Monthly Archives: February 2016

Baby Nursing For Only a Few Minutes Then Fussy? Use the 5 S’s to Settle And Focus your Newborn To Feed, Not Just to Sleep

I was wandering around baby blogs (I always like to see what other writers are saying!) and stumbled onto a sleep consultant’s post about the “cluster feeding” pattern.  These babies nurse/feed briefly then become fussy without a good reason (diaper change, illness of some kind, lack of sleep), and get hungry soon afterward.  These newborns could really use the Happiest Baby techniques to quickly settle down and have a full meal followed by a long nap.  Here is what happens when newborns get stuck into a pattern of snacking, and how to turn this ship around using Happiest Baby strategies.

Healthy newborns really can fill up when they nurse or bottle feed.  The maximum amount that they take in is largely a function of how big their tummies are. There are the babies that need to be tickled and encouraged to stay awake long enough to finish a feed, but this post is about the newborns that are alert and hungry, then just take in enough to not be famished.  They get fussy and lose their focus on eating, only to be hungry for another “snack” in an hour.  Those babies aren’t getting as many deep-sleep cycles as they need for growth, and they are developing habitual patterns that drain the whole family.  Their lactation consultant may recommend more frequent nursing, only to get the same pattern of behavior.  Parents may ask their pediatrician for a work-up for reflux or another disorder, only to be told that everything is OK.   They aren’t relieved to hear this, because their day-to-day existence is far from “OK.”

Babies that don’t sleep and feed well might not be ill, but they are more likely to develop sleep and mealtime issues as these patterns progress over time.  Breastfeeding babies aren’t getting the delicious and nutritious combo of “foremilk” at the beginning of nursing, and the “hindmilk” as they empty a breast.  (If you aren’t aware of their different qualities, ask your lactation consultant.)  The parents of fussy feeders can feel that they have failed, or become depressed from the ongoing stress and exhaustion.

When I have been asked to help parents like these learn the 5 S’s of The Happiest Baby, I know that I can offer real strategies to change this situation.  When parents use swaddling, shushing, side/stomach calming (not sleeping), sucking, and swinging, it isn’t just for good sleep.  The 5 S’s get babies calm and alert faster and longer than anything else I have ever tried.  Babies need to be calm and focused to nurse well.  They eat more, then sleep longer.  They wake hungry for another good meal, and their fussiness can be soothed with the Happiest Baby techniques. Longer feedings allow newborns to be satisfied for a longer time, not just eating enough to be not ravenous.  It can take a few days for parents to alter a newborn’s pattern of behavior , but as soon as they see a baby with a full belly sleep for a few hours, and they repeat it, I get a grateful call or e-mail.

I am going to repeat my simple and practical point again: babies need to be calm and focused to nurse well.  Learning how to calm a baby and help them focus on feeding is valuable.  Happiest Baby techniques help babies calm down quickly.   The 5 S’s are not just for sleep.  Not even close.

 

 

 

Safe Sleep Guidelines Don’t Give Parents Enough Support

I just downloaded the entire American Academy of Pediatrics’ Technical Report-SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.   It was a large file to read, but the bottom line for me was this:  they must not have any sense what it is like to be a new parent, and maybe not what it is like for practicing pediatricians.  In other words, they say what to do and what not to do to prevent SIDS, but don’t mention how to accomplish any of it in the world of actual babies and parents, where crying and sleeping is real, not theory.  No wonder parents don’t follow the guidelines.  Without useful strategies and simple explanations, most parents wouldn’t be willing to follow their recommendations for very long.  In my opinion, the most difficult guidelines for parents are the instructions to only place newborns on their backs to sleep, and not to have a baby sleep in the bed on on the parent.  Babies should be in the room, but not in the bed, with an adult.  Simple, right?  Not.

Sleep-deprived new parents are struggling to comprehend all the things they should and shouldn’t do.  Defensive driver classes say that lack of sleep makes you drive like you are drunk.  Why should we expect the parents of newborns who get 5 hours of sleep a day to think clearly?  Because they aren’t behind the wheel?  An exhausted parent isn’t just tired.  They are less capable of judging what is safe and how to follow their pediatrician’s general recommendations.    They are going to let a 4 week-old sleep in the car seat for over 30 minutes because he slept poorly last night, pick him up from his “tummy time” right away when he cries because they are so frazzled, and use a positioning wedge in the crib.  They will be afraid to use a pacifier at 5 weeks, and will abandon swaddling when they can’t get it snug.   I can’t blame them one bit.  Babies aren’t simple.  Their crying when they are put down rips a parent apart.  No one knows how to deal with newborns without some help.

Not letting your baby sleep on you or next to you, and only placing a baby to sleep on his back means that a parent needs to be shown other good sleep strategies that leave both parties comforted and calm.  Pediatricians know that back sleepers show initial delays in motor control that disappear by 18 months on average, but generally offer no other suggestions than to “do some tummy time.” There are some great methods to make Safe to Sleep successful, but the AAP doesn’t share any specific baby management secrets (if they have them.)

The New York Times ran a story in 2005 that made me stop in my tracks before I finished reading it.  They reported on the increase in parents placing their babies on their backs to sleep after hearing about the Safe to Sleep protocol from professionals.  Turns out, their newborns had a hard time sleeping in this position.  It is well known that many babies don’t sleep as deeply or as long in this position, and for some simple reasons.  Their random arm movements wake them, they turn their heads and motor reflexes wake them, and they traded the firm support of the womb for the feeling of floating in space on a bassinet mattress.  Who could sleep well like that?

