The 411 on Newborns: Eating, Sleeping & Spitting Up (w/ Dr. Ari Brown)

26:59Dr. Ari Brown:Got it. Because you're saying he's doing it with the breast. He's doing it with the bottle. He's doing it with depending on whatever's in the bottle. With formula. Right. Okay. So let's tackle reflux because this is super common. In fact, all babies have reflux. And to clarify, it's not like spit up. It's definitely like throw up. Okay. So projectile. The way I think about spit up when I hear spit up is like, you know, a bit. You kind of like dab it. This will be like... and it's just like the milk it's effortless though it's effortless okay yes all right great word to describe it yeah he's not like he's just like yeah okay so the one the this is the only thing that i want to make sure i'm not hearing is is it exorcist projectile across the room vomit.

27:49What do you mean? Like.

27:50Dr. Ari Brown:Exorcist. Like. No. Shooting across the room. But if his head's up, it will like get three inches past my. That's okay. Okay. Okay. I'm talking feet. I'm talking like. No, not feet. Okay. Okay. So effortless regurgitation is reflux. So let's tackle what reflux is. All babies have reflux to a certain degree when they're born because our gut is just a tube. And so between the esophagus and the stomach, there's a valve that is not well formed in newborns. And that valve becomes functional at about six months of life. So babies are born with a tube that doesn't have a valve, and they have a pure liquid diet.

28:41Dr. Ari Brown:That's all they're eating. So the milk goes down, and the milk comes back up. And so the larger volumes they start to take, the larger volumes you start to see come back up. Now, for some babies, it comes up and it comes out and you see it. For some babies, it comes up behind the nose and they snort like a pig. I hear that question a lot. My baby has nasal congestion all the time. Is it allergies? Is it the dog? No, it's milk. And then sometimes it actually comes out of the nose. Like, do you remember those days in college where you vomited and Came out of your nose. Yeah, well, it's all attached.

29:19Dr. Ari Brown:So those babies will, you know, it might come out of the nose. It might come out of the mouth. It might just come up. That is a laundry problem. But it's not a medical problem. Got it. Okay. And it takes about six months for it to resolve. And the best approach is to try to keep your baby upright after a feeding for like 20 minutes because that allows the milk to get out of the stomach and into the small intestine so it doesn't come back out at you. And so as much as you can, you try to keep the baby upright and you live with it and you don't wear nice shirts for a while and burp claws. It just is.

30:01Dr. Ari Brown:That's reflux. Okay, so it just is what it is happening. So I have a couple of follow-up questions. The first is with Tate, we didn't really see it much. the really big notable difference between tate and rocky tate was a very slow drinker yep rocky like houses his milk so does the pace at which your baby drink affect this ding ding ding yes okay also so this is the other strategy not only is it kind of keeping the baby upright after feedings i have a visual aid let me pull out a visual aid i was gonna ask that was my follow-up question so you're right that the pace of the feeding matters and again i don't know when you introduced a bottle with tate so that may have been also something pretty much right away okay early okay okay so um it may be just that he's um so we have different types of feeding styles and it sounds like he's a barracuda feeder um so he he tackles it he goes for it then you've got the gourmet feeders and they want to you know have a nice slow european meal yes okay so So how she eats now.

31:08Dr. Ari Brown:Okay. So this is the phrase, paste bottle feeding. So what people instinctively do is they will hold, and sorry if you're not watching this podcast, but they will hold a bottle like this and the milk will just drip into the baby's mouth. Okay. And you don't want to do that. What you want to do is you want to do paste bottle feeding. So you want to hold the bottle as horizontally as possible so there's just enough milk in the nipple so they're not sucking air. But that slows the pace of the feeding down. And so that also helps with reflux. The other reason why pace bottle feeding is really helpful is that it makes them not overeat.

31:50Dr. Ari Brown:And so whether your baby is breastfed, you know, and getting express milk in the bottle or formula fed, we don't want them to eat more than they need to. and those early days of feedings actually can have some long-term consequences on their metabolism. So we want them to eat slower. So whether you have a reflux baby or you're just trying to have your kid not overeat, you want to do paste bottle feeding. So that can be really helpful for a reflux kid. What's so funny is we just had a friend over who was like kind of holding the bottle like that and I corrected her to go more up. So my bad. i have just been like i so if you weren't watching it dr ari's hand was yeah you had it horizontal but then there was one that the one that we're not supposed to do is like dumping the milk in their mouth i've been like dumping it yeah so i've got to correct my feeding position could the paste bottle feeding could really help we are doing our best but go ahead what were you gonna ask well i was just gonna say basically he has reflux and that it just is what it is Right.

