“Newborns! Part B: The rough and tumble first few months” – with Dr. Tracey Agnese

What are parents most worried about in the first few days of their baby’s life? What’s normal in the first few days? What should you actually call your doctor about? Pediatrician Dr. Tracey Agnese joins Healthful Woman to answer some of these common questions about a baby’s first few days of life.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. 


In, let’s say, that first week, or half-week of life, so between birth, going home from the hospital and that first visit, what do you find are the most common things parents are worried about, that you’re reassuring them? Like, this is normal, that’s normal, that’s normal. Because that must happen all the time, where parents are like, “We’re worried about everything.” So what are the top things that you’ve found? Again, just those very few first days of life. 


Dr. Agnese: Yeah, sure. So there’s a lot. Yeah, I could probably go on and on, so stop me if I say too many. But one would be hiccups, right. And, you know, the babies have hiccups in the mom’s belly as well, and they have hiccups after and parents get really concerned about it. I always like to tell them, we don’t know exactly why, you know. Irritation in the diaphragm, immature neurological access, but it bothers parents more than the baby, you know. It’s fine. It’s nothing to be concerned about, hiccups. 


Sneezing is a really common one too. 


Dr. Fox: Really? 


Dr. Agnese: Yeah. Babies sneeze a lot, and they actually are congested in their nose. And those are two really common things that doesn’t alarm me but always alarms new parents. 


Dr. Fox: It’s like bubbles coming out of the nose. 


Dr. Agnese: Yeah. They always think, “Oh, does the baby have a cold?” But their nasal passages are really narrow. They’re really thin, they’re small, and they also are clogged with, like, debris from, you know, birth and delivery and everything. And sneezing is a good, normal, healthy reflex for you to try to get that out, so it’s normal that they sneeze. You don’t have to do anything about it. I usually tell them, you know, it’s the same with congestion. But if the congestion is making the baby have a hard time breathing or feeding, then you could do a little saline, over-the-counter saline drops in the nose. You know, use one of those fancy snot suckers and suck that snot out. 


Dr. Fox: A fancy snot sucker. 


Dr. Agnese: Yeah, a fancy one, yeah. There is the bulb syringes that they have in the nursery, but those are really hard to use and not much usually comes out of them, so the fancy snot suckers are the ones that you actually put your mouth on. You’re looking at me like you might not have used these. They’re actually really… 


Dr. Fox: No, definitely not. 


Dr. Agnese: Most parents are grossed out by them. Some are not. I find it so rewarding to get that snot out. So you put your mouth on it, and you suck in. It’s connected to like a straw or a long tube, and the other part of that tube looks like the traditional little bulb syringe that goes inside… 


Dr. Fox: Right, you’re just siphoning the snot out of your kid’s nose? 


Dr. Agnese: Yeah, they’re filtered, don’t worry. 


Dr. Fox: It’s like mother bird, chewing her kids’… We definitely had our kids in primitive times where that was not done. 


Dr. Agnese: Yeah, you missed out. 


Dr. Fox: That’s impressive. 


Dr. Agnese: Yeah, it’s rewarding to get that snot out. 


Dr. Fox: There’s nothing similar to that for constipation. 


Dr. Agnese: Oh, that. Well, they do make a product, but you don’t have to suck it out. Yeah. 


Dr. Fox: Oh, my god. All right, fine. I’m learning a ton here, by the way. This is great. 


Dr. Agnese: Yeah, fancy snot suckers. So congestion, sneezing, and then being really sleepy, difficult to wake up for feeds is really common in the first two weeks. 


Dr. Fox: We’re talking about one of the parents or one of the kids? 


Dr. Agnese: Yeah, parents very sleepy too. 


Dr. Fox: I just can’t get woken up. 


Dr. Agnese: Exactly. I can’t wake the mom up. She’s so tired. That is super common. The babies are usually really sleep for about two weeks, and then at about two weeks, they kind of wake up. So it’s common that you have to really fight to keep that baby awake for a feed in the beginning, you know. I find that people tend to make the baby too cozy too. So in the beginning, when you are struggling to, you know, keep your baby awake to feed, you wanna unclothe your baby. Don’t be feeding the baby all in like a blanket, cozy, near you with the temperature up. You might need to make it colder. You might need to have your baby naked. You might need to stimulate the hands and the feet. 


