Feature: How Harvey Karp Turned Baby Sleep Into Big Business


While filming it in 2002, Karp, then a pediatrician in Santa Monica with a growing reputation, had asked his patients to call him whenever their child was having a crying fit. He then drove across town to record the encounters — effectively making house calls for screaming babies. Montée, a documentary filmmaker, worked the camera. The result has a zany, homemade quality. Over and over again, Karp is seen swaddling, handling and shushing babies into submission while talking to the camera in a voice so hypnotic it could be trademarked. One exhausted-looking father praised Karp for turning his crying daughter “to Jell-O.” It wasn’t exactly revolutionary, but his method was built on fast, practical tips that, well, worked. So we clung to them, feeling a little sheepish to be following a parenting expert so literally.

Birndorf told Karp that a pediatrician had recently visited the center and suggested that babies not be put to sleep on nursing pillows or on bouncing chairs — a reversal of previous pediatric guidelines. The advice of parenting experts — many but not all of whom are doctors — kept changing, she complained. The contradictions she recounted, from conveying to women that motherhood is a natural state to instructing them on exactly how and where their babies should sleep, all while nullifying earlier recommendations, seemed to get at an inherent paradox at the heart of a profession whose stated goal is to empower parents. “Highlights from 100 years of expert solicitude confirm the dirty little secret of child rearing: Though parenting gurus preach the supreme importance of consistency, their own shifting wisdom is proof of its impossibility,” Ann Hulbert, the author of “Raising America” (2003), a sweeping history of child-rearing advice, wrote in this magazine.

Karp nodded at Birndorf sympathetically. That he is one of those gurus, peddling parenting products, didn’t seem to discomfit him. Whenever someone points out the hypocrisies of today’s parenting industry, which happens often enough, Karp doesn’t try to defend it, or himself. He commiserates, and it sounds genuine — the ambivalent doctor trying to help parents make sense of a chaotic world. That’s one reason many parents find his approach so reassuring. Unlike other parenting books, Karp’s doesn’t feel preachy or berating. His tips can be applied just as easily by fathers as by mothers, and his pragmatic advice and suggested baby schedules don’t feel like more than what they are: suggestions. But as I trailed him on his rounds, his suggestions invariably seemed to crescendo toward a pitch.

“Well,” he told Birndorf, “this is where they would use a SNOO.”

When explaining his philosophy of parenthood, Karp likes to quote his late mother: “Keep an open mind, but don’t let your brain fall out.” Karp grew up in Queens with two older sisters in a family he describes as Jewish but not Orthodox, Democratic but not political. His father was a building engineer and occasionally a door-to-door salesman; his mother was in charge of the business’s bookkeeping. As a child, Harvey was temperamental. At 12, he smashed a golf club into a painting his sister made. Later, he took up meditation. “It was right when the Beatles were doing it,” he said. This began for him a lifelong interest in Eastern and alternative practices even as he decided to enroll in medical school.

Photo


Credit
Hannah Whitaker for The New York Times

By his second year at the Albert Einstein College of Medicine in the Bronx, Karp knew that he wanted to care for children, whom he considered more “optimistic and resilient” than adults. He moved to Los Angeles for a residency at Children’s Hospital, meeting and marrying a woman who was studying to become a family counselor. At night, he pored over his wife’s textbooks about family dynamics. He trained under Barbara Korsch, a pediatrician who was among the first to study the field of doctor-patient communication and to call for “reducing the power gap” between physicians and parents. “Being smart is important, but you can’t get through the door by being an arrogant, smart doctor, unless you want to be a surgeon or a radiologist or something like that,” he said. “But if you’re dealing with patients, you’re knocking at the door and you’re being invited in. You have to be a good guest.”

In the early 1980s, he began working at U.C.L.A. hospital’s child-abuse team. He watched as babies were wheeled into the hospital in the middle of the night because their parents didn’t know how to soothe them or had badly shaken them when they screamed uncontrollably. “It was perplexing to me, because I thought: We could put a man on the moon. We could cure some types of cancer. We could make long-distance phone calls around the world. But we don’t know why babies cry, and we don’t know how to help them sleep.”

