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- [00:01]
Dr. Sanjay Gupta
You know, before I think of myself as a neurosurgeon or a journalist or anything else for that matter, I think of my primary role as a dad of three teenage girls. It is the best part of my life. And I still remember that first moment when I became a parent. I remember walking out of the hospital with Sage, my tiny newborn, and I remember thinking, wait a second, they're just going to let me take her home. I mean, there's no manual. There's no step by step guide. There's no set of instructions. And in some ways, it was one of the best experiences of my life. And it was very terrifying at the same time. And I'm a doctor. I mean, I've been through medical school. I read all the baby books. I was super prepared. But like they say, nothing can really prepare you for what's next.
- [00:53]
Dr. David Hill
You know, I think the question I get the most often from parents, new parents, and even those who've been at it for a while is, is this normal?
- [01:02]
Dr. Sanjay Gupta
That's Dr. David Hill.
- [01:03]
Host/Interviewer
He's been a pediatrician for over 20 years.
- [01:05]
Dr. Sanjay Gupta
He's written some of the books that I'm talking about. He also co hosts the American Academy of Pediatrics podcast called Pediatrics on Call. And perhaps most importantly for this conversation, he's a father of five. Now, I wanted to talk to Dr. Hill because this topic's been on my mind a lot. I have a girl who's now in college, a junior. I have another one who's starting as a freshman in college, and I have a rising junior in high school. I think about my kids all the time. But again, despite the highs, being a new parent, back to those early days, I remember it was just a little overwhelming. And it's a topic of conversation that comes up all the time with fellow parents. And to make things more complicated, the science around how to keep your kids safe, how to make sure they are developing normally or developing well is constantly evolving. So what was considered best practice 10 or 20 years ago might not be the case today. How I was raised by my parents may be very different than how I now raise my own kids. So what do today's parents and grandparents and uncles and aunts really need to know? What are the latest guidelines? And I think importantly, why have they changed? What changed over the last 20 or 30 years? That's what I wanted to explore today with Dr. Hill. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent. And this is Chasing Life.
- [02:41]
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- [03:20]
Host/Interviewer
You're a pediatrician, and I want to say something about this because when I started medical school, I really wanted to go into pediatrics. I just think pediatricians are the best doctors in the hospital, and I think it's because you're taking care of sick kids. And when I did my pediatrics rotation, no one was trying to check out early. Everyone sort of immediately just raised their hand and jumped in and you're a pediatrician. Your father was a pediatrician. And I just want to say I really. I admire that discipline so much. You know, one of the things that strikes me here, and I remember even early in my career as a medical reporter, there were all these beats that people would cover, and one of them was the parenting beat. And I remember thinking to myself, I don't want to cover that beat in large part because I feel like it's so individualized. Like, if I'm talking about Lyme disease or brain tumors or something like that, there's an objective, contextual, sort of fund of knowledge which I think I can share, that might be helpful to the audience. Parenting, very different, and very hard to say that one is right or wrong.
- [04:22]
Dr. David Hill
I think that's something that those of us who generate this literature have become very, very aware of. I have been lucky enough to be associate medical editor of our big book at the aap, Caring for your Baby and Young Child birth to age 5. And I've actually just signed on to be editor in chief for the next edition. And. And over the last two editions, we have really tried to take out a lot of the paternalism. When we looked back to a couple of editions ago, there was a lot of Telling parents how to feel. Don't be worried. Enjoy this. Don't be sad. And as I read that, I realized this is tremendously paternalistic. I can't be here telling somebody how to experience their own lived experience. That's not gonna work. So we really scrubbed that language from the last edition, recognizing People are gonna feel the way they're gonna feel. We can' what that should be. And you're right, every parent is different, every cultural tradition is different, every child is different. But I think one of the things that we've seen since I got into residency in 1990 was an understanding that we have to find people where they are. And that means finding out by asking and really listening in an active way and engaging them and letting them know that we respect where they are and where they're coming from and then asking permission rather than just, here's what you do, this is wrong, this is right. Just, are you interested today in thinking about a different way to do this? And when the answer is no, anything short of frank abuse or neglect, you're going to be like, okay, you know, if you want to talk in the future, I'm here.
- [06:02]
Host/Interviewer
Do you think being a parent is harder nowadays than it was when we were kids?