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34:06I have a great one. We're going to do Bicker of the Week. Okay. Do you know what a bicker is? Know what? It's feeding related. We have a great bicker of the week. What's our one bicker on feeding? Come on. Oh, does the bottle need to be warm or cold? Does it matter if the bottle's cold? The milk is cold.

34:27Dr. Ari Brown:Milk is coming out of the breast at, you know, 98 degrees. So most babies like it at that temperature, but it's not a requirement. And if you can get a kid to drink it cold, awesome. Thank you. He doesn't like it cold. That's crazy talk. He doesn't care. It depends. It depends on the kid. My first kid, it had to be warm. He was very particular. It had to be warm. I just think he likes the milky, the 98 degree. I think you like it. Well, I guess I like cold milk, but I don't know. He's just a baby. It doesn't make him throw up more, though. Reflex more. No, no, no, no, no, no. It's cold. No, no.

35:11Dr. Ari Brown:And if you're in a situation where you can't warm it up, I mean, you're going to feed it to them cold. That's the thing where I'm okay with it. In fact, prefer it is sometimes if we're on the go, I don't want him to have to have a warm bottle. Like he will drink a cold bottle. So I do think that's a good thing. That was my mindset here. And I researched this before we started giving it to him was that I see how many parents spend all this effort, like getting the bottle warm. They're out at a restaurant or this or that. And so just to keep one thing as simple as it can be, just drink in the bottle as it comes.

35:48I agree. Especially because when we're traveling, we'll keep it cool, like in the cooler. Okay. Go ahead.

35:58Dr. Ari Brown:I agree. To try to have your child be as low maintenance as possible is great. It's aspirational. But sometimes you can't get them to do that. You don't get to pick. But I do want to talk about reflux disease because this is something that comes up often is when do we move into this is reflux laundry problem to reflux disease, which is a medical problem. OK. It becomes a problem because over time, reflux is at its worst from two to four months of life. OK. Because they're eating their largest volume of liquid and that valve is still not working. And stomach acid can come up with that milk. And so the stomach acid irritates the esophagus lining because the esophagus is not meant to have acid up there.

36:42Dr. Ari Brown:And so then it starts to hurt. And so a buzzy term is silent reflux. So the babies who spit up, easy to identify. Silent reflux is they go to eat and then they pull back. I want to eat, but it hurts. I want to eat, but it hurts. And that's a sign of discomfort because they're arching to try to relieve the discomfort in their chest. And so those babies are miserable, and some of them end up having a feeding aversion because they associate pain with eating. And then some kids who really do vomit the entire feeding don't gain weight. And so those are your reflux disease kids who actually need some medical help.

37:21Dr. Ari Brown:So when do you cross that line when you're truly miserable and you see your child not wanting to eat or seeming like they're conflicted? They're hungry, but then they don't want to eat. So that's a great transition into the listener question, which is what is considered normal as it relates to spit up and a tummy being upset versus when should it be worrisome? Yeah. So a kid who's effortlessly spitting up, not a problem. Gaining weight, not a problem. Happy to eat, not a problem. A kid who seems conflicted about eating, seems distressed afterwards, worse when lying down because the milk is coming up when they're lying down.

38:04Dr. Ari Brown:So they have struggle, you know, struggle with sleeping because they don't want to lie flat because it hurts or they start to not gain weight appropriately. okay I think we should talk a little bit about Rocky and his specific situation on this time of being upset after Eats well okay do you want to do it or do you want me to I think you should do it yeah so I think on this topic I think I have a lot of comfort in based off what you've said in terms of his like the manner in which he's spitting up that all feels not concerning concerning um after he eats some of the time a good amount of time it's called 50 percent i was like it seems like his his stomach is upset and he's like disgruntled one thing we've noticed that helps is if we put him on his stomach and how common is that versus at what point should we be concerned what else you have to add to that did i describe it the right way yeah and i i think I actually think we've got a mild case of this tummy hurting.

