The Fussy Baby Book: Parenting your high-need child from birth to five

On the day of discharge, Janine confided to me that Charlie’s cries were interfering with her relationship with her baby. She admitted she didn’t have those love-at-first-sight feelings new mothers are supposed to have. I knew that many infants’ cries become steadily more shrill and disturbing at two weeks of age than when they are newly born. If we didn’t do something, Charlie’s cries – and his relationship with his family – were going to get worse instead of better.

So Janine and I developed a three-part plan to help mellow out Charlie’s cries. My instructions to her were as follows:

1. Wear him almost constantly in the baby sling so he has no need to fuss about feeling alone.

2. Feed him frequently, at least every two hours during the day, and as needed during the night. Don’t wait for him to fuss to announce feeding time. As soon as he opens his mouth for anything more than a yawn, fill it with a breast within the first millisecond. (Jan knew I was exaggerating, but she got the point.)

3. Keep a list of situations that set off Charlie’s cries. Try to anticipate his needs and feed him, rock him, sing to him – whatever it takes to keep him from crying.

I also suggested Charlie’s parents tape-record his cries so they could keep track of their progress in mellowing Charlie’s temperament. Sure enough, within a week Janine said, “I finally enjoy being with him. He cries much nicer now.”

Why do some infants cry with such shrill, nerve-racking noises? Having seen several babies like this one who were “born” criers, I have come to wonder if the baby is affected by the stress hormones that mother made in order to handle a particularly stressful pregnancy or painful delivery.

Give baby a calm start. Some babies are born criers, but the care they get during the first few days can influence whether or not they stay that way. Let’s look at the two room-accommodation options a newborn used to have: a slot in the nursery or a spot close to mum.

The nursery option. Fresh from a soft, warm womb and a little time in mother’s arms, a baby born even relatively recently would take a bumpy ride to the newborn nursery, where he would stay on a static mattress in a plastic box, surrounded by bright lights, chatty adults, and a line-up of other babies in plastic boxes. What he needed was to stay with his mother so that he could gaze at her face and use her smell, her movements, and her holding to help him stay calm and feel safe. He was miserable and frightened in the plastic box and cried desperately. If there was a nurse there who had time, she might pick him up, but chances are he’d have to wait. He’d cry and cry until he exhausted himself to sleep, in the process experiencing very disturbing feelings. Bonding was severely disrupted, and he learnt that he could not trust that his needs would be met.

The nursery option was a biologically incorrect set-up. The nurse was the one who initially heard the baby’s cry, but the mother (in another room) is the one who is biologically programmed to calm the cries. Most infants have two phases to their cry. The early phase, called the attachment-promoting phase, is the perfect signal, disturbing enough to prompt the listener to want to pick up and hold the baby and give a comforting response, but not so disturbing as to make the listener want to avoid the baby. In the nursery arrangement, this is the phase of the cry that the nurse heard, and she eventually took the baby down to the mother’s room. However, by the time baby got to his mother, his cries were in the next phase – the avoidance-promoting phase. His cries escalate into a shrill sound, and the mother is presented with an anxious, frightened baby whose cries cause her to be anxious, even frightened. The mother is the one person who is biologically programmed to calm the cries, yet she is not present for the opening sounds that would have made this an easy, welcome job. Mothers and babies who started out life in separate rooms were out of sync. In fact, studies have shown that infants who show long bouts of anxious and disturbing crying (dubbed the “infant distress syndrome”) were placed in the nursery rather than kept with mother from birth.

know your limits

Nothing pierces parents’ hearts more than the cry of their baby. Yet cries can push dangerous buttons, too: feelings of anger, helplessness, despair – feelings that may overwhelm you and fill your mind with scary thoughts. Some very loving mothers have confided to us crazy thoughts they’ve had, such as throwing their baby out the window. And while it’s not unusual to plead with your baby to “please, be quiet”, there are good mothers who, on occasion, actually scream “shut up” at their baby. These feelings are aggravated even more by the fatigue that comes with parenting a fussy baby.

