Category Archives: newborns

Can The Parents of Kids in Early Intervention 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 down for sleep and feeding?

You can call me for help!  Visit my website Tranquil Babies  and purchase a consultation session to ask your questions and review all the baby calming techniques in detail!  A consultation session is a great baby shower gift; it is like “phone-a-friend” on a game show, except the game show is YOUR LIFE!

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!

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!

 

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!

 

Will White Noise Harm a Newborn’s Hearing?

This question doesn’t come up as often as it should when I do Happiest Baby on the Block consultations.  The short answer is that common sense goes a long way to protecting a newborn’s hearing.  The longer answer is that understanding sound conduction and newborn development will help parents use white noise confidently.  Here we go:

White noise, selected carefully and used with some knowledge, can be a powerful way to calm newborns and it can be a go-to sleep cue for the entire first year.  Babies that recognize white noise as a cue that it is time to sleep are easier to calm when the going gets rough.  When that first cold, first tooth, or sibling tantrum comes along, the baby who calms automatically with white noise will be easier to soothe.  The gift that keeps on giving!  Is it addicting?  Only as much as your cozy pajamas are on a chilly night! Are Babies Addicted to White Noise? Yes….and No

Sound characteristics for safety and effectiveness are volume and pitch.  High pitched sounds are the more dangerous type, especially when used at high volume and close to a sleeping child’s ears.  High pitched sounds are also less effective at calming.  Examples of high and low pitched sounds?  Think about the difference between a whistle (high) and a vacuum (low pitched but loud) or water from a shower head (low pitch and moderately loud).  Everyone has heard stories of babies who stopped screaming only if they were next to the clothes dryer or when someone ran the vacuum.  Those newborns aren’t excited about housework; the rumbling low frequency sound at a moderate volume helped calm them.  Thank goodness that Dr. Karp’s Happiest Baby organization sells while noise CD’s and apps that replicate those calming sounds.  I like to vacuum, but not that much!

Babies who scream can easily reach 100 dB (decibel ). That is as loud as a lawnmower!  To use white noise to help a screaming baby calm down, you are going to have to turn up the volume temporarily to about 80-90 dB for white noise to have an effect.  Remember, I said tem-po-rarily.  Once a baby is not screaming, but is still fussy, it is time to lower the volume down gradually to a soft shower level. It is not recommended to use white noise at the volume level above 70dB all night long.  

How close should the sound source be to the baby?  It depends.  Obviously if it too far away, the effect of sound is diminished to the point where it does no good at all.  You will realize that quickly as you watch your newborn continue to scream and fuss.  Too close is not acceptable either, as the volume of sound will be too high.  By the way, Dr. Karp encourages families that want to use a cell phone for white noise to put it on Airplane Mode to diminish the amount of radio waves from the phone.  Most phones have tinny speakers that don’t deliver great low pitched sound anyway.  The most accurate way to know that the sound is a safe distance is to download a decibel meter app or buy a free-standing meter.  Place it next your child and adjust the volume so that the level for an all-night session is 65-70dB.  That is about the level of lively conversation, and a safe level for full-term babies.

Should you use white noise all day and all night?  Absolutely not.  Babies need white noise to sleep and calm, but when awake and interacting, they need to hear your loving voice, experience the quiet stillness of a peaceful home, and listen to the wonderful sounds of nature and family!

 

 

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!

Best Preemie Toy? Try An O-Ball Toy For Easy Grasping And Playing

 

Preemies often wait a long time to start playing.  NICU life isn’t about fun, it is about survival.  Once your preemie is home, you will want to get the party started.  If she has a weak grasp or isn’t coordinated enough to easily hold every rattle and toy that you got for your shower, you might want to consider the O-ball to develop visual-motor skills.

O-ball

The Original O-Ball!

This is the basic O-Ball, a great toy that I recommend for my 1-4 month clients.  I also recommend the next generation O-ball toys, such as the O-ball car, for equally easy grasp with my slightly older preemie or developmentally delayed kids.

Why do I like this ball over cloth balls or those bumpy sensory balls?  

  • The web-like design allows a child to hold it with almost any type of grasp.  Low muscle tone, spasticity, or weakness reduce a baby’s ability to grasp and retain a toy.  It just isn’t fun if your toy keeps falling out of your hand.
  • Texture, but not too much texture.  The plastic is a little bit grippy, so it doesn’t fall out of her hand like a smooth plastic ball, but not so textured that a sensitive infant would find it overstimulating.  Preemies sometimes leave the NICU a little overwhelmed by sensation, and yet many need the extra touch input to really feel what is in their hands. This ball is a good balance of tactile inputs.
  • Fun at a fraction of the weight.  A baby that has strength or tone issues needs lightweight toys to pick it up easily and continue to hold it as gravity pulls the ball down and out of his hand.
  • The O-ball is large enough and light enough for 2-handed grasp, an important developmental milestone.  As an OT, we know that using two hands at midline (the center of your body) supports all the other movements that require a sense of moving around a center…rolling, crawling and walking!  Start now to develop awareness of midline and two-handed activity.
  • Second and third generation O-balls have built-in rattles and are more colorful than this one.  None have sharp edges or pieces that can fall out.  Safety first.
  • Did you say “Spit up”?  Wipes clean in an instant.
  • It is a bit squishy, which means it will bend, not break.  If your child drops it on her face or on the floor, she might cry from surprise but not from injury.
  • It will still be fun to play with next year.  This ball will still be fun to roll and throw later on in life, unlike those rattles that will be tossed out in a few months.