39:15Yes, for sure. But, you know, it's definitely different than Tate. Like, I don't, and once again, I can't believe how much I forget from Mike Tate's first three months. It's insane. But I don't remember this, like, being a thing at all. Right. Like, maybe the receipts on the podcast would say otherwise. But, yeah.

39:38Dr. Ari Brown:Every baby's different. So he may have problems that she did not have. And again, you can have some element of reflux disease that you may be able to manage and kind of get through. But it's about to get worse if it is reflux. Two to four months is your peak. So be on the lookout for how bad is this getting? Is this manageable? Are we happy? But you're exactly right. And that's the other thing I wanted to kind of show you guys with this beautiful baby here is that a lot of parents instinctively will hold the baby up on their shoulder to comfort them or cradle them. But actually leaning forward, you know, kind of holding them like a loaf of bread or a football is actually comforting, especially for a reflux baby.

40:24Dr. Ari Brown:And so they don't want to be lying on their backs. they may or may not love being upright but a lot of them will find comfort leaning forward like this okay so let's do a couple more um output so um symptoms of actual allergies right so this is what i really want to explain to families is most of the time you don't have to do an elimination diet so if you're breastfeeding we don't want you to stop eating a bunch of different things it's probably not going to make a difference. If you're formula feeding, we don't want you to switch to a hypoallergenic or elemental formula because literally 3%, 3 % is a really small percent of kids will have a cow milk protein allergy and it's very unlikely to have other food allergies.

41:20Dr. Ari Brown:and there are some objective ways of knowing which kids are going to respond to those interventions. But many, many more people than that try these things. And I'm going to tell you the important reason why we don't want you to, other than it does promote breastfeeding because who wants to breastfeed when they can't eat anything? That's one reason. But the really key reason is everything that you're eating, there's a little bit that's going through your breast milk. And exposure to those food proteins early in life reduce the risk of the baby developing food allergies. And the same holds true with formula.

42:01Dr. Ari Brown:If you're introducing a cow milk or goat milk-based infant formula, those are the kind of more common basis, switching to a non-hypoallergenic formula, again, potentially is going to have your child more hypersensitive to these food proteins later in life. So if we can, we try to not eliminate those foods in their diet. And if we do need to, we do it for as short of a time as possible. Okay. Wow. Wow. So really only 3 % have a food allergy. Or a cow milk protein allergy, which is the number one. But I've had families who they eliminate eggs, they eliminate all their gluten and all these other foods.

42:49Dr. Ari Brown:And it really makes a difference. The one that most of the time, if it is going to be a problem, is cow milk protein, which means all mammalian dairy products. But again, that's pretty low. And that means most babies will tolerate it. It's just like, it's such a unique dynamic for parents because like we're sitting there and no matter what, all babies are going to be crying. And we're all on this, like, I guess quest you could call it to understand, all right, is this, is this like normal and part of the expected process or something off? And it's so easy to just like opt to something being wrong because we inherently all care so much.

43:30and then you end up running around like a chicken with your head cut off trying to solve a problem that isn't even a problem and so I think it's very comforting I think a consistent tone throughout this this conversation is just like how much of um what a you see your baby go through is just part of the process um which yeah it's it's very it's very comforting because that's not where a parent defaults.

43:59Dr. Ari Brown:Yeah. I want to summarize that because you brought up a really important point is we don't want to over medicalize your baby. Exactly. Yeah. And a lot of stuff that happens with babies is about being a baby, which means their nervous system is immature. It means their gut is immature. Their gut flora is immature. And so some of these signs are just early immaturity signs. But if your child does have an issue, we want to address it. And where does that cross the line? And so there are a couple of things that I would recommend for families. One is if you really do think that your child might have a milk allergy, there's something called a COMIS scale, C-O-M-I-S-S.

44:50Dr. Ari Brown:And you can actually rate it. It's in Baby411 actually, but you can find it online too. And all babies score about a three because they cry and they spit up and sometimes their tummies hurt. But kids who score a 10 or greater, those kids probably do have a milk allergy or will possibly respond to a hypoallergenic diet. Everybody else is in this fussy baby intolerance gray zone, which means a lot of those things, no matter what you do, time solves the problem. The other point that I want to make is the value of probiotics. And this is really evolving evidence. I'm super excited. Like it's one of the few things I would say that is, you know, in my career really coming to the forefront of, yeah, babies are born with a sterile gut.

