For Parents

Turn Worries into Wisdom!

"Is my baby getting enough milk?"

Every mother wonders at some time, "Is my baby getting enough milk?" We often advise mother to "just watch the baby," but what are these mothers supposed to be watching for?

Two important things to watch include baby's output and weight gain. I find it helpful to use the following visual when discussing the output. A baby would be expected to have one stool on Day One, two on Day Two, three on Day Three, four on Day Four, five on Day Five, and six on Day Six. Six stools a day would continue until about four to six weeks when the breast milk composition changes to more casein and less whey protein. After that, stools decrease, to once a day, every few days, or even less often.

Second, a mother will be instructed to watch for weight gain. We expect a gain of one ounce a day once baby regains birth weight by ten to fourteen days.

Dr. Jack Newman offers use a helpful way to see if a baby is nibbling (taking in little milk) or drinking (getting needed calories.) Watch these videos and notice how the movement of the chin, and the pauses between "drinks," is the key to this observation.

Tug-of War Between Mom and Dad

Eight-day-old Tabitha is calm when the doula first arrives for her home visit.  But as her mother undress her for her morning bath, the baby starts to rev up. At first her hands shake, then her chin trembles and her face gets red. Her face now "clouds over" as she stares out into space. (See SOS "Sign of Over-Stimulation.) As mother continues with undressing her, the baby starts to cry.

Mother hesitates a moment then leans over Tabitha and softly call out her name. "Tabitha can you calm yourself down?" The baby clearly hesitates a moment when she hears mother's voice but then starts to cry again.  At that moment her father scoops the baby up in his arms and rocks her up and down with a bit more zest than would her mother. The young mother face saddens and she looks a bit defeated watching her husband handle their fussy baby.

Though the doula was prepared to discuss a baby's sleep states and newborn "Zones", she decides instead to try out that first HUG Strategy, "Start here, not There." 

Noticing that the baby is now settled in father's arms and that both mother and father seem more relaxed, the doula goes on to discuss a normal tug-of-war that can develop between caring parents.

"Parents are often surprised by the difference in approaches of a father and a mother. Some parents even confess to feeling competitive during the first few days of their baby's life," the doula says.

Hearing these words causes both mother and father to brightened up. Dad explains, "Sometime I wonder, which one of us can get to her first and settle her down the fastest!"

The doula goes on to describe the current literature on new parenthood and competition. This literature suggest that this competition is normal and, in fact, can fuel the attachment process of a parent to his/her child. However, if these feelings are not understood and appreciated for what they contribute to the developing parent-child relationship, such competition can undermine the parent's relationship with one another.

Dad jokingly "complains" that "Mom has the breast which always trump what I can do!" But Mom quickly adds that "Dad can swaddle and comfort Tabitha like nobody else!"

This young father shares that he had been worried about this feeling of competition with his wife. "It had never occurred to me that this little competition is part of growing as parents" With a big sigh, mother adds that she, too, "is relieved to know that this tension is normal and proof that they are both working hard at being a good parent!"

How lucky is any newborn whose parents finds themselves in this loving tug-of-war, a small skirmish that helps new mothers and fathers be the best parent they can each be! (Click here for another story on mothers and fathers different styles.) And, how fortunate that this doula choose to "Start Here, not There" initially addressing the parent's agenda rather than her own.

© HUG Your Baby 2016

What's a "Lovie"?

Baby cuddles up with her "Lovie"
The HUG Your Baby's Roadmap to Breastfeeding Success (now available in English, Korean, Japanese, Italian and Spanish) makes mention of “using a ‘lovie’” at nine months and at twelve months to help babies through the developmental challenges of those time periods. (See Roadmap at bottom of blog).

Use of a “lovie” may have cultural roots in countries like the USA, where maternity leave is minimal, availability of extended families is limited, and returning to work is necessary for most young mothers who have bills to pay. However, this practice is grounded in well-established child development theories and is offered as one possible “tool” for mothers wanting to extend breastfeeding duration. (Additional critical steps to achieving the international goals for exclusive breastfeeding are reviewed in other HUG Your Baby blogs.)

Child development literature is conclusive that babies must have attentive, responsive care from family during the first year of life so that the rapidly growing brain develops to its full potential, laying the foundation for lifelong, healthy emotional attachment and psychological growth. Learning to read a baby’s feeding cues, to notice early signs of over-stimulationto respond toinfant crying, and to appreciate a baby’s active and deep sleep cycles are all important tasks of sensitive parents who seek optimal parent-child attachment and want the best for their child.
As a securely attached baby approaches his first birthday, a parent will begin to see proof of her baby’s important mental development. A mother might notice her baby glance over to her or her partner when a neighbor picks up the baby—a behavior that displays an important cognitive achievement called “social referencing.” As months go by, “stranger anxiety” (also known as “separation anxiety”) replaces the more “polite” social referencing. This baby now clearly knows that “those people are my parents” but “you are not!”