This issue of infant colic — of otherwise healthy babies who cry for more than three hours a day, at least three days a week, in the first three months of life — gnawed at him, and he immersed himself in books on evolution and anthropology. He learned about a Pygmy tribe that passes around babies between different community members all day long so that children develop multiple relationships early. He read the fieldwork of the anthropologist Melvin Konner about the infants of the !Kung San people in the Kalahari, who are carried in slings and rarely cry for more than a minute at a time. In the West, about 15 to 20 percent of babies have colic. “So either the !Kung babies were mutant babies — different from others — or those parents knew something.”

One day, when he was 29, Karp felt a dull pain in his neck as he was heading back to the hospital from lunch. He asked an intern to perform an EKG on him, but the intern didn’t know how to read the results. “So I’m showing him, ‘Here — oh, my God, this is cardiac ischemia.’ ” What he was reading was his own heart attack. He was kept in the hospital for a week for observation and advised to eat half a pound of salmon a day to reduce his cholesterol. The incident was mild enough that it didn’t have lasting effects, but it left him with a greater sense of urgency. “It was a crystalline moment,” he told me, of coming to terms with his own limitations. From then on, whenever he went for a run in Santa Monica and reached an area with outdoor stairs, he forced himself to think, as he descended, that at the very bottom “is the end of my life and to prepare for that.”

Before the heart attack, he had planned on going into child-development research, but now he thought the demands of academia would be too taxing. Instead, he joined a practice in Los Angeles with two other pediatricians and began to develop a local following. He threw himself into the job. Early in his career, he resolved never to do a checkup for less than half an hour. On some days, he visited six different hospitals to meet his newborn patients. As his work got more demanding, Karp and his wife grew apart and divorced.

Photo


Credit
Hannah Whitaker for The New York Times

Karp was beginning to develop his concept of the “missing fourth trimester.” Human babies are born about three months prematurely, the theory goes, because their heads, which grow rapidly, need to be able to fit through the birth canal. Some scientists dispute Karp’s notion that human gestation is too short. “Sadly, the evidence doesn’t support that,” Daniel Lieberman, an evolutionary biologist at Harvard, told me. But Karp insists that this explains why during the first months of life, babies can be lulled back into a womblike “trance” through the use of certain cues that Karp calls the 5 S’s: a combination of swaddling, shushing, placing the baby on her side or stomach, swinging her and letting her suck. He noticed that for each baby the “symphony of sensations” was slightly different — some babies needed extra movement, others a light jiggle — though all the infants responded well to swaddling, even if they seemed resistant at first.

By the early 1990s, Karp was running his own clinic, with a playground out back, and eventually he hired four pediatricians to work with him. “At the time, if you could get in to see Dr. Karp, then you’ve got it made,” Elaine Hall, whose son became a patient of Karp’s in 1996, told me. “He had a kind of hippie vibe to him then. He was gentle and comforting, and he had a long ponytail.” Karp gave her son a diagnosis of severe autism when he was 2. “Dr. Karp took me aside, and I’ll never forget — I get teary — he said: ‘You’re going to go on a journey. It’s a different path than you envisioned, but I can promise you you’re going to have lots of experiences that are going to make your life richer than you even imagined.”

Karp became famous for what were then unconventional methods for bonding with infants. Deena Goldstone, the mother of one of Karp’s first patients, remembers Karp suggesting that she swaddle her newborn at night, “which I thought made no sense,” she told me. Karp also advised Goldstone’s husband to hold their baby against his bare chest, in what doctors now tout as the importance of skin-to-skin contact. As his reputation grew, Hollywood celebrities took their children to see him; he treated the kids of Madonna, Michelle Pfeiffer and Larry David.

He also had a new family. He and Montée met at a party in Hollywood in 1991, when he was 40, divorced with no children. She was 11 years younger, with a 7-year-old daughter, Lexi, from a previous marriage. Montée is from Belgrade and has a highly polished complexion and the kind of thick, open-syllabled accent in English that makes “best” sound like “bast.” (Her uncle is Milan Panic, a pharmaceutical multimillionaire and former prime minister of Yugoslavia.) Karp appeared to her so unassuming that when he told her that he took care of the hosts’ son, “I thought, Oh, he’s their ‘manny,’ ” Montée told me.

