Questions From an Expecting Parent Part 1 Featuring Ari O'Donovan and pediatrician Dr. Ryan Hassan

During the first part of the conversation, Ari shares her questions as a soon-to-be parent, and Ryan answers them as our resident pediatrician. So, if you are expecting or are a new parent yourself, join us as we work through the many questions we have right before parenthood begins.

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Our Host

Ari O’Donovan

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Transcript:

Ari O'Donovan: (00:00)
Are y'all comfortable? We hope wherever you're listening to this, you're comfortable. This show is for the Bipoc communities in Oregon, hosted by a black woman about the amazing work we do every day in this state. So let's build together, connect with our communities, add some laughter and humor even when it's a difficult conversation. Let's boost our voices.

Dr. Ryan Hassan: (00:25)
Not always. And my baby is a perfect example. Olivia was preterm and she's always been very small, and she wanted to sleep, I think, up to six hours at a time when she was only a few weeks old. And we talked about that together and with our pediatrician, and we're like, well, you know, let's give it a try and see how she does with that. But she wasn't gaining weight with that, and, and she wasn't eating as well. So we said, okay, well this isn't working. We're gonna have to keep waking her up to feed her more frequently.

Ari O'Donovan: (01:02)
Welcome back y'all, to a brand new episode of boosting our Voices. I have Dr. Ryan Hassan here He is Boost Oregon's Medical Director and a practicing pediatrician. And as you all know, I am your host and Boost Oregon's Diversity Program Director. Ryan, for those who don't know you, can you share a little bit more about yourself?

Dr. Ryan Hassan: (01:25)
I'm Ryan. I'm a, uh, pediatrician in Clackamas, Oregon and work with Boost Oregon to create a lot of our educational materials and provider training and, uh, vaccine education, um, handouts and such. And this, this podcast from time to time.

Ari O'Donovan: (01:41)
Yes, he does a lot of great stuff working with us. And today's episode is really, really special. I am pregnant with my very first child and I'm due . It's very exciting. I'm due on February 1st, which isn't that far away. So I have all these questions swirling around in my head. I've taken some parenting classes, but there's always more questions. And I know there's a lot of other families that are in the same boat. They've never had a baby, and they're wondering, how do you do this? I saw a meme not too long ago that was talking about, are you really gonna let me take this new human home from the hospital?

Dr. Ryan Hassan: (02:24)
,

Ari O'Donovan: (02:24)
Please don't me do that. .

Dr. Ryan Hassan: (02:26)
It is a wild thing and I think it's a really great meme because I saw it too when we were going home with Liv. 'cause it's exactly how everyone feels. Like no one feels prepared because no one is prepared. You can't be prepared to be a parent. You have to just do it . It's a wild experience. I think it's a really good idea to just kind of go through what to expect. And you've prepared a list of questions. We'll just kind of see what, uh, you are worried about or wanna know about, and we can just kind of talk through 'em. And again, these are things that I have patients ask me all the time. So I think it, it's be helpful for, for people who want to, you know, get some of their concerns answered. And just to know like, you know, you're not alone. Like everyone, any pregnant person listening to this will have at least several of the questions that you have and say, oh wow, I guess there are other people who wonder about this.

Ari O'Donovan: (03:14)
Yeah, that's the thing for me right there. It's so nice to know that I'm not alone and I wanna make sure other families know you're not alone either . So we can get right into it. Ryan, I'll start with my very first question. Now, when you have a new baby, they're not gonna have teeth. So you might think, well, you don't really have to take care of any teeth brushing if there's no teeth. But is there any oral hygiene for babies and newborns?

Dr. Ryan Hassan: (03:46)
Uh, generally, no. You don't actually need to do anything before there's teeth. You don't really need to do any kind of brushing or anything. But once your baby gets their first tooth, it's important to brush, you know, it's recommended to brush twice a day. Once they get two teeth next to each other, it's recommended to floss today. And it's also important to know that most places in Oregon don't have fluoride in the water. And because of that, we have much higher rates of cavities than, for example, Texas, where I grew up, where we do have fluoride. So important to know and make sure that when you're, um, one, that when you brush the toothpaste you use has, has fluoride in it. You just use a small amount of it. Um, and two, you use fluoride drops once a day, once your baby's teeth come in. Now, that hopefully won't be relevant for you for a while, but, you know, you said they won't have any teeth when they're born. That's actually not always true. There are sometimes kiddos born with a tooth. And one instance I saw a kiddo who was born with two teeth, which is quite unfortunate for parents who want to breastfeed, but it does happen on rare occasions. So as soon as those first teeth come in is when you need to brush. Before that, no, you don't really need to worry.

Ari O'Donovan: (04:52)
I had no idea that some babies are actually born with teeth. So .

Dr. Ryan Hassan: (04:58)
Yeah, that's, that's

Ari O'Donovan: (04:59)
A little wild. And then I have another question, just bouncing off of that, Ryan, if you are breastfeeding, regardless of if the baby has teeth or not, do babies tend to bite down? Often?

Dr. Ryan Hassan: (05:14)
It depends on the baby, but I will say in general, breastfeeding is very challenging. It does not come as naturally as we often think it should. And it can take quite a while to really get the hang of it. Now, most parents who want to breastfeed will be able to do so. It's certainly not necessarily gonna be easy. Some kiddos will get to it real quickly and supply is great and your anatomy might be perfect and that that will make it very easy. But other times there's challenges and very frequently kiddos might take a while to learn how to latch. It might be really painful if kids do bite a lot or are gumming a lot. Or if you're just not able to get a good, good latch, usually it takes up to, you know, one to four days for milk to actually come in and it can take a few weeks before you really feel like you're get the hang of it and you're in the flow of things.

Dr. Ryan Hassan: (06:05)
And it feels like, uh, it, it seems more intuitive. So I always try to make sure people are aware. You know, it, it might be easy, but it'll probably be a little challenging and it's not something that we're anyone should be expected to do alone. So definitely ask for help. Lactation resources are incredibly helpful for this and definitely take advantage of those if you can. You know, most of the hospitals in the metro area will have lactation providers available that you can follow up with during the hospital visit. And afterwards I would certainly encourage it. But yeah, it's, it's certainly not something that is not a one person job. It requires some help and expertise from people who've done it and been there and kind of know a little more than nuance. But I think the other thing to say about it is, there was a study I saw years ago that said about half of women will think that they don't have enough breast milk, that they don't produce enough.

