October 20, 2025 • 28 mins
In this episode of Your Child Is Normal, Dr. Jessica Hochman sits down with Dr. Nina Shapiro, pediatric ENT and author of Take a Deep Breath: Clear the Air for the Health of Your Child, now out in its updated edition.
Together, they dive into one of the most common worries for parents: their baby’s breathing. Dr. Shapiro explains why newborns are “obligate nasal breathers,” what normal baby breathing actually sounds like, and when parents should (and shouldn’t) worry. You’ll also learn practical, evidence-based tips on:
- The safest and most effective way to use nasal saline
- When (and when not) to use suction devices
- How safe-sleep practices like “A B C — Alone, on their Back, in a Crib” protect babies from SIDS
- Simple tools like the "A B C D E" checklist for spotting breathing trouble
This conversation will help parents feel calmer, more confident, and better equipped to care for their baby’s breathing.
👉 Stay tuned for Part 2 next week, when Dr. Shapiro returns to discuss breathing issues in older kids — including chronic stuffy noses, snoring, and when to see a specialist.
Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more.
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YouTube channel: Ask Dr Jessica
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Nina, hi everyone, and welcome to your child as normal.
(00:09):
I'm your host. Dr JessicaHochman, and I'm so glad you're
joining us today, because wehave a very special returning
guest. Dr Nina Shapiro, apediatric ear, nose and throat
specialist. Dr Shapiro is notonly a fantastic doctor, but
she's also the author of take adeep breath, clear the air for
the health of your child. Inthis first part of our
conversation, we're focusing onthe questions I hear all the
(00:29):
time from parents of youngbabies, how to help them breathe
easier, whether your baby has acold, sounds stuffy, or
struggles to sleep comfortably.
Dr Shapiro explains how tosupport healthy breathing in
babies and young children withsafety and comfort in mind. I
know you're going to learn alot. And before we get started,
if you could take a moment toleave a five star review
wherever it is you listen topodcasts, I'd be so grateful
your reviews help other parentsdiscover your child is normal,
(00:51):
and this helps our communitycontinue to grow. Now onto my
conversation with Dr NinaShapiro. Dr Nina Shapiro, I am
so happy to have you back on thepodcast. Thank you so much for
beinghere. Great to be here. Thanks
for having me backso you have a second edition of
your book. Take a deep breaththat is in print and ready for
distribution. I'm so excited foryou. Thank you. Yeah,
(01:15):
it was a lot of fun to work on.
It was my first book, originallyback in 2011 and you think that
so many breathing issues areevergreen in children, which is
true, there are things that justdon't change, but there are
actually things that havechanged over the last 15 years.
So it was really fun to work onan update and get the latest
information and give it a bit ofa refresh. So yeah, I'm really
(01:39):
excited.
Yeah, absolutely. I noticed youtalked about chat GPT, AI, you
talked about updated VaccineInformation. So it was really a
great book. I really enjoyedreading it. And kudos to you.
Thank you. So what inspired youto write? Take a deep breath to
begin with.
So to begin with, this was backin, I guess, 2010 when I started
(02:00):
working on it, and I was inpractice at UCLA taking care of
children pediatric ENT, and Iwas seeing so many parents with
a huge range of issues withtheir babies. A lot of it was
babies with normal breathingissues that we see in babies,
and it was a lot of reassurancethat I needed to provide. Then
(02:20):
there was a large group ofparents that had babies with
mild issues, but they were soworried about these really mild
issues. But, you know, aspediatricians or Ents, we see
this, and we know that it'sreally nothing to worry about,
but I think it was reallyimportant to reassure parents.
And then lastly, the group ofparents with really severe
issues in their babies. I reallywanted to provide sort of a road
(02:43):
map for all parents who havebabies, infants, toddlers, how
to deal with mild problems,severe problems, what's normal,
what's not normal? When toworry, when to really just
relax. So I put it in sort of aquestion, answer format. It's
age based and also locationbased. So it's all chunks of
(03:07):
ages, and then it's nose tolungs for each section. Really,
just give them a road map whenthey have issues with their
babies.
That's really excellent. And asyou're talking, I feel like your
inspiration to write the book issimilar to why I'm so motivated
to do this podcast because as apediatrician, I noticed that
most of my day is spentreassuring families, making them
(03:28):
feel better about very normalprocesses that happen with kids.
But also we have to know when toworry, when there actually is an
issue, how to help guide them,and then how to draw awareness
to when there is a problem whenthere is something to do about
it. So very similar, motivation,similar. And I'm sure you give
them a lot of guidance in theoffice, like, well, here's
something that is normal andhere's something that maybe not
(03:49):
so normal. If this happens, youmay need to give us a call or be
a little concerned. But in alllikelihood, most of these issues
are normal, and it's really justscary for the parents?
Yes. And I think maybe if we canimpart good knowledge, let
people know what to look for,when to worry, hopefully that
can alleviate a lot of concerns.
Yeah, all right, so speaking ofcommon concerns, absolutely
(04:11):
something that I see a lot withparents are concerns when it
comes to breathing and how tohelp a child who seems to be
having difficulty withbreathing. So I'm excited to
talk to you about this, becausehopefully it helps parents.
Yeah, Imean, it's terrifying. I mean,
as scary as it is to have abreathing problem yourself, it
is magnitudes more scary whenit's your child that's having a
(04:35):
breathing problem. You feel itwhen it's your child. A lot of
these problems are something toworry about potentially or
something certainly to address.
But I think if parents had moreunderstanding about how babies
work, we always say this, aspeople who take care of
children, children are not justlittle adults, and certainly
(04:55):
infants and newborns are reallynot just little children.
They're their own. Beings untothemselves with different
breathing patterns, differentphysiology, different anatomy,
different structures that wedon't really understand what's
going on on the inside. And Ithink understanding a little bit
of that will give parents,hopefully, some tools and a
(05:16):
little bit more knowledge toreally address
these issues Absolutely. Sofirst, I'd like to ask you, what
is a normal nasal sound in ababy? It's just such a common
worry from parents, to the pointwhere when a child comes in for
their one month visit, I canpredict that a parent will be
(05:36):
asking me if breathing soundsare normal or have questions
about breathing. It's just socommon. So what can parents
expect? Right? So something thatsometimes parents find
interesting, and doctors whotake care of adults don't always
know this, is that newborns, upuntil anywhere up to age five
months, are obligate nasalbreathers, and that makes them
(05:59):
very different from the rest ofus, meaning that if they can't
breathe through their nose, theycan't breathe. Not to make that
scary, they can breathe, butthey will cry, and that's how
they will move air back andforth into their lungs. But if a
baby is stuffy, they areabsolutely miserable, and in
(06:20):
turn, parents will be miserable.
