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Newborns do a lot of strange movements and behaviors that quite often scare parents. What are normal newborn reflexes, and when should parents worry?

The first one most parents know and call the startle reflex. It's technically called the Moro reflex. Parents often tell me it's when their baby gets scared, but that's not really the reason. Babies don't get scared as newborns. It's due to their nervous system response to a sudden change in sensory stimulation.

And it's a good thing, actually. In fact, it's able to be seen on ultrasounds when a mom is only 16 weeks pregnant, and a baby's own cry can even stimulate it. It lasts until babies are about 2 to 3 months old.

So when should you worry? Well, if you had a difficult labor and there was concern that your baby might have had some oxygen deprivation, then an exaggerated Moro reflex could be concerned for something called hypoxic-ischemic encephalopathy. Basically, the brain is hurt by having the oxygen supply cut down.

Neurologists can help evaluate and treat this, and the good news is it's picked up really closely after birth. And if there's any concern, your baby will be in the intensive care unit really quickly for a full evaluation. If your baby is otherwise in the normal newborn nursery and goes home, there's a good chance this is not what your baby has.

Another normal reflex is the suck or rooting reflex. And that's just what it sounds like. It's basically what helps the baby learn to find a food source and eat. This reflex doesn't start until about 32 weeks of pregnancy, which is why preemies have such a hard time learning how to eat. This reflex is fully developed at about 36 weeks.

Now, when parents see this, they automatically think their baby is hungry and often that's true. It could be that it's just the reflex and they suck on their fingers and hands as a self-soothing behavior. I see a lot of parents trying to force their babies to eat and then the babies get over-full and throw up.

Then there's the tonic neck reflex. We call it the fencing reflex because they have one arm outstretched and one bent and they're about to say, "En garde!" Some parents worry that there is a problem because both arms aren't in the same position or both arms aren't being used the same way at the same time. But this is normal, and it can last until they're about 7 months old.

Finally, this isn't a reflex, but it's something parents ask me about all the time at the newborn checkups. It's called periodic breathing. Babies do this weird thing where they look like they're breathing really fast, then they can hold their breath for up to 10 seconds, and then they take a big breath in and then they're back to normal breathing. And it can happen when they're sleeping or when they're awake. And it usually lasts until they're about 6 months old.

Babies' lungs are still developing and their brains are still trying to figure out how to send messages to the lungs to remind them to breathe. Basically, they are still trying to figure out this whole breathing thing and breathing patterns. And it looks scary, but it's normal.

So when should you worry about your baby's breathing? If they're consistently breathing more than 60 times a minute, if they're having retractions where it looks like their stomach muscles are sucking in under their ribs, if they are making grunting noises with each breath, or if they hold their breath for more than 20 seconds and turn blue, those are not periodic breathing, and that needs to be evaluated right away to see if your newborn's oxygen is low. Depending on how severe the symptoms are, the best place for your newborn to be evaluated for breathing issues may be the emergency room.

One last thing. What about those eyes? Well, babies have very little control over their eye movements right away. That's why they always look at you cross-eyed. They're trying to figure out how to control their eye movements and learn to focus on things.

Also, it's not uncommon for a baby to roll their eyes when they're sleeping or when they're almost asleep, like when they're going to sleep or trying to wake up. But this should not be the norm. If they are not rolling their eyes but doing more of a rhythmic back and forth, something called nystagmus, that is absolutely not normal.

If your baby rolls their eyes often, that is not normal. If your baby's eyes roll and your little one also has stiffness in their arms or legs or has shaking that doesn't look like the startle reflex, that could be a seizure and that's an immediate trip to your local children's emergency room.

Many things can cause seizures in a new baby, including low blood sugar, low calcium levels, metabolic diseases, or brain abnormalities, in addition to epilepsy and high fevers. Your child will probably be admitted to the hospital and see a neurologist for tests to determine why they are having these weird movements and possible seizures.

So while a lot of these normal behaviors look concerning, they are often just part of your baby adjusting to being in the outside world. If your baby has any of the not-so-normal behaviors I talked about, please have them see their pediatrician right away or go to your closest pediatric emergency room.

Interviewer: So, today, we're here with Dr. John C. Carey. He's an MD and professor of pediatrics at the University of Utah Health and Primary Children's Hospital. So when we're talking about hearing loss in children, you know, when we're talking with newborns, you were telling me that there was a bit of this screening process that we do, what's it called?

Dr. Carey: So it's called universal newborn hearing screening. It was initiated in Utah in 1999, which was one of the first states to actually pass the legislation to screen all of our newborns. But by the mid part of the next decade, the mid-2000s, all 50 states had mandated that their health departments had to provide newborn screening so that we could detect early on, literally first few days of life, that that particular newborn had a hearing loss.

Interviewer: So, I guess, how frequently are we testing? Are we doing like, you know, the first week, the first month? I've heard 1-3-6.

