The Super Bowl "Shut Down"

Hail Marys, open-field blocks, scrambling...these are all terms we've been hearing this week during the Super Bowl frenzy. But, today I hear about another important activity seen (though maybe not acknowledged) around the TV sets of America: "The Super Bowl Shut Down."

That's how a sensitive, attentive mom describes her baby's activities on Sunday.

Ahmad is a full-term, healthy baby boy. He is blessed with the love and attention of his mother and a caring community of friends and family. And, Sunday he attends his first Super Bowl game. Instead of wings, beer and brauts he feasts on mother's milk.

Though this two-week-old has periods of alertness when he looks intently at his mother's face, follows his auntie's voice, and relaxes into his neighbor's gentle hands, this little one seems at first "bored" with the world of football. After short nursing spurts, he slumbers into a "gone from the world" sleep and is finally placed in his Pack 'n' Play beside the TV.

"But, I've watched your HUG DVD," Mom reports, "so I didn't worry a bit! I could tell that all the excitement and commotion of our neighbor's family room was just causing him to 'Shut Down.'"

Mom goes on to explain that the baby rested well during the entire game then woke up for another feed and alert time with Mom when they got home. She reflects on how satisfying it was to see her baby "manage" the exuberant stimulation around him by "Shutting Down." She recognizes this ability as a sign of his physical skills, his budding competence. "If I hadn't seen the DVD I might have worried that something's wrong. Maybe he can't hear? Maybe he is fragile? Or, (worst yet) maybe he doesn't like football!"

Mom and I decide that Ahmad has just invented one of the newest, and coolest, football moves: "The Super Bowl Shut Down". He's a superstar already!

© HUG Your Baby 2020

"I LOVE, but do not LIKE, my Baby"

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.

"Sleeping like a baby - or not!"

As Julie walks in for her newborn's two-week-old visit, she declares, "I've had it!"

"I'm quitting breastfeeding. I'm exhausted. I nurse little Taylor and put her down to nap. Forty-five minutes later she starts to squirm around. She smacks her lips, her eyes flash open, and she whimpers. I figure she's ready to eat again, so I get her to the breast. But she immediately falls asleep. It takes me (and my husband!) another hour to wake her up to eat. Then it starts all over again. I know breastfeeding is best for the baby and me, but maybe I need to quit!"

I am delighted that Julie is telling me this story before she stops breastfeeding. Hers is a problem I can solve by sharing just a little more information.

Julie is confusing her baby's "light/active sleep" and her baby's waking "zone."  All babies have two sleep cycles. Deep/still sleep is easily recognized as a baby fast alseep: She is totally still, her breathing is deep and regular, her eyes stay shut and still under the eyelids, and she doesn't make any noises. That's the kind of sleep people refer to when they say, "She's sleeping like a baby!"

Light/active sleep (often called Rapid Eye Movement, or REM sleep) looks very different. In light/active sleep the baby will stir, jerk his arm or leg, breathe more rapidly, flash his eyes open a moment, make sucking movements with his mouth, and grunt or make other newborn sounds. Such a baby seems like he's waking up, but, in fact, he is still asleep. All babies cycle between these two sleep zones a number of times during the night.

Julie is relieved. She returns for a weight check the following week with a big smile on her face. She reports learning to recognize her baby's light/active sleep. When Taylor gets to that Zone, she leaves her alone and in a few minutes the baby goes back to deep/still sleep. Mom gets to sleep another hour or two. When Taylor is hungry, she transitions from that light/active sleep to waking up. After she fusses for a minute or so, Julie knows that now she's really ready to eat.  This mother's breastfeeding is going great now. She has been eager to share this information with other young moms and, now the whole neighborhood is sleeping better!

© HUG Your Baby 2020

Why Does My Baby Cry So Much?

“Ayesha doesn't like my breast milk!" the young mother declares. "I guess it's time for formula."

Ayesha was born two weeks early, after a long labor and an epidural. The baby's initial suck was a bit unorganized. In addition, her bilirubin was elevated, and she had jaundice for a couple of days. Though she ended up with a few bottles of formula in the hospital, the baby was breastfeeding at discharge.

But today the mother's words are a surprise to the nurse at the community clinic. Exclusively breast-fed, four-week-old Ayesha had regained her birth weight in just ten days and is now growing at an amazing, one ounce-per-day. The nurse sees the baby's cheeks filling out, and she is "filling" her diapers with gusto. Why is this mother thinking that her breastfeeding is going poorly?

