline, verbally acknowledge good behavior, consider playgroups (they often won’t interact with other babies other than to point them out), encourage self-feeding, can help them start walking by holding onto hands or using rolling toys, say the name of objects they point to, name their emotions, tell them what’s ok to do instead of using ‘no’
Screen time: 33:10
Officially, ONLY video chatting is ok up until age 1.5-2 years,
age 2-5 years up to 1 hour per day, 5+ years up to 2 hours per day of recreational screen time
At 18 months, ok to start educational programs, but you need to watch with them
PBS kids, Pocoyo, Baby Bus, Cocomelon
Children are affected by sounds on TV - avoid anything scary or violent while baby is in the room
Screen time is associated with developmental delays; it’s like overhearing a conversation as opposed to being engaged in one
You (and other people) are your baby’s primary entertainment source for the first 2 years
There are plenty of ways to entertain your baby that don’t involve screens: singing, talking, playing with them, reading to them
If you need a few minutes: keep preferred toys in a “yes” space
Coming up, Dr. Keim will go through the checkups and advice for the next several visits. Now babies are being seen every three months, so the next few visits will be 9 months, 12 months, 15 months and 18 months.
Carole Keim is also working on a third edition of The Baby Manual coming out soon. And another book called The Baby Manual Step By Step which will go chronologically, a one chapter at a time guide. You just need to read one chapter that will go with whatever age your baby is and the closest checkup to your baby's age.
All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
In this episode Dr. Carole Keim MD covers baby illnesses and red flags. A red flag is a sign something could be wrong with your baby. Dr. Keim explains abnormal temperatures, choking, diarrhea, head injuries, seizures, and more to guide you in identifying red flags and what they might mean.
Not all red flags are emergencies that require immediate attention. Some are, but some are identified as urgent, which means your baby should be seen by your doctor within the next week or two. Dr. Keim shares this list of major red flags to watch for in the hopes it helps you, and ideally saves you and your baby a trip to the ER.
This episode will cover:
What is a red flag?
Urgent v. Emergent
Abnormal Temperature - emergency
Apnea/Cyanosis - emergency
Aspiration/Choking - emergency
Blood in the Diaper - urgent
Bulging Fontanel - emergency
Cough - emergency
COVID/flu/RSV exposure - urgent
Diarrhea/Vomiting - urgent
Head injury - emergent if signs of concussion/fx, otherwise urgent
Jaundice - urgent
Seizure - emergency
Umbilical Cord Infection - urgent
Umbilical Granuloma - urgent
What is a red flag? - 00:24
A red flag is a sign that something MIGHT be wrong and you should run it by a doctor.
Urgent vs. Emergent - 00:37
Urgent = should be seen by their doctor at the next available appointment, ideally within a week or two.
Emergent = they need to be seen that day (sometimes immediately) - go to the ER or call emergency services. If you are traveling, look up the phone number for emergency services before you go. It’s 911 in the US but different in other countries.
It is ALWAYS ok to call your doctor or emergency services if you are concerned!
Abnormal Temperature - emergency - 1:15
You should have a rectal or temporal artery (TA) thermometer at home. Go buy one if you don’t have one yet.
The rectal temperature is the most accurate in babies, since their skin doesn’t hold heat very well. If your baby is acting strange, or feels especially warm or cool to the touch, you can check a rectal temperature.
Underarm temps and infrared forehead temps are inaccurate after the first few days/weeks of life - they can read either too high or too low by as much as 2 degrees. They are ok as a screening, but they are measuring surface temperature and not core temperature, so if you are concerned and want an accurate read you need to do a core temperature - either rectal or TA.
A core temperature higher than 100.4 degrees Fahrenheit (38 degrees Celsius) is considered a fever. A rectal temperature less than 96 degrees Fahrenheit (35.5 degrees Celsius) is considered to be hypothermia.
Babies who are less than 6 months old have immature immune systems, and an abnormal temperature (either high or low) can be a sign that they have an infection.
Apnea/Cyanosis - emergency - 3:29
If your baby appears to stop breathing for several seconds (apnea), or starts turning blue (cyanosis), it’s time to call a doctor. Cyanosis is most apparent on and around the lips, fingertips, and toes.
Aspiration/Choking - emergency - 4:10
Signs of aspiration/choking include gagging, coughing, arching the back, vomiting, and turning blue. Call your doctor if your baby is experiencing these symptoms, or 911 if it’s severe.
Blood in the Diaper - urgent - 4:46
If you see blood in your baby’s diaper, and you think it is coming from the urine or stool (and not from pseudomenses), call the doctor. This is urgent but not emergent.
Bulging Fontanel - emergency - 5:30
If the anterior fontanel (soft spot) seems to be higher than the rest of the skull, this is a sign that the pressure around your baby’s brain is too high. The fontanel will often raise during crying, straining to poo, and other normal maneuvers. That is nothing to worry about. But when the fontanel is bulging when your baby is calm, you need to see a doctor.
Cough - emergency - 6:33
Hiccups are normal, sneezing is normal, but cough is not. Clearing their throat after eating doesn’t count as a cough. Any baby less than 6mo with cough needs to go to the ER - they are at risk of apnea and may need to be admitted depending on how they are doing.
OTC cough medicines are NOT to be used in children less than 6 years of age - they can cause them to stop breathing, and the safe ones (like antihistamines) just don’t work.
COVID/flu/RSV exposure - urgent - 8:47
Call your doctor or check the CDC website for current guidelines.
Everyone in the house should wash hands often. Anyone with cough or runny nose should wear a mask and try to stay away from baby. If you’re breastfeeding and you have COVID/flu/RSV, keep breastfeeding! You’re giving passive immunity to your baby that way. Just wear a mask so you don’t cough onto the baby.
Breastfeeding babies: mom can take Vitamin C, Vitamin D, echinacea, and zinc to pass through breastmilk to baby.
If baby develops cough or fever, go to the ER if under 6 mos, or call your doctor if over 6 mos.
Diarrhea/Vomiting - urgent - 12:09
Babies can get dehydrated very quickly from diarrhea and/or vomiting. Call your doctor if baby has vomiting or diarrhea 2-4x in the same day; go to the ER if it is more than 4x in a row or if baby is showing any signs of dehydration: dry lips/tongue, sunken fontanelle, irritable, lethargic.
It’s ok to rehydrate babies over 6 mos by giving water or an electrolyte solution (pedialyte, ORS) to replace losses, but only in small volumes - check with your doctor about how much is ok to give. Remember they are on a primarily liquid diet, and giving electrolyte solution can cause them to be protein/fat/calorie depleted.
Head injury - emergent if signs of concussion/fx, otherwise urgent - 14:22
Any time your baby falls off a surface (couch, changing table, bed, etc.) you need to call a doctor to make sure your baby did not sustain a concussion.
Signs of concussion include:
Losing consciousness / fainting
Vomiting
Change in personality - persistent crying, acting strange, trouble sleeping/eating, etc.
Pupils unequal size
Seizure
Weakness of the entire body or parts of the body
If you feel skull crepitus (a crunchy sensation under the skin) or if baby’s fontanel is raised, that is an emergency. Crepitus = skull fracture, bulging fontanel = bleeding around the brain.
Jaundice - urgent - 18:07
If your baby’s skin and eyes appear yellow, you should call a doctor. Most babies will have jaundice at some point, and your doctor can do a test to determine the level of bilirubin in the blood to see whether the jaundice needs treatment or not. If the level of bilirubin is too high and is not treated, it can cause brain damage.
Seizure - emergency - 20:02
Infantile seizures may be the whole body (generalized shaking and tremors), or may only involve part of the body. Some signs of seizures are:
The whole body or part of the body makes repetitive jerking movements
Sucking when there is nothing in the mouth
Fast blinking
Eyes deviated to the side
If you think your baby might be having a seizure, remove anything that might be in baby’s mouth, make sure your baby is not left unattended on a surface, and call an ambulance.
If you are able to take a video of the seizure, it can be very helpful for the doctors to see that!
Umbilical Cord Infection - urgent - 22:35
If the skin around the umbilical cord is red, swollen, warm to touch, and tender, these are signs of infection.
Umbilical Granuloma - urgent - 23:42
When the umbilical cord falls off, it’s normal to have a little bit of bleeding and what looks like yellowish goo. After the cord has fallen off, clean the area gently with a wet washcloth or a cotton ball with rubbing alcohol. The bleeding should stop immediately, and much of the yellow goo will come off. If the umbilicus is still bleeding, or there is too much yellowness, there may be an umbilical granuloma in there. This can be treated easily at the doctor’s office with a chemical called silver nitrate. The chemical cauterizes the granuloma, and the process is completely painless for your baby.
All of this information is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
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.
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.
Dr. Carole Keim MD takes listeners through vaccines in today’s episode. She explains everything from how vaccines are created to common myths and misconceptions about them. She then details each baby and childhood vaccine, and what disease each prevents.
Dr. Keim breaks down how vaccines work and what criteria they must meet in disease to be effective. She explains the four main types of vaccines and lays each vaccination out in a clear manner, covering what age your baby or child will be when they receive the vaccine and how the immune response works. These vaccines are proven to protect your baby against everything from tetanus to mumps to pertussis and more.
This episode will cover:
How vaccines work
Criteria to create a vaccine
The 4 different types of vaccines
Common myths or misconceptions about vaccines
Specific vaccines (all routine childhood vaccines)
Total number of vaccines
Common side effects and red flags, how to treat
How vaccines work: 00:44
The purpose of vaccines is to trigger an immune response faster and with less harm than the original disease.
The immune system is a lot like a microscopic team of superheroes, made up of white blood cells, antibodies, the complement system, and a few others. These superheroes fight villains such as bacteria, viruses, and other pathogens. If they cannot fight them fast enough, the villains will multiply and cause symptoms of disease.
Vaccines give your superhero team information about what the villains look like, so they can recognize them as soon as they enter the body, and fight them off quicker and easier.
Vaccine criteria: 01:26
In order to make a vaccine, certain conditions must be met
It has to be effective. We must be able to become immune to the pathogen; diseases like RSV and HFM are ones we can catch multiple times. Chickenpox is one that you become immune to after catching it once.
The pathogen must not be able to mutate faster than the vaccine can be given - we do flu boosters annually because the flu virus mutates about that often. HIV and common cold mutate too fast for a vaccine to be developed.
The vaccine must be cost-effective; it has to be cheaper to prevent the disease than to treat it
There are 4 main types of vaccines: 02:31
Inactivated (killed pathogens)
Live attenuated (weakened pathogens)
Toxoid (a piece of what’s inside the pathogen)
mRNA vaccines
Inactivated vaccines 03:44
Most common type
The bacteria or viruses in the vaccine are killed, so your immune system can safely learn to recognize the pathogen that it is trying to fight off. These vaccines do not have the potential to cause actual disease. What they do is cause the immune system superheroes to practice fighting the villains, kind of like practicing on dummies, which may cause mild signs of illness - fever, sore muscles, crankiness, or other symptoms.
Examples: IPV (polio), HPV (human papillomavirus), HiB (Haemophilus influenzae B), pneumococcus (Streptococcus pneumoniae), meningococcus (Neisseria meningitidis), and Hepatitis A and B vaccines.
Live attenuated vaccines 04:02
Made from bacteria or viruses that have been exposed to chemicals that make them weaker than the natural or “wild type” bacteria or virus.
Since these pathogens are not killed completely, your superheroes aren’t just practicing on dummies, they are actually fighting the weakened villains. So it is possible to have symptoms of the disease, but milder.
Some people with weakened immune systems may not be able to fight them off, and can get the actual disease. People taking steroid medications or immune suppressants, or who have HIV or other immune deficiencies should consult a doctor about whether it is safe to receive these vaccines.
Examples: oral polio vaccine, MMR (measles, mumps, and rubella), Varicella zoster (chickenpox), and rotavirus vaccines.
Toxoid vaccines 04:55
Made from just part of the pathogen, and protect against the kinds of bacteria that cause symptoms after the toxins inside them are released.
These toxin-carrying bacteria are like villains carrying around a bottle of poison, and the toxoid vaccine gives the superheroes the poison to sample and build up resistance to it.
Example: DTaP (diphtheria, tetanus, and acellular pertussis).