Dr. Ryan Hassan: (06:53)
But in reality, almost all women do. It's, uh, it's very uncommon for you to actually not make enough milk for your baby, but it's very common to feel like you're not making enough milk. And that's really true, regardless if you're breastfeeding or not, it's very common to just feel like your baby's not getting enough food. And I have that a concern brought up to me often because it's just, I think it's a natural inclination that we have to feel like, oh, our babies need more food. They have to get as much as they can because, you know, the alternative is that they, you know, don't get enough and they starve. And that's terrifying to all of us. So even babies who are super chunky and growing really well and eating awesome amounts, parents will still feel a little worried about it. So expect to be nervous about that and expect it to be a little challenging. But it will, it will almost certainly go just fine. Anyway.

Ari O'Donovan: (07:39)
That's really good to know. 'cause I can tell you right now, I'll, I'll be one of those people like I, I don't think there's enough milk. Uh, someone help me .

Dr. Ryan Hassan: (07:49)
Yeah, it's a hard thing. 'cause then you, you, you know, your, your psychology influences your milk supply too. So if you start worrying that you're not making enough milk, your milk supply will drop and that'll make you more nervous and it'll drop more. And so that really can be a struggle and that, you know, it'll happen, you know, pretty much no matter what you do, there's gonna be times where it goes down and goes back up again. Your supply and, you know, it's, it's part of the natural course. One thing that really helped us was one of our, um, our lactation specialist who we worked with, she had said something at one point that when my wife was wearing, she wasn't making enough, she said, Hey, you know what? Worst case scenario, you don't make enough for a little bit. That's, you have formula. You know, your baby's not gonna starve.

Dr. Ryan Hassan: (08:28)
And that really helped a lot because just knowing that like, yeah, well that is an option. So it's okay. Like, it's not the end of the world if I don't make enough milk. That I think is really reassuring. And after we heard that her supply went up because she was just so much less worried about it. That's just helpful to bear in mind, assuming, of course there's not another formula shortage. We were formula feeding during that time and that was a, a stressful, uh, moment. Uh, you may remember I wrote, I wrote a, a blog post about that even

Ari O'Donovan: (08:54)
I do remember, remember that. And that was, that was crazy. And , I'm so glad that that isn't happening now. And I'm glad that you and your wife were able to navigate through that without losing your minds and being able to calm down and relax and know that there will be enough milk .

Dr. Ryan Hassan: (09:12)
Yeah, well, you know, also, we were very lucky. I mean, I had my mother-in-law was able to send us some from Texas. But that's what inspired me to write that blog post is that there's just some families who that's not an option for, you know, and for me, it really showed us like how connected we really are. You know, like we rely on so many of these intricate systems that we have no understanding or control over. And, you know, just a very basic thing like the formula supply, you know, there's nothing we can do about the fact that there was no formula. Not on an individual level. We can certainly organize and advocate for better public health policy and infrastructure. But, you know, I think for me it was a good reminder that like we really are stuck with each other whether we like it or not. And we really need to appreciate that. You know, you can't just say, oh, I'm just gonna take care of myself. No one can. That's not possible in the world we've created now.

Ari O'Donovan: (10:03)
That's so true. We really are in this together. Whether people wanna acknowledge that for better or for worse, we really are

Dr. Ryan Hassan: (10:11)
. Yeah. That's what I tell every new parent too, is, you know, you, you cannot raise a child by yourself like humans. Were not meant to raise children, you know, with one or two adults. Like, it really does take a village. And of course many of us, my family included, often have to make do with just one or two adults. But I think it's important just to remember, you know, we really do need that community and I tell everyone they should ask for help, which that would be my unsolicited advice to you now is, you know, definitely ask for help. You know, for me of course. But you know, for family and friends, anyone who, who is available, you know, for my wife, my brother also, you know, it was a little hard for them to kind of get used to asking for help. They felt like it was a burden on others and they wanted to take care of things themselves and they didn't wanna rely on others.

Dr. Ryan Hassan: (10:56)
And I have had patients who've expressed the same to me. And the way I think about it, you know, is if I had a friend or loved one who needed something, I would feel bad if they didn't come to me and ask for help that I could give them. And on the other hand, if they did ask for help and I was able to do so, I would feel great. I'd be like, wow, I'm, I feel so happy I was able to help 'em out. So you're not burdening people when you ask for help. You are doing a kindness by allowing them to be kind to you. 'cause, and I think that that is a perspective I try to keep and I think it helps a lot just remembering, you know, we aren't a burden on the people we care about and who care about us.

Ari O'Donovan: (11:32)
Absolutely. That's one of the most, if not the most important topic to be covered during this entire episode because society will make you feel like it's your baby. It's your responsibility. Mm-Hmm. , it's nobody else's problem. You chose to have this baby 100% your responsibility and you really do have to get comfortable with asking people that you trust for help. Yeah. You just, you need to do that.

Dr. Ryan Hassan: (11:59)
Yeah. I, I completely agree. And it, you know, it's, we all have a responsibility to take care of each other and especially of our children. And you're exactly right. There's this notion that, you know, parents are in charge of and responsible for everything and every health outcome is their fault. This is, I don't know if we've touched on this before on the podcast, but I know we've, we've spoken of it before, is this is a big reason why there's so much vaccine hesitancy is because we have created a culture where parents feel like every single health, really every decision they make is completely on them and could have lifelong consequences. So every decision, even something as simple as, you know, following your provider's recommendations to get a vaccine could potentially have lifelong consequences. And it becomes much more scary to make any choice at all. It's tough, but the reality is we're not responsible or in charge of, or in control of most of our health outcomes and we cannot do any of this on our own. And we do really need to take ownership of our broader society and our, our responsibilities to help each other.

Ari O'Donovan: (13:03)
Absolutely. I agree with you, Ryan. That's why I wanted to do this episode so I can get some help and ask some questions. Somebody know what they're doing. .

