Written by Dr. IAN SHELLSHEAR - PAEDIATRICIAN (Permission Granted to be used)
Training Babies to be Happy
A person’s knowledge of newborn babies is mostly dependant on their experience of infants and children, and especially their own experiences as a child.
It is a matter of luck then, as to whether a person has any experience at all in looking after children and babies, and as to the quality of care that person had as a child.
There is usually no shortage of people to give wanted or unwanted advice, and this can cause great confusion.
The baby will probably enjoy any consistent management plan, no matter what it is, because the plan will then be understood. – A BABY IS UNLIKELY TO COPE WELL WITH FREQUENTLY CHANGING MANAGEMENT PLANS.
When a child is born, parents at first may have very little feelings for the baby, especially if it is the first.
The development of feelings depends on
- the way the baby is handled, the health of the baby,
- the health of the mother (or other carers),
- the amount of stress that the people handling the baby, are undergoing.
- If all is well, feelings usually come on quickly (over days).
There are some fairly basic facts about newborn babies that makes getting to know them easier.
1. Newborns are not used to being handled,
of course, so that they are inclined to fuss when they are first handled…being picked up, bathed, dressed, put down etc. If you stop, stroke, try to calm, then the fussing will get worse because the baby senses anxiety. If you stay calm, and continue as though nothing is happening, then the baby will get used to it and cope very quickly.
2. Babies are very sensitive to the mood of the person handling them,
and respond accordingly. It makes a big difference to babies therefore, if parents look after themselves, and minimise tension. The most frequent reason that infants are unsettled at the end of the day is tension. It is normal for the babies of all societies to fuss in the evening, in a pattern that increases up to 4-5 weeks of age, when fussing for up to 2 hours can be quite normal, as the infant learns how to handle that feeling.
There are a number of useful things that can act as tension breakers, and minimise the fussing.
- Mothers need to leave the house every day, and keep in contact with family and friends. Talking to infants is fine for a while, but people need proper conversations about what is happening in the world, to stay sane.
- The infant benefits socially, and by having the immune system charged up, so everyone wins! Going out is something of an effort, but it is well worth it.
- Managing a new baby with or without other children is very tiring, especially after a pregnancy. Mothers benefit by taking a rest each day by themselves, with the phone off the hook, and the door locked. If it is done at the same time every day, then the baby, as well as any other children, will get used to it more easily.
- If one does more stressful tasks in the morning, so that you can slow down in the afternoon, then end of day tension effects are minimized. Add in tension breakers when the baby is in a good mood in the afternoon, like a walk in the park, or a warm bath and massage that further reinforce good feelings.
- When parents get in from work, they still have work tension, and need to relieve it before transferring it to infants or children. A lifelong policy of a parent/s only time at the end of every day for half an hour either on getting in from work, or at that time at the end of any day, reduces tension for the children as well.
Children are not invited to these sessions, but need to be clearly told what they MAY do during this time, and that when you have finished your break that you will play with them. If they try to break into the session, they should be ignored altogether so that it is clear that this is a parent break.
If they then become disruptive, it is reasonable to use time out (without explanation, warning or emotion so that it’s importance is minimized) until you are finished.
Praise those who have respected the break when you are finished.
- Parents (or parent, if doing a solo) should get a baby sitter at least once a fortnight, and go out without the children (no matter how often else you go out with them). The baby has a new social experience, friends and relatives have a chance to admire your child, and parents stay strong by looking after each other.
Children are always happier if parents are content and baby sitting club can reduce expenses.
- Everyone needs a relaxation method, and parenting increases that need!
A parent cannot help feeling stressed, tired, or even angry, but we all have a duty to solve that feeling to prevent transferring those feelings to the baby. This is also the beginning of modeling to our children, how to deal with feelings.
The best strategy is to use an escape route to a place where you can relax. Having a warm shower, ringing a friend, listening to music, doing some yoga, walking around the yard; are all possibilities. If you handle a baby when you feel tense, that tension transfers to the baby, potentially making the baby even more upset and teaching the baby to cry.