By nine months the baby initiates games that reflect a new surge in her mental capacities. She squeals with delight when she drops a spoon and sees Mom retrieve it. She laughs uncontrollably when her brother plays “hide and seek,” or she giggles triumphantly when her father plays “peek-a-boo.” These games demonstrate the baby’s cognitive growth toward “object permanence”: the concept that “things that go away can come back.” This developing object permanence also contributes to increased stranger and separation anxiety.

The work of Dr. T. Berry Brazelton helps us understand that a surge in a baby’s cognitive, social or physical development typically causes temporary changes in a baby’s eating, sleeping or general behavior. (CLICK HERE to learn more about his theory of Touchpoints). Suddenly the world seems bigger to the young child, and thus, momentarily, a bit more frightening too.
The nine-month-old who had been sleeping through the night may now wake up more often and cry for her parents. Parents who do not know about, and anticipate, this normal change in development might believe the baby is hungry. If babies have been sleeping five to eight hours at night without eating, they do not now need more nighttime calories. Nevertheless, formula-feeding mothers might give a new nighttime bottle and breastfeeding mothers might resume more frequent nighttime breastfeeding.

Adding nighttime bottles and calories to the diet of a formula-fed baby can contribute to overfeeding and obesity. Though it is believed that breastfed babies[i] will not overeat, they may temporarily shift daytime calories to the nighttime if increased nighttime breastfeeding is offered.
Although giving more calories at night is not necessary, some mothers prefer to use breastfeeding to comfort her child. Certainly, breastfeeding is a source of both nourishment and nurture for every child. However, other breastfeeding mothers may be exhausted by the return of frequent nighttime awakenings, may worry that they now have insufficient milk, and may even consider weaning. 
This is when the “lovie” can be useful.

Parents can incorporate a small blanket or stuffed animal (i.e., a “lovie,” or "transitional object" in the professional jargon) into their cuddles with the baby throughout the day. Within a few days the baby will associate the closeness she feels with her parents with this sweet “lovie.” Then, when the baby needs her parents at night, the mother or father can comfort the child without feeding him by cuddling him up with his “lovie.” After a week or so of more frequent night time awakenings, most children become accustomed to the world of “object permanence” and resume their regular sleep patterns.

The next important Touchpoint, or developmental step, occurs when a baby begins learning to walk (at around one year of age). Babies this age again show disruption in their eating, sleeping or general behavior as they strive to become upright! The “lovie” can be used again to help comfort this child back to sleep without adding nighttime feeds. Of course, increased nighttime breastfeeding (as a comforting technique) may be the best option for some, but not all, mothers.

Parents who have chosen to add more nighttime feeds or breastfeeding might wonder how to get back to a regular, daytime eating pattern. Every few days a formula-feeding mother can cut in half the amount of formula in each bottle and incorporate the “lovie” into the nighttime feeding routine. A breastfeeding mother can cut in half the duration of each nighttime feed, as well as use the “lovie.” Usually, within a week or so, the baby will no longer require extra calories at night.  And after the developmental surges of separation anxiety and learning to walk have passed, the baby can continue to use the “lovie” to help him return to a good night’s sleep.
The HUG Your Baby Roadmap to Breastfeeding Success suggests, "Incorporate 'Lovie'" into breastfeeding routines at nine and twelve months.

[i] Recent research suggests that babies fed pumped breast milk mostly by bottles may run the same risks of overeating and obesity that apply to formula-fed babies.

Calming the Baby, Not JUST the Breast

Breastfeeding is magical for many reasons! It saves babies lives, it protects mother from serious illnesses, it saves families money and it enhances bonding and mother-child interaction. But . . . sometimes babies need something MORE than the breast.

 This statement is considered controversial, if not hieracy, to the lactation world where professionals (rightly) claim that breastfeeding provides the best nourishment and the best nurturing. But, I have additional experience with mothers who are stressed with the fact that their babies only calms down when on the breast. Could this behavior indicate a potential problem with self-regulation? Can we help active, energetic babies learn other ways to calm down and will this help encourage mothers to keep breastfeeding? I think so.

 Consider Romono, a thriving, robust, active 6 month-old. I meet him when 3 weeks old when even then his parents could see that sucking was his only way to settle down.  Now Romono is six months old and is always on the go! He babbles consonants, rolls over with great zest and is beginning contralateral movement - the first step to learning to crawl. He  is distracted during breastfeeding as he constantly seeks to explore and engage with the world around him. And, now he is up 8 times at night! (See paragraph below on why this baby is awake so much at night.) He can only nap when in his Mobi and mom (and his nanny) dare not move once he goes to sleep. Though mom is dedicated to breastfeeding, this behavior is exhausting and worrisome to her.