Here is another great post for parents of NICU graduates: Baby Wearing for Premature Babies

Is your preemie hypermobile?  I wrote an e-book just for you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years is finally out!  I include techniques to hold and carry your child, how to use infant exercisers and how to do “tummy time”  with a hypermobile baby.  There are chapters on how to talk with your family, babysitter, and even how to talk to your pediatrician about your child’s needs.  You can buy it on Amazon.com today!  Don’t have a Kindle?  NP!  You can read it on any screen or desktop.  Want a printable copy?  Buy it on Your Therapy Source today!

Live in the NYC area and want to learn infant massage for your preemie?

Visit my website tranquil babies and make an appointment for an in-home lesson designed just for preemies today!

Sleep Training at 2 Months: Beyond Cry-It-Out

The Wall Street Journal’s writers are known for great reporting, but they clearly didn’t do a lot of research when they wrote today’s article Can You Sleep Train Your Baby at 2 Months?  Lots of agonizing parent reports of the cry-it-out method, and professional agreement that babies 8 weeks old don’t sleep through the night normally anyway.  They totally got it right that running and picking up a waking (but not screaming) baby is not going to teach good sleep habits, but there was no mention of pick-up/put-down, using Dr. Karp’s 5 S’s for deepening sleep in newborns, not even the use of swaddling to build a precious extra hour of sleep!

Parents who do not know how to handle the screaming and/or want to develop good sleep habits will go away from this article wondering if they can truly hack listening to an infant scream for the common “30-40” minutes.  What a mistake!!  Crying like that doesn’t do anyone any good.  It isn’t good for a baby or a parent, and can lead an exhausted and demoralized parent down the path to desperation, including falling asleep on the couch holding a baby (a documented suffocation or fall risk), feeding a baby large and frequent feedings to “sedate” them, or shaking that baby after nothing works.

Creating good sleeping behaviors in the first 3 months is completely possible and much easier to do than letting them scream.  But sleep at this age isn’t a full 8 hours, it isn’t done without creating a sleep environment that supports brain development at this age.  It takes some knowledge of baby development, some patience, and a willingness to accept that the techniques that work for a 3 year-old are ridiculous for a 3 month-old.  Apples and oranges, apples and oranges.

After a few years of being a Happiest Baby on the Block educator, I am becoming increasingly frustrated and discouraged with the situations I hear out in the world of baby calming.  My grandmother from the old country knew more about handling newborns than  most professionals with doctorate degrees!  Like the story of the elephant and the blind man, many of the professionals I meet are largely concerned with protecting their piece of the authority pie than helping babies and parents.   Researchers spend more time in universities and labs than out in the field, which is to say in people’s homes, calming babies themselves.  Yes, it really builds your skills if you have actually successfully calmed babies with your recommendations, not just assembled results of research studies.  This is not “anecdotal evidence”, my friends, this is real life experience.  Get some.

Parents, please, please, do not read the WSJ article and redouble your efforts at cry-it-out with young infants.  Read Dr. Karp’s book The Happiest Baby on the Block, watch his video, contact me or another certified educator, just do not think that this is all there is out there.

BTW, Dr. Karp’s book The Happiest Baby Guide to Great Sleep will take you all the way into the kindergarten year, with good advice about toddlers and preschoolers!

 

The Informed Parent and Happiest Baby on the Block

I read The Informed Parent recently to decide whether it would be a good resource for my clients, and found that the chapters on The Art and Science of Baby Soothing, SIDS, and Sleep Training were worth reading.  This book distills a lot, a whole lot, of research that can confuse those parents who want some clarity in a sea of recommendations. The problem?  The authors, Tara Haelle and Emily Willingham, left me wanting for some good resources to offer parents once they have made their own conclusions about the available research.  They did do something wonderful for me as a Happiest Baby educator:  they included many, many research references to the 5 S’s that support the use of Dr. Karp’s techniques to calm newborns.  If you ever wondered whether swaddling is bad for your baby’s hips or whether pacifiers would help or hurt your chances of successful breastfeeding, the authors have some science-based answers for you.

