#31: Infant Sleep & The Connection To Working Parenthood

This episode is a replay of our “ask me anything” interview with Dr. Harvey Karp we hosted back in 2023.

Dr. Karp is the CEO of The Happiest Baby and creator of the SNOO Smart Sleeper, who has 25+ years of experience as a pediatrician, sleep and child development expert.

In this interview, we dug into topics like the cultural evolution of what newborns need and the hidden benefits of a smart sleeper like the SNOO.

We also fielded questions from our community of working parents to cover all things infant sleep and its connection to working parenthood.

If you've ever asked yourself how you're supposed to go back to work in the middle of a sleep regression, or if it's really possible or even recommended to sleep train a newborn, this one's for you.

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Allison: And so without further ado, I am thrilled to welcome to the virtual stage, Dr. Harvey Karp. Thank you for joining us. 

Dr. Harvey Karp: Thank you, Allison. Happy to be with you.

Allison: So I guess first things first, I assume that everyone on the line knows about the SNOO. Everyone I know loves it, knows about it. If they haven't used it, they wish they had. But why don't we start with just a really quick 90-second overview of what is the SNOO?

Dr. Harvey Karp: So SNOO is kind of short for snooze and it's a baby bed bassinet, but it's really the most advanced bassinet that's ever been created. We call it the SNOO Smart Sleeper. Here's the crazy thing in our culture.

Babies inside the womb are constantly held. They're rocked every time you breathe, your diaphragm is rocking them, and the sound is about as loud as a vacuum cleaner. And then we give birth to them, and we suddenly take it all away. It's like we say we don't want to become dependent on it. But how would you like it if we took away your bed, your pillow, your comforter, and said, why do you need all those things? Everyone else sleeps on the floor.

So SNOO will give babies the rocking and shushing and the SNOOg holding safe swaddling of the womb, but then it also responds. So when a baby fusses, the bed will go through several levels of motion, perfectly designed to imitate an experienced caregiver.

So there's motion and sound that happens about half the time we can calm crying within a minute and half the time we can because the baby's hungry or has another need. And then the last part of this has a special type of a swaddle called a five second swaddle that's very safe, very easy, and this swaddle attaches to the bed so babies can wiggle around, but they cannot flip to an unsafe position.

Allison: And remind me, founding story, when you started working on this, when you launched, because it's been a while, and I think that's one of the things that people are sometimes surprised about and comforted by, that this isn't actually a new thing. You've been doing this for quite some time, so I'm curious for you to share a little bit more about how you came up with the idea for the SNOO and what has happened since then.

‍Dr. Harvey Karp: Well, it really started. I mean, I was teaching my book, The Happy's Baby on the Block, and the video and things like that. We trained thousands of educators teaching baby sleep in WIC programs and universities and military centers and things like that. But despite over a decade of teaching that, parents were still struggling.

The number of infant deaths didn't go down. The number of women with postpartum depression didn't go down. I was giving a lecture saying that 3,500 babies die every year in their sleep. Turns out that hasn't improved in over 20 years. 300 babies every month. It's terrible. And what I was saying in this lecture is that if another country killed 3,500 of our babies each year, we would go to war. We were, there's nothing we could do to stop it. These are perfectly healthy babies who just happen to roll over or they're brought into bed with their parents sometimes. 

And so the question was, could we do something to reduce the death rate? And that's really why my wife and I started this company about 10, 11 years ago. And then for the first five years, we worked with MIT Media Lab engineers and built prototypes. And I was flying all over the place, Boston is where we did most of the research. And so we were testing it on hundreds of babies because we needed to make sure everything worked, which it did. And then we launched it six and a half years ago.

Now we've measured about 500 million hours of infant sleep. It's like McDonald's, you know, those millions of burgers. And thank you so much for mentioning it. And we just last week got FDA de novo approval as the first bed that secures babies on the back, which as everybody knows is really the number one way of keeping your baby safer.

Allison: Can you share more about that FDA approval process? Because I have some other friends in medtech. It's a big process. It takes a really long time. I think it would be interesting, even if I'm putting on my parent hat right now. What does that mean for a parent? I just used the SNOO. Now that I know it's FDA approved, what did that process look like to get there, and what does that tell me as a parent?

