Harvey Karp, M.D.: Why Sleep Can Change the World (GROWING UP)
So says Dr. Harvey Karp, author of The Happiest Baby on the Block which has Bible-like status in the world of parenting. As a beloved Los Angeles pediatrician, Harvey punctured the mainstream with the 5 S’s—swaddling, shushing, swinging, sucking, and holding the baby on its side—all simple interventions that helped parents help their newborns sleep. This was revolutionary—and certainly changed my trajectory as a new parent, as getting five straight hours instead of three can have a huge impact on your mental health. Harvey then codified his findings into “The Snoo,” a bassinet that functions as an extra set of hands: It swaddles, swings, shushes, and keeps the baby safely on its back while it sleeps. In today’s conversation we talk about what it would look like to institutionalize support of new parents, what Harvey’s trying to do about this, why it can be so awful, isolating, and hard to have kids, along with the advice most parents frequently seek. I’m lucky to call Harvey a friend and to be able to turn to him over the years—in fact, Sam slept in a prototype Snoo—so I’m thrilled to share some of his wisdom with all of you. Let’s turn to our conversation now.
MORE FROM HARVEY KARP, M.D.:
The Happiest Baby on the Block
The Happiest Toddler on the Block
Follow Happiest Baby on Instagram
EPISODES IN THE “GROWING UP” SERIES:
Niobe Way, “The Critical Need for Deep Connection”
TRANSCRIPT:
(Edited slightly for clarity.)
ELISE LOEHNEN: Was one of the impetuses, well, I know that there are many impetuses to why the Snoo, and we're going to obviously talk about the Snoo, but as you were watching these babies and children evolve and move on at a certain point, were you like, I need to follow them. I need to move into the next incarnation of Harvey Karp.
HARVEY KARP: Oh, as they're going into the world, I need to go into the world?
ELISE: Yeah. Were you like, watch these people, these children graduate from needing me. I need to graduate into the next version of myself too.
HARVEY: I can imagine how that could happen, but no, it was really about an imperative, seeing a need that was just so terrible. And yet so under under addressed or not addressed effectively. That was really the impetus to, to do this work. So, it was really trying to try to do something that would make a difference.
ELISE: Well, I want to talk about that too. And I feel like Snoo came I mean, it's been eight years because my son is about to turn eight. And had one of the prototypes of the Snoo. So yeah, Sam will always be a marker of the launch of the company. But I feel like even then there was a different culture around sleep, and we've moved slightly in understanding that no, you can't exist on fractured, poor sleep. But had that even started, this awareness of Sleep? Or maybe it was just beginning to start?
HARVEY: It's kind of a crazy thing, isn't it? It's quote unquote eight hours, a third of your life and it was yet the great frontier. We don't know what sleep does. I mean, we're still learning that and why we have it and what happens if we don't have it, how that affects our body and our psyche. So it's kind of strange that it's taken so long to evaluate that. And for babies and parents, the idea that you could do anything about it, it's so obvious that you can't do anything about it. In fact, I spoke to a researcher down in Australia, a very famous infant sleep researcher. I talked to him about Snoo and about the first months of life. He said, we actually, we don't even study sleep until babies get to be six months of age, because you really can't do anything. Their little babies. You just have to wait for them to mature. And what's really weird about that, cause that's we were all taught and everybody still teaches, and yet Pediatricians, this is very funny thing when a parent comes to you and they're so tired. And they are dealing with crying for hours and they're just about to break because they're just so brittle at that point. And that's when pediatricians whisper the secret magic, which is that there is a way to almost immediately add an extra hour or two to a baby's sleep and calm their crying and get them much happier. And that's to drive them all night in the car. Right? And I mean, we kind of know that works, but it seems like wow. But if that works, if that works, it means there's something we can do. There's something we can do. And that's really part of what led me on this chase.
ELISE: Yeah. And the shift, I mean, having gone through it with Max, who's now 11, and we'd read and watched Happiest Baby on the Block, and Rob is an architect by training, he's an excellent swaddler. But even so, it wasn't enough for us. This is pre Snoo, and I remember in that first week, the panic, the sleep deprivation, which makes me feel, like, actually very mentally ill and unstable, which I know I'm not alone in feeling that way, and getting one of those Fisher Price Swings, which I know babies are not supposed to sleep in, but it was sort of the only tool that worked to save our sanity. And I think it's so frustrating, obviously, and you know this as a pediatrician, when you just hit this wall of like, well, sorry, that's just how it is.