MRNA vaccines 05:23
Newest type
mRNA is like a copy of instructions. These give your immune system something like a sewing pattern to print out and make the dummies for your body to fight
Example: some COVID vaccines
Myths and misconceptions about vaccines: 05:45
Many parents have concerns about vaccinating their children. It only takes one serious reaction to call into question the safety of vaccines. And it has been so long since the vaccine-preventable diseases have run rampant that we in the United States don’t fully understand the scope of what is being prevented. Here are some of the top concerns that I have heard from parents, and the truth behind them.
Aluminum. There is aluminum in vaccines, but the amount is far less than babies get from other sources. The total amount of aluminum that babies get from vaccines in the first 6 months is 4.4mg. Breastfed babies consume 7mg, formula-fed babies consume 38mg, and babies on soy formula consume 114mg of aluminum in the first 6 months of life. Consuming aluminum vs. having it injected in a vaccine looks the same to the body, so the tiny amount of aluminum in vaccines will not harm your baby
Antigens. An antigen is any microscopic substance that has the possibility to elicit an immune response. Babies are exposed to over a trillion antigens in the first year that naturally occur in the environment. The entire vaccine series that children receive today contains just over 150 antigens. A young baby’s immune system can easily recognize these few antigens and make antibodies to the diseases without getting sick.
Autism. It has been proven that vaccines do NOT cause autism. The age that children first start showing signs and can be tested for autism is 15-24 months. This is the same age that children receive booster vaccines, so it is understandable that some parents think they are related.
Long-term protection. Vaccines will protect a person for just as long as if they got the original disease. So a person who had chickenpox as a child is just as protected from getting it again as a person who has received the chickenpox vaccine. Some people do not seroconvert (develop antibodies to that disease) - that depends on their immune system and is not a failure of the vaccine itself.
Mercury. There used to be a preservative called thimerosal in vaccines. That preservative (which contains mercury) has been removed from all vaccines in the US that children receive. The only vaccine that still contains thimerosal is the adult flu vaccine.
Unnatural exposure. Some people worry that getting exposed to a disease through an injection is not the same as getting it “naturally” by being exposed to a sick person. This is not true; any disease will get into your bloodstream, which is where it is recognized by the body, and once in there the body has no idea how it got in. So getting an injection looks exactly the same to your immune system as getting the disease from a sick person.
Doctors DO NOT get paid to vaccinate children
Vaccines are NOT a punishment for children who are behaving badly
Specific vaccines: 10:47
Hep B - 0, 2, 6 mos. Hepatitis B is a viral infection that can be passed from mom to baby through the placenta or during delivery. 90% of babies born with HepB will develop chronic infection and are at risk of liver cancer later in life.
DTaP - 2, 4, 6, 15 mos, 4 years. Tdap - age 11, every 10 years. DTaP has more diphtheria, Tdap has more tetanus. Bacterial infections. Diphtheria causes severe sore throat and enlarged tonsils, and can block the airway from swelling/tonsils being so enlarged. Tetanus makes spores that live in soil; any penetrating wound could have tetanus in it (nail/thumbtack, dog or cat bite) and tetanus is not killed by antibiotics so it must be prevented. Pertussis is whooping cough and causes babies less than a year old to stop breathing. Everyone who takes care of the baby should be current on their TDaP (within 10 years).
Polio - 2, 4, 6 mos, 4 years. Polio is a virus that attacks nerves and causes paralysis. Sometimes it’s minor, and sometimes it’s the diaphragm that’s affected and they stop breathing. There is no specific treatment for polio.
HiB - 2, 4, 6, 12-18 mos. HiB (haemophilus influenzae B) bacterial infection that affects children less than 5 years, and especially those under 1 year of age. It used to cause severe infections like epiglottitis, sepsis, pneumonia, and meningitis.
PCV - 2, 4, 6, 12-18 mos. PCV = pneumococcal conjugate vaccine, pneumococcus is another name for streptococcus pneumonia, which is a kind of strep that gets into the bloodstream and causes sepsis, pneumonia, and meningitis. PCV has 13 strains of strep in it right now.
Rotavirus - 2, 4, 6 mos. Viral infection that causes severe diarrhea and dehydration in babies.
Hep A - 12 and 18 mos. Hep A is a type of food poisoning, there’s no specific treatment.
MMR - 1 and 4 years. Measles causes high fever, rash, and can cause brain damage, hearing loss, and death. Mumps causes parotitis (infection of salivary glands), but in boys also causes orchitis (inflammation of testicles) and can lead to sterility. Rubella is a fever and rash; more dangerous to unborn babies, causes miscarriages and birth defects.
VZV - 1 and 4 years. Varicella Zoster virus (chickenpox) causes cold symptoms, fever, and an itchy and painful rash in children, and shingles in adults. VZV in pregnancy causes miscarriages and birth defects.
MCV - 11 and 16 years. Meningitis A, C, W, Y are viruses that cause inflammation around the brain that develops quickly and can be fatal.
HPV - 11 years. Human papilloma virus causes warts and dysplasia and can lead to cancer of the mouth, throat, anus, cervix, and penis. Currently 9 strains of HPV in the vaccine.
Flu: recommended annually
COVID: recommendations are still evolving
Vaccines that are available but not given routinely: MenB, PPSV23, Dengue, Typhoid, japanese encephalitis, yellow fever, rabies
Total numbers of vaccines: 22:35
1 at birth (Hep B)
2 mos: DTaP, polio, HiB, Hep B, PCV, rotavirus - 1 or 2 combo vaccines, PCV and rota = 2 or 3 shots plus an oral vaccine
4 mos: DTaP, polio, HiB, PCV, rotavirus - 1 combo plus PCV and rota = 2 shots and one oral
6 mos: DTaP, polio, HiB, Hep B, PCV, rotavirus - 1 or 2 combo vaccines, PCV and rota = 2 or 3 shots plus an oral vaccine
6+ mos: flu vaccine annually
12-18 mos: 2 doses Hep A, 1 of DTaP, HiB, PCV, MMR, VZV. 5-7 shots depending on combos.
4-6 years: DTaP, polio, MMR, VZV, typically given as 2 combo vaccines
11 years: Tdap, MCV, 2 doses HPV
16 years: MCV
21+ years: Tdap every 10 years; booster if you have a wound and it’s been less than 5 years, booster while pregnant
9 shots and 3 oral before 1 year of age, 5-7 shots from age 1-2, 2 shots age 4-6, 4 at age 11, 1 at age 16 = 21-23 total shots before adulthood. 18 flu shots.
Common vaccine reactions: 23:53
Birth: nothing; sometimes redness/swelling
2-6 mos: redness and swelling (local reaction), can be as much as the entire thigh and still be considered normal. Low grade fevers.
12-18 mos and 4-6 years: muscle soreness, MMR and VZV cause fevers, VZV sometimes causes rash, other vaccines can cause local reactions
11yrs: muscle soreness, local reaction with Tdap and MCV, fainting with HPV
16 yrs: local reaction from MCV
Tdap boosters: muscle soreness
Flu, COVID: flu-like symptoms
It is NOT normal to have a body rash or vomiting after vaccines; those are signs of allergy
Large local reactions and muscle soreness can be treated with cool compresses (wet washcloth) and/or acetaminophen or ibuprofen.
Fever or flu-like symptoms: acetaminophen or ibuprofen
I DON’T recommend pre-medicating your child before vaccines
If your child has an adverse reaction to a vaccine, you should report it to VAERS (vaccine adverse event reporting system). Remember that VAERS is like Yelp for vaccines, so take that about as seriously as you would a Yelp review.
All of this information is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
Dr. Carole Keim talks about two conditions that can affect your baby’s eyes. The first is lacrimal duct stenosis and the second is pinkeye. She explains what causes each condition, how they typically present in your child, and ways each modality of medicine can help with treatment. All this information will also be found in her new book, Holistic Mama’s Handbook.
Lacrimal duct stenosis is often called a blocked tear duct but it’s not the tear duct that is blocked, it’s the lacrimal duct located in the corner of the eye on the bottom eyelid. Dr. Keim details what it looks like and how long it might last. Pinkeye can be caused by viruses or by bacteria. Viral infections are more common than bacterial ones. Dr. Keim outlines the differences in each, what symptoms to watch for, and how western and alternative medicines can help.
In this episode:
Lacrimal duct stenosis 00:33
Symptoms: watery discharge, light crusting on lashes, buildup of what can look like pus in the eyes but is just skin cells, whites of eyes stay white. No long term effects, goes away typically before 1 year of age.
Western - massage the duct during diaper changes, wipe with clean washcloth, wait until 1st birthday, can consider surgical dilation. If eyes get infected, can add antibacterial eyedrops.
Acu - point near the lacrimal duct can be used and has shown great results in studies
Chiro - craniosacral / skull bones
Nutrition/supplements - none specifically.
Naturopathy - fascial manipulation, Can put breastmilk in eyes.
homeopathy - Pulsatilla, Merc Sol, Apis Mellifica, or Stannum Met may be tried.
Aromatherapy - none
Pinkeye 06:27
Symptoms: watery/purulent discharge, crusting, redness of the whites of the eyes. Viral bilateral, bacterial usually unilateral. Viral is self-limited with the illness, can last 1-2 weeks, and can sometimes get a bacterial superinfection if kids rub eyes.
Western - Viral: supportive care, cool compresses to eyes, avoid rubbing/touching. Bacterial: antibiotic eye drops
Acu - viral: treat underlying cause/imbalance. Bacterial: n/a.
Chiro - nonspecific but can help with overall wellness
Nutrition/supplements - viral: Vitamin C, Vit D, zinc, echinacea, elderberry. None for bacterial.
Naturopathy - breastmilk, topical eyedrops (western), some can make herbal tincture eyedrops (need to be sure it’s very sterile), wet socks
Homeopathy - There are homeopathic eye drops to help with symptoms of pinkeye. Euphrasia can be used orally for viral conjunctivitis. Oral Pulsatilla and Calcarea Sulph may be tried for bacterial conjunctivitis, but you should see a doctor for antibiotic eyedrops if it’s not helping within a day.
Aromatherapy - not recommended topically, but can use decongestant oils such as eucalyptus or peppermint in a diffuser
More like this in the Holistic Mamas Handbook. Next week: ears!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her book, The Baby Manual, covers the first year of baby life and is the subject of the first two seasons of this podcast. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Dr. Carole Keim MD introduces everything to know about babies at 9 months of age in this episode. She details developmental milestones and safety considerations for the 9 to 12 month age range and lets you know what to look for.
Dr. Keim encourages parents to have date nights at this stage, to leave your baby with a trusted sitter, and also to start really talking out any parenting differences that may have appeared. She talks about all the ways in which your baby will have developed, from object permanence to repetitive sounds, and covers sleep, nutrition, and teeth as well. This is the age to really start baby proofing your home with outlet covers and stairway gates, and Dr. Keim also shares advice on skincare and the 9 month check up.
This episode will cover:
Parents
Development
Sleep
Nutrition
Teeth
Elimination
Skin Care
Safety
9 Month check-up
Parents: 00:26
Typically have routines down
Engage with child often by speaking with/to them, waiting for them to respond
Infant should be able to separate or move away from parent for moments, but will check back to look at them
Have a “yes” space
Have regular date nights with a babysitter watching baby
Make time for yourself
Hang out with friends
Use consistent positive discipline (notice/comment on good behavior, avoid using the word “no” and instead tell them what they CAN do, use distraction, be a role model)
Development: 03:00
Stranger anxiety / apprehension
Seeks out parent
Uses repetitive consonant and vowel sounds while babbling
Says mama or dada (not specific)
Points out objects
Has object permanence
Interactive games (responds to peek-a-boo, cause-and-effect toys)
Explores environment with eyes, body, and mouth
Some movement across floor
Can start weaning pacifier
Sleep: 05:20
10-12h at night, 2 naps per day
Bedtime routine established: quiet time, reading, singing
In crib in parents room; consider moving to own room when 1 year old
Still no blankets until 1 year old
No bottles in bed
Nutrition: 06:21
3 meals and 2-3 snacks per day at the same time as the family
Offer a variety of foods and textures
Should be consuming 24-30oz of breast milk or formula daily
Can have water; can start using a cup
No cow’s milk or honey until 1 year of age
Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
Lots of oral exploration at this age; they might get into dog food/water, eat crumbs off the floor, eat rocks/sticks/dirt outside
Teeth: 09:59
Brush teeth BID with fluoride-free toothpaste; if there is no fluoride in water source can use a grain-of-rice sized amount of fluoride toothpaste
If no teeth yet, brush gums BID with plain water and toothbrush
First dentist visit will be at 1 year of age
Elimination: 11:10
Can start potty training by putting baby on potty after eating and upon waking
Typically voiding at least 6x per day, stooling 1-2x per day
If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day. If not enough, talk to your doctor about miralax.