Dr. Ryan Hassan: (13:13)
Yeah, let's get back to your questions. I've been meandering for a little bit here,

Ari O'Donovan: (13:16)
. These are great conversations though, so I love it. Okay, I'm gonna keep going on the whole breastfeeding thing. There's no rhyme or reason to where my questions are in order, but I'll ask now. I have heard so far that if you are going to breastfeed a newborn, they should be fed between every two to three hours. Mm-Hmm. . If your baby is sleeping and it's getting past the two hour mark or the three hour mark, should you wake them?

Dr. Ryan Hassan: (13:50)
That's a good question and I get it Often, generally, I would say not to let your baby go more than three hours without feeding them for the first week to two weeks, if not longer. Just because when they're very young, the first few days, first couple weeks, there's a risk that they could have their blood sugar should, could drop to a, a dangerous level if they go too long without eating and then they can become very tired and not wanting to eat. And it can be, it can be very challenging. It's a crucial time to practice those feeding skills to help if you're breastfeeding, to help to breast milk come in. But regardless, help them learn how to eat. So it's an important time. And we also wanna make sure they're not losing too much weight because they will lose, you know, up to 10% of their birth weight in the first week.

Dr. Ryan Hassan: (14:33)
So generally, I will say, don't go more than three hours and if they're sleeping, you know, wake them up at the three hour mark to eat if they haven't. But you know, it, it does vary. And I think most babies can pretty quickly transition out of that and kind of start taking a little longer, four hours, maybe five or even six after they've established that they're eating well and gaining weight and things are going well. It would depend on kind of your comfort level, your support system, and your pediatrician or your healthcare provider, baby health, baby's healthcare providers, comfort level and their ability to kind of monitor your baby's weight gain and such. But I know with my patients, I will often tell them, you know, around the two week visit, well look, your baby's growing beautifully. Sounds like you know, he or she wants to sleep longer, why don't you give it a try?

Dr. Ryan Hassan: (15:20)
Let 'em sleep a little longer, go a few hours and see if it works out okay. And if they are still, you know, not super fussy or anything, and if they seem to be growing, you know, eating well still, then no worries, we'll check in in a couple weeks. If there's any question about it, come in sooner, we'll do a weight check and maybe we need to not, you know, space it out that much. And that generally works out well. You know, not always. And my baby is a perfect example. Olivia was preterm and she's always been very small and she wanted to sleep, I think, up to six hours at a time when she was only a few weeks old. And we talked about that together and with our pediatrician and we're like, well, you know, let's give it a try and see how she does with that. But she wasn't gaining weight with that and, and she wasn't eating as well. So we said, okay, well this isn't working. We're gonna have to keep waking her up to feed her more frequently. So, you know, some babies will need a little bit more support, but I think most babies, if they're growing well, you can pretty quickly transition out of that and let them sleep longer. But again, it's something you would wanna just be talking about with your pediatrician, uh, and, you know, making sure that you're, they're still eating and gaining weight.

Ari O'Donovan: (16:23)
I know a lot of other friends of mine who are parents, have said that just seems so wrong to wake the baby . It was so hard to get her to sleep. Yeah. And now it's gonna be hard to get her back to sleep, but it's just something you're going to have to do because it's, it's just gonna be better for the health of your child.

Dr. Ryan Hassan: (16:46)
Yeah. It's, um, it's not very common. I'll say. I think most of the time most babies are not gonna have the problem of sleeping too much. There are certainly some who do a lot who do, but I think the majority of babies will wake up and want to eat. And what I frequently see is the cluster feeding at night where they don't eat as often in the day, but then at nighttime all of a sudden they want to eat constantly. It's rare that you'll have the privilege of being able to sleep until that three hours and then wake up your baby more often. They'll be telling you when it's time to eat.

Ari O'Donovan: (17:16)
Yeah. Now I've, I've heard that term cluster feeding, but I'm not really entirely sure what that is. Can you explain that to me? Ryan?

Dr. Ryan Hassan: (17:25)
Newborns will often go through periods of time where they want to eat a lot more frequently, maybe smaller amounts more frequently, and that often will happen like certain times of the day, usually at night. So, you know, they might feed every two, three hours in the day or maybe three, four hours. But then, you know, at nighttime they start wanting to feed every 30 minutes to one hour or so and just feeding a few minutes each time. And it just becomes a little more challenging to say the least. It's not something every baby will do and it might all not be at night, but it's a relatively common thing that we see sometimes.

Ari O'Donovan: (18:00)
Okay. That's good to know. That's not something that I wouldn't expect to potentially happens . That's not a huge shocker to me. Yeah. Um, parent is not for the faint of heart. I will say that for sure. . Yeah.

Dr. Ryan Hassan: (18:16)
It's, it's a challenge. That first year is rough. The, the sleep deprivation I think is, uh, is the hardest thing that that was, uh, one thing I got really angry about when I was going through Liv's first year. Um, I've always been a little indignant about how, you know, little, we support families in this country and parents really globally in general, but especially in, in the United States. But when my baby was born, I got so indignant about it and angry 'cause I was just so angry and sad all the time because I was tired because I was getting no sleep. And I got much more sleep than my wife did. And somehow she pulled it off much better than I did. I mean, she also struggled a lot, but I do much worse with low sleep. And it was just so frustrating 'cause I was thinking, this is not fair.

Dr. Ryan Hassan: (19:00)
Like I should be able to get enough sleep. And the reason I can't is because I don't have, you know, family and friends nearby who can like help. I don't have the money to, uh, you know, have a, a doula or a home nanny. And I, I have to work. I don't have the money to not work. It doesn't make any sense. How am I supposed to work a full-time job and then be woken up all through the night too? And I had it easy, you know, I'm a doctor so I have relatively well off. We are able to have my wife at home full-time, which is a huge perk, but it's not nearly enough. You know, the parents should be able to get enough sleep, they should have multiple, multiple caregivers who help provide for their family. And as far as I'm concerned, they should not have to work until they're ready, at least for several years. Because the most important and most difficult job that any human can have is raising a young human. And the fact that we don't even pay parents for it, you know, even given the time off even. I think that's travesty.