You can guard against doing something that you would immediately regret by rehearsing ahead of time what you would do if you felt yourself about to snap. Programme this behaviour into your mind, play-act it when things are going well, so that you will know how to react if you are pushed past your limit. When you feel overwhelmed by anger, feel like yelling at your baby, or feel that you are at your wit’s end, do one of the following: hand your baby to a less distressed set of arms; put your baby down momentarily and walk out of the room to compose yourself; put your baby in the sling and take a long, hard walk; or call an empathic friend, one who has survived the same trials.

Having these angry feelings does not mean that you are not a good mother. The mothers most bothered by their infant’s cries are often the ones who are most sensitive. Sensitivity can work to your advantage as a mother because it prompts you to try many ways of comforting your baby. Yet this same sensitivity can also set you up to feel like a failure if you can’t stop the crying. Having these feelings means that you are a tired mother, and your baby’s cries are getting to you. Take these emotions as a signal that you need some help in managing your feelings, managing your own care, and managing your baby’s cries.

The rooming-in option. Baby awakens in mother’s arms or with mother nearby and begins to cry. Because mother is right there, she hears the attachment-promoting sounds of baby’s cry, which trigger in her a nurturant response. She immediately caresses and comforts her baby – before the cry has to escalate into a more disturbing sound or enter the avoidance-promoting phase. After several of these cry-response rehearsals, mother learns to recognize baby’s pre-cry cues: a squirm, a grimace, followed by lip-smacking attempts to find something to suck on. Mother offers her breast before baby has to cry. Soon baby learns that he does not have to cry, certainly not in a disturbing way, to get what he needs. (As an added perk, the attachment-promoting phase of the infant’s cry can trigger the release of mother’s milk-releasing hormones, giving her a biologic boost for comforting; the avoidance-promoting phase of the infant’s cry can tie the mother up in knots, inhibiting her milk-releasing reflex.)

Early in my years as a newborn nursery director, I realized the difference between how nursery-reared and rooming-in babies act. We used to say, “Nursery-reared babies learn to cry harder; rooming-in babies learn to cry better.”

Imagining how your newly born baby feels can be a learning experience for a new mother who is struggling to develop a parenting style. Everything changes for the baby at birth. Think how he must feel in the drastically new environment in which he finds himself. He goes from warm, dark, smooth wetness, where he is held on all sides, and never experiences need of any kind, to cold, light, rough dryness, where he is alarmingly free on all sides and experiences a desperate need to be securely held. He has never felt the sensation of hunger before, and initially does not know that mother will ease it for him. He only knows that if he can suck he will survive. This terrifying hunger thing must be stopped! It is crucial that mother be there before baby becomes anxious and frantic (and this is possible only if they are not in separate rooms). Then baby learns not to associate the feeling of hunger with the feeling of distress. This realization is one of the earliest “house rules” that baby can learn: crying frantically when hungry is neither necessary nor the norm in this strange new life.

why babies in other cultures cry less

Infant-care specialists who study parenting styles around the world have noticed that infants in more “primitive” cultures usually cry less. One of the reasons for this diminished crying is that infants in these cultures spend most of their day in someone’s arms. Unlike babies in Western cultures, who spend much of their time in cots or infant seats, babies in many other cultures are carried in the caregiver’s arms or in a sling. In fact, some cultures have a “ground-touching ceremony”. Around six months of age babies are ceremoniously put down to crawl on the ground, and they do so quite happily. Mothers continue to hold and carry children as often as the children want, up to three years of age. Western cultures are finally catching on to what other cultures have long known – carried babies cry less.

Dr Melvin Konner, a physician and anthropologist who studies infant-care practices around the world, once translated a fear-of-spoiling passage from a best-selling American infant-care book to a group of African parents in a primitive tribe who practise a high-touch, attachment style of parenting, and whose infants are noted for their calmness. After hearing the warning about spoiling babies from picking them up too often, these mothers responded, “Doesn’t he [the author] understand it’s only a baby, that’s why it cries? You pick it up. Later when it’s older, it will have sense. It won’t cry anymore.” In essence, these intuitive parents rejected the spoiling theory as utter nonsense.