So a little nasal stuffiness isvery, very normal in everybody,
adults, babies, newborns, but ifthey have any more than a little
bit of nasal stuffiness to thepoint where it's hard for them
to breathe through their nose,it will be hard for them to
breathe period. So I think, youknow, a focus that I try to give
(06:41):
to parents is you have to keeptheir nose clean and life will
be okay for everybody,especially when we have winter
babies and, you know, and babiesthat are born in the fall, in
the winter, and they have olderchildren at home, and they have
a little nasal stuffiness, evenfrom a very mild cold, that's a
pretty cranky baby, for sure.
(07:02):
Yes.
And I think, to your point, theyare obligate nasal breathers.
They have to breathe throughtheir nose, as you said, except
for when they're crying. And theother thing is, they have very
small noses, very smallnostrils, so you know, with a
little bit of mucus, which allbabies make, if they reflux a
little bit, they're going tosound stuffy, and so it's also
very normal for babies to soundloud.
(07:25):
Yes, yes, it is. And sometimesit's literally a little tiny
booger crust in front of theirnose. It could be like a two
millimeter Bing, and then I'llliterally take it out in the
office, and all is well. So youknow, I think if parents knew
that, then they'd feel a lotmore comfortable addressing how
to keep their baby's nose clean.
One of the things that I talkabout, and that is very popular
(07:45):
for parents, are those nasalsuctions. You know, whether it's
different brands, some are nowbattery powered electric, or
some of them, like you put thelittle straw in your own mouth
and you suck the baby's nose,which I'm so glad was not
created when my infants hadwonderful and just it is the
notion of doing that is nasty.
(08:06):
So what I always tell parents isit's more about irrigation than
suctioning, because parents feelwhen they hear that their baby
is so congested that it must befilled with a ton of mucus. I'll
look at the baby's nose front toback with a little, tiny camera,
little telescope, and I willreassure them. There is almost
no mucus in there. It's juststuffy. And the more they do the
(08:28):
suctioning, the more inflamed itgets, the stuffier it gets. But
nasal saline is really like thebest stuff on Earth. There's no
chemical or any sort of toxin toworry about. It really just
flushes out the baby's nosebecause they can't do it
themselves.
Yeah, so I'd love to break thisdown. I think it's so wonderful
to talk about how to clean ababy's nose and how to do it
safely and effectively. Youtalked about nasal sailing.
(08:51):
Let's talk about this. Becausequestions that I hear a lot from
parents are they want to knowhow to do it. Sometimes they put
in nasal sailing and they feellike the child doesn't like it,
or maybe they gag on it a littlebit, and sometimes they worry
they're doing it too much,right? So what are best
practices to give saline in ababy?
So one of the reasons why babiesfeel like they're choking is a
lot of times parents will giveit to their baby when they're on
(09:14):
the changing table lying flat,and it really does make them
choke. It's like the saline goesback into their throat, and they
feel like they're gagging, andit's pretty uncomfortable. You
feel like you're restraining thebaby, and you can hold the baby
down and then sort of put thesaline in while they're on the
changing table, but it's muchmore comfortable. And think
about it for your yourself, youprobably wouldn't want that on
(09:35):
yourself. So I always say tohold the baby upright, and then
when you stick the nozzle in,you want to have it not exactly
straight up and not exactlyparallel, but sort of in the
middle at an angle inside thenose. You put the nozzle in
first and give it a good squirt.
The worst thing that happens isthe baby swallows a little bit
of it, and they probably won't,because it's really such a fine
(09:58):
myth. Just, most of it justcomes out. And that's fine too.
It's, this is a littleirrigation up and down, up and
down. It doesn't have to go allthe way back. You're not doing
sinus irrigation. This is reallyjust to keep the nose clean. I
sort of use the greenhousemetaphor that it should be like
a greenhouse in there. It shouldbe a little bit moist and a
(10:19):
little bit kind of damp inthere, and the ceiling just
creates that. You can use itonce a day. You can use it 10
times a day. It doesn't getabsorbed into their system. It's
not going to change theirelectrolytes or anything like
that. It's just a local way tokeep everything clean.
So I think that's a great pointto bring up, that you can use it
(10:39):
really as much as you want.
There are no side effects to it.
It's not like when we give kidsmedications, where we have to be
mindful of how many hours arebetween each dose. You can
really give it as much as youwant. It's salt water, yeah.
And same for pregnant people,because a lot of pregnant people
are very stuffy. So a littlenote for them, nasal saline is
great, because there are a fewmedications you can use in your
(11:01):
nose when you're pregnant.
Okay, so saline, great. Check.
Now you also mentionedsuctioning. Sometimes the advice
is given to put in Saline firstand then suction afterwards to
get the saline out. I agree thatI think suctioning has a helpful
role, but also there's a fineline where parents can overly
suction. Can you talk about thata little bit? Because I think
that's an important point tobring up to parents,
(11:25):
right? So sometimes suctioningis great, especially when there
is a really goopy nose. Babiescertainly don't know how to
clear their noses. They can'tblow their nose. They're just
really uncomfortable. A lot ofbabies don't mind the
suctioning. A lot of babies hateit, but they all feel better
afterwards, regardless of how weget through it. So if your baby
has a cold or just happens tohave a really goopy nose, you
(11:46):
can flush it out with a littlenasal saline first, just a great
idea, do the suctioning, andthen even nasal saline
afterwards, just to coat thelining. As far as how often to
do suctioning, it really justdepends on how goopy that nose
is. Sometimes it gets gooped upan hour later. Sometimes it's
just a few times a day. Sothat's just really based on how
comfortable your babyis. I'm thinking back when my
(12:06):
kids were little, I used toreally like using the bulb
suction, and my husband used tosay, you know, don't make
perfect the enemy of the good,because I would just want to
clear out every little boogerthat appeared. And the truth is,
sometimes the kids would sneezeit out on their own, I had to
learn to just reserve it forwhen it was really necessary,
andit puts pressure on their little
delicate tissues, and then itjust gets more swollen, and then
(12:28):
it just becomes a vicious cycle.