HARVEY: Right. Right. I know. With a smile. Next, next patient. It'll get better. Don't worry. You know, it'll get better. And we say that about sleep? I know. And how could we be so naïve? And ultimately abandon people in their moment of need, because that's really what's going on. You can joke about it. There's sitcoms about the guy who brushes teeth with the diaper cream or who knows what, you know, poured orange juice in his coffee. But it isn't a joke. And it is a serious issue. And by serious, I mean tens of billions of dollars of healthcare cost. Thousands of infant deaths. Hundreds of thousands of women and men developing postpartum depression and anxiety, which can go on to be a lifetime issue. Car accidents, obesity, breastfeeding failure, stress injuries, cigarette smoking, substance abuse on the medical side, and then tens of billions of dollars on the employer side with poor productivity, poor retention errors and accidents, health care costs liability from those mistakes that you make. I mean, it's not trivial. And ultimately, it reveals a critical problem in our culture, which is after thousands and thousands of years of human culture, always being the extended family, around the time of the nuclear bomb, we got the idea of the nuclear family and thought that, well, that's the normal family, you know, two parents and a child or a few children and a dog and a goldfish. And it turns out that's not. And that is where we went off the rails and that's where people are struggling and suffering for that.
ELISE: Yeah. And there's no relief. I'm interviewing Sarah Hardy at some point this summer and she has a new book, Father Time, and she's, as you know, done all the work around investigating alloparenting in this way that we used to structure community around sharing the care with certainly older adults helping young parents as well. And most of us are absolutely missing that critical fabric. Not to mention this idea that somehow one working parent is a reality for families. That went out the window in the 70s as well, but we're still told that that could be a reality. I don't really know that many people who can rely on a single income and maintain a middle class existence. It doesn't really exist, right? So you get the double whammy and then no paid family leave. I mean, this is your world, so I don't know why I'm telling...
HARVEY: because it's your world too. It's what you've lived and what you see your friends living.
ELISE: Yeah and it becomes like a cultural hazing cycle of like, when are we going to make this better for people? I know it sucked for us, but can we make it better?
HARVEY: right. And what happens if we don't make it better? You know the story about, we're the one industrial nation the world doesn't get paid a parental leave. And what is the cost of that? And we're seeing the cost of that in terms of depression and anxiety for new mothers and fathers. I mean, about 25 percent of the spouses or the partners of new mothers, who develop postpartum depression also develop depression and anxiety. So it is actually in both genders. But even more than that, because we talk a lot about the climate crisis, which is Pretty scary. We're right now in summertime going through a heat wave that is across the country. Everyone knows about that. It's been, it's in the front page news of the newspaper every single day. But there's another crisis that is arguably as serious that's going to happen 20 years sooner. It's already happening, which is the population crisis. The crisis in the drop in the birth rate.
ELISE: Mm.
HARVEY: And what we used to worry about in the seventies was there's going to be too much overpopulation and how are we going to deal with that? But populations are crashing right now. And in the United States too, it's about a 20 percent drop in the birth rate , in other countries, it's much more severe. And literally 20 years from now, they're not going to have people to carry out the social functions of their society to carry out their economic functions. It's what we call the silver tsunami. Everybody's going to be, you know, in old age homes and nobody to grow the crops and take care of the traffic and deal with delivering the mail and all of the other structures of our society. This is happening right now. And and we haven't figured out how to turn it around.
ELISE: Yeah. Except taking away women's bodily autonomy and access to birth control, which is perverse.
HARVEY: And even I don't even know that is done in a way in a thoughtful way of trying to address the issue.
ELISE: No. It's ironically, yeah, does not feel pro life. And it doesn't feel caring or supporting of the life that's here and who's going to take care of all of our older adults.
HARVEY: We need women in the workplace. Women now are a huge part of the workplace and of not just entry level administrative or secretarial work, they are major managers and vice presidents and presidents, and all aspects of business are being done by women. And it gets to your point about, well, who takes care of the children? Whose role is that? And of course it's still falls on the shoulders of a mom. What's it like in your family in terms of childcare roles?
ELISE: well, we are very privileged and that we still have support. We have essentially a third family member because we would definitely not be married and we would not be functioning as a family if it were just the two of us. We don't have any family nearby. And I work from home and Rob works somewhat from home, but I would say it's still more, even though he's incredible and gets a lot of Affirmation and attention and praise for...
