What to Expect the First Year

Acknowledgments

Even More Thanks (and Hugs)

So, you’d think that by now—after all these years of writing and rewriting What to Expect books—I’d be able to do it by myself, in my sleep, and (hey, why not?) with two hands tied behind my back. Well, the sleep part—I’ve probably done at least once or twice on deadlines, but I’ve always needed two hands (it’s a typing thing) and I’ve always needed lots of help. I couldn’t do what I do by myself—and I wouldn’t want to try.

I owe so much to so many, but let’s start with thanks to:

Erik, not only the man who planted the seed for What to Expect (literally, since he’s the father of Emma, the baby who started it all), but the man who’s helped me grow, nurture, nourish, and protect it—really, co-parent it. You know how they say that the more things change, the more they stay the same? Plenty has changed about my life and my life’s work since the day I delivered Emma and a proposal for What to Expect When You’re Expecting within just hours of each other, but there is one thing that, lucky me, stays the same (only consistently better): the man I work with, live with, and love with. And the babies we made together, Emma and Wyatt, who long ago passed me in height and shoe size—and, I like to joke, in age—but who will always be my bundles of joy (and adding to the joy, son-in-law Russell). And of course, to Lennox, for making me a grandmother, and the happiest imaginable one at that—but also for his contributions to First Year (chief among them, being in his first year while I was writing it). And for being the cutest cover baby ever, and that’s not just the grandma talking.

Always, Arlene Eisenberg, my first partner in What to Expect and always my most valued. Your legacy of caring and compassion continues to shape, inform, inspire, and, of course, live on through the next generation of What to Expect and beyond. You will always be loved and never be forgotten. All my family, especially Sandee Hathaway, Howard Eisenberg, Abby and Norman Murkoff, and Victor Shargai.

Sharon Mazel, for taking up the What to Expect mission without hesitation, joining me on the third edition of What to Expect When You’re Expecting … and, thankfully, never leaving me, even as the hours (and the indexes) got longer. Great minds may think alike, but few have probably thought alike as much as we have—and that always makes me smile, and always makes me grateful. Thanks to you, and to Jay, Daniella, Arianne, Kira, and Sophia, for sharing the amazing woman who is your wife and mom.

Suzanne Rafer, friend and editor, one of the very few who’ve been with me since conception—at least of What to Expect. I don’t know if that makes you a glutton for punishment, but I do know it makes you an exceptionally important person in my life. I’ve lost count of editions and passes, but not of the contributions you’ve made to our babies.

Peter Workman—a publishing giant who outgrew many office spaces since the day I first met him, but never outgrew his small publishing roots and values. And everyone else at Workman who has helped so much along the way: Suzie Bolotin, Lisa Hollander, Beth Levy, Barbara Peragine, Jenny Mandel, and Emily Krasner, and all the many in sales and marketing busy selling what I’m writing.

Matt Beard, our favorite photographer (and one of our favorite people ever), for perfectly capturing that Lennox essence for our cover. Lynn Parmentier, for her quilting genius and Karen Kuchar, for babies so beautiful you could practically scratch and sniff their sweetness.

Dr. Mark Widome, professor, pediatrician, and fellow grandparent—not only for knowing it all, but for being able to dispense that knowledge with equal doses of common sense, care, compassion, wisdom, and good humor. I’m more grateful than I can say for vetting our latest baby—my only beef being that you practice too far away to be Lennox’s pediatrician. Happily, that role is filled by LA’s finest, Dr. Lauren Crosby, who has helped Lennox (and his parents) through feeding struggles, sepsis, slow growth, reflux, and more with endless energy and empathy.

The AAP and pediatricians, pediatric nurses, nurse practictioners, and physician assistants everywhere, for caring so much about the health and well-being of our little ones. The passionate doctors, scientists, and public health advocates at the CDC—for absolutely everything you do, and do with such passion and tireless dedication. The greater good is so much better off because of you. And 1,000 Days—for our shared vision (together, we’ll make it happen!): healthy moms, healthy babies, and a healthy future that begins before the beginning.