Dr. Carey: In testing for all the babies that are born in the hospital, which in Utah is about 99%, the hearing screen is done before they're discharged. So it's done by one, two, three, four days of age. If they fail either ear, they get a second screen. That's usually done a week or so later. That's the one of the 1-3-6. We want to make sure that second screen is done before one month of age. And then from that, it turns out that the majority of those children who fail the first screen, don't have a hearing loss. There's something plugging their ear, like, you know, the ear wax of the newborn and so on.

So when they get their second screen, that really narrows things down to now we have a few percent of babies. And then when they're seen by three months by the audiology specialist, by the actual hearing specialist, we can determine whether or not they have what is called a permanent hearing loss or not. If there's fluid in the middle ear, it's not considered permanent because our ENT colleagues can drain that fluid with tubes. And eventually that, with time, can resolve itself. So that's not considered permanent. What's permanent is when it's not due to fluid and they still fail one or both ears, and then that's confirmed by the audiologist before three months.

Interviewer: And then you bring them in one more time at the six-month mark?

Dr. Carey: And then, well, by six months, we're hoping that all of those children who are determined to have permanent hearing loss of some degree could be mild, it could be more, but by six months all will have their hearing aids and also be, if they need them, and also be lined up for early education of children with hearing loss. So, by six months, we want that to be in motion.

Interviewer: And how many kids do you find are affected by these types of conditions?

Dr. Carey: After you go through the screening first time, second time, get the test by the audiologist, you're left at about 1 in 500 newborns. Now, there are a few weeks or months old. One in 500, which would be about 100 children a year in Utah, have a permanent hearing loss. After heart defects, hearing loss is the most common birth defect in human babies.

Interviewer: Wow.

Dr. Carey: So everything else you can think about from oral facial clefts or some of the orthopedic abnormalities or other syndromes, like Down syndrome, they all have a frequency of less than 1 in 500.

Interviewer: And what does the screening for a baby look like? Do you put little headphones on them? What does that look like?

Dr. Carey: You actually do put something in their ears. In the first screening, you put something in their ears, and this almost sounds magical, but what they're doing is they're putting a sound wave in through the ear canal. It goes through the eardrum and the three famous middle ear bones, the smallest bones in the body, through the oval window to the hearing structure called the cochlea. And so, when it gets to the cochlea, the hair cells inside, people are familiar with all that with maybe a hair cell problem, get to the hair cell, the hair cells bounce the sound wave back, and the computer detects that change.

So what you're doing, in Utah, what we're doing . . . other states do something different. Most states do what we do, which is to test cochlear, the inner hair cell function by bouncing these sound waves through, the hair cells react, bounce it back, and the computer at different frequencies, at different loudness records whether or not the cochlea is working properly.

Interviewer: Wow.

Dr. Carey: So if the hearing loss is due purely to the nerve and not necessarily the hearing nerve connected to the cochlea, but purely to the nerve, a child will pass the hearing screen much of the time. So the limitation of our hearing screening, which most states do, this is called an otoacoustic emission. You can see the words, oto, ear, acoustic, the sound. Emission is the hair cells bouncing it back, you know. Most states do otoacoustic emission.

Interviewer: So for one of these parents whose children are identified with one of these hearing issues, what kind of services can the Utah Hearing Center provide?

Dr. Carey: The beneficial aspect of early detection is that you actually get the kids in for treatment and proper education. And the majority of those children will go to a regular class in a regular school. Those that have the most profound degrees of hearing loss, that don't necessarily respond to hearing aids, can go to our outstanding special schools we have throughout the state. They're the schools for children with hearing loss and visual disabilities. They still do say deaf and blind. So those schools have their branches of them throughout the state. They provide for the children that have some of the more moderate to severe, but especially those that have the profound degree that if untreated with something like a cochlear implant, those children would go on to be called deaf.

So deafness is the degree of hearing loss preventing regular communication as you and I would have it in this type of setting so that one would have to learn sign language and then be a part of a very rich community of people with deafness. But on the other hand, would have more challenges with communicating with the rest of society. That particular place we're talking about, that particular situation, just, you know, in the last two decades, in half of my career here at Primary Children's can now be altered dramatically with a cochlear implant so that children with a cochlear implant will usually, with the right rehabilitation and such, will actually go to regular kindergarten.

Interviewer: We're here with Dr. Barbu Gociman, a craniofacial surgeon and the Medical Director of the Cleft Center here at the University of Utah. Dr. Gociman, when does a parent usually find out that their child might have a cleft lip or a cleft palate?

Dr. Gociman: Here in the United States, most cleft lip patients are diagnosed with their condition during pregnancy. So the parents will know that the baby is going to be born with a cleft. By contrast, when the babies have only a cleft palate, usually the diagnosis is not obvious on ultrasound and is not made prior to birth. So the diagnosis is made in the first day of birth.

Interviewer: So what are some of the things that a parent needs to be doing those first few months with their child to make sure that . . . how early are they getting surgeries? What do they need to be doing the first couple months?