Dr. Fox: Right. Do you believe in that adage about not waking a sleeping baby? How do you address that? 


Dr. Agnese: Not in the beginning. I don’t think any pediatrician in the beginning, in those first two weeks would say, “Don’t wake a sleeping baby.” 


So once babies get back to their birth weight, at about two weeks is usually when we say that it’s okay not to wake your baby, but they are so sleepy in the beginning and they need to feed often because their tummies are just so small that they can get dehydrated and get sick fast if you don’t wake them. So you do need to wake them so that there’s no more than, you know, three hours from the beginning of one feed to the beginning of the next feed. 


Dr. Fox: So you’re saying you would agree with that statement but only after they’re two-plus weeks, give or take. 


Dr. Agnese: Exactly. So once they’re back up to their birth weight and they’re otherwise growing fine and there’s no concerns, then it’s okay. Although I usually do, around that time, tell the parents that, you know, babies still can’t do very long stretches of sleep, you know, and so maybe they’ll do one or two longer stretches, and long is… 


Dr. Fox: Four hours. 


Dr. Agnese: Yeah, like four hours, five hours. If you do want that long stretch of sleep to be at nighttime, you might want to wake your baby up during the day, so that you don’t get that long stretch of sleep in the middle of the day. 


Dr. Fox: Yeah. That first time you get that four or five-hour stretch is such a blessing. 


Dr. Agnese: It’s magical. 


Dr. Fox: It’s unbelievable. It’s like a gift from God. 


Dr. Agnese: Yeah. 


Dr. Fox: Because you’ve been up every two to three hours for two consecutive weeks, and suddenly, you’re like, you go to sleep at midnight and you wake up at five. 


Dr. Agnese: And it feels so good. 


Dr. Fox: And of course, you always check like, is my baby alive? That’s like the first thing that happens. And then oh, my god, who fed the baby? And then it’s an amazing thing when that happens. 


Dr. Agnese: Yes. It feels very good. 


Dr. Fox: It is pretty cool. Okay, so those are some of the common things that are not a concern. What would be the…maybe not common, but what would be the things that would be concerning that could happen in the first two weeks, things that you would be concerned about as a pediatrician? 


Dr. Agnese: I have kind of answered this, both common and not common, but spit up is common, right, because babies spit up a lot. But if your baby is, you know, throwing up like what we call projectile, where it’s shooting out across the room… 


Dr. Fox: They’re throwing it at you. 


Dr. Agnese: Yeah, that would be something you want to call your doctor about. That would be concerning. 


Of course, if you ever see blood in the poop, I always say that poop can be many different colors, like of a shade of a tree, you know, brown, green, orange. But you don’t want to see red, you don’t want to see blood. So if you see blood in the poop, you would want to give a call to the doctor as well. 


And, you know, unarousable. You can’t wake your baby to feed during those times, you know, those windows. You know, if the baby’s not meeting those pee and those poo requirements in the beginning, that would be a reason to call as well. 


Dr. Fox: Right. I’m curious, you know, as a pediatrician, when you guys take call at night, you get phone calls, how do you determine, like when you get…because probably 95 of 100 calls, everything’s fine, you’re good, go back to sleep. We’ll see you in the office in three days, whatever it is. But periodically, there’s a real issue. And I would imagine, in pediatrics, especially newborns, the stakes are much higher, right? So how do you determine whether to be like super cautious and you bring every baby in and you won’t miss anything, but then you’re freaking every parent out versus being chill and laidback and okay, everything’s fine. I mean different fields, it’s different like… Like in our field, it’s generally not that complicated to figure out if something is straightforward or something is a problem. But I imagine with babies, it’s maybe harder. How do you do that? 


Dr. Agnese: I guess you just know what questions to ask, you know, over time. For the most part, you know, most of the time, it’s probably fine, you know. And even if it’s not fine, most of the time, it can wait until the morning to be seen in the office. So most of the people who are calling overnight, we wind up bringing into the office the next day, even if it’s more to just reassure the parents because they might be really worried. So most of those people are coming into the office the next day. 