As an example of what their book offers parents, the chapter on sleep training appeared to summarize all of the research findings by saying that bad sleepers aren’t necessarily disturbed or deficient.  The most helpful conclusion was that children whose parents were available to them emotionally during the bedtime period had fewer sleep disruptions. Parents might be feel less guilty but this won’t help anyone go to sleep.  If a parent is frustrated, tired, and distracted, and has an authoritarian approach to sleep: “Go to sleep NOW, because I said so!”, I believe that they are more likely to end up with a child that doesn’t want to go to sleep at bedtime, and screams for bottles or cuddles at 4 am.  But how exactly does this observation help anyone?  Perhaps there are parents that recognize themselves in that description and decide to change, but I suggest that most of us do not see ourselves as emotionally unavailable, even when we are.   My experience is that the parent-child pairs I have met who have an insecure-resistant mode of attachment (psych-speak for a child that desires parent contact but then reacts angrily or is resistant/fussy when given attention) are completely oblivious to how they contribute to their child’s behavior.   It is going to take more that a summary of scientific studies to have parents recognize the effect of their interactions on sleep problems.

I was disappointed that the authors included the “Purple crying” concept of Dr. Ronald Barr in their discussion of parents that shake a persistently crying infant.  Nothing in this  “approach” is scientific.  Telling parents that colicky crying is normal, but not offering more than “put the baby down and don’t shake him” is reprehensible when methods such as Dr. Karp’s 5 S’s  have actually helped so many families.  Of course shaking is never OK!  I really doubt that anyone that has had a screaming infant has ever felt that “knowing that crying is common and not abnormal” was very helpful.  What you want at that point to avoid doing something harmful is a solution, not a platitude.

Read The Informed Parent and let me know what was helpful and what just made you want some successful easy-to-use strategies for babies and toddlers!

To schedule a in-home training with me in the NYC metro area, or to buy a phone/video consult, visit my website and select the service that fits your needs.  

 

Active Baby? Active Mom? It May Be Epigenetics Again….

This week’s New York Times ran a story  Does Exercise During Pregnancy Lead to Exercise-Loving Offspring? that echoes what I told a mom last month during a Happiest Baby consult about how her behavior during pregnancy “taught” her son to love movement.  She is an athletic woman, a pediatric physical therapist, and her baby really didn’t calm down fully unless he was jiggled or swung.  He just craved movement.  I am not sure if she really bought my explanation about needing to recreate his womb environment to help him feel calm.  After all, she was just doing her normally active life while pregnant.  After delivery, she went back to work almost immediately.  He was laying at home in the pack n’play, trying to tell everyone (by being fussy at times) that he relaxed best by being more active too!

This article is a little complicated, and they spent a lot of time explaining rodent research.  The coolest part?  Much more of the totality of life “in utero” and immediately after birth might directly influence the DNA of a baby!  The authors did mention that this isn’t an opportunity to lay guilt on mothers, something that is done much too often.  Parents don’t need that.  This little article briefly highlights research that suggests the possibility that the entire experience of the pregnancy is important, not just prenatal vitamins and avoiding raw milk.

I wish, of course, that they had mentioned how important it is to understand the need to support newborns by providing the “4th trimester”, as Dr. Karp calls his amazing baby calming techniques.  It is entirely possible that lots of babies progressively need less movement as they develop other ways to self-calm.  And some may have had their DNA tweaked so that they simply can’t wait to get up and move.  Right from the start.

I told the mom at her consult that she had better prepare for her son joining a travel team in the future.  But knowing her, I think she will be totally OK with that!

Will Swaddling Affect Newborn Sleep?

The short answer?  It almost always gives them a slightly longer sleep cycle.  The longer answer:  many babies need more than a good swaddle to add that extra hour or so to their sleep cycle.

Interestingly enough, research and the American Academy of Pediatrics have suggested that swaddling makes a newborn’s sleep lighter.  Lighter isn’t necessarily worse.  Stomach sleeping is often deeper sleeping.  The risk for stomach sleeping is that if their nose and mouth are pressed into the mattress, they can’t or won’t turn their heads to breathe. That is why SIDS prevention guidelines say they should never sleep on their stomachs.  As a health professional, you know where I come out on that argument.  Be smart and use effective techniques for good sleep rather than use a risky move in sleep-deprived desperation.  It may be the action you regret for the rest of your life.

So if you swaddle and back-sleep and still have a fussy newborn, what do you do?  You layer on the love; those other moves from The Happiest Baby that soothe newborns and let them sleep.  That means that using the pacifier/soothing nursing, swinging, white noise are more important for sleep.

I just did a consultation with a family whose 6 week-old is already a tribute to his athletic, high-energy mom.  He calms best with movement, lots of it.  That isn’t a problem, or a sign of anything bad, but it means that to get him to sleep on his back they are going to have to give him more movement to lull him almost fully asleep before putting him down. They may even need to use the swing, filly reclined and belted in, at a higher speed for sleep.  There was some chatter about him getting “addicted” to it, but the good news is that the need for speed decreases as brain development increases. I recommended that he get some practice with the pacifier ( see my June 4, 2015 post on how to use and wean pacifiers) and that they use the harsher white noise.  It may be too soft or too far away to have enough of an effect for him.  She should, however, be prepared to sign him up for a travel team in about 10 years!

If you would like more support with your newborn but you don’t live in the NY metro area, visit my website, tranquilbabies.com, and purchase a phone or video consultation session.

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.