Dr. Gociman: Considering what the problems are, as we said, the lip, the gum, the hard and soft palate are involved. One of those structures or all of them, you can imagine the baby will have difficulty with feeding, with suckling. If a cleft lip is present, they cannot create a seal around the nipple. If there is a clefting of the palate, the babies will have a very hard time developing suction. Specialized devices are needed to provide adequate caloric intake, meaning adequate amount of milk or formula to keep with the needs of the newborns.

Interviewer: When does the first surgery usually take place?

Dr. Gociman: For a cleft lip patient, if we assure adequate nutrition, there are no other anomalies associated with the condition, and the baby grows normally, the timing is approximately three months of age. And the reason for that is the baby has grown sufficiently enough to withstand the anesthesia without any additional risk, and all the structures that are involved in the cleft are bigger and stronger, and the operation is performed easier, with less risk of things breaking down or having other complications during the surgical procedure.

Interviewer: What happens during those first three months while you're waiting for the child to get stronger? Who should they be visiting?

Dr. Gociman: Here at the University of Utah, we have an excellent system in place to assure that all the needs of cleft patients are met. For a cleft lip patient, the diagnosis is most of the time made prenatally, so the parents already had a prenatal visit with the nurse coordinator, with the physician assistant in charge of the cleft team, and with the craniofacial surgeon that will perform the repair. So they already have a good idea of what is coming.

Once the baby is born, especially if it's born here, close, at the university hospital, or even at a hospital in close proximity, a cleft surgeon will visit with the family, evaluate the exact anatomy of the cleft, and start with the process of treatment. And this involves two major elements in the first three months of life. One is assuring adequate feeding, and, as I said, there are different modalities through which this is achieved with specialized nipples, specialized bottles, specialized techniques of holding the baby to prevent regurgitation.

And the second thing that is as important is what we called molding. We are trying to achieve normal anatomy. Due to the lack of continuity in the muscles of the lip and the palate, the elements that compose those structures can migrate apart, and the anatomy becomes very difficult to recreate. So in those first three months of life, we attempt to bring all those structures together. We try to reshape the nose, the lip, the alveolus, and the palatal shelves.

Interviewer: Seems like the treatment of cleft lip and cleft palate has more than just the surgical components and just the restructuring. There's also speech. There's also feeding. There's also socialization. What sort of resources are available to a new parent here with the cleft team?

Dr. Gociman: We have a comprehensive cleft team. First, we see the patient right after birth to assure adequate feeding and the molding has been started. And at the same time, we schedule a clinic visit with the cleft team so the family gets a chance to visit with all the members of the team. And each member has an important role in cleft care. So the team is made up of a cleft craniofacial surgeon, an ENT surgeon, pediatric orthodontist, a speech therapist, feeding specialist, and a social worker. So the reason for that is to assure that all the problems encountered in cleft are addressed from the beginning and the family has a complete understanding on all the steps and all the elements that need to be addressed.

As such, the cleft surgeon will talk about a cleft repair, the sequence of different operations based on the particular anatomy of the patient.

The ENT surgeon will talk about hearing. Most cleft babies have a hard time with draining the ears and have significant infections of the middle ears and require tubes early on. Also, they have to assure later on that the speech is adequate, possibly perform speech correction surgeries down the road.

The orthodontist, as I said before, initially will have a very significant role in performing the molding and then, later on, in assuring eruption of the teeth, orthodontic work, and help with any orthodontic operations.

The speech therapist will be there, initially, to help with feeding, assure that the method that is most effective is used, and then, later on, as the speech starts developing, address any problems, involve the patient in speech therapy, and so forth.

Finally, the social worker is there at all steps of cleft care just to address any social problems that may arise, and we have quite a long number of issues that arise in our cleft patients. So it's a very useful component of the team.

Interviewer: So I understand that cleft care can be a long process. It's years and years of treatments and procedures. But it seems like this type of team can really help set a child and their family on the right path and get them started and give them a step up.

Dr. Gociman: It has been shown over and over again that having a cleft team and having a professional cleft team makes all the difference. This is a standard across the United States. We are proud to have the largest, oldest, dare I say, the best team in Utah and in surrounding states. So we are getting patients from all the states around us. We pride ourself with our results, with innovation. We publish a lot. We are actively involved in research. And we are always trying to improve our technique and our results. We are very critical with our results, and we are trying to achieve perfect outcomes every time.

Dr. Gellner: Newborns have a time schedule all their own, and often it does not match what the parents are used to. How and when should new parents try to get their baby on a sleep schedule?

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Dr. Gellner: Newborns have spent their whole existence in a dark space with no agenda except to develop and grow, being fed through the umbilical cord, peeing. That's what amniotic fluid is unborn baby pee. Not pooping and not using their lungs. So when they're born, all of a sudden they've got to adjust and figure out how to eat, breathe, poop, and when to be awake according to our schedules.