HARVEY: stroke that man.
ELISE: Who does drop off and pick up. Not exclusively, we split it. I would say if we were actually counting time, I do a lot more and I definitely am way more on top of all the administrative doing that needs to be done. And it's always been that way. But, he does more. And I think we both really love it. That's the other thing that for women, it's always set up as this, you're this or you're that. And we walk into this trap where I think we, I mean, I'll see for myself, I enjoy both. I would go crazy and be not very good at being a primary primary primary soul caretaker of my children. I really want to spend time with them. I really like going to their stuff. And I love being around them. But I need a spiritual life and I need an external life. And fortunately, I have that. And same, my husband wants to be with our kids, but he also wants to be in the world. I think that's kind of natural to have a balance, right?
HARVEY: And in fact, it's the way it always was, except in the post World War II period, when people moved away from their little town. Number one, they moved to suburbs, so they didn't have family right next door. And number two, they got the idea, the really the big lie, that the normal family was this nuclear family, and that was the way it worked. And at that time it worked kind of okay because moms primarily stayed home and the schools were around the corner and everyone went to the local school and and you had a neighborhood where kids could run around and you weren't fearful of that. That's all been upended, right?
ELISE: Yeah. One thing I'm curious about that I don't actually know, and I just want to caveat this by saying like, obviously I know you and Nina, I've known you guys for a long time, and I've tried to distract you at various points into solving other childhood things, but you have been so incredibly laser focused on sleep, which means you have had a massive impact and we can talk about that and the cultural impact. But with the happiest baby on the block and the five S's swaddling, swinging, shushing, etc. How did you, how did that come to you? Now, of course, it makes sense. And I think people kind of know it. It's really punctured culture. But how did you figure that out?
HARVEY: So I did a two years of studying child development at UCLA after I finished my residency. And and you have to do a research project. And so I wanted to do a research project on colic and how that is related to gas pain. And my professor had this pained look on his face and he said, that's not what colic is. It is a developmental issue. And I said, and that's not what I was taught. I thought they have gas, they have stomach pain. It turns out the word colic comes from the ancient Greek root, which means intestine. So colon comes from the same root as colic. And for centuries or millennia, people have thought when babies cry, they double up, they get red in the face and that they're crying because they have gas pain. And it's not that some babies don't because they probably have gas pain. discomfort or some kind of sensations. But it's really the straw that breaks the camel's back. And so as I started to study this and I learned about studies of other cultures where the babies cried much less, and they were much more capable of soothing them. So I learned about that and studied that and really found that there were a lot of studies to show we know how to calm babies down. In fact, any experienced nursery nurse or grandmother, you hold them, you rock them, you shush them. If they cry, you get more bouncy and you shush a little louder. In fact, babies teach us to do that because when you do that, the baby responds. And so for me, it was really an interesting process of trying to figure out why do they cry? What can we do? Why have we been so blind? Because the idea that you can put a man on the moon, but you couldn't figure out why babies cry, right? It just didn't make any sense. And then what I came to realize is that this is deep. This is hardwired into the brain. And it is a built in off switch almost for crying and on switch for sleep. And so it turns out that babies have over 70 inborn reflexes, things that they have to have for their own survival. If they don't have these things, they're not going to survive. So for example, sucking. A baby who can't suck, a baby who can't swallow is not going to thrive. They're not going to be able to suckle at the breast and they're going to end up dying. A baby who can't cry is a baby who isn't going to be able to solicit the help and support that they need. And there's 70 reflexes like that. Some of them are actually really curious. So there's a grasp reflex of the hand that if you put your fingers inside your baby's palm, they will grasp that. And there's a toe grasp as well. It's called plantar grasp, when you put your finger on their foot, their toes grab on.
