HUG International Teaching Tour begins with "Eye-Ball" Exercises

This week is the anniversary of the beginning of our first international HUG Your Baby Teaching Tour. Though I energetically chronicled our travels during that year, I later learned that many of you were unaware of the blog I was keeping. I thought I'd take you on our trip again by posting some of my favorite blogs. This trip informs the work I do every day and continues to be such a blessing in my life.  So indulge me as I re-step our journey and reflect on how HUG Your Baby and YOU can make a difference to babies and their parents in our world!

“Eye-ball exercises” is a HUG Your Baby technique that we teach in order to see more of a baby’s behavior, to notice more of a parent’s interaction, to “Gaze and Engage” more intentionally with the lives before us. I am hopeful that my own vision will sharpen as my husband, Jim Henderson, and I travel from country to country this year and meet young families.

As Jim and I begin our travels, it seems prudent to read of the experiences of my greatest mentor, Dr. T. Berry Brazelton, in his new memoir, Learning to Listen: A Life Caring for Children. As we fly toward Kona, Hawaii, I am delighted to read how Dr. Brazelton practiced what I call “eyeball exercises” while he and his family visited with Mayan (Zinacanteco) families in Chiapas, Mexico, in the early ‘70s. His fourteen-year-old daughter, Kitty, facilitated Dr. Brazelton's access to the lives of mothers and babies in a culture that restricted visits by non-family males to order to protect their child from a potential “evil eye.” Enjoying the local fashion in dress and head gear, Kitty was her father’s “ticket” into these home.

There he witnessed a Zinacantecon birth—along with sixteen relatives, chickens, and dogs, all “there for” the laboring mother. The mother was completely quiet, but with each labor pain, the attendants, and animals, all groaned, howled and crowed through each contraction. A healthy baby boy was born.

With intention to keep a newborn calm, the baby was put to the breast with every wiggle—up to 90 times in a day! The goal of a docile baby was further reinforced by being held in close proximity to the mother for several months and later wrapped in a robozo (effectively swaddled) for several more months to protect him “from losing his soul.” The Zinacantecon children had REMARKABLE alerting ability and sensitivity to visual and auditory stimuli. With muscle activity restricted, Dr. Brazelton could get a newborn to visually follow a moving toy or his face for a full 30 minutes—a feat he had never experienced with a North American baby.

Of course I must avoid making general assumptions from unique observations. But appreciating what behaviors are noticed by a parent, how that parent responds to her baby, and what those behaviors mean in different cultures will be of interest to Jim and me as we set eyes on foreign lands and engage with the families we will encounter.

(Learn more about HUG Your Baby's International outreach.)

Why Delay Solids until Baby is Six Months Old

Over the past few years, the American Academy of Pediatrics and other international pediatric leaders have changed their recommendations for beginning solids from four months to six months. The following immunological and developmental considerations prompted this change in recommendation[i]:

A baby’s intestines are still developing.
During early infancy the intestines secret only a small amount of IgA, an immunoglobulin protein that coats and protects the lining of the intestines. Fortunately, breast milk contains a lot of IgA that offers this protection while the intestines are developing. Between four and seven months the intestines go through a developmental process called “Closure”. This process causes the intestines to be more selective about what is allowed to pass through. If breast milk is reduced and solids are added before this closure occurs, the baby’s immune system can be triggered to begin an inflammatory, allergic-type response to proteins that leak through the intestine. It is now believed that this process can initiate life-long allergies and asthma and may be a component of a child’s later developing autoimmune illnesses such as diabetes.

Babies less than four months have the tongue-thrust reflex.
This reflex protects the baby from choking. When food is placed on the tongue, the tongue pushes the food out rather than drawing it in.

The baby’s swallowing mechanism is still immature.
Between four and six months babies develop the ability to move food from the front of the mouth, to the side for chewing, and then to the back of the throat for swallowing.

By six months most babies have developed the ability to sit.
Being upright obviously facilitates the eating of solids and a baby’s ability to participate actively in the process.

Older babies love to imitate their loved ones.
By six months a baby may grab mother’s spoon or the cracker from a sibling’s hand. This imitating of behavior not only increases a child's ability to self-feed, but also contributes to the baby’s developing cognitive, social and intellectual skills.


Calming Down - But, 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.