Babies can't tell time, so they don't know when they're supposed to be alert, when to sleep, when to eat, and so one of the jobs of a new parent is helping their new little person adjust to the outside world. Sounds easy, right? Just ask any new parent, and they'll tell you it's anything but easy. Babies think that 3:00 a.m. is a great time to be up. They think that daytime naps are good because you as a parent can get so much done while they sleep.

For the first few days of their little lives, new parents will be at the mercy of their babies in terms of time schedules. By about two to four weeks old though, babies should start to develop routines. But you may not be able to get them on a really good sleep schedule until they're two to three months old. That's when they are finishing up a big growth spurt, and their eating and sleeping patterns start to stabilize. They're eating on a more consistent and predictable basis, so they sleep a little better.

The best thing that new parents can do to help babies figure out daytime versus nighttime is to keep everything bright and stimulating and don't insist on everyone being super quiet during the day, and at night keep the lights dim, make all your interactions with your baby as boring as possible and just try to keep everything calm.

Parents should put their babies to bed drowsy but still awake so the baby learns to fall asleep in their own space, and be sure they're on their backs and there's nothing in there bassinet or crib that could suffocate them. I've found sleep sacks were great. They kept my winter babies cozy but let their arms stick out because they hated being swaddled, and then there was nothing else in their bassinet except them. No pillows, no blankets, no stuffed animals, nada. A lot of sleep issues with kids start as they get older. So if you can help your baby establish good sleep habits from a young age, it can prevent a lot of problems later on when they become toddlers.

If your baby has a lot of difficulty with getting on a good sleep schedule, talk to your baby's pediatrician so they can get a better history of what's going on and give you some guidance so you all sleep better.

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Dr. Jones: Getting let down. Getting let-down. The first is a psychological consequence and the second is about breastfeeding. How are they connected? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

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Dr. Jones: There's a world of data that suggest for newborns "Breast is Best." That puts a lot of pressure on new moms to be successful breastfeeders. In the days before formula, a newborn's life depended on a mom's ability to provide breast milk, and a mom's health might already be precarious after what might have been a dangerous delivery. For this reason, many cultures have a time after delivery, several weeks or a month, to allow moms to heal and breastfeed.

Okay. That's all good. But after that in the US of A many moms have to go to work. That means if moms are still going to provide breast milk, that breast pumping pump at work becomes a reality. Now, to provide breast milk, a mom has to be at least moderately well-nourished and well-hydrated. But almost all American moms can accomplish that in the workplace. Then, there's the problem of let-down.

To make milk, moms need to be in reasonable health. They have to be breastfeeding, meaning they have to suckle. When the infant suckles, their nerves on the chest wall and the nipple feed information back to the brain to release the hormone prolactin from the pituitary gland. This hormone helps the breast make milk. But the milk just doesn't come out in a continuous dribble. It's made in the far parts of the breast called the alveoli and collected in tubes or ducts in the breast waiting for, you got it, let-down.

When the infant suckles, nerve fibers in the nipple cause the posterior pituitary to release oxytocin, which stimulates myoepithelial cells. These are little muscular cells to squeeze milk from the milk producing part of the breast called the alveoli so it can drain into the lactiferous ducts and then squeezes the milk down the pipeline to the nipple. It takes less than a minute from the time when the infant begin suckling -- the latent period -- until the milk is secreted -- the let-down. But what happens if the baby isn't there?

You're in your office or you're in the ladies restroom with your breast pump or if you're lucky you have a private room with a lock and an electric outlet and an electric breast pump and a rocking chair. Nice, but you still have to get let-down. Many experienced breastfeeding moms know that just the sound of their baby giving a hungry cry can begin let-down and that could be embarrassing if the baby isn't close and you start to leak through your clothes. However, for new moms, pumping at work let-down can be difficult to get started.

If let-down is a neuroendocrine reflex from the brain, many things can get in the way of timely let-down. Anxiety, pain, embarrassment, stress, stimulants like caffeine and nicotine, too much alcohol gets in a way but a little bit of alcohol might be relaxing, but not in the workplace. Acute fear or anxiety can suppress let-down. The fight or flight mechanism inhibits let-down, as it should if you're running away from tigers or something else.

Many years ago, when I was a young obstetrician back at work shortly after the birth of our son and pumping when I could find the time, my residents gave me as a joke, I think, a pager duct taped to a breast pump. Now, there isn't anything less conducive to let-down in my world than my beeper going off and a disaster happening to some poor laboring woman on labor and delivery. What a let-down.

So what's a new mom at work to do? Some suggestions include bringing a picture of your baby to look at when you're pumping. Bring something like a little t-shirt that smells like your baby with you. Try to get your head in a calm space before you put the breast pump to work. Deep breathing, focused visualization of having your baby at your breast and instead of that pump can be useful. Turning up the vacuum on the breast pump or just pumping harder with the hand pump won't do. The problem is let-down, not suction.

