Harvey Karp Knows How to Make Babies Happy

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Harvey Karp Knows How to Make Babies Happy

The pediatrician and entrepreneur Harvey Karp is the most famous baby calmer in the world. To new parents, he is something between a sage and a magician, offering insight into the opaque miseries and motivations of the tiny humans newly entrusted to their care. In his multi-decade career as a public figure, across books, videos, blog posts, television appearances, and a baby-sleep-tracking app, Karp projects the affable confidence of a person who knows that he knows more than you do, but is awfully excited to bring you into the light. In 2002, after decades of pediatric practice in Los Angeles, he published the book “The Happiest Baby on the Block,” in which he lays out his “Five S’s” technique (swaddle, side-stomach position, shush, swing, and suck) for soothing infant crying and guiding them to restful sleep. The book has sold in the millions—late last year, when I had a baby, I received no fewer than three copies as gifts, with notes instructing me that it would save my sanity, my physical health, and my marriage. Even parents who haven’t turned directly to Karp for guidance are, to some degree, living in his world: many of his infant-care teachings—including the “Five S’s,” the idea of babies having a “calming reflex,” and the notion that newborns and birthing parents experience a “fourth trimester” after delivery—have become fundamental to the way that infancy is understood in America today. (Karp readily admits that these ideas are not original: swaddling, for example, a technique nearly as old as humanity, had largely fallen out of fashion in European and North American parenting until Karp helped to revive it.)

After the success of “The Happiest Baby on the Block” (and its sequel, which focusses on caring for toddlers), Karp made the jump from media to retail. “What I came to realize,” he told me recently, “is that educating millions and millions of parents every year is a really a hard job.” He began to envision a device that could help parents put his techniques into practice. That device, launched in 2016, was Snoo—just Snoo, no definite article, like a given name—a sleek, ovoid bassinet that rocks and plays white noise at graduated levels in response to a baby’s cries. With its special anchored swaddle, it is, essentially, the physical manifestation of three of Karp’s “Five S’s” (four, if you pop a pacifier in the baby’s mouth). The fifth and missing “S,” “side-stomach position,” is effective for calming an unhappy baby who is awake, but is considered unsafe for sleep. (In late March, the F.D.A. authorized the Snoo bassinet as a medical device, based on its intent to effectively keep babies on their back when sleeping, a position that reduces the risk of sudden infant death syndrome, or SIDS.) The device has skeptics, in large part because of its cost: currently, a Snoo runs sixteen hundred and ninety-five dollars to buy outright, or about a hundred and fifty dollars a month to rent—figures that are arguably at odds with the universal urgency of safe infant sleep. Happiest Baby, Inc., has also been subject to criticism, with a recent Insider investigation painting a picture of a poorly managed workplace where staffers received insufficient training. (“A hatchet job,” Karp said, when I brought up the report.) Still, Snoo’s devotees are passionate and legion. Parenting forums and group chats overflow with odes to the bassinet’s ability to coax hours of extra sleep out of finicky babies using its tech replication of motherly rocking and shushing, and to soothe parental anxieties about infant safety. It seems like every famous person who has had a child in the past seven years has a Snoo in their nursery; allegedly, Beyoncé and Jay-Z own eight.

Karp is seventy-one years old, with a goatee and a boyish flop of chestnut hair. He is retired from medical practice, but remains a fellow of the American Academy of Pediatrics, and is also the C.E.O. of Happiest Baby. He spoke to me, over Zoom, from his home in Los Angeles, about the perils of excessive individualism, the moralization of baby sleep, and why “robot” shouldn’t be a dirty word. (Our interviews have been edited for length and clarity.) At the beginning of our conversation, just as we were getting down to business, he briefly turned the interview around on me.

You yourself are a mom, right?

I am! I had a baby a few months ago.

Do you feel different? Do you feel like it’s been transformative, or do you feel like it’s in the flow of your life?

A little bit of both? I was nervous about having my identity subsumed into parenthood. But, so far, I feel very much like myself—and also I happen to have a baby, which is really nice.

Do you feel like yourself-plus?

That’s a nice way to put it.

That gives me some good context. Thanks.

What kind of context does it give you?

