SIDS, Safe Sleep and Bed Sharing: Breaking Down the Stats

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Welcome back to No One Told Us, the podcast that tells the truth about parenting and talks about all the stuff you wish you knew before having kids. I'm your host, Rachel Shepard-Ohta, and today is a very important episode. Today we're speaking with Shaelise Tor.

Chaelise has a master's and PhD in marriage and family therapy and currently works as a pediatric researcher and as a clinician in a large pediatrician's office affiliated with her local children's hospital. Most of the clinical work she does is with the 0 -3 populations supporting parents with their babies and child's developmental milestones, sleep support, breastfeeding support, and infant -parent mental health. She's also a mom herself of two little boys, each with their own unique temperaments and sleep journeys. And today, Shaelise is going to help us break down some of the research on SIDS, sleep, bed sharing, and there's so much misinformation and fear mongering out there about these topics. So I'm really excited for you to help us break it down. Welcome to the podcast. And thank you so much for being here.
Thanks for having me. I'm excited to be here to talk about such an important but also, I guess, controversial topic.
I'm just curious, I guess, what kind of got you into this specialty? Did you always have a passion for sleep and breastfeeding? Or did having kids kind of change the trajectory of your career like it does for so many of us?
Yeah I mean, I think a little bit of all of that. So I was finishing my PhD and pregnant with my first son when the pandemic hit. I was kind of during the time I was doing a lot of refugee parent child research in the community and You know, that was near and dear to my heart….. my husband and his family They're all refugees to the United States and so just really getting into that community and seeing how, you know, global perspectives kind of clash with US perspectives. And then I finished my PhD, actually was pregnant with my second son, moved down to Florida, took a position there and was teaching a lot of human development classes for masters, clinicians and research for doctoral clinicians. And I just kept coming back to this sleep stuff because, of course, as a first -time mom, I just didn't have the information.
My expectations were just all over the place. Actually, I think that's when I found your profile, among others, that made me realize, like, "Oh, there's more to this." And so I kind of started doing a deep dive into literature just for myself. And then as I was teaching these classes, it's so relevant to these clinicians that I was training. And so I was ready to make a move. We wanted to move back home to be closer to family. And I was like, what's the ideal? Where would I love to be? I would love to be in pediatrics. I would love to shift the narrative. I would love to bring this research really to the forefront. And I love, you know, an interdisciplinary setting, like how can I work in pediatrics? So I found the research position that I'm in now. That's how I end up here. And so now I'm like deep, deep in it, like everyday sleep infant sleep stuff.
Amazing. You do work in a pediatric, like integrated care setting, someone with your kind of lived experience and just your deep knowledge on this topic. How does that go working with pediatricians who have, you know, different specialties and they might not be as up to date on sleep and breastfeeding? Do you have good relationships there or is it fraught? What can you tell us about that?
Yeah. So I work from an infant and early childhood mental health perspective. And so I think that's what makes my perspective a little bit more unique, right? Like pediatricians are very focused on the physical health. And of course there are now taking a much more, especially where I'm at a biopsychosocial perspective where they realize that all these things are existing at the same time. But I'm the one who's always looking out for the dyad really, because I'm considering infants in relationship to their primary caregiver. You can't consider infants without considering the primary caregiver. We are carrying mammals, right? It's impossible for a baby to be walking until they're ready to. You know, we're not cows that are born and just, you know, start walking.
So I have this perspective that, you know, it's the developing capacity of the child to experience, regulate, and express emotions, but also form these close,
secure, interpersonal relationships. So this zero to three time is really important because you have all these neural connections that are happening, all these milestones that they're meeting. But this is also the time where the foundations for the relationships are laid as well. And those can go well or they can go not so well. And I think why it's so important to me is that 10 to 16 % of young children will experience some sort of mental health conditions, but for children living in poverty, it's even higher, it's 22%. And so I think bringing that perspective and constantly bring that perspective to the conversation makes me a valued asset to the team. I think there's ranges just like, you know, out in the real world where some people are like, Oh, yeah, like, what's the new researcher? Oh, you're right. Like that I've never considered that perspective before.
And there are some whose training is very ingrained in them of don't do this, don't do this, don't do this. And I can relate to that, right? Like I felt the same way as a first time mama, you know, it's scary, you're told all these things about what can go wrong. And not for nothing, they've had shifts in the PICU. They've had shifts in emergency medicine where they've seen horrific things. So I have empathy for that. And I think as long as we can keep the conversation open and have mutual respect that we have different areas of expertise and we can really value each other's expertise, I think it can go well.
You know, if every pediatric office had someone like you who was about in infant mental health and really thinking about that dyad and not the baby existing in a vacuum, right? And it's funny because I do polls on my page every week on Hey Sleepy Baby and one poll that I always get, people want to know is like, how many of us are lying to our pediatricians? And this last week when I did it, it's always like a little bit different, of course, but this last week when I polled that 35 % of people that have a pediatrician ask. So the three choices for the poll were, I do lie to my pediatrician, that was 35%. 33 % said that they don't lie, they tell the truth. And then everybody else said that their pediatrician just doesn't ask. So to me, that's what, like 66 % of people who are either lying or the conversation isn't coming up at all. And to me, that's just such a huge problem because that means that there is so much education that is being left on the table that these parents are leaving these visits, not having the information that they might need to have a safe situation with their baby for sleep.
Right. And especially when you think about the staff that 76 % of people are going to bedshare and 44 % of them are going to do it unintentionally. And so if you're not even having these conversations…. you're right, it just leaves so much conversation off the table, so much important information off the table.
Yeah. And can you just quickly explain the difference there? Because I think that's a really important point to me because that bed sharing is not like some hippie -dippy thing that only attachment parents do. It's not necessarily something that people think about doing when they're pregnant. In fact, in my work, in my own experience in my life, and working with parents for the last four years, I think that's a really important point to me because I think that's a this topic, I find that most, like the vast majority of people did not ever plan on bed sharing, did not want to bed share. That was not something that they ever even dreamed that they would do. So what does it mean to intentionally bed share versus unintentionally bed share? And is that kind of parsed out in the sleep research that we see?
Sure. Intentionally bed sharing means that you are making a conscious choice, that you are setting up, in most cases, right? You are making the choice to do this and you're setting up your environment to do so in a safe way. It means that you're having an awareness that this is happening, like you're planning for it, whether it's a one -time thing or, you know, one feed of the night, or whether it's every single night, this is the choice that your family is making. So that's intentional bed sharing.
Unintentional bed sharing is when you accidentally fall asleep. like feeding your baby, you're in the middle of the night, you're up and down, up and down, and up and down, and you fall asleep and then you go, "Oh crap, I woke up and the baby's here and you're padding the covers and very, very dangerous situations can happen." And so, thankfully in these surveys, people were honest and said, "44%, but I guarantee you it's higher." Right? And I guarantee you it's that the 76 % number is higher too, because there's such a bias around this and not just bias, but actual lived consequences, like some families are called,
CPS is called on them, right? If they find out that they're doing this. So there are good reasons that people are not sharing this with their providers. But I think, as you said, it speaks more to the relationship with the provider that the provider can say, like, let's have this conversation, let's open up this conversation.
But yes, in the literature it's a little bit, it's not parsed out well. A lot of times unintentional bed sharing is put in with intentional and so they don't parse it out. And the other thing that is sometimes included is falling asleep like on a chair or a rocker or a couch. And that is like the most dangerous thing, right? So it's actually safer to bring the baby to your bed in a planned safe environment than it is to fall asleep. And so when you have these parents who are like, okay, I can't bring the baby to bed, I can't bring the baby to bed, they're falling asleep on a sofa, they're more likely to face like a suffocation situation.
Yeah, that's something that drives me crazy whenever I'm looking at bed sharing research is that they say bed sharing might be defined as sharing a surface such as a bed, a water bed, a sofa, a chair, a recliner. Like, I'm like, no, that is not what we should be defining bed sharing has. Like, can we please not because then all these results get so skewed because they're just calling it all the same thing. And that's to me, just completely irresponsible. We're going to come back to bed sharing in a little bit and talk about, you know, the stats and how to make it as safe as possible and things like that. We're going to take a quick break now and when we come back I actually would love to dig in a little bit more to this idea of like cultural competency. And then we're going to talk a little bit about SIDS as well. So we'll be right back.