So unlimited saline suctioningwhen needed, right? And then,
what are some other ways that wecan help clear out the nose? I
know in your book, you alsobrought up, humidification can
be a helpful measure to clearout the nose.
Sure, if you if you live in ahome, certainly where you have
the heat on and it's very dryheat, or in the warmer months,
(12:49):
if you have the air conditioningand it's a very dry environment,
you can usually tell becauseyour baby's nose is going to be
pretty crusty. You can have ahumidifier in their bedroom or
in your room, if they'resleeping in your room. Just to
give a little moisture, youdon't necessarily have to have
it on all day, every day, butsometimes, especially if it's
extra dry, humidifier helps. Youwant to make sure that it's
(13:10):
cool. Mist is best. And anotherthing about those humidifiers,
it's a little bit laborintensive. You have to keep them
clean. They get kind of moldyand dusty, so then you're just
spreading other particulatematter into the air. So you keep
those humidifiers as clean aspossible. It's a little bit of
work.
I think that's the reason why Inever got a humidifier. Just do
(13:31):
that daunting to clean all thetime. Let's do that bulb
suction, correct. Yeah, exactly.
Okay. Now, something that youalso brought up using Afrin.
Now, admittedly, this issomething that I didn't realize,
that newborns can safely takeAfrin, so this was helpful for
me. Can you talk about Afrin?
What are the limitations? Howoften to use it? Because Afrin
(13:54):
can be a great help. So yes,please educate us. Tell us about
Afrin. Sowhat Afrin is? It's a local
decongestant, anti inflammatory.
It also shrinks all the bloodvessels in the nose, and it is
typically not indicated orrecommended for infants and even
young children. But, and there'sa big sort of caveat for that,
we as Ents use it all the time.
We use it certainly if we needto do surgery in newborn noses.
(14:18):
We use it in the hospital. Weuse it in the office setting.
And I think it should be reallylimited, because it is a
medication, but in the rightsetting, if it's a baby with
very, very severe nasalcongestion from a bad cold or
some sort of exposure, and it'stemporary and the baby is
(14:39):
absolutely miserable. That's atime to consider using Afrin.
It's not neosinephrine, which isanother topical decongestant
that is a definite no forchildren, but Afrin doesn't have
the side effects that somethinglike neosinephrine has, as far
as your heart racing and yourblood pressure, it's much safer.
For in that way, to use it invery limited it's really just in
(15:02):
rare situations. One of thetimes to consider using Afrin is
if you're flying with your baby,babies are absolutely miserable
on planes. They can't equalizepressure with their ears. And
even for older children, meaningolder infants and toddlers, a
couple of squirts of Afrinbefore the flight makes
everybody much more comfortable.
(15:25):
And describe the rule of twos,because I think this is a really
helpful way to remember how muchAfrin to use where it's still
safe, right?
And that goes for everybody, notjust infants and newborns. The
rule of twos for Afrin is nomore than two sprays each
nostril twice a day for twodays. So two sprays each nostril
(15:47):
twice a day for two days. Andthere's the 222, certainly, if
you're an adult with a sinusinfection, and if you use it for
three days, it's really fun, butyou know that, but you really
want to limit it. Afrin issomething that will cause what's
called a rebound reaction,meaning that if you use it for
too long, it starts causing thereverse and you will be very,
(16:08):
very, very stuffy, and thenyou'll feel like you keep
needing to use the Afrin, andit's going to become worse and
worse. So you really want tolimit how long you use it for,
how often you use it, and just acouple squirts in each nostril.
I've read it would really takeusing Afrin for, you know, seven
plus days to see that reboundeffect. So you're certainly
within the realm of safepractices if you stick to the
(16:30):
rule of twos. Yes, yes. I mean,I'm just thinking when I have a
cold, I'm miserable because Ican't breathe through my nose.
So these poor babies that haveto breathe through their nose,
anything that we can do to helpthem make them make them more
comfortable, I think this isgood knowledge to have when they
inevitably sound stuffy. Yes. Sonow the question I'd like to ask
you about is when to worry.
Let's say a baby is stuffy.
(16:52):
We're helping them, we're makingthem feel better, but they still
don't seem comfortable. What arethe signs that parents can think
about when they should seekmedical attention.
If a baby is stuffy and it'sreally not able to be cleared,
then you're going to start tosee other issues related to the
baby. The rate of theirbreathing is probably going to
(17:14):
pick up. And you know, allbabies breathe faster than older
children and adults, but if itbecomes really fast, and they
seem to be in distress. Theyhave something called Air
hunger, where they really looklike they're struggling. You can
start to see other muscles intheir body work hard. So you'll
see like the upper part of theirneck, their stomach or their
(17:34):
ribs, the muscles starting tomove to work, to breathe. They
just don't seem comfortable.
They can't eat, they can't sleepcomfortably. They just seem
overall miserable. Babies have afew things they need to do, they
need to eat, they need to sleep,they need to poop, and they need
to grow, and if they're notbreathing, they can't do any of
that. Well maybe they can poop.
(17:55):
But other than that, they'rereally miserable babies. And so,
you know, very early on in thefirst weeks of life, a parent
can recognize the differencebetween just a cranky baby who's
hungry or can't sleep versus ababy who's really struggling in
distress. And my mantra,especially when it comes to
infants and newborns, is neverworry alone. If you are worried,
(18:18):
you have to call somebody,because, if nothing else, you'll
get reassured that this isnormal. This is something that
you don't need to worry about,and I am taking that worry away
from you. But even if you don'tknow what's wrong, and there's
no reason a parent shouldunderstand what's wrong with
their baby, they just know thatsomething is wrong, they need to
find someone to either allaytheir fears or to address the
(18:42):
issue. And that's where our jobcomes in, as pediatric care
givers to you know, addresswhether, nope, this is fine.
This happens. This is nothing toworry about. Here's what you can
do, go back to sleep or come onin. This is something that's
urgent.
And I completely agree with you.
I think when parents areconcerned about breathing
Absolutely, reach out to yourpediatrician, because the best
(19:03):
case scenario, and the role thatI love to play is hopefully
we're just reassuring you. We'reletting you know that this is
normal, noisy newborn breathing,but also sometimes there are
concerning signs and symptomsand we can help. So I agree.
Don't do this alone. Seek help.
