(Gale enjoying new grandson!)
Gale Touger, BSN, FNP, CHT is a Family Nurse Practitioner with decades of experience working with families in a variety of settings -- from public health, to an addictions treatment center, from a Ronald McDonald Caremobile to now, a private pediatric practice. Gale had the pleasure of working with Jan Tedder, founder of The HUG, in a workplace family practice where HUG Your Baby was born. She and Jan studied with Dr. T. Berry Brazelton and worked hard to incorporate his work into the life of a family practice. But no matter the setting, Gale has always empowered patients by providing education and attending first to what matters most to the individual and family (a concept The HUG refers to as "Starting Here, Not There"). Gale finds it helpful to begin every Well Baby Visit with "Is there anything in particular you want to be sure we discuss today?" Here is an example of using The HUG to solve a breastfeeding problem.
Mom and Dad bring Josefina, their first child, in for her two-month-old well child visit. This baby is thriving but Mom is exhausted because Josefina nurses for 45 minutes every 1 to 2 hours during the day, and almost as often during the night. During the night Mom feels she has to supplement with one or two bottles of formula because she 'runs out' of breast milk.
Dad perceptively notices that Josefina snoozes on the breast. He also observes that after about an hour nap the baby wakes herself with jerky movements of her arms or legs.
When Josefina is placed on the exam table she waves her arms, kicks her legs and demonstrates the SOSs (Signs of Over-Stimulation) of looking away, getting jittery and a showing a change in skin color from pink to mottled. I point out then explain these SOSs. I then go on to demonstrate to these eager parents how to swaddle Josefina as a technique to help her sleep better. Josefina quickly settles, her color returns to pink, and she opens her eyes wide, looking right at her parents. Mom and Dad smile with amazement at their daughter's positive response to this strategy. They look forward to giving swaddling a try at bedtime.
Next I ask Mom if during the night Josefina wakes up with a full cry. Mom describes Josefina making soft noises and moving within her bassinet, but not opening her eyes or crying. Following Mom's lead I describe the difference between active sleep and deep sleep in a newborn's normal sleep cycle. Mom looks happily surprised and asks, "You mean it is ok to wait and see if she is really hungry or if she will go back to sleep?" I reflect on the fact that Josefina was a full-term baby who regained her birth weight by 10 days of life and is now growing well. Mom is relieved to learn that Josefina will let her know if she is really hungry.
Mom looks forward to weaning the baby off the nighttime formula and returning to exclusive breastfeeding. She now feels confident about her milk supply and looks forward to a bit more shut eye!
This conversation about newborn behavior fits nicely into the time allotted for a routine well child visit. The simplicity of The HUG strategies and the accessibility of The HUG language make The HUG an essential way to connect with parents and to make their jobs as parents less stressful and more joyful.
© HUG Your Baby 2012