"She's Sending out an SOS: Sign of Over-Stimulation"

Madeline had done her homework. She knew that cow's milk is best for cows and breastmilk is best for babies. She was determined to breastfeed even after delivering twins.

David was a six-pounder who seemed to have read the breastfeeding manual before his birth! A gentle stroke on the side of his mouth elicited a lovely rooting reflex. Madeline waited for him to open wide then she got the nipple into his mouth. In only a few days, David was nursing well, producing lots of pees and poops and dozing off nicely while his sister took her turn to feed.

Sara was a different story. At five pounds she seemed more fragile and more easily over-stimulated. Like her brother, Sara was eager to feed. But she seemed to get confused by her own activity. Her rooting reflect elicited a quick and energetic turning to the side. She would get red in the face and her breathing would pick up pace. Then she would startle as her mother attempted to get her to the breast. Her outside arm would swing out wildly and then she would start jiggling the nipple in her mouth as if she couldn't imagine what in the world she was supposed to do with it.

"Get a grip!" Madeline exclaimed as Sara demonstrated her eating style to me at her one-week-old weight check.

Sara's behavior is a classic example of a baby "Sending out an SOS" (Sign of Over-Stimulation.) Changes in her body--more pale or red skin, fast or choppy breathing, and increasing jerks or tremors of the arms or legs--can be a call for help.

She just can't multi-task," I explained. She is talking with her body and saying, "I can't do two things at one time: control my body and learn and how to nurse."

Madeline learned how to watch for Sara's SOSs and how to respond to them. Sara nursed best if swaddled firmly. Sometimes she would need to suck a paci or her mom's finger a minute until her SOSs decreased. A gentle sway would both calm her down and help her wake up to eat.

Mom's sensitivity to her daughter's body language helped both her and Sara learn how to nurse effectively. Now Sara weighs 12 pounds and her brother 13. They are thriving on Mom's milk, and Mom is thriving on them! (Learn more about sharing newborn behavior with parents...)

"I want to birth my own baby," she said.

She is a tiny lady with a big, basketball-sized belly. Mary Lou, who works at the bakery, and her husband, Joe, our local mechanic, had found their way to our county's childbirth education class. Mary Lou and Joe had grown up in a small Eastern North Carolina town. They had married right out of high school and now, living in Raleigh, were preparing for the birth of their first baby.

Mary Lou was quiet and soft spoken. She rarely raised a question but often jotted down notes as the class went along. When asked, "Why did you decide to come to this class?" Mary Lou had said, "'cause I want to birth my own baby. I want to push him out into this big, wonderful world!"

Mary Lou had heard stories about birth from other ladies at the bakery. Benita had been told that her "baby seemed too big," so she was induced -- only to deliver a 6 pound, 3 ounce baby boy. Jackie's doctor had thought that her pelvis might be too small, so a c-section was done and she delivered a 7 pound, "late premie."

Mary Lou's doctor had already discussed with her "getting an epidural"; he also mentioned that a c-section before the holidays might be "more convenient" for her. But Mary Lou stayed determined. "I bake great sourdough bread," she exclaimed. "It's supposed to stay in the oven for 60 minutes. If I take it out at 50 minutes, it's soft in the middle!"

Mary Lou asked for a volunteer doula to be present at her birth. The three of them made a formidable team, and Justin was born a healthy 8 pounds, 3 ounces, two days after her "due date."

It's such a big job being a parent. There are challenges such as solving early breastfeeding problems, teaching a two-year-old not to bite his best friend, advocating for a kindergarten child with learning issues, helping a school-aged boy deal with a bully in class or a teen whose friends use drugs. I often wonder what impact we have on the confidence and fortitude of parents from the get-go when such a large percent of women are told they can't even birth their own baby. What does the medical world take from women when we deny them what may be the most empowering experience of their lives?

May Lou had it right: "I want to push my baby out into this big, wonderful world." We are lucky when our job is to help her do just that!
[See http://www.dona.org/ for information on doulas]

Being Close and Pushing Away

It's national Nurse Practitioner Week, and I am thinking about what I love about my job when I wander into the exam room with Suzanne and her 15-month-old daughter, Ellie. Suzanne plays with Ellie as I rummage through my folder looking for the most recent growth chart. When I look up, Mom is all smiles as the little one reaches for her hair and playfully gives it a tug.

"What a lucky baby little Ellie is," I remark as I glance at the loving dance between the two. "As she gets older, are you and your husband thinking about a second child?" I ask.