Well, that you are part of the demographic that is interested in this stuff. There’s a science side to this, but there is also a reality-of-life, a sociological point of view that I think having a young child gives you access to. It’s kind of like how, when you walk into a supermarket, if you don’t have a dog, you have no idea where the dog food is. So having an awareness of this parallel slice of life, I think, does give different insights.

Do you think people who aren’t parents ought to be interested in what it’s like to raise a child?

There’s kind of a general fascination with babies—perhaps less so in men, maybe, than in women, but babies are a cute part of the world that we’re in, so I would imagine people have at least a passing interest in the subject. Over all, the baby is an iconic member of our society. And, of course, they are our progeny. They are the next generation that’s going to take care of us. More and more, really, there’s the issue of recognizing that the family is the cultural foundation of the nation. Nations around the world are recognizing, from a demographic point of view, that family relations are a key part of your cultural underpinnings. The birth rate, which we always took for granted, turns out to be important! The future of your nation is dependent upon it being peopled! Throughout the history of humanity, this wasn’t really a concern. After World War Two, you had to repopulate Europe, so to speak, and there was a big emphasis on that. But, for the most part, people had babies, and now, for some reason, people are choosing not to or are delaying having babies.

Is the reason for the declining birth rate really an open question? It seems to me as if there are some pretty clear reasons why it might be slowing down.

It’s complex. Cavemen lived in dangerous times, but they had a lot of babies. Of course, they didn’t have a choice in the matter. They didn’t have birth control, and, for the most part, they couldn’t control that. We now have choice. We have a lot of things distracting us. The list is long. Having a baby is on the list, but there’s also a biological imperative—did you feel that? Did you feel like there was a voice inside of you?

Not at all. But I also didn’t feel negative about it—some people know very clearly, for any number of reasons, that they absolutely do not want to be a parent, but that wasn’t me. I was pretty straightforwardly ambivalent. And now I’m obsessed with my baby. I think she’s the coolest person who’s ever existed.

Sometimes you have a baby and you go, “Oh, my God, I’m just instantly in love. I never knew it could be like this.” Sometimes it isn’t, and you’re, like, “Well, this is nice.” It takes time to fall in love, or to build a relationship. A lot of people do judge themselves if they’re not instantly in love with their baby, but sometimes that relationship takes time to blossom—especially for men. Because you’re used to having a relationship with a someone, and babies don’t become a someone, sometimes, for a number of months. But it’s still faster than you can believe—it’s already happening. The baby is being aware, being reactive, being responsive, following your smile, following your taking turns and talking. These things emerge that signal that this is really a person that you’re having a social relationship with. Sometimes you’re on the river, but it just takes a little time to drift your way through.

Did becoming a father change the way that you thought about this baby-parent relationship?

Well, no. I’m a stepfather; I never had my own biological child. I practiced pediatrics for ten years or so before I got remarried, and my daughter came into my life, and she was seven years old at the time.

So you haven’t lived with a newborn extensively?

That is kind of a funny thing, isn’t it? Maybe I’m a little bit like a priest. I’ve taken care of so many babies, but haven’t exactly had that lived experience. When I became a stepparent, I had already counselled thousands and thousands of parents, so I had some pretty clear ideas. My daughter has her own personality and temperament, and they say that an expert is an authority in their field outside of their own house. So I get plenty of challenges, but it’s a wonderful thing to really participate in the most intimate way in someone’s life, the ups and downs. As a doctor, you’re a voyeur in people’s lives—you are episodically present during severe illness and whatnot, but not on this every-single-day basis. I don’t think my philosophy’s changed at all, but my appreciation for effort has—I’ve learned that it’s harder to carry out things than it is to tell people to carry out things. If you’re doing it right fifty per cent of the time, you’re really successful.

What made you interested in baby sleep, as a subject?