Shaelise, you mentioned that people that are in lower socioeconomic status, people of color are at higher risk for things like mental illness. There's also a higher risk of SIDS. And then you also touched on the fact that lots of people people of color or people of certain cultures are not being honest with their providers because they're worried about having authorities called on them. And there have been a couple of very sensational stories that have come out about this recently with a mother. The one that I'm thinking of is a mother who lost two babies while bed sharing and was, I believe, charged. What can you tell us about that? And is this something that parents need to actually be worried about? Do parents need to keep their mouth shut about bed sharing at the pediatrician's office? What can you tell us about this? Because it is scary.
Yeah, I mean, it's a very complex question, right? I think it just speaks to systemic and structural racism that exists, especially in medicine. And then I think it speaks to the fact that West-- western medicine, you're really trained to look for pathology, right? Especially pediatricians, you are trained on a very wide breadth of topics, but only to a certain depth. So when I come into the picture, and I'm like, I spend, you know, I spent years on this literature, and I'm now contributing to this literature, you have to understand that there are nuances to this. I think that's where some of the conflict is, right?
And so I think when you're trained to look for pathology and then you're trained to find a solution, it's very different saying, hey, there's some gray areas.
And so I think that I can't speak to, you know, all of CPS, but I do know that if you have, if you do have a baby die and they look into it and they have been found to be bed sharing, it is open as a CPS case. I think to me that speaks again to like this westernized perspective of you are doing something harmful to your children and I just don't think that's the case. If you look around the world, this is what people are doing. So I think we have it very twisted in the U .S. to say, "Oh, you're a terrible parent. You're making this choice. How dare you make this choice to harm your child?" And no parent is doing that.
Of course, they should be much more informed and do things in a safe way. And that's why these situations are happening. But that to me speaks to privilege and power too. So if providers have all this privilege and this power, they are the ones that should be opening this conversation and making it safe for patients to talk to them. They're the ones that should say, "Hey, I don't come from your community. I haven't lived your life. Why do you bedshare?Why is that a choice you're making?
Yeah, I love that. So let's talk a little bit about SUID or SIDS first, because I think that it's really important for people to understand the difference between that and those more accidental suffocations. I think a lot of times when people talk about this, they kind of lump all of those things together and it can get really hard to understand. So can you explain SUID and SIDS and what that is and how that's different from like an accidental suffocation?
Yeah. So SIDS is actually part of a larger umbrella of SUID, like you said, or in actually in other countries, sometimes S -U -D -I. So again, like same exact acronym with different letters turned around. But that's sudden unexpected infant death. So when you break it down, there's explained cases and there's unexplained cases. And there's really three categories of those overall sudden unexpected infant deaths. And so that's SIDS or Sudden Infant Death Syndrome. There's ASSB, which is accidental suffocation strangulation in bed or in a sleeping environment. And then there's deaths with an unknown cause where really after thorough investigation, we still don't know what happened. And so in these cases, there is, you know, there's an autopsy report done, there's a medical examiner's office that goes and there's in where I'm from,
there's a whole like county team that goes and examines these things.
And I actually met with, we have a safe sleep coalition here in the city that I'm from because our SIDS rates are almost double what our nation's SIDS rates are. And so having conversation with them as well about what can we be doing. In New York state, we had this program where they were giving people cribs and it still wasn't helpful right? Because people are going to bedshare, right? So there's all these different categories. And I think a lot of times people say, "Oh, well, as long as I put my baby in the crib, exactly how they're supposed to be, there's going to be no risk." That's not necessarily true. And that is only talking about one category. That's talking about SIDS specifically.
Right. SIDS, it used to be called crib death.
Yeah. And so right now, the the reason, you know, the theory that exists about why are these things happening is what we call a triple risk model or a triple risk hypothesis. And that is that, you know, there's three things. There's a vulnerable infant. So whether they're premature, whether there's some underlying genetic factors, whether there's prenatal exposures, for whatever reason, there's a vulnerable infant. Then there's that critical developmental period. So that two to four months is really when there's a peak in those SIDS rates. And so you're gonna see a lot of those cases at that time. And then there's an external stressor. So that could be sleeping position, that could be, you know, ASSB like covering of the face or the head. It could be smoke exposure, you know, it could be overheating is a big one, you know, when it comes from swaddling, the controversy around swaddling, that's when the environmental factors come in. So all those things together are what we're using right now as an explanation.
Okay, that makes a lot of sense. I know that there are a lot of parents listening where this conversation is probably making them extremely anxious and I completely get it, like I worried about about SIDS every single night for all of my kids until they turned one. And then I felt like I could breathe. So I understand that this is such a heavy topic and nobody wants to think about it. But are there things that we could be doing to prevent? Are there things that, you know, are easy enough to implement that actually do kind of move the needle on risk?
Yeah, I mean, I think this is where the whole safe sleep campaign came in, right? So in the 90s, there was a huge back to sleep campaign. And this was based off of research in other countries where there were lower SIDS rates because babies were sleeping on their backs instead of their stomachs. That's a huge change. Although I will say not all those numbers are accurate because we also have changes in classifications that happened at that time.
However, sleeping on the back really is the safest thing. So even families that choose to bed share, the baby needs to be sleeping on their back. And so when we think about sleep environments, whether it's a crib, whether it's the parent's bed, whether it's a floor mattress, whether it's a bassinet, whatever, it could be a cardboard box. Literally there are some families that have a cardboard box where you put the baby in there. And that can be also safe because they're on their back in their own sleep environment. You don't have all these things that are happening around, but the other things that are preventable are not smoking during pregnancy or after having secondhand smoke.
Things that can prevent is breastfeeding. Breastfeeding is one of the main protectors against SIDS, and really that's thought to be because of one, that dyadic connection between the parent and the child and their arousal and the fact that breastfed babies are going to wake a lot more often, right? And so SIDS is really a fault to you.
Right, right, that's normal. They should be, it's protective. It's built into our biology, absolutely.
Okay, the pacifiers, having a fan in the room, are those really things that help?
Yeah, so pacifiers certainly can decrease. decrease the risk. And again, I think it's because when you think about non -nutritive sucking, it's so calming to the regulatory system, which is why it's funny when people say, "Oh, don't nurse your baby all night. "They're gonna use you as a pacifier." Well, breasts were around before pacifiers, but both are safe, right? And so it's not that you're going to have to take have a baby die, you know, if you formula feed. That's not true, but it's just that breast milk also has things in it too that are protective against it. When it comes to precursors to serotonin and melatonin, like the different chemical makeup of human milk.
I talked a little bit ago about how a lot of parents are very anxious about this. If then I know something that lots of parents like to do is buy Gadgets, the outlet or things like that because they think that they're gonna have some control or they'll be able to catch sids or prevent it. Do you find that those things are helpful? Is there any evidence to share that they actually reduce risk? What do you think about things like that?
I think that people aren't gonna like this, but no.
I think-- I find this in my own life too, like I'm sharing these things with people like really? You have to go do that. Here's the thing about outlet. I think people buy it for a good reason, right? Like, okay, if I can monitor their breathing, if I can monitor their heart rate, like it's going to be okay. But actually, one, it's not like an approved medical monitor, it's just not. And two, it can actually just like make you more anxious that you're looking at these things if there's a faulty thing in the system with the gadget. And honestly, the answer is that there's nothing you can do when it comes to monitoring the respiration to prevent it, right? So you're really just kind of perseverating on this and it can really create anxiety for a lot of families.
With a Snoo, I, again, I understand why people do it. Like you're desperate for sleep. Your baby will not sleep without being swaddled, held, touching you. We should talk about that, right? That's an infant regulatory problem, right? So I get why people do it. So I'm not, you know, shaming and blaming. But I think when it comes to gadgets like that, it's actually causing the baby to fall into a deeper state of sleep than what their brain is actually mature enough to handle. Baby sleep changes so drastically in the first three years of life, and especially in those first three months of life, where even just the structures of the brain are too immature to handle deep sleep states.
Yes, thank you for saying that, so that I don't have to. We're going to take one more quick break, and then when we come back, we are going to get into bed sharing. Be right back.
Okay, so let's let's go back to that paper that recently came out from pediatrics about bed sharing and SUID. Can you help us make sense of what these findings were? Because I did share a post on Instagram with my friend Candace, who's a public health professional. We got so many questions, it felt like it just confused people even more…… Instagram, it's just hard to, you know, do any long form explanation on there. So can you help us make sense of what these findings are? Are these findings even new or are these things that we already kind of knew?
