baby

INTERPRETING A NEWBORN’S CRIES

by

NEW YORK TIMES COLUMN: FAMILIES TODAY:
INTERPRETING A NEWBORN’S CRIES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am the grandfather of a 4-week-old girl, the first child of our daughter and her husband. How accurately can a newborn’s cries be interpreted?

A. Like all families, you wonder what your new addition is “saying.” Mothers, fathers and grandparents jockey over interpreting the new baby:. Does she want to be held? Or has she been held too much? Is she hungry or wet or weary? And who knows best?

Scientists have analyzed infants’ cries by pitch, tone, volume and rhythm. Infants indeed make cries that correlate to hunger, fatigue, discomfort, pain, a bid for interaction – or to letting off steam at the end of the day.

Feed a baby crying in one way, and she will guzzle appreciatively. A baby crying in another way will just turn her head and keep crying.

Parents may interpret their baby’s cries too narrowly. For example, they may think she is asking to be fed with each cry. Overfeeding, though, may confuse a baby into believing that feeding helps with other discomforts, like boredom or loneliness. Parents need a few weeks to learn to distinguish their baby’s cries. They may not be right each time, but they can narrow the possibilities.

A baby whose cry says “pick me up and love me” will quiet simply by being held. If she keeps crying, she may be asking for something else – to have a diaper changed, or to be swaddled more firmly for sleep.

As parents ponder a baby’s cries, she too is learning to distinguish different sensations, and to soothe herself when distressed. These will become skills of great importance.

If a baby is crying, it’s best for parents to go to her – but usually they needn’t rush to resolve the issue in seconds. Unless the baby is ill, in danger, or too fragile to tolerate her distress – as can happen for pre-term infants – you have time to prepare a feeding, check a diaper, cuddle and coo together, or help the baby soothe herself with a thumb to suck or a piece of soft cloth to touch.

Parents respond more sensitively to a baby’s cries as they learn more about her. Some babies are clearer than others in their communications.

Ultimately, all parents learn by trial and error, encouraged by family members and other parental cheerleaders who help them to feel OK about not always getting it right the first time.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

PREPARING THE FAMILY FOR THE NEXT BABY

by

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREPARING THE FAMILY FOR THE NEXT BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

(This article is adapted from “Understanding Sibling Rivalry,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Facing a second pregnancy is both thrilling and daunting. Parents will ask themselves: “What will this do to my older child? Can I manage with two? How could I ever love another child as much?”

When sibling rivalry arises, parents are bound to feel responsible, and guilty.

Later, they will find they need not divide their love, for they will love each child differently. But before the new baby arrives to help parents make this discovery, they may feel they must try not to grow attached to the new one, but instead must focus even more on the one they already have.

The fear of “deserting” the older child is inevitable. All parents wish they could eliminate the older child’s negative reactions to the new baby. This parental pressure makes the older child feel unacceptable as he is, and wonder if he really deserves to be replaced. Of course he knows that he both does and doesn’t want a new sibling.

Although these feelings are most prominent with the second pregnancy, they are likely to be present with any subsequent pregnancy. It can be a challenge to see each new baby as a “gift” to the family.

But parents needn’t feel that it is their role to protect their children from all the feelings – anger, jealousy and others – that they will experience with a new baby. Adjusting to a new sibling is a child’s opportunity to learn about these feelings and how to handle them. And parents can help.

When Do I Tell My First Child?

You never don’t tell him. As soon as you know a new baby is on the way, it can be discussed in the family openly. Your discussion is not so much an announcement as an acceptance of the baby as a future step for the whole family. But try not to overdo the information.

One couple told me that they had discussed the baby-to-be so much and so often that the older child was sick of it by the seventh month. He was tired of being prepared for so long.

Talking about the new baby coming into the family in an accepting way is different from excitedly preparing the older child for a major event. Parents can make it clear the family will “all deal with it together” without dramatizing that “everything will be different and you will have a big adjustment to make.”

Why Shouldn’t We Wait Until He Knows I’m Pregnant?

He may know almost as soon as you do.

