"He's Looking for his REAL Mommie!"

Susan looked at her baby lying in her husband's lap. Instead of that overwhelming sense of joy she expected, she instead felt fear, apprehension, that deep down worry that "I am over my head here." Susan's baby was born two weeks ago and Susan, the adopting mother, and her husband were in the delivery room.

Sammie was born full-term, robust, and healthy by all accounts. But whenever Susan would hold and talk to her newborn, he would turn his head and look the other way.

"I think he is looking for his real Mommie!" Susan confesses in tears during this first well baby check-up.

Susan is a first-time mother who comes to motherhood through the long and turbulent road of infertility, disappointment, and ultimately (and thankfully) to adoption. Her feelings of insecurity are normal, but unfortunately, her interpretation of her baby's behavior is mistaken.

Sammie is not "looking for his real Mommie." He is instead demonstrating a normal newborn behavioral SOS (Sign of Over-Stimulation) called "Switching Off." (See SOS on video clip.) Some babies who are slightly over-stimulated may actually turn away from an enthusiastic mother's talking face. This ability to "Switch Off" is actually a sign of Sammie's amazing ability to keep himself from being over-stimulated. He looks away from Mom for a second to keep himself calm.

Susan is startled to see on The HUG DVD that "Switching Off" is a sign of Sammie's competence, NOT his rejection of her mothering. She is encouraged to stop speaking to Sammie for a few seconds if he "Switches Off." Right there in the exam room Susan practices this advice. When she stops speaking and just looks at Sammie, he holds her gaze. In this moment of mutual sharing a new step toward bonding to one another occurs. Susan now knows that Sammie IS looking at his REAL Mommy--right now!

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© HUG Your Baby 2009

"Help! - I'm Out of Control!"

Samantha, a nine-month-old charmer, is frustrated as her mom puts her in the car seat for their ride home from daycare. The baby works herself into such a total tizzy that Mom has to take her out of the seat to soothe her down again.

Mary Lou, a rambunctious toddler, is gleefully opeing and closing the exam room drawers. Dad and I are trying to talk, but I am distracted by the clanging of drawers and fearful that the cabinet's instruments might go flying. Dad doesn't seem bothered by this chaos and continues to chat.

Three-year-old, Jerry, is playing with the basket of toys when I enter the exam room. Mom says, "It's time for your checkup so hop up on the table." The child does not seem to hear his mom and keeps on playing. After her third request, Jerry throws the toy with disgust into the basket and jumps noisily onto the exam table.

Mrs. Franks and her 7-year-old son are here for his check up. As I walk past the boy, he quietly pushes his foot out toward me in a feined effort to trip me up. I dodge his attempts with a little jump to the side. I'm thrown off gaurd by this child's unthoughtful move while his mother giggles.

Scenrio number one is understandable, number two challenging, number three aggravating, and number four is down right worrisome. My colleague, Dr. Barbara Howard of Johns Hopkins University, is fond of explaining that the goal of disciplining children is to help them be happy and successful adults. Most would agree that a child out of control is neither happy nor ultimately successful.

Can young children be taught self-discipline and self-control? I think so. Writings in the Zero to Three Journal highlight efforts parents can make early in a child's life to help their child move toward greater self-control and increased ability to find their way in the world. (http://www.zerotothree.org/site/PageServer?pagename=ter_key_social_selfcontrol&AddInterest=1157)

From birth to 12 months, children's parents can teach them to self comfort. Encouraging a baby to attach to a lovey (e.g., a blanket or teddy bear) can help her find internal means to self comfort. Taking a step-wise approach to comforting a fussy baby may help him demonstrate his own capabilities. (See http://www.hugyourbaby.com/calming.html) Redirecting a 12-month-old whose behavior is unacceptable moves that child to understand on some level that one behavior is acceptable and another is not.

