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

Even as newborns, most babies who are separated from their mothers click into survival mode: their breathing increases, they clench their fists, they arch their backs and tense their muscles. Their whole body language shouts, “I have to be held to survive.” The sooner parents pick up on these cues, the sooner baby will thrive. Some babies are particularly separation-sensitive, even during sleep. We decided to study the physiological effects of nighttime separation on our eighth baby, Lauren, when she was two months old. A local company loaned us £50,000 worth of equipment and their technical assistance. Using the latest in noninvasive technology, we wired Lauren to a computer that recorded her electrocardiogram, breathing movements, air flow from her nose, and her blood oxygen saturation. The instrumentation was painless and didn’t appear to disturb her sleep. The computer recorded Lauren’s physiological changes during one full night of sleeping side-by-side with Martha and the next full night of sleeping alone in the same bed. Our study revealed that Lauren’s overall physiology – her heart rate, breathing, and blood oxygen saturation – was more stable when sleeping next to Martha than when sleeping alone.

New studies are beginning to prove what savvy mothers have long suspected: growing infants develop better the more time they spend in touch and interaction with their parents.

How did these parenting “experts” come up with these numbers? One begins to wonder. Wishful thinking? There were no actual studies to back them up. By the time the study of infant behaviour developed into a science in the sixties and seventies and researchers began disproving the spoiling theory, the low-touch, high-control style of parenting was so entrenched that even today compelling research has not been able to unseat it.

The cry-it-out advice is based on the principle of reinforcement, which is simply this: if a behaviour is not reinforced (not responded to), it is extinguished, it goes away. If the behaviour is reinforced (responded to), it will be repeated. This does make a certain amount of sense, but there are several fallacies in the way this principle has been applied to infant crying. First of all, the reinforcement principle assumes that the cry is a bad behaviour to be eliminated rather than a signal to be listened to. Second, research does not support the idea that ignored cries are simply extinguished. Rather than learning to be quiet, some infants learn more disturbing means of communication. In other babies, those with whom the cry-it-out advice “works”, it is the drive to communicate that is extinguished. And along with learning that his cries have no signal value, the baby also learns that he has less value. This lays the foundation for a sense of distrust rather than trust. This is no way to begin life.

“But it works”, defenders of cry-stopping advice claim. This depends upon your point of view. Consider how you would feel if you had a desperate message to convey, and your previously trusted significant other stopped listening. You’re delivering what you feel is a very important message, at least to you. You need some help, yet the one to whom you are talking ignores you. How would you feel? You might conclude that what you are saying has little or no value to the listener. You might further conclude that your listener doesn’t care about your message, or about you. How would you react? You could yell more loudly and make yourself so obnoxious that your listener would be forced to come to your rescue. By this time you’d be a very angry person and would carry that anger with you, perhaps turning it inward. You could just quit delivering your message, sniffle to yourself a few times, and decide that you can’t depend on anyone but yourself or that maybe you don’t deserve to be heard. A baby who makes this shift might even be rewarded with the tag of “good baby”, one who doesn’t bother anyone. A third alternative is to go on delivering your message, sincerely hoping your listeners will stretch themselves to really hear what you have to say, and will respond appropriately.

cry-it-out advice: 1897-style

The following is a quote from one of the most influential baby-care books of the nineteenth century, Diseases of Infancy and Childhood, by paediatrician Dr Emmett Holt, published in 1897. This excerpt will help you appreciate the misguided, controlling origins of the cry-it-out advice. After Dr Holt advises mothers to respond to their baby’s cries if they believe the cry is due to illness, he goes on to admonish them: “The cry of habit is one of the most difficult to recognize. These habits are formed by indulging infants in various ways. Some children cry to be held, some to be carried, some to be rocked, some for a light in the nursery, some for a rubber nipple or some other thing to suck. The extent to which even very young infants may indulge in this kind of crying, is surprising, and it explains much of the crying of early childhood. The fact that the cry ceases immediately when the child gets what it wants is diagnostic of the cry from habit. The only successful treatment of such cases is to allow the child to ‘cry it out’ once or twice and then the habit is broken … On admission to Babies’ Hospital very young infants almost invariably cry a great deal for the first two days. It being against the rules to take such children from their cots and hold them to quiet their crying, they soon cease the habit, and give no further trouble … The mothers were forbidden to quiet the infants by taking them up, and after two or three days’ discipline the crying ceased and peace and order were again restored.”