Even a young child will notice. Leslie was 2 1/2 and and came to my office for a checkup. He was a handsome curly headed, dark-skinned toddler – the adored child of his lovely parents.

Every time he leaned over in my office, every time he’d lower himself to the floor, he’d let out a soft grunt. I thought that he might be hiding a bellyache or some problem in his joints. I felt his stomach more carefully. No tenderness. I examined his hips and legs. No problem. I watched him walk. Absolutely perfect, even graceful. I kept observing him. Each grunting sound made me more alert and more anxious. No physical signs.

Finally, out of the blue, I questioned his mother: “Are you pregnant?”

“No,” she assured me. A few days later, she called me to say, “I am pregnant. But I’m only eight weeks along. How did you know before I did?”

I was quick to answer: “I didn’t, really. But Leslie did.”

The job for parents is to give a name to the change the child senses, and gradually to make it seem real to the child. You might tell him, “You and Mommy and Daddy are going to have a baby. You can help us with the baby. You’ll be a big brother.”

Then, listen. Don’t keep telling him about the new baby. Wait for his questions. They’ll come.

When he passes a baby carriage, watch his eyes and his behavior change. He may say, “Can I help push the carriage?”

“Of course. You can be my best helper.”

He is already learning about giving. You are helping him discover its rewards. This is, of course, one of the most important lessons a sibling can ever learn.

How Will My Toddler React?

Everyone is talking about the changes that will occur. Of course, an older sibling has his questions: “When?” “Why?” (Aren’t I good enough?) “Will he be like me? Who will take care of me?”

All these questions deserve answers. As you answer, you’ll demonstrate your caring, and help your child “become a big brother.”

What you say may not matter as much as your being available. Your responsiveness is most important. This is a good time for each parent to start planning a regular “date” with the older child. Talk about it all week: “You and I will have our time together later this week. You can ask me all your questions and we can be together by ourselves. You are my big boy now and you’ll always be my first love.”

Labor and Delivery and the Older Child

As the delivery approaches, talk about going to the hospital to help the baby come “out.” Let your child know exactly who will stay with him at home, and who will take him to visit his mother and the new baby at the hospital.

It is a wonderful time for a father or a grandparent to point out that he or she will be there for the older child. One of the most rewarding experiences for me as a father was the opportunity to be completely available for my older daughters – and to have them all to myself!

Toward the end, be ready for the older child to build up excitement, as does the rest of the family. Tantrums, whining, sleep setbacks, food refusal and bedwetting can all be expected. These will arise from his confusion about all the intense anticipation as well as from his awareness of your heightened vulnerability.

The more he does now to share his distress, the easier it may be for him later.

When labor begins, and you must leave for the hospital, be sure to say goodbye. Tell him again that you’re going to the hospital for a few days. Remind him that he can call you, and come to visit. Reassure him again about who will be with him.

Tell him when you expect to come home. Show him on the calendar. All this preparation leaves him with a known structure and expectation. This can protect him from his deepest fear – that she’s “gone off to have the baby” and leave him. This fear is predictable for a young child, but parents can help allay it.

Reclaiming the Crib, and the ‘Big Boy’s Bed’

When parents are expecting a second child, they are often tempted to reclaim the first child’s crib to ready it for the new baby. Don’t.

If the older child is still in the crib during the pregnancy, don’t make him move unless you absolutely have to (for example, if he weighs too much for the crib, or is climbing out and at risk of being hurt). He’s already feeling displaced, and he will only feel more so once the baby is here.

Instead, you’ll have to get another crib for the baby and then wait until the older child really feels proud of being “a big brother.”

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

CONCERN ABOUT LOW BIRTH WEIGHT

by

NEW YORK TIMES COLUMN: FAMILIES TODAY:
CONCERN ABOUT LOW BIRTH WEIGHT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Please help. I am trying to find information on the causes of my grandchild’s low birth weight. She was full term and weighed 4 pounds 7 ounces. I am concerned about the consequences for her growth and development.

Should my daughter be concerned about the outcome of future pregnancies?