I’ve always been interested in unsolved problems. From 1979 to 1980, between residency and doing a fellowship, I spent a year in pediatric practice. At that time, we would give crying babies burp drops to ease their stomach pain, because the concept we were working with was that babies cry because they have stomach pain, or they have gas. Even the word “colic”—the way we refer to uncontrollable crying—comes from the same ancient Greek root as “colon.” When I went to U.C.L.A. to study child development, I had to do a research project, and I figured I would demonstrate exactly how burp drops reduce crying. At that time, the definition of colic, which had originated in the nineteen-fifties, was the rule of threes: a baby who cried for at least three hours a day, three days a week, for more than three weeks. That’s how we defined colic—but what is colic? It started really making sense to me that, in babies, crying wasn’t actually related to stomach pain, or acid reflux, even though millions of babies were being put on medicine for acid reflux. I learned about the !Kung people, in southern Africa, who could calm their babies much more effectively than Americans could. At the same time, I was working on the child-abuse team, and I was seeing babies who were injured by their parents, some who were literally shaken to death, because their parents couldn’t handle their crying. I became fascinated by this question: How do you calm crying? That kind of led me down the rabbit hole.

What did you find down there?

Babies don’t cry like this when they’re first born. They don’t have colicky crying; they don’t have uncontrolled crying or continuous crying. They’ll cry, but then they calm down when you feed them or hold them. The continual crying of colic didn’t really start until two or three weeks of age. It peaked at six to eight weeks, and then was gone by three or four months.

So that didn’t sound to me like gas—babies still have gas at four months! They’re pooping, they’re farting, they’re spitting up. And, interestingly, premature babies don’t get colic until after their due date. A baby born three months early—they’re pooping, they’re passing gas. But they don’t get colic until they’re three months old. So it was clear that this was developmental.

So what is colic?

It turns out that it’s a series of several different things, for the most part. Maybe five or ten per cent are babies who really do have a medical issue: a stomach problem, acid reflux, or something like that. But, for the most part, it’s a combination of temperament and the environment. Babies are born with different preferences for what calms them down—rocking, shushing, being held.

At the time I was starting to practice, every pediatrician was recommending a magic trick that you could do to soothe crying babies, and, for that matter, to get them to sleep: drive the babies around in the car. Well, driving a car doesn’t do anything for stomach pain. So, as you put the pieces together, it became pretty clear that there was a story there that hadn’t been told yet. Swaddling was known, white noise was known, motion was known. Holding the baby over your shoulder as opposed to lying down in your arms was known. There were a lot of studies, actually, but all the pearls hadn’t been threaded together.

As I went into medical practice, I taught these techniques with my patients. People in my neighborhood would meet each other at the park—someone would watch a mother soothing a baby, and they’d go up to her and say, “Is Karp your pediatrician?” It just worked, and it worked every time—unless the baby was sick, in which case that was helpful information, too. So that led me onto the path of crying. And then sleep is intimately related to crying, because not every baby’s colicky but every baby is a whole mess of sleep issues for new parents. Right?

Right.

We did a survey, many years ago, showing that sleep was the No. 1 stressor for new parents. More than more money, more than more sex, they wanted more sleep. As a society, we’re all getting less sleep than we did fifty years ago. Now we know that leads to billions of dollars of health-care costs, and billions of dollars of employer costs, but for young parents it literally can lead them to the breaking point. Sleep affects marital stress, depression, car accidents, obesity, unsafe sleeping practices, child abuse—so many things that you wouldn’t necessarily connect to it. In general, we think of crying babies as kind of a sitcom punch line, you know? The exhausted parent falling asleep at the red light, or pouring orange juice in their coffee, or brushing their teeth with the sunscreen, or crazy things like that—which is funny, but it turns out it’s actually very serious.

It feels as if it’s only relatively recently that conversations about things like postpartum depression and postpartum psychosis have recognized that sleep is a huge component of parental mental health.

In large part, the psychiatrists taking care of the mental health of women who are taking care of a baby—they’re focussed on medication, and on psychiatric interventions like cognitive behavioral therapy. These are great and important, but I worry that they don’t realize how important it is for parents to learn how to take care of their babies in a way that reduces these stressors.

The way I look at it, taking care of a baby is a three-legged stool: feed the baby successfully, calm their crying successfully, and get them to sleep. The other things—shampooing the hair, taking care of the umbilical cord—they’re not that hard. But, if you fail at feeding, crying, or sleep, you go down a very dark hole. There’s tons of support for feeding babies. There’s a whole infrastructure: formula, La Leche League, lactation consultants. But there used to be no information about calming crying, or about getting sleep. In fact, what we used to tell everyone was “There’s nothing you can do. Just suck it up and deal with it.” We had blinders on, and those blinders were leading to a lot of stress, and literally to illness and death in some families.