If I can share one mnemonic thatI like to tell parents to think
about, think about when they'rehome with their kids and they're
(19:25):
trying to assess if there's anissue, I talk about the a, b, c,
d, es, so A is for airway, youknow, looking at the nasal
passages, seeing if they lookpatent and open. B is breathing,
looking at their rate ofbreathing. Are they breathing
too quickly? Are they having adifficult time breathing? Are
they retracting and working tobreathe? C for color. They
(19:45):
shouldn't be blue around themouth. You talked about this
really nicely in your book. D isfor diet. Are they still able to
feed? Because if their nose isso stuffy, they're going to have
trouble feeding, right? Becausethey have to breathe through
their nose. And E, we talkabout. About energy. What's
their activity like? Are theyacting normal? Do they have
normal energy? If there's anyquestion about any of those,
(20:06):
talk to your pediatrician, reachout and get your baby seen. I
like, I like a good mnemonic,okay? And I also tell parents, I
try to flip the script a littlebit, that if your baby's a noisy
breather, it's not always bad,because at night, when you're
sleeping, you know, sometimes weworry if they're too quiet,
what's going on with them? Arethey okay? But if you listen
really closely, you can hearthem breathing, and know that
(20:28):
they're doing all right, thatthey're breathing, they're
thriving, they're sleeping. It'snot always a bad thing to have a
noisy breather.
Yeah, I get that complaint alot. After I take out a child's
tonsils, the parents say wecan't hear them anymore. Like,
that's actually a good thing, alittle noise maturing on that
monitor.
Yeah, it's a small benefit.
Small benefit, right? Okay, now,you talked very nicely in your
(20:49):
book about safety and safepractices to help babies with
sleeping, right? Can you mentionwhat is the safest way to have a
baby go to sleep? Because whatwe know about babies is the
number one reason why a babypasses away in the first year of
life is from something calledSIDS, and this is something
that, with Safe Sleep practices,we can help really mitigate that
risk. Yes,so that's another mnemonic, ABC
(21:12):
alone on their back in the crib.
That is the safest way. Thatdoesn't necessarily mean that
they need to be in another room.
I think this is a greatpractice, certainly in the early
weeks, to have your baby in thesame room as you so you know not
necessarily that they're in ahuge crib in your room, but in a
(21:32):
bassinet, which is a very smallcrib space in your room is the
safest way. And this is veryboring. There should be nothing
in the crib and no more bumpers,no more toys, no blankets, no
pillows, none of the cute stuffthat we all loved. You know you
see in the pictures, actually,the safest practice is all of
(21:56):
that should be gone for a while.
Crib bumpers, which are like thesort of cloth puffy liners of
the crib, were considered verysafe so the baby wouldn't get
their arms stuck like in the inthe slats of the crib. But then
they were finding that thebumpers were not safe because
babies can get stuck under thebumpers. So now it's no bumpers
(22:20):
in a very boring, plainmattress, tight fitting sheet on
a crib, on their back and alonefed. Sharing is really a very,
very high risk factor. It'sunfortunately
and I think this is a reallyimportant topic to bring up,
because I hear a lot of concernsfrom parents about this
(22:41):
recommendation for a couple ofreasons. One is they're worried
if their child spits up a lot,which a lot of babies do.
They're worried if my child's ontheir back, will they aspirate?
Will they spit up and thenswallow it? The other concern I
hear is parents like to cosleep. I just heard this week, a
parent said to me, we're theonly mammal that doesn't sleep
(23:01):
with their young ones, and itfeels so unnatural to have them
alone, sleeping by themselves. Ihear what they're saying, but at
the same time, something that Iunderstand as a pediatrician,
the best recommendation we canmake to a parent when they come
in for their first visit is toemphasize sleeping on their
back, because we will actuallyinevitably save lives, because
(23:22):
sleeping on your back, followingthose ABCs decreases the
incidence of SIDS by over half.
Correct, it's dramatic, and youknow the issue of co sleeping,
of course. I mean, everyoneloves that. For that, I say, let
them sleep on you, next to you,while you're holding them, or
even in your bed, but you cannotsleep during that time. If you
(23:43):
want to have your baby in yourbed, in your arms or in a chair
with you, that's a time for youto be awake and watching your
baby. And that's certainly fine.
And babies certainly newborns.
They sleep 1819, hours a day, sothere's plenty of time for that.
But when you are asleep, theyneed to be somewhere else.
And what would you say about asa pediatric ENT, the concern
(24:06):
about babies spitting up and theconcern for aspiration is that
something that you see as anENT,
so all babies have a little bitof reflux, meaning there's a
little bit of acid, a little bitof stomach contents that come up
the esophagus into the back ofthe throat, and sometimes that
causes a little bit ofirritation. Usually it doesn't
cause any problems. Babies areso tiny, the distance between
(24:28):
the stomach and the airway isjust a few inches, there's
always going to be a little bitof spit up. But babies have
reflexes, just like we havereflexes when they're asleep. If
they are actually going to spitup, they will wake up and cough
and be miserable and cry. So thenotion of vomiting in their Slee
(24:51):
is not a normal baby reaction.
The idea of it is terrifying, ofcourse. And you know. You've
heard of adults who've donethat, who've been, you know,
horrible drug overdoses, andthey aspirate in their sleep
because they're overdosing ondrugs. This is a human who has
reflexes, so if your baby'sgoing to be spitting up, it's
(25:13):
not something they do whilethey're asleep. If it starts
while they're asleep, they'regoing to wake up and cry and
like yesand and they have a very, very
sensitive gag reflex, which isreally helpful, really helpful
for babies. For parents, theyprotect themselves, yes, all
right, well, this has been sucha helpful overview on infants
and stuffy noses and safe sleeppractices. I'm curious, are
(25:38):
there any myths that you hear alot from parents that you'd like
to clear up about breathing? Anymyths that we haven't talked
about that you'd like to clearup that can help parents worry
less?
