Surviving Sleep Regressions

Even babies who sleep through the night may go through periods of multiple nighttime wakings. What causes sleep regressions? When should parents expect them? And how can you help your baby get back to sleep on their own?

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Episode Transcript

Natalie Gross 0:00
You finally get your baby to sleep through the night, then a sleep regression hits and you're back to multiple nighttime wakings. On today's show, you'll learn all about sleep regressions and how to survive them when I bring on a baby sleep expert and experienced mamas to answer all your burning questions. This is Newbies.

Natalie Gross 0:57
Welcome to Newbies. Newbies is your online on the go support group guiding new mothers through their baby's first year. I'm Natalie Gross, mom to a three year old boy and a baby girl. We've got a great show today talking about sleep regressions. Now if you haven't already, be sure to visit our website that's And you could subscribe to our weekly newsletter that keeps you updated on all of the episodes that we release each week. Another great way to stay updated is to hit that subscribe button and your podcast app. And if you're looking for a way to get even more involved with our show, then you can check out our membership club called Mighty Moms. That's where we chat more about the topics discussed here on the show. And it's also an easy way to learn about our recordings so that maybe you can join us. I'd like to introduce our panel of guests who are with us today. We have pediatric sleep consultant Jayne Havens as our featured guest. We also have moms Amanda and Chloe joining us to share their experiences with this topic as well. So thank you all so much for being here. Let's kick it off with some introduction. So tell us a little bit about you and your family. Jane, do you want to kick us off?

Jayne Havens 1:56
Sure. Thank you so much for having me today. My name is Jayne Havens. I am a mom of two I live in Baltimore, Maryland. I am a pediatric sleep consultant. My business is called Snooze Fest by Jane Havens. And I'm also the owner and founder of Center for Pediatric sleep management, where I train and mentor and certify others to become sleep consultants.

Natalie Gross 2:17
Wonderful. Thanks so much for being here. Amanda, what about you?

Amanda Kraker 2:20
Hi, my name is Amanda. I am a mom of four. We live in Michigan currently. I am a stay at home mom currently homeschooling my first grader and my preschooler. All right, and how old are your kids? Amanda? I've got a six a four or two and a five month.

Natalie Gross 2:37
Great. And Chloe, what about you?

Chloe Anagnos Pierce 2:39
Hey there, thanks for having me. My name is Chloe Anagnos Pierce, I live in Indianapolis, Indiana with my husband and our nine month old daughter. And in my full time capacity, I am a work from home mom. And I'm the director of marketing for a nonprofit that's based in DC but I've been remote ever since the pandemic. So it's been nice to be home and spend time with our daughter and be able to work at the same time.

Natalie Gross 3:07
Jayne, can you walk us through what sleep regressions are and what causes them. And then mom's you know, as she's talking, be thinking about your own experiences with your babies. And I'd love for you to share those as well.