Such is the frightening advice that was to infect parenting throughout the next century.

For some infants, the cry-it-out advice does seem to “work”, in that they stop crying as much. These infants seem to be the compliant type, the “easy” babies. And many seem none the worse for wear when trained to become “good babies”. The older “easy” baby may wind himself down from a cry, realizing that he can do this without outside help and that he is really all right afterward. This does not happen with high-need babies, as mothers we have interviewed testify. Most of these mothers revealed that if they tried the cry-it-out advice, their babies just kept crying persistently, and afterward both the mothers and their babies were emotional wrecks. In fact, many mothers who have, in desperation, left their babies to cry it out, have later confided, “I’ll never do that again.”

What cry research tells us. Researchers Sylvia Bell and Mary Ainsworth performed studies in the 1970s that should have put the spoiling theory on the shelf to spoil forever. These researchers studied two groups of mother-infant pairs. Group 1 mothers gave a prompt and nurturant response to their infant’s cries. Group 2 mothers were more restrained in their response. They found that children in Group 1 were less likely to use crying as a means of communication at one year of age. These children seemed more securely attached to their mothers and had developed better communicative skills, becoming less whiny and manipulative.

Up until that time parents had been led to believe that if they picked up their baby every time she cried, she would never learn to settle herself and would become more demanding. Bell’s and Ainsworth’s research showed the opposite. Babies who developed a secure attachment and whose cues were responded to in a prompt and nurturant way became less clingy and demanding. More studies were done to shoot down the spoiling theory, showing that babies whose cries were not promptly responded to began to cry more, longer, and in a more disturbing way. In one study comparing two groups of crying babies, one group of infants received an immediate, nurturant response to their cries, while the other group was left to cry it out. The babies whose cries were sensitively attended to cried 70 per cent less. The babies in the cry-it-out group, on the other hand, did not decrease their crying. In essence, crying research has shown that babies whose cries are listened to and responded to learn to cry “better”; infants who are the product of a more restrained style of parenting learn to cry “harder”. It is interesting that the studies revealed differences not only in how the babies communicated with the parents based on the response they got to their cries, but there were also differences in the mothers. Studies showed that mothers who gave a more restrained and less nurturant response gradually became more insensitive to their baby’s cries, and this insensitivity carried over to other aspects of their parent-child relationship. Research showed that leaving baby to cry it out spoils the whole family.

Discipline confused with control. Another reason the cry-it-out advice has survived so long is that it was marketed as one of the essential points of discipline. Parents were led to feel that if they didn’t let their baby cry they were wimpy parents and that their children would always have the upper hand. This approach to child rearing confused discipline with control, a confusion that persists in some parenting-advice circles. With the parent-in-control philosophy, the infant’s temperament and personality play no part in determining the style of care he receives. The infant is given no voice in his own management. This undermines the whole foundation of parental discipline: knowing your infant and creating a trusting relationship between parent and child. Babies, even newborns, can learn the basic principle of trust: distress is followed by comfort, and thus the world of the family is a nurturing and responsive place to be. In contrast, the cry-it-out advice creates a distance between infants and parents, a distance that makes disciplining the growing child more difficult.

Crying isn’t “good for baby’s lungs”. One of the most ridiculous pieces of medical folklore is the dictum “Let baby cry – it’s good for his lungs.” In the late 1970s, research showed that babies who were left to cry had heart rates that reached worrisome levels and lowered oxygen levels in their blood. When these infants’ cries were soothed, their cardiovascular system rapidly returned to normal, showing how quickly babies recognize the status of well-being on a physiologic level. When a baby’s cries are not soothed, he remains in physiological as well as psychological distress.

The erroneous belief about the healthfulness of crying survives even today in one of the items factored into the Apgar score, a test that physicians use to assess a newborn’s condition rapidly in the first few minutes after birth. Babies get an extra two points for “crying lustily”. I remember pondering this back in the mid-1970s, when I was the director of a university hospital’s newborn nursery, even before fathering a high-need baby had turned me into an opponent of crying it out. It seemed to me that awarding points for crying made no sense physiologically. The newborn who was in the state of quiet alertness and breathing normally was actually pinker than a crying infant, even though the quiet baby lost points on the Apgar score. It amazes me that the most intriguing of all human sounds – the infant’s cry – is still so misunderstood.