All of my passionate, purple-wearing friends at WhatToExpect.com, (especially Michael Rose and Diane Otter, Ben Wolin and Scott Wolf, the awesome edit and product team) for making my online and mobile home feel, well, like home. I love working with you, because it never feels like work. My beautiful, sweet, nurturing publicist and friend, Heidi Schaeffer. And the other men in my life: my agent, Alan Nevins, and my attorney, Marc Chamlin.

The amazing USO, for partnering with the What to Expect Foundation to create Special Delivery—and give me the opportunity to hug so many military mamas and babies.

And most of all, to the mamas and daddies who sacrifice sleep, showers, and sit-down meals to nurture the babies we all get to love on. You inspire me every moment of every day. So much love, especially, to my WhatToExpect.com family of families, as well as my Twitter and Facebook families (keep those baby fixes coming!).

Big hugs,

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Introduction

A Very Different First Year

You know all that stuff they say about becoming a grandmother? How amazing it is … how much you’ll love it … how it’s all the best parts of being a parent—without the sleep deprivation?

Well, they don’t tell you the half it. Becoming a grandmother, as I did on February 12, 2013, when Lennox entered the world, and minutes later, my welcoming arms, was life-changing, mind-blowing, heart-swelling … thrilling to the core. The heavens opened up. The earth moved. The love that washed over me as I held that sweet bundle for the first time was instantaneous, it was intense, it was unabashed … it hit me like a ton of bricks, and practically knocked me off my feet. I was smitten.

And I knew just how to hold him.

Rewind 29 years earlier, and the picture was a little different. Babies, as they say, don’t come with instructions (and P.S.… I hadn’t written the instructions yet either, so I couldn’t very well follow them). Clueless? That would be giving me far too much crib cred. I was hopelessly clueless. Didn’t know how to hold Emma. Didn’t know how to feed her. To diaper her. To rock her or burp her or calm her or even talk to her. I knew that I loved her, but I was pretty sure this squalling red stranger sniffing at my breast didn’t feel the same about me. And who could blame her? Yes, I’d carried her and nurtured her before delivery with ease—even the delivery had been pretty much a piece of cake (if you didn’t count those 3½ hours of pushing). But now what? I fumbled as I tried to support her wobbly head, jam floppy arms through the sleeves of her t-shirt, guide my nipple into her unwilling mouth. Maternal instincts, I prayed, don’t fail me now(they did).

My crumbling of confidence followed me home. Stop me if you’ve heard this one: Two new parents walk into an apartment with a crying baby … and suddenly realize that not only is this crying baby theirs—but that she’s their full-time responsibility. Cue … my crying. Fortunately, Erik’s instincts kicked in quicker than mine did, and between his cool head and uncanny natural ability and my frantic flipping through my mother’s tattered copy of Dr. Spock, we managed to find our way, one diaper blowout, one botched bath, one sleepless night, one colicky afternoon at a time.

So what did I do next? I did what any young, naive and clueless mom would do—motherhood being the mother of invention, I decided to write a book. A book that would help other parents steer through that first year with more confidence, more knowledge, more joy, less stress: What to Expect the First Year (though first, of course, I wrote a book on pregnancy, What to Expect When You’re Expecting, that did the same for parents-to-be). I didn’t write about my experience—which, let’s be real, wasn’t anything to write home about, never mind publish—but I wrote with experience. I’d been there, I’d done that, and I’d lived to write about it—that is, after I learned, through research and more research, everything that there was to know about it. And when it came to the first year the second time around (in the form of a baby boy named Wyatt), I had a book to turn to, and also—some mom cred to fall back on. Knowledge and know-how—a powerful parenting punch.

The moral of the story? While today’s parents definitely have the information edge when it comes to what to expect the first year of their baby’s life (there’s not only a book now, but a website and an app for that, and Emma was lucky to have access to all three), tiny babies still bring huge challenges, especially for newbie moms and dads. And even with an ever-expanding array of resources, new parents still do much of their learning on the job, in the trenches … much as Erik and I did three decades ago.