Jayne Havens 3:17
Sure sleep regressions are so it's such a hot topic in parenting when you think of moms and dads who have young kids and they are analyzing and perhaps sometimes over analyzing their baby's sleep and, you know, we often describe our baby sleep as good or bad or it's better or worse, right. And when I think of a sleep regression, I think of something that's just changing, right. And sometimes the sleep progression, the big one that everybody thinks of is that for months sleep regression, that's sort of the most well known sleep regression. This is actually a neuro developmental maturation where actually, the infant sleep cycles are becoming more like adult sleep cycles. So in that situation, it's actually our baby's brains that are developing, and I like to think of it more as a progression rather than a regression. I'll get back to that one in a minute. All the other sleep progressions are really just an I'll go through sort of the different categories, but they're all just sort of, they could happen at any time. If you're reading a lot about baby sleep, you might hear about an eight month sleep regression, or an 18 month sleep regression or a two year sleep regression. And honestly, sleep regression can really happen at any time. So if we want to quickly run through sort of what I think are the main causes versus the progression, the first one I'll go back to that four months sleep regression where a baby's sleep cycles are literally changing. So when you think about a newborn baby, they sleep really deeply. They can cycle in and out of sleep cycles without much effort they they need to be roused and go back to sleep or they don't even rouse because they're just in deeper sleeps. And then they get a little bit older and all of a sudden they wake up and they look around and they're overstimulated by their surroundings. And sometimes they have trouble getting back to sleep. That's what parents see at four months. That one really is an entirely different category than the rest of them. The other ones I would categorize as just like changes that happened to your baby's sleep for one reason or another. One common reason for a sleep regression would be asleep Association creeping in. So maybe your baby was sleeping independently falling asleep independently, and you go on a trip, let's say, and when you're in a new environment, and everything is strange, it's a different crib, or maybe the baby's sleeping in a pack and play. They don't know where they are their room sharing with their parent, when previously they had been in their own room, the baby might be nervous, and a little anxious to fall asleep independently in that new surrounding. So in that situation, a parent may say, oh, you know what we're on vacation, that baby's little nervous about sleeping in this new room, we're going to rock him to sleep, right. And so a new sleep association creeps in, in this case, the rocking, or it might become feeding or it might become bouncing or whatever other options there are. And then you get home from vacation. And all of a sudden, your baby's waking up every single hour, because they're expecting to be rocked back to sleep the way that they are, or the way they were when they were on vacation. So you know, these sleep associations that creep in it can happen during travel, when a baby is sick, teething, it really can happen at any point, right? The next category of sleep regression, I would say is like when there's a need for a schedule modification. So let's use let's use a baby who is on to naps, who needs to go down to one nap. At this age, maybe it's a one year old or a little 14 month old baby. And they're taking their two naps a day. But all of a sudden, they're getting so much day sleep during the day that they aren't tired at night. So then they wake up in the middle of the night, and they have long wakeful periods in the middle of the night. Or perhaps they're waking up really early in that situation, it might be time to adjust down to one nap, so that they're more tired overnight and can sleep more peacefully and soundly for those 11 to 12 hours that they typically need overnight. And then the last major category for sleep progressions, I would I would lump into the category of sort of like developmental milestones that impact sleep, sometimes a little bit negatively. The best example I can give here is usually around eight or nine months old babies will learn to stand, right. And this happens, a lot of the time they practice these skills in their crib. So for a baby that's falling asleep independently falling back to sleep independently has completely independent sleep habits. All of a sudden, they're in their crib, and they realize they can stand up, but oh my gosh, they don't know how to get back down yet. Or perhaps they might know how to get back down. But mom or dad sees this on the monitor, and is nervous that oh my gosh, they just stood up for the first time, I'm gonna go lie them down so they don't get hurt, right. And then it becomes a game of the baby standing up, mom going into lay him down. Mom leaves baby stands up again. And next thing you know, it becomes a sort of cause and effect little behavior, where baby knows that if he stands up in the crib, mom comes in to lie him back down. And he likes that. And so it becomes a little bit of a game. And sometimes babies then can lose their confidence that they're actually totally okay to be in their cribs by themselves. Because they get so used to seeing a parent pop in every time they do that new thing that they're working on that perhaps is making their parents a little bit nervous. So just to sort of like, quickly recap them, you know, the four month sleep regression, which is really truly the only real one that happens at like a very specific age, it usually happens between three and four months. And then the other ones are either like sleep associations that creep in, or the need for a schedule adjustment or developmental milestones that can negatively impact sleep. I think I covered it all.

Natalie Gross 9:27
Does it continue after age three, because I'm pretty sure I'm in one with my toddler.

Jayne Havens 9:31
Yeah, so does your three year old still nap?

Natalie Gross 9:34
We're trying to cut it some days, mostly, but we're trying.

Jayne Havens 9:38
Yeah, so I think that that would fall into the need for a schedule adjustment. Great. So three year olds that struggle with sleep if you're having bedtime battles, my guess is like if there's still a nap and bedtime is really hard. And then if there's not a nap then they're like cranky and really tired come bedtime and then that can be hard to so really just nailing down a good schedule and a good routine. And then also when you think about older children, it's just really, I wouldn't put that into a sleep regression category. It looks like a sleep regression. But really it's a boundary setting situation. It's it's an issue of parents feeling nervous and anxious about setting firm boundaries around sleep. And and when parents decide to set really firm and respectful boundaries around sleep, usually all of the shenanigans wash away.

Natalie Gross 10:30
Yeah. Well, Chloe and Amanda, as Jayne was talking there, what are your experiences with sleep regressions? Does any of that resonate with you?