If you are out, and the baby is upset, then rest the baby face down along your arm, or across your knee, and relax without stroking the baby.
The idea is to give the body language that everything is OK. As soon as the baby quietens, stroke, and rock the baby to reinforce the feeling of relaxation.
STOP if the baby cries, and RESTART as soon as quiet, until the baby is settled. You are teaching the baby how to relax. Many people put the baby to their shoulder and bang the baby on the back, so that the baby is shouting in their ear. The tension levels rise sharply!!
3. New Babies have a very open mind on the world, and learn by your reactions.
If babies do something, and you react in any way, then a memory is made, and that ‘something’ becomes worthwhile because it works. If the baby is happy and you react, then the baby learns to be happy. If the baby is miserable and you react, then the baby learns to be miserable. The obvious thing to do therefore, is to strongly reinforce happy periods.
There are two important times to work on during the day:
(1) When the baby first stirs coming near a feed time, pick the baby up straight away. This trains the baby to wake happily, provides 10 – 15 minutes of enjoyable play time before wanting to feed, and brings mother and baby to the feed in a relaxed mood. This is obviously a top bonding time!!
(2) When the baby is finished the feed, continue to handle the baby for as long as the baby continues in a good mood. Read to the baby, sing songs, play music, do exercises … any stimulation method will be good. If you are too busy to handle the infant, then use a sling, or place the infant in a baby chair or bean bag where they can watch you.
If the baby becomes unsettled, then put the baby to bed so they can understand clearly that when you put them down, you mean it. It is very hard on babies if their carers give them mixed messages that they cannot understand.
When babies are unsettled and not due a feed, it is usually because they are tense, tired or want to poo. Adults in these phases prefer to be left alone, and babies seem to work better if we give them the time and space to settle themselves when they are the same. If the fussing is unusual, then the important questions after seeing that the baby hasn’t got stuck in the bars of the cot, are:
Got a temperature??
If these are solid then there is not likely to be any important medical condition present (see part 7).
Babies will settle faster if no-one is in the room staring at them; if there is a lot of noise in the background (especially vacuum cleaners, dishwashers and music); and if they are left alone until they ARE asleep! When we feel cranky, we also like to be left alone until we feel ok.
4. Nature has designed the bowel to be a one way organ,
With food, fluid and air entering the top end, and wastes, including air, coming out the bottom! The regular passage of air appears important in the normal function of the bowel at all ages. No animal on earth is to be found shaking its young up and down after a meal, and no tribal society can be found beating up their young (unless they have learnt from westerners).
Infants do not need to be ‘winded’ either!
A normal infant’s bowel should be heard gurgling all the time, and infants noted to be fluffing regularly. Passing air is painless, but infants do carry on about passing bowel actions for the first three months, a procedure often accompanied by much air. Our European ancestors were undoubtedly caught out when they picked up crying infants, who then stopped crying and burped. The actual sequence, of course, is that the infant stops crying because of being picked up (and unfortunately is then taught to cry as an attracting signal), and then burps because they have been crying! In this arrangement the infant cries with increasing frequency (because it works), and therefore burps even more, and is then accused of having ‘wind’ or ‘colic’.
It is probably reasonable to sit the infant up half way through, and again at the end of a feed, for no more than thirty seconds, allowing the infant to burp…if they want to! It can be shown on x-ray that when an infant is hit on the back, it makes infants swallow lots more air, so it is quite likely the infant will burp air they have been make to swallow after a time. Swallowed air only remains in the stomach for a few minutes, then passes on into the bowel, and can only go forward to the bottom end after that. “Wind” sadly, is often used as a cover for real reasons for the baby to be miserable, such as tension, tiredness or constipation (see section7).
5. Babies have a couple of signals that do not mean a lot.
The first is sucking the fist, which is a general signal of comfort, used for tiredness, hunger, thirst, boredom, tension etc. It does not necessarily mean that the baby is hungry. One of the common reasons for sucking the fist is wanting to pass bowels.
