Annie VerSteeg wrote:

> Hi All,
> I just wanted to make sure everybody knows there is a video version of The
> Happiest Baby on the Block.  I have found the video to be an extremely
useful
> tool in the immediate post-partum period.  Many parents are too stressed
to
> get thru the book. This is a 38 minute video and all thru it you get to
see
> Dr. Karp calming babies, then you see the parents a week later and hear
about
> their experiences.  Dr Karp is so wonderful with babies, he obviously
loves
> his job!  I had a chance to meet him and watch him first hand with a baby,
it
> was great, like a lovely dance.  I have no financial interest/gain in the
> video or book.  I have a huge interest in a realtively easy, loving &
happy
> post-partum time for all new families.  The book, video and dvd are
available
> from his website happiestbaby.com.

I have not seen the video or DVD. I felt that the book's breastfeeding
advice could cause problems for some mothers and babies. I was disappointed
to see this, as I could tell from his writings that Dr. Karp cares a great
deal about babies (as Annie observed in person), and his information on
colic and the need for a "fourth trimester" was great. Here are some areas
that I found troublesome:

- On Page 36, he says poops after one or two months may only come once a day
or less. He adds that the longest he has seen a healthy breastfed baby go
without a stool is 21 days. On Page 199, he again says, "breast-fed babies
almost never get constipated. They may skip a few days between poops, but
even then their consistency is pasty to loose." However, on Page 200, he
says, "If your baby goes more than two days without a stool and does not
improve with a change in formula or your diet, you should check in with your
doctor." He says the doctor may want to evaluate the baby for
hypothyroidism, Hirschsprung's disease, or infantile botulism.

- Page 174: "You can satisfy your baby's sucking needs one of two ways: 1.
Use a pacifier; 2. You as a pacifier. For thousands of years a mother's
breasts have been their baby's pacifiers. That arrangement may be fine for
some moms, but it's a burden for others. Luckily, parents today have [an]
efficient alternative-pacifiers." Follows with tips on how to use. He does
mention nipple confusion as a possible pitfall, but says, "You may offer
your baby a pacifier on Day One, but be prepared to stop using it for a
while if your baby is having trouble breast-feeding."

- Page 176: "Try not to offer your baby a bottle until she's two weeks old
and the feeding is going really well. Then offer her a bottle every day or
two." He continues, "Most moms fill the bottle with breast milk, water,
glucose water, or mint or chamomile tea."  He cautions, "Don't wait one to
two months before introducing the bottle. Parents who do this are often
rudely surprised by their baby's emphatic rejection of the synthetic
 nipple."  No explanation is provided about why it is necessary to offer a
bottle; it sounds like a mandatory part of baby care.

- Page 178: In response to a mother who nurses often and was worried that
she was spoiling her baby or making him colicky, he says that you can't
spoil a baby, but that "she needed to call her doctor to make sure her baby
was getting enough milk." Maybe in his practice this call would be fruitful,
but in many, it would be the on-ramp to premature weaning. He also says this
mother is ignoring other calming tools, and dad will feel left out.

- Page 179: "Once your baby's teeth begin to come in, be aware that nursing
through the night (feedings lasting more than a half hour) can cause tooth
decay."

- Pages 180-81: He tells of a seven-week-old pulling away after 10 minutes
and arching as though he had forgotten how to eat. "Seconds later he would
arch his back and wail as if he wanted to be out of his mother's arms." But
if put down he cried harder. His diagnosis is oversupply, and his
description is: "When Stanley tried extra suckling for fun at the end of his
feeding, Maria's breasts continued releasing a steady stream of milk into
his throat ..  Once [the parents] began offering the pacifier when he
finished his feedings, he became an angel again."

- On page 198, in a discussion of food allergies, he says that if you
eliminate dairy because baby is sensitive, there are many other ways to get
calcium and baby is not at risk. He adds, "However, if you stop dairy
products for more than a few weeks, speak to your doctor or your baby's
doctor to make sure you're meeting your body's calcium needs."

- On page 199, he says bottle-fed babies "certainly do get constipated."
When that happens, he encourages their parents to add to the formula one
ounce of water or one-half to one ounce of prune juice, and to insert a
Vaseline-greased thermometer or Q-tip one inch into the anus to prompt a
b.m. The breastfeeding mother cannot stop drinking milk without calling her
doctor to see if it's safe, but the formula-feeding mother is advised to
tweak the mixing of formula or stick things in baby's anus without checking
with the doctor ... I feel this sends the wrong message about which feeding
method is normal and which is risky.

- Page 201: Where sore or cracked nipples are mentioned, he advises letting
milk dry on them and provides no other suggestions -- no mention of
positioning or latch.

- Pages 200-01, addressing whether baby is crying because he is not getting
enough milk, Dr. Karp says that if you answer no to ANY of the following
questions, it's possible that baby is hungry, so, "Try giving her a few
ounces of formula or pumped breast milk. If she's truly hungry, that will
stop her fussing immediately." Here are some problems I see with the
questions:
    * Nothing is said about the frequency of feeds.
    * He has "Is your baby peeing enough?" with no mention of bowel
movements. He says baby should pee five to eight times a day after the first
few days. How does any mother whose baby is in diapers measure how many
times a baby pees?
    * "Are your breasts making enough milk?" He qualifies them if they feel
heavy when mother wakes, they occasionally leak, and you can hear baby
gulping when feeding.
    * "Is your baby happy to suck on your finger or pacifier?" Remember that
any "no" here means you need to try supplementing, and think of how many
reasons there may be for baby to not be "happy" to suck on a finger or
pacifier.
    * Dr. Karp does appropriately include "Is your baby gaining weight
normally?" and gives four to seven ounces a week as the range. He also
states that babies lose eight to 12 ounces over the first few days of life
and gain after that.

On a personal note, I was concerned with the advocating of swings for long
periods of time without mention of carriers or a caregiver's arms as a
possibility to provide the sensation of motion he recommends.  Here are some
examples of passages on this topic:
- Page 165: "Far from spoiling Sasha, his eight hours in the swing were a
small compensation for being evicted from the uterus." Dr. Karp even goes on
to label as "silly" worries that babies should be in their mothers' arms. He
adds, "In today's mini-families, a swing can replace those missing pair
pairs of hands that you need to comfort your baby while you shower, go to
the bathroom, or just sit and rest a moment." These things don't add up to
eight hours for me!
- Page 169: "Some babies . are only happy when they're swinging all day."
- Page 215: Dr. Karp says that the movement of a sling or vibrating seat can
help baby sleep longer at night. "I know many parents whose babies sleep
well only when they swing all night during their first four months of life."

I am hoping that future editions contain revisions of some of this
breastfeeding advice, as I would otherwise recommend it.
Janice Berry
Westerville, Ohio

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