Dear Dr. Mama,

We are fostering a precious Angels baby who will be 1 month old tomorrow. My husband and I have 3 grown children – our youngest is 23 – and I’ll admit, we’re a bit rusty on the care of tiny infants.We were shocked to learn how much things have changed; from super-absorbent diapers to on-demand feeding, everything’s different than it was when we were raising ours! But my question is about 2 of the changes that really confuse me, and I’d love to get your opinion about them.

1st is the new rule about putting babies to sleep on their backs instead of their tummies. This seems so strange to me! In my day we ALWAYS put our little ones down on their tummies. The idea was that if they spit up they wouldn’t choke on it. It made so much sense! Why the change? Every time I put our little guy down on his back for a nap or to sleep for the night I worry. It’s really bugging me. Is it really the right thing to do?

Next is what his pediatrician told us about solid foods. This little guy wakes up every few hours like clockwork all night long and wants a bottle. When mine were this age we started them on rice cereal to fill up their bellies (especially for that last feeding before bed at night) and help them sleep through. But the doctor told us to give him only formula until he’s 4 months old, no matter what.

What do you think? Why the change? I’d love it if he’d sleep through the night, and the solid food really helps. Is there anything else I can do?
~ Out of touch in Oceanside

Dear OOT,

If it makes you feel any better, you’re not the only one. Baby care and child health information change constantly, and you need a scorecard to keep up. Here’s what they told us on the first day of medical school: “Half of what you learn here will turn out to be wrong. The problem is, we don’t know which half”.
I wish I could tell you that these two pieces of new info aren’t necessarily true, but I can’t. Both are now supported by so much research that we don’t have much room to question them.

I, too, used to put my babies to sleep on their bellies; because that’s what we thought was best back in the dark ages of the 1980s. But then researchers began to study the relationship between SIDS (sudden infant death syndrome) and sleep position, and the results were compelling. So compelling that they ended the study earlier than planned, and in 1992 The American Academy of Pediatrics issued a statement with the catchy title “Back to Sleep”. The numbers of SIDS deaths have been dropping ever since.

Once your little guy learns to flip himself over sometime around 3 months all bets are off. He may very well turn over during the night and sleep in the position most comforting for him, and that’s fine. No need to worry about keeping him on his back after that.

As far as delaying solid feeding, evidence of the benefits is well documented there also. Infant formula (or breast milk) contains all the nutrition your baby needs for the first

4 – 6 months. Babies’ intestines need to mature before they’re able to handle solid foods. Solids before 4 months can lead to food allergies later because the immature gut has been exposed prematurely. Before 4 months they’re not even able to digest and absorb the nutrients in solid food, so there’s no upside to starting early.

Wait until your little guy is between 4 and 6 months and start offering one type of food at a time. If he doesn’t seem interested in the spoon, wait a bit and try again. NEVER force-feed. Starting with rice cereal is fine, but we’re not so rigid about the process anymore. A relatively recent technique called ‘baby-led solids’ gives your baby the choice. As long as you begin with simple, single foods and wait a few days before adding the next one (in case it doesn’t agree with your guy) you should do fine.

Finally, the sleep issue. I won’t lie to you, tiny ones may need to wake up to eat several times a night. Yes, it’s exhausting and can be frustrating – especially if he seems to be sleeping for longer stretches during the day. But there are some things you can do to stretch out his sleep periods during the nighttime hours.

First, make a clear distinction between daytime and nighttime. During the day your home should be light and bright with all the typical daytime noise and activity. None of this “Shhhh …  the baby’s sleeping” stuff. Let the phone ring, talk normally, and run the vacuum cleaner when you need to. Feed him frequently (at least every 3 – 4 hours) and maximize awake time.

Right before bed in the evening give a full feeding and encourage as much formula as he’s willing to take. Make it part of the bedtime ritual. Then turn out the lights and keep things relatively quiet. When he wakes up to eat keep the lights low and avoid “playtime”. It’s feeding time ONLY. If you need to change a diaper, do it quickly with as little stimulation as possible. The idea is to keep him in a semi-sleepy state, even when he’s feeding. He may be 6 months old before he can make it all the way through without a bottle, but you should be able to stretch out the sleep periods between.

Your little guy is so lucky to have such loving and caring foster parents. You are doing an amazing thing, and we thank you!

~ Dr. Mama