Bringing Up Baby

The Bringing Up Baby experiment needed to adapt some of the ideas contained in the three childcare manuals to reflect modern-day medical thinking.

We asked Harvey Marcovitch (who has been a consultant paediatrician for 25 years and, in 2007, was made an honorary fellow of the Royal College of Paediatrics & Child Health) to consider some of the key topics and provides up-to-date advice for parents.

Please note: Only general answers can be offered on this site. Before making changes to any medical or dietary treatment you should check with your family doctor or health visitor.

How can I reduce the risk of cot death?

• Always place babies on their back to sleep – not on their tummy and not on their side
• Don't smoke when pregnant or expose babies to second-hand smoke (dad too)
• Don't bed share if you have been drinking or taking drugs or if you are a smoker
• Don't let the baby get too hot: keep their head uncovered and feet to the foot of the cot to stop them wriggling under the covers
• Get medical advice if the baby seems unwell
• Research evidence suggests a baby should spend the first six months sleeping in a cot in the parents' room.

What about sharing a bed ('co-sleeping')?

In the UK it is estimated that up to 100,000 parents bring a baby into their own bed at some time. In a study of all unexpected deaths in babies in South West England, half were co-sleeping at the time but 90% of those were in an 'unsafe' co-sleeping environment – which means the real danger is if you have been drinking, taking any drug that might make you more sleepy, or fall asleep with a baby somewhere you can't move freely like a sofa or settee. Mothers who smoke also increase the risk to their babies if they co-sleep. So, by avoiding these risk factors, it is quite possible to share a bed without increasing your baby's risk.

Is breast really best?

Yes – your breast milk is a complex chemical and biological mix designed not just for babies in general but specifically programmed to suit your baby. The biggest advantage is protection against cot death and lung and gut infections. The jury is out on whether it prevents obesity or protects against heart disease or diabetes in later life.

Is formula milk unhealthy?

No – unless you prepare it with unclean water or don't sterilise bottles, which can be a problem in developing countries but shouldn't be in the UK. If breastfeeding isn't for you, don't feel guilty about using a bottle.

When should I give solids?

The UK Department of Health, advised by experts in nutrition and child health, says breast milk is all that a baby needs until 6 months. The US Academy of Pediatrics agrees but doesn't object to solids at 4 months, perhaps because it knows not many families hold out for as long as six months.

When will my baby sleep through?

Research shows that 2 out of 3 babies sleep through the night by 12 weeks regardless of how they have been handled (the definition of 'through the night' though, is generally a stretch of around six hours). The 'mature' pattern of being mostly awake during the day and sleeping at night starts to happen at about one month and should be well established by six months. You can help your baby to sleep better by establishing good sleep habits from early on.

What is excessive crying?

Scientists who have devoted their lives to studying infant crying use 'the rule of 3'. They say that crying for more than 3 hours a day on more than 3 days a week for more than 3 weeks is excessive crying (often called 'colic'). It is estimated that between 5 and 25% of babies are affected by colic. However, some fussing and crying is a normal part of a baby's development. At two weeks of age, the average baby cries for around two hours a day. A baby's crying tends to peak at around six weeks of age and decreases gradually after that.

How can you tell why a baby is crying?

Often, you can't. For example, although many parents say they can tell a tired cry from a hungry cry, research using analysis of sound waves show no difference. What singles out crying as unusual is how long it goes on for, how difficult it is to soothe the baby and when you can find no obvious reason for the crying. When a baby under 3 or 4 months does this it is often called 'colic' because it resembles the way older children or adults describe the pain they have with gut illnesses like gastroenteritis or early appendicitis.

What causes colic and what can I do about it?

I wish we knew. There are lots of theories about immature gut hormones causing the intestines to squeeze and twist but little hard evidence. In some countries mothers 'swaddle' their babies – that is they wind a long piece of fabric round and round them, holding down their arms and legs so they can scarcely move. They claim it stops colic but the scientific tests haven't been done. Swamping a baby with other stimuli – movement and sound for example – seems to help, whether it is putting them in the car and going for a drive or the pedestrian method of pushing them up and down in the pram while leaving the vacuum cleaner running.

Is fresh air a good thing?

Again there is no evidence though some are convinced. If you take a young baby outside, what matters is that they don't get too cold. Remember babies lose a lot of heat from their heads (especially if they don't have much hair) so in cool or cold weather a hat is important.