You know, there’s not a lot of things that we would be worried about in the middle of the night. I guess breathing would be one, right, if there’s respiratory distress. Sometimes we hear, we’ll say, “Put the phone to the baby’s…” you know, so we can hear. Croup is something you can easily know over the phone, you know. You can hear if there’s respiratory distress. So oftentimes we’ll do that. That will be one of the things. 


But babies, actually, to another point of something that’s common that freaks out newborn parents is babies have a very irregular breathing pattern. So you know, in adults, when we’re counting the respiratory rate, you count over 15 seconds then you multiply by 4. You can’t do that in a baby. You have to actually look and count over one full minute because they do this…they’ll do like [various breathing patterns]. So oftentimes, when the parents called about that and breathing, then I’ll tell them, “Unclothe the baby, take a look at the belly. Do you the ribs sucking in? Do you see the belly see-sawing up and down?” And most of the time, the answer is no, and then, your baby’s not in respiratory distress. Most likely count, I’ll tell them, “Count over a full minute. Tell me what that number is over a full minute, not just for the 10 seconds.” And with those things, you can get a sense that, most of the time, the baby’s okay. 


Dr. Fox: And also, I think most or many pediatrician offices are open seven days a week in some capacity, for this exact reason. Someone calls on Friday night, it’s like, well… 


Dr. Agnese: Come in in the morning. 


Dr. Fox: Otherwise, you have to go to the emergency room. No one wants that. 


Dr. Agnese: Most of the times, we can get through, you know, to the morning with our guidance with whatever that is, look out for X, Y, Z, or, you know, do whatever, as far as maybe an over-the-counter medicine or something where we’re not sending them to the emergency room unless we have to. 


Dr. Fox: Right. And nowadays, also, when people do get sent to the emergency room, at least in most major cities, the emergency rooms will have a specific pediatric wing, pediatric emergency room, so it’s pediatricians. And now, it’s also, most of the time, people get sent to the emergency room, their babies end up being fine and go home. 


Dr. Agnese: Absolutely. 


Dr. Fox: So it’s just like we want to make sure sooner rather than later. Because when you go to the emergency room, it does not mean, oh, my god. You know, it’s just something we’re gonna be up three hours at night and it’s gonna be a rough night, but that doesn’t mean anything bad’s gonna necessarily happen. 


Dr. Agnese: That’s why I like pediatrics because babies tend to be fine. Kids tend to, even if they are sick, they tend to bounce back really quickly. 


Dr. Fox: Right. Have you been…especially, obviously with the pandemic, but have you been using any…like Zoom and video platforms now for… 


Dr. Agnese: Yeah. 


Dr. Fox: Because I imagine, a lot of this stuff, well-baby exams, obvioulsy, you can’t listen to the heart and lungs, but things like sort of rashes, you can see, how does the kid look breathing, all those things. You can look at the poop, for example. Is that something that you’ve been able to incorporate into your practice? 


Dr. Agnese: Yeah, absolutely, we did. It was something that I was thinking about before the pandemic, but we didn’t incorporate. And then as soon as the pandemic hit, we incorporated it. And people love it. It can be really good for a lot of things. And we use it. We’re still using it now, you know, for…as many people who don’t want to come in or it’s a hassle to kind of, you know, get out of the house with the baby. You know, we can definitely do a lot on that, you know. 


In March and April, when things were really bad, people really were scared to leave, I had a lot of new parents who had scales at home, and we would even do some of those weight checks, which, in general, I don’t recommend, because I find that having a scale at home, the parents become, like, too obsessive about the numbers and you don’t need to be weighing the baby every day and worrying about the day to day most of the time. So I usually advise against it, but it was helpful during the pandemic, to be able to do that, especially too when people left the city and weren’t around, you can have that check in, which was [inaudible 00:10:53] 


Dr. Fox: As some people have said, those were unprecedented times, I’ve heard that term periodically, just during the day. And then as they get a little bit older, like, you know, maybe not the first couple of weeks, let’s say the first couple of months, sort of same question, what are the common things that babies do that are weird and freak parents out but then are fine, that are normal? 


