Category Archives: newborns

Can The Parents of Pediatric Clients Have PTSD?

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I wrote a post about the common complications seen with long-term neonatal medical issues The Subtle Ways Chronic Medical Care Affects Infant and Toddler Development, but the rest of the family isn’t immune to trauma reactions.  A difficult pregnancy or delivery, the shock of a unexpected genetic disorder diagnosis, or the crises that arise in the NICU all weigh heavily on parents too.

Most pediatric therapists aren’t seeing children in the NICU or the hospital.  We are in the home, the clinic or the school.  Acute medical issues are few and far between in these settings.  But the effects of trauma can continue to color treatment long after a child is medically stable.  What looks like a personality problem or a poor fit between therapist and a family can really be PTSD that hasn’t been acknowledged and treated.  Many parents are so focused on therapy for their child that they won’t even consider that they need to help themselves as well.  This should change.

I recently read a research study comparing the PTSD symptoms of parents with rare disorders like Ehlers-Danlos, Prader-Willi, and autism.  The parents whose children were aggressive or injured themselves, or had serious accidental injuries scored strongly on a standard PTSD scale.  If you have ever spent time with a child with these behaviors and wondered how their family handled it, well, it leaves emotional as well as physical scars.

The following are only a few of the common scenarios that can be the result of untreated parental PTSD:

  1. Parents who ask for a therapist’s guidance and then question the recommendations repeatedly.  When the medical picture changes rapidly in a crisis, and multiple doctors give conflicting recommendations or predictions, parents become gun-shy about anything any professional tells them later on.  Even though their experience with therapists may have been positive, the stain spreads around.
  2.  Families that withhold information from therapists, and may even resist open communication between team members.  See #1.  “Splitting” is a common response from people who are convinced that controlling other people protects them in some way.  It also sustains drama and focuses attention away from issues that are painful, such as the lack of a child’s progress or the final diagnosis.
  3. Signs of common illnesses create high levels of anxiety and agitation.  Parents that have witnessed resuscitation and emergency surgeries can become absolutely distraught over a URI.  The memory of a child gasping for breath or being unresponsive is so painful that a common cold brings it all back.
  4. Parents who are developing addictions or whose addictions are increasing in severity.  A mother who is anorexic, a father who is using prescription drugs or alcohol more frequently, or a parent who is spending more time online than is healthy may be responding to their pain in ways that are dangerous for them and their family.  If a parent is a trauma survivor, there are things that can help them handle their reactions to their child’s treatments: Are You a Trauma Survivor AND the Parent of a Special Needs Child?.

Parents are essential allies in therapy, and it is important to support them as well as our pediatric patients.  Some kind and compassionate words can go a long way, and even sharing this post with a parent may help them think about finding support to address the pain that they are holding onto, long after they have left the hospital.

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Parents With Disabilities Need The Happiest Toddler on the Block Techniques

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I usually write about children with disabilities, but today’s post is about parents with challenges.  As an occupational therapist that sees children in their homes through the Early Intervention program, I meet all kinds of parents.  This includes parents with disabilities of their own.  Some parents have vision or hearing issues, some have orthopedic issues (try lifting a toddler all day with a bad back!}), and some have emotional or cognitive issues.  I have worked with parents with addictions and parents that were intellectually challenged.  I may have seen it all, with the exception of parents in wheelchairs and parents that are deaf.  But my career isn’t over yet; there is still time.

They all have had one thing in common:  parenting small children is even harder when you have a disability.  Not impossible, and no reason to think that they cannot do a good or even a great job.  But it is definitely harder to raise children when you have a disability.  Small children are demanding, in a 24/7, self-centered manner.  That is normal, that is the natural state of a young child.  It doesn’t make it any easier.  There are no coffee breaks, there is no weekend off.  Not unless you have willing relatives or friends that will come over or take care of them in their own homes.

The Happiest Toddler on the Block techniques are methods to teach children self-regulating skills and strategies to help children learn to communicate their needs and feelings without aggression or defiance.  They don’t require an advanced degree, and they could save you from going to a therapist yourself, just to complete a sentence that doesn’t start with “For goodness sake,….!”