Amanda Kraker 10:40
Most certainly, with me. We just are on the tail end of the four month sleep regression with my daughter. And it's been not as bad as some of my other kids. But she's, she's been waking up in the middle of the night and singing to herself. She hasn't like, been crying in the middle of the night like my other kids did. But she's she wakes up in the middle of night and sings to herself or her naps have been shorter, like she'll wake up after the, like 45 minutes. And then she'll just want to kind of stay awake. And it's hard, especially since we we live in a small apartment right now. And she hears her siblings, and so she doesn't really want to go back to sleep at all. So we're kind of on the tail end of that she'll she's starting to go back to sleep now. And she's not waking up at night anymore. And my son is in a nap reression. Because he's two and a half. And he does not want to take his nap his sisters are are awake and playing and he hears them and it's so much fun. And he doesn't want to take his nap. And then he's really, really a mess later.

Natalie Gross 11:53
Yep. Chloe, what about you? Yeah, unfortunately, we were in the same boat. When my daughter was about four months, she hit that really dreaded four month sleep regression, where she would wake up, I'd say almost every two to three hours throughout the night, which was really hard. We did some sleep training with her that seemed to help for a while. And then she hit I would say another sleep regression around eight months where it was waking up probably every four hours throughout the night. And now I'd say she really only gets up maybe once during the night for, I want to say maybe a couple minutes, because she wants about half a bottle. She also was born a month early. And so I have a feeling that a lot of the sleep regressions and some of the troubles that we've had there, from a neurological standpoint, can have for maybe a little bit behind. That's what our pediatrician had mentioned to us when I said that we were struggling with sleep. But it's also funny because even though she was born premature, her height and weight has all caught up to her which is great. But she's still very much like a skinny little string bean. And so she although she shouldn't be waking up during the middle of the night to eat, which is what she really wants. She is still doing that. So it's one of those things where we have to kind of adjust, you know, feedings throughout the day, and you know, adding more calories and whatnot to, to her food and all that good stuff. But eventually, we'll get to 12 hours, but we're not quite there yet.

Natalie Gross 13:29
Were either of you familiar with the concept of sleep progressions? Or is it something that you discovered when it happened to you?

Amanda Kraker 13:36
I had no clue with my first kid. Not at all. Terrible sleeper. I didn't know about sleep regressions, or sleep training or any of that. So that was news to me. But after that with my other three than I was more expecting it because I had read up on sleep regressions and stuff from my first. I do feel like it's something that people don't talk a lot about. You hear sleep training, or, you know, getting them to sleep through the night and all these concepts but sleep regressions

Natalie Gross 14:04
Yeah, similar to you, I had no idea with my first

Chloe Anagnos Pierce 14:07
I learned more about sleep regressions and sleep training than I ever thought that I would Tiktok, so that's where my TikTok and then a lot of my girlfriends, I'm one of the middle in my friend group to have to have kiddos and so I got some good advice from them. But in this instance, the Internet was very helpful to me.

Natalie Gross 14:28
Well, thank you so much for sharing your experiences. We're going to take a quick break and when we come back I'll be talking more with our expert Jayne. So stay tuned.

Natalie Gross 14:41
Welcome back, everyone. You've already met our expert Jayne Havens with Snooze Fest. She is a certified pediatric sleep consultant through the Institute of pediatric sleep and parenting and Center for Pediatric sleep management, which she already talked about. So Jayne, we kind of already talked about the ages and the stages where babies go through these sleep regressions. Do all babies go through this regardless of whether they were sleeping through the night before they hit a certain age?

