Category Archives: newborn feeding issues

Infants With Sensory Sensitivity: When Your Fussy Baby Takes Over Your Life

Parents are often the first to suspect that their infant’s constant and intense complaints are more than just fussiness.  Sometimes pediatricians pick up on a pattern of edginess that cannot be explained by all the usual suspects:  teething, food sensitivity, temperament.  Having a baby who complains bitterly about the most common events, such as diaper changes and nursing, can take over a parent’s life and make them question their sanity.

Judging by the research literature, you would think that sensory sensitivity only happens to toddlers or preschoolers!  Those 4 year-olds who refuse to wear shirts with long sleeves and cannot handle a car ride without vomiting often started out as super-fussy babies.  Their parents may have tried the lactation consultant, the pediatrician, maybe even the neurologist, in a frantic search for help.  They could have used an OT.

I have treated babies as young as 6 months-old that displayed clear signs of sensory sensitivity after prolonged periods of peri-natal NICU stays or procedures.  Why would a few months in the NICU make a baby sensory-averse to diaper changes and being held?  Well, look at it from the perspective of an immature nervous system.  They got more stimulation than they could handle, and their brains responded by interpreting everything as a potentially invasive experience.  Turns out, a good percentage of children who require intensive and ongoing medical procedures to save their lives don’t recall the experience, but their body does. Ask psychiatrists doing fMRIs, or functional MRI’s, what they see in adult trauma victims.  Parts of the brain that encode emotion and memory will light up like Christmas trees when faced with innocuous stimuli.  Oops.

Progressive NICU’s are making changes, but those nurses have no choice to perform multiple and invasive procedures and do them in a very stimulating environment.  They are working hard at a very difficult task; saving the lives of really tiny, really sick babies.

Is a NICU stay the only way to become a sensory-averse infant?  Not at all.  It seems some infants are just wired to be more sensitive, and some babies need only a little bit of extra excitement to become sensitive.  I treated an infant under 6 months of age that struggled to nurse.  She had the oral motor skills to suck, the swallowing skills to avoid choking, but she disliked the feel of her mother’s skin touching her face.  She nursed until she wasn’t starving, then refused any more.  Her mother felt rejected and not in love with her little girl any more.  The baby wasn’t growing and was constantly agitated.  We worked hard in therapy to help this baby, but until we realized what the problem was, every time her mom tried to get her to nurse more, she was repeating the cycle of aversion and agitation.

My approach for my youngest sensory-averse clients combines everything I know from Happiest Baby on the Block and all my training in sensory processing theory and practice as a pediatric occupational therapist.  The first step is convincing parents that they didn’t cause this behavior, and then convincing them that there is treatment that works.  Combining calming sensory input, environmental adaptations, and skill building in these little babies can make a huge difference in their lives and their family’s experience.  If your baby is incredible fussy and no one can find a good reason, pursue pediatric occupational therapy with an experienced therapist.  It could calm things down more quickly than you think!

First Father’s Day? You Might Be the Best Baby Calmer In The House

Fathers are often the partners that jump right into practicing the Happiest Baby on the Block techniques.  They “shush” loud and long, they do the quick jiggle (for swinging) with enthusiasm, and they can usually use just one arm to support a newborn on it’s side to calm them.  Moms are in awe of their guy who couldn’t stand to change a diaper and was too nervous to even hold that baby a few weeks ago.  Go, Daddy!

Women do not have the corner on the comforting market.  Yes, they can nurse a baby to calm them, but not every fussy baby is a hungry baby.  Men can be a warm, yet rock-solid, source of physical comfort for children.  The Happiest Baby techniques seem more intense than a standard soft cuddle.  It’s because they are more intense.  Not dangerous in any way, but designed to give newborns a replication of the more sensory-rich womb experience .  Dr. Karp’s awareness of temperament and early development refine that basic concept to give newborns what they need to pull it together, get calm, and get some sleep.  Giving them more touch, more movement and more loud and steady white-noise sounds all together is the key.  The fact is that learning these techniques are new to moms as well helps a father not be intimidated by the “natural” knowledge of women.  The truth is that no one is born knowing what to do, and you can’t google it either.  The parents I teach are pretty much on a level playing field for this stuff.  And the men sometimes amaze me with their new skills.

Happy Father’s Day to all the dads who have stepped up their game, and mastered the easy way to calm their newborns!

 

Out Of The Swaddle And Into The Frying Pan

Those first 2 weeks of life are pretty simple:  feed, sleep, diaper.  Lather, rinse and repeat.  From about 2 weeks until 12-14 weeks, the Happiest Baby strategies for getting a baby calm and sleeping soundly really do work to keep newborns (and parents) happy.  I am a certified Happiest Baby educator, and it is relatively easy to decode the common complaints of newborns in those first weeks and months.  In fact, using The Happiest Baby techniques can make it easier to see true medical problems that fussiness and intractable crying were masking.  This is one of the best reasons to learn these techniques if you or your partner are not pediatric clinicians.  And maybe even if you are.

After that period, the swaddle is replaced by a sleep garment, side and stomach positioning to calm doesn’t have much of an effect, and the swing is put away in the garage.   Using white noise can continue, and so can the pacifier.  If so, then why is this period a minefield for accidental parenting?  Because changes in behavior that are just normal development aren’t anticipated and interpreted.  All you fans of the 5 S’s of Happiest Baby on the Block, here is what is coming down the line:  big changes that you need to anticipate and manage in a forward-thinking manner.  It won’t be so simple at 4 months.  Don’t be nervous; keep your eyes open and read the rest of this post!