Dr. Agnese: Sure. We talk about poop a lot in pediatrics, so I’ll start with poop. But I always tell people at the one-month visit, you know, not to worry if the frequency of the poop goes down, because at one month, parents start to think their baby’s constipated because they’re just not pooping as often as they were in te beginning, but that’s totally normal. 


Dr. Fox: This is their gut getting used to life and whatever. 


Dr. Agnese: Yeah, their GI tract is literally getting longer, you know. If their GI tract is a little more mature and can kind of hold on to, you know, what they need to, and you just kind of work and function a little better. So as long as the poop is soft when it comes out and not hard, like rabbit balls, pellets, then your baby is most likely not constipated. So that’s a common thing that comes up at one month of age. 


And then at two months is when they get the first set of vaccines, you know, so then we… 


Dr. Fox: That’s a fun day. 


Dr. Agnese: Yeah. A lot of crying parents on that day. I always try to tell them, “You don’t remember your first set of shots, so your baby won’t either. It’s okay.” That’s when we start talking about how to manage fevers because fevers then become very common in kids, although again, not now, because most people aren’t getting them, but in general, fevers are something that we can talk about at that two month visit, because before the baby is two months, they get their first set of shots, you know, like I said before, you call the doctor if the baby has a fever. But at that two-month visit, we expect that a fever might be a side effect of the shot, so we always go over the dosing because the bottle says, “Call your doctor,” so we go over that. We always have a dosing chart on our website too, because the dosing is always based on weight, not by age, but they want you to check in. 


But going forward, from two months, you don’t have to call your doctor in the middle of the night if it’s just a fever. You know, you usually can give some Tylenol and see how the baby does, and then check in the next day. Most of the time, we do want to see them if they’re that little, you know, for sure that next day. But if it’s just that, people get so worried about fevers, but you know, I like to do a lot of reassuring that it’s just a number. There’s no number of it that is really going to harm your baby. It’s your baby is responding to something and it’s a healthy reaction and that’s okay. 


Dr. Fox: Right. Again, except maybe the first week or two of life. That’s different. 


Dr. Agnese: Right. In the first two months of life, I would say, that’s completely different. But then once that baby gets that first set of shots and we start to expect that a fever might happen and they might, you know, as a sign of beginning of a virus, then, you know… 


Dr. Fox: Right. I was curious as to what your thoughts were, because we have a lot of parents tell us about classes. People take classes when they’re pregnant. And some of them are about the pregnancy and the delivery, and some are about newborns, for example, newborn CPR or like various parenting or whatnot. Do you find them to be helpful? Are you sort of neutral on them? You think that some of them are like teaching parents bad things? What’s been your experience with these classes? 


Dr. Agnese: Yeah, there’s so many different things out there that, of course, I haven’t reviewed the content of all of them, and sometimes, you know, I don’t know but I think, in general, I always think of it as like learning to swim, right? You can read up all you want about it, you can take all the classes in the world, but until you jump into the water, do it, you’re not gonna really know… 


Dr. Fox: Right, choke a little bit. 


Dr. Agnese: …how to do it. That being said, I think it’s good to have that knowledge because when you are preparing for the baby and you have the time, you can go through some of that, maybe CPR or maybe breastfeeding or newborn care or newborn sleep or something like that, because you’re not gonna retain everything, right, and so you have to do it. Generally, we all have to hear things a few times to really understand it and actually be able to do it. So I think it’s the same kind of thing that if you hear it one time, you know, in a class before, then maybe when you’re in the woods, or in the weeds and need to know what to do, maybe then you’re hearing it for the second time or you know exactly, you know, what book or place to go to and that can be helpful. 


Dr. Fox: What about in terms of, you were saying the frequency of visits, what is the frequency of visits after that first visit a few days after birth? Because we actually didn’t go…I was just curious what they are. 


Dr. Agnese: Sure. So it depends, of course, on all those… the weight and the jaundice where we might say come back tomorrow, if we’re concerned, really concerned about either of those. But once the baby gets back up to birth weight at two weeks and the jaundice isn’t a concern anymore either, so we would do a two-week checkup, usually. Then we do a one-month checkup, and then we do a checkup at two months of age. That’s usually the first set of… 


Dr. Fox: So two days, two weeks, one month, two months. 


