I’m a pediatrician and child developmentalist. I practiced pediatrics in Los Angeles for many, many years and then started writing books to help guide parents. My joke is that my job is half pediatrician and half grandmother because so often parents need something other than medical information to help guide them.
In many ways, today’s parents are the most educated parents who ever lived. But they’re also the least experienced when it comes to taking care of babies. Many parents have never even held a baby before they have their own.
Young people are excited by the idea of moving to a city. You want novelty, you want difference, you want change, and then you get stuck in the city. Your family is back where you came from. You’re not living next door to them, and for much of your life, you really don’t want to live next door to them. Then suddenly you have a baby and go, “Oh my god, that’s why people live next door to each other.”
The big lie ... is that the normal family is two parents and a child.
It’s a serious issue because it leads to the big lie, which is that the normal family is two parents and a child. When you consider human evolution, that is completely abnormal. The extended family is normal. The nuclear family is, in many ways, a wrong turn.
Think about it this way: if it’s two parents and a child in a house, how many relationships can that child have? The child has a relationship with the mother, with the father, with both parents together, and with themselves. Maybe they have a goldfish or a dog and that increases the number. But it used to be that you had three siblings, grandparents nearby, and the kids next door—that’s 12 people, and the number of permutations there is over a hundred. We don’t appreciate the impact of this on our kids. We saw this in spades during the pandemic. What drives parents crazy is that they not only have to cook and clean and do their work and be in a relationship, but they have to be a 24-hour caregiver and playmate to their little kids.
That is not easy. It really takes all day long to be a playmate. When you don’t have those other people around, the kids struggle and the parents struggle. It’s missing the key ingredient; it’s missing the garlic from the tomato sauce. People who put their kids in daycare are not doing a bad thing and abdicating their responsibilities, they’re doing a good thing and giving their kids a socially enriched environment.
It’s very hard on parents, especially if you make the wrong assumption. I was just talking to someone at the University of Texas who did a study asking women the type of help they expect to have after their baby is born. It turns out that the biggest predictor of depression isn't the lack of help you have after the baby’s born, but the expectation that you’ll have help or you won’t need help—and then suddenly needing it. It’s a misalignment of expectation and reality.
I grew up in Bayside, Queens. It was a little neighborhood, so we could roam around and ride our bikes and play with our friends and go up to the park. It was really a good childhood. It was New York, but it was far enough away that it felt like the suburbs and close enough to be able to get into the city.
I graduated from SUNY Buffalo in 1972. We called ourselves the “Berkeley of the East.” Of course, Berkeley probably laughed at that. I was a strike leader. We got targeted with buckshot by the local sheriffs and we threw back tear gas canisters and went down to Washington to protest the Vietnam War. It was a very, very politically active group. Vietnam was hanging over my head big time. I had a fairly low draft number, but I got a deferment for going to medical school. And by then, the war was coming to an end.
I thought being a doctor was perfect because you could make your own hours. My father was an engineer and he worked for himself. I wanted to do the same thing, but in science. I had no idea the amount of commitment that’s required. So, yes, you can work for yourself as a doctor, but you’re still on call.
Pediatrics, especially, you’re on call all the time, 24 hours a day. It was very intensive, but very wonderful because when you’re available around the clock, you really get to know families and children and build relationships. It is the great joy and reward of being a practicing pediatrician.
My patients from Venice were the people behind the camera—directors, writers, producers ... The actors lived in Santa Monica and Beverly Hills.
While studying in New York, I worked in the South Bronx where a lot of my patients were Spanish-speaking, so I learned Spanish. This allowed me to be able to practice and take care of my community in Los Angeles, which was a real mix of backgrounds and privilege.
My practice in Los Angeles was in a converted little house. People waited in the living room and then came upstairs where we had turned a couple of bedrooms into examination rooms. I’d ride my bicycle or walk to work, because I lived just 10 blocks away. I’d also ride to home births and do house calls. It’s what you might think of being in a rural area, but this was Santa Monica in the early 1980s. It was really wonderful to get to know the families in my neighborhood. People would bring their friends to my practice and I would know them and their neighbors. It’s not an impersonal thing. To this day, I’m still in touch with some of those kids who grew up to be dieticians, cardiac surgeons, professors, actors, and all that. It’s really cool to see everyone growing up and doing well in the world.
Santa Monica is right on the Venice border, and much more expensive than Venice. My patients from Venice were the people behind the camera—directors, writers, producers, et cetera. The actors lived in Santa Monica and Beverly Hills and whatnot. I mean, I had a fair number of them, like Pierce Brosnan, Michelle Pfeiffer, Larry David, Madonna. People found their way to me. But mostly I saw the creative people behind the camera, which was a really great group of folks.
It always seemed to me that if we could put a man on the moon, we could figure out why babies were crying.
I was always interested in questions that hadn’t been answered—medical mysteries. One of the mysteries in young babies is this thing called colic, which is really babies who cry and cry. Pretty much any book you read will say that we don’t know what causes it, but it goes away. “It might be gas, it might be an upset stomach, but don’t worry about it—they’ll outgrow it.” It always seemed to me that if we could put a man on the moon, we could figure out why babies were crying.