Mellow out yourself. One of the most difficult things about parenting for a novice mother is keeping her cool when baby loses his. It’s a perfectly normal reaction for a new mother, on the first note of her baby’s cry, to jump up immediately, rush to the baby, pick her up with tense arms, stare at baby intently as if to say “What’s wrong?!”, and begin frantically bouncing baby up and down as if trying to jiggle the cry out of him. It’s as though the mother is reacting out of guilt and fear that something she did – putting the baby down alone perhaps – caused the crying. Even though she means this tense reaction as a loving gesture of comfort, the baby may catch her worry, and the cry will escalate. A more effective reaction would start with putting on her best worry-free face, calmly and smoothly picking baby up to comfort him, and rocking in an easy, slow motion, giving baby the message “I’m right here. I won’t put you down again.”

Though some new mothers are more anxious than others, they can all learn the easy art of baby calming. Having confidence in your mothering skills is the first step. You will notice that an experienced mother can often comfort your baby more easily than you can, at least temporarily. Watch her perform. The baby’s cry doesn’t rattle her; but slowly, calmly, in a relaxed, yet caring way, she uses her whole body to give the baby the message that there is no need to cry harder, She transmits her quiet confidence to the baby, and the baby incorporates her relaxed attitude into his own state of being. Even if you’re new to mothering, you can still feel confident. From the moment your baby is born, you are the person who knows him best. Trust yourself.

crying and child abuse

One day I was counselling a teenage mother who had confessed to beating her one-year-old child with a wooden spoon. During our session, this usually capable and caring girl broke down crying. “His cries were so grating on my nerves, and he wouldn’t stop. Those shrieks just got to me, and I got so angry. I had flashbacks of my father hitting me with a wooden spoon during one of my tantrums. Before I knew it, I grabbed the wooden spoon and let this poor little baby have it.”

Child abuse studies have shown the following findings:

• Battered babies generally have more disturbing cries.

• Battering parents are more likely to label their babies “difficult”.

• Battering parents are more likely to practise a less responsive style of parenting.

It is important to teach babies to cry, “better”, so they don’t develop an ear-grating cry that triggers anger rather than empathy. Much child abuse could be avoided by teaching parents who are at risk for child abuse (families in high-stress situations and parents who were themselves abused as children) to give a nurturant response to their baby’s cries. The prevention of child abuse is another example of the good that can happen when parents learn to listen to their babies.

Anticipate. The best way to ward off an all-out wail is to try, as much as possible, to set conditions so that baby does not have to cry to get her needs met. Try to read your baby’s pre-cry signals and intervene at that point; don’t let her learn that she has to cry loudly to get a response. The skill of anticipating cries can come only after days and weeks of baby watching, learning to pick up on little cues that say that your baby needs something, that a cry is soon to follow. If your baby sucks on her fingers, seems disappointed, and then starts to cry, next time feed her when the finger sucking begins, a cue that she is hungry. You’ll avoid the crying stage. Developing your skills as a baby-comforter means walking that fine line between responding too quickly and waiting too long. This will be different for different babies and in different situations. Don’t worry, your baby will grade you mainly on your effort, not on whether you always read the cues right.

danger zone

The feeling that you want to shake your baby is a red flag, signalling a need for immediate help. Sometimes the ear-shattering shrieks of a hurting, colicky baby can stretch a parent to the point of irrational anger when the parent just wants to “shake it out of him”. Angrily shaking baby’s fragile brain and spinal structures can cause permanent, sometimes fatal, damage. Cry-sis (now called Serene) operates a hotline for parents to call if they feel themselves reaching this point. 020 7474 5011.