In an effort to increase the success at milk production and future breastfeeding for moms of very premature infants, some research has been illuminating. You can imagine that having a very sick newborn that you've never been able to nurse because they're too little and you're sitting in a pumping room next to the intensive care nursery might not be conducive to let-down.

A paper published in advances in neonatal care took 162 mothers of premature babies who were trying to provide breast milk for their babies and divided them into four groups. One group had standard instructions in a breast pumping room. The other group was taught guided imagery, imagining their babies and imagining themselves in a safe, warm, quite place with their newborns. Another group was given soothing music. And the fourth was given imagery and soothing music.

Women who were taught guided imagery or given soothing music had more output of milk. And the women who had music and guided imagery together has the most milk of all. Now, this wasn't just a little difference. Moms who had the interventions had two to three times more milk than moms who didn't. Mothers who had interventions to decrease stress also had more milk fat, had richer milk in the first days of the study.

So what else is out there? Last year the annual Make the Breast Pump, Not Suck Hackathon -- isn't that a great meeting -- awarded the Technology Frontiers Award to group that were testing out virtual let-down by transforming pumping rooms at work and in public places into a nursery decorated with pictures and videos and sounds of their babies by using a virtual reality headset.

So what do you do? For a new mom committed to breastfeeding and is returning to the workplace or needs to travel away from their baby, what do you do? Practice using your pump at home in your baby's room before you take it to a strange place. Get your head in the right place. This can take time and practice before you're rushing into a pumping place or a bathroom in the airport or your workplace. Get some soothing music and, yes, there are YouTube videos with music and guided imagery and meditation that you can use. You can just power it up on your phone, put in your headphones.

But use these first with your baby so the association can be stronger. Stay well-hydrated. And if you're struggling, get a coach through your hospital nurse lactation specialist or a La Leche League. This is hard, but you can do it. Don't get let down.

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Dr. Gellner: With this being my fifth year of recording, my producers have asked me to do a best of episode with the top five topics I think parents need to know about before bringing their child to their pediatrician. These are concerns that I hear often or ones that really need to be in the spotlight. I'm Dr. Cindy Gellner, and you're listening to my "Five Best Topics" on The Scope.

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Dr. Gellner: It was pretty easy to come up with my top choice -- the poop on poop, everything parents want to know about their kid's poop. It's pretty amazing how obsessed parents are with their kid's poop. Parents have even brought me poopy diapers and sent me pictures of their child's poop wondering what's going on. Babies and kids have developing digestive systems, so their pooping cycles are different from those of us as adults.

For newborns, dyschezia or apparently painful pooping is the norm until they learn how to coordinate all the muscles needed to poop. For breastfed babies, pooping with every feeding or only once a week are both normal. While formula-fed babies can go several times a day to once every three to four days.

Kids who are potty training often get scared of pooping and start holding it in leading to constipation issues. Some kids develop constipation shortly after they turn one, especially if there's a family history of others with constipation.

I see so many kids with constipation, I've actually been given the nickname of the poop whisperer at my office. Not one I choose for myself, but apparently I'm good at fixing constipated kids. The bottom line literally is everyone poops a little differently. If it hurts, if there's blood, if it's rock hard and causing stomach pain, then it's time for your child to be seen.

For number two, I would choose anything mental health related. Most pediatricians will tell you that we are the ones managing anxiety, depression, ADHD, behavior issues, most of the psychiatric issues in kids lately. There are days I see so many patients with behavior or mental health issues that I feel like a child psychiatrist.

Sadly, there's been a notable increase in mental health issues in people of all ages, and there's not been an increase in the number of mental health providers to help manage these issues. While all of us pediatricians are able to address many mental health diagnoses, there are some that are just out of our scope. We aren't counselors or therapists. Many of us cannot manage complex mental health issues, and medication prescriptions can be tricky as there aren't as many options for patients under age 18.

Your pediatrician will be the one that you bring your child to for the initial evaluation. But please understand that we can only help so much and often we need to refer you to a specialist. I always explain it as you wouldn't want your child's psychiatrist to manage your child's asthma. The pediatrician is better at that. In the same way, a child psychiatrist is better for addressing your child's mental health needs if they are beyond what we as pediatricians are trained to do and are comfortable treating.

Number three would be kids and colds. It seems that's my daily special lately. Everyone is coming in coughing, sneezing, not wearing a mask, so I wear mine and look like a duck all day. It's hard when you see little ones coming in and they look miserable and parents are exhausted. And for most of these viruses, all you can do is nasal saline, humidifier, honey if they're over one and lots and lots of TLC.

Parents often bring their kids in wanting something to help make their kids feel better faster, but unfortunately there isn't much out there other than supportive care. Antibiotics won't help unless they have a bacterial infection, like an ear infection or pneumonia. Breathing treatments won't help unless they have asthma. Green boogers don't always mean a sinus infection and pulling at ears doesn't automatically mean an ear infection.