Why would baby human beings do that? Well, it's kind of interesting, right? Because you can imagine how important that is for monkeys. To have that and maybe that's an echo of our ancient, you know, relationship to other ape species. But the point being that why would they have an off switch for crying? Why would that be important for survival? And what I came to realize is that in the womb, the last two months of pregnancy, before the baby is born, they need to keep their heads down. If they're swimming around too much and if they get stuck on a sideways position or a breech position, which is where the feet are down and the head is up, they may not survive birth because the head gets stuck as they're coming out and they can basically strangle and actually even kill their mothers. My wife, Nina's grandmother died in childbirth in the 1930s in Czechoslovakia. And women, I don't know if you know this, it's kind of an interesting story, the Aztecs had a pyramid of hierarchy for heaven and the highest levels of heaven were reserved for warriors who died in battle and women who died in childbirth. And this was a frightening experience, right? Because you didn't know if you were going to survive the birth of your own child. And it turns out that what this calming reflex does is the inside the womb, the sound is louder than a vacuum cleaner, and they're constantly rocked, and they're held in that tight little ball.
All of those sensations Turn on this Zen reflex, this calming reflex where the baby chills out and mothers will tell you when I go to bed at night and I stop the rhythms of the day, my baby starts kicking and moving more. And if I walk around or during the day, I just don't feel that. And so it turns out that this reflex evolved to keep babies kind of in this zen state. So they don't wiggle around too much and get stuck in the wrong position. They keep their heads down the last two months of pregnancy and they're ready to be born. And then it doesn't really serve a purpose once they're born. And by four or five months, it disappears, this reflex it's already did its job. And so that's what it was the aha moment, because what's really weird in medicine is that adults calm when you're held and rocked and shushed, when you're rocking a hammock, the sound of the wind in the ocean or flying in an airplane. And so it turns out this was part of our human biology that is universal and yet was never explained before. And so that was exciting for me to kind of write about that in The Happiest Baby and the five S's were the five ways you turn on the calming reflex. And it was just a simple way that people could remember it, right? Because half of the battle is just kind of figuring out the meme that is going to be memorable.
ELISE: no, I mean and it had an amazing impact and essentially was codified or in some way made simpler by the Snoo, right? And I'm sure the listeners are probably, from particularly anyone who has a child who's eight or under is probably familiar with the Snoo. Talk to me about like getting it into hospitals, renting it, making it available, affordable, sustainable for families was sort of the driving motivation. How's that going? Is it an insurance benefit yet? Yeah.
HARVEY: No, actually we're just starting with some insurance companies. So the answer is yes, it's just starting to happen. And Anthem Blue Cross are the first ones actually. Maven care is also subsidizing it for some workers. So Snoo is a little baby bed that rocks and shushes. And when the baby cries, it responds with increasing motion and sound imitating kind of what a caregiver would do. We've measured now over 600 million hours of sleep and we showed that it adds an hour or two to the baby's sleep. And then it also prevents babies from rolling to an unsafe position because that actually was the impetus for starting the project, which was 3, 500 babies die every year in the United States. No change in the last 20 years these are healthy babies. It's unpredictable who's going to die. It could happen to anybody. Over the last 20 years, that means about 70, 000 babies have died, which is similar to the number of Americans who died in the Vietnam War, for example, where they built a big memorial in Washington. So this is a tragic situation that once it happens you never recover from that. It becomes part of the family story. And we know that back sleeping is safer. In the 1990s, when I was a pediatrician way back in the beginning days, I would say never let your baby sleep on the back because if they vomit, they would choke.
ELISE: Mm.
HARVEY: and then in the early 90s, we learned that was exactly 180 degrees wrong and that being on the back was the safe position, being on the stomach was the unsafe position in terms of babies stopping breathing. And and when we told everyone to put the baby on the back, we went from 5, 500 deaths a year to 3, 500 deaths a year in the United States. And then we said, and breastfeed and don't bed share and have the baby in your bedroom for the first six months and use a pacifier and, don't overheat the room or make it too cold. And despite all of those other instructions, and despite telling everybody to put their babies on the back, we've seen no change in the last 20 years in the death rate. Why? It's because babies don't sleep well on the back. And so parents who are desperate to get some sleep, intentionally or accidentally fall asleep with the baby in bed with them or put the baby on the stomach even though they know they shouldn't because they say it's the only way my baby will sleep and I can't get in a car accident. I've got to be able to work and this is what my baby is responding to. And so there was just an article published last month in a pediatric journal saying, People are not listening to us, the doctors, because we're not listening to them, and we have to find ways to improve sleep. That's what was the part of the happiest baby on the block 20 years ago, was using white noise, using swaddling, things that were out of favor at that point in time but now they're common practice for parents. And then as you said, we built the 5S's into Snoo. Snoo is really kind of like a member of the family. It's really a caregiver. It's not just rocking and shushing a baby like the swing that you talked about, but it actually responds with four different levels of motion and sound. So we've demonstrated in over 28 million cry episodes that we're able to calm the baby's crying, usually in a minute or two about 50 percent of the time. And if it doesn't work, then it means they're hungry or they need a hug or they need a diaper change or something else.