Skin care: 13:29
Bathe as often as they get dirty (2-3x per week)
Can use lotion
Use sunblock if spending more than 30 mins outside
Insect repellant for babies (citronella based is best)
Safety: 14:54
Baby proof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach
Keep baby in arms or a high chair or playpen in the kitchen and bathroom; never allow baby to be alone in those rooms
Set water temp to 120’F
Avoid secondhand smoke
Rear facing car seat until age 2
Don’t leave heavy objects or hot liquids on tablecloths or coffee table
Save poison control number in your phone
9mo Checkup: 18:40
Expect them to tear up and try to eat the exam room paper
They try to eat my stethoscope and badge
Full head-to-toe exam
Postpartum depression screening
No vaccines this visit, other than flu and covid
Next checkup is at 1 year of age (after first birthday); will do vaccines at that visit
Reminder that after 1 year of age should have their first dentist visit and eye exam at ophthalmologist
All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
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
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)
Dr. Carole Keim talks all about picky eaters in this episode. Is it normal when your toddler reaches a point of only eating five beige foods? Yes. Dr. Keim covers this and everything to do with development, child nutrition, tempting picky eaters, and when to see a doctor about food concerns.
Dr. Keim also addresses why the old food pyramid is out of date and explains the actual nutrients your child needs and which foods they appear in. She shares why eating an actual apple is healthier than processed apple sauce, why processed foods aren’t good for kids, and how to keep kids interested in trying new things. Toddler palates and pickiness are de-mystified in this episode.
In this episode:
Normal development
Macronutrients
Micronutrients
Food pyramid
Green/yellow/red light foods
Talking with children about nutrition
Tips for new foods
When to see the doctor
Normal development 00:25
0-6 mos: only eat one thing
6-12 mos: they only eat what you give them, simple palate (1-3 ingredients, no spices)
12-24 mos: tend to be great eaters and willing to try most things
Around age 2-3 they go through a phase of eating 5 foods
Eating pattern: eat one meal, pick at one meal, skip one meal
Most outgrow this within a year
Macronutrients 03:03
Carbohydrates
Protein / complete proteins (9 essential AAs)
Fat
Micronutrients 07:12
vitamins A, B, C, D, E, K
Iron and other minerals
Omegas
Probiotics and prebiotics
Fruits and veggies
Food pyramid 11:20
outdated; developed in 1992
became my plate in 2011
2020 guidelines focus on limiting processed foods, increasing nutrient-dense foods, and limiting added sugar to <10% of daily calories, Saturated fat to <10%, sodium to less than 2.3g, and alcohol to 2/day for men and 1/day for women
Green/yellow/red light foods 13:55
another way to think about it; easy for kids to understand
Still puts food into the “good vs. bad” spectrum
Talking about nutrition with young children 16:49
Focus on benefits - fiber, vitamins, nutrients, keeps you full, fuels your body, helps you grow strong, etc.
Talk about flavors and textures - fresh fruit and veggies often crunch
Eat the rainbow; color = vitamins/nutrients
Put all food on the plate at the same time (including treats)
Don’t use dessert as a reward, or other
Avoid the “clean plate club” - puts a lot of stress on children. Can let children serve themselves or tell you how much they want.
Tips for trying new foods 21:03
Eat together as a family
You provide the food, they decide whether to eat it
No pressure to taste new foods
Keep offering
Offer a variety
Make it look fun / fun utensils
Let kids help with shopping and meal planning
Let kids help prep food
Once your child likes a new food, offer similar foods
Pair new foods with preferred foods
Use “we” statements
When to see the doctor 24:55
Poor weight gain or weight loss
Lack of variety longer than 1 year
Avoidance of certain textures
Gagging or vomiting after eating
Stomachaches associated with food
Chronic abnormal poops
This guide will help you navigate nutrition for your toddler, letting you know what’s normal pickiness and when to worry. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
In this second episode of Season 2, Dr. Carole Keim discusses what to expect at the 18 month stage. Your baby is a toddler now, and showing ever more personality, and Dr. Keim has advice on everything from tantrums to sleep.
Dr. Keim addresses what social and motor development looks like at this age. Your baby will want to play with you and they understand a lot more language than their few words would have you believe. She talks about the “terrible twos” and shares ways to avoid tantrums. She addresses sleep and what bed your baby should sleep in at 18 months. How should teeth brushing go? How do you navigate potty training? What are major safety concerns to address? Dr. Keim has insight on all these questions and more in this episode.
In this episode….
Social development and language
Motor development
Behavior
Digital media
Sleep
Nutrition
Teeth
Elimination
Safety
Skin care, bathing, sun protection
18mo Checkup
Social development: 00:40
Engaging with others for play
Help with dressing and undressing
Points at pictures in books
Shows things to parents by pointing or bringing objects
Parents: encourage use of language by naming what you see, talk and sing to child, use words to describe feelings and emotions
Motor development: 04:30
Can run, kick a ball
Walks up stairs by doing step-together and while holding a hand
Can sit in a small chair
Walks around with toys
Scribble
Throw a ball
Behavior: 06:10
Terrible two’s start now - they know how to use “no”
Offer 2 suitable choices as often as possible throughout the day. Let them choose how things get done.
They have a hard time expressing preferences; pretty good with needs
Modify their environment to avoid conflict; plan ahead for new and difficult situations
Hitting and biting are attempts to communicate - teach them how to communicate effectively
Anticipate anxiety/clinging in new situations
Spend at least 10-15 minutes in child-led play
Prepare child for new sibling by reading books, getting them a doll
Digital media: 14:14
Promote reading, physical activity, and play with non-electronic toys
Make time for play every day
No screens for at least 2 hours before bedtime; instead plan on tech-free play, bath, reading
Use methods other than screens to calm them down: distraction, removing trigger, going outside, addressing needs like hunger/sleep
If you do use digital media, choose high quality programs/apps and use them together: PBS kids, Daniel Tiger
Limit viewing to less than 1 hour per day
Be mindful of your own screen use; make a plan for family media use
Avoid having TV on in the background, especially during meals
Sleep: 17:55
10-14h at night, 0-1 nap per day.
In crib in their own room; consider moving to toddler bed when it’s ok for them to get out of bed (walking independently, able to safely get to your room and wake you up)
Night waking is normal; reassure briefly, offer stuffed animal or blanket so they can self-console
Lifehack while potty training: layer sheets and chucks
Blankets ok; no pillows til age 2
No food or drinks in bed
No electronic devices in the bedroom (TV, tablet)
Nutrition: 20:57
3 meals and 2-3 snacks per day at the same time as the family
Offer a variety of foods and textures
Encourage self feeding and use of utensils
Use a cup for water; offer water with all meals and snacks
Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
You determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze). They are typically not picky and want to try new foods at this age.
Less than 24oz of milk per day, less than 4oz juice (ideally NO juice)
Teeth: 25:10
Brush teeth BID with small smear of fluoride toothpaste
They should see a dentist 1-2x per year
Elimination: 26:09
Typical age to start potty training - start noticing them hiding to poop or anticipate when they will go, they know and tell you when they’ve peed/pooped, they can pull pants up/down
Typically voiding at least 6x per day, stooling 1-2x per day
If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day. If not enough, talk to your doctor about miralax.
Can start potty training by putting toddler on potty after eating and upon waking
If toddler is resistant to potty training, can start with sitting while clothed and entertain them with a book or toy, then sitting with pants and diaper off
Read books about using the potty
Can keep the potty in your bathroom and try going at the same time - they love to mimic adults at this age
Start boys sitting on the toilet; they can stand later. Standing too early can lead to constipation.
Potty signal: songs
Safety: 33:13
Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools, small and sharp objects out of reach
Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of them
Set water temp to 120’F
Avoid secondhand smoke
Rear facing car seat until age 2, make sure everyone in the car is using a seat belt
Don’t leave heavy objects or hot liquids on tablecloths or coffee table
Save poison control number in your phone
Remove guns from the home or keep them locked and unloaded in a safe
Make a fire escape plan with the family, check smoke detectors often
Skin care: 37:38
Bathe as often as they get dirty (daily)
Can use lotion; many have started outgrowing eczema by now
Use sunblock if spending more than 30 mins outside, apply 30 mins before you go outside, and use SPF 30 or higher. Also use a hat, sun protection clothing (long sleeve swim shirts)
Insect repellant that is safe for babies
18mo Checkup: 39:05
Expect them to be clingy and sad if you leave them on the table
Full head-to-toe exam
Routine vaccines at this visit; should be all caught up now until age 4!
Dr. Carole Keim discusses ears and two main issues that your baby can experience. Ear infections, also called otitis media, and ear wax. Dr. Keim explains the many symptoms of an ear infection, what causes them, and explores the holistic options for treating the pain and infection. She also talks about how best to clear ear wax from a baby’s ears.
While Dr. Keim doesn’t talk about swimmer’s ear in this episode, she covers it in the Holistic Mamas Handbook for those who want that info. But for ear infections and wax, you’re going to learn a lot in this episode. What do you look for in terms of ear infection symptoms in an infant? What modalities offer the most help? What supplements can be given to babies? Are Q-Tips really as bad as people say? Carole answers all these questions related and more.
In this episode:
Otitis media (ear infection) 01:09
Symptoms: ear pain, sometimes also fever. Pain is worse with pressure on canal and tragus, and a little worse with pulling on pinna. Typically occurs along with (or just after) congestion/URI symptoms/allergies - anything that causes swelling in the nasopharynx. More common in babies who lie down with a bottle and those who are formula fed. If untreated, can cause ruptured eardrum, mastoiditis, and rarely meningitis. Recurrent AOM can cause scarring of the eardrum, and persistent fluid can cause verbal delays.
Western - ibuprofen x 48h. Antibiotics for bacterial AOM - high dose. Ear tubes for recurrent AOM. Decongestants for symptoms (ginger, steam, nasal saline, spicy foods), fluids, rest.
Chiro - neck adjustments and craniosacral therapy help fluid to drain; can treat the active infection and/or prevent future infections. Definitely recommended for children at risk of needing ear tubes.
Acu - acupuncture and/or herbs can help
Nutrition/supplements - avoid sugar and dairy as these feed bacterial infection. Can use immune boosting vitamins like vit C, vit D, zinc, echinacea, elderberry for viral infections. Most AOM is viral.
Pain mix: 1/2 oz vegetable oil, 10 drops lavender, 5 drops german chamomile, 6 drops palmarosa, 3 drops cardamom; mix and put 1-2 drops into ear for pain.
Infection mix 1: 1/2 oz vegetable oil, 3 drops thyme, 3 drops lavender, 10 drops roman chamomile, 3 drops palmarosa; mix and put 1-2 drops into affected ear.
If the ear is very painful, you can wet a washcloth with warm water, put 1/2 teaspoon on the washcloth, and use as a warm compress outside the ear.
Earwax 19:30
Symptoms: often asymptomatic, sometimes hearing loss / verbal delay, wax leaking from ears, sometimes discomfort.
Western - q-tips / cotton swabs daily or for yellow wax (medical community is split on this, some recommend doing nothing); for brown wax use debrox, hydrogen peroxide, ear wash (irrigation) with warm water and dish soap, curette removal, baby oil, colace drops.
Chiro - n/a
Acu - no acupuncture but chinese herbal drops, ear candling
Nutrition/supplements - garlic mullein oil or olive oil drops in the ears can help break up wax and make it flush out more easily
Naturopathy - fish oil (po) (mom can take if breastfeeding), food intolerances if chronic, ear lavage with hydrogen peroxide (syringe with dull needle)
Homeopathy - not really, would need to be as part of a constellation of symptoms
Oils - no EOs, can use olive oil or garlic mullein
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her book, The Baby Manual, covers the first year of baby life and is the subject of the first two seasons of this podcast. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Dr. Carole Keim gives parents information on daycare and preschool - from the different types of preschools available to how they operate - so you can find the best fit for your child, but also for you in terms of community.