Ari O'Donovan: (19:55)
I absolutely agree. Ryan. You're preaching to the choir. You better turn around and face congregation . I definitely agree. Your wife is a warrior for getting through that whole first year. Anybody that gets through that whole first year, uh, that's my whole thing. When you have a first year, uh, birthday for your baby, it's not really entirely for them. That's for you two because you made it this long, you kept this

Dr. Ryan Hassan: (20:24)
Child alive. Yeah. That is, that is your party. Yeah,

Ari O'Donovan: (20:26)
Most definitely.

Dr. Ryan Hassan: (20:27)
There are plenty of libations that our baby's first year party.

Ari O'Donovan: (20:31)
Good, good. I, but I agree. I, I think that to expect all that from any parent, regardless of if you're the one breastfeeding or not, if you are caring for a child and to expect someone to do all of that extra work while they're also learning to care for an infant or a new baby is, I don't know how anybody really gets through it without slightly losing their mind. I really don't know how,

Dr. Ryan Hassan: (20:58)
I don't think anyone does . I mean, there's some people who have have a great setup, good family community and you know, we're relatively well off. But, uh, yeah, it's certainly not the majority. I think

Ari O'Donovan: (21:10)
A lot of people, yeah, like you said, Ryan don't, and, and my husband and I are in the same very similar boat. We have family here, but um, a lot of them have never had kids. So the best they could come to do is help wash some dishes or something, which is great. Um, it's still, you know, fairly limited, so. Yeah. Yeah. That's a lot of families.

Dr. Ryan Hassan: (21:32)
Yeah. It's a hard thing. We were lucky, my mother-in-law came quite a bit to help out in the first year especially. She had to fly out from Texas, but we had to like really, we had to train her. You know, we had to, my wife had to talk with her about like, this is how we do everything and this is, you know, our routine until we were comfortable letting, you know, letting your take care live without us. Nothing against her. She's, uh, fantastic. I mean amazing with our baby, but it's just, you know, anyone who caress for your baby you're not gonna feel comfortable with until you really know that they can care for your baby. I tell families that a lot too, is if you have parents or other family who, or friends who you know, want to help, let them do so and you know, don't, you know, feel bad about insisting on doing some training. Like showing 'em, look, this is what we do, this is how we do it, this is how you respond to this situation so that you really do feel comfortable, uh, and so that they feel comfortable taking care of your baby.

Ari O'Donovan: (22:22)
Definitely. Definitely. That's just you being a responsible parent. . Yeah. And trying to make things go smoothly for your baby, for you and the person trying to help. I do have another question about breastfeeding. Mm-Hmm. , but it's mostly about the milk. Can you or should you mix breast milk with formula? When can you do that? Or should you do that at all? Sure.

Dr. Ryan Hassan: (22:48)
Well, I don't ever should on my patients, but you can definitely, and I think we, yeah, we did. It's actually quite common. Some babies like ours, premature babies often need fortified milk. So you might use fortified formula only, but for us, we wanted to breastfeed or use breast milk. So my wife would pump breast milk and then we would add formula to fortify it to have more calories per ounce so that she got a denser, you know, food so she could get more calories. Now you don't wanna just do that, you know, automatically. Most babies don't need fortified feeds. It's not a good idea if you don't need it. But even if you're not, you can still mix, you know, formula regularly and then add it to, you know, an amount of milk. So it's not fortified, but it's just mixed together. So you could certainly do that. There wouldn't be a problem with that. But I think what is usually, usually happens, most of the families I work with, if they feel like they don't have enough breast milk or for whatever reason wanna use some formula, they'll, they'll feed with breast milk and then feed with formula after or for a different feed. And I think mostly just 'cause it's easier to do it that way, but you certainly can mix if you need to.

Ari O'Donovan: (23:54)
That's really good to know. Um, friends of mine who have had kids have said that it was nice when they had to go back to work and they didn't always have time to pump or, and they definitely couldn't be around constantly to breastfeed directly.

Dr. Ryan Hassan: (24:12)
Yeah. I would say that's very common. And again, it goes back to the same, you know, drained pool politics if wouldn't be a problem if parents weren't forced to go back to work within weeks sometimes of delivering. But yeah, oftentimes it is very challenging to continue breastfeeding when you're working. And so a lot of families at that time will switch to formula or use more formula, even if you're not, even if you use pumped milk, if you are fortunate enough to have a job that is going to allow you and support you in, in pumping, it still can be a transition. 'cause going from like breastfeeding directly versus using a bottle for pumped milk is, is a big skill change too. Babies will, you know, be, won't necessarily be as comfortable doing, uh, one as they are at the other. Um, 'cause it's a little different skill for each.

Ari O'Donovan: (25:02)
Yeah. Yeah. I've heard that. Someone said to me that it's a good idea to try to get them used to the breasts first and then incorporate a bottle if you try to do them off and on at the same time. There's gonna be like, I think they called it nipple confusion

Dr. Ryan Hassan: (25:19)
Or something. Nipple confusion. Yeah. I actually don't worry about that anymore. It was something that kind of changed during my training. But initially, and this would've been 10, 15 years ago, there was this, uh, concern about nipple confusion that, you know, this is why they used to discourage pacifiers a lot is if you introduce a pacifier or a bottle or even like a finger too quickly, then it might make it harder for babies to understand how to, to latch and feed with, with breastfeeding. But that's actually been studied and it found that actually there's not really a significant change. You know, even within a day or so, you're usually not gonna have much difference. So I really don't worry about it at all. I think there's no harm in just exclusively breastfeeding and waiting on formula. And certainly there's benefits to that. Um, but I wouldn't say, you know, if if you have formula or you have a bottle, it's easier to do.

Dr. Ryan Hassan: (26:12)
Like I wouldn't say no, don't do that because your baby will get nipple confusion. I would say do what works, what's most easy for you and what makes the most sense depending on the position you're in, you know, resting will be hard one way or the other. It, it's not gonna make it harder just because you, you know, use a bottle more. But, um, I will say along those lines, it is helpful still to practice regularly. So that's another reason is good to feed your baby, you know, every few hours. Especially in those fir you know, the first, uh, few days and weeks even. Because, um, it does take that practice for them to learn how to do it. It's okay if they're practicing on, you know, bottle feeding and breastfeeding, but you do need to practice for them to learn. And it's, um, and that's a big reason why as I said, you know, it takes up to four days for milk to come in, but you still need to have them nursing regularly so that they are learning how to latch. And also that helps stimulate milk let down if you're breastfeeding too.