ELISE: Yeah. And it's small and beautiful and fits right by the bed. So you're not bed sharing, but you are for that anxiety that we all experience of like, is my baby breathing? It can be right there.
HARVEY: The point you're raising is an important one because then how does new effect infant death. And by securing babies on the back, they can't roll to an unsafe position. So it's now FDA de novo authorized for keeping babies safely on the back. And as the FDA says, back sleeping is known to reduce the risk of infant death. And in addition, by improving sleep, parents are less likely to accidentally fall asleep in a dangerous place because they're more rested and they can put the baby down. So it really meets the needs of parents. And so from the very beginning, our goal with this was that everyone would get this for free. That was the goal from the beginning. Of course, we couldn't give it for free when it first launched. And people said, Oh, that's that expensive bougie baby badge. You know, that is just for, you know, celebrities and rich people. And in the beginning, you know, a lot of people just couldn't afford it. Then we started renting it for about 5 a day, which is still not affordable for everyone, but it is sort of a cup of coffee to get a 24 hour helper in the house and more sleep and a safer baby. And people use it during the day too. So when you're cooking dinner, taking a shower you get a little bit of extra help, but now thousands of people get it for free from their employers. So from JP Morgan and Citibank and Deutsche Bank, but also Under Armour and Snapchat and pharmaceutical companies and trucking companies and Dunkin Donuts and Sonic Burgers, the NFL. So we're really working hard so that working folks can get this for free. And the companies do that because it pays them money. Because if you can retain a good employee, Right, it used to be women going out on maternity would be 23, 24 years old. Now they're 33, 34 years old, and those are very hard people to replace. It's painful for companies to lose that institutional wisdom and competence that these women have. And so now we're starting to work with Medicaid programs and get this into communities at high risk. In rural communities, we're in hospitals now, 160 hospitals use Snoo to improve care. And what we showed last year is that each bed reduces nurse labor, four to five hours per day. So these stressed out nurses, right? Remember the whole COVID deal with everybody being burned out. So that's another thing we're doing. And then next stage is working with the U S military. And we've subsidized 6, 000 active duty military, and now we're hoping that it's going to get written into the defense budget that we can start a project using this with our active duty folks.
ELISE: That's amazing. That's amazing. And obviously, I mean infant safety being and sleep being primary, but just as someone who has benefited from this product and both of my kids were sort of good sleepers in part just because extreme swaddling with max and swings and whatnot. But the relief that you feel as a parent when you can go from 11 until four or five in the morning is so profound. And it's only then that you realize how frankly crazy you feel and totally strung out. And at least for me, by the time I had my kids and I did epidurals, et cetera, for both, in part because, well, one, I was induced, but both times, but also because I was able to take a nap. And I just remember the sleep deprivation that I had reached by the end of my pregnancies by being so uncomfortable, so big, I was already going into the experience wrecked. So it's not, enviable place to be, that's for sure. And it is dangerous.
HARVEY: No, but you know, like you said, there's an expectation, I remember a wonderful psychologist was talking about, we shouldn't, should on ourselves. Don't should on yourself. And it's all of what I should do. And there's a big lie for new moms, which is that when the baby is born, you should take care of the baby. You're the best person. You're the mother. There's no one else who's going to take care of your baby in the same way. And of course you should be holding skin to skin, have the opportunity to breastfeed. But there was never a mother who was expected to take care of her baby without the help of her aunt and her grandmother and her sister and things like that.
And if you think about it, in the hospital, there's only one place where we make patients take care of other patients, right? And what's going on now is women are falling asleep with the babies in their hospital bed and hundreds and hundreds of babies fall out of bed every year in the United States and they get injuries, skull fractures, shoulder fractures, things like that. So one of the things we're doing with a hospital Snoo's is getting them into the mother baby room. So the mother has a little helper in the room with her and she can put the baby down and the bed is going to respond to the baby so she can get an hour more sleep before she has to go home and take care of her child.