There is a lot to consider when choosing a preschool: in the United States there are three main types of preschools and they would each suit specific child needs or parent desires differently. Dr. Keim breaks down what to expect and what to look for in preschools. She also explains the frequency of illnesses that children are more likely to get in school, how they circulate, and how you can avoid germs at home.
In this episode:
Daycare
Montessori
Waldorf
Reggio Emilia
Considerations
Illnesses at school
Avoiding germs at school
Daycare 00:33
Wide range, often regulated by health and safety organizations
Sometimes mixed ages, sometimes separate ages
Ratio of children to teachers can vary
Setting can vary - can be in a classroom, in home, at a public building, etc.
Montessori 01:34
Layout: furniture is child sized, wooden shelves along the walls, low educational pictures/diagrams, shelf layout increases in difficulty as you move left to right and top to bottom (children are meant to move through them sequentially)
Atmosphere: Children move around freely, do what they want when they want, adults are there to give presentations or to intervene only when needed, children of various ages help each other
Layout: natural, decorated with things from nature, plain wooden toys (encourage creative play), few distractions
Atmosphere: simplicity, goodness, beauty, wonder; free play, nature exploration, projects / handcrafts, classroom functions like a home. Reading/writing/math introduced later than in public school
Teachers: accredited, masters degree or certificate, stay with the children their whole time at the school, i.e. K-5 or K-8
Children: creative entrepreneurs, problem solvers, self-directed learners, imaginative thinking
Reggio Emilia 06:59
Layout: child-based, colorful, activity/theme stations, children’s artwork on the walls
Atmosphere: play-based learning, teachers play with the children, learning by theme, some structured activities, plenty of play time and child-directed time
Teachers: certified in early childhood education
Children: learn to follow their passion, creative thinkers, well-rounded children, problem solvers
Things to consider 09:33
Hours
Cost
Location
Ratio of children to teachers
Teaching style
Community
Tour the school to get a feel for it
Illness at school 11:14
Average 4-6 illnesses per year for the first 2-3 years (sick enough to come to the doctor), plus some milder ones
Tend to cluster in winter months
Can spread between family members
Avoiding germs at home 12:31
There’s a chapter in my book, The Baby Manual
Wash hands as soon as you get home
Use separate hand towels
Keep toothbrushes apart (not in a cup with other people’s)
Sleep in a different bed than the sick person
Don’t share utensils or food, blow on children’s food if you’re sick, or touch their food to your lips to see if it’s hot
If anyone is sick, they should not come within 6 feet (and ideally in the same room) as anyone at high risk, such as babies under a year, people with medical conditions, etc.
Dr. Keim’s information here is designed to help you make daycare and preschool choices for your children a bit easier. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember, it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
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
Dr. Carole Keim explains all the toddler behavior you can expect at different ages between ages one and three. She goes through all main behavior and ability changes and gets to the heart of why toddlers are acting in the way they are.
The more understanding you have of why children are behaving in a certain way, the easier it is to see things from their point of view. Dr. Keim offers tips and tricks for navigating the word no, the repeated question why, three year old defiance, and other notable toddler behaviors. It will be difficult, they tend to push all your buttons while learning boundaries, but Dr. Keim will make you feel more confident in your navigation.
In this episode:
1-1.5 yo
1.5-2 yo
2 yo
3 yo
Resources
1-1.5 yo 00:37
Starting to be able to do things for themselves
Just starting to walk/talk, can feed themselves
Don’t have a lot of opinions/preferences yet
Stranger anxiety - most will stay within sight of a parent
Fairly easy behavior
Parents: this is an ideal time to take a parenting class together
1.5-2yo 07:03
Can walk, use some words, pick things up off the floor / get things for themselves
Separation anxiety, strong attachment to parent - explores with a parent nearby
Mimicking
Want to try things for themselves, show off
Trying out their independence
Learn how to use the word “no”
Advocate for themselves
Most wants are actually needs
Start having some opinions and preferences but can’t express them yet
Offer 2 suitable choices
Empathy
2yo 13:21
Run / run away
Say no
Like attention (any kind) - spend 10 mins/day in child-led play
Struggle with transitions, have no sense of time
Can understand sequence a little bit - when/then statements
Want to experience things for themselves - natural consequences
Empathy, choices still
3yo 18:30
Drama - know about emotion, how to tell stories, have very active imaginations, are egocentric
Start expressing a wide range of emotions
Understand that their actions impact others but don’t understand empathy/theory of mind yet
Ask “why?” repeatedly - attempt to connect
Test boundaries to see where they are
Test consequences to look for cause-and-effect
See how much they can get away with (testing that you still love them)
As above (when/then statements, natural consequences, empathy, choices) plus modeling how to handle anger/frustration, anger wheel of choice, logical consequences
This guide is all about toddlers and why they behave in the way they do. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
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 talks you through everything about sleep in this episode. Your baby’s sleep and yours as well. She addresses sleep patterns, helping your baby fall asleep and stay asleep, crying, safe sleep and reducing SIDS risk, and how to consider nighttime work division with a partner so both of you can get your own sleep.
Sleep is vital for both you and your baby. For the first months of your baby’s life, they will sleep a lot in two or three hour increments, and wake to feed often, while you don’t really sleep at all. Dr. Carole offers suggestions on how to help your baby learn the difference between night and day so you can teach that nighttime is for sleep. Develop a nighttime routine for your baby that will help them be ready to fall asleep faster in their crib. Dr. Carole also explains why she’s pro-pacifier and swaddling and cautions about other ideas that may not be safe for your baby. Learn all about your baby’s sleep health so you can get back to your own night rest.
This episode will cover:
Baby sleep patterns
How to help baby fall asleep and transfer to the bed
How much crying is ok
Safe sleep / SIDS
Co-sleeping
Division of night work
Tips to help you sleep better
Sleep training
Baby sleep patterns: 00:44
Newborns: about 18h per day, in 2-3h increments, and MUST be woken up to feed if they have slept 4 hours. NB are only awake to feed/pee/poop/cry.
Around a month they learn the night-day difference, and will start to sleep longer stretches at night and shorter ones during the day. They still wake at least 1-3x per night and nap throughout the day.
You can help by interacting more during the day, and keeping the lights dim and a quiet voice at night
Around 2 months they are allowed to sleep more than 4h at a time; check with your doctor to make sure they are gaining weight consistently
By 6 months some babies may sleep through the night, but most will still wake up at least once. They are also typically taking 3 naps per day at this age, then 2/day at 9 mos, and 1/day at 1 year.
It is normal even for the first few years of life to wake 1-2x per night. Can make it less appealing by adding water to the bottle after 1y of age.
The 4-6mo sleep regression - not a medical thing, may be due to teething. Many babies actually start to sleep better at this age - this is not due to starting solid foods, but more likely due to their ability to consume larger amounts of breastmilk/formula at a time.
Total hours of sleep: 18h per 24h for newborn scattered throughout the day, 14-18h per 24h for 6 mos old (12-14 at night, then 2-3 naps 1-2h each), 12-14h per 24h for 1 year (11-12 at night, 1 nap for 1-2h)
Help baby fall/stay asleep: 05:43
Signs baby is tired: drooping eyelids, rubbing eyes, yawning, fussing
Swaddle baby for the first month or until they bust out of it; can go longer if baby loves it, but MUST stop when baby can roll over
Have a wind down routine
Last nighttime feed in arms / high chair
Brush teeth or gums
Bath (optional; they don’t need it daily, but it can be relaxing)
Sway/rock with baby in arms
Speak in a quiet, soothing voice
Read a book / sing a lullaby
Place baby down “awake but drowsy” - they will get used to falling asleep in their bed
All babies hate their bed!
If baby falls asleep in arms, transfer quickly to bed, place a hand over them for 10-20 seconds or until they seem settled in, then walk away
For babies who seem to want more, can sit in a chair near the crib and move the chair progressively farther away each night, eventually stand in doorway while they fall asleep, then you should be able to walk away
Can try adding in blackout blinds, white noise machine, lotion, etc - keep in mind that baby will get used to this and it can make sleep harder later
Tylenol/ibuprofen at bedtime for teething infants can help them sleep better
DO NOT put rice cereal in the bottle for sleep, or start solids early; these actually contain less calories per ounce than breastmilk/formula and will make them get hungry sooner
DO NOT use melatonin in babies less than a year, or for more than 2 nights in a row after 1 year of age
DO NOT give your infant or child sedating antihistamines or other sleep medicines, they are not safe
How much crying is reasonable? 12:07
Most babies will wake up a little as you set them down, and many will cry
It’s ok to put a hand on them, rock them gently in their bed, pat them gently, talk to them, sing, etc. but try not to pick them up for a few mins
Generally 5-20 mins of crying is ok, but if it is hard for you to wait that long it’s ok to pick baby up sooner. Just make sure you give them a chance to self-soothe.
This is not the same as cry-it-out or CIO; that allows them to cry until they become exhausted and fall asleep, and I do NOT recommend that
If your baby cries to the point of breath holding, gasping, or vomiting, that is too much
Safe sleep / reducing the risk of SIDS: 13:31
The ABCs of safe sleep: Alone, on their Back, in a Crib
Alone - no blankets until 1 year of age, and no pillows until age 2. No toys, no crib bumpers, no loose sheets, no netting. They CAN have a pacifier and be swaddled.
Back, on their - aka face up
Crib - may also be a bassinet or other safe surface. Safe sleep surfaces are firm, have tight-fitting sheets, and baby is unable to fall out of it. It is ok for baby to sleep in a car seat, swing, or stroller for about 20-30 mins while observed, but you must transfer to a safe sleep surface ASAP for babies less than 6 months.
Pacifiers can reduce the risk of SIDS
Smoking is a big risk factor for SIDS, so smoking outside or stopping smoking will help reduce this risk
Around 4-6 months when baby is rolling:
No swaddling
No blankets
When they roll themselves over, you don’t have to turn them back. still place them on their back to sleep initially though.
Transition to crib in parents’ room until 1y of age
Crib in their own room at 1 year
Toddler bed when you are ok with them getting out of it or if they are escaping the crib (typically age 2-3)
Co-sleeping: 17:14
Considered unsafe by the AAP for the first year of life
After 1 yr can sleep in a bed with blankets, and at age 2 can have pillows; safe to co sleep at age 2 years
Many parents will co-sleep at some point, often when baby is sick, which is arguably the most dangerous time
To co sleep safely: firm mattress (with tight fitted sheet) on the floor, no blankets, no pillows
There are safe and unsafe co-sleepers on the market. Safe ones have 3 or 4 hard sides, and a firm flat bottom, and are sometimes also called bassinets. Unsafe ones have soft pillow sides, or are inclined more than 10 degrees.
It is not safe to sleep in a chair holding your baby, or to sleep with your baby lying next to or on top of you in bed
Tips to help you sleep better: 19:45
If you have a partner: divide the night
Split the night into shifts from 10p-2a and 2a-6a. Keep in mind, newborns will be more awake during that 2-6am time (for the first month or so) and mom’s milk production is highest at that time. Baby takes bottles of EBM during partner’s shift, and mom pumps.
Alternate nights
Split the duties: one parent feeds, the other changes diapers. I typically don’t recommend this one, because then neither parent gets any stretch of sleep longer than 2-3 hour
Minimize screen time, and no screens for 2h before your ideal bedtime. The blue light from screens decreases sleep quality. Amber glasses and night-shift mode can help, but no devices is better.
Have a wind-down routine for yourself that includes hygiene and a relaxing activity like stretching, meditating, praying, or reading
Keep the bedroom dark and quiet; consider blackout blinds and white noise machine for parents’ room
Avoid caffeine and alcohol; both will decrease sleep quality. Drink loads of water.
Eat healthy power snacks at night (plain yogurt, cottage cheese, fruit, nuts) if you are breastfeeding, rather than processed foods which provide quick energy/calories and could make it harder to go back to sleep.