Dr. Agnese: Yeah. After two months, it becomes at two months, at four months, at six months, and that is when you get the booster shots, the same kind of series of shots, at two, four, and six months. And then after that, usually there’s a visit around nine months, and then it become about every three months after that for a little while until the baby is about two years old, and then it becomes every six months, and then every year. 


Dr. Fox: That’s a lot of visits. These are just the routine visits. This does not include the coughing season, fevers, constipation, all those visits. 


Dr. Agnese: Exactly. Or flu shot, maybe too, depending, you know. 


Dr. Fox: Which is why being close to the pediatrician is so helpful. 


Dr. Agnese: Is important, yeah, because you’re there a lot. 


Dr. Fox: You mentioned it before, I’m curious, what has been your experience, at least in your practice in New York City, what is the general attitude of your patients abut vaccines? Is it something where they’re all like lining up to get them or you’re like wrestling them to the floor to try to convince them to do it? Or is it like somewhere between? 


Dr. Agnese: Most of our patients are very good and excited and want to get the vaccines. It is something that comes up in prenatal visits where often they’ll ask in a way that they want to make sure they’re not coning to a place that doesn’t vaccinate children, which I always love to hear. 


Dr. Fox: What’s the code question? What’s your opinion on vaccines? 


Dr. Agnese: Well, yeah, I could see in their face the reaction that is a good reaction, where it’s like I’m happy to know that they’re on board with the vaccines. 


Dr. Fox: What do you do with parents who are not on board with them? Obviously, you tell them what’s recommended and the why, you go over with them, but what happens logistically when parents say, “No, I’m out. I don’t want to do it.” 


Dr. Agnese: Yeah. So every practice is a little bit different. You know, some practices are fine with that. I, personally, am not fine with that, because if you’re not gonna vaccinate, then I don’t want to put my other patients at risk, and so I don’t want…if you don’t have any vaccines and then you have a fever, I don’t want you coming into my office and putting my newborn babies at risk. 


Dr. Fox: Unless, of course, they can’t be vaccinated for health reasons. 


Dr. Agnese: Of course. 


Dr. Fox: Which is rare, but it happens. 


Dr. Agnese: It’s very rare. If somebody just completely chooses not to have, you know, any vaccines, I’ll say maybe it’s not a good fit. 


Dr. Fox: Do the schools even let them in without vaccines? 


Dr. Agnese: No. 


Dr. Fox: New York City, you have to be vaccinated, right? 


Dr. Agnese: Yeah, you have to be. More common than people completely refusing vaccines, I feel like, at least in what we see is people being all hesitant, people having questions. And I’ll guide them to resources to read more about it. Or wanting to do some sort of alternate schedule which I’m not a fan of, but, you know, sometimes, within reason, I work with. 


Dr. Fox: Try to space them out, yeah. 


Dr. Agnese: Yeah, and I always say, like, first of all, there’s no reason. Vaccines, it’s a debate in pop culture, but not in medicine. We don’t have a debate about it. And they’re very safe to give all together the way it’s been studied. And as a parent too, I actually find it to be nicer and better for the baby to just give the vaccines on the schedule versus when they want to draw it out and say come back in two weeks to do the next shot. And then the baby has a little fever, is a little fussy, has a sore leg, and then gets better after two or three days, and then you come back in two weeks and do the next one, and then the same thing happens. And then you come back in two weeks and you do the next one. And I just think that that draws it out totally unnecessarily and causes more overall distress for the baby and it’s just not necessary. 


Dr. Fox: And I find also, it’s such an interesting concept and listen, I get it, I’m a parent and everyone has their own feelings about their kids and what they want to do and God bless them. I think those are…some of it is maybe just this there’s a belief, for whatever reason, that they’re not good. Or sometimes, you can see that there’s like this issue of control, that you want to have more control over it. All right, whatever, people do that, it’s not the end of the world. 


But I think what people don’t sometimes realize is even if it doesn’t matter how the kid gets the vaccines or what schedule, if you spread them out, and even if they’re okay with the idea that my kid’s gonna have a fever every two weeks instead of every two to three months, fine, but the problem is I think people don’t always realize is the way medical care works, if you go to a practice that’s busy and seeing a lot of kids everyday and everyone in the office knows, at this visit, we do this vaccines, it’s not gonna get missed. There’s no way a kid’s gonna get through your office, do the two-month checkup, without getting the right vaccines, because your front desk knows, your schedulers knows, your nurses know, you know, the person who mops the floor knows. Every single person knows. 