Jayne Havens 15:05
So the four month sleep regression, every baby does go through something developmentally where their sleep cycles do mature. That being said, babies who are already falling asleep independently and putting themselves back to sleep in the middle of the night, if they roused in the middle of the night, those babies those independent sleepers typically don't regress. You know, I put that in air quotes, the way that babies who don't have independent sleep habits will regress. So parents often see the four months sleep regression, when you know they're rocking their babies to sleep at bedtime, they're rocking them back to sleep in the middle of the night, that's largely working maybe at four months, the baby's waking up once or twice in the middle of the night and just needing a Passier quick feed, and they're very easily going back to sleep at four months. Those babies who don't know how to fall asleep on their own, they're the ones that start waking up every hour, crying for a pacifier or crying to be assisted back to sleep. So the babies that already have their independent sleep habits, they aren't typically affected so greatly by it. And then you know, the other sleep progressions that I discussed, you know, that get impacted by travel or developmental milestones. You know, some babies are more prone to this than others, some babies are really quick to latch on to new habits, and others can, you know, take things in stride and move right along, I have a little nephew who is he's about to be a year. And a couple of months ago, he had a little surgery. And when he did, you know, he came home and he he needed some extra support. He was an independent sleeper, he knew how to fall asleep and back to sleep independently. But when he came home from his procedure, he needed those cuddles, he needed to be rocked to sleep for a day or two. And I you know, as a sleep consultant, I had my eye on it really closely, and fully supported them, giving him those extra snuggles and that extra support that he needed. But once he was recovered, and once he was feeling better, they went back to putting him down in his crib entirely awake, and he just put himself to sleep with no fuss. And for a lot of babies, that would be a tough habit to break. So I do think to some degree, it depends on temperament. And some babies are easier to sort of get back on track when things go awry, and others have a really hard time with it.

Natalie Gross 17:30
Okay, so you know, if someone listening, their baby's going through progression, the four months or six months, nine months, whenever they're waking up in the middle of the night at times when they weren't before? Should you feed them to try to get them down to do rip their bag? Like in your opinion, what should the parent do?

Jayne Havens 17:49
So I think that, you know, it's so tricky in the when I get asked these questions, because the answer is always It depends. Right? I wish it were so simple. When I want to make it really clear for people who are listening, and maybe don't have so much knowledge on this topic when it comes to sleep training and establishing healthy and independent sleep habits for babies. Sleep training and night weaning are really two entirely different things. So you know, when I work with families to teach their children how to fall asleep and back to sleep independently, a lot of the time at the end of our time together, the baby's still eating in the middle of the night because they're not ready tonight we are maybe mom isn't ready tonight wean it totally depends, right? So for a baby that's not eating in the middle of the night and hasn't been for some time. I personally don't think that feeding is ever the answer. Because if they've become accustomed to going the entire night without being fed, if they're waking up in the middle of the night, for some reason, it's highly unlikely that it's due to hunger. And because you've already established that sort of boundary that calories are consumed during the daytime and not overnight. I don't think there's any reason to ever change that. For babies that are let's use the example of like, if they're sick, if they're teething, and they're regressing. If you're worried about your baby's health, if you're worried about their comfort level, it's always okay to provide some additional support. I never want parents to think that they can't support their babies through short term struggles. That being said, there's a difference between supporting a baby and giving them some extra help and sort of reverting back to old habits of completely assisting them to sleep. So you know if you can sort of take the path to least resistance and you know, maybe some extra snuggles before bedtime, maybe a few extra back rubs but not entirely patting your baby back to sleep that's always going to help you in the long run. But you also should feel confident that if you do slip into those habits are providing more support because you feel your baby needs it in that moment. You can always make a change when you feel confident that they're feeling better.

Natalie Gross 19:54
Okay. And how long does the four month sleep regression last or you know, typically when there's a regression or progression, as you said, Yeah. How long did this typically last?

Jayne Havens 20:04
Yeah. So it lasts until you make a change, especially with a four month sleep regression. You know, parents come to me all the time. And they'll say, you know, my baby is seven months old. And they'll, they'll give me a whole history. And they'll say, sleep was really good until about four months, and then we hit the four month sleep regression. And we're still struggling three months later, right. So nothing really changes, if nothing changes, if nothing changes, right. So for a baby that is being assisted to sleep, and then assisted back to sleep hourly, in the middle of the night, that is unlikely to magically resolve without the parents making some sort of change on their end. The most common thing that I see is parents popping a pacifier back in every single hour. And for a baby who cannot replace the pacifier on their own, you know, in order to get over that hump, you really need to sort of make a change and stop using the pacifier at least until they can replace it on their own. So with most regressions, it really actually takes some sort of parent involvement to see a major change. Whether that be a schedule modification, changing the way that you respond in the middle of the night, or changing the way that you put a baby down for bedtime. Usually, in order to see progress, it does take some direction coming from parents.

Natalie Gross 21:18
Okay. At what point should new parents you know, especially someone who's concerned this the progression isn't ending? What do I do? When do they go see a pediatrician or a sleep consultant like yourself?