ELISE: no, that I mean, an improvement on that experience, which is such a fine line, right? I think for the second, we were eager to get home. But for my first I was like, How am I going to do that? I don't know how to do any of this. And that line between like needing that support and that help. And then also needing to not be in a hospital where it's, as we know, not very easy to heal or rest.
HARVEY: And so that's where we say Snoo and that's why employees give this is because it's really childcare. It's childcare in the first six months of life. It's there 24 seven, seven days a week, holidays, doesn't matter. You don't use it 24 hours a day, but it's there, available to you. As almost, my parents describe it as an extra pair of hands. I wanted to tell you one other thing that's really kind of intriguing, and most people don't recognize about Snoo. And it has to do with another thing we're discovering about the needs of babies. So there's something called kangaroo mother care. Have you ever heard of kangaroo?
ELISE: Mm mm.
HARVEY: So, about 40 years ago, maybe I think it was in Columbia or maybe it was in Ecuador. They didn't have enough incubators to take care of premature babies. And so they developed this idea that let's strap the baby onto the mother's chest, skin to skin, wrap the baby up, put a big hood over the mother's head so that there's warmth in the air that she's breathing. Her breathing is warming the air. And let's see if that helps these premature babies survive. So little two pound and three pound babies were put on their mother's chest. And lo and behold, it was immediately obvious that that improved the care of these babies. So much so that now it's used around the world, including in the most high tech hospitals. That skin to skin contact is so incredibly important for the mother and the baby and feeling the rhythms of her breathing and smelling her scent and those reassure babies. It's been already shown in many, many studies that it reduces the risk of even the infant's death in those early months, it helps these premature babies stay alive, even if it's only four or five hours a day of holding.
ELISE: wow.
HARVEY: What we've now studied is looking at their brains 15 years later, and we see that it didn't just help them survive during those early weeks of life, but it led to architectural improvements, healing, if you will, of the brain 15 years later, maturation of the brain 15 years later. So that gets to a really important question, which is what is normal for a newborn baby? Is it to be held in close to you and rocked or to be in a dark quiet room on their back by themselves alone for 12 hours a day? Ask a thousand babies, would you like to be alone on your back by yourself for 12 hours? Or am I arms rocked and shushed and held and cuddled? I mean, it is laughable, right? We kind of know what the babies are going to say. But what if that is important for brain nurturing? What if we're giving our babies 12 hours of sensory deprivation?
ELISE: mm.
HARVEY: That really the best we can do for babies? Well, the kangaroo care studies would hint at No, we should give them more holding more rocking and how much can you even do? I can't do it all night long I gotta get some sleep. But what if we could have a tool that rocks and shushes babies and responds to them? Would that end up not just helping them sleep which is great and important and not just keeping them from rolling to a dangerous position, But might it be even more nurturing for them? And that's what's being studied now. So there's a study at Vanderbilt and a study at Tampa General Hospital, and we've already seen something really interesting. We know we can add to a baby's sleep, but what we didn't know and we've discovered is that by two to three months of age, this kind of gets to the point you were making, by two to three months of age, a normal three month old might give you a five hour stretch of unbroken sleep. In Snoo, it's six and a half to seven hours. Forty percent more sleep, which means that we've matured the brain's sleep regulatory ability two to three months earlier than we ever thought was possible. We never even knew this was possible. And so it's really exciting from the pediatric side and from a parent raising a child might we have the opportunity? And we don't know yet, we really don't have the study, so I'm not. I'm not claiming we can do this, but might we be able to improve the development of a child's brain, their ability to endure stress because we're giving them this rich reassurance for 12 hours a night.
ELISE: yeah. And this is obviously at a point the sensations are human like enough potentially to maybe not be as wonderful as being carried chest to chest, but better than being alone. If you were to sort of fantasize, besides things like paid family leave, I mean, that's interesting and this is wild, so I'm not suggesting that this is, and this is clearly probably not legal. But with Sam, I went back to work at six weeks. I needed to, that was sort of our leave policy and things were really busy. Not ideal in some ways, but I brought him with me.
HARVEY: Oh, that was great.
ELISE: Yeah, for six weeks. He was the office baby. I had a swing, but he was rarely in it because he was like on me or in with someone at the office. He was just sort of...
HARVEY: yeah. Passed around.
ELISE: And it was awesome.
HARVEY: That's you on the intercom. Hello. This is Elise. Can someone tell me where my baby is?