The toddler years give parents ample opportunity to teach self-control. Toddlers are programmed to push a parent's buttons; the trick is not to act like a toddler yourself! Naming feelings ("I see you are mad!" "I can tell you feel really sad." "You are super happy right now.") gives children a feeling vocabulary. This language can be a tool to help a child learn to control, rather than to be controlled by, their feelings. In addition, plafully giving a child the opportunity to practice patience ("Let's see if we can count to five before I give you the cookie!") will help them practice skills of self-control.

Remember that a child's temperament certainly affects how to teach self-control and how easy this process of learning can be (or not!). Jorey always described her toddler as "low-key and easy to hang with!" On the other hand, Rachael's son is described as "full of beans and always on the go!" Rachael discovers early on that helping her son learn self-control will be one of her primary tasks as a mom.

Helping a child find their inner strength as well as to appreciate what it means to be part of a larger family can be a daunting task at times. Family, friends, and professionals may be of help. But your child is your greatest teacher as you come to understand his/her personality and needs. Learning what makes them tick - instead of what ticks you off - is a big step along the path!

Being a Work-at-Home Dad!

"Dad just makes him laugh," Mom reports. And sure enough...the boy bursts out in a big smile when his tall, athletic dad swoops down to pick him up. Mom beams as she watches "her favorite men" enjoy one another. Though born a few weeks early, Noah is now a vigorous, all-ready-for-life nine-month-old!

Noah's situation is especially special. Dad is a work-at-home dad and is the primary daytime caregiver for this energetic, rambunctious fellow. This family is already demonstrating some of the positive impacts of a dad at home with his baby. I savor the energy, love, and joy of being in the same room with this young family.

As Mom, Dad, and I laugh at Noah's funny efforts to get his dad's attention, I'm inspired to share with these parents recent research which looks at the impact of a father's regular, caregiving involovement with his baby.

Work by Dr. Kyle Pruett is especially salient in elucidating this remarkable impact. [http://en.wikipedia.org/wiki/Kyle_Pruett] A ten-year study shows that children who have been cared for primarily by fathers are active, vigorous, robust, and thriving. They function above normal, particularly in areas of problem solving and social adaptation. These kids are attracted to stimulation and are eager to engage with the world around them. They also expect their intense, curious, and sometimes challenging behavior to be tolerated by adults. Earlier studies showed that such babies performed better on developmental tests and were more resilient in the face of stressful life situations.

As expected, Noah cries after his nine-month-old shots. Mom scoops him up with a tender and loving embrace while I hear Dad say, "Oh, big man, be tough. You're ok!" After a hug and a kiss from Mom, Noah reaches out to his dad, who tosses him halfway to the ceiling. Noak cackles with glee. His mom and I can't help but cackle too! [see "Moms and Dads Can Be Really Different!" - blog on January 21, 2008]

A Worried Dad Finds Relief

Howard is the Dad of two-month-old JT and he has lots of questions. As I mentioned in the last two blogs ( Feb.5th and 7th) Howard has many worries as well.

Reseaarch by M Sills, S.Shetterly, et al (http://pediatrics.aappublications.org/cgi/content/full/119/4/e829) confirm that depression in even one parent increases visits to the primary care provider and ER and reduces well-child visits (especially with the older children). When patients are "frequent fliers" as we call them in our practice, consider depresion in either the mother or father.

Now my "rule of three" kicks in. When Howard ask his third question I stop trying to reassure Howard. Instead I say, "I can see you love you baby so much that you want only to do what's best for him." Acknowledging his list of questions as an expression of Dad's love seems to slow down the questions. Howard takes a deep breath, smiles, and admits to being a "bit worried about the baby." Now we are talking about his real worries not the symptoms of his concern.

Dr. T. Berry Brazelton would describe this approach as the Touchpoint's technique of "acknowledge the parent's passion." In this case this acknowledgement opens the door so now we can discuss the difference between everday worries and anxious depression. (It surprises men to learn that research shows that spouses can have hormone changes during their wife's pregnancy and that these changes can contribute to his depression as they do in the woman.)