it’s not your fault

Parents, take heart! If you are responsive to your baby and try to keep him feeling secure in his new world, you need not feel that it’s your fault if your baby cries a lot. Nor is it your job to make your baby stop crying. Of course, you stay open to learning new things to help your baby, like a change in your diet (see Chapter 10), or a new way of wearing baby (see here), and you get your doctor involved if you suspect a physical cause behind the crying (see Chapter 10). But there will be times when you won’t know why your baby is crying – you’ll wonder if baby even knows why he’s crying. There may be times when baby needs to cry, perhaps because he just feels stressed. You needn’t feel desperate to make him stop after trying all the usual things. It’s a fact of new parent life that although babies cry to express a need, the style in which they do so is the result of their own temperament. Don’t take your baby’s cries personally. Your job is to create a supportive environment that lessens your baby’s need to cry, to offer a set of caring and relaxed arms so that your baby does not need to cry alone, and to do as much detective work as you can to figure out why your baby is crying and how you can help. The rest is up to your baby.

When I was confused about my mothering, I asked a seasoned, calm, impartial mother to observe how I handled my baby on a typical day in my home. Even though I know I am the expert on my own baby, sometimes it is hard to be objective, and the voice of experience can be helpful.

Letting baby cry desensitizes mother. Not only is the cry-it-out advice bad for babies, it’s bad for mothers. When we began writing about babies, we interviewed hundreds of mothers about their views on the cry-it-out advice. Ninety-five per cent of the mothers told us that this advice went against their basic intuition. It made them feel “not right”. We concluded that 95 per cent of mothers couldn’t be wrong.

Besides being physiologically harmful to babies, the cry-it-out advice makes no physiologic sense for mothers. The infant’s cry affects the mother’s body chemistry, and that’s what makes it so special. No other sound in the world triggers such intense emotions in the mother. The cry is supposed to do that, and the mother is supposed to feel that way.

Mothers are biologically programmed to respond to their infant’s cries. When a mother goes against her basic intuitive response and “hardens her heart against the little tyrant”, she desensitizes herself to the language of her infant. This opens the door and lets in the “infection” of insensitivity, which can one day land mother, father, and child in the office of the discipline counsellors. Insensitivity gets new parents into trouble and makes their job more and more difficult.

the shutdown syndrome

Throughout our twenty-five years of working with parents and babies, we have grown to appreciate the correlation between how well children thrive (emotionally and physically) and the style of parenting they receive. First-time parents Linda and Nigel brought their four-month-old high-need baby, Heather, into my surgery for consultation because Heather had stopped growing. Heather had previously been a happy baby, thriving on a full dose of attachment parenting. She was carried many hours a day in a baby sling, her cries were given a prompt and nurturant response, she was breast-fed on cue, and she was literally in physical touch with one of her parents most of the day. The whole family was thriving and this style of parenting was working for them. Well-meaning friends convinced these parents that they were spoiling their baby, that she was manipulating them, and that Heather would grow up to be a clingy, dependent child.

Like many first-time parents, Nigel and Linda lost confidence in what they were doing and yielded to the peer pressure of adopting a more restrained and distant style of parenting. They let Heather cry herself to sleep, scheduled her feedings, and for fear of spoiling, they didn’t carry her as much. Over the next two months Heather went from being happy and interactive to sad and withdrawn. Her weight levelled off, and she went from the top of the growth chart to the bottom.

Heather was no longer thriving, and neither were her parents.

After two months of no growth, Heather was labelled by her doctor “failure to thrive” and was about to undergo an extensive medical workup. When the parents consulted me, I diagnosed the shutdown syndrome. I explained that Heather had been thriving because of their responsive style of parenting. Because of their parenting, Heather had trusted that her needs would be met and her overall physiology had been organized. In thinking they were doing the best for their infant, these parents let themselves be persuaded into another style of parenting. They unknowingly pulled the attachment plug on Heather, and the connection that had caused her to thrive was gone. A sort of baby depression resulted, and her physiologic systems slowed down. I advised the parents to return to their previous high-touch, attachment style of parenting: to carry her a lot, breast-feed her on cue, and respond sensitively to her cries by day and night. Within a month Heather was once again thriving.

We believe every baby has a critical level of need for touch and nurturing in order to thrive. (Thriving means not just getting bigger, but growing to one’s potential, physically and emotionally.) We believe that babies have the ability to teach their parents what level of parenting they need. It’s up to the parents to listen, and it’s up to professionals to support the parents’ confidence and not undermine it by advising a more distant style of parenting, such as “let your baby cry it out” or “you’ve got to put him down more.” Only the baby knows his or her level of need; and the parents are the ones that are best able to read their baby’s language.