Ari O'Donovan: (27:08)
That's really good to know. And it just, all these questions and the answers you're providing kind of widen, um, my understanding of what's possible and what isn't. And especially for people that I have a lot of flexibility in my job when I do return to work. Other people might not. I have often thought to myself, you know, there's someone out there working a construction job right now that wants to be able to breastfeed their child Yeah. And, and really be there for them like that. And they're just not going to be able to.

Dr. Ryan Hassan: (27:44)
I've struggled with that a lot since becoming a parent. Every time I see, you know, my own patient's parents and they're, they're have these new babies and they're just, you know, having to go back to work and they're struggling and I can see it on their face, you know, they're trying to figure everything out and they're exhausted and it just, yeah. It's, it's a very unjust and uneconomical way to approach things. It just doesn't make any sense. , we'd all be better off in every way if we paid parents to be parents and we allowed them to raise their children, uh, and supported them to do so. The children would be better. We'd be, we'd be supporting families, having healthier families, more resilient families. It would help parents to be more rested and patient with their children and spend more time connecting with them. It would help children to have more emotional attachment, connection with their, with their parents to learn how to be patient and resilient themselves and to help become emotionally intelligent rather than emotionally stunted, which is, you know, you, you look around anywhere on online or on, on the news or on tv and look to our politicians.

Dr. Ryan Hassan: (28:50)
I mean, this is, these are people who are the results of traumatized childhoods and traumatized homes. You know, they don't know how to speak kindly to each other. How to work through problems without fighting and arguing, yelling and bick bickering and name calling. They don't understand the importance of supporting their fellow humans come up with, you know, stigmatizing and racist narratives for the way we talk about people. Like, this is what happens when you don't have a childhood that helps you learn the value of actually respecting humans and each other and understanding emotions and processing those emotions in healthy ways rather than repressing them until we're all anxious and neurotic. And I see this on, it's a bit tangential, but I, I see this day to day, I see it when I see my, these families, these patients, kids get older and they get more, they start having problems with being hyperactive and inattentive and, and oppositional and angry.

Dr. Ryan Hassan: (29:42)
And um, and of course these words aren't great descriptors. They describe the environment around them. They don't describe anything intrinsic to the child, but these are a result of an environment that's not adequately suited to care for these children. And, and I see when I see these families, okay, this is a family that doesn't really have the support they need and they're gonna run into some problems later on. And then they do. And it's, it's easy to predict, but it's very hard to do anything to support because it's not as though it's the family's fault. It's not as though I can tell them, do this thing differently and you'll prevent this outcome. It's the, the environment that they're situated in.

Ari O'Donovan: (30:17)
You know, , this, that could be a whole episode by itself. Ryan, I I really do believe that. I hear all the time, be kind to your kids. Do all you can for your kids. Always put your kids first because they didn't choose to be born. They didn't choose to have you as parents. They didn't choose, um, where they're born or any of that. And those things are true. Parents didn't choose to have a society to live in. A society that continuously makes it hard for them to be parents. It's almost as if society has a hatred. Parents and for kids from the moment they are born, before they're born, there are people that are real interested in that child . But the moment they're born, that is your problem. Do it right. Make sure the child comes out perfect. 'cause if not, it's your fault. No, we're not gonna provide you resources or anything that's going to help you. Mm-Hmm. , nobody chooses that.

Dr. Ryan Hassan: (31:19)
Yeah. And,

Ari O'Donovan: (31:20)
And what is the other option? Just don't have kids. Then it's like, well, that, that is not really . That shouldn't be the answer. . Yeah.

Dr. Ryan Hassan: (31:28)
Yeah. I totally agree. It's, it's this like personal response, bootstraps nonsense that, uh, we all somehow should be able to take care of ourselves. But as I mentioned earlier, you know, like formula shortage is one perfect example of how it's just, it's literally not possible. Mm-Hmm. Um, it's, it's, you can't do it. But that's what we're trying to focus on today. , there, there are things we can do. And so, um, you know, we could keep talking about what we can do.

Ari O'Donovan: (31:52)
Absolutely. That's a good thing to stay focused on because otherwise you're gonna get sad and angry . So every time, uh, someone has a baby, then you have an umbilical cord that needs to be cut. And when it's cut, then you have a little stump. So how do you care for that stump? Does the stump come off on its own? Or

Dr. Ryan Hassan: (32:15)
Sometimes you will actually be able to have what's called delayed cord clamping. I don't know if you've heard of this at all.

Ari O'Donovan: (32:22)
I have not heard about that.

Dr. Ryan Hassan: (32:23)
It used to be more of like a fringe thing that wasn't as common. Uh, but you know, at least in the US it, it's actually been common in other countries for a while. But we're now recognizing in the last, well, decade or so that it, it has benefits, um, that basically what you do is you wait a couple minutes to let blood continue flowing through the umbilical cord to the baby before clamping. Or you'll do, you'll kind of milk the cord to get some of that blood out before clamping and cutting it. And in a sense, it, it makes sense that that would be a good idea because that's what would happen naturally for most of human history would be that, you know, the cord would not be cut. It would, you would just, it would just stay there until it, you know, uh, dries out and maybe the mom like chews through it or something.

Dr. Ryan Hassan: (33:08)
But like, you know, that's, that's it. So it, it makes sense that that would be a more appropriate way to do it. Now it's not always a great idea. We used to not do it because kiddos would be maybe more risk for having jaundice where there's yellowing of the skin. But now we find it actually generally is gonna be better. It'll, it won't increase the risk for needing intervention from that yellowing of the skin. And it will maybe reduce the risk for anemia later on. So something to think about. And your provider will probably, or at least should kind of discuss that with you. Not always a good idea. Certainly if you need to, you know, if there's any, if your baby needs any kind of resuscitation, then it's not even an option. You, you plant the cord and you, but I just mentioned that.

Dr. Ryan Hassan: (33:45)
'cause I think it's something that parents should know about and just talk with their provider about if that's something they want to plan for. Now after the cords cut, basically it's just dying skin that's gonna dry out and fall off on its own. Think of it like a scab. It's essentially the same thing. It's dead skin that will dry out and crust over and eventually it'll just kind of fall off when the skin under it is healed. So you don't need to do anything with it. It'll be clamped so it doesn't keep bleeding. And then by the time you go home from the hospital, you know, pre they'll take the clamp off, it'll be dried and then you don't really need to do anything with it. Just, you know, don't mess with it too much. Don't, you know, do you don't want, do you don't wanna wash it or use alcohol or any, anything else.