Still, the more you know, well, the less you have to learn. Which is where this third edition of What to Expect the First Year comes in—a brand new baby-care guide for a brand new generation of new parents.

What’s new in the new First Year? It’s easier to use, making flipping to need-to-know info (yes, even frantic flipping) faster than ever. It’s just as empathetic and reassuring as ever (because we all need a hand to hold, a shoulder to cry on, a parental pep talk when the going gets tough), but even more fun to read (because we all need a good laugh, too). It covers both the timeless baby basics (diaper changing 101) and the baby trends (all-in-one cloth diapers). There’s much more on making breastfeeding work (including how to take it back to work), baby classes and technology (iBaby?), and buying for baby (so you can navigate that dizzying selection of nursery products vying for your consideration … and your credit card). There’s a whole new developmental timeline to keep track of baby’s milestones, practical new tips for new parents (including stay-at-home dads), and an expanded chapter for parents of preemies (with a glossary of medical terms and acronyms you’ll hear tossed around the NICU). A monthly at-a-glance look at feeding, sleeping, and playing. New strategies for feeding your baby well and getting your baby to sleep, as well as boosting baby’s brain power (without ever cracking a curriculum). And of course, the most up-to-date information available on your baby’s health (from the latest on vaccines and vitamins to the lowdown on baby CAM therapies, probiotics, and homeopathics) and safety (choosing and using the safest products, first aid for every emergency).

I wrote the first edition of What to Expect the First Year with Emma’s first year just barely finished—the experience still so fresh I could easily summon up that sweet new-baby smell (not to mention a whole lot of other new-baby smells, not so sweet). I wrote the third edition during Lennox’s first year—with his sweet smell just five minutes away, inspiring me, refreshing my memories, and providing not only a mountain of new material (from feeding struggles to GERD to an umbilical site infection that landed him in the hospital) but a plethora of new perspectives.

All that, and a new cover, too, thanks to Lennox, our new cover baby. He’s the baby of the baby who started it all—and one of my proudest joys yet.

And, I know just how to hold him.

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Chapter 1

Get Ready, Get Set

You’ve watched (the ultrasound screen) and waited for 9 months, counting kicks and punches, playing Name That Bump, and dreaming of your baby-to-be. And now there’s finally a light at the end of the tunnel … maybe even effacement and dilation at the end of the cervix. But with just weeks to go before D-day, have you come to terms with your baby coming to term? Will you be ready when that big moment—and that little bundle—arrives?

Though being 100 percent prepared for your baby’s arrival probably isn’t possible (there are bound to be surprises, especially if you’re a first-time parent), there are steps you can take and decisions you can make now—before baby makes three (or more)—to help make the transition a smoother one. From selecting the right baby name to selecting the right doctor. Deciding between breast and bottle—or opting to go combo. Choosing to circumcise (or not) or hire a postpartum doula or baby nurse (or not).

Feeling a little overwhelmed by the flurry of prepping? First, think of it as good training for what you’re prepping for: your hectic new life with a new baby. Second, read on to get ready, get set, and get going.

Choosing Breast or Formula, or Both

There’s no question you’ll be feeding your baby (a lot), but maybe you’re still questioning how. Will it be all breast, all the time? A breast start to the first year, and a formula finish? Formula from day one? Or a creative combo that lets you give your baby the breast … and yourself some flexibility? Still questioning those questions and more? Not to worry. The best way to bring that fuzzy baby-feeding picture into focus is to explore the facts and factor in your feelings.