Have a lighter meal in the evening
If you are anxious about sleeping through something important, keep in mind that a baby’s cry is the very best alarm clock for moms, they tend to be in sync with mom’s sleep cycle (so you are likely to wake at the same time anyway), and you can always set a 4-hour timer to wake you both up so baby doesn’t sleep through a feed
Avoid sedating medications whenever possible (especially OTC ones like diphenhydramine or melatonin) because you need to be able to wake up when your baby needs you
Go to bed after your baby’s first evening feed (the one after your dinner). It can add 2-3 hours of sleep per night, which is immensely helpful
Sleep training: 27:53
Cry it out / Extinction method: Leave them until they fall asleep, do not go back to check on them. This is not recommended, babies feel neglected and very stressed with this method.
Babywise: Schedule feedings, play, and sleep. This is not recommended; has been associated with serious problems (dehydration, poor weight gain, failure to thrive, delayed development, early weaning)
Dr. Sears: promotes co-sleeping and following baby’s cues; co-sleeping is not recommended.
Dr. Spock: recommends following baby’s cues but suggested placing them face down, which is associated with SIDS and not recommended.
Ferber method: Have a wind-down routine. Leave the room, and allow progressively longer intervals of time before checking on baby (every 5 mins, then every 10, then every 15, etc); when you check on baby you may verbally soothe but do not pick them up.
Happiest baby on the block: 5 s’s: swaddling, side/stomach position, shushing, swinging, and sucking. Swaddling and side/stomach are not recommended, but shushing, gently swinging/swaying with baby, and allowing them to suck on a pacifier are all recommended.
Closing remarks: 31:43
This is one of the hardest things parents deal with (their lack of sleep due to baby’s inconsistent sleep)
The first few weeks are the hardest; it gets better with time, and all people eventually sleep through the night, typically by the time they are going to preschool
Try not to compare babies (siblings, cousins, friends’ babies, yourself as a baby etc.). Babies are all different and there is a HUGE range of normal.
There are SO MANY sleep books out there because there are so many different ways to ‘train’ your child to sleep - feel free to read them, but keep in mind that if there was one book that actually worked for all children, it would be the only book.
Switching between different things can actually make it harder for your child to fall asleep. Consistency is key here. Pick a pattern and stick to it, and your baby will adapt, typically within a few days.
Sleep is VERY cultural and you will have lots of opinions; please keep in mind safe sleeping practices
Optimizing your sleep will make you feel better, keep you healthier, and allow you to be the best version of yourself for your baby
All of this information on sleep is also in The Baby Manual book, which is available for purchase. And remember to also protect your own sleep to help you be the best parent you can be for your baby.
Dr. Carole Keim discusses all the supportive care options available for your child’s cold, beyond the over-the-counter medications. She details alternative medicines and things you can do to alleviate your child’s cold symptoms.
Most viruses don’t have specific treatments in Western medicine. We have COVID and flu vaccines, but beyond that, there isn’t much medically to be done for a cold. Dr. Keim not only explains what alternative options are available, she breaks down exactly what each virus does and what symptoms manifest in your child. This is a truly valuable resource episode.
In this episode:
Overview of colds
Fever
Congestion and ear pain
Runny nose
Cough
Immune boosters
Sample regimens
Overview 00:51
Viral infections - no specific treatment for most
Many types and subtypes of viruses
Typical course: illness lasts 7-10 days, peak on day 4, cough can linger for up to 2 weeks after
Red flags: respiratory distress, dehydration (dry lips/tongue, decreased urine output, lethargy), fever for 5 or more days in a row, fever that goes away for more than 24 hours and then comes back (can indicate a secondary infection such as UTI/AOM/pneumonia)
Fever 04:40
Acetaminophen / paracetamol
Ibuprofen
These will also help with systemic symptoms - pain, body aches, lack of energy, lack of appetite, trouble sleeping.
These do NOT treat cough, congestion, or runny nose
Magic socks - wet cotton socks, cover with wool socks before bed
I don’t recommend potatoes, garlic, or onions on feet - I’ve seen some burns
Congestion and ear pain 09:01
Eustachian tubes drain at the back of the nasopharynx, so congestion leads to fluid buildup in ears, so decongestants treat both
Medications for adults and children over age 6: pseudoephedrine by mouth, oxymetazoline nose spray
Children under age 6: nothing for congestion; ibuprofen for ear pain (x48h before abx)
Saline nose spray or sinus wash - hypertonic saline
Sinus drain/massage - OMT or chiropractic - tapping on sinuses and pressing along lymphatic channels
Acupuncture
Onion earmuffs for ear pain
Runny nose 18:43
Antihistamines DO NOT work.
Use saline spray to keep the mucus cleared out. Can use bulb sucker if boogers are stuck.
Wash your hands every time you wipe their nose
Color of mucus has to do with the amount of inflammation and not necessarily whether it’s a bacterial or viral infection
If mucus is very thick and seems to be stuck, can use guaifenesin (Mucinex) to help them clear it out. Kids almost never need this and it works by causing them to cough, so many parents avoid it because it makes their child seem worse.
Cough 21:45
Mucinex causes more cough
Dextromethorphan, codeine, and similar anti-cough agents work by decreasing respiratory drive and can cause children under age 6 to stop breathing
Antihistamines only work if it’s allergies, not for infections
The only thing that has been shown to be both safe and effective in Western medicine trials is honey (and only for children older than 1 year because of the risk of botulism!)
Teach children to cough in their elbow
Immune boosters 23:45
Vitamin D - 400 units
Vitamin C - 1000mg for adults; 100mg per 10 lbs
Zinc - 30-60mg for adults
Echinacea - after exposure or at the onset of symptoms
Elderberry - syrup or gummies
Garlic
Lemon juice
Fruits and veggies - 10 servings per day, or supplement
The vitamins and supplements my family takes is in my link tree
Sample regimens 29:10
RSV and/or common cold 29:13
Tylenol/ibuprofen, saline nose spray/drops before eating and sleeping, can bulb suck after each time (or not), bring them into the bathroom when you shower so they can breathe the steam, put vicks or essential oils on yourself or the shower floor before getting in, use a nighttime humidifier if you live in a dry climate, give vitamin C and D, zinc, echinacea, elderberry, consider chiropractic and acupuncture
Keep baby hydrated - it’s fine if they don’t eat anything at all for days, but they need to be drinking water and have at least a little sugar and salt each day. If they have breastmilk or formula that is plenty, they don’t need food on top of that. It’s VERY hard to eat with RSV because of the congestion.
If breastfeeding, take immune boosters and keep breastfeeding as much as possible. If you’re sick, wear a mask so you don’t cough or sneeze onto your baby.
Do NOT allow children with “just a little runny nose” around your baby - RSV causes very mild symptoms in children and adults, but can cause about 1% of babies to end up hospitalized
Do NOT share bulb suckers or pacifiers between children
COVID 34:51
As for RSV; there might be specific treatment in the future but right now only for adults.
Adults in the household should be vaccinated
Flu 35:27
Acetaminophen/ibuprofen for fever and body aches, can also help with sleep and appetite
Saline drops/spray for congestion, honey for cough (over 1 year), ginger for congestion and to settle the stomach
For vomiting and diarrhea, keep them hydrated with small sips of water, watered-down juice (50% water or more), oral rehydration solution, popsicles, jello, or commercial drinks like pedialyte/gatorade. If they are unable to keep down fluids you need to bring them to the ER.
Tamiflu is sometimes helpful and sometimes causes GI upset. It’s approved for ages 6mos and up.
Adults and children over 6 months of age can be vaccinated
Holistic Mama’s Handbook 39:43
I am in the midst of writing HMH
Collaborating with pediatric acupuncturists, chiropractors, dietitians, naturopaths, etc
For parents of young children
Release date Fall 2023
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments will come together in her new book, “The Holistic Mama’s Handbook”, due out Fall of 2023. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. And remember, it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
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).
Dr. Carole Keim talks about constipation and urinary tract infections (UTIs) in this episode. Dr. Keim details how to tell if your infant or child is truly constipated and what can be done to help alleviate the discomfort, as well as what to look for if you suspect a UTI. Her advice includes all holistic options that are applicable to alternative care.
The rate of true constipation in infants under a year old is very rare, roughly 3% of babies. But that changes when children are older than a year. Constipation can become a lot more common as children age. Dr. Keim explains all the science, medical information, and care options for constipation and she also explains that children who are constipated are more likely to also get UTIs, which is why this episode is about both topics. UTIs tend to be more common in summer and in girls, but Dr. Keim explains that they can happen throughout the year and to boys as well. The information in this episode will ensure you are prepared to assist your child through either condition, should they arise.
In this episode:
Constipation (00:32)
Symptoms: poorly defined; decreased number of poops with harder texture. Pellets in the diaper. Note: discoordinate stooling happens at 4-6 weeks of age and is a normal phase they go through; your baby isn’t constipated at this age!
Western - in first 6 months just increase amount of feeds (don’t add water until they are eating foods) and talk to your doctor about possible food allergy/intolerance; when they start solids start offering 1oz of water for each 1oz of food; avoid milk at 1 year of age; increase water intake in children 6 months and older, prune juice as a medicine, increase fiber, P foods (pears, plums, peaches), polyethylene glycol (miralax), belly massage, tummy time, warm compresses to abdomen.
Homeopathy - speak with a CCH, they need to look at the constellation of symptoms
Aromatherapy - Ginger, fennel, peppermint, rosemary, lemon, and lavender oil may help - in a diffuser or mixed with a carrier oil and rubbed onto the abdomen. Also any of these, or castor oil on a warm wet washcloth on the abdomen can help. Don’t give EOs or castor oil by mouth; EOs are potentially poisonous and castor oil is very irritating to the gut and no longer recommended.
Yoga can also help with constipation - check out videos on youtube!
UTI (21:00)
Symptoms: urinary frequency, urgency, and dysuria (pain with urination), bed wetting in a potty trained child, fever in infants (warrants immediate medical intervention). There shouldn’t be blood; if there is blood in the urine that also warrants immediate medical check. Test is urinalysis. Constipation can lead to UTIs in children; also being in a wet diaper or swimsuit too long, tight clothing/sweating in the summer, and bubble baths.
Western - antibiotics, increase fluids, phenazopyridine / pyridium / AZO in older children, plain water baths
Acu - acupuncture and herbs can help
Chiro - no
Nutrition/supplements - limit sugar and dairy, low acidity foods (limit citrus and tomatoes), cranberry juice or supplements, probiotics
Homeopathy - not recommended
Aromatherapy - not recommended
Also in Holistic Mamas Handbook: pinworms (the most common cause of itchy butt in children!)
Next week: Allergies and eczema!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, which can be ordered here. Her first book, The Baby Manual, covers year one of your baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
More like this in the Holistic Mamas Handbook. You can order the Holistic Mamas Handbook here: https://amzn.to/3rlXhb7
Dr. Carole Keim discusses vomiting and diarrhea in this episode, explaining the causes and symptoms of each. Beyond Western medicine treatment, Dr. Keim dives into alternative and holistic options for the treatment of both vomiting and diarrhea in babies and toddlers.
Vomiting and diarrhea can often appear together, caused by viral infections, but vomiting alone can be a red flag for issues beyond infection, especially in older children. Dr. Keim details what to look for if your child is vomiting and how best to treat the symptoms. While the medical community isn’t fully in agreement on how to define diarrhea, it is essentially looser and more frequent stools. Dr. Keim explains the various colors that can appear in a baby’s stool and when they should see a doctor versus when holistic options may be useful.
In this episode:
Vomiting (02:38)
Symptoms: Forceful expulsion of stomach contents; different than spitting up. Note: if vomit is green that indicates bile and may be a sign of obstruction and warrants immediate medical attention.
Western - we typically don’t treat vomiting in children as it keeps the infection in longer; focus on liquids (small sips at a time - broth, tea, watered-down juice, oral rehydration solution), popsicles, smaller light meals of bland foods
Acu - acupuncture and herbs can help
Chiro - can help with overall wellness and inflammation, but doesn’t specifically treat this.
Nutrition/supplements - ginger, small sips of liquids, bland foods; for viral infections, supplements such as Vitamin C, Zinc, Echinacea, Vitamin D, and Elderberry can help boost the immune system and heal the body faster.