- [06:07]
Dr. David Hill
You know, that is such a apples to oranges question. But I think that there are unique challenges that our parents certainly didn't have to face. You hear about free range childhood, right? I just get on my bike and they didn't know where I was. But you don't see that. And then you do see this means of the world coming in through these phones, that ideas of self worth or perhaps inadequate self worth, that political radicalization, that sex trafficking or exploitation can come in through this screen. You know, we began to have to deal with that. We began to have to keep the phones in our bedroom at night. So that wasn't foreign to us. But I think it has evolved so far beyond where we were at that time. And as somebody who tries to provide guidance on this to parents, I gotta tell you, it's a scary place out there.
- [07:02]
Host/Interviewer
Do you think we'll ever go back?
- [07:04]
Dr. David Hill
I do. I mean we're already seeing some counter trends. So you're hearing, hey, let's just go to the park, let's go out into the woods, let's put our phones down. They know these things are not helping them and they're moving to self regulate their own use of these electronic media and work as they know they need to on real world relationship, on, as they say these days, touching grass. Right. They know they need to touch grass and I think parents do too. So I think we're already seeing a significant change in terms of this perhaps helicopter parenting or hyper monitoring and also this reliance on the electronics.
- [07:44]
Host/Interviewer
Yeah, I hope and think you are right and I think the kids themselves, the young adults now themselves are saying hey, look, that's not how I want to live my life. Let me ask you about some basics if I can, while I have you. Sleep, safe sleep. That is a concern for parents, obviously. How have sleep recommendations changed since your kids were very little? And why does it matter?
- [08:05]
Dr. David Hill
So at the time, all parents, all their grandparents, were taught by pediatricians, including my dad, that their babies needed to sleep on their stomachs in case they would throw up and aspirate, would go into their lungs and they might choke or gag and even die. And they thought maybe that's what causes sudden Infant death syndrome. And it took the Australians looking at who actually suffered Sudden Infant death syndrome and what the circumstances were to say, wait a second, the kids who are sleeping on their stomachs are having SIDS twice as often as the children sleeping on their backs. And this was mind blowing. And yet the data were there and they were strong. And so just as I was coming through residency, we had the back to sleep program, which has now become the Safe sleep program. And we've got even more data. So now we know not only should babies be sleeping on their backs, they should be on a firm surface. They should not be in the parents bed. And I know that that is controversial in some corners, but, but those data hold up very strongly across the whole population. They should certainly not be sleeping on a couch or a chair with a parent. Ideally, nobody would be smoking in the house. If they can, they should be breastfeeding and they shouldn't have all that cool stuff in the crib that looks great on Pinterest or Instagram but can lead to suffocation. So bumpers, blankets, stuffed animals, pillows, positioners, all those things can lead to entrapment and suffocation. We also change the way cribs are made to put the slats closer together so that children heads couldn't get trapped in the slats, they wouldn't get choked. So all those changes have led to a greater than 50% reduction in sudden Infant Death syndrome. And I will tell you every morning when I round in the nursery, I've got just a couple of minutes to talk to parents. And the one thing that I emphasize, because this is the thing most likely to keep their children alive for the next year is safe sleep.
- [10:02]
Host/Interviewer
But why is SID Sudden Infant Death syndrome so associated with sleeping on your stomach?
- [10:07]
Dr. David Hill
So I'm not an expert in sudden infant death sy, but my understanding is it's not a choking situation at all. It's really an ability of the brain to detect high levels of carbon dioxide and respond to those levels, at least, that's the going theory right now. So the problem is actually these babies are sleeping too deeply, in short, and they sleep so deeply that they don't respond to those rising levels of carbon dioxide and eventually just stop breathing. There are some genetic mutations that have been associated with an increased risk for this problem. But then, then there are also situations, and then there are some cases of sudden infant death syndrome that we simply do not understand. Everything was perfect, the situation was great, and these babies still stop breathing and nobody knows why.
- [10:58]
Host/Interviewer
Yeah, I mean, you're being a good parent and then this tragedy still happens. It's just so difficult to reconcile in any way. People look for answers, which is why I asked the question, let me ask about nourishing children. Breast versus formula milk. Are you a bad mom if you're not doing breastfeeding?