Dr. Harvey Karp: Well, I mean, years, it took years, because the FDA's first job is to say, is this safe? And how do you prove to me this is safe? So we gave them data on 100,000 babies. I mean, an enormous amount of information to demonstrate that… putting babies in this was going to be completely safe for them. And then the other part of that was, can you prove that it keeps babies on the back? And so we submitted video tapes and things like that to demonstrate efficacy for keeping babies on the back. 

The reason that was important is because everybody, the CDC, the American Academy of Pediatrics has proven if you keep babies on the back, it reduces the risk of SIDS, reduces these deaths, because the babies, for the most part, die when they end up on their bellies. For parents, I think that having the FDA approval is a nice thing. It's a good thing to have, but I think people already knew that this was safer. Everyone who responds to us says, oh my God, I had peace of mind. I didn't have to worry. I didn't have to check and check that my baby rolled in the middle of the night. 

But for insurance companies and corporations and governmental agencies, that FDA validation is extremely important to allow them to spend some money to help support employees and subscribers and things like that. So I think that's really the main… new advance.

Allison: And from a business perspective, does getting that approval change anything? I mean, I think from the consumer's perspective, you're right. So many parents already trusted it, knew it. So it doesn't really change theoretically their perspective, but does this allow you to sell in a different way? I read that possibly get reimbursed or fly insurance. Tell more about what that means for that side of the story.

Dr. Harvey Karp:  So our goal from the very beginning was not to sell an expensive advanced baby bed. It was that everyone gets a free SNOO. You know, I was retired already. My wife and I were retired. We weren't looking to start a startup. The goal was to affect change in the entire culture. So that's really where we're headed towards. 

And ultimately insurance companies and governmental agencies will subsidize this. We're working with the state of Virginia. We've had over 5,000 active duty military use these beds. But the first step with the approval is now we're going to get HSA and FSA approval, at least it's tax deductible. 

And then the validation from the FDA allows us to go to insurance companies and say, guys, if you wanna keep your baby safe and help your parents, this isn't just our idea. The FDA has vetted this thoroughly and they can vouch for the fact that it's safe and effective. And so that gives people more confidence. Then we're working with various insurance companies now.

Ultimately, and I heard you say that there are HR folks and benefits folks on the call, and we have over 60 companies that give this as a benefit for their employees. And seriously, we have a very quick return on investment. The companies make money by providing this for families through improved productivity and recruitment and retention and reduced errors and accidents and absenteeism and liability. 

And even hospitals, like Children's Hospital of New Orleans, give this to all of their employees. Last couple of years because they started using it in the hospital and they saw how incredibly effective it was for the babies. The nurses said, hey, what about us? You know, we want this too. So our goal has always been 100% of people get this subsidized.

And so now our big push this year is actually bringing on more corporations. We've got JP Morgan and Under Armour and Snapchat and Hulu and Inspire Foods like Sonic Burgers and Dunkin Donuts and the National Air Traffic Controllers Union. And NFL football teams. It's really been very exciting because more and more companies are doing this to compete. You know, they know that recruiting young people in the parenting age is really where they're going to, and retaining them.

So McKinsey had a survey a couple of years ago showing that 34% of women after having a baby didn't return for at least a year. And that means you have to recruit, retrain, go through all of that painful process.

And even if they do come back after a month or two, that's actually when the babies still aren't sleeping well, so they're tired and there are all sorts of issues with bringing people back when they're not really fully ready to be there.

Allison: So here's the interesting thing that's striking me. We spent the first 10 minutes talking about how this is saving lives, and clearly this is an incredible thing for her for saving lives. But what I'm feeling guilty about as a parent is the reason I used it was actually to get more sleep. 

Now, maybe it's because it was my third kid, so I was less nervous about SIDS, which I should not have been, as you mentioned. You know, there's a lot…I don't wanna say by the time you have your third kid, you're not at risk for that, but I think my fear was a little bit less on that. And my main goal was: I wanna sleep more. 