Mm -hmm. I think you guys did a great job breaking it down in terms of like the main findings. So I think what I'll focus on is really like what are some of the main takeaways and really what does this contribute to the conversation, right? So I think what was interesting is that 59 .5 % of SUID were surface sharing when they died and 40 .5 % were not. And so there's, again, this idea of, well, if my baby's in a crib, it's gonna be fine. And in this particular study, the ones that were in a crib were mostly non -Hispanic white babies and had a higher proportion of them were privately insured, but they were also found on their stomachs.
Right? So again, this push for this back to sleep campaign really did have some effect in the fact that we should be putting babies to sleep on their backs. And so I can't speak to why that was the case, but there were racial differences. So those were found surface sharing were zero to three months old, non -Hispanic black, publicly insured, found on their back, but were in an adult bed or a chair or a couch and had a higher number of unsafe sleep factors in addition to surface sharing. And I think that's one of the main takeaways is it's not the fact that people are bringing their babies to bed that is in its itself unsafe. Okay, so it's not unsafe to bring a baby to the parent's bed if the environment is set up.
And so I think what this contributes to the literature is that one, we need to be having such more conversation around this. We cannot be having an abstinence only approach and we differ from other countries in this in the US and not a good way, right? So other countries are having a lot more nuanced conversations because they realize that these approaches don't work. I work in a pediatric setting. We have conversations all the time about drugs, about sex with teenagers, right? Abstinence-only approaches don't work for these other things. Why would they work for bed sharing, right? And so I think that's one of the main things that contributes.
I think the other thing we need to think about is... is social determinants of health, like thinking about how families are living in the communities that they're living in that are already going to put them at risk and then having these conversations even more. And I think really the biggest thing for me is that it's saying that there were all these other unsafe sleep factors present. It was not bringing the baby to bed that was the unsafe thing. And then of course they lumped in again the adult bed and the chair and the couch. So again, this speaks to methodological issues in the research, which there is a small group of us in this area that are like really fighting to parse out.
Like we cannot be combining intentional and unintentional bedsharing. You just cannot.
Nothing drives me more crazy than that. So what are some examples then of what the unsafe sleep factors would have been? So those other things that were happening that contributed to this death?
Yeah, so in terms of babies found in their cribs, again, they were on their stomach, which is not the correct position. Sometimes there were crib bumpers present, blankets, things like that. In terms of the babies that were found in adult bed, the other hazards that were present could have been smoking… That was one that they mentioned. That's a big no. Soft, like soft bedding covers, pillows, blankets, those kind of things near the baby's head.
And I imagine probably they didn't, I don't think they said this specifically, but like how the baby was dressed because overheating is such a factor as well. But they did mention that there were some found in chairs and couches and things like that. So we know that that's not safe.
Right. So something else that you mentioned that I think is so important for us to understand, because we tend in the US to think it's all about us all the time. But actually, other countries are doing this very well is, you know, educating parents on how to do this safely. And I think about it, like there are so many analogies we could use. But I saw recently this post where people were kind of saying "Bed sharing is always awful. It's such a risk. Why would you do it? You're a terrible parent if you decide to do this." You know, it's like we don't tell people to use drugs in a safer way and we don't tell people to drive without seatbelts and I'm just like, "Do you even hear yourself?"
My husband worked in drug prevention and homelessness and all of that stuff as a social worker and so this is just always top of mind for me, I guess, but harm reduction policies. do work for drug users. They do work. Seat belts and traffic laws also work to prevent car deaths because those things are inherently dangerous and they are not without risk. We put things in place to make sure that they are done as safely as possible so that we can eliminate as many deaths as possible. So why is it not the same with something like bed sharing? Where, yes, this can happen. be dangerous because having a baby is dangerous. Like we already said, they can also pass away in their cribs. So why are we vilifying people for this instead of offering them compassionate care and resources that they need to be as safe as possible, regardless of what they choose? And you mentioned that other countries are doing this and they're having success with it. So it's just so frustrating that we have this abstinence -only approach and that people have to get their... information from Instagram.
It's crazy because then you run into this whole other problem where it's like there's no there's no oversight with people you follow on the internet and like you know some of us do our very best to make sure that we're very careful in the words that we choose and that we're only providing evidence -based information but it's a minefield and parents are exhausted and they don't have the time to check everybody's credentials and to make sure that everybody is legit in what they say. So it's just so irresponsible in my opinion for us to not be giving parents this knowledge. And in some cases, it's the opposite where they're asked to actually sign like a waiver or something like the hospital saying that…..
Oh, I did that. I did that with my first.
No, you didn't. I did.
Well, everything you said is like so loaded, right? And I'm like, I'm right there with you like I'm fired up as well. I think like, I, I don't know, I can speculate why we do what we do. And I think that one, we, in the US, we do have a lot of privilege, we do have a lot of power, we do have a lot of money, we're looked at in other nations as let's be leading in all these policies. And I think in a lot of ways we are in some new science, new inventions, things like that.
I think when it comes to public health, let's take a backseat. We don't have universal healthcare. We should maybe not be leading the way. And so I think a lot of times when we look at other countries that are similar in funds, demographics, things like that, to us, we look at the UK and we look at Canada. They are doing a more nuanced approach in these countries, and they have lower rates of SIDS. They just do. And I think that to take such a stance that is so abstinence only, that is so rigid and so inflexible has actually increased the number of deaths that we have. I said what I said.
I'm sure that you're right, and I can't wait for all your research that's gonna be coming out soon to prove you correct.
Yeah, so okay, so let's backtrack a little bit. So I think that's because, so the Children's Hospital that I work at is one of the leaders in like, safe sleep, we've got a safe sleep coalition. Again, we have a huge, huge problem in my community. And so like I, whenever I talk about this stuff, I never want people to think that I'm against safe sleep. Like I'm really on board so much so that I'm looking at the nuances, right? Like that's the perspective that I come from. And so I also think it's just incredibly racist, ableist, classist to say other countries are wrong for doing this. Like that's just so Western Centric and individualistic.
And I think it speaks to this whole push for independence that we have in the U .S. Again, because of these systemic issues, we don't have universal healthcare, paid family leave, all these things. So parents are put in predicaments that they are not put in in other countries. It's not even a question of where the baby will sleep when everyone sleeps in the same room. It's not even a question when you only have one room in your house, right?
I was just talking to a family the other day about, oh, but I read on, you know, Instagram that you have to turn the sound machine up if the baby, you know, is unsettled. And I'm like, well, first of all, 50 decibels or less. Second of all, did the baby like in that country over there, how's their sound machine going? Is that working for them? Right? Like we just have such individualistic and US centric approach to all of this. And I think for, I will speak to pediatricians, I think there's some, some fear there, which some is valid around, are they going to get in trouble? Are they going to be liable? And it's this stance, right? Because in these cases where a CPS case is opened, they do sometimes come back to the pediatrician and say, well, what did you say to them?
Right, right. Yeah, so it's understandable. It's a systemic issue. It's not any one individual's problem. Before we wrap up, the most important part of the conversation is probably…. Okay, so how do you create a safe situation for bed sharing? How do you intentionally bed share in a way that is going to reduce as many risks as possible? So what can you tell us about that?
So for providers that are listening, the best thing you can do is say, where does the baby sleep? And where else do they sleep?
Yeah, right? Yeah. And where else do they sleep? And what's your plan for night waking? How do you plan to handle that? And does the baby ever end up in your bed? Right? Just a couple of extra questions. I know, and I know what the US healthcare system is like, I work in it too. I know what time constraints are. I know you have a certain billable amount of time, two extra questions, three extra questions, tops….. can offer a multiple multitude of information, right?
For families that feel like they have to make this choice or want to make this choice, right? There are both. If you Google, or we can attach it to here, the, you know, La Leche League, Safe Sleep Seven, there's a cute little song that you can sing to help you remember. But the most important things are that there should be no smoking. There should be a sober parent. And that is not just when we think about things like alcohol and weed. I'm also talking about like, if you are not feeling well and you're taking Nyquil, if you're taking extra doses of melatonin, anything that's going to affect you waking up to respond to your child, maybe that night is a better, there's a better situation right?