Babies who are “trained” not to express their needs may appear to be docile, compliant, or “good” babies. Yet these babies could be depressed babies who are shutting down the expression of their needs, and they may become children who don’t ever speak up to get their needs met and eventually become the highest-need adults.

should you ever let baby cry? (#ulink_cd9ea9f0-1398-5358-9726-4a86f806580d)

There cannot be a rigid yes or no answer to this question. The mother-infant communication network is too intricate and sensitive to be subjected to dictums from an outsider. But be warned: it is the rare baby who follows the cry-it-out time charts displayed in various baby books over the past hundred years. These charts promise that crying will diminish; for many babies and in many circumstances this is not true. Nevertheless, there are times when you’d like some guidelines on how to hold up your end of the communication network while still giving your baby opportunities to grow toward independence.

The following guidelines are not meant to override your sensitivity. If, when, and how you decide to let your baby or toddler solve his difficulties without you must remain a parental cry-by-cry judgement.

Here are some suggestions to help you decide how quickly you need to respond to cries:

1. Listen to yourself. Listen to your own inner sensitivity as to whether any part of the cry-it-out approach is right for you, right for your baby, right for your baby’s stage of development, or right for your individual family circumstances – regardless of the norms of your friends.

2. Consider the depth of your attachment with your baby. If you practise the overall style of attachment parenting, are a high-touch, high-response parent, and have a healthy trust relationship with your baby, then you can become more restrained in your cry response without damaging that trust as baby grows older. In fact, your knowledge of your baby will help you here. You’ll know which cries need an immediate response and which ones are the sounds of your baby working things out on her own. You’ll respond instantly to the cry of a ten-day-old baby, be able to discern what’s wrong when a ten-week-old cries, while still responding quickly, and when a ten-month-old cries, your discernment may lead you to delay your response for a few minutes.

3. Use baby as the barometer. Don’t lock yourself into a set number of minutes or nights that you will delay your response to your baby’s cry. Let baby’s overall behaviour influence your decision as to whether or not your response time is right for you and your baby. Don’t persist with a bad experiment.

4. Consider your baby’s temperament. Easier-temperament babies are more likely to resettle without your help. The intensity of their cries gradually winds down as they learn to self-soothe. Not so the high-need baby, whose cries continue to escalate.

5. Analyse whether you are reinforcing baby’s cry. The closer you and your baby are, the more you may, without realizing it, be giving your baby a message that “you need to cry”. Mothers mirror emotions to their babies. If you are anxious, baby perceives that there really is something to cry about. I see this often in my paediatric practice. Parents new to our practice bring their infant into the surgery for a check-up. Seeing a stranger, baby begins to fuss and clings to mum. This makes mum anxious and she clings back to baby, giving baby the message that there really is something to be afraid about. Let’s replay this scenario. Suppose this mother puts on her best everything’s-okay face, giving baby the message that she is calm and in control. Then, if baby fusses, she continues her, “it’s okay” body language, while at the same time reassuring baby with a cool “it’s no big deal” attitude. A certain amount of anxiety is appropriate in strange situations, but it’s up to mum to model the calm behaviour she wants her baby to learn. I have noticed that first-time parents sometimes panic at their baby’s cries and jump every time their baby makes a peep. Veteran parents, on the other hand, are better able to distinguish “biggies”, those cries needing prompt attention, from “smallies”, those triggered by something baby can handle with little or no help, or they have learned to meet baby’s needs before baby has to cry. (See related discussions “Don’t Panic!” opposite, and “No Problem”, page 72.)

6. Consider how important your need to let baby self-settle is. One of the most difficult parts of parenting is weighing baby’s needs against your needs, for example, your need for sleep versus baby’s need to be comforted. Signals that your parental balance system needs adjustments include these: You are not enjoying motherhood; you are having second thoughts about the style of parenting you are doing; you are becoming a tired and cranky mother, and the whole family is suffering. One of the principles that we have found helpful in our own family and in counselling other mothers who are burning out is this one:

if you resent it, change it

If you are beginning to resent your style of parenting and your constant baby tending and are feeling at the mercy of your baby’s cries, take this as a signal that you need to make a change somewhere in your cry-response system. This is more easily said than done and may not necessarily mean that crying it out is the solution. In the following section and in the chapters to come we will help you find ways to meet both your needs and those of your baby and provide sensitive practical alternatives.

don’t panic!