- [11:19]
Dr. David Hill
You know, there was a time when we made people feel like that and of things that I wish I could go back and change, that would be one of them. And yes, there are definitely physiologic advantages to breastfeeding, both for the newborn and for the mother. I think there was a time when we may have overstated the case a little bit and our zealousness to pursue that. But yeah, for moms who are capable of breastfeeding and interested in it, it is a superb way to feed a baby. That said, formula is also really well constructed these days and showing major outcome differences between breastfed babies and formula fed babies. The differences that do exist are not so vast that anybody's going to say, this is an awful thing to do, don't do it. And of the parents that I every day I get people all over the map and often for very personal reasons. And that's the other thing about asking and finding out where somebody is coming from. Mom will sometimes tell me, I tried it with my first child. I tried so hard. It was incredibly difficult. It was painful. I was crying. They told me eventually my child wasn't gaining weight and I had to give formula. And I just never want to go through that again. I am hardly going to be the person to say, well, let's go through that again. Right? That's their lived experience and it's valid and we have a perfectly great option for them. I think we really have to individualize and find out what works for a given family. Give them all the support we can if they're interested in breastfeeding, make sure that they've got good lactation support, good social supports, which makes it a lot easier. But Ultimately, this is a personal decision, and certainly as a male physician stalking into the room, I have no place telling somebody, okay, you gotta do it this way.
- [13:12]
Host/Interviewer
This was a really challenging time for my wife. Our oldest daughter did not breastfeed well. And I remember my wife walking in and her just being in tears and thinking, I'm a terrible mother. This is something wrong, and the child's gonna be adversely affected for this. They should not feel that way.
- [13:31]
Dr. David Hill
Oh, absolutely. No. Let's remove that level of guilt altogether. This is hard enough without somebody putting that on you. A fed baby is better than a starving baby under all circumstances.
- [13:43]
Host/Interviewer
What about allergens? This has been a big topic lately, especially peanuts.
- [13:47]
Dr. David Hill
I'm so glad you brought that up, because the other 180 degree spin that we've seen over the course of my career has been with exposure to foods that are considered allergenic, specifically peanuts and eggs. So we had this wave of peanut allergies. These peanut allergies can be absolutely life threatening, incredibly frightening. Anaphylaxis to peanuts, eggs, and other food are one of those emergency conditions that we have to treat immediately or they can lead to very bad outcomes. And our response to this, again, was the common sense response of, okay, well, let's not give kids peanuts or eggs until they're like, I don't know, two years old, three years old. Let's just hold off. And it turned out that was exactly the wrong thing to do. And it took the Israelis, who have these little crackers called bombas that are made of peanut, and they had an extraordinarily low rate of peanut allergies. All their kids were using these as teething crackers. So they ran the data, and the answer was it was the crackers. It was that early peanut exposure. And it turns out that this early exposure, at least to peanut allergens and egg allergens, is the key to reducing the rates of these very dangerous food allergies. And so peanuts, for example, as soon as children are starting to eat solids, that's usually around six months of age, and not a big wad that get, you know, trapped or become a choking hazard, but just a little smear on whatever else they're eating. Same thing with eggs. When they're in a place where they can, you know, chew and swallow some solids, bring the eggs in early. It seems that the earlier we introduce them, the less likely they are to have allergies against these foods.
- [15:27]
Dr. Sanjay Gupta
Coming up, a speed round on car seats and pacifiers and other such things. And also, what does it really mean to be a perfect parent. We'll be right back.
- [15:42]
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- [16:50]
Dr. David Hill
Anytime a baby is harmed, we want.
- [16:53]
Host/Interviewer
To hold someone responsible.
- [16:55]
Dr. David Hill
I didn't have anything to hide.
- [16:57]
Dr. Sanjay Gupta
They're saying she was murdered.
- [16:59]
Dr. David Hill
This case, you almost couldn't make it up. Ashley and Albert Doublebot were living out their dream when they brought their baby home, but their time as parents would be anything but normal. From the Atlanta Journal Constitution this is the 11th season of Breakdown three days in May, out now, wherever you get your podcasts.
- [17:27]
Host/Interviewer
Well, I'm not an expert, but I think it's interesting to sort of think about things that we believe to be true and how they change over time. What does that mean for parents who are just trying to separate fact from fiction, fact from fad right now? Who are listening.
