The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer Harvey Karp, Bantam Books, 2002, 267 pp., paper back, $14.95; hard cover, $22.95.
Dr. Karp, a general pediatrician in Los Angeles, has written a popular book aimed at teaching new parents how to calm their crying infants. The nice thing about this book is its respectful tone towards parents. Unfortunately, there is not much more to recommend this volume. In fact, many of Dr. Karp's comments and suggestions are opposed to current research and go far beyond safe practice.
Dr. Karp's major premise is that human babies were born too early, that is he suggests that infants should have remained in utero for another 3 months, and thereby spared their parents the distress of trying to calm these irritable newborns. He suggests that babies would prefer the comforts of the womb to the reality of the world. Any pediatrician who has cared for post-term infants with the serious medical consequences that often befall them, will be put on guard by this point.
Here are a few of the medical facts that Dr. Karp espouses that are just plain wrong: pp. 47 "during the first few months of life babies aren't able to tell when their mothers are distressed and worried"; pp. 59 "Since temperament is largely an inherited trait, a baby's personality almost always reflects his parents'"; pp. 141 "Although the sound inside the uterus is louder than a vacuum cleaner (70+dB), your baby doesn't hear it that loud. That's because her middle ears are waterlogged with fluid, her ear canals absorb sound and are plugged with waxy vernix, and she has thick, inefficient eardrums…These sound-damping factors last until a few months after birth."; and pp. 150 "All new babies have muffled hearing. So the noise that sounds loud to us sounds quieter to them."
If misinformation were the only problem with this book, I would not have bothered writing this review. The real danger in the text is that desperate parents with irritable infants may read this, take Dr. Karp's recommendations seriously and they could then potentially harm their infants.
Dr. Karp's suggestions for calming a fussy baby can be summarized by his five "S's" or steps to activate what he calls a baby's calming reflex: Swaddling, Side/Stomach, Shhhhing, Swinging and Sucking. In the chapter on swaddling Dr. Karp includes some nice diagrams teaching parents how to securely wrap an infant. However, in vignettes he suggests that the swaddle might be enhanced by being secured by a belt (pp. 109) or duct tape (pp. 119) and he ends the chapter by suggesting "your baby is calmer if she is swaddled twelve to twenty hours a day to start with." (pp. 121).
The second "S" is side/stomach positioning. Dr. Karp writes "The more upset your baby is, the unhappier she will be on her back. Rolling your infant onto her side or stomach will make her much more serene. Just this simple trick can sometimes activate a baby's calming reflex…within seconds." (pp. 126) My concern with this suggestion is that Dr. Karp stresses the importance of stomach positioning many times in his text and he warns of the dangers of leaving infants to sleep on their stomachs much less often.
In the chapter discussing Shhhhhing Dr. Karp recommends loud verbal shhhhing and appliances like hair dryers, vacuums, fans and CDs with white noise that match the babies' noise level when they are crying. He suggests that parents place the noise 1 to 2 feet from the baby's ears to get the maximum effect and, if the noise is so loud that it bothers parents, he suggests that parents use ear plugs. He reassures parents that using this kind of white noise for 12 hours a day is acceptable and even expected.
The 4th "S" is swinging and these suggestions are among the most concerning ones in this book. Two forms of swinging are described. For parents who use swings Dr. Karp recommends that "Cranky kids settle best on the fast speed and many sleep best that way all night long." (pp. 169). For parents who are holding their babies and swinging them, Dr. Karp writes that parents must "Start out fast and jiggly" and "Jiggle the head more than the body. Jiggling triggers your baby's calming reflex by switching on motion detectors in his head. So, it is the jiggling of the head (the site of these sensors), not the motion of the body, that really turns the reflex on. As you jiggle your baby, don't cup your hands firmly around his head. It's critical that you allow your hands to be a little open and relaxed so his head makes tiny wiggles, like Jell-O quivering on a plate. If you hold his head too snugly, it won't wiggle and you probably won't activate the reflex." (pp. 158) To me this is the most frightening recommendation of all. Dr. Karp goes on to describe the difference between a jiggle (the head moves at most 2 inches from side to side) and a shake and warns parents not to do this when angry. Unfortunately, he has already crossed the line of reason before he makes this statement. Although on casual reading these suggestions may sound reasonable, I fear that a frantic parent reading this and trying to calm an inconsolable infant could cause serious damage, possibly even shaken baby syndrome in carrying out Dr. Karp's recipe.
The fifth "S" is sucking and this suggestion is his most benign and most acceptable in my view. My only concern here is that Dr. Karp suggests that making a mother into a human pacifier is reasonable, and in my own experience as a pediatrician in the US, this has rarely been successful for either infant or mother.
I think that Dr. Karp's words speak for themselves as a review of this work and I cannot recommend it to anyone.
PAMELA HIGH, M.D.
Brown Medical School
Hasbro Children's Hospital
Women and Infants' Hospital
Providence, Rhode Island