And when you go off schedule, and do things in a weird way, sometimes, this gets missed. What if the kid is sick at the day of that vaccine and you’re not gonna remember… It’s like hard, and you don’t want to… I always tell people, would you ever ask your quarterback to come in and start throwing lefty instead of righty? It’s like maybe they could do it, but why would they every do that? They always do it righty. That’s how they practice. That’s how they play. That’s how they’re used to it. That’s how it’s gonna get done. That’s how the play is designed. That’s where they look. And it’s like asking your pediatrician to do it lefty. 


Dr. Agnese: Yeah, that’s a really good point. 


Dr. Fox: I tell people that when they ask me to deliver them…listen, I don’t do it that way. Why would you ask me to do it in a way that I’m not comfortable doing it? I might be fine with it, like it may go okay, but I’d been doing it the same way for 12 years, you want me to now switch? It’s just weird. 


Dr. Agnese: Yeah, absolutely. And I also think too, like, if you don’t trust me that this is safe for your child, you know, then maybe it’s not a good relationship, because you have to be able to trust that I’m not harming your child. Otherwise, then maybe, you know, I shouldn’t be your pediatrician if you think I’m trying to harm your child. I’m not. Like I’m doing what’s in the best interest. 


Dr. Fox: Right. And you must be getting so much…you must be getting just pounded with COVID questions and vaccine, and it must be exciting. 


Dr. Agnese: Yeah. It’s hard. It’s hard to navigate for any one particular person and family and then, just, you know, over and over with. And things change so frequently, as you know, and it’s just like… Yeah, it’s been interesting. 


Dr. Fox: One of the fascinating things I found about COVID is, sort of, unlike other viruses, kids seem to do fine for the most part. It’s like remarkable. It’s not the opposite of what you would expect, but it’s unusual because we’re always worried about kids, because they had less immune systems and this. Even newborns, and obviously, there’s been a couple of cases where there are very sick kids from COVID, but it seems to be safer than the flu at the age of the kids you’re taking care of. 


Dr. Agnese: I know. I’m so excited to find out why. I’ve done so many theories and so many thoughts as to like why this is and I can’t wait to find out the answer. It’s interesting too because maybe it’ll shed light on, so for example, Kawasaki’s disease, which is really common in pediatrics and we’ve been seeing it for…we’ve seen it forever. And it’s similar, it seems like, in a way to the MIS-C that we’re getting from COVID, so Kawasaki disease, we don’t know exactly what causes it. But I’m thinking, well, maybe we’ll find some, you know…shed some light on that and other things while we kind of learn more about COVID. I don’t know. It’s interesting. It’s really interesting. 


Dr. Fox: Have you had a lot of patients whose kids tested positive for COVID, either at birth or after birth? Is that something that comes up a lot or is it pretty rare? 


Dr. Agnese: Yeah, no, not a lot, definitely. We’ve had somebody, but it’s definitely not a lot. 


Dr. Fox: What do you tell parents about colic? That’s another one that our family…we struggled with that. 


Dr. Agnese: Me too. I did a video on it. Colic is so hard. 


Dr. Fox: A video, this is what it sounds like for a baby to scream… 


Dr. Agnese: I did, a YouTube video. 


Dr. Fox: …five straight hours. 


Dr. Agnese: Because I had a colicky baby, it is really, really hard. Yeah, so basically, I kind of have a checklist to go through with the baby’s…things you could try when the baby’s crying. Of course, you want to make sure the baby’s well-fed and all that stuff and you go through this checklist of what you can do. But if you truly have a colicky baby, it is so hard. And I like to tell the parents a few things. One is it will pass. And just reassure them that it will pass. That’s kind of the beauty of newborns and pediatrics in general is that babies change so fast so no matter it is, whether it’s that wonderful snuggly period where you’re smelling the and you love it and it’s wonderful or if it’s this colicky period where you just don’t know what to do, no matter what it is, it is transient and you will get through it and your baby will change. So it will pass. 