Howard describes his new job responsibilites and the extra time he now must spend away from home. Research shows that many new fathers worry deeply about the strain on time and money that new parenthood creates.

Next, I set up a specific time to call Howard weekly for the next three weeks and set up a followup visit in a few weeks. Knowing that I will contact he and his wife seems to harness his worries and decrease his calls to me. I suggest he jot down any worries so we can be sure to discuss them at the phone call or visit.

At the following visit I discuss the concept of anxious depression a bit more and ask about Howard's personal and family history of depression. In addition, I ask about alcohol use since this can contribute to or cause depression at any time in a patient's life. Howard promises to go back on his exercise program and cut back on his caffiene. He agrees to accept a little more help from family and friends and he his wife plan a time to go out to dinner on a well-deserved "date night."

Howard's history and symptoms were significant enough to put him on an antidepressant. After three weeks Howard said "I feel like myself again." By JT's four-month-visit Howard, his son, and wife are much better. Howard brags about his son's new trick of rolling over, and laughs when JT swats at Howard's nose. Howard is back, more able to be present with his son and to find joy in these precious moments. Likewise, I'm back on track as their provider. Addressing the cause rather than the symptoms allow me to feel more compassion and be more able to use my skills and knowledge to help these parents be the parents they want to be.

I'm looking for your ideas!

As I mentioned in the February 5, 2008 blog, "Three Strikes and You're Out..." Howard is a challenging parent. "I was really ready to see eight-week-old, JT. In addition to several office visits, I had spoken over the phone to Howard, his Dad, numerous times since the child's birth. I was starting to dread the moment his cell number would appear on my desk. I had it memorized." I confessed my last blog.

Surely many of you have been in a similar situation with a parent. How would you approach this scenario? What would be your goal for further interaction? What would you say? What would you do? Send me a quick email with a little or a big idea! I'd love to hear from you and reflect in a future blog on your (and my) ideas for helping this sturggling Dad (and nurse practitioner!)

"Three strikes and you're OUT"...or "In"...Trouble, that is!

I was really ready to see eight-week-old, JT. In addition to several office visits, I had spoken over the phone to Howard, his Dad, numerous times since the child's birth. I was starting to dread the moment his cell number would appear on my desk. I had it memorized.

J. T. is in for his routine visit and is growing at the 80% in height and the 60% in weight. He cackles once when I palpate his abdomen and looks up at his dad when I listen to his lungs. Though I'm finding this behavior delightful, Howard hardly notices. He looks worried. "Is his head big enough?" "Does it hurt J. T.'s back if he lies on his stomach?" "He always strains his face when he poops. Is that ok?"

Worry seems to be on the job description of most new parents. Each of Howard's questions alone seems resonable; however, this dad has an extraordinarily long list of questions and can't be reassured. He is an attentive father who reads everything about babies on the Internet. He collects ideas from friends and family. He is hypervigilant in his care: getting up several times at night (while the baby sleeps!) to be sure everything is ok, counting every calorie the baby eats, keeping an elaborate diary of the child's sleep, eating, and elimination. Though the data piles up, the questions and worries keep coming. "Anxious attachment," a term used by some professionals, describes the budding relationship between Howard and his baby. Though J. T. is thriving now, babies can eventually sense this anxiousness and over time can look and even act anxious themselves.

Anxious attachment is seen as a form of postpartum depression and can occur in either the mother or the father. This conditiion does not look like classic depression: a "slowed down" parent who becomes teary and sad, has trouble concentrating, appears distracted, and becomes less involved with their baby. Howard is super involved but cannot trust his instincts or learn to read his baby's behavior accurately. When asked, Howard will state that he is "not depressed." "I'm just worried," Howard explains. He, and others like him, need help: frequent contact and support, counselling, and sometimes medication.

When I care for young families I follow the "rule of three." If a parent asks a third question and cannot be reassured, but follows with yet another concern, I start looking for anxious postpartum depression. See the next blog for some strategies to help Howard cope with this situation.