The second signal consists of screaming, going blue in the face, sweating all over, beating the sheets, and pulling the knees right up on the chest. This DOES NOT represent a belly pain, but IS a tantrum, and like tantrums of all ages, is best left alone unless it is an unusual behaviour.
Then the same questions need to be asked after checking that the babies head is not caught in the bars….feeding well? Weight gain? Temperature? The usual cause of a tantrum is being tense or overtired, especially after a big day out, but can also be caused having a bit of trouble passing bowels, or if in pain with an ear infection.
6. Feeding Patterns
Babies are highly intelligent creatures, and learn very quickly, provided you are clear in your actions, in order to be understood.
At birth infants are born with an extra store of energy in their liver, which lasts a few days to allow time for the breast milk to come in. Many infants do not feed very well initially, but should settle into a reasonable feeding action after 48 hours. Some babies have difficultly attaching at first, and you may need help from an experienced nurse who knows the tricks.
Infants are capable of adjusting their feeding pattern according to the responses of the parents, so that the only ‘right’ pattern is one in which
- the mother is comfortable, is getting adequate rest and sleep,
- and in which the infant is getting enough food and attention.
Infants have energy and fluid reserves that are sufficient for a few days (not that one would allow that to happen!). This allows considerable flexibility in establishing feeding patterns.
Most babies settle into a roughly 3-4 hourly pattern by day, and longer periods at night. Babies usually feed better if they wake naturally (demand feeding).
Any pattern of day feeding that is comfortable for the mother is obviously good, since the baby will then be sensing relaxed rather than tense feelings. It is nevertheless reasonable to say ‘no’ if the baby wakes too soon eg. After one hour… a time that usually represents a call to pass bowels. Allowing the infant to return to sleep by themselves, usually results in the infant sleeping better between feeds thereafter, provided bowels are operating well.
It has been shown that mothers have reduced post natal depression if they have a reasonable night’s sleep, and of course they are then in a superior mood to give the baby good quality attention by day.
- I recommend that the baby be trained to wait 4 hours between feeds at night by not responding short of that time, so that the baby learns to go back to sleep by themselves when they wake at the wrong time. This learning only takes one or two nights at worst.
- Night feeds should be in the dark, with no talking or eye contact, and the baby put straight back to bed, so that night feeds are likely to stop by 3 months of age. Play time is by day, surrounding feeds, and cannot be overdone while that baby is in a good mood.
Infants feeding properly, will take 95% of available milk from one side in four minutes, so that stopping feeds after thirty minutes is very reasonable, provides good stimulation to produce more milk, and teaches the infant to feed properly.
If the baby does not feed well, but is healthy, then having the baby wait the full time to the next feed, ensures hunger and good feeding.
If the milk supply is failing for any reason, then giving frequent, short day time feeds builds milk quickly (especially if you express after the feed). Night feeds should be kept at over four hours to ensure rested and relaxed mothers, who will have improved letdown.
7. When a baby suddenly changes behaviour for the worse,
then there are a number of checks to be made. If a baby is feeding well, gaining weight, and has no temperature, then the most likely causes are tension, tiredness or bowel malfunction. If the baby has gone longer than usual with bowels, and seems miserable, then giving a hand with prune juice, brown sugar and water, or a commercial preparation like lactulose is safe. The correct does is the dose that is effective!
If the bowels are green, exploding , and burning the bottom, then the mothers diet should be checked. Acidic foods like fresh fruits and green vegetable (especially citrus juice) are most common, but laxatives (chocolate, maternal laxatives, antibiotics), stimulants (coffee, alcohol), and rarely allergens (nut protein, cow milk products, egg, shellfoods, strawberries etc ) may also be a cause. Most babies are not bothered by any of these foods, and diet should only be altered if there is still a problem after more usually causes of tension, and tiredness are dealt with.