The more I studied it, the more I realized there are a lot of very common ways to calm babies that people actually already know. Driving them in the car all night, for example. We know that those rhythms are helpful. But how and why are they helpful? And why are they not helpful for some people? Those were the questions that I asked myself. And the more I practiced these things, the more I could see that basically there wasn’t a baby I couldn’t calm. I figured if I could do that, then I could teach other people to do it. That led to writing my book.
I could see that basically there wasn’t a baby I couldn’t calm. I figured if I could do that, then I could teach other people to do it.
I did my research in my office. There was one family where both parents were marketers and I said to them, “I’m writing this book about solving colic and doing all the things that you know, the shushing and swaddling”—the things I taught everybody. I told them I wanted their opinion on the title, which was going to be The Karp Colic Cure. I thought that would be the best title because it’s alliterative.
They basically puked and said, “That is the worst title we have ever heard. We would never buy that book. You don’t expect to have a colicky baby, so you’re not going to buy it before the baby is born. And if my baby has colic, I’m never going to get to a bookstore. And besides, it’s for people who don’t have colicky babies, too.” That’s when I came up with the much more inclusive title, The Happiest Baby on the Block.
It came out exactly 20 years ago and became a phenomenon. I mean, to this day, a generation later, people are still recommending it to their friends because it’s extremely practical and it helps people figure out what’s going on in those little heads. Ashton Kutcher, we were talking once and he said, “I love it when no one knows how to do the five S’s because I’m the magician. I can take these babies one, two, three and everyone applauds.” It’s really been wonderful to train parents and give people those skills. We’ve also trained thousands of educators in 20 nations to teach this. Right now, all you’re taught is breastfeeding or bottle feeding. Yet you have to know how to calm crying and get sleep as well, so we’ve trained people to teach those things.
But while people can do that during the day, what do you do all night long? People were stressed out of their minds. I gave a lecture in San Francisco many years ago and said if another country were killing 3500 of our babies every year, we would declare war. Thirty-five hundred babies die every year in their sleep. That’s 10 a day. Why aren’t we doing more? That was really when I started thinking, What would I do if I were there to calm the baby? How can we put that into a device? How can we prevent infant sleep deaths? So we came up with the idea of the SNOO. That was 10 years ago. It took five years to make and then we launched it five and a half years ago.
First we proved it out. We bootstrapped it in the beginning with just the money that we had from friends and family to be able to test hundreds of babies. By the time we went to raise funds, people were going, “It’s genius and why didn’t someone think of this before?” It was that kind of a thing. It’s so obvious when you see it. And it turns out that part of the reason no one did it before is because it was very hard to do.
It’s really fundamental: mothers need to rest after they have a baby.
Most people consider the SNOO a baby bed, which is kind of a misunderstanding of what it is. It’s really a robotic assistant. In the hospital, it’s an assistant nurse. The important thing here is that it’s supporting mothers. When you have it in the room with the mom, it can be a little baby nurse there for her to take care of the baby while she gets some rest.
It’s really fundamental: mothers need to rest after they have a baby. In every other culture, they have five people taking care of them and the baby. This is the only situation in a hospital where you make one patient take care of another patient. The SNOO helps the nurses soothe the babies more efficiently. We’ve shown that each bed reduces nurse labor four to five hours a day. We’re in 140 hospitals already. We’re working in residential centers for homeless moms, and there are prisons that teach the five S’s to their inmates. We would love to be able to do more work to help support incarcerated women with new babies.
Babies who are withdrawing from drugs need it even more. They need more rocking and more shushing and more holding. Sometimes even bounciness because they are so distraught that you have to override it with a little bit of vigor.
Babies born dependent on opioids used to be given morphine or methadone, and we would gradually reduce the dose and then send them home when they were able to be clean and off of the medicine. That would take, on average, four, sometimes six weeks in the hospital. Then, about a decade ago, a group at Yale said, “I don’t think we need to do all that.” They started a program called Eat, Sleep, Console, which means feed them more, hold them more. See if you can soothe them enough with non-pharmacologic steps to be able to send them home without medication.
Lo and behold, they did great. They were able to reduce the length of time the baby was in the hospital down to something like 10 or 11 days. It was a massive improvement, getting these babies out of the hospital and back to their parents much sooner. But there’s one problem: These babies are still very, very difficult and now you’re giving them back to a stressed out family that doesn’t necessarily know how to deal with them or may already be dealing with their own drug habits or anything else they’re doing just to survive.
It’s important for parents to child-proof in general, but especially if you have anything that looks like candy.
So now we are starting studies where we use the SNOO to support these families for those first months when the baby is challenging but at home. Whether it’s the parents or the grandparents or foster care, people need extra help to deal with them.
Our goal has never been to sell a chichi baby bed, but for everyone to get a free SNOO. That’s what we’re working toward—the way you get a free breast pump through insurance or the government. Thousands of people already get free SNOOs, through companies that provide it as a benefit.
Okay, one last thing, because this is Gossamer: gummies and consumables. It’s crucial that people realize that once kids start toddling around and getting to nine months and above, those things look really attractive to them. It’s important for parents to child-proof in general, but especially if you have anything that looks like candy, including pills.
This interview has been edited and condensed for clarity. Dr. Harvey Karp photographed by Tracy Nguyen in Los Angeles. If you like this Conversation, please feel free to share it with friends or enemies. Subscribe to our newsletter here.