Dr. Ryan Hassan: (34:22)
You just kind of leave it alone and try not to rub against it too much. You know, if, if you rub it too much, like, just like a scab, it might fall off early. It's not a huge issue. But like there might be some drainage, bleeding, discharge, things like that. And then, you know, it can be just annoying. So just kind of leave it alone. And generally around two weeks or so, usually before that it'll fall off and then afterwards you just kind of clean it. Normally there might be, there will probably be a little bit of drainage for maybe a, a day or so afterwards, but it usually stops after that. If not, it's a pretty easy thing to treat, just see, you know, your provider about it. That's really it. You just kind of wanna treat it like regular scabbed skin and then, and don't rub it and don't use any other special things on it. Just kind of wash around the area when you wash your baby.

Ari O'Donovan: (35:08)
That's good to know. And I had, I really wasn't aware of the delayed clamping of the cord. Mm-Hmm. . And that's something that I am interested in and would like to talk to my provider about. So yeah, that's really good to know.

Dr. Ryan Hassan: (35:22)
Let me know what they think. I haven't talked with an OB about it for a while. I might reach out to my mom though for listeners who don't know. My mom is an ob but it's something we used to do pretty commonly in preemie kids and I think it's now more routinely offered to, you know, term babies as well. But yeah, definitely ask and see what they say. I'd be interested to, to

Ari O'Donovan: (35:40)
Hear. Yeah, I will let you know. So I kind of, kind of goes into the same thing with, um, when your baby's born, they're covered in a bunch of stuff. It's not just this perfectly clean baby that's just like in a movie or something. It's never that clean. Should you leave that stuff on the child or immediately remove it,

Dr. Ryan Hassan: (36:02)
You generally leave it on. So what you're referring to is usually gonna, it, it's called um, Vernick, uh, not, uh, not Vernix. Yes, vernix. We all have cheese sometimes because it looks like cheese. So some babies have a lot of it. They'll be like, oh, this is a really cheesy baby. Others not so much. protect the baby's skin, helps 'em promote their, uh, immunity and can also contribute to warmth and things. So it's, uh, it's helpful. Definitely not worry about trying to get it all off. You know, usually like the resuscitation team, if they have one, they'll, you know, wipe some of it off so you can actually hold your baby, but you don't need to like scrape it, scrape them clean. It's uh, it's protective.

Ari O'Donovan: (36:41)
Good. That's really good to know because you know, you might see your baby born with all this stuff they're covered in and you'll be like, this probably shouldn't be there, but no, it should be there. . Yeah. And I, I definitely don't think after what I'm hearing, that you should immediately be in any hurry to bathe your child.

Dr. Ryan Hassan: (37:00)
. Um,

Ari O'Donovan: (37:02)
Probably not.

Dr. Ryan Hassan: (37:03)
. Yeah, I don't worry about it. And I think a lot of times I don't think they're doing this as much, but used to be more routine. They would, you would have a, you know, baby would get a bath before going home from the hospital. Uh, I, I don't think that's common anymore. Certainly most of my patients won't get a bath before they go home. But yeah, it's one of the things where, you know, you can give your baby a bath, like a sponge bath and that's fine, but it's certainly not, not necessary. And in general it can be helpful to delay the first bath, you know, at least a few days. And I don't remember when we gave Liv a bath. It's all a blur 'cause we were in the NICU for 10 days. So I have to ask my wife. I don't know if we did for a while, but you certainly don't need to if they stink, you can though.

Ari O'Donovan: (37:44)
That's really good to know. Yeah.

Dr. Ryan Hassan: (37:46)
Oh you know, I was just looking up vernix to make sure I got the right word, which I did. But yeah, it actually means cheesy in Latin, so that's interesting. makes sense. That's, see we're not that creative when we just, we just use Latin words to make us sound smart. But that's . They were like, huh, this is cheesy. What should we call it? Let's just call it Latin for cheesy

Ari O'Donovan: (38:07)
. It makes it easier to remember too. for me. .

Dr. Ryan Hassan: (38:13)
Yeah. I mean, I don't know. I try to speak English but , you know, old timey docs, they run the show still. Yeah, they like Latin.

Ari O'Donovan: (38:23)
That's definitely true. When should a parent first bathe their newborn and how frequently thereafter? I've heard that you should only use water if you are are with diaper changes. If you're cleaning your baby well enough every time, you really shouldn't have to use any soap. Do you use soap? Yeah. Should you?

Dr. Ryan Hassan: (38:44)
Um, I would say I don't have strong recommendations on it. I don't think it's a huge issue. My general guidance is bathe however much you like. You know, if you don't want to don't, it's fine. You don't really need to, you really don't need to bathe your baby much at all. Uh, you know, if they're getting stinky and sticky, if they got a lot of, you know, milk dried on them and stuff like, you know, clean them and you could do that even with just like a cloth or a diaper wipe, which we frequently did, but you can give 'em a bath instead and that's fine. I think it's, it's a matter of preference. And I don't know, probably most of my patients would give younger babies maybe once a week or a couple times a week. But we certainly did it much, much less.

Dr. Ryan Hassan: (39:31)
But I certainly have other families who wanna do a bath every night and that's also fine in the first few weeks you do want to do just kind of like a sponge bath and mostly just like, you know, water, you don't really need soap. It's okay to use soap, but you wanna make sure you use a very gentle unscented soap. That's not gonna be irritating at all. And you don't need much very small amount. The other thing to know I think that about bathing generally is water dries out skin ironically enough. So if you're giving your baby a lot of bath, it could dry out their skin more and you might have worsening eczema, which is, again, it's essentially just Latin for dry skin. So I do recommend if parents are bathing their kids a lot, they might wanna be more diligent about using a moisturizing cream or ointment afterwards. You know, we would do that every time we gave her a bath. It can help with bedtime routine later on. Um, meaning you can't really sleep, train a kiddo or teach them to sleep through the night until they're, you know, at least four to six months old. Um, but it, it can be nice for that part of that routine to be, you know, a bath. So that could be helpful too.