Cold meds aren't safe in kids under age six, and many adult cold medications contain aspirin which aren't safe for anyone under 18. As a parent, I know how frustrating it is and how one would do anything to make their child feel better, but with cold viruses, it's symptom relief only.

Number four would probably need to be any of my Debunking Old Wives' Tales pieces. I spend a good deal of time on these in the office. No, your child can't get a cold because the weather changed or they went outside without a coat. Yes, your child can get their vaccines if they just have a mild virus. No, teething doesn't cause a fever or diarrhea. And yes, a little bleeding when your newborn's umbilical cord is coming off is actually normal and expected. And unfortunately, no, telling your child to eat their carrots won't really improve their eyesight.

Number five would have to be picky eating in toddlers. I get this concern at least once a day. I've had it twice today. Usually at a well-child visit when I asked how a child's eating is and parents tell me they were doing so good and now I can't get him to eat anything, I'll look at the growth curve and show the parents that their child has gained two pounds since I last saw them, and the parents are like, "How can that be? They're not eating?"

Well, kids' metabolisms put the brakes on between one and five. They only gain a few pounds a year during that before they hit their kindergarten growth spurt, so their eating patterns change. Some days they'll eat great. Other days they'll have five Cheerios and call it a day. Some days they will only eat mac and cheese for a whole week, and the next week mac and cheese is the most disgusting food on the planet and they won't go near it. Yep. All normal.

Our kids wouldn't eat well at home, but they did great at daycare or at a restaurant and we decided they just needed an audience to eat. As pediatricians, we're good at tracking your child's growth and if there are any red flags, we'll let you know. Until then the best advice is don't force your child to eat. Limit milk to 24 ounces per day, so they don't fill up on liquids, and make meals a positive experience. And trust that when your kid is hungry, they'll eat.

So those are my top five topics that I think parents need to listen to before rushing to their pediatricians' office. Hopefully, they've been helpful.

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Interviewer: It's time for another listener question and we're here with Dr. Kirtly Parker Jones. Dr. Jones, the question sent in was, "Could my baby be allergic to my breast milk? I've noticed that he's not really absorbing it, he's not really taking it, but he's fine with formula milk."

Dr. Jones: To start at the beginning, babies cannot be allergic to your breast milk.

Interviewer: The answer is just no?

Dr. Jones: The answer is no. However, there are proteins in what you eat that are absorbed into your bloodstream that then come out in the breast milk, and certainly there are flavors in what you eat that come out in the breast milk. In fact, there are flavors of what you eat when you're pregnant that flavor the amniotic fluid, and the baby is already kind of drinking your garlic or your hot sauce, or whatever it might be. The babies will not be allergic to your breast milk. Newborns don't actually form an allergic response. So it takes a while for babies to be able to even form an allergic response.

So, if newborns are throwing up, you start to really worry that maybe they have a problem with their stomach. So sometimes babies actually have a weakness in their stomach that allows the fluid to come back up. So some babies actually have to be fed kind of thickened milk or have to be slept tilted like people who have reflux. So babies can have reflux and newborns can have reflux until they're a little older. So babies can have reflux and that can make them throw up, and it's not they're allergic, it's just that they can't keep the fluid down.

Secondly, there are some babies with congenital malformations that cause a blockage in the esophagus. This is very rare and it's devastating. So there's a blockage in the esophagus and the fluids go down into their lungs. This is called a TE, a tracheoesophageal fistula. Once again, it's the baby that's not actually absorbing because it's going down the wrong way.

Now, let's take babies a little bit older. They actually can be allergic and develop an allergy to things that are in your food, and the most common is milk. So milk proteins in milk, of course, when . . . oh, cow's milk, there is something called casein and this is a protein that a mom might actually have in her blood and that the baby might actually develop an allergy to. That being the case, babies might get a little distended, they might be a little uncomfortable, and sometimes, they may even have a rash around their rear where it's kind of irritating.

Now, what about the baby that seems to be fine with formula and not so well with breast milk? Well then, the questions is, is the baby getting better suckling with the nipple . . . the formula? Is there something in the mother's food that's flavoring her breast milk? Meaning is she eating a lot more garlic, or is she eating spicy things that are getting through and the baby doesn't like the taste? And then the question is, is the mother putting anything on the nipple that the baby doesn't like the taste of? So we put all these lotions on our bodies and women put lotions and Bag Balm, which doesn't really taste very good. Bag Balm is something they put on nipples of cows when the nipples break down with nursing cattle, and so that may not taste very good.

So what are you putting on the skin and the answer is nothing, is the baby actually latching on well? So sometimes the baby has to struggle getting the whole nipple in their mouth, but it's easy to put the nipple from the bottle. There are many cultural norms about what you should and should not eat because of what goes in your breast milk, like don't eat cabbage because it will make your baby bloated. Well, unfortunately, cabbage won't make your baby bloated. It might make you bloated, but not your baby.