There's okay, we're going to leave the baby in the crib, or the bassinet this night, because I'm not feeling well, and I'm not sure I can wake. So the one that's a little bit controversial, and we need more research on is breastfeeding infant, right? So we know that breastfeeding infants, it is protective against SIDS for the reasons of the human milk, but also because of the way that the baby is positioned at the breast. And so if you are by feeding human milk or formula, it's still, um, you still need to have the baby on the back and positioned in the way. So when we think about that, we think about the cuddle curl position that had, you know, the hand behind the head,
your legs are curled up under you. You're in a C right around the baby on your side. And that way you really cannot, if you lay down on the floor and practice right now, you really cannot move and lay over the baby. Baby has to be on their back, lightly dressed, so there's no overheating, certainly no swaddling, and even something like a sleep sack is really too heavy, so something very light, like a light onesie, long sleeve onesie zip up. The bed cannot be too soft, and you really need to look for hanging cords for anything, like your window treatments.
Think about the position of the bed, that I get super detailed. detailed with families on like, so tell me about your bedroom. Where is your bed? Right? So are there gaps because that's a huge risk for entrapment if the baby gets stuck between the wall and the bed?
Yeah. Covers you want to have your if you do have a pillow yourself again, it needs to be up behind your own head and under your own arm. And if you do have covers, they need to be at your hip or below. The safest, safest thing to do is dress warmly and don't have a blanket. Although I know a lot of us, you know, are like, Oh, I don't like that. So you can have like an adult sleep sack is a good idea or having the covers again at your hip because the baby should be in your, in that c position. And really those are the safe sleep seven.
Okay, amazing. And I will link all of that too. And while you were saying this, I was like, Oh, I know that people are going to be like the safe sleep seven is an evidence based. It's not safe. What do you have to say about people who critique the safe sleep seven? Is it just that they're against all bed sharing? And they just are like salty that there's this research for parents? Should we, you know, do more research on the safe sleep seven to see, you know, in my opinion, it does come from research.
It does. Yeah. It does. It is evidence based. -based. I think because people don't understand research, so they like to throw around like, "Oh, that's not good research." I'm like, "Okay, well, let's talk about that," because there's different levels of research and forms of research, and they're all important. So, I think everyone's like, "Well, it's not an RCT, so we can't count it." Right. Well, okay, but how do we also get other research, right? Like, I'm doing a qualitative study right now, and that's so important because it's filling in gaps.
When you think about case control studies, it's important. It fills in gaps and gives us information. So of course, there are different levels of quality of studies, different levels of evidence. But the safe sleep seven is evidence based, right? The baby's on the back, which is based on research. The baby is breastfeeding, which is based on research, the position of the baby, the head of the baby, because sleeping with the baby on your chest, even unsupervised. So like, not a contact, like contact naps are fine because it's supervised, right? But sleeping with a baby on your chest can be dangerous if the baby's head falls down in a certain position.
So all of these things are based on evidence. Thank you so much for clearing that up because that's another one of my big pet peeves on social media. Which maybe like judging from this conversation, I should probably get off TikTok because it's just making me mad.
Good self -reflection. It's good to have like the self -reflection.
I think it's not self -aware. Where can people connect with you? And I would love to hear what you're currently working on in the research world.
Yeah, so I have a very small private sleep business in Rochester, New York. You can find me on Instagram. It's settled and soothed. So this is basically just private, you know, one -on -one sleep clients, families that are not wanting to do the cry it out methods, traditional sleep training methods, but also don't want to... take this complete wait it out and do nothing approach. So my approach is very moderate, evidence -based, infant mental health informed, attachment informed, all of those things.
And then I also, like I said, I am a clinician at Golisano Children's Hospital pediatric practice, so families who are patients there can also work with me for their sleep. concerns and they can use their health insurance, um, which most of our families, um, use Medicaid in our clinic. And so, um, I'm providing the same quality and level of care for those families as well. And then,
um, for research, I have a couple of interesting things going on right now. Um, I'm trying to figure out what's going on with breastfeeding in Rochester, New York for black women specifically. We have had so many grants in New York state, especially, um, and yet this racial disparity still exists. So I'm trying to understand what's going on there.
I have a large CDC PRAMS data set that's looking at the relationship between postpartum depression and bed sharing. So I'm sure that will be interesting. And one of my colleagues, Melissa Bartick, is a co -author on that. And I know I think you had mentioned her in one of, she was speaking out with the whole Boston Globe thing going on.
And the last thing I'm sure will be interesting is I do have a systematic review that I'm working on right now about the outcomes of sleep training. And so I'm looking at all the sleep training literature and really trying to make sense of it for families because people tend to kind of pick and choose which studies they want to talk about. And they don't necessarily talk about targeted outcomes. and all of the methodological issues. So I am, I'm doing that. It's registered. It's under Prospero as a systematic review. So that will be coming in the next year or two.
When that's done, we're going to have to do a part two with you because that's another one that, yeah, is so many things to say about that research too.
Thank you so much for taking the time to talk to us today. I really, really appreciate it and I hope everyone goes to check out your page, Settled and Soothed and read all of your amazing research that's going to be coming out. Thanks so much.
Thank you.
Thank you for having me, Rachael. It's good to be here.
I'm so excited to have you because we've been in contact really since the beginning. Like we started our accounts on Instagram, maybe in the same month. Did you start in March 2020, like peak pandemic times?
Yeah. I must have been right before you then. I think I was in 2019. But yes, it was definitely that moment in time.
That insane moment in time. And you were really like such a pioneer in the Instagram, like quote unquote, parenting expert, or you know, whatever you want to call it space, there really were not so many resources before you started your account. And I was super interested in baby led weaning as a new mom when I started kind of like that food journey. And all I had was a book, really. So like your account and your resources were so helpful. And before we kind of dive into our conversation today, I would love to just hear from you as like a mom who built this incredible business and this incredible resource for other parents. How did you do that? Because you are also a mom of three. And so I know how hard it is. And you have been so incredibly successful. So I would love to hear how you did it, where you got the idea in the first place to start this type of an Instagram page.
Yeah, I mean, it's funny because now our Instagram is actually one of the smaller sort of pieces of what we do. Our app is in the top 10 % of the world, our free food database, we can kind of look and see how it comes out. any food for a baby. And we're writing two books and we've got like 17 million visitors with the website each month or something.
It's so insane.
Every country in the world. I just found that out. Every country in the world is using our resources, which is like blows my mind. So gosh, you know, I never set out to build a business. I've actually never worked in the private sector in my entire life. I'm sort of a bleeding nonprofit heart type. No, I was very frustrated with my first go with solids with my first born. It didn't go well. He didn't like the purees. He really didn't like spoon feeding. And honestly, I'm not even sure he liked just puree as a texture. It just didn't go well. And I didn't know any other way was possible. And so I kind of panicked and kept trying to force this certain, you know, traditional method on him. And he eventually stopped eating entirely and down, down we spiraled, you know, I started pressuring him more at the table. And so when my twins came around, I remember being pregnant thinking, I cannot do that part again like that. Like, I need to do my homework with starting solids. And so I read all the books and I, you know, stumbled upon baby led weaning and all that. And it kind of was like a light bulb in my head like, oh my gosh. this is, I think what my firstborn would have really benefited from in so many ways.
And so I wanted to provide a visual resource for teaching babies to feed themselves and to show our experiment because there really was no visual guidance in terms of infographics or even pictures of how do you cut this cucumber? And you know, how can I see a six -month -old baby eating the steak? I know you're telling me that intellectually it's safe, but I need to see it for my own, for my own, for myself, I need to see it in my own eyes. And so we set out, gosh, I think my original campaign, it was originally a campaign, to be honest. I think we set out to try to introduce a thousand foods to my twins, which was, you know, we're not even close to doing but I had this ambition of like, well, if anything can be made safe for baby, like, why not try all the variety and document that and explore it and put it up on Instagram so others could learn from it.
I really set out to do a campaign on introducing, you know, quote unquote real food to babies and to really visually show that. And, you know, as you know, it caught on really quickly and kind of built itself. And eventually, you know, I tried to answer every DM at the time. And I'd be up at four in the morning answering these DMs, trying to get back to every single one. And eventually, you start seeing a lot of patterns, right? People are asking you for the same exact thing and the same exact question just phrased in different ways. And so I like, this is silly, I should just, you know, make a guide or something.
Yeah, I made a few guides. And then, not long after that, I realized with we were on to something big, frankly, and quickly assembled a team of licensed feeding professionals, a pediatrician, an allergist, swallowing professionals, occupational therapists, you know, the whole lactation consultants and the lovely algorithm, love -hate relationship there and hashtags let me to find easily finding people who are also passionate about baby led weaning and these things. And so I actually found our team or even our pediatrician and our allergist through Instagram and then just sort of vetted them, you know, real deal outside of social media.