And just to find that support that you need to take care of yourself and this goes back to really trying to teach the new mom to take care of herself because, you know, it is okay to put the baby in a safe place, a crib, a safe place, you know, make sure that it’s a safe environment, there’s nothing around, it’s a safe environment, and then walk away and let that baby cry. And do what you need to do. You can cry. You can take a deep breath. You can call your friend. You can put earplugs in. You can do a dance, listen to a song. You know, do something and it’s fine that your baby’s crying and you need to take care of yourself. And support from other people is really important and to be able to… 


I remember so many times of, you know, when I had a colicky baby and my mom would show up at my door, and I just would hand her the baby and say, “Here.” But to be able to give somebody else, you know, the baby for a little bit so that you can go for a walk, get out, do something. It’s really important, and it’s okay. You still love your baby, you’re still a great mom. Your baby loves you, and take that break. 


Dr. Fox: Yeah, that was definitely the best advice we got after, you know, months of this. I mean, every night, one of our kids, from 7 pm till midnight, it was just like scream time. That’s like every day. And then eventually, you know, [inaudible 00:25:14] put her in the crib, close the door. We’re like, wait, are we [inaudible 00:25:19]? No. It’s like put her on one side of the door, he goes, that’s it. He goes, there’s nothing wrong with her. Just do it. And actually, she fell asleep. And after that, she was like sleep-trained. It was so [inaudible 00:25:31]. There’s nothing wrong with her. She’s not being hurt. She’s screaming. She’s screaming when you’re holding her, so just put her down, close the door. 


I think that’s a really good segue because the last thing I wanted to talk too about is this idea of the role of the pediatrician in the care of the parents. I’ll go specifically with the mother, even though it is the parents. I’ll start with the mother because, you know, I deal with women’s health, and obviously, we, as obstetricians, we take care of women during pregnancy and beyond. But the interesting thing is from the time they get discharged from the hospital, we typically don’t see them till six weeks later. Sometimes we do, but usually now, we have no contact. And they’re seeing you 1, 2, 4, 6, 12 times. 


And so in a certain sense, you’re the doctor that they see in that post-partum period when so much can happen physically, emotionally, spiritually, family relationships. How do you view your role? Because obviously, you’re the doctor for the child, for the baby. But you have this other person, again, it’s not always the mother, clearly, but we’ll talk about her, who’s coming in to see you. How do you view yourself as one of her providers, potentially? Is this role like a direct role, or are you just sort of peripherally? Are there things you formally screen for or informally? How do you view that? I’m always so curious about that. 


Dr. Agnese: Yeah, one of the things I’m passionate about and I love to talk about is the fourth trimester, and that’s really how I think of it. It’s like that three months after baby’s, you know, born, where the baby is learning how to live in life, but really, it’s the mother is adjusting to this post-partum period and it’s just so…it’s such a special, unique time. And it’s interesting how cultures around the world… I think we, in the U.S., do such a bad job of taking care of that fourth trimester, you know, mom. As a culture, we don’t support her as much. We expect a lot of her. We expect her to host family. We expect all these things where other cultures have this, like, defined name for the period. It’s usually about a month or 40 days, and they, you know, all kind of take care of her too. So I think it’s really important. 


So formally, what we do, we do depression screening. The mom has to fill that out at basically every visit in the first month, and then at the two months and at four months as well. 


Dr. Fox: That’s fantastic. I can’t stress how important that is because a lot of women have post-partum either like a clinical depression or something, let’s say, less severe than that, people call the blues or this, whatever, but some form of that. And they don’t always know it’s abnormal. They just think, “I’m supposed to feel miserable all the time,” and they say, “Oh, it’s because I’m tired or because I’m hungry or because I’m in pain.” And they’re not screened. So I don’t know if all pediatricians do that or not, but it’s so important that you do that and it’s critical because you’re seeing them and you can really intervene or lead them to someone who can help them early. So that’s great, so thank you. 


Dr. Agnese: I think most do. Yeah, it’s American Academy of Pediatrics recommends it. I think most do. And we are, we’re seeing them so much that we know…we develop that relationship with them where we know what to ask for. And yeah, it’s so important. 


