“The Happiest Baby on the Block,” by Harvey Karp, MD
Dr. Karp sets out to do one job and he does it well, teaching parents how to effectively calm and soothe their crying baby. In “The Happiest Baby on the Block,” Dr. Harvey Karp explains the “fourth trimester” and spells out the “5 S’s” approach to calming your baby.
There’s really nothing bad to say about this book, except maybe that it could be a tenth of its length (but author’s gotta sell a book!). I love how balanced this book is—it’s written without religious fervor or arrogance. It doesn’t yell or scream about its virtues. It simply teaches parents a wonderful method for calming their babies. It teaches the one skill parents would give their left arm to learn. And here it is.
The Fourth Trimester; What is it?
The fourth trimester is the period from birth through the third month of life. Babies are born before they are fully ready for the world, so the first three months of life should be all about recreating the womb environment.
In the womb, the baby was enveloped by warmth and a persistent shushing sound while rocked and jiggled for much of the day. That’s why traditional baby calming techniques around the world imitate one of these sensations: holding, dancing, rocking, wrapping, white noise or singing, car rides, walks outside, feeding and swings. They all trigger a reflex called the calming reflex.
Crying
Your top job is to show your baby affection; your next two jobs are to feed her and soothe her when she cries.
Infants rarely cry unless they’re upset about something and it’s our duty to figure out what they need and how to provide it. You should soothe your baby whenever she cries during the first few months. You want her to learn that you’ll come whenever she cries. The more you love and cuddle your little baby, the more confident and resilient she becomes.
It’s impossible to spoil your baby by letting her suckle or stay in your arms for hours. In these four months, you have a job that is 100 times more important than preventing spoiling: nurturing your baby’s confidence in you and the world. Predictable, consistent love and support builds your baby’s trust in you and becomes the bedrock of faith in those closest to her.
Some baby books tell parents that, with careful observation, they can decipher a baby’s message from her cries; but forty years of studies by the world’s leading colic researchers have taught us that’s not really true. However, the more intense and shrill your baby’s cry, the more likely she’s in pain or needs your help right away. By 3 months, your baby will learn to make many different noises, making it easier to understand her.
This last part was such a relief for me. I had always heard how parents could decipher their baby’s cries. But I couldn’t. I didn’t know what I was missing. I was a stay at home mom, so was around my baby a lot; I was attentive to her whenever she cried; I have pretty good hearing and a decent IQ—so why couldn’t I distinguish her cries? Here was the answer! When a medical professional cites studies, I’m prone to believe them. As I’ve mentioned in my review of “The Baby Whisperer,” that author’s assertion that parents can understand their baby’s cries is complete rubbish. So, don’t feel bad!
It’s not a tragedy if your baby cries for 10 minutes while you’re in the bathroom or doing an errand. The love you’ve been giving her all day easily outweighs that short-lived frustration.
There is no explanation for colic. They are not crying because of gas, acid reflux, maternal anxiety, brain immaturity or inborn fussiness. Only 10-15% of colicky babies have a medical explanation, e.g., food allergy or acid reflux. The only theory that fully explains the mystery of colic is the missing fourth trimester. The cause of colic is simply that fussy babies need the sensations of the womb to feel calm.
I firmly believe that babies cry for a reason. I find that parents often throw the word “colic” around without a medical diagnosis, thinking their baby has some sort of intestinal problem or internal pain. However, that is rarely the case. It is so important to take the time to figure out what is bothering your baby and lead with the assumption that you can and will find a way to calm her. From my limited experience, babies who have “colic” are often placed in overstimulated and loud environments. It’s easy to see when your baby is hungry or needs a diaper, but overstimulation and feelings of insecurity are harder for us to see. If your baby checks off on the “possible problems list” then try the 5 “S”’s in a quiet room to see if they work.
A relative had recently explained to me that a cousin’s baby was extremely fussy; the parents were going absolutely crazy. A few days later I saw this relative with her six week old. She was sitting in a loud room with a number of people, the baby was propped in a sitting position on her lap, flopped over her forearm. I never give unsolicited advice so kept quiet, but I felt there was a good chance the baby was fussy because he wasn’t being sheltered. Months later I met with the mother who spoke about her now happy baby due to the help of a consultant. The “diagnosis” the consultant gave? “Overstimulation.” They created a more quiet, secure environment, and her baby’s entire temperament changed.