Suzanne responds with sudden and (for me) unexpected tears. "No, Fred went and got fixed. We're done making babies," she explains.

I continue to be touched by how close to the most important issues in another's life my life as a nurse practitioner takes me. There is no time to rush through a patient visit, no time for a quick call reminding my husband to pick up a pizza, nor time to spend on paperwork. This very moment is the most important moment in my life right now.

"I just want to hold on so tightly to every bit of her being a baby," Suzanne shares. "I can't stop looking at her face, tickling her toes, and laughing whenever she giggles. Every second seems like the best moment in my life."

"I see how she looks back at you," I remark. "She seems to glow from feeling your love and attention." Suzanne reaches out and gives Ellie a gigantic hug.

It's not easy being a young family these days; it's a constant challenge to balance the financial, emotional, and physical energy required to parent with the joys and challengers of being a mom and dad. My job often is to direct a parent's attention back to their little one, to focus on the fruit of their labor, to remind them that parenting is the most important work they do.

Suzanne and I laugh together as Ellie pushes free of mom's hold and toddles across the room with an air of determination and confidence. "I guess all those hugs paid off!" Mom exclaims. I couldn't agree more. "They paid off for Ellie, and for her mom, didn't they?" I reflect.

"Shutting Down": A Baby's First "Words"

Little Ying was nearly to her birthday. By that I mean she was a few days away from reaching the day she was due to be born. However, she and her twin brother were born six weeks early, and Ying had struggled to grow into her due date.

As a tiny newborn, Ying would easily "shut down" (www.hugyourbaby.com). Routine baby care -- changing diapers, moving her from the crib to the bassinet, and feeding her -- would seem to overwhelm Ying. Mom wondered if her daughter were "bored." With a bit of stimulation Ying would look like she'd had a long night of partying; she'd get drowsy and lethargic. Mom was still trying to nurse Ying and was frequently confused about what Ying was saying with her body.

It just didn't make sense that Mom should need to comfort Ying more in order to wake her up. But that's what Ying's body language was saying: "I'm overloaded...It's too much for me!...Can't I just check out for a L-O-N-G nap?"

Ying's mom became increasingly sensitive to her daughter's special way of communicating. Mom would look carefully at Ying when she would appear sleepy. If Ying had a relaxed, settled face with slow, relaxed breathing and relaxed arms and legs, then Ying was ready to drift off to sleep. But if Ying looked sleepy -- accompanied by a closing in of her eyebrows, a forced closing of her eyes, and a tightening of her face muscles -- then Ying was "saying" I'm really having an SOS (Sign of Over-Stimulation - http://www.hugyourbaby.com/skills.html), and I'm checking out.

Ying's mom became a great baby detective! She learned to notice this behavior as an SOS and to respond by swaddling Ying or holding her hand against her chest. A gentle sway, or even encouraging Ying to suck her pacifier, would help Ying wake up and get to the Ready Zone to eat or play.

Two-year-old Ying is now thriving. She loves the special Chinese rattle grandma brought her from Beijing. But now she bangs it like a drumstick to get her brother's attention. She chases her brother around the house and can't stop talking -- both English and Chinese. Those days of being a fragile, tiny newborn are far behind, possibly because her mom learned to see Ying's "shutting down" as just the first "words" her Ying learned to say!

A Teen and Her Baby

It saddened me when I walked into the room. Carrie, a sixteen-year-old new mom, was gazing out the window - at nothing in particular. Just gazing out, not looking in, or over at the baby in the room. Grandma sat beside the exam table and patted the back of three-week-old Ricky, a healthy, full-term guy who appeared to be under the watchful care of his grandmother. I asked questions about the delivery and feeding. I commented on the little one's abundance of hair and his sweet nose. I mused over the wonder of a new baby. But Carrie still glanced out the window, unengaged by the swirl of attention her newborn was receiving.

Ricky began to squirm on the exam table, wrinkle up his face, and hover on the verge of changing from a calm to a fussy baby. As he wiggled he seemed, quite by accident, to hit the side of his face with his fisted hand. This movement triggered his in-born rooting reflex. His tiny mouth opened wide and clamped down on his first and second finger. He started to suck.

"Wow!" I exclaimed. "Look how smart you are to get that finger in your mouth all by yourself!"

Carrie was jolted by my enthusiastic response. She pushed her chair a few inches away from the window and turned her head a full 20 degrees in our direction.