Dr. Fox: Are there other things that you either have seen or look for or talk about even whether it’s formally or informally that comes up that will sort of give a heads up to them or the OB or to somebody else? Like hey, this is something that needs to be addressed. 


Dr. Agnese: Breastfeeding is something that we do a lot of. I actually just got my IBCLC. 


Dr. Fox: Great. 


Dr. Agnese: Yeah, it’s something that me and one of my partners actually started doing during COVID was lactation consultants too in our office, for our patients because that’s such an important part at the beginning. 


Dr. Fox: And they couldn’t get someone to come to their home. 


Dr. Agnese: They couldn’t get someone to come to their home, so we started to do it at that time, and it’s really helpful, because that is such a struggle of the new mom physically, emotionally, feeding her baby and to be able to help her with that is really great. 


Dr. Fox: It’s so fascinating. I was just thinking about this. Everyone, you know, we go through, either sort of in pop culture or even in medical school, everyone thinks, like, oh, the people that go in pediatrics have to be good with kids. Well, no. They have to be good with parents. Right? You could be horrible with kids, you could be terrible with kids, but you have to be good with parents, because that’s really the relationship of the…with the pediatrician until whatever it is, 10, 12, 13, you know, when the kid starts to getting a relationship with a doctor on their own that’s meaningful, not just acute. 


So for the first 5 to 10 years of life, that relationship is parent, or whoever the caregiver is, and the pediatrician. And so when people are looking for pediatrician, you don’t…if you think, “Oh, this person’s gonna be great with my kid,” say, “Is this person great with me?” Because sometimes people who look like they’re great with kids might annoy you, or something or vice versa. And so that’s really the important thing, is this someone who I can trust to talk to about concerns I have with my child, or if I’m not doing well or whatever it is. That’s such an important point I think people miss all the time. 


Dr. Agnese: Yeah, they don’t really think about it so much, but we really are directly talking to parents all the time. And I’m always checking in too about, you know, the new mom about if she has seen her, a mental health provider, if she has seen one before, and doing all that. 


Dr. Fox: That’s amazing. 


Dr. Agnese: It’s a special time, that fourth trimester, and it’s a lot of change for the mom. 


Dr. Fox: That’s great. Is there anything else that just about the first three months, in that fourth trimester, that you think parents should know about, or stuff that you routinely cover that maybe we didn’t cover? We’re certainly gonna have you back… 


Dr. Agnese: This is so fun. I love it. 


Dr. Fox: Childhood goes forever. I’m still a child and probably should be seeing my pediatrician, but, you know, those who maybe called to 18, but we’re gonna talk about all of that. But is there anything else that you wanted to cover today? 


Dr. Agnese: I think we got a lot of it. I guess the one thing, maybe, I just like to say is it’s overwhelming, you know, when you’re a new parent and people give a lot of unsolicited advice. 


Dr. Fox: So helpful. 


Dr. Agnese: Whether that be family or friends, you know, and also online, on social media, on Google, on whatever. You just find so much stuff. A lot of times, it’s super conflicting. And so I like to tell new parents, just pick one or two people that you trust to listen to. It probably should be your pediatrician, maybe your mom, maybe your best friend who has a few kids, or maybe not, maybe someone else, who knows. Pick a few people, probably not more than two or three, listen to them. You can take everything they say with a grain of salt here and there, you know, but listen to them as your guide and really just ignore everyone else, and just say, “Okay, thanks,” and move on. 


Dr. Fox: That’s great. That’s great advice. Tracey, thank you so much for coming here. 


Dr. Agnese: Thanks so much for having me. 


Dr. Fox: For coming and talking about such important stuff. And I really appreciate, A, you coming; B, your helpful advice and recommendations and information, and obviously, it’s very clear that you’re good at communication, you’re good at explaining thing, you’re good at talking to and I can see why parents would really like you as their pediatrician. 


Dr. Agnese: Thanks. Thanks for having me. And I’ll share with you too. I have a post, a planning guide, that if you’re patients want, it’s to prepare for the fourth trimester while you’re in the second or third trimester. 


Dr. Fox: That’s awesome. 


Dr. Agnese: I can share it with you if you want. 


Dr. Fox: Thank you so much. All right. 


Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L-W-O-M-A-N.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 


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