We believed the lie—just like parents today believe the lie—that the quote-unquote normal family is parents and a child. In fact, that is the most abnormal family in the world. The only normal family is extended family, with your grandmother, your aunt, your sister, your next-door neighbor. Today, if you have a nanny, you’re well off, but everyone should have five nannies—an extended family, a community. You don’t really think about that when you move to New York City, and you have a professional life, and then you have a baby and you go, “Oh, so that’s why people live in a duplex.”

There seems to be something quite American—or maybe Western, in general—about the way that we’ve tried to fit parenthood into the same kind of intensely individualist, almost isolated way of thinking about ourselves and our society.

There’s another part of it, too: even though we’re very well educated, we don’t all have that experience with taking care of babies early in life, which a lot of times plants the seed. Well-educated people think that they are going to master things by mastering information. With babies, there’s some information, but most of it is really “Groundhog Day,” right? Wash, rinse, repeat. If you’re successful at that, you feel smart and competent. If you’re struggling with that, you feel like everyone else knows what they’re doing and you’re the only incompetent person in the world, because you feel like it’s supposed to be intuitive that you do these things.

It turns out it’s not intuitive. Love is intuitive, the attachment’s intuitive, but the skills are skills! And, when you don’t know from your own personal experience, that’s when you’re subject to the crossfire of ideological polarity, and you have to decide how you’re going to raise your baby. Choice has undermined so many sociological structures. If you just are going to follow your religion, or be with your group and do what everybody else does—in a way, that’s constricting, but, in a way, it’s also simplifying. If you’re just going to send your child to the local school, that’s easy. But if you’re choosing among eight schools, if you’re stressing about applying early enough, all these choices—it’s much more stressful.

How much of this issue of choice is a product of affluence?

To a certain point, when you’re forced to make choices, life is a little easier, yes, and people who don’t have means have fewer choices. With Snoo, for example, when we started the company, the goal was always that everyone gets a Snoo. People said, “Well, that’s just a fancy baby bed. It’s for celebrities,” and stuff like that, because when you have new technology, it’s expensive. But we built Snoo so that it could be reused over and over and over again. Now we have thousands of parents getting it for free from their employers, and we’re now in conversation with with state agencies to get it accessible to folks on Medicaid. We think of it kind of like the breast pump: it’s a tool you need. So at least that’s one of the choices we’re hoping to remove from applying only to affluent people.

I feel like I should admit that I bought my Snoo secondhand.

It’s interesting, from a company point of view, because it has actually worked really well for us that people lend the bed, sell the bed on, things like that. We built it to be very robust. Though we don’t get any revenue from that, and, ultimately, our company can’t exist without being able to get revenue.

I did buy a bunch of your swaddles.

Oh, there you go. All right. That’s a help. But, in truth, that never really was a concern for us. Our focus is getting Snoo adopted by third-party payers—ultimately, we want insurance companies paying for this. That’s why we launched the rental model, so that we can use each bed over and over and over again. It is a need, a cultural need, for people to have help to reduce crying and increase sleep.

Though, actually, it’s even more than that—there are two cultural shifts that we’re trying to bring people’s awareness to. One is safety. You would never drive three minutes in the car without putting your child in a car seat, would you? You’re not going to get into a car accident, but you still wouldn’t take that chance. You wouldn’t perch your baby on the front seat of your car and say, “Oh, I’m just going out to Target. It’s just a super-quick trip.” It would be against the law.

The No. 1 place babies die is in their own beds. The way they die, for the most part, is they roll over and they get their face in a blanket, or they get their face in the mattress. You wake up, and your baby is dead, from suffocation and/or what we call SIDS—sudden infant death syndrome. It turns out, when you’re on your chest, your brain doesn’t remember how to breathe as well. It isn’t just suffocation. There are other aspects of neurological awareness that are reduced when you’re on the stomach, compared with being on the back. Thirty-five hundred babies die every year of infant sleep death, which is more than the number of people who died in 9/11. There’s been virtually no improvement in that number for twenty years.