I think you know, one of themyths, I don't know if it's a
myth, but just sort of amisunderstanding, is, again,
that it's better to be in thesame bed. I think there are a
(25:59):
lot of parents who still believethat co sleeping is safer and
healthier and more nurturing andwill lead to sort of a more
robust development, I thinkthat's a myth. There's plenty of
time during the other 24 hoursof the day, or 18 hours of the
day, to have you know with yourbaby, otherwise, the
irregularity to breathing thatbabies have, they don't
(26:22):
necessarily have the regularbreathing that older infants and
children have, and so if youwatch a sleeping baby, you may
notice that there are periods oftime where it looks like they're
not breathing, and they're notbreathing, they have something
called Central apnea, wheretheir brain is not fully
developed To start breathing ata regular rate all the time. So
(26:43):
if you watch a baby, you maynotice that they just pause for,
you know, 510, seconds, which isa lifetime for you as a parent,
and then they just startbreathing again. They're not
gasping, they're not struggling,they're not waking up. So that's
something that I think a lot ofparents don't know about. It's
scary, but usually theseepisodes go away in the first
(27:04):
few months, and they
Nina, hi everyone, and welcome to your child as normal.
(00:09):
I'm your host. Dr JessicaHochman, and I'm so glad you're
joining us today, because wehave a very special returning
guest. Dr Nina Shapiro, apediatric ear, nose and throat
specialist. Dr Shapiro is notonly a fantastic doctor, but
she's also the author of take adeep breath, clear the air for
the health of your child. Inthis first part of our
conversation, we're focusing onthe questions I hear all the
(00:29):
time from parents of youngbabies, how to help them breathe
easier, whether your baby has acold, sounds stuffy, or
struggles to sleep comfortably.
Dr Shapiro explains how tosupport healthy breathing in
babies and young children withsafety and comfort in mind. I
know you're going to learn alot. And before we get started,
if you could take a moment toleave a five star review
wherever it is you listen topodcasts, I'd be so grateful
your reviews help other parentsdiscover your child is normal,
(00:51):
and this helps our communitycontinue to grow. Now onto my
conversation with Dr NinaShapiro. Dr Nina Shapiro, I am
so happy to have you back on thepodcast. Thank you so much for
beinghere. Great to be here. Thanks
for having me backso you have a second edition of
your book. Take a deep breaththat is in print and ready for
distribution. I'm so excited foryou. Thank you. Yeah,
(01:15):
it was a lot of fun to work on.
It was my first book, originallyback in 2011 and you think that
so many breathing issues areevergreen in children, which is
true, there are things that justdon't change, but there are
actually things that havechanged over the last 15 years.
So it was really fun to work onan update and get the latest
information and give it a bit ofa refresh. So yeah, I'm really
(01:39):
excited.
Yeah, absolutely. I noticed youtalked about chat GPT, AI, you
talked about updated VaccineInformation. So it was really a
great book. I really enjoyedreading it. And kudos to you.
Thank you. So what inspired youto write? Take a deep breath to
begin with.
So to begin with, this was backin, I guess, 2010 when I started
(02:00):
working on it, and I was inpractice at UCLA taking care of
children pediatric ENT, and Iwas seeing so many parents with
a huge range of issues withtheir babies. A lot of it was
babies with normal breathingissues that we see in babies,
and it was a lot of reassurancethat I needed to provide. Then
(02:20):
there was a large group ofparents that had babies with
mild issues, but they were soworried about these really mild
issues. But, you know, aspediatricians or Ents, we see
this, and we know that it'sreally nothing to worry about,
but I think it was reallyimportant to reassure parents.
And then lastly, the group ofparents with really severe
issues in their babies. I reallywanted to provide sort of a road
(02:43):
map for all parents who havebabies, infants, toddlers, how
to deal with mild problems,severe problems, what's normal,
what's not normal? When toworry, when to really just
relax. So I put it in sort of aquestion, answer format. It's
age based and also locationbased. So it's all chunks of
(03:07):
ages, and then it's nose tolungs for each section. Really,
just give them a road map whenthey have issues with their
babies.
That's really excellent. And asyou're talking, I feel like your
inspiration to write the book issimilar to why I'm so motivated
to do this podcast because as apediatrician, I noticed that
most of my day is spentreassuring families, making them
(03:28):
feel better about very normalprocesses that happen with kids.
But also we have to know when toworry, when there actually is an
issue, how to help guide them,and then how to draw awareness
to when there is a problem whenthere is something to do about
it. So very similar, motivation,similar. And I'm sure you give
them a lot of guidance in theoffice, like, well, here's
something that is normal andhere's something that maybe not
(03:49):
so normal. If this happens, youmay need to give us a call or be
a little concerned. But in alllikelihood, most of these issues
are normal, and it's really justscary for the parents?
Yes. And I think maybe if we canimpart good knowledge, let
people know what to look for,when to worry, hopefully that
can alleviate a lot of concerns.
Yeah, all right, so speaking ofcommon concerns, absolutely
(04:11):
something that I see a lot withparents are concerns when it
comes to breathing and how tohelp a child who seems to be
having difficulty withbreathing. So I'm excited to
talk to you about this, becausehopefully it helps parents.
Yeah, Imean, it's terrifying. I mean,
as scary as it is to have abreathing problem yourself, it
is magnitudes more scary whenit's your child that's having a
(04:35):
breathing problem. You feel itwhen it's your child. A lot of
these problems are something toworry about potentially or
something certainly to address.
But I think if parents had moreunderstanding about how babies
work, we always say this, aspeople who take care of
children, children are not justlittle adults, and certainly
(04:55):
infants and newborns are reallynot just little children.
They're their own. Beings untothemselves with different
breathing patterns, differentphysiology, different anatomy,
different structures that wedon't really understand what's
going on on the inside. And Ithink understanding a little bit
of that will give parents,hopefully, some tools and a
(05:16):
little bit more knowledge toreally address
these issues Absolutely. Sofirst, I'd like to ask you, what
is a normal nasal sound in ababy? It's just such a common
worry from parents, to the pointwhere when a child comes in for
their one month visit, I canpredict that a parent will be
(05:36):
asking me if breathing soundsare normal or have questions
about breathing. It's just socommon. So what can parents
expect? Right? So something thatsometimes parents find
interesting, and doctors whotake care of adults don't always
know this, is that newborns, upuntil anywhere up to age five
months, are obligate nasalbreathers, and that makes them
(05:59):
very different from the rest ofus, meaning that if they can't
breathe through their nose, theycan't breathe. Not to make that
scary, they can breathe, butthey will cry, and that's how
they will move air back andforth into their lungs. But if a
baby is stuffy, they areabsolutely miserable, and in
(06:20):
turn, parents will be miserable.