A. There are many causes for low birth weight. Some may predict future pregnancies resulting in low birth weight babies, or at least suggest some increased risk for more small babies, while others may be more likely to be once-only occurrences.

Among the possible causes: cigarette smoking during pregnancy, elevated blood pressure, problems with the placenta (which brings nutrition to the fetus’ blood stream from the mother’s), and inadequate maternal weight gain during pregnancy.

The impact of a mother’s health on her pregnancy and her baby’s future is one reason why prenatal care is so important. High blood pressure can develop for the first time during pregnancy in women with no prior history of it, and can be effectively treated, so blood pressure monitoring is a cornerstone of prenatal care.

But since some health issues are evident before a pregnancy and will take more than nine months to address, access to health care for all women of childbearing age is critical for healthy pregnancies and healthy babies.

It will also save a bundle in health care and educational expenses that many premature and very low birth weight babies will need. Six billion dollars per year of our health care costs are spent on neonatal intensive care for premature infants, to say nothing of the costs for special education and other services that premature infants are more likely to need later on. A health care system that fails to care for all women of childbearing age will cost us all more in the long run.

Significant stress during pregnancy has been found to be associated with premature births, and may also be associated with low birth weight in full-term babies since stress in the expectant mother can increase her stress hormones, which in turn can constrict the uterine artery which supplies nutrients through the placenta to the fetus.

A recent study found that mothers who took time off during the last three months of pregnancy were less likely to have premature babies. With only three months of unpaid maternity leave, few working expectant mothers can afford this luxury. Paid maternity leave during the last trimester could reduce the risks – and the costs – of prematurity and low birth weight.

Your daughter’s obstetrician may be able to tell her whether there was any evidence of problems with the placenta or other troubles during this pregnancy, and whether they are of the sort that might be more likely to occur again.

The pediatrician may also be able to help out here. A baby’s length in proportion to her weight may indicate whether low weight is more likely a result of a placental problem late in pregnancy or, instead, whether genetic or other less common causes are involved.

A long, skinny baby (normal length, low weight) is more likely to be the result of a problem with the placenta late in pregnancy: Often they look wizened and worried, and may be irritable and more difficult to soothe. A very “small all over” baby (low weight and length) may have experienced a problem earlier in the pregnancy, for example an infection, or again a problem with the placenta beginning earlier on.

Genetics may also play a role – especially in a baby whose height and weight are low – as a cause for a disorder in the child of which low birth weight is only one feature. In this case there would be other, more specific signs of such a disorder as well. Your daughter can ask the baby’s pediatrician if the low birth weight is a standalone issue or part of a larger syndrome.

As for these and other possible causes of concern for a low birth weight baby’s growth and development, we would hate to see you and your daughter worry about all the possibilities and would instead urge you to ask the pediatrician to review the pregnancy with the obstetrician, and then to watch carefully over her growth and development with you.

If your daughter’s pregnancy was entirely normal and your grandchild is entirely healthy, then chances are good that her growth and development will proceed normally too. But urge the pediatrician to follow closely. Let him or her know that if the baby does need help catching up, you all are ready to get going, the sooner the better.

You may be concerned about the “fetal programming” hypothesis put forward by David Barker which states that conditions during pregnancy can have lifelong effects for the fetus’ future health, and correlates low birth weight due to malnutrition during pregnancy with future health problems. However, it is important to remember that research like Barker’s examines statistical probabilities for very large population samples, and can’t really tell you much about your grandchild. These large studies that predict the chance of one outcome or another in large groups of people can’t tell us which way the coin will flip for any single individual.

Fortunately, you are there to vigilantly watch over this baby’s growth and development, and to help your daughter respond if the pediatrician finds any cause for concern.

Development is such a powerful force, especially in the first years of life. The human brain never again grows and changes as dramatically as it does in infants. In this period it is remarkably adaptive, developing new circuits and pathways to bypass and overcome specific areas that are not able to keep up.

Early intervention – before a child turns 3 years of age – provided by specially trained professionals (speech and language therapists, occupational therapists and physical therapists, for example) can help make the most of the astounding capacity of the very young human brain to recover and grow.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.