45:46Dr. Ari Brown:They have no flora, and it starts to get populated at birth. Vaginal deliveries, they get more flora than C-sections. Helps to breastfeed. But in general, all babies are kind of deficient in the first eight weeks of life. And so I think a lot of the symptoms that we see, and there's really good data to demonstrate these colicky babies, seem to improve when they get probiotics. But the strains matter. That's what we're learning about. Which strains are the right strains. And I do think probiotics can be really helpful for fussy babies. And it does reduce their symptoms of crying and discomfort.

46:25Wow. My only kind of follow up to that is, so you spoke to not over medicalizing things and a lot of what parents experience is just a baby, being a baby. And then you spoke to the scale. What's it called?

46:42Dr. Ari Brown:Comis. Comis. Sorry, I'm taking notes and then it goes out. So the Comis, what are other, because on the other end, as a parent, you don't want to miss things. So what are the points of, hey, you should go and this is worth looking into more and bringing to your medical provider. You said the Comis. You said if the vomit is truly projectile across the room, Call it north of a foot and a half. Well, and the reflux disease, if it seems like they don't want to eat. Yeah, reflux disease. Anything else that should be? Yes. Okay, perfect. So for the reflux, there is a questionnaire also in Baby 411.

47:29Dr. Ari Brown:You can get it online. IGERQ, I-G-E-R-Q, which actually is objective ways of scaling, scoring your baby's reflux symptoms. So when does it go beyond reflux? into reflux disease. And then look at the poop. So this is a key point. No one, when they come to parenthood, unless you're a pediatrician, knows what baby poop looks like. It definitely doesn't look like yours. So then you're like, well, is this normal? Is this not normal? Breastfed poop is usually kind of described as yellow, seedy. I practiced in Baltimore for a Wow. We called it crab mustard. Oh, and gray poupon. Like, you know, people come up with all kinds of clever ways of describing that kind of seedy stool.

48:19Dr. Ari Brown:Formula poo is usually kind of green-ish pasty. I don't care if it's yellow, green, or brown. It's not the color. It's the texture that's really important. But when you have a child who may have a cow milk protein allergy, I describe it as slimy and mucusy like snot. Like snot. It glistens. And when you peel the diaper away, like you will see the stringy snot. I actually have a TikTok video on this because like people are like, what are you talking about? And so when they see it, they're like, oh, my kid has that. Now, just to be clear, that doesn't mean your child has a cow milk allergy. but it is one very useful indicator to show to your pediatrician.

49:04Wow. So good to know. Now, if they have that, does mom eliminate it?

49:10Dr. Ari Brown:So what I'll do is I'll test that poop. It has to be fresh poop, by the way. I'll test it in the lab for microscopic blood. And if there is blood, we actually will try to do an elimination diet for mom or for the baby. But again, we try to do it for as short as possible. I used to back in the day, because I've been doing this a long time, I used to say, okay, we're not going to have any cow milk or goat milk or any mammalian milk products for the next six months. Now we'll be like, let's see how the next month goes. And then we may try to gradually reintroduce it. Because again, we don't want to eliminate it from their diets, if at all possible.

49:46Dr. Ari Brown:But if they're truly having a tolerance issue, it can and does help. I'm sure tremendously. Okay. Okay. That's like, that is so fascinating that I didn't know that the diaper looked so different if they have a cow's milk allergy. All right. Diaper blowouts. Okay. So why do they happen? And is there anything that we can do to lessen them? And when do they stop? So in the first six weeks of life, babies are very stimulated to poop every time they eat. As humans, we are stimulated for our bowels to move when we eat, but we don't usually just go poop every single time we eat. And that's because our gut is a little bit more mature and the transit time has changed.

50:28Dr. Ari Brown:But the first six weeks, they're pooping a lot. And then suddenly slows down because the transit time matures. And then you may have a day or two where not everything is moving along and then be prepared for the motherlode because it's coming. So like they just clean out. They just have to clean out. So it's okay. But yes, that usually requires, you know, emergency bath after that blowout. But usually things improve two to three months of life, but you're still going to have those. I mean, they're days. It happens. Totally. Totally. So that, I mean, that's just part of it. Right. I would say. Okay.

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52:21All right. So fussiness and soothing, because we would love to provide a little bit of trouble working, trouble working, troubleshooting framework if possible. So the listener question is, why is my baby fussy or uncomfortable? What do I do and when does it get better? Yeah.

