"Why does my baby cry so much?"

“Ayesha doesn't like my breast milk!" the young mother declares. "I guess it's time for formula."

Ayesha had be born two weeks early after a long labor and an epidural which kept mother in bed for many hours. The baby's initial suck was a bit unorganized and she had some jaundice and an elevated bilirubin for a few days.  Though she ended up with a few bottles of formula in the hospital the baby was breastfeeding at discharge.

But today the mother's words are a surprise to the nurse at the community clinic. Exclusively breast-fed three-week-old Ayesha had regained her birth weight in just ten days and was now growing at an amazing, one ounce-per-day. The nurse sees the baby's cheeks filling out, and she is "filling" her diapers with gusto. Why is this mother thinking that her breastfeeding is going poorly?

"She just doesn't seem satisfied," Ayesha's mother explains. After a deep sigh, this young mother adds, “and she seems to be crying much more than she did last week.”

The young mother lifts Ayesha out of her car seat. Ayesha has a startle and moves quickly from the peaceful, Ready Zone, to crying intently. This mother pats her on the head, giggles her on her shoulder, stands up and walks around the room, and talks to her in an energetic (if not anxious) voice. 

Research on breastfeeding demonstrate that this mother's feelings are common: mothers often notice non-feeding behaviors and worry that these are signs of inadequate milk.  In addition, mothers who cannot manage their infants crying are less likely to continue breastfeeding and more likely to develop postpartum depression.  

The nurse remembers that most babies increase her crying at about this age. She also notices that this baby might have been at high risk for Zone regulation issues and be a more challenging baby to calm down. It seems important to help this mother see her baby's ability to calm down with a stepwise approach to comforting.

The nurse is quick to reflect on the normal anxiety every feels when the baby cries more than is expected and is more challenging to calm down. "Most babies cry a bit more at this time in their lives," the nurse says. Maybe together we can discover techniques that might help Ayesha settle down.

"I see that your babyseems to be responding to your voice," the nurse remarks. Many babies like that sing song voice you were just using. With some encouragement the mother leans over the baby and repeats several times,, "I see you are trying to calm down." The nurse encourages the mother to bring the baby's arms to her chest while continuing that sing song voice and it's clear that Ayesha is working hard to respond to her mother efforts.  Next the nurse shows mother how to bring the baby up for a sway and almost like magic Ayeshs takes a big breath and stops crying. 

The nurse describes the behavior she now witnesses“Though she needed your help right now she looks so content in your arms." When you talk to your baby her forehead relaxes, her eyes widen, and her eyebrows go up.” A moment later she goes on, “When you speak, she lifts her face toward yours and slows down her breathing. ” 

Then the nurse invites the mother to watch Ayesha play some baby “games.” the young mother smiles and hands the nurse the baby. The nurse sways her again to bring her to the more fully alert, “Ready Zone.” The baby’s eyes brighten and she looks intently at the nurse's red rattle, held just ten inches from her face. As the nurse slowly shakes the rattle, the baby's eyes follow the toy intently from one side to the other. Her mother giggles and remarks, "She's really smart, I guess!" 

Holding Ayesha near her mother’s face, the nurse encourage the young mother to call her baby's name. Her mother initially gets still when she hears her mother’s voice, and then her eyes seem to shift toward her mother. The mother is delighted to see her daughter actually turn her head slowly in her mom's direction and then notices how their eyes “lock” in an endearing gaze. With a big grin Ayesha's mom lifts her from the nurse's hands and snuggles her face into the crease of the baby's soft neck. One of the mother's hands go to her breast to suppress the unexpected let down of milk. 

Having learned more about Ayesha's remarkable abilities, her mother seems to relax. Now it is easier for her to hear the reassuring comments from the nurse as they discuss normal fussiness in a baby this age and evidence that breastfeeding is goig very well. 

Three months later, Ayesha's mom is a breastfeeding star and an advocate for other new moms. One afternoon she comes to the nurse's breastfeeding class to discuss the challenges and joys of breastfeeding. Cuddling with her baby, she remarks "Don't just count those pees and poops. Learn about the amazing abilities of your newborn and you'll know for sure that your breastmilk is perfect!" 

© HUG Your Baby 2017

HUG Your Baby included in Nurse's PhD Project in Japan

Yasue Ota has just been awarded her PhD in Nursing from Juntendo University in Chiba. We are delighted that she incorporated HUG Your Baby into her PhD implementation project to enhance nurses’ ability to promote mother-infant bonding.

Background: Nurses can play an important role in facilitating mother-infant bonding during the early postnatal period. But often nurses do not meet this goal.  This researcher worked to develop a user-friendly, accessible, web-based training to enhance nurses’ ability to facilitate mother-infant bonding.

Methods: First, nurses and mother-baby dyads were observed. Next, semi-structured interviews with those nurses was conducted, a literature review was performed and the web-based  program was developed. The web-based program included: 1) Completion of HUG Your Baby’s Japanese online program (J. Tedder) to enhance nurses’ knowledge about infants’ behaviors; 2) training in effective communication skills and childrearing support to enhance mother-infant bonding and; 3) review of case studies to apply knowledge and skills to clinical practice. The ICE Model Theory (F. Young) and the Reflective Approach Model (G. Gibbs) were applied to the design of this educational program. The program was pilot-tested with ten midwives at a birth center.