Show baby a sweeter sound. Give baby a sound he likes to hear better than his own cry. Crying quickly becomes self-perpetuating – the more loudly baby cries, the more he is driven to cry. By interrupting a cry long enough to get eye contact you can help him stop. To calm a high-need baby you need to come up with a wide repertoire of sounds. As soon as your infant starts crying, begin humming, singing, whistling, talking nonsense, whatever loud or soft voice or facial contortion catches your baby’s attention mid-cry and prompts him to listen to you. Gesturing and whispering “Shhhh” is unlikely to mute a melodramatic crier. Yet this “shush” sound repeated rhythmically over and over resembles the sound of uterine blood flow and, once you get baby’s attention, may be a familiar sound that soothes.

Don’t expect competing sounds to mellow your baby’s cry every time, but it is good practice to get an early start teaching baby which sounds trigger pleasant responses. Crying babies often turn into whiny toddlers, and you can call on the ear-pleasing sounds learned in babyhood to improve the audio quality of the toddler’s communication. Give your toddler the message “I don’t respond to whining” by telling him, “Let mummy hear your big boy voice, and then we’ll go out and play.” The earlier you begin practising these voice lessons, the more likely they are to work.

chapter 4 (#ulink_f697e84c-8300-508e-9f4e-049b553b5610)

creative ways to soothe a fussy baby (#ulink_f697e84c-8300-508e-9f4e-049b553b5610)

Babies fuss and parents comfort. That’s a realistic fact of new family life. Developing your skills as a baby-comforter will be your first priority as a new parent. If you include feeding and changing baby’s nappy on the list of comforting interactions with your new baby, keeping your baby comfortable will occupy almost every waking minute you spend together.

Comforting a fussy baby can be as easy as taking an afternoon walk around the room or as hard as climbing a mountain at 2am. While many people intuitively do the right things to calm a fussy baby (probably because these things were done for them), others are thrown into a panic and don’t have a clue (probably because they were not comforted as infants).

It helps to understand what calms a baby and why. Most calming techniques involve at least one of these four things:

• rhythmic motion

• soothing sounds

• visual delights and distractions

• close physical contact and touching

Most calming techniques (except visual ones) are like re-creating the womb baby has been used to for nine months. This chapter contains baby-calming techniques that worked with our own fussy babies or that we have learned from experienced baby-calmers in our paediatric practice. Remember, your baby has individual needs. Try these techniques as a starting point, and improvise. After a few months, you and your baby will have a large repertoire of fuss-busters that work.

motions that mellow (#ulink_9177b0ac-c1e5-5e62-9391-9eea7c35c46e)

1. Wearing Baby in a Sling

A baby carrier will be your most useful fuss-preventing tool. Infant-development researchers who study baby-care practices are unanimous in reporting infants who are carried more cry less. In fact, research has shown that babies who are carried at least three hours a day cry 40 per cent less than infants who aren’t carried as much. Over the years in paediatric practice, I have listened to and watched veteran baby-calmers and heard a recurrent theme: “As long as I have my baby in my arms or on my body, she’s content.” This observation led us to popularize the term “babywearing”. “Wearing” means more than just picking up baby and putting him in a carrier when he fusses. It means carrying baby many hours a day before baby needs to fuss. This means the carrier you choose must be easy to use and versatile. We have found the sling-type carrier to be the most conducive to baby-wearing. Baby becomes like part of your apparel and you can easily wear your baby in a sling many hours a day. Mothers who do this tell us, “My baby seems to forget to fuss.” The sling is not only helpful for high-need babies, it’s essential. Here’s why babywearing works.

Babywearing.

The outside womb. Being nestled in the arms, against the chest, and near the parent’s face gives baby the most soothing of all environments. Mother’s walking motion “reminds” baby of the rhythm he enjoyed while in the womb. The sling encircles and contains the infant who would otherwise become agitated and waste energy flinging arms and legs around. The worn baby is only a breath away from the parent’s voice, the familiar sound he has grown to associate with feeling good. Babies settle better in this “live” environment than they do when parked in swings or plastic infant seats.

Sights aplenty. Being up in arms gives baby a visual advantage. He now has a wider view of his world. Up near adult eye level, there are more visual attractions to distract baby from fussing.