And we discovered we were all so incredibly passionate about this, about changing the narrative and the story about how you should feed babies or how, you know, what choices you have in that venture. And we all kind of worked for free together for about three years. And just sort of recently started reinvesting the profit to grow. But I never set out to build a business. It's kind of funny to me that it is one 'cause I still don't even see it as one. But yeah, it's gotten quite big at this point. I don't think I could slow it down if I tried.
No, it's huge. And it's like, it's everything! It's such a genius name. Like people can remember it so easily. And you're like branding just the way you present the information. And like you said, it's so visually based, which I think for busy, tired parents is so helpful. 'Cause like I said, like when we started with Starting Solids, I only had a baby led weaning book. And my husband looked at me like I was an insane person that I wanted to give my son a whole florae of broccoli. And I was like, no, it's like the book says you can. Me reading the book was enough. I wasn't going to get him to read the book. So he just luckily trusted me. But now we have the app. I have a 14 month old now. And the app has been so incredibly helpful because we both just have it on our phone. If he's out with her without me, and he's not sure how to give something to her, he just looks it up quickly. And it's just so convenient.
And I love it. That's so good.
I'm not an app person either. I'm not really an app person.

No, me either. Me either. It's one of the very few.
If you're running the popular app, I would have laughed you out of town, but it just lent to, actually that, I didn't set out to build an app either. I put the free food database for how to cut these foods on our website and just make it free forever. And then every single follower was like, I really need this in an app. I really need this in an app. I'm like, really? And then we did a grassroots funding campaign and the followers essentially funded it. So it was something that organically blossomed out of, I think, frankly, being a good listener maybe, like listening to what people needed and actually taking the time to interact one -on -one with each of the community members, which is easier to do when you have 10 ,000 followers. Now it requires a large team to do that.
Yeah, right.
Yeah, I built the thing I needed when I was a mom and I wanted to kind of mom it forward in that way.
I love that so much and I love, and this could be like a whole separate conversation, but I love that you have been so real and so open about things that you wish you did differently, things that you would consider were mistakes with your first, like we all make mistakes with our first kid and with all of our kids really, but I just love how open you are about that. And I've also noticed that you've kind of started to shift away from talking about your own kids' experience so much. Can you talk a little bit about that and why you've kind of made that shift in that decision?
Yeah, you know, it's so interesting. Like I am a sort of communicator and connector by nature. I was always wanting to be a photographer, a filmmaker in some way. And so my kids are really used to me, you know, filming them and taking pictures. It's not a day when I don't have you know used to be my Nikon at my side But now it's my iPhone in my in my yoga pants pocket.
Yeah They're quite used to that and I I love storytelling and I love sharing in that in that format and to me, you know Gosh, like had I had a resource that really showed me what to do when your kid was throwing food at you and saying this is the worst dinner ever !" You can read a 300 page book about it,
but you can almost have that same leap of knowledge when shown in a real time moment. So I wasn't shy about doing that, but as the account got bigger, and honestly, as I've gotten older, my family's gotten older, my life is definitely less relatable now to a mom with a six month old baby. (laughs) That child is eight years old, right? So it's not really relevant anymore.
But yeah, I mean, we're also just shifting honestly, if I'm being candid to the algorithm as well, because, you know, back in when we started, honestly, when we started stories, Instagram stories, weren’t even a thing, that was sort of a new …. Reels and stories had not yet been formed. And a fantastic storytelling format to use in the video is kind of king at this point. But it used to be that you posted something and people saw it. And it was that simple. And if you posted it at two o 'clock, they saw it at two o 'clock or whenever they logged back in. And now I really do feel like all of us are sort of fighting with the algorithm. It's depressing everything. You're a fraction of your followers see your posts. And frankly, it's not like a great... great investment of time for us. The app is growing faster on its own without us doing anything just by word of mouth. So we don't have to work as hard and show up as much on social media as we did when we were just sort of building momentum to be completely candid, but also to like there's, you know, obvious downsides to being vulnerable in front of, you know, larger growing public, you're going to face more criticism.
You're going to get more flack. My kids are stopped on the street. People know who they are, and they're sort of aware that they're kind of a public family in that way. And that was something I really wanted to-- as much as I love the people who stop and say, hello, I wanted to kind of stop that. So yeah. Yeah, so we're, you know, I think today, most folks-- don't really know who we are necessarily, but it's just a large team of mostly medical professionals. And I'm kind of the bringing the mom lens, taking all the medical jargon and the feeding therapy jargon, putting it through a lens that I think is understandable, easily digestible, forgive the pun. And ideally visual, right? So, you know, you can kind of go, talk to a pediatrician or a swallowing therapist and they're like okay so here's the statistics on this and this is how this is going to work but like I'm going to take that information and show you that in a video so that you're like I get what you're saying I know what you mean.
Absolutely and I think that is why part of why you guys have been so successful too is you do strike such a perfect balance of like here's what it looks like in real life in real homes you show you know people from all over the world doing this for real with their real life babies. But then you also have this incredible professional base of knowledge. And I think that just helps so much with trust, right? Where you feel like, this is a place I can go to get real evidence -based information, but they're also moms who get it. And I get to see real babies that are just like mine.
And I think with something like feeding that is so key because something like like gagging or choking or a baby eating a piece of steak, like you kind of do need to see that to to fully get it.
Cause yeah, I used to get really upset if folks called us like a mom blog or just an Instagram account. I'm like, how on Instagram account does not mean that we are an Instagram team. Like, let me show you how much it costs to pay these medical professionals,
right? Oh my God.
We’re a quasi -institution at this point, sort of a medical institution, which is where we wanted to go. Now that we see we've got this momentum and tools that can be scaled and used all around the world, we're hoping to actually shift toward becoming kind of a quasi -medical institution, dare I say akin to the respect of the AAP or Mayo Clinic, but for this niche of feeding babies and our recent launch with Solid Starts Pro, where dieticians, pediatricians, lactation professionals, occupational therapists, you name it, can come get continuing education credit with our pro courses, our professional courses that are much longer and more geeky like the neurobiology is following and things like that. So I think long term, you're going to see our books out there that'll be the evergreen and how to feed babies. You'll see our app continue to grow. And you'll see Solid Starts Pro really flourish with professionals around the world coming together for conferences and learning virtually with our trainers.
So cool. When I saw that you were launching that, I was like, this is exactly what we need. And that's like one of my long -term lofty dreams, too, is providing that information for the professionals that are actually seeing the parents every single day and that the parents are really listening to. I can't tell you how many times and you probably get it all the time too. Someone will DM me right after their pediatrician appointment and be like, "My pediatrician just told me this. What do you think?" And so much of the time, it's either really antiquated advice or really kind of judgy advice and not all pediatricians. We have an amazing pediatrician. I know that there are incredible providers out there too. But there does seem to be this disconnect, right? Especially with things like sleep or feeding, where pediatricians are giving parents advice that is very conflicting with what they're seeing online.
Yeah, and we certainly experience that daily as well. We often get messages, you know, they're almost like a second opinion in nature, like my pediatrician said this, what do you think? And that shows some sort of lack of trust to begin with if you're seeking a second opinion. But in the defense of pediatricians, what I will say is that I kind of think they're set up to fail in some ways because the age range that they cover is so large.
So even if you just focused on age zero to three, like allergen science, everything is so rapidly changing, you would have to constantly be doing continuing education to stay ahead of the curve on immunology, you know, all the things involved. So yeah, in their defense, it's a really like large set of material to stay on top of.
But, you know, the other thing is just that the institutions that guide them are also very slow, you know, to get something changed at the AAP level, it could take a couple of years and by the time it's published, it's dated already again. So I think that it's nice that, you know, look, when there are gaps in knowledge or institutions and government institutions move too slowly, the people will respond and create the resources that we need. So thankfully we're nimble enough where we can do that. But gosh, I know, I wish we could get to the pediatricians more efficiently. It's one of the it's one of the challenges We're having right now that I need to crack ….. is how do we how do we get directly to the pediatrician because you try To go through the AAP it's just gonna take too long and be too slow. So we're hoping that we cracked more pediatricians to take our pro courses …. and and they're not even long Right. like some of them, you know, maybe an hour and a half two hours you get continuing education credit which you have to do anyway? So hopefully amazing can attend more conferences and get to the doctors. So the level of information that is being circulated is at least like, you know, within the last couple of years of research and evidence.