I chatted on in my nurse-to-baby style, next noticing Ricky's eyes turning to focus on me. "My goodness! You heard my voice and turned right toward me! What other amazing tricks do you have?"

Carrie eased toward the exam table and, now, glanced down at Ricky. Her son demonstrated an amazing ability to get to and stay in that Ready Zone. His eyes were bright, his movements relaxed, and his shoulders dropped in an "I'm-ready-for-the-next-event" kind of look.

I picked up Ricky and encouraged Carrie to call his name. She did, at first tentatively, but with a bit more gusto after some encouragement. As I expected, Ricky slowly turned in his mother's direction, and then he looked into her face, contentedly.

A smile crept over Carrie's face as she looked down at her child. With some hesitation she received the newborn I gently placed in her arms. Carrie surprised me when she put her nose into Ricky's face and nuzzled for a moment. Ricky seemed to tilt toward his mom and into an awkward, but warm, cuddle.

Helping this new and fragile mom appreciate her baby's effort to connect made my day. "He's a real person," Carrie whispered.

"Yes, and he knows his real mother," I responded. Now, I didn't feel so sad.

Listening to your Baby Talk!

Debbie came to see me for a check up with Rebecca, her six-month-old daughter. Though I do not provide prenatal care, I had seen this mother a number of times during her pregnancy. She described herself as "a worrier” and wanted to discuss with me the things she was worried about or the things she might find worrisome in the future. I realized that Debbie was at significant risk for post-partum depression and wanted to keep a close eye on her when the baby was born.

I meet Rebecca when she was only a few days old. She had newborn jaundice and was struggling to wake up to nurse. Debbie was determined to succeed with breastfeeding so was open to any ideas which might help. From my first visit with Rebecca, I focused on helping Debbie tune into what “Rebecca is telling us.” Debbie and I watched together as Rebecca “told us” about her sleep cycles and how she could be aroused from active/light sleep but not quiet/deep sleep. (See http://www.hugyourbaby.com/sleeping.html to tell sleep cycles apart) Debbie learned to read her daughter’s SOSs (Signs of Over-Stimulation) and to tell when Rebecca needed a rest or could handle more interaction and play. (See http://www.hugyourbaby.com/skills.html for tips on SOSs)

Debbie taught me something very important. The more a mom learns to read her baby’s body language, the less she will worry. This mother, who had worried and suffered much during her pregnancy, never did develop post-partum depression. Instead, she learned to read her daughter's "body talk," and she gained confidence as a mom while learning to do so. At our last visit Debbie summed it up this way: “I worried a lot when she was inside of me. It’s easier to have her on the outside telling me just how she is doing.” And, Rebecca seemed to say, “Gee, Mom, I’m doing great!”

Baby ZORRO and his Sword Fighting!

Chris was two weeks old and already seemed like a rambunctious boy to his parents! He was always "on the go." He would wiggle when Mom would bring him to the breast to nurse. An arm might shoot out, a foot jerk, and his mouth would move quickly from side to side as Mom tried to get him to nurse. He was sure to squirm on Dad's shoulder and bobble his head up and down as Dad did his burping duty. Lie him on his back to rest and both arms would splay out in a startle and his feet would start pumping as if he were leading a baby aerobics class. Chris was always moving!

When Chris would get upset, he would sometimes do the oddest thing. His arms and legs would pump a moment, then all of a sudden he would turn his head toward the right and look like he was taking up sword fighting. He would extend his right arm and leg, and flex his left leg and arm. This sword fighting position would seem to calm him down. From this position Chris could watch his own hand move and practice his eye-hand coordination. He might even pull his hand to his mouth to comfort himself from this position.

This position is technically called the "Fencing Reflex." It lasts in babies until they are 3-6 months old. Because the newborn's neck muscles are still strengthening and the back of the head is round, many babies will tend to tilt their head to the side when on their back. The majority of babies turn toward their right, which some suggest is caused by (or leads to) more right-handed than left-handed children. Most righted-handed mothers hold their baby in their left arm which allows mom to use her right hand easier and encourages the baby to look up at mom as he turns naturally toward the right.

No one would say that Chris assumed the sword fighting position on purpose, but researchers are learning daily how newborn reflexes serve a purpose. When Chris's parents watch him successfully use this reflex, they are reminded once again how remarkable newborns are and how especially smart their little ZORRO is!