Today we explored and practiced ways to enhance Romono's ability to contribute to settling himself. When he showed tired signs, Mom put the baby to the breast.  Though she usually nursed the baby down to deep sleep, today she took him off the breast when he started flutter nursing. She held him securely a few minutes then put him on the bed. He initially wiggled and vocalized but mother used her voice to "shoosh" the baby and held his hands to his mouth so he could suck his finger. After a bit he settle down but moved to an alert, contented state. After about 10 minutes of contented self play (exploring hands, bringing hands and toe to mouth, babbling) he began to fuss a bit. Mom assumed he "was hungry again" and was ready to put him back to the breast. But with encouragement, she returned to the comforting activities just practiced. The baby immediately calmed again without needing the breast. The plan is to practice these calming behaviors when putting down at night, add a lovey to the settling process and see is comforting without additional breastfeeding will help with nighttime awakenings. (Click here for more information on use of a lovie.) More frequent awakenings: See previous blogs on Touchpoints - a surge in a baby's developmental which causes a temporary disruption in eating, sleeping or general behavior. If breastfeeding mothers do not understand and anticipate these changes, they will add more frequent nursing at night.

"Help! My baby is crying more!"

(Sample E-newsletter from The Roadmap to Breastfeeding Success lactation support program.)

Huge tears rolling down Maria’s face say it all. “Anna cries all the time, and so do I!” this young mother tells her husband. As if on cue, Anna seems to wind up for a big one. Her face gets red, her hands start to tremble, and her legs stiffen. Though Maria knew that all babies cry, she never imagined how overwhelmed she would feel when her tiny newborn enters the fussing/crying, "Rebooting Zone."

Maria's husband comments, "That baby must be hungry!" And, though Maria has been committed to breastfeeding she now wonders if her baby might need a little formula. Surely a bottle or two a day of that expensive "gas-free" formula would help her crying baby.
But, Maria vaguely remembers that the birth center's lactation consultant (LC) had mentioned something about extra crying spells during their prenatal breastfeeding class. Didn't that "Roadmap" handout say something about crying? Maria shuffles through some papers beside the couch. Yes, it  says to "anticipate increased crying" at two weeks. Maria decides to get a bit more advice before buying even one can of formula. 
"I'm desperate! Just tell me what TO DO!" Maria asks the LC when she and her husband arrive at the clinic the next day.

The Science: "Just Tell Me What T.O. DO!"
Most normal, healthy babies begin to cry more around forty-two weeks gestation, or two weeks after birth (if the baby was born full-term). Babies typically move from crying two hours a day to crying three hours a day by six weeks of age. Then their crying tapers to about one hour a day by twelve weeks of age.
The LC shares with Maria some easy-to-remember tips she just learned:  Talk to your baby. Lean over and use a persistent, sing-songy voice close to her ear. Give your baby a few seconds to notice and respond to your voice. 
– Observe your baby's efforts to contribute to his own calming. Many parents are surprised to learn that babies have instinctive behaviors that help them calm down. She might bring her hand to her mouth (perhaps with your help) and suck her finger or thumb. Or she may make sucking movements and start to quiet. 
Another baby may look like she’s taking up sword fighting (the fencing reflex): Her head turns to the side, one arm and one leg extend, while the other arm and leg flex. This instinctive maneuver helps some babies start to calm. Finally, some babies use behavioral SOSs (Signs of Over-Stimulation) to turn off the excessive stimulation around them. The baby may stare into space or appear drowsy and then begin to settle. 
DO – If the baby is still crying, a parent's help is needed. Hold her arms against her chest and continue that quiet, persistent talking. Encourage the baby to suck your finger or the breast, or swaddle her safely. Techniques for safe swaddling include:
  1. Bend the knees upward and rotate them outward to protect the hips. (Here is the International Hip Dysplasia Institutes's link to safe swaddling.)
  2. Do not swaddle tightly, or for long periods of time.
  3. Monitor the baby's temperature to avoid over-heating.
  4. Never put a swaddled (or un-swaddled) baby to sleep on his stomach.
  5. Stop swaddling baby once she can roll over (at about 3-4 months old).
If parents take these actions, one step at a time, mothers and fathers will soon discover what is most comforting to their baby. 
Click here to watch a music video of a father using skills he learned to comfort his crying baby.
An "Ah-Ha" Moment for these Young Parents
When little Anna starts to cry at her clinic visit the next morning, the LC leans over the baby and speaks quietly into her ear. Anna looks surprised but continues to cry. She smacks her lips a moment and then quiets right down when the LC holds her tiny but strong arms securely against her chest. 
Maria and her husband can’t believe their eyes (or ears!). Anna's father gently holds his baby's hands in this comforting position and sees his now peaceful baby look right up into his eyes. Maria then brings the baby to the breast for a good feed before their ride home. “We are a good team,” she tells the LC. “We’ll work this out togetherand without any formula!"