Jayne Havens 21:31
Yes. So for babies that were sleeping independently, and had really healthy and independent sleep habits before this said regression, I always tell parents, if something randomly starts to go really arrive, checking in with your pediatrician is always a good idea. It's actually often the ears. Parents are very quick to blame teething on sleep disruptions and sleep disturbances. But I can't even tell you how many ear infections I've diagnosed either like in Facebook groups, or just with people texting me about random sleep progressions, I always tell them, you know, go have your baby's ears, check to make sure that they're feeling okay. An ear infection can present without a fever. So sometimes parents just don't even realize that that's what's going on. So checking in with your pediatrician is always a good idea. And then otherwise, you know, if your baby was sleeping really well and had healthy sleep habits, and then all of a sudden they don't, and they're healthy, and they're okay, they're just no longer sleeping independently. I say it's time to work on it as soon as you're ready to work on it.

Natalie Gross 22:33
Okay, well, good to know. Thank you so much for sharing this important information. Jayne, we're going to take another quick break, and then bring our moms Chloe and Amanda back into the conversation.

Natalie Gross 22:48
All right, welcome back, mamas. Any thoughts on what we've just heard from Jayne?

Amanda Kraker 22:52
I thought it was interesting that your problems could cause sleep disruptions, because I always thought it was just like, usually the teething or you know, the developmental and stuff like that. But I thought that was interesting to check ears.

Natalie Gross 23:06
Absolutely. I had not thought of that either.

Chloe Anagnos Pierce 23:09
One thing that really stood out to me was teaching your baby to sleep independently, or at least trying to get them to figure out how to fall back asleep without you. And that's one thing that we worked really hard on was sleep training, whether that be the blinky, that's the cuddle buddy or the pacifier or just, you know, shushing, and having the white noise and making sure that everything is the way that it needs to be for sleep. That's one thing that especially when I tried to describe sleep training to folks that are either in my parents generation, or that are actually my parents, sleep training is always something that they're kind of like, what you paid to you paid to have someone tell you how to get your kid to sleep. What that's crazy. But those are not necessarily things that people always think about. So it's nice to have that that reassurance from a professional.

Natalie Gross 24:02
Yeah, absolutely. Jayne, can you actually talk a little bit more about what it means to put your child to sleep and let them fall asleep independently? Instead of yes, I'm guessing that's the opposite of like nursing to sleep?

Jayne Havens 24:13
Yeah, exactly. So there's a whole lot of sort of, how do I describe this sort of drama around this topic, for lack of a better way of saying it because babies who fall asleep independently for the first time, are often a little bit sad about it, or are they're a little bit frustrated to be learning to fall asleep in a new way, but the way that babies fall asleep, is entirely behavioral. So for a baby that is used to nursing to sleep, that is their habit that is their preference. It doesn't mean that they're not capable of falling asleep without nursing. It's just what they know. And it's what they expect, at some point. Whether the baby is six months old, or sometimes even three and a half years old. You know, these children nursing to sleep no longer becomes sustainable for everybody in the family. And when the decision is made to work on teaching the baby or toddler or preschooler how to fall asleep in a new way, sometimes it can feel stressful and overwhelming. And there's so many ways to do it. I don't know that I should go into all of them here. But the basic premise is that you can gradually work on it. So just to give you an example, for that baby who is being nursed to sleep, a really gradual way of working on it would be to shift to rocking them to sleep. So you're still assisting them to sleep just in a way that is maybe less familiar to them. And then for a baby that is then was nursed asleep, and now is rocked to sleep, perhaps the next step is just holding them and shushing in their ear while they fall asleep. And the step after that would be putting them into the crib and putting a heavy hand on their back or on their chest and shushing so that they felt safe and confident or comfortable to fall asleep in their crib rather than in your arms. Now, I want to be super clear that none of this means that there's going to be no crying, it doesn't mean that there's, it's not going to be hard or challenging or a little bit stressful, but it's totally worth it. Now, that's sort of the most gradual way that I teach parents to teach their babies to fall asleep. And then the other option on the other end of the spectrum is just to sort of like, put them down and second night say love, you give them a kiss and give them an opportunity to try. A lot of parents love to call this cried out. I like to call it trying to fall asleep in a new way. And there's a whole spectrum of options in between the two that I just shared here, there's lots of ways to work on it. But at the end of the day, when a child can fall asleep independently without the nursing or the rocking, or the bouncing or the pacifiers, then when they rouse in the middle of the night, they have the tools, and they have the confidence to get themselves back to sleep without struggle. Now all of this sort of like anti sleep training brigade will come at me and say, you know, babies are supposed to wake up in the middle of the night, and it's, you know, biologically normal for babies to wake in the middle of the night. And that is all completely true. Sleep training does not teach babies not to wake in the middle of the night, they still wake up, they just quietly get themselves back to sleep without so much struggle.