ELISE: Does do I need to feed my baby? But it was kind of fun. And I think about that not as necessarily like a workable model for most people, but I really enjoy that and then he hits like three months and three or four months and he was like on the moon, they just hit a milestone, it's a different child in some ways and it was much easier at that point to also not be with him all the time.
HARVEY: That's why we call it the fourth trimester. Right. And it was very cool. Two years ago, the Merriam Webster dictionary introduced the term the fourth trimester into the dictionary to to represent this first four months of life or so when they really are more fetuses outside the uterus, then they really are babies ready to be in the world.
ELISE: Yeah, 100%. So when you think about sort of the fantasy of what you've been working for as a pediatrician with Snoo in your work on protecting the environment, like within a realistic, we could actually do this? What does it look like?
HARVEY: It's so exciting because we're doing it already. I mean, the goal is that everyone gets a free Snoo, not just in the United States, but in the developed world, that all hospitals around the world use Snoo as a way of supporting their nursing staff. 90 percent of the deaths occur when babies are on their stomach or when they're brought into bed with their parents. So the potential, our goal is to prevent 90 percent of these 3, 500 deaths a year. But more than that, there's about 800, 000 women just in the United States alone who get postpartum depression. We're not going to prevent that, but we might be able to reduce 30 or 40 percent, because we know sleep and crying and anxiety, those things all contribute to postpartum mental health issues. And then we want to tackle the birth situation, because the countries like Italy and Korea and Japan have shown that just giving tax credits is not enough. They have to do more. They're going to give more cash, but they really have to give child care support. And so Snoo, I think, will be part of that for the first six months of life, and then they'll have to have child care centers after the first six months. And when you say paid parental leave, which is super important, I think, if we love American families, and we love children and we want our families to be strong, we have to support them, right? But what's interesting is Health Canada reported that in Canada, where they have almost a year of paid maternal leave, the incidence of postpartum depression is higher than in the United States.
ELISE: Mm.
HARVEY: Which is unexpected, right?
ELISE: Yeah.
HARVEY: And part of that may be they have longer winters, darker winters and things like that, because there's seasonal affective disorder that can lead to depression. But part of it is that around a month or two, a lot of women are going, can someone else take care of my baby and let me go back to work? Because it's much easier being in the adult world than it is doing this 24 7. Because it's challenging to do this around the clock. And so, to give that type of support, we think is going to be something that governments do to be able to encourage parents to stay healthy, come back to the workplace, and encourage them to have more children.
ELISE: Yeah. I mean, Universal Preschool all of these things that were supposed to happen in the 70s. Thank you, Pat Buchanan and Phyllis Shafley and that were these bipartisan, fully supported and then jettisoned at the last minute, but this idea that like, can we be a culture that cares and wants to make it viable for families to succeed and thrive and and yeah, I hear you. I don't know what the ideal paid family leave, I think it's really important that men also take parental leave and normalize that and so that it stops feeling like such a penalty for women to step out of work, but that it's shared and prioritized by men. But I certainly felt like an itchiness to be also in the adult world and not that you know, I don't want to say skilled, but I have friends who are just like incredibly gifted men and women caretakers where this is like their joy and their genius.
HARVEY: Mm hmm.
ELISE: I mean, look at teachers, right? Like there's a genius there that not all of us possess.
HARVEY: We want those people going into child care. We want them going into being preschool teachers. And that's actually one of the hard things, because the salary of preschool teachers has gone up quite a bit. And child care workers have gone up quite a bit over the last five and ten years. Nowhere near where it needs to be, but it's gone up quite a bit, which is great because we're retaining good people in the field. But that means you have to pay more for childcare. And so it means that and you'll hear this, I'm sure from your friends, you know, I'm spending two thirds of my salary just for my care for my child. It's not a sustainable situation. And the other thing is we're talking so much about babies, but once they get to be toddlers, a lot of people have no idea what to do with their toddlers. People that are very educated. They've got college degrees and who knows whatever, but they may have no experience with little children and the toddler stuff turns out to be even more confusing and more challenging for a lot of families. And it's so important because ultimately that helps to determine who your child's going to be for the rest of their life.