There was a change, wasn’t there, in the way that babies were recommended to sleep? Parents had been told to position babies on their stomachs, and the guidance changed to putting them on their backs.

That was in 1994, and it changed things radically. Between ’94 and the year 2000, the incidence of these deaths went from about five thousand a year to under four thousand a year. It was massive. We pediatricians, we thought, Done deal! We said, “And breast-feed, and don’t smoke cigarettes, and get your vaccinations, and room-share, and don’t have bulky bedding in with the baby.” We thought, Another five, ten years, the numbers will keep going down, and this will be done. But, over the past twenty-two years, there’s been no change. The C.D.C. just last month came out with a new report showing no improvement from 2015 to 2020. Infant mortality over all is at its lowest ever. And yet SUID—sudden unexpected infant death, which includes SIDS, suffocation, and accidental strangulation—has had no change from the year 2000.

Well, why is that? The answer, bizarrely, is because sleeping on your back is not the way that babies like to sleep. If you ask babies, “Who wants to sleep on your back in total darkness and total silence for fourteen hours a day?” they say no! They say, “I want to be in your arms. I want to be held. I want to be cozy. I want to be cuddled.” That’s how babies are happy. So the whole idea of the ABCs of safe sleep, which stands for Alone on your Back in a Crib—well, for sure, the back is the only safe position, but they wake themselves up, they get disturbed. What’s happened, to explain this plateau, is we see that, since 2000, bed sharing has increased. Other unsafe sleeping practices have also made no improvement: people still put their babies to sleep on the stomach. They go, “Listen, my baby likes it.” Or, “I don’t know what else to do. I’m dying here out of being awakened every hour at night.”

People pay a lot of attention to the ways a Snoo improves baby sleep, but that part is not really surprising. We’re also seeing that it isn’t just for sleep use. Studies have shown that if you feed babies but you don’t pick them up, their brains don’t develop normally. Babies need more than milk. If you hold premature babies skin to skin for an hour or two a day, it improves their weight gain and their physiologic stability. For babies born in withdrawal from opiates, hospitals have cuddler programs, where volunteers come in to hold and rock the babies, and it improves the outcomes. If an hour a day works, what could happen if you rock and shush that baby twelve hours a day? Would that have additional benefits? We don’t really know the answer to that, but it’s a reasonable hypothesis. This is the second thing I’m hoping to shift opinion about: the idea that babies need rhythmic holding and rocking and shushing just as much as they need calories.

How important is it that the cuddler be a human, though? There’s something a little uncanny to me about the idea of thinking of Snoo as a robot caregiver.

Well, ask your baby. What does your baby think? Your point is a bit irrelevant. It’s not that you shouldn’t hold your baby—you should hold your baby as much as you can. But, honestly, mothers really don’t hold their babies very much in other cultures. Grandmother does. The older sister does. The next-door neighbor’s older daughter. It does take a village, and it’s a big lie in our culture that the mother should be, for twenty-four hours a day, the only support of that type of rhythmic stimulation. It’s not realistic. From a baby’s point of view, should the baby be deprived of rocking and shushing because you’re asleep, or you’re busy with your three-year-old, or you’re helping your seven-year-old with homework? Snoo is just another tool. You’re not a better housekeeper if you don’t use a vacuum cleaner or a food processor.

That word, “robot”—it’s kind of a problematic word. No one wants to put their baby in the care of a robot. “Robot” comes from a Slavic word, rab, meaning “slave.” Robots are, basically, machines doing human activities, whether it’s picking and packing in a warehouse or a Roomba figuring out the layout of your house to vacuum your floors. It’s humanlike behavior. The real stressor in modern families is that they don’t have extended families. From that point of view, Snoo is trying to be a Band-Aid, a little bit of a help to families when they’re sleeping, when they’re otherwise too busy to meet the baby’s needs. It’s designed to help the parents expand their capabilities.

It all seems to be making up for losing that village.