- [17:46]
Dr. David Hill
Let'S acknowledge. First of all, there is no perfect parent. I don't know the way to be a perfect parent. So if you're putting that on yourself, let it go. You're not going to be that. And even if you were, I wouldn't know how to define it. So a, we're going to do things that we look back and think, I could have done that differently, right? But B, it's more important than ever to ask where is this information coming from and what are the motivations of the person who's giving it to me. Now, full disclosure. I work closely with the American Academy of Pediatrics on our parent facing information. But I do that because I know over decades of experience how dedicated everybody in that group is to making sure we get this right, including being willing to get egg on our faces and say, you know what? We were wrong when we were wrong, and that's really critical. Anybody who's never wrong, I don't trust, because none of us is perfect. Right? So I would really urge parents to look at trusted, reliable parties of information, sources of information that have been validated, that use real data, and honestly talk to your child's doctor. Develop that relationship, because that's what we dedicated our lives to doing. So bring it up, ask it. I'm never offended. People come to me with stuff all the time. And those relationships, I think, are going to sort of steer us through this swamp of misinformation and disinformation that's out there right now. You know, I think the question I get the most often from parents, new parents, and even those who've been at it for a while is, is this normal? Is this okay? As somebody who's seen probably over 10,000 children and studied that, it is a joy for me to almost always be able to reassure and be like, yeah, that's fine. They do that. Kids do a lot of weird things, and they do a lot of things at their own pace. So normal can be all over the map. One of the questions I get the most often is a second child who is not speaking as early as the first child did. And that's almost always fine. It is. Kids are going to learn to speak at different rates. Now, we do do some screening exams to make sure that they're not way outside the range, because in those cases, we may need to do some hearing testing or developmental testing. Again, with walking. Some kids walk really early, nine months. Others are not walking until 15 months or even a little later. There's a really widespread. And our job is to figure out, okay, is there an issue here? Is this just a kid doing what they do?
- [20:14]
Host/Interviewer
Is there something that worries you in particular right now, some trend or something like that that you think we're going to look back 10 years from now and say, hey, man, we got that one wrong?
- [20:23]
Dr. David Hill
Absolutely. And I think in terms of parenting, that trend is going to be extending the grind culture to our children, this sense that if they don't, if they're not the very best, best, best of the best, then nothing else that they do matters. Children don't need to grind. They need to be grounded. They need to be able to play soccer because it's fun. They need to be able to learn piano because they want to play some songs for their friends. They need to be able to dance because they enjoy moving their bodies to music. Just let them have a good time. I hope that we live in a world in 10 years or 20 years where we can relax and let our children do stuff because it's interesting and because it's fun, not because we're like, okay, they have to get into this school or pursue this career because there are no other options.
- [21:13]
Host/Interviewer
It is a weirdly competitive culture in this regard. I've just gone through this twice now with kids going to college, and it's bizarre to me sometimes to have these conversations with other parents. My kids are smart kids. They're good kids. They're grounded kids, they're curious kids, which I really love that about them. I got a quick lightning round I'd like to do with you, and then I do want to just get some advice from you personally for a second.
- [21:37]
Dr. David Hill
All right, so lightning round, hit it, please.
- [21:39]
Host/Interviewer
Current wisdom on car seats, both in terms of position and how long, as.
- [21:44]
Dr. David Hill
Long as you can, and rear facing as long as you can. Each car seat will come with a height and weight recommendation on it. And when you take your child to their wellness exam with the pediatrician, their health maintenance exam, they're going to get a great height and a weight and then take that back to the side of the car seat and see how it compares. We know that the forces on the head and the neck are a lot gentler when children are facing rear. Especially, you know this when they're babies. They've got huge heads, right? Big old Charlie Brown bobblehead. And supporting that head as well as we can, as long as we can, is critical. So at least age 2, rear facing, but really as long as you can, ideally in the middle of the backseat of the car. Not everybody's car has a backseat or a middle, but you do want to make sure they're not going to get hit by an airbag wherever they're positioned.
- [22:33]
Host/Interviewer
Crib bumpers, yes or no?
- [22:35]
Dr. David Hill
No.
- [22:36]
Host/Interviewer
No. Crib bumpers?
- [22:36]
Dr. David Hill
No, no, no, no, no. So crib bumpers are among the soft things in the crib that can actually lead to entrapment and strangulation. So big. No. And it's sad because there are some really cute crib bumpers out there. But really, the more boring your crib looks, the safer it is for you.
- [22:53]
Host/Interviewer
So no stuffed animals or blankets or things like that in the crib either.
- [22:56]
Dr. David Hill
Exactly. So this is part of my talk to every parent that I send home every day, is please, no heavy blankets, no stuffed animals, nice firm surface, baby on the back, not elevated. And ideally in the same room with the parent for the first six months. We know that sleeping near the parent.