First, the facts:

Breastfeeding

What’s the best food—and food delivery system—for babies? There’s no question about that: Breast is best by far. Here are just some of the reasons why:

• It’s custom-made. Tailored to the needs of human infants, breast milk contains at least 100 ingredients that aren’t found in cow’s milk and that can’t be synthesized in the laboratory. And unlike formula, the composition of breast milk changes constantly to meet a baby’s ever-changing needs: It’s different in the morning than it is in the late afternoon, different at the beginning of a feeding than at the end, different the first month than the seventh, different for a preemie than for a full-term newborn. It even tastes different, depending on what you’ve been snacking on (just like your amniotic fluid does when you’re pregnant). A one-of-a-kind food for your one-of-a-kind baby.

• It goes down easily. Breast milk is designed for a new baby’s brand new digestive system. The protein and fat in breast milk are easier to digest than those in cow’s milk formula, and its important micronutrients are more easily absorbed. The bottom line for newborn nursers: better nourishment.

• It’s a tummy soother. Breast milk is not only easier going down, it’s easier staying down … and easier going out. Breastfed babies are less likely to have tummy troubles (including excessive gas or spitting up) and almost never become constipated (formula can sometimes clog up the works). And although their poops are normally quite soft, nursers rarely have diarrhea. In fact, breast milk appears to reduce the risk of digestive upset both by keeping harmful microorganisms in check and by encouraging the growth of beneficial ones. You know the much-touted pre- and probiotics that are added to some formulas? They’re naturally occurring in breast milk.

• It’s naturally safe. You can be sure that the milk served up from your breasts is always perfectly prepared—and never spoiled, contaminated, expired, or recalled.

• It’s virtually allergy-proof. Babies are almost never truly allergic to breast milk (though occasionally an infant may be sensitive to something mom has eaten). The formula flip side? About 2 to 3 percent of babies turn out to have an allergy to cow’s milk formula. And there’s more good news on the allergy front: evidence that breastfed babies may be less likely to develop asthma and eczema than babies fed formula.

• It doesn’t make a stink. Breastfed babies fill their diapers with sweeter-smelling stool—at least until solids are spooned up.

• It’s a diaper rash eradicator. That sweeter-smelling poop is also less likely to trigger diaper rash—for a sweeter (and softer) bottom line.

• It’s an infection fighter. With each and every feeding, nursers get a healthy dose of antibodies to boost their immunity to bugs of all varieties (some pediatricians like to refer to breastfeeding as a baby’s first immunization). In general, breastfed babies will come down with fewer colds, ear infections, lower respiratory tract infections, urinary tract infections, and other illnesses than bottle-fed infants, and when they do get sick, they’ll usually recover more quickly and with fewer complications. Breastfeeding may improve the immune response to immunizations for some diseases. Plus, it may offer some protection against Sudden Infant Death Syndrome (SIDS).

• It’s a fat flattener. Breastfed infants are less likely to be too chubby. That is, in part, because breastfeeding lets baby’s appetite call the shots—and the ounces. A breastfed baby is likely to stop feeding when full, while a bottle-fed infant may be urged to keep feeding until the bottle’s emptied. What’s more, breast milk is actually ingeniously calorie controlled. The lower-calorie foremilk (served up at the start of a feed) is designed as a thirst quencher. The higher calorie hindmilk (served up at the end of a feed) is a filler-upper, signaling to a nurser that it’s quitting time. And research suggests that the fat-defeating benefits of breastfeeding follow a baby out of the nursery—and into high school. Studies show that former breastfeeders are less likely to battle weight as teens—and the longer they were breastfed, the lower their risk of becoming overweight. Another potential health plus for nursers once they’ve graduated to adulthood: Breastfeeding is linked to lower cholesterol levels and lower blood pressure later in life.

• It’s a brain booster. Breastfeeding appears to slightly increase a child’s IQ, at least through age 15, and possibly beyond. This may be related not only to the brain-building fatty acids (DHA) in breast milk, but also to the closeness and mother–baby interaction that is built into breastfeeding, which is believed to nurture a newborn’s intellectual development. (Bottle-feeding parents can tap into this benefit, too, by keeping close during feeds, even doing skin-to-skin feeds).

