Peer-reviewed journal to publish article on HUG-New Mexico WIC Collaboration!

Jan Tedder and Elsa Quintana

"Online education for WIC professionals: Teaching child development to extend breastfeeding duration" has just been accepted for publication in the peer-reviewed journal, Clinical Lactation! This article describes a collaborative, innovative outreach project and pilot study that took place in 2016-2017 between Jan Tedder, (IBCLC, FNP and creator of HUG Your Baby) and Elsa Quintana (IBCLC and WIC Breastfeeding Coordinator for New Mexico). 

Elsa and her colleagues recognized that while breastfeeding initiation is on the rise in New Mexico, women there (and across the nation) often do not meet either their personal breastfeeding goals or international breastfeeding recommendations. 

These professionals know that misunderstanding a baby’s behavior is a common reason that women add formula, begin solids prematurely, or give up breastfeeding altogether. 

Aiming to help parents better understand how child development impacts breastfeeding, Elsa arranged for 138 New Mexico WIC professionals to take HUG Your Baby’s Roadmap to Breastfeeding Success—a two-hour online program, with accompanying resources, that covers key information from birth to one year. 

Jan and Elsa are very pleased that the positive results of their study will be published in a format that includes video links to components of The HUG program. They hope that this study will inspire other leaders in lactation--across the nation and around the world--to use these resources and to study their effectiveness to enhance professional education and to extend breastfeeding duration.

© HUG Your Baby 2018

Help HUG Your Baby celebrate, and thank, Dr. T. Berry Brazelton on his 100th Birthday!

Twenty years ago I drank a gin and tonic on my back porch with Dr. T. Berry Brazelton. He was visiting his son at UNC and asked me for a last-minute visit to learn more about my Touchpoints work at SAS Health Care Center in Cary, NC. Several years later he called to congratulate me on my newly released HUG Your Baby DVD. "You did what I always wanted to do," he said. "You made the behaviors of babies accessible to parents!"

This famous pediatrician and Harvard professor reshaped the view of infants and children around the world--and changed my life forever. Every day I enter an exam room or living room to see a new parent, I practice what he taught me: to SEE, and to SHARE, a baby's behavior with her parents.

Many of you know of Dr. Brazelton's primary contributions: the Neonatal Behavioral Assessment Scale (NBAS) and Touchpoints. I was certified in both and spent decades "translating" them for primary care and lactation patients, and birth and parenting professionals, both in North Carolina and in 20 countries around the world.

The NBAS, used mostly as a research tool, looks ever so closely at an infant by evaluating 28 behaviors (on a 9-point scale) and 20 other neurological items (on a 4-point scale). This scale (highlighted in my HUG Strategies online course) has been used to illuminate the impact on a newborn, among other issues, of smoking during pregnancy, of newborn jaundice, and of skin-to-skin care. It also identifies challenging traits in a baby (such as frequent state changes, high activity level, or low interactive abilities) that can interfere with the developing parent-child relationship.

Dr. Brazelton's Touchpoints work (highlighted in my Roadmap to Breastfeeding Success online course) taught me how a surge in a baby's development can temporarily disorganize that baby's eating, sleeping, and/or general disposition. Parents who do not understand or anticipate such a change in behavior can feel more confused and less close to their baby, and may add formula or give up breastfeeding altogether.

We have LOTS to be thankful for as Dr. Brazelton turns 100! Join me in Boston if you can on April 23, 2018, to celebrate his life and achievements with hundreds of his fans! Click HERE for more info about the birthday gathering.

If you are unable to attend, please email me (jan@hugyourbaby.org) a short written tribute to Dr. B., and I will create a HUG Your Baby "thank you" gift to pass on to him.

"See, then Share" - Creating a Teachable Moment

Tara, a new home visiting nurse, arrived for her first home visit with Isabella, a brand new mom. Isabella is 21 years old, lives with her parents, and is a new single mom. Her baby was born full term and healthy. Isabella claims to "know nothing about babies" but glows with that enthusiasm (and rush of adrenalin) mother nature bestows on new parents.

Tara glances down at her worksheet. Wow, there is so much that could be covered at this important first visit. Do you have help while your husband is at work? Did the midwife tell you about back-to-sleep?  Do you think that your baby can see your face? Tara's head spins as she wonders where to start.

Last week Tara completed The HUG continuing education class at her health department and is excited to integrate this information into her work as a home visiting nurse. She remembers that the teacher, Jan, said, "If you ever feel confused about what to do next, just See, then Share" the baby's behavior. Jan explained that Seeing the baby's behavior and Sharing that behavior with parents can create an important connection with new parents. 