Homeopathy - antimonium crudum
Aromatherapy - ginger, peppermint, lavender, fennel seed, lemon, rose - either in a diffuser or diluted in a carrier oil and rubbed on the abdomen
Diarrhea (11:25)
Symptoms: poorly defined but more frequent and looser stools; poop that soaks into the diaper. Note: normal baby poop is very loose and yellow or green but sits on top of the diaper lining.
Western - typically no medications as this can make the infection worse; BRAT diet (bananas, rice, applesauce, toast), bland foods, limit juices or only give watered-down juice
Acu - acupuncture and herbs can help
Chiro - can help with overall wellness and inflammation, but doesn’t specifically treat this.
Nutrition/supplements - for babies with green poop can do block feeding (twice on one breast, twice on the other) or mix pumped milk in the fridge to get more hind milk and less fore milk; older children avoid dairy and sugar, avoid fruits, give probiotics; For viral infections, supplements such as Vitamin C, Zinc, Echinacea, Vitamin D, and Elderberry can help boost the immune system and heal the body faster.
Homeopathy - china officianalis, arsenicum album, podophyllum peltatum
Aromatherapy - anise, fennel, peppermint, coriander, lemon balm, cardamom, cinnamon - either in a diffuser or diluted in a carrier oil and rubbed on the abdomen.
Next week: constipation and UTI!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her first book, The Baby Manual, covers the year one of baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
More like this in the Holistic Mamas Handbook. Pre-order the Holistic Mamas Handbook, launch date 11/15/23
Dr. Carole Keim MD congratulates all parents on making it through the first year. She reminds everyone how much babies have developed in that year and then goes through what to expect at 12 months and beyond. From development to parenting decisions to skin and teeth care, Dr. Keim covers what you need to know.
Dr. Keim addresses how best to engage with your baby once they’re a year old. She details how they’ve developed and exactly how much they can understand and accomplish. She talks about nutrition and all the things your baby should be eating at this age. Teeth brushing should be a regular part of the bedtime routine and Dr. Keim explains what your baby’s sleeping arrangement should look like. She covers safety and childproofing your home, skincare, and what exactly to expect from their 12 month checkup.
In this episode….
Parents
Development
Sleep
Nutrition
Teeth
Elimination
Skin care
Safety
12mo checkup
Parents: 00:23
Engage with child often by speaking with them, tell them the names of objects
Baby should be able to separate or move away from parent for moments, but will check back to look at them
Have a “yes” space
Have regular date nights with a babysitter watching baby
Make time for yourself
Hang out with friends
Use consistent positive discipline (notice/comment on good behavior, avoid using the word “no” and instead tell them what they CAN do, use distraction, be a role model)
Give your child regular down time during the day
Look for parent-toddler play groups
Congratulate yourself on making it through the first year! Think of how much you have grown and changed, and your baby too!
Birthday party planning: it’s mostly for the parents. Kids can have cake for the first time. Expect your baby to be done after an hour or two, and allow downtime afterwards.
This is the time that parenting expectations start to come to the surface. Talk them over with your partner. Consider taking a Love and Logic class or other parenting class together.
Development: 09:21
Stranger anxiety / apprehension goes away
Might have a preferred parent
Starting to talk - says mama, dada, and one other word (typically hi), imitates sounds, jabbers with inflection
Points out objects and brings objects to show parents
Plays interactive games (responds to peek-a-boo, pat-a-cake)
Hands parents a book or toy
Follows simple directions (put this away / hand me a toy)
Waves bye
Starting to walk/cruise along furniture, stand alone for a few seconds
Identified people upon request
Wean pacifier and bottle - switch to a cup for drinks
Sleep: 14:28
10-12h at night, 1 nap per day. Sometimes takes a few weeks to transition from 2 naps to 1 nap.
Bedtime routine established: brush teeth together, quiet time, reading, singing
In crib in own room; consider moving to toddler bed when it’s ok for them to get out of bed (walking independently, able to safely get to your room and wake you up)
Blankets ok; no pillows til age 2
No bottles in bed; if you need to wean bedtime bottle, can start progressively watering it down until it’s only water
Nutrition: 16:29
3 meals and 2-3 snacks per day at the same time as the family
Offer a variety of foods and textures
Encourage self feeding
Can stop breastmilk or formula (use up what you have); ok to breastfeed as long as you want
Use a cup for water; offer water with all meals and snacks
Cow’s milk and honey are ok now
Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
You determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze)
Teeth: 20:03
Brush teeth BID with fluoride-free toothpaste; if there is no fluoride in water source can use a grain-of-rice sized amount of fluoride toothpaste
If no teeth yet, brush gums BID with plain water and toothbrush
Schedule first dentist checkup now or when first tooth is in
Elimination: 20:53
Can start potty training by putting baby on potty after eating and upon waking
Typically voiding at least 6x per day, stooling 1-2x per day
If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day. If not enough, talk to your doctor about miralax.
Skin care: 22:56
Bathe as often as they get dirty (2-3x per week)
Can use lotion
Use sunblock if spending more than 30 mins outside
Insect repellant for babies (citronella based is best)
Safety: 23:43
Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools
Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of them
Keep baby in arms or a high chair or playpen in the kitchen and bathroom; never allow baby to be alone in those rooms
Set water temp to 120’F
Avoid secondhand smoke
Rear facing car seat until age 2
Don’t leave heavy objects or hot liquids on tablecloths or coffee table
Save poison control number in your phone
Remove guns from the home or keep them locked and unloaded in a safe
12mo Checkup: 27:54
Typically able to sit alone on the table; stay within arms reach so they don’t fall off
Full head-to-toe exam
Routine vaccines at this visit and the next two: a total of 5-7, plus flu/covid
Next checkup at 15 mos
Reminder that after 1 year of age should have their first dentist visit and eye exam at ophthalmologist
All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
Dr. Carole Keim is a pediatrician, mom, and author who helps new parents all over the world understand their babies and navigate the challenges that arise daily. In season four she will guide listeners in sorting through pregnancy, baby, and toddler items that are useful versus those that are a waste of time and money. The focus of today’s episode is baby clothing. What do you really need to clothe your baby and what is helpful? And what clothes are really just cute but not that functional or useful?
Dr. Keim talks about onesies, shirts and pants, socks and scratch mitts, sleepwear and outerwear, covering clothes from newborn to one year of age. She explains what’s the best for nighttime diaper changes, getting babies to sleep, and why scratch mitts don’t work the way we want them to. In every category, she explores what styles and brands offer ideal design elements, what to consider about safety and comfort, and the reality of what a baby will truly wear without it falling off. Her guidance will show new parents exactly what to spend money on and what can be ignored for an easy first year of dressing your baby.
As an Amazon Associate, I earn from qualifying purchases.
Dr. Keim has extensively researched the information presented in this episode. She is pulling on the knowledge of hundreds of thousands of new parents, other pediatricians, doctor moms, the Academy of Pediatrics, and breaking pediatrics news sites. Her insight and knowledge on alternative and holistic treatments can be found in her book Holistic Mamas Handbook, and her first book, The Baby Manual, covers year one of a baby’s life. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers.
Resources discussed in this episode:
The Holistic Mamas Handbook is available on Amazon
Welcome to Season 2 of The Baby Manual with Dr. Carole Keim MD. This first episode of Season 2 is all about your baby at 15 months of age. From parenting to nutrition to skin care, Dr. Keim covers all the major developments of the 15 month age group.
Dr. Keim discusses the developmental progress of your baby at 15 months and notes that they understand the word no, they have preferences, and they also feel upset if those preferences aren’t met. They quite like to help and mimic your actions. She addresses what children should eat and drink and how toddlers like trying things at this age, and explores how often to brush their teeth, when to see a dentist, making your home safe for their exploration, and what to expect at the 15 month check up. A lot of information is here to help you feel confident in navigating everything from tantrums to health.
In this episode….
Parents
Development
Behavior
Sleep
Nutrition
Teeth
Elimination
Skin care
Safety
15mo checkup
Parents: 00:31
Engage with child often by speaking with them, tell them the names of objects
Support toddler’s need for safety and reassurance
Boundaries are reassuring to them
Baby should be able to separate or move away from parent for moments, but will check back to look at them
Look for parent-toddler play groups - Parallel play
Use consistent positive discipline (notice/comment on good behavior, avoid using the word “no” and instead tell them what they CAN do, use distraction, be a role model)
Give your child regular down time during the day; might still be napping
Development: 05:14
Stranger anxiety comes back
Might have a preferred parent
Points out objects and brings objects to show parents
Hands parents a book or toy to play with
Follows simple directions (put this away / hand me a toy)
Imitate parent behavior (talking on the phone, taking pictures, feeding dolls, etc)
Look around when asked questions like “where is your ball?”
Stoop and recover
Crawl up stairs
Start to run
Vocabulary starts to explode; should know at least 3 words and jabber with inflection
Scribble with a crayon or marker (and not just eat it)
Feed themselves well with hands, drink from a cup without spilling
Behavior: 08:28
Terrible two’s start now - they learn how to use “no”
Offer 2 suitable choices as often as possible throughout the day. Let them choose how things get done.
They have a hard time expressing preferences; pretty good with needs
Modify their environment to avoid conflict
Hitting and biting are attempts to communicate - teach them how to communicate effectively
Sleep: 10:41
10-14h at night, 0-1 nap per day.
Bedtime routine established: brush teeth together, quiet time, reading, singing
In crib in their own room; consider moving to toddler bed when it’s ok for them to get out of bed (walking independently, able to safely get to your room and wake you up)
Night waking is normal; reassure briefly, offer stuffed animal or blanket so they can self-console
Lifehack while potty training: layer sheets and chucks
Blankets ok; no pillows til age 2
No food or drinks in bed
No electronic devices in the bedroom (TV, tablet)
Nutrition: 13:25
3 meals and 2-3 snacks per day at the same time as the family
Offer a variety of foods and textures
Encourage self feeding
Use a cup for water; offer water with all meals and snacks
Should be eating greens daily; ok to have meat; supplement with iron if not eating greens daily or red meat 3x per week
You determine when child eats and what is offered, but allow child to decide how much to eat (many toddlers graze). They are typically not picky and want to try new foods at this age.
Teeth: 16:48
Brush teeth BID with small smear of fluoride toothpaste; if there is no fluoride in water source can use a grain-of-rice sized amount of fluoride toothpaste
They should see a dentist 1-2x per year
Elimination: 17:31
Typically voiding at least 6x per day, stooling 1-2x per day
If baby is constipated: first increase water intake, increase fiber (fruit and veggies), then consider prune juice or pear juice 2oz 1-2x per day. If not enough, talk to your doctor about miralax.
Can start potty training by putting toddler on potty after eating and upon waking
If toddler is resistant to potty training, can start with sitting while clothed and entertain them with a book or toy, then sitting with pants and diaper off
Can keep the potty in your bathroom and try going at the same time - they love to mimic adults at this age
Skin care: 20:09
Bathe as often as they get dirty (daily)
Can use lotion
Use sunblock if spending more than 30 mins outside
Insect repellant that is safe for babies (citronella based is best)
Safety: 20:52
Childproof the house - outlet covers, stairway gates, barriers around space heaters, cleaning products locked away, electrical cords out of reach, gates around pools
Don’t take medicines in front of children - they will learn that you’re supposed to open those bottles and put things in your mouth out of them
Keep baby in arms or a high chair in the kitchen, keep the bathroom door shut and bring them in with you; never allow baby to be alone in those rooms
Set water temp to 120’F
Avoid secondhand smoke
Rear facing car seat until age 2
Don’t leave heavy objects or hot liquids on tablecloths or coffee table
Save poison control number in your phone
Remove guns from the home or keep them locked and unloaded in a safe
Make a fire escape plan with the family, check smoke detectors often
15mo Checkup: 24:32
Typically able to sit alone on the table; stay within arms reach so they don’t fall off
Full head-to-toe exam
Routine vaccines at this visit and the next one
Next checkup at 18 mos
Reminder that after 1 year of age should have their first eye exam at ophthalmologist
All of the information in this episode is also in The Baby Manual book, which is available for purchase. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
Dr. Carole Keim talks about baby’s skin today, specifically baby acne and diaper rash. She explains what causes each irritation as well as how they typically present. She then goes through Western and alternative medicines that offer relief or healing.