52:39Dr. Ari Brown:So the things that we've already talked about, those are the troubleshooting things. does my baby have a reflux disease problem that really is going to kind of rear its ugly head two to four months of life maybe a little bit sooner does my baby have a milk allergy maybe look at the poop and see you know look at the coma scale see if your baby has that if your baby is just fussy in the first few weeks of life and it kind of starts around three four weeks of life that is what we used to call colic we still kind of call it colic now there's this newer term called purple crying and I don't love this acronym because as a pediatrician purple babies make me think this child needs oxygen so this is not baby the baby is not purple to be clear it's an acronym for persistent unexplained crying.

53:39Dr. Ari Brown:It's long lasting. It starts around, you know, three, four weeks, maybe peaks at about two months of life, starts to get better around three up to five months of life. And it happens for really long stretches. And it's always at the end of the day in the evening. So E is for evening. So it's horrible. And so what do you do for those babies who are just fussy and they're just babies. And at the end of the day, I think it's worse because their nervous system, they're just tired and hungry and they just want to go to sleep and they don't know how to get there. So I would say troubleshooting wise, here are some things you can do for just a normal newborn who's having trouble settling.

54:21Dr. Ari Brown:One is motion is really helpful. Whether you're walking around doing the parent bounce, maybe you're sitting on an exercise ball and doing the parent bounce. maybe you're going for a car ride that works beautifully for a lot of babies or you're going for a walk in the stroller motion is helpful i do think some of the white noise and the shushing is helpful um and i think position is helpful so again if your baby's not soothed by being up on your shoulder try having them leaning forward holding them kind of like a football or a loaf of bread because leaning forward sometimes can be really soothing for them and then the final thing I'll say is if you are at wit's end and you cannot figure out how to console your baby and they are not consolable you get in the car and you just keep on driving because if you have an unconsolable baby you're going to the ER so I do want people to be mindful of that and also if you're at wit's end and you don't feel like you're in control it's okay to put your baby in the crib and just walk away and regain your composure because these are the moments where parents are truly exhausted and sometimes they need just a break for a minute and that's okay.

55:33When you say inconsolable, you're going to the ER. How long is that?

55:36Dr. Ari Brown:I think if you've tried everything for over an hour, you know, you've fed them, you've done a diaper change, you've done all the, you know, tricks to try to get your baby to soothe and they are not consolable. You just start driving. And a lot of times they will fall asleep. I was going to say on the drive. Yeah. Yeah. If you get around the neighborhood and they fall asleep, great. If they don't, you know, then they probably do need to be evaluated. I always laugh because if I get if back when we had Tate now with Rocky, when he falls asleep in the car seat, if I hit a red light and I stop, I finally wake up.

56:10So I always am like pumping my brake. And I always think if you see a car doing that, they probably just have a newborn that fell asleep in the car seat and they're trying not to stop the car whenever i pump the brake that's why i'm practicing you break get a lot of trouble for pumping the brake too much um let's discuss because i got a lot of deep what dad joke it's not a joke if you have to explain it remember well you didn't laugh i got but i got it i knew i knew this is a bad joke i did a chuckle inside my head so i got a lot of dms about chiropractics for babies they were very pull some and then people were commenting, go to the chiropractor.

56:44And then everyone below it was like, no baby should go to the chiropractor. I was like, we're not going to the chiropractor, but I do feel as though I should ask you your thoughts on it. Okay.

56:53Dr. Ari Brown:Well, to be clear, I am not a chiropractor. So chiropractors are going to tell you what their area of expertise is. In my experience, the only times I've interfaced with an infant and a chiropractor is doing craniosacral massage. And I do have lactation consultants that I work very closely with. And sometimes we have these babies who come out of the womb and their neck is really stiff and they are struggling with their latch. And we've tried a lot of different things. And sometimes we try craniosacral massage. And for some babies, it can be helpful. But for your reflux babies and their abdominal pain, I do not personally recommend going to a chiropractor for that particular issue.

57:43Dr. Ari Brown:But a chiropractor will probably tell you something different on things that they do. It's just not my expertise. Yeah. Okay. Well, we're going to steer clear of it, but I did see a lot of comments that were talking about it. All right. So out of this and into the sleep schedules, sleep and schedules, how should parents think about sleeping routines in the first three months of a baby's life? Great question. So sleep routines and newborns don't go together. And so if you can just, you know, throw control out the window, like I think it feels so much better. And I'm a person who likes to be in control.