Parents with disabilities often think that what they need most are the skills or the capacity that they lack.  And I am not going to tell you that being able to see well, hear well, move easily or have boundless energy wouldn’t be a good thing.  But if a child is able to calm down, wait for a snack or a toy, follow directions and even assist the parent in accomplishing something, life gets so, so much better.  Just the removal of stress from tantrums and whining makes everyone’s life better.  You are able to focus and work out how to get things done and feel good about yourself as a parent.  Children that can self-regulate are better able to handle the frustrations of life, and better able to empathize with others.

If you are a parent with a disability, or you know such a parent, please share this post with them.  Tell them to read Why Telling Your Child “It’s OK” Doesn’t Calm Him Down (And What To Do Instead) , Stretch Your Toddler’s Patience, Starting Today! and Use The Fast Food Rule For Better Attunement With Your Child for some useful strategies that start turning things around right away.

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New Baby? Exhausted? Try Dr. Karp’s 5 S’s To Pull Things Together

 

 

annie-spratt-178364New parents are often shocked at how tired they are.  After all, newborns don’t DO much.  They eat, sleep, pee and poop, and that is about it.  But they do it around the clock and they aren’t very experienced with any of it.  Dr. Karp’s 5 S’s can help all of you learn more and get some sleep.

Not because the 5 s’s give babies exactly what they had in the womb.  They do, but what swaddling, swinging, sucking, etc provide is a roadmap for how baby nervous systems work.  Once you know that babies need this, not that, you feel more in control of the situation and you can relax.  And babies that have been calmed down faster and more effectively feel that you get them, you really get them.  They sense that their parents can help them better than their aunties and neighbors.  Feeing understood starts here.

 

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When babies stop crying faster sleep an hour or so longer (yes, doing the 5 S’s can do that!) and eat/nurse more easily, life is less exhausting.  Not completely a day at the beach, but not as tough as it was before.  For more information, take a look at Help Your Newborn Adjust to Daycare By Using Happiest Baby on the Block Strategies and Why Some Newborns Look Like They Hate To Be Swaddled.

Wishing all you new parents a wonderful first year!!!

Why You Still Need the 5S’s, Even If You Bought a SNOO

 

 

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Want peace?  Of course you do!

OK, I won’t make you wait to get the answer to this question:  your newborn won’t spend all day, every day, in the SNOO!  Don’t know what the SNOO is?  The SNOO smart sleeper was designed by pediatrician Dr. Harvey Karp as a bassinet that uses many of his fabulous Happiest Baby on the Block techniques to soothe your newborn for sleep.  It effectively quiets and calms newborns with the touch of a button (almost).

After seeing what the SNOO can do, you may WANT to leave her there all day, peacefully dozing away.  That isn’t a reality for most parents.  After the first few weeks, and sometimes earlier than that, you will want or need to take your little bundle out of the SNOO and out of your home.  You may visit your parents, go shopping, go to the park with older children, etc.  Uh-oh!  The SNOO can’t come with you!  Oh, and by the way, leaving your little one in any device with her head against a surface for too many hours of the day places her at risk for “positional plagiocephaly”.  Yes, giving your child a flattened skull.  The same cranial bones that are malleable enough to slide through the birth canal can be deformed by letting a child lie in one position too long.  So no, you cannot leaver her in the SNOO all day long!

We know that the agitated screaming that is called colic starts on average at 2 weeks after the due date, and peaks around 6-7 weeks of age.  For the great majority of babies, serious digestive problems and other medical issues aren’t the reason for all that crying.  Babies are often just too little to be able to handle the complexity of post-uterine life in those first few months.  Combine individual temperament, limited brain development, and the big shift to the external world’s demands, and their tiny nervous systems get overwhelmed and they end up screaming.  Loudly, and often for a long, long time.  Parents get exhausted and discouraged.  The SNOO does provide the neuro-developmental needs these tiny babies have so they can calm down.    But asking the SNOO to solve your baby’s problems all day long is going to mean that you will have to be tethered to it for months!