So a little nasal stuffiness isvery, very normal in everybody,
adults, babies, newborns, but ifthey have any more than a little
bit of nasal stuffiness to thepoint where it's hard for them
to breathe through their nose,it will be hard for them to
breathe period. So I think, youknow, a focus that I try to give
(06:41):
to parents is you have to keeptheir nose clean and life will
be okay for everybody,especially when we have winter
babies and, you know, and babiesthat are born in the fall, in
the winter, and they have olderchildren at home, and they have
a little nasal stuffiness, evenfrom a very mild cold, that's a
pretty cranky baby, for sure.
(07:02):
Yes.
And I think, to your point, theyare obligate nasal breathers.
They have to breathe throughtheir nose, as you said, except
for when they're crying. And theother thing is, they have very
small noses, very smallnostrils, so you know, with a
little bit of mucus, which allbabies make, if they reflux a
little bit, they're going tosound stuffy, and so it's also
very normal for babies to soundloud.
(07:25):
Yes, yes, it is. And sometimesit's literally a little tiny
booger crust in front of theirnose. It could be like a two
millimeter Bing, and then I'llliterally take it out in the
office, and all is well. So youknow, I think if parents knew
that, then they'd feel a lotmore comfortable addressing how
to keep their baby's nose clean.
One of the things that I talkabout, and that is very popular
(07:45):
for parents, are those nasalsuctions. You know, whether it's
different brands, some are nowbattery powered electric, or
some of them, like you put thelittle straw in your own mouth
and you suck the baby's nose,which I'm so glad was not
created when my infants hadwonderful and just it is the
notion of doing that is nasty.
(08:06):
So what I always tell parents isit's more about irrigation than
suctioning, because parents feelwhen they hear that their baby
is so congested that it must befilled with a ton of mucus. I'll
look at the baby's nose front toback with a little, tiny camera,
little telescope, and I willreassure them. There is almost
no mucus in there. It's juststuffy. And the more they do the
(08:28):
suctioning, the more inflamed itgets, the stuffier it gets. But
nasal saline is really like thebest stuff on Earth. There's no
chemical or any sort of toxin toworry about. It really just
flushes out the baby's nosebecause they can't do it
themselves.
Yeah, so I'd love to break thisdown. I think it's so wonderful
to talk about how to clean ababy's nose and how to do it
safely and effectively. Youtalked about nasal sailing.
(08:51):
Let's talk about this. Becausequestions that I hear a lot from
parents are they want to knowhow to do it. Sometimes they put
in nasal sailing and they feellike the child doesn't like it,
or maybe they gag on it a littlebit, and sometimes they worry
they're doing it too much,right? So what are best
practices to give saline in ababy?
So one of the reasons why babiesfeel like they're choking is a
lot of times parents will giveit to their baby when they're on
(09:14):
the changing table lying flat,and it really does make them
choke. It's like the saline goesback into their throat, and they
feel like they're gagging, andit's pretty uncomfortable. You
feel like you're restraining thebaby, and you can hold the baby
down and then sort of put thesaline in while they're on the
changing table, but it's muchmore comfortable. And think
about it for your yourself, youprobably wouldn't want that on
(09:35):
yourself. So I always say tohold the baby upright, and then
when you stick the nozzle in,you want to have it not exactly
straight up and not exactlyparallel, but sort of in the
middle at an angle inside thenose. You put the nozzle in
first and give it a good squirt.
The worst thing that happens isthe baby swallows a little bit
of it, and they probably won't,because it's really such a fine
(09:58):
myth. Just, most of it justcomes out. And that's fine too.
It's, this is a littleirrigation up and down, up and
down. It doesn't have to go allthe way back. You're not doing
sinus irrigation. This is reallyjust to keep the nose clean. I
sort of use the greenhousemetaphor that it should be like
a greenhouse in there. It shouldbe a little bit moist and a
(10:19):
little bit kind of damp inthere, and the ceiling just
creates that. You can use itonce a day. You can use it 10
times a day. It doesn't getabsorbed into their system. It's
not going to change theirelectrolytes or anything like
that. It's just a local way tokeep everything clean.
So I think that's a great pointto bring up, that you can use it
(10:39):
really as much as you want.
There are no side effects to it.
It's not like when we give kidsmedications, where we have to be
mindful of how many hours arebetween each dose. You can
really give it as much as youwant. It's salt water, yeah.
And same for pregnant people,because a lot of pregnant people
are very stuffy. So a littlenote for them, nasal saline is
great, because there are a fewmedications you can use in your
(11:01):
nose when you're pregnant.
Okay, so saline, great. Check.
Now you also mentionedsuctioning. Sometimes the advice
is given to put in Saline firstand then suction afterwards to
get the saline out. I agree thatI think suctioning has a helpful
role, but also there's a fineline where parents can overly
suction. Can you talk about thata little bit? Because I think
that's an important point tobring up to parents,
(11:25):
right? So sometimes suctioningis great, especially when there
is a really goopy nose. Babiescertainly don't know how to
clear their noses. They can'tblow their nose. They're just
really uncomfortable. A lot ofbabies don't mind the
suctioning. A lot of babies hateit, but they all feel better
afterwards, regardless of how weget through it. So if your baby
has a cold or just happens tohave a really goopy nose, you
(11:46):
can flush it out with a littlenasal saline first, just a great
idea, do the suctioning, andthen even nasal saline
afterwards, just to coat thelining. As far as how often to
do suctioning, it really justdepends on how goopy that nose
is. Sometimes it gets gooped upan hour later. Sometimes it's
just a few times a day. Sothat's just really based on how
comfortable your babyis. I'm thinking back when my
(12:06):
kids were little, I used toreally like using the bulb
suction, and my husband used tosay, you know, don't make
perfect the enemy of the good,because I would just want to
clear out every little boogerthat appeared. And the truth is,
sometimes the kids would sneezeit out on their own, I had to
learn to just reserve it forwhen it was really necessary,
andit puts pressure on their little
delicate tissues, and then itjust gets more swollen, and then
(12:28):
it just becomes a vicious cycle.
So unlimited saline suctioningwhen needed, right? And then,
what are some other ways that wecan help clear out the nose? I
know in your book, you alsobrought up, humidification can
be a helpful measure to clearout the nose.