And I think what's interesting about this being offered as an employee benefit is, yes, now the FDA has said it is successful at keeping babies on their backs, which is safer. And so everyone should care about that and that's great. But I do wonder, are companies more drawn to the fact that if you can give better sleep to their employees, they're going to come back more productive? Because at least from a personal perspective, that's why I wanted to use it.

So it's just funny because I'm feeling bad about myself thinking, oh, I didn't even think about that when I wanted to use this new eye.

Dr. Harvey Karp:  Well, but three, you deserve an extra hour or two of sleep. I mean, you need it. Hey, listen, honestly, are you a better parent if you get an extra hour of sleep?

Allison: Absolutely.

Dr. Harvey Karp: And you're healthier and you're more available for your family. There's a big lie in our culture, which is that parents are supposed to do it all. The normal family is, you know, two parents and a child. That is the most abnormal family that ever existed.

The normal family is two parents, a child, grandparents, cousins, aunt and uncles, dogs and cats and goats and things like that. And that's really important to understand because parents think they have to do everything and do their job and post happy pictures on Instagram. And they feel like failures if nothing is going according to plan. And they need to be there every second that the baby wakes up. Well, not really. I mean…

If you live with your grandparents and your parents, they would be holding the baby as much as you're holding the baby, and you would be doing other things, which would be fine. You wouldn't feel guilty about that. So using SNOO is not a cheat. It's really a safe swing, if you wanna think of it that way, but a smarter swing that's giving you a chance to get some rest so you can be the mom or the dad or the parent that you wanna be.

Allison: Yeah. When I first came across the SNOO as a corporate benefit, we run these parental leave audits. It's kind of like a consulting project where we get brought into really large companies and we survey everyone who's gone on parental leave in the past two years and their managers, and we get feedback on all sorts of things. What are the benefits that you liked? And the feedback, we had one client that we did this with and they offered the SNOO as a corporate benefit and the feedback was just raving. And it was so fascinating to hear them talk about the direct impact to their work.

And that's where I thought this is so interesting because it actually is pretty cheap in terms of like the line item budget for companies. What they're doing is they're renting it. They're not buying a SNOO for everyone, they're renting it. So maybe share just 60 seconds of tactically what is that corporate rental program? Because I just think it's a really smart benefit.

Dr. Harvey Karp: You know, the joke is that if you have a baby and then a friend of yours brings over lasagna and says, Allison, just eat it. Don't even clean the dish. I just want you to know I'm taking care of you. 20 years later, you'd be joking about, remember you brought that lasagna over to my house? 

So imagine instead of a lasagna, your employer gives you a 24 hour helper that gives you more sleep, a safer baby, sleep trains your baby, and helps you out all day long when you're taking care of your toddler and showering and things like that. You're gonna feel loyal and appreciative, and that's why people are over the moon for this as a benefit.

I do have to say though, the whole idea of parental exhaustion, which people say, well, that's just normal. You just have to suck it up and deal with it. Actually, there are three jobs that parents have, main jobs when you have a new baby. Feed the baby, calm crying, and get sleep, shampoo the hair and whatnot, all that, you'll figure it out. But if you fail at feeding, if you fail at calming your baby, your baby's crying for hours and hours a day, or you're not getting sleep, you feel terrible. 

We literally train Navy SEALs to endure torture by putting them through sleep deprivation with the sound of crying babies over loudspeakers. It's hard and it's harsh.

Allison: I would love to start throwing some Q&A at you. We got a lot of questions about sleep. Take advantage of your time here.

First question is around sleep regressions. We actually hear this a lot in our return award group coaching, which is many… Companies have a four month paid parental leave. That's sort of the norm that we've seen in corporate America trying to attract top talent. But then we hear a lot about the four month sleep regression. 

What is a sleep regression? Is it real? What is happening? And what is your advice for that four month or any other sleep regression?

Dr. Harvey Karp: Yeah, it is a real thing. Not every baby goes through it, but it's a real thing. And actually there are many sleep regressions that babies go through. Sleep regression just means that they were doing so much better last week, what happened? It can be teething, it can be growth spurts where they need more calories, it can be developmental change. So around four months what's happening is babies are waking up to the world, they become more social, they like to goo goo ga ga with you, but they wake up and they go, wait a second, I know you're there somewhere, and so they call out.