The Magic Calming Combo: “The 5 S’s”
Combining “the 5 S’s” leads to a perfect recipe for your baby’s bliss; it is the only tool you’ll need to soothe a fussy infant. However, like all reflexes, it will only trigger if done correctly. The 5 S’s are also only meant for a well-fed and otherwise comfortable baby.
- Swaddling
This is the essential first step in calming a fussy baby; it keeps your baby from flailing and helps her focus on the other S’s. Many irritable babies resist wrapping, but it’s a mistake to think this means they need their hands free. Newborns love being confined, and when they’re frantic and out of control, they need your help to restrain their frantic arms and legs.
You can start swaddling anytime during the first three months. Try swaddling when baby is sleepy and most receptive to it. A new baby should be swaddled 12-20 hours a day; after 1-2 months, you can reduce the time according to how calm she is without it.
Don’t worry that baby can’t access her fingers; it will take 3-4 months for your baby to be coordinated enough to suck her fingers. Don’t be surprised or lose confidence if your baby suddenly cries louder when you pull the blanket tight. Her cry means she’s still out of control and unaware that she’s about to be calmed. Swaddling may also help her learn about her world, since she can pay more attention when her arms aren’t constantly flailing.
Swaddling is a great way for dads to take part in childcare. Fathers are often better at getting a tight wrap.
Read Dr. Karp’s swaddling instructions here: happiestbaby.com/blogs/baby/dudu-swaddle or watch this video: https://www.youtube.com/watch?v=ikBYRi5f32g
This last piece was TOTALLY true for us! I initially thought my husband was better at swaddling because he had done it more in the hospital. But no, he remained the champion throughout my daughter’s “fourth trimester.”
2. Side/stomach
Lay baby on her side or stomach. Babies feel good in this position and it shuts off the Moro reflex (baby’s feeling of falling). When your baby is ready for sleep, put her on her back.
A few of Dr. Karp’s favorite carrying positions are: the reverse breastfeeding hold, the football hold and the over-the-shoulder hold. (link: https://www.happiestbaby.com/blogs/baby/how-to-hold-a-baby). This is by no means an exhaustive list of calming baby holds. Play around to figure out which position works best for your baby.
I found that the position you choose depends not only on your baby, but also on who’s holding her. The preferred position for my baby was different between me and my husband. The same position didn’t necessarily feel the same to our daughter due to our different bodies, strength, etc. When you’re doing the same thing as your spouse and it’s not working as well, don’t feel dejected; the same thing may not work for both of you.
3. Shushing/loud white noise.
As strange as it sounds, your baby doesn’t want or need peace and quiet. What she yearns for are the pulsating rhythms that surrounded her in the womb. Loud shushing sound is music to your baby’s ears. The louder her environment, the louder the shushing needs to be to calm her.
Directions:
- Place your mouth 2-4 inches away from your baby’s ear.
- Start releasing a shhh sound.
- Quickly raise the volume of your shhh until it matches the level of your baby’s crying. Do a rough, harsh, insistent shhh. Try different pitches and see what works best for your baby. When you find the right sound, she will quiet in seconds. Your shushing will sound much louder to you than to your baby.
- After the infant calms, gradually lower the volume. When baby starts to wail again, crank it back up.
- Teach older kids how to do this; they’ll feel proud they can calm baby, too.
Once your baby settles, she will probably need continuing, moderate white noise to keep her calm. There are many mechanical tools and apps to help.
There are other rhythmic sounds and substitutes for shhhing:
- Native American rain dance type chant (hey..ho ho ho).
- Dr. Sears recommends the “neck nestle” where baby’s head is nestled between your chest and jaw, and your voice box is pressed against the head. Make deep groaning sounds in the back of your throat.
- Recording: womb sounds; fan/noisy appliance/hairdryer/vacuum cleaner; static on the radio or baby monitor.
- Dryer with sneakers or tennis balls inside.
- Dishwasher, running water.
- Car ride.
With any of these, gradually increase the volume and see how your baby responds to determine what works best. Place the sound 1-6 feet away from baby’s ears (depending on how loud it is) for maximum effect with the lowest volume. Use a noise CD all night to help baby sleep longer and better.