One thousand per cent. That is the metaphor. Though there were problems with that, also—that isn’t an ideal world, it isn’t a utopia. Everyone knowing your business and everyone giving you their opinions and whatnot, and you have to deal with surly family members. But when you’re raising children—there’s a psychiatrist, Bruce Perry, who does this thing, which is looking at the number of relationships that a young child has. If it’s a single parent and a single child, how many relationships are possible for that child to have? Two: their relationship with themselves, and their relationship with the parent. That’s pretty much it. If there are two parents and two children, now you actually have one parent and the child, two parents and the child, two parents and the two children, the child and the other child, the child by themselves. Suddenly, you’ve increased it by a factorial relationship. And so if you have cousins and the next-door neighbors, and you’ve got a dog and a cat, suddenly you see this very rich social environment as opposed to, really, a social poverty.

And having these relationships builds resilience?

It builds an understanding of human complexity so that you can have social relations. Preschool is a perfect example. Parents go, “But I don’t want to put my kid in preschool. That’s like farming out the job of raising them. I’m the most important person in their life.” Actually, no. You are, of course, the most important person in their life, but you’re also, at a certain point, yesterday’s fish.

They love you, but they see a couple of three-year-olds, and suddenly it’s, like, “See ya, Mom,” and they’re gone, because that is much more interesting from a social point of view. Parents are very, very important, but getting social exposure is super important. It’s just like learning languages: the brain is built to learn social relations, but if you don’t feed it that opportunity it’s more likely to be stunted, especially depending on the temperament of the child.

My joke is that I’m half pediatrician, half grandmother, because a lot of the things I teach [are things] you shouldn’t be asking your doctor. Your grandmother should teach you that. Snoo is a scientific advance, but it’s really one of the oldest forms of parenting: holding and rocking babies. So, from that point of view, we are re-creating the village, a quasi-village, if you will, to support parents.

Photograph by Graeme Mitchell / Redux

“I was retired when we launched Snoo,”  Karp says. “I’m an academic; my joy is in science. I’m not a business-builder; I’m not the guy who always wanted to have a startup.”

What was it about the postwar era that made doctors and parents say, “We’re done with swaddles. We’re done with rocking. Let’s treat the baby like a tiny adult”?

It actually shifted much earlier than that. Swaddling was the routine way of caring for babies in all cultures, but in Western civilization it stopped in the seventeen-hundreds. This was for a few reasons. One, it was the period of the Enlightenment. Rousseau was talking about natural development, and we looked at this ancient practice of swaddling and said, “Human beings shouldn’t be born into bondage. Why are we shackling our babies?” Also, it was a time of scientific revolution. People had been wrapping babies for all sorts of reasons, including based on a fear that, if you didn’t, they were going to pluck out their own eyeballs, and dislocate their shoulders, and do all sorts of terrible things to themselves. Scientists in this era said, “Well, what if you don’t swaddle a baby?” And it turns out they didn’t pluck out their eyeballs, and they didn’t dislocate their shoulders. So scientists declared the necessity of swaddling an old wives’ tale, and not scientifically based.

Then a new scientific discovery came along that really took away any need to swaddle babies. That was the discovery of opium.

Oh, shit.

Your baby’s crying? No need to swaddle. Just give opium! Opium was sold in drugstores, not just in Europe but all across America. When I was training at Albert Einstein, in the nineteen-seventies, I was taught how to prescribe it for the medical treatment of crying babies. It was called paregoric, or tincture of opium. It puts them to sleep; it gets them to stop crying. And, unfortunately, some babies died when they overdosed on it.

Anyway, all through the early nineteen-hundreds, people said, “Don’t cuddle your babies—you have to show tough love. Don’t make them dependent on you—you want independence, and they need to learn to self-soothe.” There was so much reinforcing of this messaging of letting babies cry. But the truth was, we weren’t even thinking about babies. We were thinking about what we thought was right and wrong, and not really observing what babies needed.

One of the things I’ve found most surprising about parenthood is how much the baby really does tell me what she needs. And that my job, as a parent, is basically to learn how to understand her language.

So true. People tell us that, with Snoo, it helps them in a very binary way to understand what their baby needs. If it calms the baby, then they’re not hungry, and they’re not in pain, and they’re O.K. If Snoo doesn’t calm the crying in thirty or forty seconds, O.K., it’s the parents’ turn. I like to joke that having a Snoo doesn’t mean you can go away for the weekend. It’s not a substitute for parents. It’s a helper.