• It’s made for suckers. It takes longer to drain a breast than a bottle, giving newborns more of the comforting sucking satisfaction they crave. Plus, a breastfed baby can continue to comfort-suck on a nearly empty breast—something an empty bottle doesn’t allow.

• It builds stronger mouths. Mama’s nipples and baby’s mouth are made for each other—a naturally perfect pair. Even the most scientifically designed bottle nipple can’t match a breast nipple, which gives a baby’s jaws, gums, and palate a good work-out—a workout that ensures optimum oral development and some perks for baby’s future teeth. Babies who are breastfed may also be less likely to get cavities later on in childhood.

There are also breastfeeding benefits for mom (and dad):

• Convenience. Breast milk is the ultimate convenience food—always in stock, ready to serve, and consistently dispensed at the perfect temperature. It’s fast food, too: no formula to run out of, shop for, or lug around, no bottles to clean or refill, no powders to mix, no meals to warm (say, when you’re on a conference call and baby’s wailing in the background). Wherever you are—in bed, on the road, at the mall, on the beach—all the nourishment your baby needs is always on tap, no muss (or mess), no fuss.

• Free feedings, free delivery. The best things in life are free, and that includes breast milk and breast milk delivery. On the other hand, bottle-feeding (once you factor in formula, bottles, nipples, and cleaning supplies) can be a pretty pricey proposition. There’s no waste with breastfeeding, either—what baby doesn’t end up drinking at one feed will stay fresh for the next.

• Speedier postpartum recovery. It’s only natural that breastfeeding is best for newly delivered moms, too—after all, it’s the natural conclusion to pregnancy and childbirth. It’ll help your uterus shrink back to prepregnancy size more quickly, which in turn will reduce your flow of lochia (the postpartum discharge), decreasing blood loss. And by burning upward of 500 extra calories a day, breastfeeding your little one can help you shed those leftover pregnancy pounds faster. Some of those pounds were laid down as fat reserves earmarked specifically for milk production—now’s your chance to use them.

• Some protection against pregnancy. It’s not a sure bet, but since ovulation is often suppressed in nursing moms for several months or more, exclusively breastfeeding your baby may offer some family planning perks, as well as a reprieve from periods. Is this a bet you should take without a birth control backup? Definitely not, unless back-to-back pregnancies are your objective. Since ovulation can quietly precede your first postpartum period, you won’t necessarily know when the contraceptive protection offered by breastfeeding will stop—leaving you unprotected against pregnancy.

• Health benefits. Plenty of perks here: Women who breastfeed have a slightly lower risk of developing uterine cancer, ovarian cancer, and premenopausal breast cancer. They’re also less likely to develop rheumatoid arthritis than women who don’t breastfeed. Plus, women who nurse have a lower risk of developing osteoporosis later in life than women who have never breastfed.

• Rest stops. A nursing newborn spends a whole lot of time feeding—which means a nursing mom spends a whole lot of time sitting or lying down. The upshot? You’ll have frequent breaks during those exhausting early weeks, when you’ll be forced to get off your feet and take a rest, whether you feel you have time to or not.

• Nighttime feeds that are a (relative) breeze. Have a hungry baby at 2 a.m.? You will. And when you do, you’ll appreciate how fast you’ll be able to fill that baby’s tummy if you’re breastfeeding. No stumbling to the kitchen to prepare a bottle in the dark. Just pop a warm breast into that warm little mouth.

• Eventually, easy multitasking. Sure, nursing your newborn will take two arms and a lot of focus. But once you and baby become nursing pros, you’ll be able to do just about anything else at the same time—from eating dinner to playing with your toddler.

• Built-in bonding. The benefit of breastfeeding you’re likely to appreciate most is the bond it nurtures between you and your little one. There’s skin-to-skin and eye-to-eye contact, and the opportunity to cuddle, baby-babble, and coo built right into every feed. True, bottle-feeding mamas (and daddies) can get just as close to their babies—but it takes a more conscious effort.