HUG Your Baby in The Netherlands!

Anita Speigels is becoming a Certified HUG Teacher in The Netherlands (Holland). She has begun translating some of our HUG teaching material into Dutch.

Certified HUG Teacher Uses The HUG as a Childbirth Educator

Nancy Winn works as a Childbirth Educator and Case Manager for a non-profit child abuse prevention agency in Salida, California. Though she has years of experience serving young families, she is completing the Certified HUG Teacher program to better prepare these men and women for parenthood. She shares her efforts and this journey with us.

As part of my CAPPA childbirth educator training, I took Part 1 of the HUG training.  I was immediately anxious to learn more about HUG Your Baby and become a Certified HUG Teacher so that I could teach The HUG tips and techniques to the new the families I serve.  I hoped that adding this class to my childbirth education series, would prepare new families to understand newborn behaviors and be more confident in meeting the needs of their infants.

It is easy for new parents to become overwhelmed with advice from well- meaning friends and family.  But, The HUG approach is fun to teach!  Describing the HUG Zones and SOSs (Signs of Over-Stimulation) and teaching calming techniques helps to enhance the bond these new parents have with their child. 

Recently I met with a mom and her 3-week-old baby. This breastfeeding baby had regained her birth weight and was steadily growing an ounce a day.  When I arrived the baby was initially fussy, turning red in the face, crying and showing SOSs and signs of beginning to Reboot.  Mom attempted to calm the baby by swaddling her and then putting baby to breast.  The baby wouldn’t latch. Mom sighs, “she keeps doing this. I thought she was hungry, but I guess she's not. Am I doing something wrong”?    

I talked with mom about the HUG Zones. Practicing the HUG Strategy, "Gaze and Engage", I observed the baby and the mother's reaction to her child's behavior. I then discussed the SOS signals the baby was sending out.  I was then able to show mom different calming techniques and how to get the baby from the Rebooting to the Ready Zone. Using The HUG approach of swaddling, talking softly and swaying the baby was all the baby (and the mother) needed! Giving this mother skills to calm her fussy baby was an important step to helping her continue to be a breastfeeding mother.

Japanese Certified HUG Teacher Helps a Mother Avoid Giving Formula

Yasue Ota has been a registered midwife in Japan for about 10 years and is now teaching maternity nursing and midwifery at Juntendo University in Chiba. Yasue discovered The HUG website and was attracted to the words, ‘Baby Zones and SOSs’. Yasue thinks that “HUG Your Baby Zones and SOSs” are such a wonderful and easy tool to help new parents understand their baby.

Read the exciting account, below, of how using The HUG kept one Japanese mother from giving formula!

I visited Maya when she was 2 weeks old. That was just 1 week after leaving the hospital. Her mother, Tomoko, told me that Maya cries all the time. Tomoko felt that perhaps her breast milk is not enough for her baby. So Tomoko was wondering if her baby might need a little formula. I shared with Tomoko the following ideas about a baby’s crying:

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.

I explained some easy-to-remember tips to Tomoko, who says what all new parents holding a crying baby say: “Just tell me what TO DO!” Sharing HUG Your Baby concepts, I told Maria:

T – 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.

O – Observe your baby's efforts to contribute to his own calming.

Maya was crying loudly while I talked to Tomoko. We paused to observe Maya’s efforts to calm herself. We were delighted to see Maya bringing her hand to her mouth, sucking her finger, and starting to quiet. Tomoko was surprised to learn that babies have instinctive behaviors that help them calm down.

I added another tip to DO (to calm the baby): If the baby is still crying, hold her arms against her chest and continue that quiet, persistent talking—and encourage the baby to suck your finger or the breast, or swaddle her safely.

Maya started to cry again and Tomoko leaned over the baby and spoke quietly into her ear. When Maya continued to cry Tomoko waited a moment and then noticed that the baby smacked her lips. The baby then quiets right down when Tomoko holds her tiny but strong arms securely against her chest. With a smile on her face, the mother then brought the baby to the breast for a good feed. “Now I see how I can work it all out without any formula!” Tomoko tells me.

I really feel pleasure in seeing the "ah ha" moments parents have when I use The HUG ideas and teaching strategies as they relate to their individual baby. I think HUG Your Baby is such a useful tool for facilitating breastfeeding, fostering mother-baby bonding, and enhancing parent confidence.