58:23Dr. Ari Brown:And I can tell you that was such an important thing that I learned as a new parent is I am not controlling this baby. And so for the first really eight weeks of life, they're going to have very erratic eating and feeding. So there's no such thing as routine. And if you let them do what they're going to do, they're going to feed better and they're going to sleep better. But as you come out of that, then you will start to see somewhat of a schedule emerge. And so some babies are better than others at this, but you will start to see a natural routine emerge. And so I always tell families when you're coming out of that phase, two or three months of life, just follow your baby's lead and see where they're naturally falling.

59:10Dr. Ari Brown:And then you don't have to wait for them to show you they're hungry and you don't have to wait for them to show you they're tired because they're probably overtired and overhungry at that point. And so they will start to get into a little bit of a pattern and they will have more wakeful time. And so there is no wake window for a newborn. Newborns, you know, they're awake between feedings. That's it, right? But they will be more awake two to four months. And then you will start to have something that actually looks like a nap schedule and something that looks like a bedtime. But that's really, you know, closer to three months.

59:45Dr. Ari Brown:And definitely by four, like three to four months, you should be in a nice routine. So three to four months, we're going to start how many naps a day? So a three-month-old usually has four naps a day. Okay. wow that's i can't believe like we it's i can't remember any of it to be a broken i know a broken record like we we had this so dialed in a year and a half ago and now you tell me when do when do the regular naps start no idea well four naps is more than i was thinking for a three-month-old the um one of the things though that you said there that that really resonated was uh just as a parent identifying right what are the areas that we just need to put our hands up and completely trust the process versus what are areas that we can be more active and have more control and put more structure in and just that um like getting comfortable with the uncomfortableness um is something that's been very helpful on identifying what areas that is and what areas that isn't yeah and i think with sleeping just saying okay not happening yeah until four months you can start to kind of put some pieces in play totally totally um okay so when do wake windows actually start to matter yeah so i would say as you're approaching three months you should start to see more awake time and that's what people call wake windows and so you'll see that there is some pattern emerging and so a three-month-old might be awake for an hour, hour and a half, and then it's time to take a nap.

1:01:23Dr. Ari Brown:You know, on a certain level, you're going to look at the baby. You know, don't look at the clock, look at the baby. For sure, the first eight weeks of life. But within a range, if you can try to be consistent, it pays off. It really does. And so, and that's the thing that I think is important to talk about when it comes to sleep is consistency and structure and routine really helps relax the brain and when you have a baby who's neurologically immature that's not going to work but around three months of age as they're you know and then going into four months it really does help and it helps you create a healthy routine for your baby's sleep.

1:02:11Dr. Ari Brown:Okay. Okay. So now we're going to go with the, the when to worry. Listen, they are, these are mainly all. Okay. So newborns are obviously noisy. Um, how do you tell normal noises from worrisome ones? So some of it is looking at the baby and not just listening, but grunting consistently is a problem. So that can be, you know, and again, not just one or two, but consistent. And along with grunting, if you're watching, the baby will be breathing fast and shallow, and you can even see retractions between the rib cage. So grunting is a sign. There is a sign of what is a floppy airway. Speaking of airways, no, let's get it.

1:03:01The adult version of that.

1:03:03Dr. Ari Brown:Oh, my goodness. All right, we're good. Sorry about that. Okay, we're good. Okay, so some babies will have a floppy airway that's called laryngomalacia, and they'll have a squeaky noise, and it's only when they're lying down. So when they're upright, they're fine, but they're squeaking when they're lying down. If they're always squeaking, you need to check in with your doctor. But then the other noisy breathing, which we kind of talked about already, is nasal congestion. And if it's just they sound like a pig all the time, that's probably reflux. But they're OK. They're OK. So grunting is concerning.

1:03:38Dr. Ari Brown:Consistent grunting. Squeaky, yeah, squeaky breathing all the time. And then the sign of something that's not a newborn sign, but something you want to listen for, which is called strider. I call that the Darth Vader noise. So if your child sounds like Darth Vader, kind of Strider, that is something that you need to, that requires immediate care. Okay. Okay. That's really helpful. Okay. So when do you go to the ER for croup? Yeah. So this is Barking Seal versus Darth Vader. So croup is a virus that causes a swelling right where your voice box is. And so the smaller your voice box is, the more impacted you are by it.