Of the things that they worry about, cow's milk is the first and about 2% to 3% of babies might actually be allergic to the cow's milk that their mother has in their food. And if a baby seems like it's not absorbing or is irritated by the breast milk, the question is what is it? And you have to kind of take things away. The top ones are peanut, soy, and cow's milk, but there may be other things. So moms need to eat carefully. The baby may not like garlic in their breast milk. By the way, wine goes right through the breast milk, too, so be careful.

So the long and the short of it is the baby is not allergic to your breast milk, but it can be allergic to what you're eating. There are lots of cultural superstitions about what mom should and shouldn't eat, and what should go in the breast milk. There's not much science, but if you take away one thing at a time and see if the baby does better, you might figure out what it is. And of course, your pediatrician can really help you work this out.

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Dr. Gellner: "Top Five Old Wives' Tales About your Newborns," or, "How to Troubleshoot your Newborn," on today's "Scope." I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do when raising your kids? Find out if it's true or not. This is "Debunking Old Wives' Tales" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Newborns don't come with instruction manuals, so parents often worry when things really are normal. For example, "Excessive crying means something is seriously wrong." Not necessarily. Newborns cry up to two hours a day, sometimes it's because they're hungry, babies have a "nah" cry for this. Sometimes it's because they're wet or their diaper is too tight, or they're stimulated, and babies have a "wah" cry for this. I know, it's pretty cool. I learned that from my lactation consultant.

Or it could be colic, and your pediatrician can help you determine if this is why your baby cries. As the mom of a former colicky baby, I say, "Good luck and good news," it does go away by itself in three to four months. It's making it through the colic period that's tough.

Another concern for parents of girls is that some baby girls have vaginal bleeding. No, your daughter's not going through puberty already. It's actually due to mom's hormones coming out of her system. Little girls get white discharge during the latter part of the first week of life and sometimes it turns blood-tinged. Normally, this goes away in a few days and unless your daughter starts having pubic hair before age eight, you're fine.

Then there's periodic breathing, which freaks a lot of parents out. Babies have this funny way of breathing where they'll sometimes hold their breath and then they'll breathe really fast, and then normal again, and it might seem like an eternity that they're holding their breath, but it's really only seconds. This happens because the part of the brain that controls breathing hasn't fully developed yet. Now, if your baby stops breathing for more than 20 seconds and turns blue, that's not periodic breathing, that's a trip to the ER.

Then there's their bellybutton That scares parents most of all, it seems. Everyone thinks that the yellow goop is an infection, but it's not. It's the remnants of something called Wharton's jelly, which is what makes up the umbilical cord. True infections are very rare. Bleeding is common too. Remember, that's where all the blood vessels were that connected baby to mom. The blood finishes coming out until the cord completely seals itself. If you have any questions about your baby's navel, pediatricians are really good at evaluating cute baby bellies.

Finally, "Yellow drainage from one or both eyes is a serious infection or pink eye." Probably not. It's most likely an infected tear duct. Your baby probably has one eye that waters a lot too. The tear ducts can take awhile to open, so it's easy to get them infected. Antibiotic drops will help with the goopiness, but it will come back until the tear duct itself opens, usually by a year old. Bottom line is, if you have any concerns about your newborn, don't hesitate to ask your pediatrician. Babies are what we do best.

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Dr. Jones: Moms are most likely to experience depression in their mid-30s and 40s. Well, is that because it's the time of life, or is it because they're the moms of teens? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: A recent study of over 2,000 mothers with children from newborns to early adulthood looked at levels of anxiety and depression in these mothers. We all know that post-partum depression is common, affecting about 12% of women who just had a baby. That feeling of being overwhelmed, being inadequate to the job of being a mom. Depression and anxiety is well-described, and clinicians are ever more focused on identifying moms with postpartum depression and helping them get better.

However, what this new study published in the Journal of Developmental Psychology suggests is that moms are more likely to be overwhelmed and depressed when their kids are early teens than when they're newborns. What's going on here and what shall we do about it?

Firstly, being the mom of teens is much harder than being the mom of a healthy newborn, even if it's your first baby. Babies are moderately predictable. Yes, you get sleepless, but usually you have the tools to figure out what the baby needs and get the job done. There is a very significant hormonal shift after giving birth that can upset the emotional applecart for women.

They're vulnerable, but for most women, the combination of increased awareness, social and psychological help and occasionally, some medicine, gets most women over the hump of postpartum blues in about a year. The baby starts to smile and giggle, you feel more comfortable in your role, and things are still pretty well-defined.

But being the mom of a teen is really hard for many women, and at least a baby will give you a full-on genuine smile once a day. There's no guarantee that an early teen will give you a smile once a month, one that isn't a little twisted with a "Gotcha." They're pushing the boundaries of their bonds with their mom, and it isn't very pretty and it isn't very predictable.