In 2000, a famous actress brought in her young son to see Karp. She was accompanied by her baby nurse, a British woman named Tracy Hogg. Karp demonstrated his methods for soothing babies, including swaddling and his theory about the calming reflex. About six months later, he says, he heard that Hogg was working on a manuscript about how to calm a baby. That book, called “Secrets of the Baby Whisperer,” went on to become a best seller later that year: “You have to re-create the womb,” it advises, before going on to recommend swaddling infants tightly. “It had nothing to do with my stuff,” Karp said diplomatically. “But it got publishers interested.” Hogg, who died in 2004, advocated what she called a “structured routine” for a newborn — with precise hours for feeding, “activity,” sleeping and “you” time. Karp got to work on his own book, wanting to document his techniques for calming crying while promoting a more lenient approach. He visited his patients at home in order to test out his theories. “I needed to understand, When does it not work?” he said. “I needed to see it in the wild.” He often worked through the night, reciting bullet-pointed thoughts into dictation software because he was frustrated by the pace of his typing, then drove Lexi to school in the mornings wearing the same outfit as the day before.

Photo


Credit
Hannah Whitaker for The New York Times

Karp’s agent turned down a $450,000 advance for the manuscript, and Karp grew apprehensive that they wouldn’t get a better offer. That morning, Montée gave her husband a pep talk. “Act like you have a million dollars in your backpack,” she told him, a joke that is now part of the family lore. She turned out to be right: Karp ended up securing a $1.1 million advance for “The Happiest Baby on the Block,” along with a sequel for toddlers. Karp describes Montée as the one in the household who “seals the deal.” At Happiest Baby Inc., she is in charge of business strategy and creative direction (“As a co-founder, Ruth, I’m so excited,” she told me more than once, having mastered the marketing technique of first-name repetition).

A segment on “Good Morning America” in 2002 helped cement Karp’s success, and Montée had the idea of bringing the book’s testimonial sections to life by recording Karp’s interactions with his patients on DVD. Their timing couldn’t have been better. “The Happiest Baby on the Block” came out just as parenting literature was undergoing a transition of its own.

For years, the prevailing philosophy on child rearing had been Dr. Benjamin Spock’s rallying call to parents: “Trust yourself. You know more than you think you do.” Spock’s “The Common Sense Book of Baby and Child Care,” which was published in 1946 and sold more than 50 million copies worldwide, was so thoroughly embraced that some women kept copies of his paperback all over the house, including in their glove compartments. Detractors later blamed him for the permissiveness that they argued set the stage for the 1960s counterculture — for children being “Spocked when they should have been spanked.” In the late ’60s, Spock’s involvement in the anti-Vietnam War movement caused some of his readers to turn on him. His sales figures soon dropped by half, though he remains, to this day, the world’s most famous pediatrician.

As Spock lost ground, the field of expert advice became more polarized between a “hard” camp, which stressed discipline and conformity, and a “soft” camp, which believed in the importance of bonding and individuality. The issue of baby sleep was particularly contentious. In 1985, Dr. Richard Ferber, who founded what is now known as the Sleep Center at Boston Children’s Hospital, published a sleep manual so popular that his name became a verb. To “Ferberize” is now synonymous with letting a child cry it out (even though his book doesn’t quite advocate that). Following Ferber’s best seller, child-rearing literature was inundated with sleep guides, each with its own impossibly alluring title — “Twelve Hours Sleep by Twelve Weeks Old,” “The No-Cry Sleep Solution.”

The soaring popularity of sleep guides may have been propelled by an observable, objective deterioration in baby sleep, which can be traced back to a single year, 1992, when the American Academy of Pediatrics, upon reviewing research on sudden infant death syndrome, or SIDS, came out with the recommendation that parents put babies to sleep exclusively on their backs in the first year of life. The number of SIDS cases did in fact fall — by half, according to the National Center for Health Statistics. But the change came at a price. Babies sleep significantly worse on their backs, a fact that pediatricians openly acknowledge.