Newly Certified HUG Teacher Enjoys "Broadcasting" Baby's Behavior

Sandra Janovitch is a postpartum doula in Durham, North Carolina. Let’s hear about her experience becoming a Certified HUG Teacher.

As a Postpartum Doula I recognize that new parents are overwhelmed by how their lives have changed since they brought their newborn home. An easy postpartum transition has proven to be the most effective defense for postpartum depression. Being a PP doula gives me the opportunity to gently guide families through the postpartum time by helping parents learn the signs of baby communication and the skills to attend to the baby’s needs thereby promoting strong bonds.

At first I presented The HUG in a disconnected manner, as if it were information separate from having a baby. As I became more comfortable with the concepts and had the opportunity to work with more babies, I realized that as a postpartum doula I’m like an instruction manual myself. It’s my job to help parents understand their baby.

The HUG has given me the training to integrate necessary information and skills into my regular PP visits. During visits I pay close attention to the mother/baby and partner/baby interaction as well as to the baby’s behaviors. I like to introduce parents to their baby’s behavior by broadcasting what I observe. “Oh look, your baby has her hand to her mouth/ sucking on her tongue.” Then I make a suggestion, such as, “I wonder if the baby wants to eat. Let’s try to feed him. Wow, look, he must have been hungry!” Next I reiterate the baby’s behavior and what it meant. The next time the baby puts her hand to her mouth/ sucks her tongue I’ll point out the behavior to the parents and ask them to say what the baby is telling them.

I use this method, incorporating all the HUG Zones, SOS signals and calming techniques, over the course of several visits. After I’ve visited with the family 2-3 times we watch the video and go over the slides and discuss any questions or concerns. I love how the parents will say, “Oh yeah. We talked about that" or "I remember you showed that to me.”

I am grateful to have a program that answers the age-old question: "Does this baby come with instructions?”

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 suppose 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. Stools drop with baby only stooling once a day, every few days or even less often.

Secondly, a mother will be instructed to watch for weight gain. We expect a gain of one ounce a day once baby regain 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 pauses between "drinks" is the key to this observation. Dr. Jack Newman videos

Daddy Knows Best (Sometimes!)

Chastity Owens, a newly Certified HUG Teacher, is a high school social worker from Chicago, Illinois. She is incorporating HUG Your Baby into her work with teen moms and new families. She shares how the HUG techniques have enhanced her work with young families.

RJ was said to be born at 37 weeks at gestation; however, the doctors said that he was 35 weeks by examination. “What does that mean?” Melinda, RJ’s mother, asked. I explained to Melinda that the doctors thought she was 37 weeks when RJ was born. However, RJ appears to resemble a baby who was born at 35 weeks because he was about 5 pounds at birth.

I explained to his parents that observing the body language of an early baby is critical to helping him grow and develop.  Though he can look like he is ready to be in this world, he can be easily over-stimulated and is likely to struggle with his sleep wake cycles.

As I talked to the baby, I observed his behavior. RJ took self-comforting actions such as making sucking movements and bringing his hand to his mouth. I used one of his rattles and played with RJ, shaking the rattle and moving it so that RJ could follow it with his eyes. When I held RJ’s hands to his chest, he pushed it away and placed his hands around his face. I recognized these early feeding cues and placed baby skin to-skin with his mother.

After a good feed, RJ engaged in active sleep for about 5 minutes. I talked gently to RJ and rubbed his back and he settled back and then showed his parents what deep sleep looked like: characterized by being totally still, not making any sounds, with regular heart rate and breathing. 

“That’s what I do,” Robert Sr., RJ’s father said. “When he wakes up in the middle of the night, I rub his back and tell him that it’s okay.”  I validated Robert Sr.’s actions and explained that as babies mature they must pass from deep sleep to light sleep and back to deep sleep in order to learn to sleep for longer periods of time. However the lactation consultant at the hospital had explained to Robert and his mother that babies born early are still developing these sleep patterns. RJ will need to be put to the breast to feed more frequently until these sleep patterns mature. I reiterated that as RJ moves past his due date, rubbing his back is a great alternative to picking him while he’s still engaged in active sleep in the middle of the night.  

Knowing that there is a lot to learn about caring for an early baby, I made plans see this family more frequently over the next few weeks.