The solutions to their own unhappiness isn't found in a simple checklist. Are they doing drugs? Check. Are they having sex? Check. Are they really going evil places in the Internet? Check. Are they being bullied? Check. Will they even talk to you? Check. Mothers with kids this age have the highest level of stress and loneliness of moms of kids at all ages, and the lowest levels of life satisfaction and fulfillment.

The second possibility is that some of the same hormonal re-wiring of the kids' brain is happening in the moms' brains. The study looked at "well-educated" women who probably didn't have their kids when they were 15 and now they're just 30. More likely, first kid at 25 and now they're about 40. And if they're moms of several teens, they're probably in their mid-40s. Their own hormones are less predictable.

Symptoms of women with PMS are often most prevalent and the most severe in women in their late-30s and early-40s. Our own health may be changing and our relationships may be changing. This is a time of significant stress in marital relationships, and that can add to the loneliness. It's totally unfair that our children are going through very significant mental, physical and social changes at the very time that we're going through our own. In fact, for mothers, "the mid-life crisis" is most likely when their kids are in their early teens.

The third possibility is that this is just part of the biopsychosocial phenomenon called the U-shaped curve of happiness. Studies done all over the world, men and women, rich and poor, highly educated and less educated, millions of people studied show that the levels of happiness are relatively high in the late teens and early 20s, lowest in the 40s, and starting to rise up again about 50, and are the highest in the late 60s to 70s.

Is the U-shaped curved with the bottom of the U of happiness coinciding with the time that most of us have early teens? There are many reasons proposed for this, combined with crazy teens, tough marriage, aging parents, perception there is more good years behind us than ahead of us, and physical aging. The U-shaped curve of happiness is the same for men and women, so it can't be blamed on menopause or pre-menopause.

So what's to do? There are lots of blogs, hotlines for new moms. There are movies and pop stars coming out to talk about their postpartum depression, and it's all the rage. But mid-life moms are on their own, and they don't need to be. The answer of mid-life moms who are tweens who struggle, they share the same similarities with those other new moms. Let's get someone to talk to, someone who's there or has been there. Maybe your mom or sister, or maybe not. Be assured that your friends with the kids of the same age are going through the same things.

Get a group, go out to dinner with your tweenie-mom friends. Giggle a little, reach out to them. You know the kids who are in trouble, more trouble than your own. Reach out and help someone else. Get out of your own head and share with others. Just get out, go for a walk, take an exercise class. Best of all, go for a walk with other tweenie-moms. Many moms had a support group called a playgroup when their kids were little. Now, you should invent a tweenie-moms playgroup for moms to go get out and play.

But sometimes, this won't be enough. If you need more help, and there's no shame in asking for it, healthcare professionals know about this mid-life slump and can help. Women in trouble can get better with therapy, and sometimes a medication can help. It is often a hard time for the kids, the partners, the entire family, but remember, in the event of a sudden loss of cabin pressure, put on your own mask first.

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Dr. Gellner: Every parent wonders if their new baby is on track developmentally. I'll tell you five milestones in the first year of life that really matter on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Every milestone is exciting when you have a new little person in your life. Most parents already know about the ones like rolling over and walking. But what about the not-so-subtle milestones that are important?

Eye contact is one of the first milestones you'll notice. Babies usually start looking you in the eye when they are about six to eight weeks old. Your face is going to be what they look at most, so if your baby doesn't make eye contact by their two month well visit, be sure to mention it to your pediatrician so they can take another look.

Another milestone that should come around the same time is the social smile. This isn't the spontaneous smile that happens when your baby passes gas. It's the smile that your baby gives when you smile at your baby and your baby smiles back at you. It's a sign that the vision and social parts of his brain are developing. Your baby should be smiling by three to four months old. If not, it could be a vision problem or a problem attaching to parent figures.

Next is babbling by six months. This is different from cooing that newborns do because it requires babies to figure out how to use their tongue and the front of their mouth to make sounds like da, ba, ga, ma. No, your baby will not say mama or dada and know they are referring to you as parents specifically, although I do get told that a lot. Recognizing you guys and saying mama and dada and meaning mama and dada is closer to nine-month scale.

Be sure to encourage the babbling by talking back to your baby. This is how they learn language skills. If there is no babbling by six months old, your pediatrician may want get your baby's hearing checked again, even if it was normal in the nursery.

Then there is reaching and grabbing, which is followed by babies putting everything they grab directly into their mouths. This is good, actually. It shows curiosity and interest in learning more about their environment and it should be encouraged so your baby can use all their senses. But it also a prime time for childproofing and making sure there are no choking hazards around your baby.

Finally, there is pulling to a stand. This is one of the most important gross motor milestones because it shows the stability and strength of the legs and torso that is needed for walking to start. It also shows that your baby is motivated to move and get something they want. Babies should start doing this around 10 months old and should be walking by 18 months old. If they don't have the ability to do this, then your pediatrician may have them see a physical or occupational therapist to help with this milestone.

We as pediatricians monitor every milestone closely. So if you have any concerns about your baby's milestones, be sure to ask and we can let you know if you need to worry of not

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