Ari O'Donovan: (40:39)
That's really important. 'cause I, I wondered, you know, especially the moisturizing the skin part 'cause it's like well you probably moisturize your own skin and if you don't then you can tell that it's drier than usual. So moisturize your baby

Dr. Ryan Hassan: (40:55)
. Yeah. Yeah. I don't think, you know, you don't necessarily need to. And certainly some babies, you know, you don't need any moisturizer, but it can help and some babies will need it because they will get dry skin after if they don't. So with Liv, we gave her like a lotion massage every night for bedtime. It was a great part of the bedtime routine and she liked it. It was a good way to just get some more touch time with her and add another thing into our routine. And it just helped keep her skin moisturized because especially with preemies, they're a little bit higher risk for having irritated skin. And if your baby poops a lot, a friend of mine who had a baby recently, here's babies pooping all the time and like that will definitely predispose to a diaper rash. So, you know, we would use Aquaphor every time we moisturized or every time we changed a diaper just to minimize any chance of her getting a diaper rash. 'cause those can be really irritating and it's easier to prevent them than it is to treat it once it's there.

Ari O'Donovan: (41:50)
That's really great to know. First of all, I love that idea. I'm gonna do the same thing with my baby with nighttime. Yeah, it's, yeah, it's great.

Dr. Ryan Hassan: (42:01)
It's, it's just another excuse to be touching your baby. Babies really need physical contact and sensory stimulation from their parents. So any opportunity you have to touch them, hold them skin to skin, uh, for them to be close to you smelling you, seeing you hearing your voice, that's what they want. That's what they crave. It helps build that connection, build those neurons, helps them learn how to be emotionally attuned to you. And it's those kinds of things that will help when, you know, 13 years from now he starts getting a little bit angry about things. It's that attunement you build now, that connection you build now that will help kind of carry you through some of those more challenging times. And I say challenging, I mean, it's not the right word. It, it's, uh, I think, I don't think, it doesn't need to be challenging at all when kid at any age that kids are. Um, it just depends on how well you're able to, you know, respect their autonomy and, and build that relationship of trust. Maybe challenging is the right word. It it is challenging but also rewarding.

Ari O'Donovan: (43:02)
Definitely. And starting early with that is, is really great. I have heard of a lot of, well not a lot, but some babies that I've known who are extremely constipated. What do you do for a newborn especially that's constipated? Obviously you should take them probably to the pediatrician, but pediatrician, what, what should you do with that?

Dr. Ryan Hassan: (43:27)
There are rare causes of constipation that can be concerning that you know, would require intervention. There's conditions where you might not, uh, you might have anatomical problems with, uh, your lower intestines that need to be addressed where you might still have some kind of obstruction of your, of your intestines that could be an emergency. So this is almost never gonna be the case. If your baby is constipated, then it's almost definitely not this, but it's important just to be aware that like you should , always talk to your provider. Don't take anything, you know, just from this podcast for example, to make sure there's nothing wrong. But generally, you know, if your baby, if your baby is not passing gas, not pooping at all, their tummy gets just, you know, firm and full and swollen, like those are red flag symptoms you need to tell someone right away.

Dr. Ryan Hassan: (44:13)
Or if they really have like struggled to pass every single poop from birth. Like that's something a, you know, just to ask your provider like, Hey, could this be some kind of anatomic issue just to make sure that it's, it's being considered. That said, for most kiddos, there's nothing wrong at all. They're totally normal healthy babies and you don't need, need to do anything. Most of the time, probably for the friends, most of the friends or if not all the friends you you're referencing when babies are, you know, having a hard time pooping. It's a matter of that they just don't know how to poop, right? I mean this is a new skill. Everything's a new skill, right? I mean they've been, right now your baby's floating right? And he doesn't have to do anything at all. And then in a couple of months he's gonna have to start breathing.

Dr. Ryan Hassan: (44:56)
He's gonna have to clear his lungs of fluid and fill them with air, which is insane that that's even possible. Holes in his heart are gonna have to close. Um, and he's gonna have to start learning how to swallow, aortic, coordinate all those muscles in his mouth and his lips and his throat and, and then all of his gut muscles have to start working. And then he has to coordinate all of those to start pooping. Um, among all the other things he has to do, he's gonna have to, you know, deal with gravity. So this is a lot of things and just pooping in itself is really hard. I mean if you think about what it is involved when you go to poop, like you have to use some muscles and it's not necessarily, you know, intuitive how you do that. We all know how to do it.

Dr. Ryan Hassan: (45:37)
We've been doing it for years, but with a baby, you know, they've never done it before. And they have to figure out, okay, how do I, what am I doing? What do I, what muscles do I push year? And you know, uh, maybe a good analogy would be for, you know, labor itself for a mother going into labor for the first time. Um, it, it often for a lot of parents it can be hard to figure that out like what muscles you use 'cause you're pushing with muscles you haven't before. Um, and sometimes it's really tricky to figure out, okay, it, am I pushing right? Am I doing the right maneuvers? Am I using the right muscles? So I think that might be a good way to think about it. Babies just don't know which muscles to use or how to use 'em and they have to figure out how to coordinate those.

Dr. Ryan Hassan: (46:16)
And so you'll often have times which are we did to where babies might just be really grunting and fussing for a while while they're trying to poop. And for us, I think it was a period of a few weeks after Liv was born, 4:00 AM every morning like clockwork, she would start pooping and she would just be grunting and screaming for like an hour before, uh, she would poop and it was horrible and there was nothing we could do other than try to sleep unsuccessfully. It's just kind of what they have to kind of figure out. And so I think the important thing to know is it is normal. It is okay, they will be fine. And generally you don't need to do much as long as your provider, you know, says there's, doesn't think there's some other issue. It can help to, you know, do some bicy bicycling of the legs and such, or like put them into a squatted position just to help open up the sphincter.