"She just doesn't seem satisfied," Ayesha's mother explains. After a deep sigh, this young mother adds, “She seems to be crying much more now than she did last week.”

The young mother lifts Ayesha out of her car seat. Ayesha has a startle and moves quickly from the peaceful, Ready Zone, to crying intently. This mother pats her baby's head, jiggles her on her shoulder, stands up and walks around the room, and talks to her baby in an energetic (if somewhat anxious) voice. 

Research on breastfeeding demonstrate that this mother's feelings are common: Mothers often notice non-feeding behaviors and worry that these are signs of inadequate milk. In addition, mothers who cannot manage their infants' crying are less likely to continue breastfeeding and more likely to develop postpartum depression.  

The nurse remembers that babies born early increase their crying at just this age. She also considers that this baby has risk factors for Zone regulation issues, which could make her a baby who fusses more than many. Perhaps a stepwise approach to calming this baby will help Mother both settle the baby and appreciate her daughter's capabilities. 

"Let's see how your baby responds to your voice," the nurse remarks. "Many babies like that sing-song voice you were just using." 

With some encouragement the mother leans over the baby and repeats several times, "Hey little one! I see you are trying to calm down." The nurse then encourages the mother to bring the baby's arms to her chest while continuing that sing-song voice. Next the nurse shows mother how to sway the baby. Almost like magic, Ayesha takes a big breath and stops crying. 

The nurse describes the behavior she now witnesses. “Though Ayesha needs your help right now, she looks so content in your arms. When you talk to your baby her forehead relaxes, her eyes widen, and her eyebrows go up.” A moment later she goes on, “When you speak, Ayesha lifts her face toward yours and slows down her breathing.” 

At the end of her visit with this family, the nurse encourages the young mother to call her baby's name. When she hears her mother’s voice, the baby initially gets still; then her eyes shift up toward her mother. The mother is delighted to see her daughter's eyes “lock” in an endearing gaze. With a big grin Ayesha's mom lifts her from the nurse's hands and snuggles her face into the baby's soft head. One of the mother's hands go to her breast to suppress the unexpected let-down of milk. 



Three months later, Ayesha's mom is a breastfeeding star and a support for other new moms. One afternoon she comes to the nurse's breastfeeding class to discuss the challenges and joys of breastfeeding. Cuddling with her baby, she remarks, "Don't just count those pees and poops. Learn about the amazing abilities of your newborn, and you'll know for sure that your breastmilk is perfect!" 

© HUG Your Baby 2020

"I'll play with my baby when he can play ball," the new dad says.

That's what Jerry, the husband of 28 year-old Elizabeth, said one afternoon at their first pre-natal visit. "All the baby does is eat and sleep that first year anyway, " Jerry explains.

Jerry is not alone in this view of a newborn. A study by Zero-to-Three asked new parents "at what age do you think babies can 'take in the world?" 61% of parents thought that a baby needed to be two- to three-months-old to notice the world around them.

The real truth is good news for you, Jerry (and for Elizabeth too!). Most babies can "play ball" (and actively engage in the world around them) as the tiniest of newborns. But parents need to notice a baby's special ways of approaching this ball game. (HUG Parent video)

Now, at the young family's first post-natal check-up, Jerry holds his newborn, Joey, and gazes intently into his eyes. I almost have to pry little Joey from his daddy's arms. In addition to the routine physical exam, I always love to take time to help parents appreciate some of the amazing capabilities of their baby.

As I hold Joey in front of me his eyes fix on mine. I slowly tilt my head to the side; Joey's eyes follow. As I move a bit more to the left, his eyes drop from my gaze. I hesitate a moment, and then he engages with me again. I'm not worried when I see his eyes jerk a bit as they move. (It will be a few weeks before they move continuously like grown-up's eyes.) "Wow!" Jerry says. "He can really pay attention!"

Then I pick up my little red ball. Joey stares at the ball differently than when he looked at my face It is normal for many babies to be more interested in a face, initially, than in an object. But I just jiggle the ball a second and Joey's eyes start to follow it as I slowly move it. When Joey starts to wiggle around, and his breathing increases, I recognize an SOS (Sign of Over-Stimulation). I hold his little hands gently against his chest, and his eyes immediately look intently at the ball again. Now he follows its movement from one side to the other.

"Yep! Like I thought," Jerry declares to all. "He's a star ball player already! It's my turn to play ball with him now!"

© HUG Your Baby 2020

"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.
http://nbci.ca/index.php?option=com_content&view=category&layout=blog&id=6&Itemid=13

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