Sure, if you if you live in ahome, certainly where you have
the heat on and it's very dryheat, or in the warmer months,
(12:49):
if you have the air conditioningand it's a very dry environment,
you can usually tell becauseyour baby's nose is going to be
pretty crusty. You can have ahumidifier in their bedroom or
in your room, if they'resleeping in your room. Just to
give a little moisture, youdon't necessarily have to have
it on all day, every day, butsometimes, especially if it's
extra dry, humidifier helps. Youwant to make sure that it's
(13:10):
cool. Mist is best. And anotherthing about those humidifiers,
it's a little bit laborintensive. You have to keep them
clean. They get kind of moldyand dusty, so then you're just
spreading other particulatematter into the air. So you keep
those humidifiers as clean aspossible. It's a little bit of
work.
I think that's the reason why Inever got a humidifier. Just do
(13:31):
that daunting to clean all thetime. Let's do that bulb
suction, correct. Yeah, exactly.
Okay. Now, something that youalso brought up using Afrin.
Now, admittedly, this issomething that I didn't realize,
that newborns can safely takeAfrin, so this was helpful for
me. Can you talk about Afrin?
What are the limitations? Howoften to use it? Because Afrin
(13:54):
can be a great help. So yes,please educate us. Tell us about
Afrin. Sowhat Afrin is? It's a local
decongestant, anti inflammatory.
It also shrinks all the bloodvessels in the nose, and it is
typically not indicated orrecommended for infants and even
young children. But, and there'sa big sort of caveat for that,
we as Ents use it all the time.
We use it certainly if we needto do surgery in newborn noses.
(14:18):
We use it in the hospital. Weuse it in the office setting.
And I think it should be reallylimited, because it is a
medication, but in the rightsetting, if it's a baby with
very, very severe nasalcongestion from a bad cold or
some sort of exposure, and it'stemporary and the baby is
(14:39):
absolutely miserable. That's atime to consider using Afrin.
It's not neosinephrine, which isanother topical decongestant
that is a definite no forchildren, but Afrin doesn't have
the side effects that somethinglike neosinephrine has, as far
as your heart racing and yourblood pressure, it's much safer.
For in that way, to use it invery limited it's really just in
(15:02):
rare situations. One of thetimes to consider using Afrin is
if you're flying with your baby,babies are absolutely miserable
on planes. They can't equalizepressure with their ears. And
even for older children, meaningolder infants and toddlers, a
couple of squirts of Afrinbefore the flight makes
everybody much more comfortable.
(15:25):
And describe the rule of twos,because I think this is a really
helpful way to remember how muchAfrin to use where it's still
safe, right?
And that goes for everybody, notjust infants and newborns. The
rule of twos for Afrin is nomore than two sprays each
nostril twice a day for twodays. So two sprays each nostril
(15:47):
twice a day for two days. Andthere's the 222, certainly, if
you're an adult with a sinusinfection, and if you use it for
three days, it's really fun, butyou know that, but you really
want to limit it. Afrin issomething that will cause what's
called a rebound reaction,meaning that if you use it for
too long, it starts causing thereverse and you will be very,
(16:08):
very, very stuffy, and thenyou'll feel like you keep
needing to use the Afrin, andit's going to become worse and
worse. So you really want tolimit how long you use it for,
how often you use it, and just acouple squirts in each nostril.
I've read it would really takeusing Afrin for, you know, seven
plus days to see that reboundeffect. So you're certainly
within the realm of safepractices if you stick to the
(16:30):
rule of twos. Yes, yes. I mean,I'm just thinking when I have a
cold, I'm miserable because Ican't breathe through my nose.
So these poor babies that haveto breathe through their nose,
anything that we can do to helpthem make them make them more
comfortable, I think this isgood knowledge to have when they
inevitably sound stuffy. Yes. Sonow the question I'd like to ask
you about is when to worry.
Let's say a baby is stuffy.
(16:52):
We're helping them, we're makingthem feel better, but they still
don't seem comfortable. What arethe signs that parents can think
about when they should seekmedical attention.
If a baby is stuffy and it'sreally not able to be cleared,
then you're going to start tosee other issues related to the
baby. The rate of theirbreathing is probably going to
(17:14):
pick up. And you know, allbabies breathe faster than older
children and adults, but if itbecomes really fast, and they
seem to be in distress. Theyhave something called Air
hunger, where they really looklike they're struggling. You can
start to see other muscles intheir body work hard. So you'll
see like the upper part of theirneck, their stomach or their
(17:34):
ribs, the muscles starting tomove to work, to breathe. They
just don't seem comfortable.
They can't eat, they can't sleepcomfortably. They just seem
overall miserable. Babies have afew things they need to do, they
need to eat, they need to sleep,they need to poop, and they need
to grow, and if they're notbreathing, they can't do any of
that. Well maybe they can poop.
(17:55):
But other than that, they'rereally miserable babies. And so,
you know, very early on in thefirst weeks of life, a parent
can recognize the differencebetween just a cranky baby who's
hungry or can't sleep versus ababy who's really struggling in
distress. And my mantra,especially when it comes to
infants and newborns, is neverworry alone. If you are worried,
(18:18):
you have to call somebody,because, if nothing else, you'll
get reassured that this isnormal. This is something that
you don't need to worry about,and I am taking that worry away
from you. But even if you don'tknow what's wrong, and there's
no reason a parent shouldunderstand what's wrong with
their baby, they just know thatsomething is wrong, they need to
find someone to either allaytheir fears or to address the
(18:42):
issue. And that's where our jobcomes in, as pediatric care
givers to you know, addresswhether, nope, this is fine.
This happens. This is nothing toworry about. Here's what you can
do, go back to sleep or come onin. This is something that's
urgent.
And I completely agree with you.
I think when parents areconcerned about breathing
Absolutely, reach out to yourpediatrician, because the best
(19:03):
case scenario, and the role thatI love to play is hopefully
we're just reassuring you. We'reletting you know that this is
normal, noisy newborn breathing,but also sometimes there are
concerning signs and symptomsand we can help. So I agree.
Don't do this alone. Seek help.