And so the four month sleep progression, and it really can be a three to four months because some babies are getting there earlier, is this waking up in the middle of the night feeling all alone. It's no baby's idea of a good time to be 12 hours on the back in a dark, silent room. You might like sleeping like that, but no baby wants that. They want to be held and rocked. And so when they wake up in the middle of the night, they look around, they go, where did you go? And what happens is if you fill that environment with soothing, you know, sensations. 

And that can be a white noise machine that can be swaddling for the first couple of months. We have to stop swaddling once they can start rolling over. Or in SNOO, they can be swaddled for six months. They get the white noise and the motion and a responsive motion.

So what happens is when they wake up, it's kind of like you when you're on an airplane. And in the middle of the trip, you know, you fall asleep and then you wake up, you look around, but there's still the humming of the motor and whatnot. And then you close your eyes and go back to sleep. 

That's what happens in SNOO. And if they're alone in the dark, in the silence, they tend to wake up and they want attention. But your point is exactly right. At four months is when they're going back to work and suddenly when the baby's waking up every two or three hours again, that becomes really burdensome.

Allison: Yeah. You mentioned white noise. We got some questions about that. Noise machines, what is the science behind them? How long should we rely on them? Are they ever bad? Do we need to cut them out at any point? Curious what your thoughts are on, in general, white noise machines.

Dr. Harvey Karp: Why do you use white noise? Because the sound in the womb is a white noise. And so the babies, when they hear that, they go into more of a sense of calm. Even adults sleep better with white noise. I recommend it at least for the first year, but many people use it beyond that. And I know people sometimes say, but then they're addicted to it. But, you know, are you addicted to your bed and pillow? Well,

Maybe, I don't know. You're always gonna pick a hotel that has beds and pillows. And nowadays it's pretty easy to bring white noise around with you. So it's a sleep association that's helpful rather than something that's unhelpful or interfering.

Allison: So you've answered that question that I'm sure everyone's wondering, which is do we need to cut it off at any point in time? I use white noise to sleep, my five-year-old does. When we travel, we put it on our phone and it's super easy. So it sounds like there's no downside to that.

We're getting some questions about, just to clarify your comment about the FDA approval and FSA, it's not FSA eligible yet. Is that correct?

Dr. Harvey Karp: That's correct, not yet.

Allison: How long will that take you approximately?

Dr. Harvey Karp: That's a good question. I mean, I'm hoping it'll just be two or three months.

Allison: Okay.

Dr. Harvey Karp: But that still remains to be seen. One of the things that's interesting for benefits managers is that once you've used this for a year, what we're working with companies with is now to pass this along out of the benefits budget and how- be a covered benefit by the health insurer. Because ultimately, the health benefits are so obvious that corporations can make a good argument saying, hey, listen, we want this as a covered benefit. It really should be on your budget, not ours.

Allison: Yeah, I love that. We got a lot of pre-submitted questions and now questions around, when can I move the baby out of my room? I think previously it used to be the recommendation was keep the baby in your room for a year, then it got moved down to six months.

I personally have experienced a lot of guilt moving the babies out before that time, but we did have a few people submit questions about is it okay to move them out early and then are there any challenges if we move them into a room with a toddler?

Dr. Harvey Karp: Toddlers are problematic because they want to be helpful and go play with my train and drop it on the baby's head. So you don't really want them in the room with a toddler. In general, the Academy Pediatric says that they should be in the room with the parents for the first six months, which is pretty convenient anyway, if you're feeding and whatnot in the middle of the night. 

And then between six and 12 months, it's your choice about when you move them to a different room. SNOO is used for around six months. By six months of age, the brain is doubled in size. And so babies are much better able to maintain their sleep patterns.

Allison: I wanna talk about the cry it out, but maybe I'm gonna throw way too many questions at you at once, but. We had a few different flavors of this question, which is there's a reason babies cry, and we as parents are trying to get them to stop crying for selfish reasons and otherwise, but how should we think about baby crying? And what the questions we're getting at is, is it bad that the SNOO, for example, will put them back to sleep? Are they trying to tell us something and the SNOO is masking it, they're hungry, and now we're not feeding them? That was one flavor of it. 