Photo


Credit
Hannah Whitaker for The New York Times

Certain parental concerns have vanished with technological advances like infant formula or polio vaccines. Others — like our anxiety about said technological advances — are perennial: Speaking to mothers in 1910, the pediatrician L. Emmett Holt worried about sensory overload in “these days of factory and locomotive whistles, trolley cars and automobiles.” But sleep — how much our children, and by extension we, get; whether it’s continuous or interrupted, light or deep, crying-induced or self-soothed — is a particularly of-the-moment obsession, particularly among well-off parents. The intense focus on sleep may have less to do with babies and more to do with parents, especially middle-class mothers, who provide as much as or more child care today than housewives did in the 1960s. Highly educated working mothers, Brigid Schulte, the author of “Overwhelmed: Work Love and Play When No One Has the Time,” told me in an email, have “made their children such a priority” that they spend “virtually all of their leisure time with their children.”

As baby sleep came to be seen as a national problem, the pressure intensified on parents to enforce stricter regimens. Champions of “hard” advice became known as parent-centered. Many of these advocates were from the Christian right, including Gary Ezzo, whose “On Becoming Baby Wise,” published in 1995, promoted rigid feeding schedules, “highchair manners” and physical punishment, or “chastisement” — preferably with a rubber spatula. (These recommendations have since changed.) Ezzo’s and other parent-centered advice books grew in direct opposition to the “ideological humanists” of the child-centered approach, with their insistence on feeding on demand, co-sleeping and a shunning of schedules and training methods.

Parent-centered advocates inveighed against the 1993 “Baby Book” — the bible of child-centered parents, written by William and Martha Sears, a pediatrician-and-nurse couple and parents of eight children. The “Baby Book” begins with an aphorism that puts many women at a disadvantage before they’ve even started mothering: “Feeling good about your baby’s birth carries over into feeling good about your baby.” (Tell that to the woman recovering from an emergency C-section.) They go on to ask, hypothetically, “Won’t holding our baby a lot, responding to cries, breast-feeding on cue and even sleeping with baby create a spoiled and overly dependent child?” To which they provide an emphatic answer: “No!” (Their son Robert, who is also a pediatrician and a “Baby Book” co-author, has become a vocal critic of vaccination laws, counter to evidence-based medical consensus.) Though they see themselves as Spock’s disciples, experts from the soft camp can seem exceedingly hard on parents, especially mothers, not to mention downright punitive for anyone with a full-time job.

Karp’s manual represented a welcome middle ground. “I try to be an omnivore and just reflect on each issue and judge it on its own merit or lack of merit, but I’m much closer to the Dr. Sears approach,” he said. He emphasizes the benefits of breast-feeding but argues that experts have become “dogmatic and inflexible about it to the point where we could be hurting kids and certainly hurting mothers.” He includes sections in his books on weaning — from swaddling, pacifiers, rocking — even as he dismisses professionals who warn that children could become addicted to these crutches. (“Are we ‘addicted’ to sleeping on a bed with a pillow?” he retorts.)

Karp “kind of serves the purpose that Grandma would have served in the past,” Alison Gopnik, a professor of psychology at the University of California, Berkeley, and author of the book “The Philosophical Baby,” told me. “But what science tells us is that variability is the most distinctive feature in terms of what children are like, what parents are like and what caregiving is like. So it’s unlikely that you’re going to find one piece of advice that’s going to suit all the different varieties of children and cultures.”

Photo


Credit
Hannah Whitaker for The New York Times

Karp’s manner is open, engaging, empathetic, inviting confession; ask him about his work, though, and the layers of humility begin to peel off. “Nobody else noticed this stuff in the whole world!” he told me at the end of dinner one evening when we talked about the 5 S’s. “No one knew about swaddling. Nobody knew about sleep.” As “The Happiest Baby on the Block” began to take off, Karp left his pediatric practice and with Montée turned the “Happiest Baby” into a franchise that now includes three books, two DVDs, a line of swaddles and white noises for purchase on iTunes, as well as SNOO, which rocks and plays white noise continuously and has sensors that respond to a baby’s cry by changing intensities; it keeps the baby swaddled and fastened inside the crib and can be controlled from afar on a smartphone.