If I can share one mnemonic thatI like to tell parents to think
about, think about when they'rehome with their kids and they're
(19:25):
trying to assess if there's anissue, I talk about the a, b, c,
d, es, so A is for airway, youknow, looking at the nasal
passages, seeing if they lookpatent and open. B is breathing,
looking at their rate ofbreathing. Are they breathing
too quickly? Are they having adifficult time breathing? Are
they retracting and working tobreathe? C for color. They
(19:45):
shouldn't be blue around themouth. You talked about this
really nicely in your book. D isfor diet. Are they still able to
feed? Because if their nose isso stuffy, they're going to have
trouble feeding, right? Becausethey have to breathe through
their nose. And E, we talkabout. About energy. What's
their activity like? Are theyacting normal? Do they have
normal energy? If there's anyquestion about any of those,
(20:06):
talk to your pediatrician, reachout and get your baby seen. I
like, I like a good mnemonic,okay? And I also tell parents, I
try to flip the script a littlebit, that if your baby's a noisy
breather, it's not always bad,because at night, when you're
sleeping, you know, sometimes weworry if they're too quiet,
what's going on with them? Arethey okay? But if you listen
really closely, you can hearthem breathing, and know that
(20:28):
they're doing all right, thatthey're breathing, they're
thriving, they're sleeping. It'snot always a bad thing to have a
noisy breather.
Yeah, I get that complaint alot. After I take out a child's
tonsils, the parents say wecan't hear them anymore. Like,
that's actually a good thing, alittle noise maturing on that
monitor.
Yeah, it's a small benefit.
Small benefit, right? Okay, now,you talked very nicely in your
(20:49):
book about safety and safepractices to help babies with
sleeping, right? Can you mentionwhat is the safest way to have a
baby go to sleep? Because whatwe know about babies is the
number one reason why a babypasses away in the first year of
life is from something calledSIDS, and this is something
that, with Safe Sleep practices,we can help really mitigate that
risk. Yes,so that's another mnemonic, ABC
(21:12):
alone on their back in the crib.
That is the safest way. Thatdoesn't necessarily mean that
they need to be in another room.
I think this is a greatpractice, certainly in the early
weeks, to have your baby in thesame room as you so you know not
necessarily that they're in ahuge crib in your room, but in a
(21:32):
bassinet, which is a very smallcrib space in your room is the
safest way. And this is veryboring. There should be nothing
in the crib and no more bumpers,no more toys, no blankets, no
pillows, none of the cute stuffthat we all loved. You know you
see in the pictures, actually,the safest practice is all of
(21:56):
that should be gone for a while.
Crib bumpers, which are like thesort of cloth puffy liners of
the crib, were considered verysafe so the baby wouldn't get
their arms stuck like in the inthe slats of the crib. But then
they were finding that thebumpers were not safe because
babies can get stuck under thebumpers. So now it's no bumpers
(22:20):
in a very boring, plainmattress, tight fitting sheet on
a crib, on their back and alonefed. Sharing is really a very,
very high risk factor. It'sunfortunately
and I think this is a reallyimportant topic to bring up,
because I hear a lot of concernsfrom parents about this
(22:41):
recommendation for a couple ofreasons. One is they're worried
if their child spits up a lot,which a lot of babies do.
They're worried if my child's ontheir back, will they aspirate?
Will they spit up and thenswallow it? The other concern I
hear is parents like to cosleep. I just heard this week, a
parent said to me, we're theonly mammal that doesn't sleep
(23:01):
with their young ones, and itfeels so unnatural to have them
alone, sleeping by themselves. Ihear what they're saying, but at
the same time, something that Iunderstand as a pediatrician,
the best recommendation we canmake to a parent when they come
in for their first visit is toemphasize sleeping on their
back, because we will actuallyinevitably save lives, because
(23:22):
sleeping on your back, followingthose ABCs decreases the
incidence of SIDS by over half.
Correct, it's dramatic, and youknow the issue of co sleeping,
of course. I mean, everyoneloves that. For that, I say, let
them sleep on you, next to you,while you're holding them, or
even in your bed, but you cannotsleep during that time. If you
(23:43):
want to have your baby in yourbed, in your arms or in a chair
with you, that's a time for youto be awake and watching your
baby. And that's certainly fine.
And babies certainly newborns.
They sleep 1819, hours a day, sothere's plenty of time for that.
But when you are asleep, theyneed to be somewhere else.
And what would you say about asa pediatric ENT, the concern
(24:06):
about babies spitting up and theconcern for aspiration is that
something that you see as anENT,
so all babies have a little bitof reflux, meaning there's a
little bit of acid, a little bitof stomach contents that come up
the esophagus into the back ofthe throat, and sometimes that
causes a little bit ofirritation. Usually it doesn't
cause any problems. Babies areso tiny, the distance between
(24:28):
the stomach and the airway isjust a few inches, there's
always going to be a little bitof spit up. But babies have
reflexes, just like we havereflexes when they're asleep. If
they are actually going to spitup, they will wake up and cough
and be miserable and cry. So thenotion of vomiting in their Slee
(24:51):
is not a normal baby reaction.
The idea of it is terrifying, ofcourse. And you know. You've
heard of adults who've donethat, who've been, you know,
horrible drug overdoses, andthey aspirate in their sleep
because they're overdosing ondrugs. This is a human who has
reflexes, so if your baby'sgoing to be spitting up, it's
(25:13):
not something they do whilethey're asleep. If it starts
while they're asleep, they'regoing to wake up and cry and
like yesand and they have a very, very
sensitive gag reflex, which isreally helpful, really helpful
for babies. For parents, theyprotect themselves, yes, all
right, well, this has been sucha helpful overview on infants
and stuffy noses and safe sleeppractices. I'm curious, are
(25:38):
there any myths that you hear alot from parents that you'd like
to clear up about breathing? Anymyths that we haven't talked
about that you'd like to clearup that can help parents worry
less?
I think you know, one of themyths, I don't know if it's a
myth, but just sort of amisunderstanding, is, again,
that it's better to be in thesame bed. I think there are a
(25:59):
lot of parents who still believethat co sleeping is safer and
healthier and more nurturing andwill lead to sort of a more
robust development, I thinkthat's a myth. There's plenty of
time during the other 24 hoursof the day, or 18 hours of the
day, to have you know with yourbaby, otherwise, the
irregularity to breathing thatbabies have, they don't
(26:22):
necessarily have the regularbreathing that older infants and
children have, and so if youwatch a sleeping baby, you may
notice that there are periods oftime where it looks like they're
not breathing, and they're notbreathing, they have something
called Central apnea, wheretheir brain is not fully
developed To start breathing ata regular rate all the time. So
(26:43):
if you watch a baby, you maynotice that they just pause for,
you know, 510, seconds, which isa lifetime for you as a parent,
and then they just startbreathing again. They're not
gasping, they're not struggling,they're not waking up. So that's
something that I think a lot ofparents don't know about. It's
scary, but usually theseepisodes go away in the first
(27:04):
few months, and they
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