Baby acne often starts in the first month or so of a baby’s life. There are several causes for baby acne and it will typically cover the face and upper chest. There are ways to soothe it or help it heal faster but, as Dr. Keim says, it’s “self-limited” and goes away on its own. Diaper rash is extremely common and there isn’t just one type that babies can get. The redness and irritation can get colonized with yeast or it may be one of two types of bacterial infections worsening the rash. Dr. Keim details what to look for with each type of diaper rash, when to contact a doctor, and all of the prevention and curative measures offered by healing modalities.
In this episode:
Baby Acne (00:45)
Symptoms: pimples on face and upper chest. Caused by a combination of hormones, dryness, and irritation. Hormones cause increased oil production, dryness causes sebaceous glands to produce more oil to moisturize skin, oil gets trapped in the pores and becomes acne. Being overheated or sweaty will do the same thing. Dirt, too much lotion, and regurgitated milk can irritate the skin and block the pores, making acne flare up more.
Western - typically no treatment; keep baby clean but don’t wash too often (1-2x per week) so skin doesn’t get too dry. Keep room temp 68-72 degrees so they don’t overheat. No need to change diet. Call your doctor if your baby has pimples that are larger than 2mm across, if the lesions are filled with clear fluid or yellow pus, if the pimples are in clusters, or if you aren’t sure if it’s baby acne or something else.
Acu/traditional Chinese medicine - acupuncture doesn’t specifically treat baby acne, but can decrease overall inflammation, and someone certified in Chinese herbalism may be able to recommend topical treatments
Chiro - n/a
Nutrition/supplements - can put breastmilk on baby’s skin
Homeopathy - calendula cream topically; no oral remedies
Aromatherapy - Calendula oil, lavender oil, oregano oil, and tea tree oil may be mixed into a carrier oil and applied topically
Diaper Rash (08:19)
Symptoms: caused by moisture + friction; most babies will have one at some point. Starts with redness/irritation of skin but can get colonized / super infected with yeast or bacteria. Candida rash (yeast) has satellite lesions. Bacterial has boils. Strep butt (perianal strep infection) is a bright red circle around the anus and happens in older children.
Western - prevention (decreased likelihood, sometimes you can’t prevent it!) involves changing diaper as soon as it’s wet/poopy, use water wipes after each poop, apply diaper cream (zinc oxide based vs petroleum), air it out, don’t use baby powder. If not improving within 2-3 days with these treatments, it might be colonized/infected. Nystatin cream for candida, mupirocin for bacterial - both are used 3x per day; use regular cream in between. Oral amoxicillin for perianal strep.
Acu/TCM - acupuncture doesn’t treat diaper rash; chinese herbs may be helpful, check with a pediatric acupuncturist
Chiro - n/a
Nutrition/supplements - acidic foods make it worse (strawberries, citrus, tomatoes). Probiotics can help.
Homeopathy - calendula cream topically; borax veneta, calendula officinalis, cantharis, merc sol, nitric acid, and sulphur can be given by mouth, or dissolved in water and applied topically.
Aromatherapy - nothing for regular/irritant rash. For candida, can use oregano, geranium, or tea tree in a carrier oil. For bacterial, can use tea tree or lemongrass in an oil on the boils.
Also in the Holistic Mamas Handbook: ringworm, cradle cap
Refer to last week’s episode about eczema
Next week: Sleep!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, which can be ordered here. Her first book, The Baby Manual, covers year one of your baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
There is more information like this in the Holistic Mamas Handbook. You can order the Holistic Mamas Handbook on Amazon
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)
In this episode, Dr. Carole Keim talks all about potty training. While potty training usually involves toddlers - the common age is between two and four years - it can be started as early as infanthood with what’s called elimination communication. Dr. Keim walks parents through all the major questions and issues about potty training.
Dr. Keim first explains how to identify when your toddler is ready to start training. She then talks about how to potty train and explains various methods of working with a reluctant toddler or what she calls “secret poopers”. In addition she addresses various things that could go wrong, such as constipation or diarrhea, and how to take care of your toddler if one of these issues should arise. Dr. Keim imparts sound and thorough advice to prepare parents for the journey of getting toddlers to use the toilet.
In this episode….
Elimination communication
Signs your toddler is ready
Secret poopers
Resistant children
Constipation
Diarrhea
UTIs
Elimination communication 00:42
Can start at any age
Pre-verbal children
You indicate when it’s time to potty and make noises while holding them over a potty, adult toilet, or sink
Times to take them : after they eat, when they wake up
Toddler potty training 01:45
Dry for 2+ hours at a time
They indicate when they’ve gone or you can tell when they’re going
Start anticipating these times (after meals, upon waking) and/or use a schedule
Sit them on the potty / toilet seat with adapter
They don’t have to be fully independent with moving/removing clothing, pulling up pants, getting on and off the toilet, and washing hands. Use scaffolding.
It can take a while for them to get the hang of it
Don’t punish them for accidents
Don’t use treats unless you need to
Daniel Tiger episode
Children who don’t mind sitting in a dirty diaper 04:51
aka “secret poopers”
Can try the “oh crap” book
Allow them to run around without diaper or pants on, especially outside
Try nature pees/poops
Can try the potty training in a weekend method
Have a potty in each room so it’s easy
Children who fight using the potty 05:56
Try nature pees/poops
Have a potty in each room to get them used to it
Let them sit on the potty fully clothed and play while siting there
Have fun potty time - read a special book together, play with a toy on the potty
If using potty treats: sticker charts are often too delayed of a reward except in children 4 and up. I suggest a treat for trying, and a treat if anything comes out. Food treats tend to motivate children more but are also associated with more performance anxiety.
It is ok to praise attempts to use the potty and success in using it, but excessive praise can also cause performance anxiety
Becoming angry at child for refusing to use the potty can backfire on parents, as this is one of the only things a child can control
Constipation 09:17
Decrease in frequency or size of bowel movements, harder stools, pain with stooling
Can be acute or chronic
How chronic constipation happens
Avoiding it: choose high fiber and low processed foods - fresh fruit and veggies for more than 50% of each meal / 10 fistfuls per day. Avoid dairy products. Make sure child is drinking 1/2oz per pound of weight in water each day (so a 25 lb child should drink at least 12.5oz of water). Try to establish positive associations with sitting on the toilet.
Treating it when it’s acute: can try prune juice as a laxative, a glycerin suppository if stool is very hard, or an enema for a one-time cleanout.
Chronic constipation: first disimpaction - enema of hypertonic saline or a suppository x1, followed by a stimulant laxative x 2-3 days, and a stool softener for several weeks. At the same time, increase fiber and water, decrease processed foods, and eliminate dairy. Encourage frequent and prolonged sitting on the toilet.
How stimulant laxatives work and why they are addictive and shouldn’t be used more than a few days
How miralax and psyllium work as stool softeners and why they can be used long term
Diarrhea 16:32
Teething - symptoms, why it happens
Viral - tend to have no or low-grade fever, no blood, can be foul smelling and green
Bacteria - can have fever, can have blood, can have it for over a week, can be profuse or just a few times per day. Requires test to determine type of bacteria to guide treatment; sometimes antibiotics help, sometimes they make it worse.
After antibiotics
From juice
From food
When to be concerned
Treatment - more water, BRAT diet x 1 day, bland foods, avoid dairy, probiotics, avoid dehydration
Why we can’t use diarrhea medicines in children
Avoiding spread to family members
Rotavirus vaccine
UTIs 19:48
Symptoms: pain with urination, urinary frequency, urgency, accidents in a potty trained child, sometimes bad smell of urine. Fever is a late sign.
Caused by constipation, staying in wet clothing/swimsuit too long, poor hygiene (not bathing enough, staying in dirty diaper too long), tight clothing/sweat, bubble baths
Treatment: antibiotics.
Prevention in those who get more than 1 UTI: increase water intake, more frequent voiding, avoid risk factors, decrease sugar intake. Also they should get an ultrasound of the kidneys to determine risk for pyelo.
These are the major things to do with potty training. For additional tips and advice on babies and toddlers, follow Dr. Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
Dr. Carole Keim explores the topics of allergies and eczema in this episode. She defines what each disease is and what typically causes their appearance. All your questions about what symptoms to look for in your infant or child as well as how you can treat allergies and eczema when discovered will be answered by Dr. Keim.
Allergies, eczema, and asthma are called atopic diseases and tend to run in families. So if there’s a family member that has either allergies or eczema or asthma, or multiples of these, your child is at higher risk of developing them. Dr. Keim explains the science behind the reactions and symptoms before detailing exactly what types of medicines or interventions are safe and effective. While there are many Western medicine treatments available, holistic alternatives do exist and Dr. Keim explains which are safest to pursue.
In this episode:
Allergies (01:10)
Symptoms: allergic cascade: antigen binds to IgE (produced by B cells which are white blood cells), IgE binds to mast cells, and mast cells degranulate and release histamine and other cytokines (cellular chemicals) that cause blood vessels to dilate and leak fluid into surrounding tissue, which causes symptoms of nasal congestion, watery eyes, runny nose, and mucus in airways / cough; histamine also causes itching, rashes/hives, and spasm of airways causing wheezing. Severe allergic reactions can make the blood pressure drop dangerously low from the blood vessels dilating and can cause severe airway spasm and swelling - this is known as anaphylaxis. Parents who have allergies/asthma/eczema (atopic diseases) are more likely to have a child with allergies, but it’s often to different things than the parents are allergic to.
Western - avoid allergen (keep the house clean, use HEPA filters, avoid pets, wash off after being outside, avoid foods and medications you’re allergic to); we work backwards / up the allergic cascade: antihistamines, steroids, mast cell stabilizers, anti-IgE injections, allergy shots (which contain small amounts of what your child is allergic to and are gradually increased to retrain the immune system into recognizing it as ok); epinephrine for anaphylaxis to reverse the vasodilation and bronchospasm
Acu - decreases overall inflammation, great for environmental allergies
Chiropractic - can help with overall wellness and inflammation, but doesn’t specifically treat allergies.
Nutrition/supplements - none in the US other than avoiding foods you’re allergic to (nuts, fish, and shellfish will cross-react with others in the same group, and milk will cross-react with soy); outside the US they do sublingual immune therapy which is kind of like allergy shots but the antigen is given orally, but this has a risk for anaphylaxis.
Homeopathy - whatever the allergen is
Oils - eucalyptus/peppermint in a diffuser, lavender and tea tree topically (anti-inflammatory)
Eczema (23:01)
Symptoms: dry skin, rash, itching; more common on surfaces that rub (cheeks and extensor surfaces in babies, flexor surfaces in older children)
Western - keep skin moisturized (emollients like vaseline or aquaphor for dry skin, unscented lotion on a daily basis), avoid scented lotions/soaps/detergents, wash new clothes before wearing them, steroid cream
Acu - decreases overall inflammation and can help
Chiropractic - can help with overall wellness and inflammation, but doesn’t specifically treat eczema
Nutrition/supplements - avoid allergenic foods (wheat, dairy, eggs, nuts, fish), consider hydrolyzed formula, limit sugar in older children, add more fresh fruit/veggies/fiber to decrease inflammation, vitamin C, Vitamin D.
Homeopathy - calendula cream, pine tar soap, antimonium crudum, graphites, sulphur
Oils - can try topical oils in a carrier - lavender, chamomile, oregano, tea tree - sometimes topical oils or the carrier oil will make eczema worse
Also in Holistic Mamas Handbook: asthma, nosebleeds (can be related to allergies)
Next week: baby acne and diaper rash!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, which can be ordered here. Her first book, The Baby Manual, covers year one of your baby’s life and is the subject of the first two seasons of this podcast. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
More like this in the Holistic Mamas Handbook. You can order the Holistic Mamas Handbook here: https://amzn.to/3rlXhb7
Dr. Carole Keim talks about colic and reflux in this episode. She explains what they are and explores how different modalities can help alleviate your baby’s discomfort. There are supportive and alternative care options that Dr. Keim doesn’t often get a chance to address in the office but can present here.
Dr. Keim defines a baby with true colic as one who cries for “three hours per day, three days per week, for three weeks”, or the rule of threes. The cause of colic is still largely unknown but common understanding links it to gas in the intestines. Dr. Keim lays out all the options for alleviating your baby’s colic distress. Reflux, or when stomach contents come up into the esophagus of young babies, is mainly treated with non-medicinal measures, a variety of which Dr. Keim explains.
