I was rather shocked by the perspective of the young mother referred by my colleague, Gale. "Gale thought you could help me out," the young woman explains.
Lizzie was Samantha and Sarah's second baby. She was healthy and full-term. Labor and delivery had gone well, breastfeeding was successful, and Samantha had two months of maternity leave. "What could be that wrong?" I wonder.
"She fusses all the time!" Samantha explains as she lays the baby on the exam table. "See, like now! Hear her making all those grumpy sounds! I love, but sometimes, do not like my baby."
Lizzie is a robust, wide-eyed six-week-old. She is very busy in her movements as she wiggles and squirms on the exam table. Her level of activity is a wonder to behold. She seems to wind up a second, then one arm shoots out to the side, both legs kick upward, and she arches her back. She is also very busy with her vocalizing—a grunt here, a groan there, or was that a coo? The activity and sounds coming from her cute little body are normal and even entertaining to me. But her activity level and vocalizing seem to be off-putting to her mothers, who thinks Lizzie is fussing all the time.
"See Jessie there," Sarah says as she points to her four-year-old daughter coloring peacefully on the floor at our feet. "She is so calm and easy to be around. When Samantha and I decided to have a family we promised each other that we would have a peaceful household! But Lizzie just keeps on fussing," Sarah remarks as she hands me her baby.
Samantha and Sarah are describing a temperament difference in their children. The work by Thomas and Chess in the mid and late 1950's was important in confirming what all grandmas know: babies are born different one from another! Some are quiet and laid back, while another is busy and rather demanding. One is predictable while another is a surprise every minute. And a parent's own temperament makes it easier to "hang" with one kind of child than another. Certainly issues in a parent's own upbringing also impact their ease (or not) with a certain style or temperament. If a parent misunderstands a child's temperament or intention, problems in the developing parent-child relationship can begin and escalate.
What an opportunity and a challenge this moment is! Can I help this mother see her second daughter through a different lens? As usual, when I feel challenged by a patient encounter, I focus on and begin to describe the behavior of the baby. I demonstrate Lizzie's normal reflexes and get excited when she brings her hand to her mouth and begins to calm down. I pick up the end of my red stethoscope and engage the baby in a little game of following its movement with her eyes. Of course, I finish with the grand finale of having Samantha call out the baby's name. Lizzie hesitates only a moment before she turns toward her mother and—I believe she actually gives her a wink!
Samantha giggles and scoops up the baby from my arms as I discuss this high, but normal, level of activity and vocalizing. We talk about how each baby has a special temperament and style, right from birth. "Her body activity and enjoyment of vocalizing are part of Lizzie's inborn personality," I explain. Both Samantha and Sarah smile as Samantha gives Lizzie a hug. “I guess she’s just a real go-getter,” Sarah responds.
Lizzie is three years old now. Every time she and her family come to the clinic to see Gale, they stop by and say hello to me. "Lizzie's not really fussy anymore," Samantha explains. "But she's still a busy and noisy little gal!" Lizzie runs down the hall ahead of her mom, who laughs out loud as sister Jessie squeals in pursuit.