Right, right. Yeah. Parents deserve that.
I Imagine the sleep world is probably just fraught with opinionated, I would say probably a lot of opinionated dispenses of information that maybe are not rooted in any kind of evidence.
No, it's really really rough out there. It's really rough for the advice parents are getting about sleep. Yeah Yeah, I mean talk about Antiquated and a lot of it is opinion -based too, right? Like a lot of it like you said like with sleep …… There's really not tons and tons of data that we have, so a lot of it is just based on like this is what I did with my kids Or this is what worked for my other patients or something like that and It's tough. I get lots of those messages every day and it kind of breaks my heart. But that's why something like a pro program, like what you're talking about with Solid Starts would be my dream project is just something to say, "Here, doctors, give this to your patients, tell them this." I don't know. It's tough when parents feel like there's just this overabundance of information and then they don't know who to trust, who to listen to, what's right, what's not right. It's overwhelming.
My hope, and I think this will happen eventually, is that in some way, you know, solid starts disrupted a traditional norm that was held to be the way you had to do things, you know, you had to do things for baby food or a pouch, and that was the only way in stage one of thickness, stage two of thickness and gradually, what we now know is that there is zero evidence behind that approach. And actually, it was just a marketing exercise by baby food companies back in the 1950s that just sort of stuck.
But who were very successful in getting to the pediatricians, by the way, you could get a free sample of whoever from your pediatrician if you wanted, because, you know, money and marketing, they did their thing. So I'm hoping to reverse some of that pathway, but through the public, right? So now we've got parents asking their pediatrician. about Baby Led Weaning and we have parents asking their pediatrician about alternatives to a hyper -controlled food feeding kind of approach or just, you know, rice cereal or texturalist food.
And the pediatricians are starting to realize that they're behind the curve if they don't have the actual answer to that. So in some way, the public demand is the parents are creating the demand in the pediatricians. And I think they'll have to, they'll have to kind of catch up sooner.

Yes, that's so true. Okay, I want to come back after the break and talk about what you just said, which was kind of like the spoon feeding versus baby lead weeding. We'll be right back.
Okay, Jenny. So let's talk about this whole idea of baby led weaning. I don't know about you, but I obviously am a consumer, not only a creator, but I'm a consumer of social media content. And one thing that I see a lot of is this idea that like, there's baby led weaning or there's spoon feeding, and you have to pick one. And there's one that's superior. And if you don't do it this way,
you're a bad mom. What do you have to say about that? Because obviously, solid starts is a great, like incredible resource for baby led weaning. But there are still a lot of parents that are scared to try baby led weaning, or that decide they just really don't want to do it for some reason. So what is kind of your take on this like mommy wars or culture wars about like baby led weaning versus spoon feeding?
The dichotomy is not helpful and it's also unnecessary because when we really look at the positive aspects of let's say both styles, starting with a spoon feeding of texture less food, you know purees that type of food. approach versus letting baby feed themselves, pick up finger food or table food. When you really look at the benefits of those things, what we really see, like the biggest benefits in my opinion, baby led weaning is, well, first you've got the neurological choice, baby decides to eat, which is both good for building a good food relationship. You know, I'm deciding what I eat and what goes into my mouth when and how quickly.
But also the trust that's really kind of built into that relationship, I'm going to trust my baby to pick up that food, put it in their mouth and to stop eating when they're full. You know, what's really interesting to me is that, and I think this goes back to bottle feeding and breastfeeding, there is a term called responsive feeding that's kind of, in my opinion, rising from the ashes. So if you have a canyon and you've got spoon feeding on one side and baby lead weaning on the other side, put any two things in parenting on those sides, sleep training, go bed sharing, formula, breastfeeding, whatever the camps are, you've got a canyon in between. And when it comes to feeding, I really want to know all the quote -unquote methods to go away.
This is food. We all need to eat. We all need to sleep. There doesn't have to be a method for every single thing in our lives. There doesn't have to be a method for a particular diet or a particular way of exercise or a particular way of practicing, you know, runs, whatever. I'm kind of done with methods. What I would like and what I think we're seeing and what I'm hoping to foster is this refocusing back on what is called responsive feeding, not responsible, but responsive feeding, which is basically just being in tune with your child, feeding them when they are hungry, stopping when they are full, honoring and trusting your baby throughout that process, knowing that they will communicate. Trust that they will communicate to you when they're hungry, and that they'll communicate fullness as well. And that just because there's a little more left in the pouch or the jar, doesn't mean you need to be scraping the bottom and getting that one more bite in.
If baby is full, baby is full, you can stop. Or if baby just not having it, right? Even if you think they're hungry, then it's time to go back to that, you know,
bottle or breastfeed. That's okay too, especially in the first, the first year of life where that's a primary source of nutrition anyway. So my hope is to actually refocus everyone on what really matters here, which is trusting your child and whether that's trusting them to grab the spoon from you and to put That puree in their own mouth or trusting them to pick up a piece of finger food and To know when they're full hungry versus you know all of that to me it really comes down to trust.
And I think if people need a name to attach to it, let it be responsive feeding. We actually dropped the baby -leaning moniker from our account a couple of years ago, because what I was really realizing is that, well, first I didn't want to further the dichotomy. And look, I can be a pretty forward and candid speaker in these forums. And, you know, people probably see me as a baby -led -weaning advocate because I talk about the neurological, the science -backed reasons to let baby feed themselves. But what we're really talking about is not withholding chewable food from babies. Because what we know is that from six to eight months of age, babies have built in automatic reflexes that help them learn how to chew. And it's not that if you start introducing chewable food at nine or 10 months of age that baby won't learn, they will, of course they will. Like your grandmother said, well, I was fine. She was, she will be. But it's easier to do from six to eight months of age.
And in a lot of ways it's safer as well because the other reflexes that baby has from six to eight months of age that are really kind of prime and sensitive are the protective reflexes against choking. They're kind of at their all time high in the six to eight month age range. So it's like this beautiful magic window that you've got where baby's body is primed to teach them how to chew through repetition and automatic reflexes. If you put your finger on baby's gums at five month olds, they're going to bite down on you. And that happens that that kind of phasic bite reflex continues to happen through six to eight months. The protective reflexes, tongue thrust, gagging, coughing, these are also very sensitive in a six to eight month old baby.
But some of those start to fade with age, meaning like for you and I to gag on a piece of food, that food has to get pretty far back in our throat to elicit that kind of retching motion to protect it from getting into the airway going down the wrong tube. For a baby to gag, it only has to hit the middle of their tongue, so that reflex is further forward in the mouth. So from a feeding therapist's perspective, and our feeding therapists teach the neurobiology of swallowing as well as the neurobiology of choking, they love that magic window, that six to eight month period of time, because not only is the body primed to learn how to chew food at that time, but without maybe even necessarily trying the... protective reflexes are super sensitive So it creates this kind of fertile environment for learning and safely making mistakes.
We like to say we're not worried about the six -month -old with the hunk of steak. We're worried about the 12 -month -old that's never had any chewable food. The pincer grasp and can pick up small toy parts or small, you know a peanut or pistachio shell…. When you look at choking data in emergency rooms, we've analyzed, oh my gosh, like exhaustively for the last five years, the likelihood of choking is actually higher in toddlerhood.
But overall, the risk of choking is actually really low. It's less than 1%. Really? At age 4… This is a misconception that media has sort of, I think they misinterpret, I think like you know, like Fox News or whatever, you know. they misinterpret the CDC data, which is categorized kind of oddly. It's you have to really know what you're doing to make sure you get it. And what happens is media will report like, choking is the leading cause of death under age four, when it's actually like far from it, it's less than 1%.
And half of those instances are not on food. They're on marbles, batteries, jewelry, grandmas, you know, know, whatever. Like it's, if, in a lot of ways, our worries about choking are far out of proportion with the statistical likelihood of them happening. So I'm sorry.
Oh my God, I mean, that makes me feel so much better because my followers that have been with me for a long time know that choking is like my number one phobia with my kids, even though it's never happened.