"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 www.dona.org/ for information on doulas and www.birthsource.com for further birthing information]

Moms and Dads Can Be Really Different!

Terry is an energetic, seventeen-year-old dad. He is the quarterback and a senior at the local high school and comes to the office today with his girlfriend, Diane, and Eric, their three-week-old son.

Terry holds his son like a football then places him enthusiastically on the exam table for his check-up. Diane laughs as Terry starts to poke at his son. First he pokes at his feet, then his knees, then his stomach, then his nose. Eric starts to breathe a bit faster and his feet start to look jerky. His eyes spring wide open, his eye brows rise, and his shoulders go up toward his ears. "I'm ready for you, Dad!" his body seems to say.

Dad steps back from the exam table as Mom reaches over to undress Eric for his exam. As she moves toward the baby, Eric's eyes start to look drowsy and his body relaxes. His movement slows down and his breathing quiets and becomes regular.

Though certainly there are differences in individual parents and babies, Eric demonstrates what research now shows, that dads and moms approach babies differently. Even fathers with childcare experience often approach a baby with big, enthusiastic movements. Their very presence seems to stimulate the newborn, as if to get baby ready for the big world out there.

The more stereotypical mother's approach is quieter, one that seems to calm the baby rather than stimulate him even more.

Babies benefit from both approaches as they grow and learn, suggests psychologist Kyle Pruett. They may learn to regulate their internal stimulation from one parent, and learn to deal with external excitement from another. See Pruett's Fatherneed: Why Father Care Is as Essential as Mother Care for Your Child. http://www.drkylepruett.com/publications.htm

Most mothers and fathers experience some conflict as they struggle to love their baby in the best way they can. It's the lucky baby whose parents approach this struggle with passion and humor as they each become the parents they were meant to be.

In Celebration of Grandpa's Life 2/27/23-1/18/2008

“Not Aware of the Moment”
-Tagores

I was not aware of the moment when I
first crossed the threshold of this life.

What was that power that made me
open into this vast mystery
Like a bud in the forest at midnight?
And yet when in the morning I looked
upon the light
I felt in a moment that I was no stranger
in this world.

That the inscrutable, without name and form
had taken me in its arms in
the form of my own mother.
Even so, in the end, the same unknown
will appear as ever known to me.
And because I love this life I know
I can never fear death.

The child cries out when from the right
breast the mother takes it away
And the very next moment to find
in the left one its consolation.

"I'll Play With My Baby When He Can Catch a Ball!"

That's what Jerry, the husband of 28 year-old Elizabeth, said one afternoon at their first pre-natal visit. "All the baby does is eat and sleep that first year anyway, " Jerry explains.

Jerry is not alone in this view of a newborn. A study by Zero-to-Three asked new parents "at what age do you think babies can 'take in the world?" 61% of parents thought that a baby needed to be two- to three-months-old to notice the world around them.

The real truth is good news for you, Jerry (and for Elizabeth too!). Most babies can "play ball" (and actively engage in the world around them) as the tiniest of newborns. But parents need to notice a baby's special ways of approaching this ball game.

Now, at the young family's first post-natal check-up, Jerry holds his newborn, Joey, and gazes intently into his eyes. I almost have to pry little Joey from his daddy's arms. In addition to the routine physical exam, I always love to take time to help parents appreciate some of the amazing capabilities of their baby.

As I hold Joey in front of me his eyes fix on mine. I slowly tilt my head to the side; Joey's eyes follow. As I move a bit more to the left, his eyes drop from my gaze. I hesitate a moment, and then he engages with me again. I'm not worried when I see his eyes jerk a bit as they move. (It will be a few weeks before they move continuously like grown-up's eyes.) "Wow!" Jerry says. "He can really pay attention!"

Then I pick up my little red ball. Joey stares at the ball differently than when he looked at my face It is normal for many babies to be more interested in a face, initially, than in an object. But I just jiggle the ball a second and Joey's eyes start to follow it as I slowly move it. When Joey starts to wiggle around, and his breathing increases, I recognize an SOS (Sign of Over-Stimulation). [See blog article: Babies send out an SOS] I hold his little hands gently against his chest, and his eyes immediately look intently at the ball again. Now he follows its movement from one side to the other.