I am a big fan of The Baby Whisperer’s books, with her strategies for a flexible but firm routine in the first year.  Tracy Hogg’s infant routines can seem a bit rigid to some parents, but if you asked a little one, they don’t find reasonable routines (not rigid ones) to be strict.  Routines help little people know what to expect and when to expect it.  Trust me, the younger you are, the more it helps to use routines to communicate.  Without the ability to speak, babies can’t tell us what is going on for them either.  Knowing that a child is behaving inconsistently is an important way to see a leap in development or an emerging illness.  How else would you know that refusing to nurse is because of an actual problem instead of being overtired?  Without a baseline of regular behavior at regular times, it is much harder to see inconsistent reactions that signal distress once babies are more complicated.  And at 4 months and up, things get more complicated.

Take a look at the Baby Whisperer’s  E.A.S.Y. plans for eating, activity, sleep, time for you at different stages.  Beware of what she calls “accidental parenting”.  Dr. Karp does a nice job talking about this trap as well in his great book The Happiest Baby Guide to Great Sleep but I think that Tracy Hogg gives more helpful hints on schedules and real-life baby day scenarios.  Accidental parenting is like John Lennon’s famous line “Life is what happens when you are busy doing other things.” Accidental parenting happens when the solution to a heat-of-the moment problem results in habits that cause bigger problems.

A good example is a young infant that is fussy and falls asleep nursing, and after a few nights of this super-easy way to get him to sleep, now cannot fall asleep any other way.  Why is this a problem?  Because when mom is at the store, this child is exhausted and unable to nap.  He also cannot sleep in his crib or anywhere else but on his mom.  This is not a child who is experiencing the warmth of connection:  this is a child who is uncomfortable unless he has exactly one situation and one alone.  He has accidentally been taught that there is only one way to settle and sleep, by the very people that want him to feel safe and calm in his own body anywhere.   That is the problem with accidental parenting.  The actions taken were a short-term fix for a problem, not a real long-term plan for greater peace and flexibility.

Both the Baby Whisperer and Dr. Karp have similar solutions for you if you have done some accidental parenting at this young age.  Again, I am going to say that Tracy Hogg gives you more details about the solutions, but they both have good ideas. The most important things to remember about their solutions:

  1. Have confidence that your future vision of calmness and your newly-found knowledge from these experts will work.  The current atmosphere is to distrust “authorities” of all stripes, but there are people that know their way around these early months.  If you distrust everyone, you are left hoping that your guess is the right one.
  2. Learn to read your child’s cues correctly.  They both give you information that can counter there frantic sense that there is no rhyme or reason to all that fussiness.  You can only interpret these cues if you know a lot about normal development and pay attention to your child over time.
  3. Expect change, and learn what the next stage is.  Everyone changes, but babies change fast.  A 6 week-old and a 6 month-old can be so very different.  That is only a difference of a few months but it is an eternity in infant development.  Stay on your toes and anticipate this.  You are the receiver and that child is the quarterback.  Pay attention and get ready for new signals.  Sorry to confuse those of you who don’t follow American Football.  But I think you get the general idea.  Anticipate change.
  4. Don’t expect an easy fix, and don’t waiver in your commitment.  The older the child, and the stronger their temperament, the longer a habit created from accidental parenting takes to shift.
  5. Get support, and don’t try a strategy that you really resist.  Forcing a child is not what routines are about, and if you need to tweak a strategy, then do it.  If you are the parent that can’t handle even a little fussing, then switch off to your partner to help your child realize that his distress about switching from nursing to sleep to sleeping another way is habitual and can change.  Because it can.
  6. Notice when you are unrealistic about what babies can manage, or if you are so uncomfortable with any fussiness that you are qualify as a victim of Tracy Hogg’s “poor baby syndrome”, in which you feel so guilty about any crying for any reason at all that you lose your wider view of what a child needs.

Accidental parenting is nothing to be ashamed of.  This parenting thing is hard, very hard, and everyone is doing their best.  I really believe that.  Habits can change, and things can go forward successfully with a different approach!

Too Fussy to Breastfeed? It May Not Be Latching-On Issues

Latch-on is a big deal when you nurse.  Getting a newborn to achieve that solid seal and then synchronize the suck-swallow-breathe rhythm is essential.  When I was a younger occupational therapist, I was all about the mechanics of achieving oral control and teaching that rhythm.  Some babies have medical issues that make it harder, but some are just fussy bussies.  They react to everything, and their own crying fuels even more crying.  I realized that if a baby is agitated, they aren’t in a place where they can learn the rhythm.  Of course!  Fussy babies are lousy learners, and therefore they are often lousy feeders.  What could get a fussy, uncoordinated baby calmer to focus and learn one of the most important skills of this period of their lives? That was one of the questions that lead me to become a Happiest Baby educator.  Dr. Harvey Karp’s Happiest Baby on the Block techniques deliver just the right combo of sensory input to get a newborn calm and focused to nurse, not just calmer for sleep.

Some lactation consultants have suggested to me that the 5 S’s of Happiest Baby interfere with nursing.  I really have no good response.  If they decided that getting babies calmer with Happiest Baby is bad for breastfeeding, what could possibly be going on in their minds?  I found that they didn’t know all the steps, just the swaddle, thought that it would work so well that babies wouldn’t be awake enough to feed (it is rare indeed that a healthy baby doesn’t wake when hungry), or mistakenly thought that good calming with any other technique would dissuade a mom from nursing her baby.

I haven’t met one, not one, mother who thought that nursing should end because she had a better way to calm her baby.  Quite the other way around.  Moms that can get babies calm and focused faster enjoy nursing and are encouraged to keep going.  They do not incorrectly assume that a fussy baby is “done” with nursing.  Thinking that fussiness equals dislike is a big error of judgement, and an actual reason that mothers give when they are asked why they stopped breastfeeding.  Happiest Baby techniques could have helped them see what their babies needed:  some calming sensory input to help them get down to business!

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.