In this episode:
Colic (00:52)
Symptoms: Rule of 3s: 3 hours per day, 3 days per week, for 3 weeks. Peaks at 4-6 weeks of age.
Western - Nonmedical: burp baby every 5 minutes if breastfeeding or after each 1oz if bottle feeding, tummy time, bicycle legs / up and downs, belly massage (clockwise) or back massage (counterclockwise). Medicines: probiotics, simethicone (OTC).
Acu - both acupuncture and chinese herbs can help with colic; check with a pediatric acupuncturist
Chiro - helps with colic
Nutrition/supplements - probiotics, prebiotics (increase fruit/veggies if breastfeeding; formula and breastmilk have prebiotics in them), gripe water (not FDA regulated), chamomile/licorice/ginger/mint tea (mom can consume if breastfeeding; can make it 1/2 to 1/4 strength and give a spoonful 1-2x per day to baby).
Homeopathy - chamomilla vulgaris, colocynthis, and lycopodium clavatum
Aromatherapy - can use fennel, star anise, marjoram, ginger, roman chamomile, rosemary, and/or bergamot topically - mix the essential oil with a carrier oil and massage in a clockwise direction on the abdomen. Breastfeeding moms can consume 2-5 drops of peppermint, ginger, or chamomile oil in water and drink it; don’t give oral essential oils to babies
Reflux (09:19)
Symptoms: spitting up (sometimes through the nose too), arching the back. GERD is when the reflux is so bad that it causes other problems like severe pain, inability to gain weight / weight loss, or aspiration (choking). All babies have reflux for 6-12 mos as the lower esophageal sphincter (LES) matures.
Western - Nonmedical approaches: burp often, keep upright for 20-30 mins after feeds, avoid swinging/rocking/laying baby flat/belly massage for those 20-30 mins. Can consider thickening feeds; check with your doctor first. Medicine: ranitidine will decrease the acidity of stomach contents but doesn’t stop the reflux from happening, so still use supportive measures.
Acu - both acupuncture and Chinese herbs can help
Chiro - can help with reflux and spit ups
Nutrition/supplements - thickened feeds, breastfeeding moms can decrease acidity by eating less acidic foods and avoiding chocolate, caffeine, alcohol, spicy foods; ginger tea, chamomile tea, (only a spoonful of dilute tea for babies less than 1 year, or mom can drink the tea if she’s breastfeeding and it will get into breastmilk; can allow children over 1 year with reflux to drink ginger or chamomile tea, can use honey or sugar to sweeten it over 1 year of age)
Aromatherapy - ginger, chamomile - mix in carrier oil, apply topically for babies under 1 year, can give a few drops of diluted oil orally for children over 1 year
Next week: vomiting/diarrhea!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her first book, The Baby Manual, covers the year one of baby’s life and is the subject of the first two seasons of this podcast. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Resources discussed in this episode:
More like this in the Holistic Mamas Handbook. Pre-order the Holistic Mamas Handbook, launch date 11/15/23
Dr. Carole Keim talks about teething, a subject that comes up a lot and that parents have many questions about. She explains all about what to expect in terms of your baby’s teething discomfort and what modalities can help alleviate some of the pain.
Teething happens to babies and then again to older children and is uncomfortable both times, though the experiences are slightly different. Dr. Keim discusses how teething can take place at varied intervals for each child, what sort of symptoms might show up in babies and younger children, and how Western medicine treats teething pain. She also explores what acupuncture, chiropractic treatment, and nutrition and supplements have to offer your baby.
Western - tylenol, ibuprofen (over 6 mos), orajel, frozen washcloths, frozen fruit in mesh teethers, teething toys (list in email series!)
Acu - acupuncture / acupressure points on hands and feet, herbs for teething
Chiro - adjustments can help - upper neck (very gently with pinkies only) and/or skull bones (craniosacral therapy). Soft tissue techniques - move swelling out of the jaw /neck
Nutrition/supplements - soft cold foods (yogurt, applesauce, jello, mashed fruit, pureed baby food), teething foods (teething crackers), calcium (dairy, soy, dark green veggies), vitamin D (sunlight, supplements), magnesium (green veggies, nuts, legumes), phosphorus (meat), Vit A (eggs, dairy, yellow/orange veggies), Vit C (citrus fruits, strawberries), fiber (fruit, veg)
Homeopathy - Hylands tablets - cautious
Aromatherapy - lavender and chamomile oil on jawline (under 6 mos), 6-24 mos can use ginger oil on gums and marjoram on jawline, over 24 mos can use clove bud oil on gums
Next week: colic/reflux!
Dr. Keim has extensively researched the information presented in this episode. Her insight and knowledge on alternative and holistic treatments come together in her new book, Holistic Mamas Handbook, launching on November 15, 2023. Pre-orders are available here. Her book, The Baby Manual, covers the first year of baby life and is the subject of the first two seasons of this podcast. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. And remember, it’s always okay to call your doctor or emergency services if you have concerns about your child’s health.
Dr. Carole Keim talks about baby furniture in today’s episode. She summarizes the furniture needed for your baby as a place for your baby to sleep, a place to set your baby down in each room, some stuff to care for your baby’s everyday needs, stuff for travel, and some babyproofing items. But there are so many things on the market, how can you know what’s useful and what isn’t? That’s what this episode is about.
Dr. Keim talks about cribs and how 3-in-1 cribs are very useful but for the first 12 months of life, you don’t need that crib. You need a bassinet. So you can wait to buy the crib. She talks about what travel bassinets to invest in, what crib sheets work best, and even what kind of light works best in your baby’s room. For every one of your baby’s needs, Dr. Keim sorts through the furniture you need and when you actually need it, advising on what things can wait and what things aren’t even important. This guide will ensure you get the most useful things first and help you sort through all the furniture on offer.
Don’t get: any mesh for the crib, bumpers, pillows, blankets, white noise machine, blackout curtains, music for baby to fall asleep to, anything that hangs over the crib
Don’t get: those backpack things with a pillow behind their head for in case they fall backwards
As an Amazon Associate, I earn from qualifying purchases.
Dr. Keim has extensively researched the information presented in this episode. She is pulling on the knowledge of hundreds of thousands of new parents, other pediatricians, doctor moms, the Academy of Pediatrics, and breaking pediatrics news sites. Her insight and knowledge on alternative and holistic treatments can be found in her book Holistic Mamas Handbook, and her first book, The Baby Manual, covers year one of a baby’s life. Follow Dr. Carole Keim on her TikTok and YouTube channels for additional tips and advice on babies and toddlers.
Resources discussed in this episode:
The Holistic Mamas Handbook is available on Amazon
In this episode of Season Two, Dr. Carole Keim discusses two year olds. Dr. Keim explains exactly what developmental and behavioral milestones to expect, offers potty training and safety advice, and touches on preschool and checkups for your two year old.
This age is often called “the terrible twos” largely because children have learned the word ‘no’ and have started advocating for themselves. They’re exploring their environments with increased motor skills and speech but not as many words as they’d like to express things. They’re also exploring boundaries. Dr. Keim explains how to navigate their frustrations and tantrums from a place of understanding where they’re at.
In this episode….
Social development
Motor skills
Behavior
Potty training
Safety
Preschool
2 year checkup
Social 00:33
Parallel play
50+ words
Combines 2 words
Follows 2-step command
Speech 50% intelligible to strangers
Names at least 5 body parts
Likes familiarity - might want the same book every night
Many children start preschool around age 2-3
Types of preschools - Montessori, Waldorf, Reggio Emilia
Preschool vs daycare
Motor 05:31
Scoop with a spoon
Kick a ball
Hop with 2 feet
Runs well
Climb a ladder at a playground
Removes clothing - esp socks
stacks objects
turns pages in book
draw a line
Behavior 06:31
exploring boundaries
Starting to advocate for themselves
Praise/notice good behavior
Help them express joy, anger, sadness, frustration
You’ll start to notice their personality around people/situations
Encourage free play up to 1 hour per day
Make time for learning through reading, talking, singing, exploring together
Limit TV to 1 hour of high quality programming that you watch together
Avoid TV during meal times and in bedrooms
Be aware of your own screen use around child
Potty training 09:19
plan for frequent potty breaks (up to 10x per day)
Teach them to wash hands
For independence, must be able to remove/replace clothing, get on/off toilet
Safety 11:12
Car seat - can change to forward facing
Use helmet for anything with wheels
Remove firearms from home
Preschool 12:45
Can help with social interactions, sharing
2-year checkup 13:13
No vaccines other than flu/covid until age 4
Ok to allow child to answer questions, but be ready to jump in if they feel nervous or give wrong answers (which they often do at this age)
They typically feel comfortable during the physical exam
Ask your doctor if you have any specific questions about behavior, tantrums, nutrition, vitamins, potty training, constipation, and sleep routines
Hopefully this helps you enjoy time with your two year old with less worry. For additional tips and advice on babies and toddlers, follow Dr. Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your baby’s health.
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)
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.
In this episode, Dr. Carole Keim talks about what to expect from your two and a half year old. Your child is getting older, is super cute, and is now talking more, so Dr. Keim explains everything from motor skills to nutrition, and offers some parenting advice.
A child at two and a half will have enough language to communicate basics with you but their lack of full verbal skills can frustrate them and cause acting out. Their motor skills are more developed, they can run pretty well and wash and dry their hands. But they still don’t have proper awareness of dangers like cars, dogs, and especially water. Dr. Keim walks through all the ways in which two and a half year olds are advancing and all the things they need help with and that you may need patience for. It can be a tricky age but you’ve got this.
In this episode:
Social development
Motor skills
Behavior
Parenting
Nutrition
Potty training
Safety
2.5 year checkup
Social Development 00:30
Starting imaginary play
Says “look at me!” to parents
Starting to play with others
Phrases of 2-3 words
Speech 50% intelligible to strangers
When they speak, repeat back with correct grammar and pronunciation
They can use pronouns correctly
Many children start preschool around age 2-3
Types of preschools - Montessori, Waldorf, Reggio Emilia
Preschool vs daycare
Expect them to play with other children but not be able to share or take turns yet
They may start to follow older children around and copycat them
Motor Skills 03:02
Stabs food with a fork
Walks up stairs alternating feet
Runs well without falling
Washes and dries hands
Catch a beach ball
Behavior 04:13
Start testing boundaries and setting their own
Praise/notice good behavior
Offer two reasonable choices as often as possible
Parenting 05:55
Maintain routines - meals, bedtime
Have fun outings together - museums, zoos, library
Make time for learning through reading, talking, singing, exploring together
Limit TV to 1 hour of high quality programming that you watch together
Avoid TV during meal times and in bedrooms
Be aware of your own screen use around child
Nutrition 08:09
Pattern: eat 1 meal, skip 1 meal, pick at 1 meal
Might graze throughout the day
May start to get picky at this age; try to offer a variety and avoid falling into the trap of beige foods and sweets
Potty Training 09:25
plan for frequent potty breaks (up to 10x per day), relax during potty time by reading or singing to them
Teach them to wash hands with soap and dry with towel
Dress them in clothing that is easy for them to remove
For independence, must be able to remove/replace clothing, get on/off toilet
Safety 10:28
Car seat - can be forward facing
Use helmet for anything with wheels
Remove firearms from home
Supervise around dogs, cars
Touch supervision near water - pools, toilet, bathtubs
2.5 Year Checkup 12:43
No vaccines other than flu/covid until age 4
Ok to allow child to answer questions, but be ready to jump in if they feel nervous or give wrong answers (which they often do at this age)
They typically feel comfortable during the physical exam
Ask your doctor if you have any specific questions about preschool, behavior, tantrums, nutrition, vitamins, potty training, constipation, and sleep routines
Regular dental visits 1-2x per year
This guide should ideally help you enjoy time with your two and a half year old. For additional tips and advice on babies and toddlers, follow Dr. Carole Keim on her TikTok and YouTube channels. Her book, “The Baby Manual”, covers the first year of baby life and is the subject of Season One of this podcast. Remember it is always okay to call your doctor or emergency services if you have concerns about your child’s health.
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