1:04:30Dr. Ari Brown:So adults actually get croup too. And we just get laryngitis. So bigger the airway, less swollen it is. But the tiniest airways, when they are swollen, they will make a noise, which is called stridor, which sounds like Darth Vader. And so if they are kind of, then first thing you want to do is go in the bathroom, turn on the shower because the steam will actually help relax the airway. And if that does not work, then you are going to head to the ER. So that's when it needs intervention. The other less serious form of croup is a barking seal. So these kids will be coughing and barking like a seal.

1:05:12Dr. Ari Brown:And that's okay. Yeah. It's always worse at night. It's a miserable three nights, but it's not so worrisome. Okay. Okay. All right. So signs of a fever or when to take the temperature of a baby. They say if your baby feels warmer than normal, but if they're crying or sleeping, then they're usually hot. Needing to use the rectal thermometer, I feel like I should be sure that I need to take the temperature and I'm not just overreacting. People freak out about taking a rectal temperature. And I'm here to tell you the babies don't care. And in fact, it makes them poop. So if you have a baby who's not pooped, the first thing we're going to tell you is take erectile temperature.

1:05:50Dr. Ari Brown:Smart. So do not fear. But it's the most accurate way to take a baby's temperature. And the difference between 100.3 and 100.4 for a baby under a month of life is home in your bed or going to the hospital. So it does make a difference. So under the arm or temporal, all those other ways are not as accurate as a rectal temp. But the question is if your baby feels hot, well, the first thing is, you know, take them out of their clothing and let them cool off if they've been asleep. And then if they still feel hot, I mean, you know your baby best. You've been holding them 24 hours a day. So they feel hot.

1:06:33Dr. Ari Brown:You take their temperature. But the unique period of time, definitely the first month of life, but up to the first three months of life, if your baby has a fever, we want to hear from you. Under a month of life, if they have a fever, they're going to be at the hospital for a couple of days. Okay. Okay. And then the last listener question. After their first three-day appointment, when should the next newborn appointment be? With our first baby, his second checkup wasn't until four weeks, and he was not back to birth weight. So can we request a two-week appointment? A two-week appointment is actually standard of care.

1:07:09Dr. Ari Brown:So I can't speak to what happened in that scenario, but we'll do a newborn follow-up visit a day or two after you go home from the hospital. Sometimes we need to keep following if the baby's jaundiced or the baby's losing weight. And then once we turn you loose, we see them at the two-week well check to make sure that the babies regain their birth weight because they drop weight and then they should gain about an ounce a day. So that two-week well check is actually really important. So if you want one and your pediatrician doesn't give you one, which I'm surprised, you should ask for one. And then the next one is the two-month?

1:07:44Dr. Ari Brown:And then standard is a two-month well check. Some people will do a four-week well check, especially if the baby isn't gaining weight or there's a particular reason that we're following it. But in general, it's two weeks and two months. Okay. That's what we were just the other day wondering. But we, because I think where we got confused is Tate had a one month as well. Yeah. Tate dropped a lot more weight than Rocky did. Yeah. Yeah. Okay. Is there anything that I missed? I feel like that was, like, I just learned a lot. Do you think, is there anything else you want to discuss? No. I just did a review of the notes.

1:08:17Everything was covered. Is there anything you want to add? I don't know. I feel like we covered a lot. Yeah, we covered a lot. That was like a, that was a whole newborn. Yeah. I feel like we answered everything. Yeah? Okay. So, guys, there it is. Tell them where they can find you.

1:08:38Dr. Ari Brown:You can always find me at Ari Brown, MD, on socials here in Austin. I'm at 411 Pediatrics. And then I have two out of the three new editions that are launched now. So Baby 411 and Toddler 411 have launched. And Expecting 411 is coming in August. New editions. August. Okay. so that's when it's coming and you've got them right there beside you you want to see them yeah our number one preferred book series so yes and thank you you weren't here the last time thank you for being the blurber for toddler oh yes of course I was I've never done that I was quite thrilled okay it was fun for me okay well it's fun for me too so thanks okay you guys thank you for listening and we will see you this comes out tomorrow so we'll see you Monday thank you and thank you oh yeah My pleasure.