Karp earnestly compares the $1,200 bassinet to the advent of penicillin — “I’m not here to promote a product, but I am saying if someone developed penicillin, wouldn’t it be important to tell people about it?” — and insists that it can save lives by stopping babies from rolling into an unsafe position in their sleep. Raising the money for SNOO, Karp drew on his celebrity appeal: Justin Timberlake and Jessica Biel are investors, as are Scarlett Johansson, Gwyneth Paltrow and Zoe Saldana. (Or, as Montée put it, “We have Justin and Jessica and Gwyneth and Scarlett and Zoe.”)

So far, 30,000 beds have gone into production, and of those, some were given free or at a steep markdown to social “influencers” — a far cry from Karp’s days of working with abused children. Hulu and Activision have begun offering discounted SNOOs as a benefit to their employees. Karp says he hopes to take SNOO beyond the gated precincts of Los Angeles and Silicon Valley: “Once we get medical studies, we can get insurance companies and employers to subsidize this. It will be like breast pumps ultimately. That’s the goal.”

Other “Happiest Baby” innovations can be viewed as truly helpful or slightly ominous, depending on your level of credulity. Its engineers are aiming to update the SNOO app to serve as a dutiful personal assistant, providing parents a full report on their child in the morning, like “Baby Sophie’s diaper is full; she had a runny nose; the humidifier is on,” Montée explained one morning when I visited the company’s headquarters in a squat building on a main drag in Santa Monica. She saw my face. “I know,” she said. “At the beginning I thought, Come on, really? But then I see Lexi’s friends, and they turn to an app just to tell them which breast they fed from last. It’s a different generation.”

“Hey, love!” Karp called out to Montée as we walked through their house on a recent weekend afternoon. They live in a converted A-frame chalet nestled deep in the hills of the Pacific Palisades that looks like the ideal location for a dream sequence in a film set in 2030. It has a hydraulic door with a laser-perforated metal screen, smooth white terrazzo floors, white floating stairs and an arresting view of the ocean. There are no visible light switches anywhere (Montée is “allergic”) and nothing made of plastic: Karp and Montée are environmental activists, and both serve as directors of the Environmental Working Group, a nonprofit research and advocacy organization. With its glass facades and sharp corners, their house also looks decidedly un-baby-proofed. Perhaps the only indication of Karp’s profession can be found upstairs, in his study, where there is a first-edition Dr. Spock and a cloth baby carrier from the Peruvian Amazon — a gift from Olivia Newton-John and her husband.

Karp has devoted his entire career to babies, so it came as a surprise to learn that he has never raised one of his own. For two years after he and Montée married, they tried to conceive but couldn’t. Devastated, they considered surrogacy or adoption but in the end decided against it. “We had Lexi,” Karp explained. He came back to that decision in a later conversation. “I kind of feel like everyone is my child,” he told me, his eyes glistening. “I don’t feel the barriers. There’s this passage in ‘Siddhartha,’ by Hermann Hesse, where Siddhartha’s friend Govinda looks into his face and sees the flow of thousands of human faces like a procession. It’s our joining of humanity.” Does this mean that he views all the children he has treated over the years as, in some sense, his own? “And their parents,” he said keenly.

Part of the appeal of Karp’s methods for calming babies was that they didn’t require anything fancy, not even the pre-made swaddles that are sold today — any old blanket would do. As he himself noted in his book, “For thousands of years, the most skilled parents have used the 5 S’s to soothe their babies.” Now he was suggesting that, actually, the best way to improve your baby’s sleep required splurging on a sensory bed. Effective as his invention may be, its forbidding price reflects an old-fashioned idea: that child rearing is inherently tied to social status, that you have to spend in order to care.

As the sun began to set over the ocean, the light glinting on the water like sequins, Karp and Montée still had a long night of work ahead. “We can stay up more than any youngsters and do — how do you say? Overnighters?” Montée said. In the coming months, they would launch SNOO in China, and Karp would go on the Home Shopping Network to advertise it. For him, though, that was just the beginning. He mused about Gutenberg’s invention of movable type and how his contemporaries had been alarmed that people wouldn’t memorize anything anymore because of it. He chuckled. “You can’t get in the way of progress,” he said. Then, standing by the patio with his hands in his pockets, he put it differently: “The idea is that I could be in every nursery in America.”

Continue reading the main story