Yeah, it's never happened, but I, used to get, and I still do sometimes, like the worst anxiety when I knew my kids were going to be with somebody else and that they were going to be eating. It was just like my thing. And I still get comments like I posted a lunchbox idea the other day for my six year old. And someone messaged me like, aren't great tomatoes and string cheese major choking hazards as per solid starts. I'm like, guys, just because because like a baby could choke on it does not mean that I can't give it to my six -year -old and you're not helping me with my choking phobia, please. So that just made me feel so much better. I love it. So I've got to watch out for the marbles and the batteries and the Legos instead."
Yeah, and email me and I'll send you the data too because, you know, what's really relevant for your audience and your account, Rachael, is that the sleep issues and SIDS are really far outweigh, unfortunately, the fatalities. The things we should really be nervous about as parents are suffocation and sleep, whether that's a pillow or a blanket or a body, human body, and drowning, bathtub, pools, any body of water. It's not intuitive even to toddlers that they can put their hands down and push their chest up out of the water. So if you actually attend like, you know, swim classes with babies, then if it's a really good class, they'll teach the toddlers in shallow water how to push up their hands. But it's really, it's car accidents, it's drowning, it's SIDS, it's sleep. um, stuff, choking. You know, if we, if you did a line chart, you wouldn't even see a line because it would be so flat.
Oh my gosh. Okay. That makes me feel a lot better. So what then would be like, if someone has major anxiety about starting solids, regardless of what philosophy, I don't even want to use the word method because of what you just said, um, regardless of, you know, their philosophy with how they approach food, what would be like the number one thing you would tell them to ease that anxiety to feel confident and feel comfortable with giving their child food?

Yeah, I have three things. First, the research shows that when humans feed themselves regardless of age, the choking risk is infinitely lower. And think about it. It makes sense. Think about someone else putting food in your mouth. You're not really ready for it. it. But when you're talking to you, look at the food, you decide, I'm going, I see that food. I'm going to pick up that food. I'm intentionally placing it in your mouth. Not only are your salivary, I don't know the term, you start salivating. Your brain starts to prepare for eating. And you are much more ready to coordinate all the 50 muscles that are required for thorough chewing and safe swallowing. So self feeding is actually one way to reduce the risk. If you're not ready for table food or finger food, let baby grab the spoon from you. That's really important. So number one is let your baby feed themselves.
Number two, if you're really anxious about choking, start with food teeters. So when it's, you know, when you're, you know, moving, moving past purees or whatever your next step is, look for unbreakable foods that baby can't take a bite of. So the seed of a mango pit, like the inner seed of a mango, the mango pit, you can take off most the fruit and let baby kind of teeth on that. They're getting a little bit of the fruit, but they're also poking and prodding their mouth and strengthening their jaws at the same time. So it's a low risk, high reward type of food. Other examples of that. would be like corn on the cob. If you're really nervous, take all the kernels off. The cob will certainly advance the chewing skills and the reflexes and help baby's brain form mental map of the mouth with all the poking and prodding it will do. We have a list of these foods on our website at solidstarts .com if you just put in teeters. And you go, oh, can't they learn that with a rubber teeter or a silicone teeter? They can sort of the brain learns best in context. So the brain learns more quickly if it's about eating food, using a food teeter will advance those skills more quickly.
And the third thing I would say, even though the choking risk is less than 1 % under age four, and that includes babies, even though it is very unlikely that baby will choke, the baby's body is really designed to protect itself. There's multiple layers of defense when it comes to preventing food from going down the wrong tube and into the airway. Even then, still do the infant rescue maneuvers, you know, watch those. We have a course that shows them with real babies, both toddlers and young babies, because I took the course, but like you're working with a doll, for like a come on, not really as shabby or as wiggly or as scary. So that was one of the things when we built our video courses, I wanted to show, have our doctors and show the maneuvers with a real screaming child, like a real, you know, like show me how this really works.
Do those and know it like the back of your hand, put we have a free infant rescue guide you can put on the wall, it's visual, put it, you know, where your baby is eating so that you're never having to look up the the instructions in the moment. Because the thing is that once you know those maneuvers and you understand that they are extremely effective, you start to feel more comfortable because you're like, "I know what to do. I really know what to do." I liken it to when I had to first use the EpiPen with my firstborn who had a severe allergic reaction. We knew he had allergies by that point, so I had all the equipment in the house, but I never had to use it until this one day.
And you know, it's a big needle. It's a big needle. It was so scary. So I called 911. Even though the instructions are on the EpiPen, I just I kind of wanted 911 there because he was having an anaphylactic reaction and starting to stop breathing and all of that stuff. So I called 911, I put it on speaker and he said, Okay, open the EpiPen, pull it out. And then he said, You're "This is what you're gonna do. On the count of three, you and I together, you're going to put that into his thigh. Ready? Let's go. One, two, three, swing, boom." And within seconds, he was fine. It was like magic. It worked out like instantly.
And by the time the firefighters banged down my door and came rushing in, he was like playing with a toy, we're like, "Hey, guys, what's..." up? I share that example as terrifying as it sounds, because after I did the EpiPen that one time, I was no longer afraid. And hopefully you'll never need to use the rescue maneuvers in the situation of choking. But well, actually, you want to know what's more likely, probably going to save someone else's child in a restaurant. People always ask us, you know, whether it's distractions or Disneyland, whether it's popcorn or a movie theater where there's a big distraction, sudden noises. People always ask us, you know, do we need a life vac? Do we need a choking, an anti -choking device, these like suction devices and the initial research and we've done thorough testing of the products ourselves our doctor has. The initial research is, it's promising to be candid, it's promising, but it's highly unlikely you're going to have it with you.
Right. So I don't want parents buying these devices in lieu of knowing proper CPR and rescue maneuvers. Because if you're not going to carry it with you to Disneyland, you're not going to have it on the airplane, you're not going to have it at a restaurant. At some point when you get comfortable, you think your toddler's eating really well, you're going to stop caring about it. And that's likely when something could go wrong. Sort of like when we let our guard down, there's a lot of distractions going on, maybe eating a food the child is not necessarily comfortable with, they're talking, they're laughing.
The real way to reduce the risk of choking is actually typically about the environment the child is in. Are they sitting completely upright? Yes, check. Are they sitting down, first of all? A lot of toddlers, if you look at the emergency room data, they're running around with high -risk foods like popcorn, candy, things that are served at picnics outside. There's a lot of freedom to eat and run. You want to create a safe eating environment that is ideally calm, free of distractions, upright, high chair, no reclined eating, not even a bit.
Don't feed in the car seat, don't feed in the stroller, pull the stroller over for a little bit. When you are on the go and you're stuck in traffic and they're screaming in the back, that's a great time for a pouch, right? Like something super low risk that you're not going to have to worry about. It's going to be messy.
But you know what though, I recently found these incredible toppers for pouches on Amazon and they're life changing because I can give it to her in the car and she won't squirt it all over the place. She has to bite a little bit on it or something. I don't know.
Nice. Nice. Love it. I love it. Yes. We want to create a safe environment. environment and just also just know that your baby's body really has their back. It is physiologically designed to protect itself.
I love that. It comes back to what you were saying at the beginning all about trust, right? Jenny, right when we come back, I wanna talk about pickiness and I wanna ask you about what you would do differently right when we come back.

Sounds good.
Okay, we're back and Jenny at the top of the episode you kind of talked about how you approached feeding with your first and it in your opinion led to some picky eating and picky eating is something that probably many parents deal with if not when they're babies then when they're bigger kids. I used to brag all the time about my kids eating because I was like oh we did baby led weaning they're not picky at all they eat salmon. They eat absolutely everything and now they're four and six and I make a delicious dinner every night and most of the time they say, "That's gross. I'm not eating that." What advice do you have for parents for preventing picky eating if that's even possible? And then when the inevitable picky eating phase comes, how do we approach that?
Such good questions. I love it. Okay. So, first of all...there's a difference between run -of -the -mill toddler selectivity and what a feeding therapist might classify as severe picky eating. There's a really big difference. When we talk about, I think when parents talk about picky eating, most of the time they're talking about toddler selectiveness, which looks like they used to eat broccoli and now they don't or they used to eat this and now They don't or they used to eat chicken and now they won't and the difference between that and true picky eating is more like intense screaming at the table because the texture is like freaking them out or Unwillingness to even touch the food because they don't want to get their hands sticky or slimy or only eats like maybe less than 20 foods and that's it….. is brand loyal.