8. Normal Newborn events that are of no concern
- Sneezing a lot (lasts about 6 weeks)
- Hiccoughing a lot (especially after the milk comes in)
- Some coughing on waking from sleep, and at the end of feeds
- Snuffling and snorting (usually weeks, but may last a year. May be helped by saline sprays when a cold interferes with feeding)
- Trembling of the jaw and hands
- Grunting, going red in the face with bowels.
Normal breast fed bowels are yellow water with sesame seeds;
Bottle fed motions vary from green to yellow to brown, and are usually toothpaste like.
- Small white spots, initially on the nose, but spreading to the cheeks in later weeks. They may become zits between 4 to 8 weeks.
- Red spots with white centres, like insect bites, that come and go for the first 2-3 weeks. (Urticaria Neonatorum … no treatment needed)
- Red patches in the middle of the wet nappy. Not blood, but a byproduct of body building. It usually has a slightly orange tinge.
- A prominent lump at the end of the breast bone (‘xiphisternum’…normal)
- Swellings in the breast tissue of boys or girls, and even the production of milk. This resolves over weeks. It should not become hot with spreading redness.
- The eyes crossing on and off. This should stop by 6 months. They should not be crossed all the time, and the eyes should not flicker.
- Looking through you, when there is an interesting window behind you!
- Watery eyes normally fix themselves in 3-6 months, but may become infected from time to time. Washing with tap water is usually enough, but breast milk can help further, and local antibiotic may be needed if very infected. If still a problem after six months, the tear duct/s may need to be cleared out under an anaesthetic.
- Vomiting frequent small amounts of milk, and occasional larger amounts. No problem if weight gain is good, there is no blood in it, and the baby is not greatly concerned by it. It may come up through the nose!
- The umbilical cord comes off by rotting off! It should not smell bad, or develop spreading redness. (use Betadine into it each nappy change if it does, and see the doctor if not improving quickly). The cord normally separates by 5-8 days. All babies have a hernia initially, where the cord passed through the abdominal wall, that should heal by 2 years of age. It is not a danger, unlike hernias in the groin, that must be fixed right away.
9. Illness, pain and discomfort
If the baby has been generally calm, then suddenly becomes unsettled, it is almost never due to air in the bowel! Consider the following causes:
- Tension of any kind is very readily sensed by infants (see 2)
- Food or medications passing through the milk.
- Blocked nose (salt water sprays if feeding is difficult)
- Ear infection..fever, URTI, pain, pulling at the ear
- Tonsillitis.. fever, URTI, refusing feeds, pain
- Thrush .. milk like layer inside the cheeks, a spotty rash in the groin. Mothers nipples may be infected. Put Daktarin to the nipples before feeding for 4 days.
- Constipation (see 7) does not mean hard stools, but that the baby is unhappy about them. Hard stools can cause bleeding on the outside of the bowels, from painful splits.
- Poor weight gain (normal average 180 grms a week), can be caused by poor supply (mothers are often unaware) or by infant illness. Poor supply is usually caused by poor infant suckling, or maternal illness.
- Thirst. Sometime infants need water as well as their milk, though it is not common. This may occur in hot weather, when mother is also thirsty, or the baby is bottle fed. Infants will quickly reject it if it is not needed.
- Temperature. Is the baby too hot or too cold?
If none of these seem to apply, then there are some medical conditions to look for including urine infection, and less commonly reflux of stomach acid with burning. If there is a medical problem then there will usually be poor feeding, poor weight gain, or obvious illness.
Creating a loving and lasting bond with a newborn baby is the most important target of all, but it is not always as easy as it seems it should be. Being clear and consistent with the baby, and focusing strongly on the happy baby, really seems to work for developing good feelings for each other.
Babies are very sensitive to the feelings of those handling them. You can never handle the happy baby too much, but allowing the infant space and time to settle when they are irritable is also important.
Parental self care sets the stage for a comfortable and enjoyable relationship
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