ELISE: yeah, I mean, that's a whole nother conversation. But I'm curious, just a hot take from you, even though I know you've been heads down focused on babies and sleep, but it feels like our culture is moving in this direction where parents are being primed, in some ways to be sort of these like PhD wielding algorithms with the scripts to respond to every state or mood or issue or question, there's a huge amount of pressure on parents to to like take in all this content about parenting which is very different, I think, than when I was growing up, where it was like, yeah, maybe read some books and have conversations with your healthcare providers. How do you feel about that? It feels very anxiety inducing, I tend to sort of exit stage left, but what's your take on that?
HARVEY: So, two things, a lot of it is good and some of it, maybe not so much. The good part is that if you don't have any experience with little kids, you should go out and learn some stuff, right? I mean, don't just wing it because experienced teachers and psychologists and pediatricians have experience, right? They can teach you a couple of things that you might not know. And it doesn't mean that you have to do everything they say. But there's a sense of the fragility of the child that I think is unfair and incorrect, which is that you're going to screw it up and you have to do it this way. And part of parenting is that you're going to make a million mistakes, it's the repair process. It's the part about, okay, I screwed up, you know, let's make this better and, and then talking after, after whatever happens, happens there is respect and caring and love that you generate through the words you say, the way you respond to a child. But the idea that if you don't do it right, it's going to be damaging to them and ultimately diminish their human hood later in life. I think that that's over the top. Here's one little tip though, for people listening, so this is out of the happiest toddler on the block book, which is this thing called toddler ease. So it turns out that when you speak to someone, even for adults, when you're speaking to someone who has high emotions, You change the way you speak. Whether they're positive or negative emotions doesn't really matter, you change the way you speak. The more emotional a person is, the more we speak in a telegraphic language. I call it toddler ese. In the past it's been called parent ese or mother ese. But the concept is three steps: short phrases, repetition, and mirroring a third of their emotion in your tone of voice and your gestures. So it's kind of a thing that parents do automatically when their kids are very happy, right? The child kind of finds up the slide and turns around and looks at the mom, beaming with a sense of pride and success because they never did this before. And the mother does not usually say very good, sweetheart. Mother is proud. I will tell father ... We go, . Look at you. Wow. You climbed it. You did one foot and then another. Yeah. Good job. Wow. Good job. Short phrases, repetition and mirroring a third of their emotion, not maybe as much emotion. And that's part of the dance. You don't want to overwhelm them with your reflection of emotion. It's really just about a third.
And so when they're very unhappy, now parents are taught to reflect their feelings and say, sweetheart, I know you didn't like that. That was frustrating. Mommy understands that... that again is like this pseudo psychiatrist kind of language, which feels icky. You kind of want to don't be around a person like that. In fact, rather saying to a little kid, Oh no, you're so frustrated. You're mad. You're super, super mad. You don't like that. You say, mommy, I'm not happy right now. That's for like a one to two year old. And as the older they get, your language gets a little bit more mature. And then as they calm down, then your language bit by bit gets more normal. But it's the same thing you do for adults. Someone who's grieving, you're not going to say, I'm so sorry your husband died. I mean, you might say that, but more likely you're going to go, I don't even, I'm so sorry. I'm just so incredibly, incredibly sorry. That feels more real than the script that you were talking about. And then as they talk to you, then your language gets more back to normal. And that's just a little tip for parents out there and how to handle when things are really going off the rails.
ELISE: Yeah. Oh, and I think just that I was just interviewing Niobe Way, who studies boy culture and boys, and she has a section in her book, she's going to come back and talk to me about it, about transformative listening, which is really what this is, right? Like, being present with your child's emotion and curious and responsive.
HARVEY: And setting limits because that's the part that gets confusing is how strict should I be? How much should I set limits? What type of limits should I set? Right? Because you kind of feel like you're being a friend. You want to be gentle and loving, which of course you do want to do. And even when you set limits, you want to be loving when you do that and respectful. But sometimes you have to say, this is a wall, no matter how much you push it. And I know you want to push it and you're pushing it hard. It's not going to move. So I'm just telling you right now, you want it so bad. You want that candy. You love, love, love candy. You want me to give you so much in your face is sad now. And you're just so crying and sad because you want that candy now. And mama loves you. And we'll even have a little tiny piece of candy after dinner, if you want, or you can have a cookie your choice, but I know how much you want it, but honey, we just can't do it before dinner. It's the rule. You know what I mean? That's kind of the concept.
ELISE: Ugh, as my therapist says, every conversation is ultimately about boundaries. Well, thank you for everything. Thank you for what you're doing for all of us. May we support families better.