But first, Tara must "See". She worked hard at the workshop to gain new knowledge and skills in observing and interacting with newborns. She glances over at Isabella son, Mateo, and remarks, "Oh, I see he's in the Ready Zone. He looks ready to play with us." 

Tara's right. Mateo's eyes are bright, his body is rather still, and his breathing is calm and regular. As his mother reaches for her Diet Coke, Mateo follows her with his eyes.

"Oh, I see that he is watching you right now," Tara exclaims. Isabella notices what Tara means and quickly joins the game. She tilts her head slowly in the other direction, and Mateo tracks right after her. "You nosey little man!" Isabella laughs as she picks up her son.

About that time Tara notices Mateo start to change. His eyes drift down, away from his mother's face, and he gets a bit pale. His chin tremors and his body stiffens a bit. "Oh, do you think I've bored him already?" Isabella asks.

But Tara is quick to remember what she just learned from class. "Oh, no," she gently explains. "Mateo is just showing a little SOS, or Sign of Over-Stimulation. That's really normal for new babies. Hey, let's swaddle him for a minute and see what happens."

 Isabella is surprised to see that when swaddled a few minutes, Mateo is able to look back toward his mother; he even turns in her direction when she whispers his name.

"Wow, you're so smart! I'm going to take take super-good care of you!" mother giggles with Mateo in her arms. Isabella snuggles with her baby as Tara covers a few of the important questions from her notes. Seeing, then Sharing this baby's behavior created a teachable moment that every nurse longs for!


© HUG Your Baby 2018

Tug-of-War between Mother and Father

Three-week-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.  As mother continues with undressing her, the baby starts to cry.

Mother hesitates a moment then leans over Tabitha and softly calls 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! 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 2018

HUG Your Baby goes to WIC-Guildford County North Carolina

It was my great pleasure to join 40 WIC professionals in Greensboro, North Carolina, this morning. It was exciting to see that those present included lactation consultants, nutritionists, peer counselors and administrative staff. When considering how to integrate a new program into a facility, it's important to include ALL the professionals who will interact with patients. That's what happened today!

We explored HUG Your Baby's "Roadmap to Breastfeeding Success." Participants seemed especially interested in video demonstrating how to calm a fussy baby, how to differentiate a baby's deep and light sleep, and how to identify a baby's signs of over-stimulation. At the end of the workshop these professionals broke into small groups to consider what steps they might take to bring these child development and breastfeeding resources to patients. They had LOTS of good ideas!

Participants completed knowledge pre- and post-tests. They also completed a  survey on their current teaching of patients about how changes in a child's development impacts breastfeeding and on how they intend to teach after the workshop. In addition, they shared information about their confidence to teach parents and their feedback about the workshop. See results below.

Pre- and Post-Test Results

Pre-test: 31% failed; 69% passed

Post-test: 6% failed; 94% passed

Your Teaching of Parents

You teach (or give written information on) issues BEFORE workshop compared to your plans to teach (or give written information on) issues AFTER workshop

1.     Teaching about signs of over-stimulation

a.     Before Workshop: 37%

b.     Plans after Workshop: 97%

2.     Teaching about crying

a.     Before Workshop: 44%

b.     Plans after Workshop: 97%

3.     Teaching about sleep cycles

a.     Before Workshop: 25%

b.     Plans after Workshop: 97%

4.     Teaching about change in stooling at 4-6 weeks

a.     Before Workshop: 79%

b.     Plans after Workshop: 97%

5.     Teaching about 4-month-old’s distractibility

a.     Before Workshop: 37%

b.     Plans after Workshop: 97%

6.     Teaching about 9-month-old’s stranger anxiety

a.     Before Workshop: 22%

b.     Plans after Workshop: 94%

Your CONFIDENCE to teach parents

7.     I am confident that I can identify an infant’s response to OVER-STIMULATION

a.     Before Workshop: 15%

b.     After Workshop: 97%

8.     I am confident that I can comfort a CRYING baby

a.     Before Workshop: 82%

b.     After Workshop: 100%

9.     I am confident that I can identify an infant’s LIGHT AND DEEP SLEEP

a.     Before Workshop: 65%

b.     After Workshop: 100%

EVALUATION of Workshop

10.  “I think this material was evidence-based.” - 100% Strongly Agree or Agree

11.  “I would recommend this workshop to other colleagues.” -  100% Strongly Agree or Agree