Lullabies are usually powerless in the throes of a crying frenzy. A tune with a rhythm of 2-3 beats per second, like “A Hard Day’s Night,” works better with repetition, as your baby gradually learns to associate soothing cuddling with the song.
4. Swinging
Vigorous, tiny movements calm a fussy baby better than slow, broad swinging. Once your baby’s quiet, movements can be reduced to a gentler motion to maintain calm.
Rules for successful swinging:
1) Start out fast and jiggly with small, trembly movements (he uses the example of acting like a person with terrible shivers).
2) Movement of their head, not body, is what’s most important. Cup your hands loosely around their head so it makes tiny wiggles – like jello quivering on a plate.
3) For proper back patting, thumping should be loud enough to hear across the room, but not in the next room.
Dr. Karp spells out a few swing methods: jello head, milk shake and windshield wiper, which you can view here: https://www.happiestbaby.com/blogs/baby/how-to-calm-a-crying-baby
Swinging can also be accomplished through any rhythmic action. Some of the most popular methods are placing baby in a sling or carrier, dancing with quick little moves up and down, rhythmic pats on back or bottom, hammocks, rocking chairs, car rides, vibrating bouncy seats, bouncing on an exercise ball, brisk walks or an infant swing.
Tips for effectively using a swing:
- Start early; if baby was preterm or has hypotonia, ask your doctor first.
- Never put a screaming baby into a swing; settle her for a few minutes first.
- Keep baby’s arms wrapped, and put a bar or belt between her wrapped legs.
- Recline baby as much as possible; her neck should never be doubled over.
- If crying starts again, grab the seat and jiggle forward and back an inch, 2-3 times per second. Crying should stop after 20 seconds.
- Use the fastest speed.
Products that vibrate or swing are even better than car rides.
Shaken baby syndrome results when baby’s head is whipped back and forth. In healthy swinging, the head moves 1-2 inches at most; the movements are tiny. The head stays in line with the body – there’s no whipping action where the body goes one way and head abruptly the other. Never shake or jiggle baby when angry!
I was glad when he touched upon this! This worry was definitely at the forefront of my mind when I read about the “vigorous” swinging the 5 S’s entailed.
I found it interesting that he’s not against machines or “props” like many other parenting books are. I’ve noticed this in all doctor-written books – they don’t seem hung up on the minutiae. They look at what’s been proved, tried and true and give a pretty unemotional, balanced view of what they think should be done. You don’t see a lot of hard “don’ts.” There is a big slant toward doing whatever works.
Personally, I did not use mechanical swings or mechanisms to calm my baby. I liked the approach of a more natural, “less-hypnotic” lull for my baby. I took the philosophy of Magda Gerber and made it my own: While she suggests a total ban on mechanical swings and battery-operated toys, etc., I allowed for some toys and calming tools in moderation. I didn’t think it was the end of the world to have a baby shusher or musical toyhere or there. But overall, my daughter’s environment was geared to be less stimulating, natural and more simply composed.
5. Sucking
Bottles and pacifiers should be avoided for the first 2-3 weeks (or longer if there are breastfeeding problems).
Once your cranky baby stops crying from the swaddle, side position, shushing and swinging, she’s ready for sucking. It is impossible for young babies to suck too much. Sucking is an integral part of the fourth trimester, a highly sophisticated calming tool, and one of baby’s first steps to self-reliance. Whether on a nipple, finger or pacifier, it triggers the calming reflex and releases natural chemicals within the brain.
Use reverse psychology to keep the pacifier from falling out. Offer the pacifier when baby is calm. When she starts to suck, tug lightly, but don’t take it out. Baby will automatically suck harder. Wait a moment and do again. Repeat 10-20 times whenever you give the pacifier. This will teach her to keep a firm grip.
My daughter did not take to the pacifier. For the life of me, I couldn’t get her to suck one for more than a few minutes. However, this last trick was genius in getting her to suck better- it absolutely works for those babies who want a pacifier (but mine still didn’t)!
Final thoughts on the 5 S’s
The methods described are not new; what is new is the vigor and the combining of these into a method.