I can't eat those chicken nuggets because they're not shaped like dinosaurs or I won't eat those chicken fingers at a restaurant because they're not like the ones I've had at home. So you can start to see this actually a really big difference between what we would call toddler selectivity and picky eating. And we have on our website solidstarts.com a questionnaire, you can kind of take yourself through to know like, which bucket am I in here? Is this the regular type?
That's so helpful.
Yeah. Yeah. It sounds like there's a sensory component too. Sorry to interrupt you, but it sounds like there's a big piece of it, the sensory.
There are often ways but not always. What's actually at the root of most severe picky eating tends to be, if you put neurodiversity aside, just put that aside for a moment because that's sort of a small percentage of the cases. It tends to be anxiety and that can come from a number of different ways. If they've never been allowed to touch food or have been taught that food is dirty, you're so messy. I'm going to aggressively wipe your face right now that if they've been force fed, they're scared to come to the table. If they've never dealt with any texture, food in their mouth…..they may be gagging intensely. I used to share with folks that my four -year -old would gag on the same food more than my eight -month -old twins when he was four and they were eight months because he never... I delayed... I had him on purees until he was almost two.
So when when he was first introduced to chewable food, he had no idea what to do with it in the mouth. His brain was confused. His body was confused You know, he's mostly been living off of smoothies and purees and pouches because I was so afraid. So once we separate toddler selectivity and picky eating just kind of know that they are very different. But the term picky eating is kind of used interchangeably. First let's talk about the regular toddler situation because that's actually the more likely scenario right?
Let's move on to story time and breakfast will be there tomorrow. And what happens in this moment where toddlers start kind of trying to control food,
it's one of the only things they have control over at their age, which is one of the reasons we love offering choices served at the same time. So don't just put like this, you know, one chicken and this, you know, one vegetable, like, hey, should we have broccoli or bell peppers tonight, or even offer them both at the same time and small portions, and the child feels they have a little bit of choice in the agency in it.

Toddlers are sort of wired to push back, they're wired to push boundaries, and when they see it bothers you, they kind of like it, and they're going to do it more.
It's so much more fun for them.
Yeah, it's so much more fun. And it lasts for a long time, this phase. It can last for two to three years, and so people start thinking, "Oh, I did baby led weaning, and now my child just eats chicken nuggets and whatever.
And so it failed. It didn't work. It actually has a lot more to do with the parent -child relationship than how you started solids. So yes, there are lots of studies that show the more variety, colors, textures, mouth tastes, flavors, whatever a child a baby is exposed to before 12 months of age, the more likely it is they'll be open to new foods and to eating vegetables. That's true.
That is true.
But most children will go through a period of selectivity where they kind of will winnow down what they're willing to eat. It's in that moment as a parent where you can kind of nudge them into the lane of exploring and learning or you can reinforce the problem. Right? And I think we've all had these days where just like screw it, just eat goldfish for dinner. Like, I don't care. You know what I mean? Like, you're just like done. And we call those short game days, at solid starts You're allowed to have them. You know, you have the poop blow out and one hit over there and this toddler is jumping from the window over there and you just burnt dinner and like you have short game days. It's real. It happens.
You got to pick your battle sometimes.
It's okay. You know, goldfish for dinner would have left over pancakes and they're like, it's okay. Food is food. But what we want is to kind of refrain from is engaging with that downward spiral so let's say your toddler says I am NOT eating your chicken that's the worst chicken ever and throws it across the room and I only want chicken nuggets that's the only thing I'm gonna eat is chicken nuggets…. chicken nuggets chicken nuggets chicken nuggets and so tomorrow you serve chicken nuggets because you just don't want to deal with the tantrum or the breakdown. When we start kind of only serving what is being demanded at the toddler level, we end up reinforcing the problem and you're going to downward spiral and you may end up together, end up in a more severe picky eating situation. We like to say don't go back to the kitchen. Think of it. Think of how to try to prevent that scenario at the outset.
Okay…. so let's say the child hasn't eaten any protein in two weeks, you're kind of panicking, you want some protein in the meal. Let's make two chicken nuggets available and then the rest of the chicken that you planned that night. And this is all we have for tonight, but you have a choice of these nuggets and this chicken drumstick and this rice and these vegetables. And at the moment when they eat the two chicken nuggets and then demand chicken nuggets, we don't have any more chicken nuggets on the menu. tonight, but you have rice and you have this other chicken. Do you think you should chop this chicken or eat it off the bone? I'm gonna take a bite of mine, eat off the bone and see if that tastes good.
Well, I wonder if I dip mine in ketchup if it'll taste good. Is there something we could add to this? And you start kind of getting them in a mode of problem solving and exploring and self kind of owning the situation, being in control of solving the problem at hand, which is there are no more chicken nuggets on the menu tonight. You can set a boundary there. Boundaries are okay. It's not, you know, evil to…. children need boundaries. It's okay. We kind of call them loving boundaries. You can set a boundary, but you know, you can also try to prevent the situation from happening, which is like, okay, let's make some... choices available at the served at the same time. Don't have a pattern where you go back to the, okay, if dinner is thrown out, okay, let's go have a bar, right, like those things that happens and it really reinforces the problem.
So I think I've got a little off topic here, but you wanted to talk about preventing picky eating for the mothers with the parents with the young babies here who want to actually avoid picky eating. I would say as soon as you feel comfortable, as soon as you feel comfortable, serve your child the food you are eating, serve the family meal as soon as you're comfortable. Our feeding therapists with their second, third kids, like after they've gotten comfortable, they don't even do like they just offer exactly what they're eating.
Oh yeah. It's so much easier that way.
And you can adapt, you can use our app to adapt. the chicken or whatever you're serving that night to see how do I cut it in a safe way for a baby's age and eating ability. Serve the same food. And when you start getting to that toddler moment where they're like, I just want a snack. I don't want that. I just want this thing in a package. I don't want that. You have a choice of how often you make those things available. I love serving snacks and desserts and things that kind of tend to steal the show…. to be honest, in unlimited quantities at snack time. Because then the child has a choice, like, I'm going to have cookies or popcorn or whatever, this bar for snack. And it kind of gets it out of the way. And there's no limitation or restriction on it. It's like, this is what's available for snack, which one would you like? Get it out of the way, maybe serve a glass of milk, there's a little protein with it.
And then by dinner, it's just what we're having. And that's that. That's what's on the menu.
I love that. Jenny, before we go, this has been such an amazing conversation. Thank you so much. And one thing that I always try to ask parents that come on the podcast is, what is something…. it could be food related or completely different? What is something that you wish someone had told you before you became a mom for the first time?
Well, I wish they had told me that I should introduce finger food or chewable food earlier than I did. But then I wouldn't be here, I don't know.
Right, I know.

That's probably my biggest pain point as a parent was just not having enough information about solids. Now I think the pain point might be that there's too much information, you know, social media, there was like, that wasn't a thing when I was a parent, right? I just got like a tear off from my pediatrician that was like a half a piece of paper with four tablespoons of rice cereal.
Oh God.
And it was like, no. That’s all I get here, because this is super scary. So for me, it was that. But I think, I don't know. I guess my advice at this point is choose your people wisely. The algorithm is going to push all sorts of stuff in your feed, and it's going to push advertisements for different things in every aspect of your life, whether you know what's happening or not. Find the people whose values seem to match with yours, sort of parenting philosophy or life philosophy. Check the background. Are they the real deal? Is there a real team here or is that just the blog, right?
Let's check the background. And if those two things match up, then honestly, just follow one or two and put your blinders onto the rest of it because you can trust your gut before all of the books and accounts and everything else. We just had our little villages and our gut and most of the time your gut is actually going to be right. I'd love to see this next generation of parents trust themselves and their babies a little bit more.
So well said. I completely agree. Thank you so much, Jenny. Where can everybody find your amazing resources?
Yeah, so our app is the most popular thing. You can just go to the app store on iPhone or Android, Google Play, and download the Solid Starts app. Look for our blue logo. The full database of how to cut foods is also on our website at solidstarts .com. So there's lots of resources there. And we have guided meal plans and things like that for the folks who want to have a little bit more of a handheld process. So solidstarts .com, get everything there.
Awesome, yeah, the guides are amazing. There's so much information about allergies and choking and gagging and serving sizes, portions, like everything that you could possibly need is there. So thank you so much for just providing such incredible resources for us parents who had no idea what we were doing. But now we do. Thanks to you guys. So thank you so much and I will chat with you soon.
Sounds good. Thanks for having me.

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