Category Archives: newborns

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!

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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!

After Kangaroo Care: Infant Massage and Tummy Time on Mommy (or Daddy)!

“Kangaroo Care” is the term your NICU used for placing your newborn directly on your chest, face turned to one side, and letting her get the sensory and regulatory benefits that neonatologists believe she can gain from this position.

Then she gets stronger and you all go home.  What can you do at home?  Well, you could try to keep using this lovely position, but babies start to move, and they want to get up and go.  It’s hard to keep them on your chest when they are wiggling around.  If she navigated the NICU successfully, this is a wonderful problem to have: she is energetic and active!

Keep the love, warmth and connection going, and give her all the physical benefits of skin contact with infant massage and by placing her on her stomach on your chest while you lie in a partially reclined position, with her trying to look up at you.

Infant massage is easy to learn (I teach it in one or two 50-minute sessions) and it is easy to incorporate into your routines.  Even babies with medical issues can handle most of the standard massage moves, and a little goes a long way.  I teach unique adaptations for special needs preemies that don’t stress them out.

You won’t be massaging her for more than 10 minutes at first.  The effects of touch and movement on your newborn can support growth, sleep and focusing.  There have been a few research studies that suggest more specific benefits on health, but the secret is that infant massage is good for you too.  It will relax you and build your store of feel-good neurochemicals.  How cool is that?

Tummy time for tiny ones isn’t that complicated, but it is a bit different for NICU graduates. You may need to give her some assistance to keep those little elbows directly under her shoulders (they tend to drift out to the sides) .  Entertain her with funny faces and (interesting but not overwhelming) sounds from toys or sounds you make, and sing a little.  Babies are very forgiving and will tell you with their breathing patterns and muscle tension if you are getting it right.  Be positive, even if she is fussing, and be creative.

Tummy time for 45 seconds 10x/day is way better than 3 minutes of crying 3x/day.  There is encouraging, and there is pushing.  Be the coach she deserves, supporting her with the right moves, right from the start!!

Bringing Home Your Preemie: What Your Therapists Would Like You To Know

Discharge day for a preemie is special, but it is just the beginning of a journey that often includes therapy at home.  As an Early Intervention therapist, I thought parents could use some insights into what your team is really thinking when they begin to work with you and your baby.

  1. We know that you are nervous.  This is your first experience with a medically fragile child, but it isn’t ours.  Most of us have worked in hospitals before, and are well-acquainted with universal precautions, shunts and feeding tubes.  We are always looking for signs that things aren’t going well, and we will do everything we can to ensure your child’s safety at all times.  That may mean that we will tell you that things like placing a Bumbo chair on a table is a risk, and those chairs do not give your child the correct support for growth.  Regardless of what your sister-in-law said about her child.
  2. We aren’t doctors, so we will not give you a diagnosis, even if we suspect something.  Legally, we can’t diagnose, so even though we suspect that your child may have cerebral palsy or another issue, you won’t hear it from us.  In the past 15 years, I have seen neurologists in NY delay diagnosing conditions such as CP for well over a year after birth, even when there isn’t any alternative diagnosis that fits.  Parents are left waiting and wondering, hoping that it isn’t so.  The internet allows parents to learn quickly what all that muscle rigidity and terms like “leukomalacia” can indicate.  I suspect that medical liability issues are at the heart of this delay, and it is tearing parents up inside.  But we aren’t allowed to tell you our suspicions.
  3. You are the greatest determinant of therapy success.  We can only guide you, demonstrate techniques, positioning, and give you therapeutic activities.  What you do every day is essential and will determine much of the success of our work.  If we suggest that you hold your baby in a manner that builds head control, reduces arching or encourages reaching, we know that your actions will determine if it works.  If you ignore our suggestions without discussing your concerns, or worse, tell us you are doing them when you aren’t ( we can actually tell),  you aren’t getting very much from your child’s therapy or your therapists.
  4. Babies can feel fear or confidence, so ask questions and get more reviews and guidance if you don’t really understand what your therapists have suggested.  We do this all day long, and most of us have been handling premature babies for years.  We know this is all new to you.  No judgements!