The NYT author quoted a parent that suggested that her NICU nurses encouraged stomach sleeping on discharge, even though they had to tell her officially not to do so.  A Manhattan newborn care instructor was quoted saying that “the role of a professional is to say these are the recommendations and this is why.  The role of the parent is to think critically and apply those recommendations in a way that makes their life manageable.”

I see things differently.  Professionals should anticipate the need to provide practical strategies when they teach their lifesaving guidelines.  Expecting exhausted parents to “think critically and apply these recommendations” is asking much too much from well-meaning but tired and vulnerable people.  It just seems very unfair for pediatricians to know full well how hard those first few months are, and yet not be more practically helpful.

Then again, they may not have any direct experience or even know what to do with a baby after a checkup or a treatment.  After all, they treat medical problems.  SIDS is a medical problem. Sleeping, calming and caring for babies isn’t really a medical problem.

If doctors or other professionals are not able to provide real-life instruction in ways to make the Safe to Sleep program successful in the real world, they should have resources to offer to parents. As a Happiest Baby educator and a pediatric occupational therapist, I wish that every parent had the ability to learn how to use Dr. Karp’s amazing baby calming and sleep techniques from me, and how to carry and hold their babies to develop good head control.  I wish I could show every parent how to make “tummy time” fun and easy.  I write this blog in order to reach out to parents with love and support.  They don’t have as many resources as they deserve.

 

Teach Spoon Grip By Making It Fun And Sharing a Laugh With Your Child

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Whether you are teaching a younger child to grip a toddler spoon or teaching an older child to hold a spoon in the mature pattern, kids can resist practicing this important skill.  I created a game that makes it really fun and builds a warm connection with your child.  You share a laugh and allow your toddler or preschooler to be “the baby” for a few minutes instead of giving in to all the whining that children can generate when they are challenged.  This is especially important if your child has motor delays, is on the spectrum, or has a spirited temperament.  Let me explain why developing self-feeding skills are important, and then I will describe the game.

Mealtime utensil use is the first time that your child uses a tool to obtain something.  Tool use is a visual-motor skill milestone.  Some children grab the spoon from you at 8-9 months.  Some avoid even trying, preferring to be fed.  Take a look at  Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control!  for some hidden (but not to OTs and PTs!) activities that build pincer grasp for self-feeding before 12 months.  And some older kids with fine motor challenges will use that “fisted” grasp well into preschool and kindergarten.  Here is a thought:  Your child’s fine motor skills can expand daily when mealtime gives them a chance to practice grasp and grading movement!  Want more motivation?  Take a look at this recent post Using Utensils To Eat Prepares Your Child To Write .  Feeding yourself gives you clear feedback on your success or failure.  You either get your food in your mouth or not, get the spoon into your mouth smoothly or awkwardly, etc.  All immediate feedback, and not from an adult.  No criticism, no pressure from anyone.  I love it when I can recommend strategies that don’t involve an adult making judgements or demands!  In this case, the circumstances and the game do all the work.  You are going to add a social component and make practice really fun!

You need: two plastic bowls and two spoons and a scoop-able food.  Use toddler spoons if you have them for better grasp and control.  Toddler spoons typically have a non-slip handle and a slightly smaller “bowl” (where the food rests.)  Metal spoons with thin handles are the most challenging, and we are trying to make this easy and fun, remember?  The only reason to use a larger utensil would be if your child is older and their hand clearly is too large for a toddler spoon. Choose a bowl that is shallow and has straighter sides, the better to scoop up a spoonful.  They also tend to be less tippy than a deeper bowl with angled sides.  Select a food that your child likes, and one that stays on the spoon easily.  A bad choice?  Peas or dry cooked macaroni.  A good choice?  Oatmeal, mashed potatoes, Greek yogurt, pudding, ice cream.  You might want a few damp paper towels as well.

Your approach:  this is fun but it could be messy.  Don’t wear your best clothes, and don’t react immediately or negatively to a bit of dripping.  Wipe it if you need to for your child’s comfort, but try not to give the impression that spillage is bad.  What child would try this if failure was embarrassing or distressing?  This is going to be silly, so get ready to smile and laugh at yourself.  Most of us need to do more of that anyway.

Help your child by placing his hand on the spoon in the fisted grasp for a small child or the mature grasp (thumb on top, all fingers curled slightly under the handle, index finger may come on the side of the handle) for a 3 year-old child with fair control or an older child with motor issues.  Hold your spoon in a mature grip even if they are not ready yet, because modeling the advanced skill is usually best.  You feed your child a scoop from their bowl, THEN YOU ASK YOUR CHILD TO FEED YOU!!  Open wide but let them work on their aim.  Now you know why you need to wear washable clothes for this one!

Most kids over 2.5 years get the joke and laugh with glee!  Go ahead and make baby sounds or use baby talk, and allow them to be “the baby” when you feed them.  Children sometimes long for those days when life was easier, when they were fed and carried.  Some kids will insist on being carried or behave in an immature way when they feel they need more attention.  This is a chance to pretend and remember, but to do it in play and to do it in fun.

Enjoy this little game a few times, and watch spoon grasp just explode!

Looking for more mealtime ideas?  Check out OXO for Kids: Great Tableware For Older Kids With Sensory and Motor Issues and Which Spoon Is Best To Teach Grown-Up Grasp?.