And then also once they get to a certain age and you're just exhausted, sleep training, how do we do that? Is it okay to ignore the crying? Let's start with the first part of that question, which is if the baby's crying and the SNOO is rocking them back to sleep, make me feel better about my guilt, ignoring the crying.

Dr. Harvey Karp: So crying is a smoke alarm. It's a messaging system to get your attention. And it's very important for survival. That's why babies have it, that even premature babies can cry. And they cry at a pitch that our brains go, uh-oh, I need to respond to this. So we have a neurological response that makes us get out of a warm bed on a cold night and run down the hall. So that's the way the system works and it was designed to work that way.  And so that's great. 

However, you know, if you're in the shower and you get out of the shower and you hear, Oh my God, my baby's been crying. I don't know if they've been crying for five minutes. Not the worst thing in the world. I mean, they're going to survive that. 

But in general, when your baby cries, it's soliciting your attention and you do want to pay attention to it. In SNOO, what happens is SNOO pays attention to it and it responds with four different levels of motion and sound. And like I said, half the time it'll calm the crying within a minute. And if it doesn't, then bing, then it means probably hungry, I know it's been three hours, or maybe needs a diaper change, and you realize that it's your turn. And that's not a bad thing. Getting a little bit of help is not a bad thing. 

And so when it comes to the cry it out sleep routines, sometimes that's necessary and it's really hard. The old joke is to put cotton in your ears and gin in your stomach to get through it, but that can be a successful way as well. But in general with SNOO, we don't really have to go through that because they're already sleep trained automatically.

Allison: Yeah, it's one thing I didn't realize until I used the SNOO was that the SNOO doesn't just keep going. If the baby keeps crying, the SNOO stops. And I don't remember exactly how you're alerted, but it was kind of nice because it's like, let the SNOO try. And if it doesn't work, then I know I need to go in and actually feed the baby or whatever, figure out what's going on. But it's not like it just keeps going forever. You know, at a certain point, the baby needs attention.

Dr. Harvey Karp: Exactly. So it shuts off automatically after three minutes. Three minutes is really a very modest amount, but most parents actually will get the baby within a minute because pretty much no, you know what? This is getting, this is escalating. Yeah, it's not getting better. And so usually within a minute, you can pretty much tell if it's gonna work or not.

Allison: Yeah, we're getting a lot of questions in the comments. So I wanna address some of these. Let's see, what research would you tell people about who think the SNOO and swaddles in general are too restrictive for babies movement?

Dr. Harvey Karp: Well, you just have to look at how people around the world have cared for babies for thousands of years. You know, wrapping babies is something that every culture has done. Babies need motion, they need to exercise their muscles, they need to do tummy time, but then they're not doing that for 12 hours of sleep, they're sleeping. 

So they don't need freedom, they need security, they need confidence, they need trust, and the world is like…you know, in the womb, they have that protection around them. And now the world is kind of too big and they startle themselves. And so studies have been showing that cultures that swaddle babies for the first six months, like around the clock swaddling, there's no change in the neurological development or their muscle development. I mean.

Allison: Yeah, awesome. We have a question here and we had some pre-submitted around toddler sleep. And is that a thing to have toddler sleep regression where all of a sudden at the age of one and a half or two or three the child is now waking up multiple times, coming into bed with the parents. The one in the comments says, my one and a half year old sleeps on her crib mattress on the floor. She wakes up three times every night and walks into my room to be held and puts her back to bed. Any suggestions to help her sleep through the night without waking up?

Dr. Harvey Karp: Yeah, very common. And it can happen again at two and at three and at five, different things, traumatic things, scary things can interfere with their sleep. On our website there's information about helping toddlers sleep as well. There's a technique I used to use when I was in practice called Twinkle Interruptus, kind of a silly name, but it can be extremely helpful. 

There's actually a whole Happiest Toddler on the Block book and video for kids eight months to about 97 years of age because everyone becomes a toddler if they get upset enough, even teenagers and whatnot, even spouses. So there are lots of techniques in there just for everyday communication. but a specific one and you can read about it on our website, which is Twinkle Interruptus.