Results: There was positive feedback from nurses about the course’s length, its interest and its level of difficulty.

Conclusion: This comprehensive educational programme for nurses has the potential to contribute to facilitating nurses’ responsiveness to infants and mother-infant bonding during the early postnatal period.

Publication: Yasue Ota, Mari Takahashi (2016). Nurses’ support to facilitate mother-infant attachment during the early postpartum period. Japanese Journal of Maternal Health, 56(4), 618-625.

In linea di valutazione del corso: Aiutare i genitori a prendersi cura del loro bambino

Cinquanta professionisti completato il corso, Aiutare i genitori a prendersi cura del loro bambino.  Ecco il feedback su questo corso.

1.         Il corso mi ha dato utili idee e risorse per aiutare i genitori a capire e prendersi cura dei loro bambini
a.     52% Completamente  d’accordo 
b.     48% D’ accordo 
c.     0% Disaccordo
d.     0% Completamente in disaccordo

2.         Il corso ha aumentato la mia confidenza nell’insegnare ai genitori.
a.     42.3% Completamente  d’accordo 
b.     57.7% D’ accordo 
c.     0% Disaccordo
d.     0% Completamente in disaccordo

3.         Il format online è stato facile da seguire.
a.     57.7% Completamente  d’accordo 
b.     42.3% D’ accordo 
c.     0% Disaccordo
d.     0% Completamente in disaccordo

4.         Credo che i genitori con cui lavorerò avranno beneficio dalla visione del video HUG.
a.     50% Completamente  d’accordo 
b.     50% D’ accordo 
c.     0% Disaccordo
d.     0% Completamente in disaccordo

5.         Raccomanderei questo corso ai colleghi.
a.     50% Completamente  d’accordo 
b.     50% D’ accordo 
c.     0% Disaccordo
d.     0% Completamente in disaccordo

6.         Come ha saputo di questo corso? Da chi è stato consigliato ?
a.     92.3% Dall'AIMI ( Associazione Italiana Massaggio Infantile
b.     3.8% Da un/una college
c.     3.8% A scuola o all'università 
d.     0% Ho ricevuto un email
e.     0% Ho trovato il corso su internet 
f.      0% Altro

7.         Il mio principale lavoro è:
a.     7.7% Infermier
b.     7.7% Ostetrica
c.     0% Medico
d.     7.7% Psicologo
e.     0% Consulente Allattamento
f.      30.7% Insegnante, educatore 
g.     7.7% Educatore pre-natale
h.     12.5% Insegnante Massaggio Infantile
i.      4% Doula
j.      23% Alto

8.         E’ un insegnante di massaggio infantile dell’Aimi?
a.     100% Si
b.     0% No

9.         Per cortesia, utilizzi lo spazio sottostante per  ulteriori commenti. Ad esempio : quale informazione è stata particolarmente utile? Ha imparato qualcosa di nuovo da questo corso? 
a.     L'aspetto che per me è stato più utile è stato il poter vedere le immagini dei bambini riferite ai vari argomenti che si stava trattando.Il corso è strutturato in maniera chiara ed esaustiva.
b.     Conoscere i segnali di sovrastimolazione e come aiutare i genitori a comprenderli e a gestirli.
c.     è stato molto utile capire le variazioni del pianto del bambino nelle diverse settimane successive al parto. Come si modifica l'allattamento al seno e scoprire meglio il passaggio da una Zona all'altra del neonato.
d.     il corso ha rinforzato alcune conoscenze che già ho potuto acquisire in corsi Brazelton
e.     Ho visto modo di fasciare.
f.      Alcune informazioni su allattamento
g.     molto interessante i cicli sonno-veglia
h.     Alattamento
i.      Questo corso è stato molto utile, perchè ha fornito precisazoni sull'influenza degli ormoni, ulteriori strumenti e informazioni per svolgere , in modo più professionale, il mio lavoro di sostegno alla genitorialità e consulenza all'allatamento
j.      Nonostante alcune informazioni fossero già presenti nel mio bagaglio, ho potuto dare una rinfrescate alle mie nozioni ed imparare nuove "tecniche" per aiutare i genitori a prendersi cura del proprio bimbo
k.     della fasciatura conoscevo poco
l.      quella più utile è stata la conoscenza degli stati del pianto
m.   Ho imparato a riconoscere meglio alcuni segnali dei neonati e a trasmettere meglio le mie conoscenze ai genitori.
n.     E' stato molto utile riprendere e approfondire i concetti legati ai segnali del bambino e all'importanza dell'interazione tra bambino e figura di cura. Sono stati utili soprattutto i filmati.
p.     Sono state molto utili le informazioni sull'allattamento e sul ruolo fondamentale dei genitori nel cogliere i segnali del proprio bambino.
q.     Ho trovato molto interessante e ben fatta la II lezione sui ritmi di sonno e segnali di sovrastimolazione.
r.      La parte dell'interazione genitore bambino
s.     Mi piacerebbe poter scaricare i video e avere le slides mostrate nei video
t.      all'interno delle mie lezioni di massaggio infantile, per dare ai genitori la possibilità di
u.     il corso ha sollecitato in me la curiosità di approfondire il tema sulla regolazione delle zone e trovo sia un modo semplificato per spiegare gli stati comportamentali ai genitori