Newborn care seems especially fertile ground for trends and fads. There was the era of cry-it-out sleep training, and a backlash to that, and now a backlash to the backlash. I was given your book as a gift, and I was also given three other surefire-cure baby-sleep books, most of which give contradictory advice.

It’s our value system. When you’re pregnant, the first question they ask you is “When are you due?” When you have the baby, the first question they ask you is “Boy or girl?” Once you’re home with the baby, the first question they ask you is “How’s the baby sleeping?” If you can say, “My baby’s a great sleeper,” you feel proud of yourself, you feel like you’re accomplished. If your baby’s not sleeping well, you feel like you’re deficient. It’s literally torture—I don’t know if you know this, but we train our Navy SEALs for torture by playing the sound of crying babies over loudspeakers. They do it at Guantánamo to stress out the prisoners: sleep deprivation and the sound of screaming babies. It goes deep into our neurology. Parents are desperate for help. Especially when you follow the rules, and the rules are wrong. The mother’s desperate for help; the father’s desperate for help. You’re subject to all of these crosscurrents of “Bed-share, don’t bed-share.” “Don’t let them cry it out, let them cry it out.”

These things are all born out of misunderstanding babies. If you just ask a baby, they’ll tell you: “Hold me and rock me. That’s how I want to sleep.” Then the problem is that, if you always hold and rock your baby to sleep, when the baby wakes up in the middle of the night, they go, “Where did you go? Come back! Hold me and rock me!” One of the things that Snoo accomplishes is you’re always there to rock your baby throughout the night.

Or, at least, Snoo is there.

Well, that’s what I mean: Snoo is your ambassador. You’re delegating it to Snoo to be kind of a smart swing. From your baby’s point of view, they’d say, “Of course, I’d rather have my mother holding me. That’s obvious, but this is not a bad second fiddle.” Most babies tolerate that pretty well.

It seems that there’s this moral element which is applied to how well your baby sleeps. If you are a good mother, you’ll be rewarded with a baby who sleeps well, and, if you have a baby who sleeps poorly, that reflects poorly on you: you’re not doing the right things, you’re not trying hard enough, you haven’t bought the right Instagram classes, or whatever it might be. Obviously, it’s not a moral issue. Babies are babies, and parents try as hard as they can. You’re shaking your head.

I would say it’s our culture. Our culture has a lot of moralistic threads going through it. In the nineteen-sixties and even the nineteen-fifties, people weren’t breast-feeding—they thought it was dirty, unsafe, and animalistic. And then these innovators came along saying, “No, no, no, breast-feeding is safer for your baby than milk that’s manufactured in a factory.” Maybe because of who they were—these sort of granola, Birkenstock-wearing, back-to-nature folks, who were part of this counterculture to the existing culture of “better living through chemistry” and nuclear weapons and all of that kind of stuff—breast-feeding became a culture war. That then encouraged scientific study, and, after thirty or forty years of scientific study, breast-feeding became the standard. And then we realized that you can go too far—so, instead of “breast is best,” we moved to “fed is best,” because women felt so criticized and judged. The goal, of course, was never to make people feel bad about themselves. It was to encourage people, to give people the skills and the support that they needed to successfully breast-feed. And if you couldn’t do that, or if you choose not to for whatever reason, of course you shouldn’t feel bad about yourself.

One of the reasons I first came to Los Angeles was to study with Dr. Barbara Korsch, whose specialty was doctor-patient communication. I was really interested in that question of what makes you a healer. What makes you a competent doctor? How do you influence people in a positive way? One of Dr. Korsch’s big lessons was that you’re not going to succeed at anything, as a doctor, unless you address people’s real concerns. That’s a big issue when it comes to vaccination, for example. You can’t just say, “Babies need this, or they’re going to die, and it’s your responsibility to do it.” It’s true, but it’s not necessarily going to win the argument—not until you really respectfully understand where people are coming from and then try to work with them in terms of their ideological point of view. For me, that was the most fun part of pediatrics: every child is different, every family is different.

It sounds like having two patients. You have the child, but you also have the parent, and both in different ways need care.