Why Doesn’t Swaddling Alone Calm Newborns?

I attended a local function last night, and this question was on my mind as parents recounted their experiences with newborns and calming.  They thought that they were doing the swaddling wrong.  Or that their child was abnormal.  Not likely.  They just didn’t realize that for most babies, swaddling alone doesn’t do the deal.

As a certified Happiest Baby educator, I am aware that there are a small percentage of babies that are so mellow that they might not even need a swaddle.  These newborns just eat, poop, pee and sleep.  Anywhere, any time.  Having such a baby feels like winning the lottery.  It is, and it is almost as rare.  Dr. Karp estimates the percentage of “easy” babies as somewhere between 5 and 15%.  Enjoy it, but do not think that baby #2 will be the same.  It isn’t inherited, or your divine guidance, or that your husband is a gem.  You got lucky.

Most babies are in between as far as temperament and fussiness, and need at least some of the 5 S’s.  Swinging, sucking, side/stomach positioning (to calm only), shush-ing, and the swaddle.  They are only occasionally fussy, and it is clear to you what they need after you know the Happiest Baby moves.

And then there are the babies that he classifies as “spirited”.  You know if you have one of these.  Peals of joy, but also screams that could make the sheetrock fall off the walls.  If they are hungry, you’d think they were being starved.  If they are tired, they are hysterical.  If you don’t pick them up in time, they make it clear that you will rue the day you do that again.  They are not possessed, they are expressing a combo of lack of self-calming skills, a really immature brain, and a fiery temperament.  You need to do all the moves of Happiest Baby, and do them right.  I can help.  Read more of my posts, get Dr. Karp’s DVD, and practice the moves until you could teach my classes.

So, swaddling does work, it just isn’t the end of the story for most babies.  If you have a baby for whom swaddling isn’t enough, don’t give up.  Take a class, get a consultation from me or another educator, and don’t worry that a screaming newborn means a lifetime of this rollercoaster!

Why Some Newborns Look Like They Hate To Be Swaddled

Yes, I said it.  Some babies scream louder after you swaddle them, and parents assume that this means that they are horrified of being restricted.  This is usually far from the truth, but you have to know a little bit about newborn neurology to understand why this is likely not to be a case of protesting imprisonment and more a request for more layers of calming.

For 9 months, a newborn has been living in a tighter and tighter space.  Baby bumps get bigger, but the uterus can only expand so far.  At the end of pregnancy, babies are a snug fit.  Really snug.  They aren’t uncomfortable, and in fact, swaddling is replicating the whole-body firm hug that they know so well.  It is diminishing the shock of the Moro (startle) reflex that scares them and makes them cry more.  It keeps them at a consistent temperature, just like the womb.

So why do some of them scream more right after you swaddle them?  Well, some babies are sensitive little souls, the kind that cry with new noises, too much talking, or even when their digestion “toots” a little or they get very hungry.  They can go straight from happy to upset after too much activity, too much socializing, or too much interaction.  By the end of the day, they are at the end of their ability to handle life.  This can be partly temperament, their unique way of interacting with the world.  It can also be that their nervous system is still very immature, and they are taking a while to develop self-calming.  That is not a medical problem.  Every baby is new at this life-after-womb thing.  Some babies just need a little more time living like they did for 9 months, cozy and comforted.

These babies need swaddling more than some others, but they find anything new to be a challenge.  Give them a chance to get used to it, and make sure that you are doing a good swaddle.  Check how toasty they are, by making sure that they are not sweating behind their neck or ears (if so, lighten up on layers and swaddle in light cotton).  They probably also need more than swaddling to pull it together.  If you haven’t read Happiest Baby on the Block or seen the DVD, you might not be aware that swaddling alone is not going to finish the job for sensitive kids.  Sucking, shushing, side or stomach positioning (for calming only) and swinging may all be needed to calm these babies down.

So for all those parents who think that their baby is the one that hates swaddling, I encourage you to make sure that your technique is solid, your blanket or swaddle garment fits correctly, and that you layer on the love moves with more than a swaddle to calm your little one!