Natalie Gross 27:33
You know, I want to kind of give some practical tips for other moms out there who are struggling through sleep regressions right now, Amanda, you're an experienced mama for anything that's worked for you.

Amanda Kraker 27:46
Well, the biggest thing that helped us and it's usually it helps during like the developmental sleep regressions, like when they're practicing in their cribs, is I really try to practice their new skills with them while they're awake. Because they're wanting to get practice in anyway. Right. So my, the thing that I've seen the biggest success with with that, anyway is like if they're learning how to, to stamp, and then they stand up in their crib, and they can't get down and they're really sad. So I'll practice with them during the day, how to sit back down in their crib. Or if they're learning how to sit, you know, I'll give them plenty of opportunity during the day to learn how to sit. So that that night time, they're not wanting to practice as much and they're more tired.

Natalie Gross 28:39
Yeah, that's a great idea. Chloe, any any thoughts from you?

Chloe Anagnos Pierce 28:43
Yeah, and I think one of the big things for me, at least with being a first time mom, and you know, remember, our daughter's nine months old, so I've only been doing this for nine months is that being really strict about our routine, especially when it comes to sleep and nighttime has been instrumental. And that's one thing that we've worked on a lot with, whether it be a babysitter or my parents or my in laws, or anyone that's going to be watching our daughter, if we're going out on a date night or something is that this is the schedule, this is routine. This is why we're sticking to it. And if you don't stick to the routine, these are the consequences in terms of you know, someone being up all night and being cranky, or you know, you're not getting the sleep that you need kind of thing. So for us it's it's dinner, bath, blankie and cuddles with you know, when when we put jammies on that kind of thing, reading a book, rocking and some music and then we do we say okay, good night, when it's time to go to bed, put her down. And that usually will do it. And I will say a couple times when we've noticed that she's teething or you know, unfortunately, she had RSV a couple of weeks ago. She's fine now. But sometimes, you know, sickness and discomfort can make it a little bit harder but those are just some of the tools that we've got so that, you know, we can continue to do everything we can to support her so that she grows and so that we can support our own sanity as well. Because that's one of the big things. Being a first time parent, no one really tells you how difficult sleep can be. So we're thankful for that.

Natalie Gross 30:19
For sure. Jayne, any last thoughts as we wrap up here?

Jayne Havens 30:23
Going back to sort of like establishing those healthy sleep habits, I want to say out loud that you do this because it works best for your family. It's a personal choice. If you are thriving with your child being assisted to sleep, and then you know waking hourly and you popping the pasty every hour and that works for you. And that what that's what feels best for you as a parent, and that's working for your child. totally great. And if that no longer feels sustainable, there are ways to make a change so that everybody can thrive.

Natalie Gross 30:58
Yeah. Well, thank you so much, Jayne, for sharing this information. Thank you, Chloe and Amanda for coming on and sharing your experiences as well. Listeners, you can find out more about Jayne's work at Love that name, by the way.

Jayne Havens 31:11
Thank you.

Natalie Gross 31:11
Also check out new where we have all of our podcast episodes plus videos and more.

Natalie Gross 31:28
That wraps up our show for today. We appreciate you listening to Newbies. Don't forget to check out our sister shows Preggie Pals for expecting parents, Parents Savers for moms and dads with toddlers, the Boob Group for moms who get breast milk to their babies, and Twin Talks for parents of multiples. Thanks for listening to Newbies, your go-to source for new moms and new babies.

Unknown Speaker 31:53
This has been a New Mommy Media production. Information and materials in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate. It is not intended to replace or substitute for professional medical advice or care and should not be used for diagnosing or treating healthcare problem or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health, or the health of your baby, please seek assistance from a qualified health care provider.

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