Thank goodness you don’t have to!  Before he developed the SNOO, Dr. Karp created the 5 S’s  New Baby? Exhausted? Try The 5 S’s To Pull Things Together.  Dr. Karp’s 5 S’s are what will save your sanity when you pop him out of the SNOO and take your show on the road.  Knowing how to swaddle, shush, swing, use sucking and the side/stomach positioning (for calming, not sleep) will make your whole day better and more flexible.  I teach the Happiest Baby concepts in classes and in individual consultations, and I think that every parent should learn the 5S’s and buy the SNOO.

If the SNOO’s steep price tag has you hesitating, then you definitely need to learn the 5 S’s.  Get the video or go to a class.  But don’t think that you are a bad parent or that your baby is in trouble because of all that crying.  Most newborns are just fine; they just need your help to pull themselves together until they are old enough and skilled enough to do it themselves.  Learn to give your baby what she needs, and you all can sleep a little bit better this week!

 

Looking for more information on the 5 S’s and helping your baby calm for sleep and feeding?  Take a look at Successful Swaddling May Take More Layers of Calmness and Why Some Newborns Look Like They Hate To Be Swaddled.  As a nationally certified Happiest Baby educator, I love to help parents learn what their little one needs to settle down and make that “fourth trimester” transition!

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

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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!

Help Your Newborn Adjust to Daycare By Using Happiest Baby on the Block Strategies

ID-100108085.jpgReturning to work soon after delivery can mean putting your 3-month old in daycare.  As challenging as this can be emotionally, it can also be a struggle for your baby, especially if her only self-calming strategy has been nursing.  Should you (or could you) quit your job or just tough it out?  There is another alternative:  teach your little one to respond to  a wider variety of self-calming cues.

Self-calming at 3 months?  Well, yes and no.  Babies at this age are learning to respond to messages that we send.  This is the very beginning of self-regulation.  Actions and sensory inputs that tell their nervous system ” You are safe”, “It’s time to sleep” and “I get it; you need a little more help to calm down and I know what to do”.  They aren’t able to devise  their own solutions yet, but they can begin to self-calm if we read their behavior correctly and understand what they need developmentally and neurologically.  This is where Dr. Harvey Karp’s Happiest Baby on the Block strategies, and his other great sleep solutions, can save your sanity and your child’s sleep.  Many of the 5 S’s that worked so well in the first 12 weeks of life can be adjusted to support this transition into daycare.

The weeks between 3 months and 6 months are almost the 5th trimester (Dr. Karp refers to the first 3 months of life as the “4th trimester”).   I think it is a bridge period in which babies need more help to calm down than many realize.  At this age, they suck their fingers to self-soothe while awake.   But… they aren’t strong enough to keep their hands or their thumbs in their mouth when they are lying down and falling asleep.  Gravity pulls those heavy hands down to the crib mattress. They don’t babble their way to sleep the way a 6 month-old does, and they are barely ready to listen to lullabies. So what can you do?  Be creative and use the 5 S’s as a launching point for your new routines.

Swaddling may not be as effective, or even safe, at this stage.  Babies who are rolling could be strong enough to roll onto their bellies.  With their arms swaddled, they are at risk for suffocation.  Once your baby is in that “I’m gonna practice this rolling thing all day” stage, swaddling becomes more of a risk than a solution.

There are swaddle garments that convert to safer solutions for this stage.  The garments that still give firm pressure over the chest but leave legs and arms free are specifically designed to keep that nice calm feeling going.  They allow your child to roll freely.  Dr. Karp also suggests that swaddling in an infant swing is another safe choice for those babies that are experimenting with rolling but still need swaddling to pull it all together.  REMEMBER:  your baby needs to be put into the swing calm, and securely strapped in.  If she is too big for the swing, then don’t use it.  Just because it is calming for her is not a reason to use a too-small swaddling blanket or a tiny infant swing.