© HUG Your Baby 2015

"Touchpoint" in Everyday Life

As I enter the room Keema, Katherine's energetic eleven month old, is standing beside mom's chair. As I walk into the room Keema momentarily turns toward and glances at her mom before reaching a cubby hand in my direction. She takes two wobbly steps toward the exam table where she then goes on about her business of exploring the chair, nearby drawer, and rolling stool. I seem to bore her right now.

 Mom looks tired as she leans over, picks up and undresses her daughter to show me her summer-time diaper rash. Keema twist and squirms on the table communicating quite clearly that she was not done with her investigation of the room and her practice walking. The diaper rash is easy to care for. Hearing and responding to mom's concern about her daughter's behavior is more challenging. Katherine describes a long weekend in Richmond at her favorite family reunion. She explains that her family reunions get bigger every year as sisters, cousins, and neices become new moms.

Last year Keema had gone as a newborn and mom had enjoyed the extra attention she and the baby has gotten as well as the special rest she had received in this community of loved ones. This vacation was different. Keema would go to bed as usual, then cry 2-3 times at night (somthing all family members did not appreciate!) Mom would find her standing in her crib "looking like she was really mad 'cause she couldn't figure out how to lay back down." Katherine has already appreciated that her girl was "strong willed and has a mind of her own."

 But Katherine explains that her daughter seemed more out of sorts this past week and did not call forth the same adoration for family members as mom had experienced the year before. "This reunion seems more like 'work' than 'vacation' and I'm just plain worn out." This is a Touchpoints moment and an opportunity for me to connect significantly with this mom .

 As I watch Keema toddle around the room I reflect on her activity. "She has that wide-based gait of a new walker and hold her arms rather stifly in order to keep her balance. She almost lunges from one hand hold to the next and doesn't mind a few tumbles to the floor, " I say. Mom gigles at all the details of this newest milestone and perks up quickly as I go own to explain the concept of how a develpments surge like this almost always impacts a child sleep for a week or two. We discussed how mom could help her practice getting back down from standing during the day so her girl would not be so frustrated at night.

In addition we discussed that "A, B, C" (Attention that is Boring AND Caring") approach to night-time parenting of the toddler. Mom laughs and rubs her baby's curly head. I can just imagine how this new information will play out at nest Sunday's mom-to-mom family bruch. This young mom will be the newest "expert" as she shares how these temporary "ups and downs" at night are just proof of her child's normal and dynamic development.

Understanding en Responding to a "Touchpoint" (Part II)

See Touchpoints (Part I) for the story of Martha and her nine-month-old, Molly, who is up many times at night, refusing her morning cereal, and grumpy and crying at childcare. I had time to speak with Martha about the normal Touchpoints which occur during the first two years of a baby's life. Specifically, we discussed the "Separation (or Stranger) Anxiety" (as described by Piaget) that was plaguing Molly's (and Martha's) life right now.

Once Martha understood that Molly's behavior actually represented important growth in her baby's development, Martha seemed to relax. "But, are there things I can do to help both of us out?" Martha asked. And YES! there are. Molly needs comforting as she passes through this phase of life, and Martha wants to respond lovingly but without creating new nighttime "habits."

So Martha is keen on learning how to "wean" Molly from how much of you she needs at night! When Molly cries the next night, Martha goes to her quickly, picks her up, but does not nurse her. She pats her back, speakes lovingly to her, and rocks her back to sleep.

The following night Martha responds to the baby's cries quickly once again, but this time does not pick her up. Instead, Martha gently pats the baby's back and speaks quietly and reassuringly into Molly's ear. Molly calms down and returns to sleep. The next night Martha responds to her daughter again, but this time pats her back but without speaking. Again, Molly calms down and returns to sleep. Two nights later Martha responds to the baby's cry as usual but this time stands sweetly beside the baby's bed. The baby looks up and returns to sleep. The next night, and thereafter, Molly sleeps through the night. Molly and Martha have returned to sleeping at night. In a few more days, Molly enjoys her morning cereal with a smile on her face and no longer cries when left at childcare. Martha is able to go to work with a smile on her face, and not be exhausted and anxious as she does her job. What a wonderful job this duo has done! Molly seems invigorated by a newfound understanding of the world and her mom by a newfound understanding of her daughter.

Martha reads up on that next Touchpoint (which begins when the baby starts to walk, around twelve months) and is determined to meet this challenge with the wisdom and confidence she is learning to have as a parent. Read more on the Touchpoints philosophy and techniques.