Allison: Great. Another question, is it ever too late or is there a moment in time by which you want to try and sleep train or you've missed the boat?

Dr. Harvey Karp: No.

Allison: Okay, good.

Dr. Harvey Karp: Oh, and it's not one and done. I mean, you may sleep train and then six months later have to sleep train again. And so the technique you use, it's important because if you're not very clear in how you're doing it, you can give mixed messages to kids which kind of makes them crazy and then they cry longer. So you do want to be really applying the right approach when you do that. Again, there's information on our website about that.

Allison: Do men and women have different reactions to babies' cries? I love that question.

Dr. Harvey Karp: Yes, yes. For the most part, women are more emotive outwardly. But men also can be extremely emotionally charged by infant crying. Men are the number one perpetrators of shaken baby syndrome, which is triggered by crying babies. So like the guy who said, I'm not angry. No, I think you are. You know, so we may not be as aware of it as women. I think it's really what the general experience is.

Interestingly, just one side note, which is kind of fun, is that same thing in terms of the way men and women interact with babies. Women are strokers and men are pokers. So women are more likely to go at the end, you know, the legs or the arms and whatnot, and be gentle and smooth in the motions. And guys are more like, you know poking inside at the belly and trying to get them to laugh. And babies respond differently. Women tend to get more sustained, continuous attention and men tend to get more excited attention and then babies pulling away because they're a little bit overdone.

Allison: It's so interesting. Is the SNOO designed to just put a wide awake baby in and they'll fall asleep? If not, how long should I rock the baby before putting them in?

Dr. Harvey Karp: So most parents find that, number one, every baby's different, and we have 24-hour telephone service. We have free sleep consultations and help people along the path. So it's not just take this and do it. We're helping to guide people to success. 

And so most parents will put the baby in a wake, and the SNOO will rock them the last 10 minutes or so. In fact, many people will kick it up a notch so that it's rocking... It's kind of what you would do in a rocking chair, a little faster. And as they fall asleep, you slow down, and that's what you can do with SNOO as well.

But there's some babies who are very, very alert and they don't wanna be put in by themselves. And so it helps to put them in a sleep so that they're already having a white noise playing in the background and get them, you know, kind of really, really drowsy and falling into a sleep. And then the SNOO carries the process.

Allison: Does it also depend on their age at which you're using the SNOO?

Dr. Harvey Karp: It can. Again, around three months or so, babies get much more aware of the environment. This reflex that happens when you jiggle them, we call it the fourth trimester. By four months, five months, it's kind of not as automatic in putting them to sleep because now the kids have their own opinions. And so you have to do a little bit more. Like one of the things we recommend a lot is to put babies in SNOO just for a massage. Fun experiences there, not like they're always put down and abandoned every time you put them in there. By three, four months, five months for sure, you know, they can be aware of those things.

‍Allison: Do you recommend the SNOO for all baby naps and bedtime, or does it aid in the bedtime routine if it's only used overnight?

‍Dr. Harvey Karp: No, you want to use it all the time. No one does it every nap. I mean, you're out and about and whatnot. They fall asleep in the car. But it's kind of like breastfeeding. The more you do it, the more the baby learns and understands. And then once they've gotten it well, yeah, then after a month or a few weeks, you'll start a bottle once a day so that they learn how to take a bottle too. So in general, the more they're in SNOO, the better it works.

Allison: Great. We are one minute shy of the limits and I have a final question which was asked to everyone and I already know your answer, but I'm gonna ask you anyway, do you have a favorite sleep training book slash method?

‍Dr. Harvey Karp: So I do have a book called The Happiest Baby Guide to Great Sleep. Which is for kids the first five years of life. So I do have to say that's my favorite and has all of the tricks and tips that I use with thousands of families that I took care of when I was in practice.

‍Allison: I knew it. I knew that was your answer. Thank you so much, Dr. Harvey Karp for your time today. I have personally learned so much from you. Love your book, love the snoo.

‍Dr. Harvey Karp: Thanks so much, Alison. Really appreciate it.