And the parents much more than the child, for the most part, especially during those first six, seven years. The parent is the conduit. The parents are the bridge, and they are part of the treatment team.

Was there a point for you, as a young doctor, when you felt, like, O.K., I understand babies now?

In my training as a child developmentalist at U.C.L.A., one of the earliest assignments I had was to just sit in the nursery at the hospital and watch babies: What do they do? How do they go through these cycles? I would pick the baby up, feed the baby, and then also do a neurological examination on the baby and learn how they respond. I spent many, many, many hours doing something that might sound boring, but it’s kind of fascinating—to watch these little creatures, and see how they respond to the different lights and sounds and sensations around them, and to their own internal sensations.

Well before Snoo, and well before the “Happiest Baby” book and the “Happiest Toddler” book, my real dedication—my avocation, almost—was in environmental health. During my college years, I was a strike leader, I helped to lead the first Earth Day celebration that we had, and things like that. It’s another one of these commonsense things: it was so obvious to me that we needed to pay more attention to the degradation of the environment. There was the big hole in the ozone that was occurring, and what were we going to do about that? The Cuyahoga River was burning for weeks. Air pollution was terrible. I got really interested in environmental issues, and that became a through line for me. It really is kind of parallel to taking care of babies, because it’s just such basic common sense and so foundational to our lives. I think that the baby stuff kind of fit for me, because it really is very ecological.

I suppose in both areas it’s about understanding that the future exists, that things we do now have later effects.

It’s also kind of merging new science with ancient wisdom, which has always been interesting to me. My mother wanted me to do meditation. She was a big proponent of yoga, of organic food, and things like that. She had had a heart attack when she was in her forties, so we were very careful about the diet we ate. I think the environmental issues are the same thing, and babies are the same thing. There’s a lot of ancient wisdom, but here we also have this tool: we can use modern scientific principles to be able to deliver ancient types of stimuli to babies.

There’s been some pushback to this idea of, basically, medicalizing or technologizing these practices which were almost wiped out in the first place through medicalization. Though, at the same time, a lot of what I’ve seen in parenting forums and on social media about “decolonizing” infant care is often a gateway to practices such as free birthing and bed sharing, which can be very dangerous. How do you thread that needle?

I think that’s just a dilemma we have in life, period. Who do we believe, and why do we believe it? It’s a mixture of ideology and proof. As a pediatrician, my job for decades was to meet parents where they were, and to try to help them make decisions within their own specific ideology. Every parent’s different. That’s one of the things that’s fun about parenting: you get to choose. It’s daunting as well, because you may have no basis for making a choice, and you’re struggling to get the right information.

You were known as a pediatrician to the stars—your patients have been reported to include people such as Madonna, Pierce Brosnan, and Michelle Pfeiffer—and now you’re a celebrity in your own right. Did you have an ambition to become famous?

In Los Angeles, you’re right, there are a lot of celebrities. Most pediatricians have some celebrities in their practice, but I had many, many more patients who were on government support. I saw patients on Medicaid, I made home visits, I took care of everyday workers, I took care of teen parents. This concept of being a celebrity doctor really misses the point. I really never had an interest in being a public figure. I had an interest in right and wrong, and in helping people. And, I guess, I’m an impatient person, and seeing that there were these incredible truths that people were not being exposed to—the “Five S’s,” the calming reflex, the fourth trimester—I wanted to do something about that.

Do you find it challenging to balance your priorities as a physician with those as the head of a billion-dollar company?

No, not at all. I turned seventy-one last year. I was retired when we launched Snoo—I was writing books and lecturing. I’m an academic; my joy is in science. I’m not a business-builder; I’m not the guy who always wanted to have a startup. We kind of came into this against our will, because there’s no university, there is no governmental program that is really succeeding at reducing the risks of infant death. None that are succeeding at reducing child abuse, or postpartum depression. These are terrible, terrible calamities that are befalling families. I know it sounds odd to say this, but I feel like I’m the only person who is paying attention to these things. There are many, many people, of course, who are paying attention, but they’re missing an important part of the puzzle that I’m trying to get across. Ultimately, we have investors, and we have to be profitable for the investors and whatnot, but that’s not at all the motivation. It never was. ♦

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