Pacifiers are recommended by both Dr. Karp and the American Academy of Pediatrics, but some babies don’t love them, and some parents are afraid of creating a paci addict.  For those nervous parents, I wrote a special post: Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic.  The truth is that sucking is a normal developmentally-appropriate self-calming behavior, and addiction really doesn’t become an issue until your child has nothing else that works at all.

Between 3-6 months, your little one is still benefitting from sucking, and she can learn to use a paci in daycare.  She isn’t at risk of nipple confusion, unlike a 2 week-old, and she won’t reject your breast because of paci use.  Nursing is the total package of love, warmth and nutrition.  If she says “no more” to nursing, it is likely that she would have done so without the paci.  Some babies are just ready to be done early.  Use Dr. Karp’s paci learning technique to teach a baby how to handle a paci and keep it in her mouth.  By 3 months, she has strong oral muscles, so it is a matter of practice and helping her to realize how handy pacis can be to calm a bit for sleep.  If she spits it out while asleep….well, mission accomplished!

White noise is the one HBOTB strategy that never needs to end.  But for these little guys, the new noises of daycare are so different from home that this may be the secret weapon.  Dr. Karp sells his carefully designed white noise CD.  It can be loaded onto a phone as well from iTunes. Select the track that matches your child’s state (crying, drowsy  and calm, etc.) and watch the magic begin.  Encourage your daycare to use this totally safe method of soothing.

Rocking a baby in your arms can replace the infant swing, and some older newborns still calm down when held on their sides or stomach.  Again, this is never a sleep position, just a calming position.  But if it works for your baby, feel free to use it when you hold her.

Once you have created an updated HBOTB routine that works, share it with the daycare staff.  You may find that they have rules and regulations, and some staff aren’t open to new ideas.  My suggestion is to emphasize how easily you can get her calm.  Even the most rigid care provider’s ears perk up when she thinks that there is a way to make her job easier.  These people work long hours and work hard.  Think of this as helping her and your little one have a better day!

Successful Swaddling May Take More Layers of Calmness

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Newborn crying can make you feel like you are on a ferris wheel; around and around you go!

Swaddling is a skill, but it is also an art.  Once you have your little one snug as a bean burrito, they don’t always stop crying right away.  When I teach parents the 5 S’s as part of a Happiest Baby on the Block consultation or class, I try very hard to explain that most children need more layers of love.  Parents aren’t doing it wrong if they keep crying, and babies aren’t resisting the swaddle.  They just need more support because they have little brains and few experiences in this world.  Once you figure out what combo of moves your child needs, you have success!

Once you have done a good-enough swaddle, use the side or stomach-down calming move right away.  As a pediatric occupational therapist, this is my favorite, since it is using the neurology of the vestibular (balance) system to help your child chill out.  Really.  They aren’t thinking  “Gee, I love the view in this direction”, or ” I am much calmer looking at the floor”.  Their brain is getting some calming signals from their inner ear, diminishing that arching from the Startle Reflex and helping them pull together.  Try both positions, and make little adjustments in the exact tilt.  Everyone’s brain is a little different, so your child might need side-plus-slightly face-down to hit that calm point.

Think of it like this:  when you sleep, why do you think people curl up on their sides?  Because the bed is too short?  It is relaxing, naturally relaxing, to many people.  No one told them to sleep that way, they just do.  The number of back sleepers is far fewer, yet pediatricians insist on back sleep for safety and give you no idea how to convince your child to chill in this position.  That seems unfair, but then, many pediatricians aren’t baby care experts, they are baby health experts.  We just want them to be.

Now you can do all the gentle swinging, shushing and sucking layers you learned in Happiest Baby.  They all work well, and you will quickly learn which one is the most powerful for your unique little baby.  As your child grows, the layers aren’t as needed as much, but you may find that one of them really makes a difference.  Often it is the white noise of shushing.  Now you know why.  It’s their neurological sleep signal.

Sweet dreams, and remember to layer it on!