"Yep! Like I thought," Jerry declares to all. "He's a star ball player already! It's my turn to play ball with him now!"

Learning to Talk "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!”

Being a Parent is a Tall Order!!

I call them the "TALL Family." That's because when they enter the exam room, Mom, Dad, and both grandparents tower over me. They're all over six feet tall. As they place their very LONG baby onto the exam table, Mom suddenly bursts into tears.

"He hasn't stopped crying since we got home," Mom weeps. "It's been four very long days. We waited so long for this baby, and now we must be doing all the wrong things!"

Sabrina had indeed waited a long time--three miscarriages, two years of infertility work-ups, and then, at last, little (and long!) Jakie.

I start Jakie's physical exam. When I check out his hips he starts to fuss. Eight eager arms reach out immediately to comfort Jakie. But he seems to cry even more. The next time he cries, I suggest that we add a new ingredient to the mix. "Let's watch him just a second when he cries and see what happens."

I turn Jakie over to check his back and he starts to fuss. I then lie him gently on the table and talk softly over his face. "Little Jakie, can you help calm yourself down? Are you listening, little Jakie?" Jakie pumps his arms a second, then hesitates, then looks off to the side and stops crying. He looks relieved, as do his parents and grandparents. Mom then swoops up Jakie in her arms with a big smile and a hug.

Parents who have suffered much loss before the birth of a baby often see their young one as very fragile. For parents such as these it is especially magical to be able to see their newborn participate in calming down. Parents then see his capacities, his abilities, and his strength.

Two weeks later I saw the "Tall Family" again. As Mom was leaving the waiting room, she told me how calm and happy Jakie is. "We're a team now. We help him, and he teaches us every day how to be the parents he needs us to be."

Mom glowed as she marched out. She looked ten feet tall!

Grandpa and My Boys

The road leading from his apartment building is Bittersweet Lane. Those words capture the mood of this holiday season as we move my father-in-law to hospice care at an assisted living apartment. It all feels a bit surreal. Can this journey with him be our last trip together before his transition onward?

Like most people in this situation, I take time to look through photo albums and to dwell on details of memory, attempting to understand the comings and goings of life. I am particularly drawn to a picture of Grandpa cradling my second son (and his namesake, David Robert) minutes after the birth. I am struck with how completely his arms encircle the infant. How wise, secure, dependable, and reassuring those arms look to me now--as they did then, 21 years ago!

Moments of watching this grandparent interact with my children have been unexpectedly rich and satisfying. Grandpa's early games with his grandson: "How big are you?" or "How strong is David?" made us all chuckle, as Grandpa captured the attention of a one-year-old. Tommy Taxi's chugging around the carport with our older son, Jonathan, was delightful as Jonathan shouted, "I'll take a Coke," to Grandpa who played the role of drve-through staff. "I hate Banks," David announced about his best and beloved three-year-old friend in an effort to spend a morning with Grandpa instead of one at pre-school. A five-year-old Jonathan traveled atop a handmade wooden "booster seat" in Grandpa's truck with ample time for conversation about soccer, Dr. Suess, and God. How many dozen times did David and Jonathan run for an Oreo cookie from Grandpa, who regularly "bribed" his grandsons into lunch on the playground at the school where he volunteered as "Mr. Fix-it"?

Caring for babies, as I do, often causes me to marvel at the mystery of beginnings. That sense of beginning seems very connected, now, to this feeling of ending I have, as Grandpa prepares to move on. A Buddhist friend reminds me of the circle of life and the comfort and reassurance of sensing ourselves on and in that cycle. Tonight the "sweet" holds more power than the "bitter," as I look again at the picture of Grandpa and his grandson. The promises and hopes of those young family days are fulfilled in me tonight, and for this, I am grateful.