To succeed in stopping the cycle of crying, meet the baby’s level of intensity. The more frantically a baby is crying, the tighter the swaddling, louder the shushing, more jiggly the swinging needs to be. You can gradually slow your motion once your screaming baby pauses for a few moments. Any return to crying should be met with renewed vigor.
Expect your baby to resist the 5 S’s until she calms down enough to realize that your shushing and jiggling are exactly what she needs. The first few times you use these methods, your baby may ignore you or even cry louder. Even if you apply the 5 S’s perfectly, it may take a few minutes for baby to respond. After calming down, baby may need you to continue the 5 S’s for 5-10 minutes.
To find your baby’s favorite calming technique, place her on her back when she is a little fussy. One by one, add an “S” and see how many (and which ones) it takes to settle her.
By 3-4 months, she should be able to calm herself with cooing, moving and sucking hands.
Weaning
At 4 months, you can start weaning baby off the S’s.
Begin with removing swinging. Usually, by 2-3 months you can reduce swing speed to the slowest setting. A few days later, if still sleeping well, baby should sleep in the swing while it is still. If that works for a few days, move baby to a bassinet. Baby should be weaned from the swing by 5 months
Next, remove sucking, usually between 4-6 months.
Next, swaddling. The right age to wean off swaddling varies from baby to baby. To decide if your infant no longer needs to be wrapped, try this: After she reaches 2-3 months of age, swaddle her with one arm out. If she gets fussier, continue wrapping for a few more weeks, but if she stays calm, she doesn’t need it anymore. With few exceptions (some sleep better wrapped even up to a year), babies are ready to be weaned off wrapping by 3-4 months.
Last, remove the shhhing or white noise. Do so by slowly lowering the volume over a span of two weeks. Although baby could be weaned off noise by 3-4 months, the author recommends noise for at least 12 months for naps and at night.
When you want a break from the 5 S’s, these three time-honored tricks work well: massage, a walk outside and a little extra warming, including a warm bath, a warm blanket (put it in dryer, but thoroughly check for hot spots), warm hat, warm hot water bottle (lay baby tummy-down on it), warm socks. Studies show that full-term babies massaged 15 minutes a day produce fewer stress hormones and enjoy other benefits.
Schedules
Dr. Karp is not gung-ho on schedules. If you want to put your baby on a schedule after 1-2 months, he suggests increasing daytime feedings to 3 hours. Of course, if hungry – feed her. Next step is to train her to fall asleep without a nipple in her mouth. After each feeding, play with her a bit before you put her to sleep. It’s easier to establish a schedule if you follow the same pattern every day.
Sleep
The 5 S’s can calm baby at night and may keep her soothed until daybreak. By 3 months, most babies are ready to learn how to fall asleep on their own and should be placed in their crib sleepy but awake. Blackout curtains and white noise can help baby sleep longer. No bed sharing (but most doctors agree it’s OK after 6 months).
During the day, your newborn should have motion during naps—in a swing, bouncy chair, or carried in a baby sling. Babies frequently cuddled/touched and feeling motion throughout day are often calmer at night.
Start a nighttime routine at 1 month. A great routine includes lowering lights, giving a warm bath, calming massage with heated oil,* some warm milk, cozy swaddle, lullaby and gentle white noise playing in background.
* Dr. Karp recommends Vimala McClure’s “Infant Massage” as a great massage resource.This is a great video explaining how to give an infant massage: https://www.youtube.com/watch?v=mbCv6BBTV5c
Final Words
Dr. Karp finishes with,“Relax and remember that all your baby really needs from you is milk and your nourishing love. And all you really need is patience, support, a little information, and perhaps a massage every once in a while.”
To wrap it all up, this is a great book to learn how to soothe your baby. It doesn’t give a lot of restrictions or specific baby-rearing philosophies, but that’s generally the way of any pediatrician-written book. I noticed that this book is referenced more than any other parenting book I’ve read as a great method for calming your baby. It’s just really chill, calm and balanced in its approach so it’s no surprise it’s so well-liked.
Although you can definitely read the book, I think you’re probably better off watching a few YouTube videos like this one https://www.youtube.com/watch?v=IMM7CrIeBfA to learn how to perfect the techniques. Wishing you a calm and happy baby!