Patricia, a new mother of a high-need baby, was a psychologist specializing in child development. Because clients with low self-esteem had consumed her counselling days, she was determined that she would bring up her child to have healthy self-esteem. She understood the value of giving a nurturant response to her baby’s cries. But baby Christopher didn’t just cry, he shrieked. Within the first millisecond of Christopher’s shriek, Patricia would jump up, a tense mother with a worried face, inadvertently increasing his tension and sending him into an all-out fit that could have been avoided.

Martha watched this behaviour unfold one day when Patricia was over for a visit. Patricia had come over for Martha’s advice because she couldn’t get Christopher to go into the sling. Each time she tried, Christopher would shriek, and Patricia would panic and quickly end the lesson by grabbing her baby out of the sling and calming him. Martha showed Patricia several ways of positioning Christopher in the sling, and, sure enough, each position was unpopular with Christopher. Patricia would visibly tense up and look worried until Martha suggested another position. Finally, Martha figured out which position worked best for the two of them, and then, although Christopher was beginning to fret, Martha calmly said, “Now let’s go for a walk around the block.” This had two results. Christopher started to relax as Patricia started moving, and Patricia took her mind off the baby for a few minutes.

Martha and Patricia chatted as they walked, and Christopher became more and more relaxed. Soon Patricia was sensing that Christopher was actually enjoying the sling, and they both relaxed even more, so much so that the baby fell asleep. Patricia learned that she could mirror relaxation to her baby by staying calm and walking onward despite the fussing. Christopher needed his mother to set the mood and allow him enough time to follow suit. Patricia discovered that without much effort her baby would catch mum’s mood, and they could relax together.

Don’t let yourself panic at baby’s first squeak. This overreaction relays the message to baby that there really is something to fuss about, and he will usually oblige. For some babies, the quick response will ward off a hysterical cry; for others, it stimulates it. This is why you have to play each cry by ear. As soon as your baby starts to fuss, put on a relaxed “it’s okay” expression as you calmly tend to him. With a baby of four or five months, you can delay your response a minute or so, depending on the time of day and the situation, to see if baby discovers on his own that there is nothing to fuss about. Throughout the day, each episode will need an individual response. I notice a difference between many first-time mothers, who get easily panicked by the first whimper and are hyper-responsive, and seasoned veterans, who take a more relaxed, but still nurturant, approach to responding to baby’s crying.

Giving the right response for each situation is part of being mature as a parent. And guess what? You don’t always have to get it right. Babies are forgiving, and they seem to appreciate that at least you are trying. It’s not your fault that your baby cries; nor is it always your responsibility to keep baby from crying. Your job is to set the conditions to lessen baby’s need to cry and to offer a nurturant response when baby does need to cry. The rest is up to baby.

mellowing baby’s cries (#ulink_66230673-e080-5fd2-8d1b-c4600057d63f)

All babies cry, but some cries are easier to tolerate and respond to than others. Here are some practical things you can do with your baby to mellow her cries from mind-shattering screams to easy-listening communication.

Start early. When I was director of a newborn nursery, I learned a lot from veteran nurses who had spent years coping with crying babies. There wasn’t a sound they hadn’t heard and learned to live with. These nurses used to tag the babies’ temperaments as early as the first day of life: “Jason’s going to be easy”, or “Susannah’s going to be a handful”, or “George’s cry is going to shatter his mother’s nerves.” I realized the importance of mellowing a baby’s cry early on so that it can promote mother-infant attachment instead of mother-infant avoidance.

Baby Charlie was the second-born child of an easygoing and nurturing mother. During her pregnancy Janine would tell me, “I can tell this baby’s going to be a challenge by the way he kicks. He’s been a tummy-pounder and a bladder-thumper all during my pregnancy.” Her prediction came true. Charlie came out crying, and kept crying. He announced to the world that his was a voice to be reckoned with. Even during that magnificent passage from obstetrician’s hands to mother’s breasts Charlie let out a shriek that startled the obstetrician so much that Janine feared he would drop him. While most newborn’s cries evoke a sympathetic and tender feeling in the listener, Charlie’s did not. His cries were so shrill, they made everyone want to plug their ears and run. Charlie’s cries soon cleared the birth room.

Janine, an otherwise unflappable mother, cringed when her baby shrieked. The nursery nurses couldn’t stand Charlie’s quickly escalating cries, so at the first shriek they would immediately shuttle him out to his mother (which was good for Charlie, who wanted to be with his mother).