- [23:13]
Host/Interviewer
Is protective screen time for infants. Yes or no. And not at all. Not at all.
- [23:20]
Dr. David Hill
I mean, yeah, it's just, it's unnecessary. And the cool thing about the data, what infants are learning their neurologic development is how the physical world works. You know, if you throw a ball, does it bounce, does it stop, does it roll? What happens? And their whole brain is trying to sort out the rules of the visual world. Nothing about a flat screen helps them understand that. And what they really need is to engage, most importantly, with their caretaker's face. Anything that comes between your face and the baby's face is getting in the way because they're learning everything about the world from your facial expression, your voice, your smile, even your smell. And that's why reading with your baby, making faces at your baby, talking to your baby, is by far the best thing you can do for their neurologic development.
- [24:09]
Host/Interviewer
Yeah, and you know, parents enjoy that too. Pacifiers, good or bad?
- [24:14]
Dr. David Hill
So pacifiers do provide some protection against sudden infant death syndrome when introduced. If you're working at initiating breastfeeding, sometimes the pacifier can. It's a different way to suck. And so you want to make sure that breastfeeding is well established. Once that's in place, then the pacifier can be protective. Understanding you can't force a pacifier on a baby. Some like it, some don't. If they keep spitting it out. Okay, you're not a pacifier.
- [24:37]
Host/Interviewer
Better than sucking thumb though.
- [24:39]
Dr. David Hill
You know, I don't know that the data are there on the thumb sucking people. It's easy to do data on a pacifier over time. The thumb sucking as a child gets into the toddler years can affect tooth development. So if you're worried about that, you should talk to your child's dentist about when that's an issue. There are some great habit reversal training techniques you can use to stop the thumb sucking that are not punitive. They just help the child move to a different form of self calming baby powder. Nope, no baby. This is the.
- [25:10]
Host/Interviewer
You know it's literally called baby powder.
- [25:13]
Dr. David Hill
I know, right? So it can cause pulmonary problems. The old talcum powder that our parents used actually had trace of asbestos in it, which was especially dangerous. But even current talcum powders, they sort of get airborne. Babies breathe them in, and honestly, a good ointment of choice on the booty's gonna do at least as well as the talcum powder.
- [25:34]
Host/Interviewer
White noise.
- [25:35]
Dr. David Hill
Helpful.
- [25:36]
Host/Interviewer
Harmful.
- [25:37]
Dr. David Hill
So it can help with sleep. But remember, that baby's hearing is very sensitive. So a sound, when we crank it up, we're like, ah, that's good. Way too loud for a baby. And there are reports of hearing loss as a result of chronic exposure to loud white noise. So really nice and quiet, nice and gentle, but you don't want to crank that thing up to the maximum settings or anywhere close because you can risk hearing loss.
- [26:04]
Host/Interviewer
All right, doc. You know, I feel like based on your answers, my wife and I did a reasonably good job. Reasonably. I don't know if a plus would be the grade, but we did reasonably. We definitely passed.
- [26:15]
Dr. David Hill
We do not give out grades, so don't worry about it.
- [26:18]
Host/Interviewer
Let me take a moment of personal privilege here. Just because I have you as my guest and you are a few years ahead of me in terms of where your kids are. They're all out of the house. I'm really nervous about this whole empty nesting sort of phase of life. But how was that part of life for you when the kids started leaving the house?
- [26:36]
Dr. David Hill
Every single day that my children live, they become more interesting, and that's the reward. Like I thought, like you, I am sentimental. I thought I'd be looking back and missing the babies and missing, you know, having them read in my lap or pushing them on swings or whatever. But every time I meet them, they bring me new ideas, new visions of the world, new ways to think about things. And so I'm never, like, backwards looking because the person in front of me is so fascinating right now. And that just keeps going.
- [27:12]
Host/Interviewer
What a pleasure to talk to you, doctor. A real pleasure, A real privilege. Thank you, Sanjay.
- [27:18]
Dr. David Hill
Thank you so very much. I am looking forward to it and keep enjoying this ride, man. It sounds like you are having a great time, and I promise it just keeps getting better.
- [27:28]
Dr. Sanjay Gupta
That was Dr. David Hill, pediatrician, author, father of five, and spokesperson of the American Academy of Pediatrics. Thanks so much for listening.
- [27:43]
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