Dr. Ryan Hassan: (47:08)
Um, but that's really about it. I would say it's important that if they are straining a lot, and especially if they're pooping a lot, like a lot of small poops throughout the day, again, like that could potentially lead to a diaper rash. You'll wanna make sure you're carefully wiping gently with a, you know, a very gentle wipe and that you're moisturizing well after to kind of reduce the risk for getting a diaper rash. And that's probably it I should say. There's, you know, a lot of people in the space will talk about the, you know, the potential for a food allergy or sensitivity playing a role here. And so there's a lot of people who will recommend or suggest, you know, switching if you're formula, using formula switching to a different formula. If you're breast milk, uh, breastfeeding, then, you know, changing your own diet while breastfeeding, uh, to cut out certain foods or to switch to other formulas.

Dr. Ryan Hassan: (47:59)
Um, and you know, a common, a common, um, victim or scapegoat is milk or dairy. Like it's often thought, oh, maybe dairy is the culprit. Let's cut out dairy from your diet. Or you know, let's get rid of this milk protein formula and use a soy formula instead. And that's usually not gonna help. Uh, and in general, most of the time these kind of formula changes, I would say aren't gonna make a big difference. So I would caution against putting too much effort into making those changes. Now that's not to say don't do any changes, just that I think it's generally oversold to parents as like this way to fix things. Because as providers we want to fix things and we wanna say, here's this thing that you can do to fix it. But usually with this kind of issue, there's just not a fix.

Dr. Ryan Hassan: (48:42)
It just takes time. So, you know, I'll often have families who will switch formula and then, oh, their baby's feeding better and, and that's great, but probably it was because, well, it was just a few weeks went by and they learned how to poop and so they're pooping better and they would've pooped the same regardless of whether you made a change. So I think that's an important thing to know. I will say there is such a thing as like having a milk protein allergy, having dairy intolerance and like sometimes it can be helpful for breastfeeding moms to cut out milk and dairy and sometimes it can be helpful to use, you know, partially broken down formulas if you're using a formula that might be easier to digest. And there's not necessarily any harm to trying that if you're not having to, you know, spend a lot of extra money or time or effort to do that.

Dr. Ryan Hassan: (49:27)
But I generally discourage moms from changing their diets just because they wanna optimize their baby's poops 'cause it's probably not gonna make a difference unless there's significant problems with really irritable fussing and like blood in the poop or things like that. Like I'm usually not gonna make any kind of recommendation to change, especially if babies are growing well. And the other thing I would say is generally soy formula not necessary and not a good idea unless you want to use soy in order to of like use a plant-based product, like great. But if you're trying to use soy as an alternative to milk, like it just, it's not recommended because if your baby's allergic to milk, they're probably allergic to soy. And so if you have a problem with a milk formula and switch to soy formula and the problem's gone, it's not because you switched, it's just coincidental probably. Um, so if it really is a formula, an issue, there are other formula options that have partially broken down proteins that can help. And that's a pretty high level brief overview. So certainly, you know, if it's something you had end up having to consider, I would say talk to your provider about it.

Ari O'Donovan: (50:29)
Of course . But it's good to have the information though. And a question that I now have based on that is, I know that you've said the best way to prevent a diaper rash to deal with a diaper rash is to just prevent it altogether. Do you recommend a, a specific type of wipes or a brand or specific types of diapers, a moisturizer or something that could, that you use all the time to help prevent that?

Dr. Ryan Hassan: (50:58)
I use Aquaphor for my kiddo 'cause it's a thick ointment. I think ointments work best generally, especially for babies. The ointments are, so you've got, you know, three types of moisturizers essentially. There's lotion, cream and ointment. And they vary essentially in like how much they're more water based or not. Like lotion is the most watery. That's why it's the thinnest, it's the easiest to apply. And rub in cream is a little less water, so it takes a little more to rub in. And ointment is very, very little water. So it's, you know, you feel very oily if you put an ointment like Aquaphor on you. But it also moisturize bests. So Aquaphor or like Vaseline or some other ointment. That's what I usually like best for, especially for bottoms. But in general for babies it's helpful 'cause it's just, you can oil 'em up great and it'll keep 'em really moisturized and they don't care.

Dr. Ryan Hassan: (51:41)
You know, I wouldn't wanna put Aquaphor on myself usually 'cause like, I don't like being all oily, so I use creams for myself. But I think Aquaphor is a good ointment, but creams are good and I don't have a big preference. You know, there's, you could also just use, if you're wanting to use an ointment, you can just use regular, you know, petroleum jelly, you know, the generic stuff. If you find that it's basically same thing as far as I'm concerned. But you know, also there's Sevy and Vanicream and Cetaphil and Eucerin. Those are all fine options. I like bore's butt paste. That's a really good one. I often don't use it 'cause it's super thick and it's really annoying to get off of your hands. But it's, that's because it works really well. So if Liv does start getting a bad rash, then we'll usually go to that and that'll, that'll pretty frequently take care of it quick.

Dr. Ryan Hassan: (52:30)
But generally day-to-day, we would use Aquaphor. In terms of wipes, you know, I, I wouldn't say I have a preference. Generally most of them are gonna be good. They should all be like alcohol free and unscented and it's just, you know, just try to be gentle. We use diaper brand, D-Y-P-E-R and that's just because it's a plant-based B Corp. They have like, you know, uh, sustainably sourced bamboo to make all their products and they can compost them and everything. So that's why I use them. But I don't have like a preference beyond that in terms of like, uh, gentleness. They should all be pretty good as long as they're alcohol free and non, uh, scented.

Ari O'Donovan: (53:05)
That's really great. I I've always, I mean, Vaseline has so many uses and to know that it's also gonna work for your baby too. Yeah, and it's not that it's not expensive either. So for people who are just trying to do a good thing for their baby and, and don't have the money to spend a lot of it on these expensive products, that might not even help now that that works.

Dr. Ryan Hassan: (53:29)
Yeah, I mean it's like anything else in this country, right? It's all branding, right? I mean, , it's all this marketing stuff and mostly, especially with skin products, I mean the branding is really superfluous. Like most of the best stuff you need for your skin, you can get over the counter. That's true for babies as well.

Ari O'Donovan: (53:46)
Good to know.

Speaker 4: (53:59)
Thanks for listening to this episode. Came bringing the community info without the community. Appreciate you showing up. If you wanna reach out, hit us up on ig at boosting our voices or at our website, boost oregon.org. Keep doing great things. Keep uplifting one another and we'll do the same. See you next time.