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2/25/04
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Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
SECRETS OF BABY BEHAVIORJane Heinig, Jennifer Bañuelos, Jackie Kampp, Jennifer Goldbronn, Luz Vera Becerra, Kerri Moore – Presented by Deborah Schy
Acknowledgement
This work has been funded at least in part with Federal funds from the U S Department ofFederal funds from the U.S. Department of Agriculture, Food and Nutrition Service. The contents of this presentation/publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U Sorganizations imply endorsement by the U.S. Government.The Fit WIC Baby Behavior Study was funded by a USDA WIC Special Projects Grant (2006‐2009).
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Baby Behavior Overview
USDA Fit WIC Baby Behavior StudyUSDA Fit WIC Baby Behavior Study BackgroundPurposeStudy DesignOutcomes
Baby States, Cues, Crying, and SleepTeaching others about Babies!
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
WIC Materials Available Online
All of the study related Baby Behavior l (h d ) dmaterials (handouts, posters, etc.) are posted
on the Fit WIC website (USDA Food and Nutrition Service)
http://www.nal.usda.gov/wicworks/Sharing_Center/statedev_FIT.html
California Baby Behavior CampaignmaterialsCalifornia Baby Behavior Campaign materials available from CA WIC website
http://www.cdph.ca.gov/programs/wicworks/Pages/WICCaliforniaBabyBehaviorCampaign.aspx
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Important Baby Behavior “Secrets”
Babies are driven to learn, socialize, and connect with people around themwith people around themThis instinct is crucial for survivalCan be frustrating when they are unable to do this “job”
Babies always have a reason for the things they dok h hWe may not know what the reason is…
We may not like the reason…But there is always a reason
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Secrets of Baby Behavior
Infant StatesInfant States
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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What is an Infant State?
State: Reflect an infant’s level of arousal and ability to respond to stimuliand ability to respond to stimuli.Groups of behavioral and physiological characteristics that occur together, including: Body movementEye movementBreathing (rate and intensity)Ability to respond
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Barnard 2010
Infant States
Crying
Irritable
Quiet Alert
Drowsy
All babies move through these 6
states…
…but not always in a predictable way!
Intensity
Active Sleep
Quiet SleepCreated by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Crying
Jerking Motions
Color Changes
Tight Muscles
Rapid Breathingg
Takes time to respond
Tears
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Crying is stressful for parents but it is an important communication tool for babies
Irritable
Lots of body and facial movement
Irregular breathing
Resists interaction
Sometimes fussy
Sensitive to what’s going on inside andgoing on inside and around them
Common before feeding
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Babies are driven to socialize and learn and get irritated by distractions or overstimulation
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Quiet Alert
Little body movementEyes open and wideSteady, regular breathingHighly responsiveWants to learn and play interactiveplay – interactiveTiring! This state requires effort to control.
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Moms feel rested, but babies work hard during quiet alert periods
Drowsy
Variable movementIrregular breathingOpen and closes eyesEyes glazedTakes time toTakes time to reactEasily startled
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Babies will give signals when they need to rest. Some babies get irritated when they feel drowsy.
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Active Sleep
Head and body movementIrregular breathingFacial twitchesRapid eye movement (REM)Easy to wake
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Dreaming is important but dreaming babies wake easily.
Quiet Sleep
No body movementRhythmic breathingBursts of suckingStartles, but does not wakeDoes not respond to stimulationHard to wake
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: Babies also need deeper sleep to rest and recover. Babies move very little in quiet sleep.
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Changing States
Babies can move through the states on their own, but sometimes they will need a caregiver’s help moving from one state to another
Use different positions, touch, & wordsWill take longer if very drowsy or in deep sleep
Address the child’s needs – see if change in position or circumstances helpsRepeat actions or words over
Variety to Waken Repetition to Soothe
they will need a caregiver s help moving from one state to another…
p pCan take up to 10 to 15 minutes for very young infants to wake up enough to eat well
pand overMay take time if infant is very upset
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Barnard 2010
Key Messages for Parents
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Sleepy babies need lots of stimulationof stimulation Using the same actions and sounds over and over will calm overstimulated babies
h ld bParents should be patient
Listen for a change in the cry for a few minutes before trying something else
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Secrets of Baby Behavior
Infant CuesInfant Cues
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Types of Infant Cues
Infant cues are specific behaviors (movements, noises etc) babies use to communicate whatnoises, etc) babies use to communicate what type of interaction, if any, they needEngagement cues – behaviors that indicate that a baby wants to interact
Disengagement cues – behaviors that indicate that a b b d hi b diffbaby needs something to be different
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Kelly et al. 2003
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Engagement Cues
Looking intently at face Eyes openoo g e y a ace
Rooting
Feeding sounds
Smiling
Smooth body
yes ope
Face relaxed
Feeding posture
Raising head
Following voice andSmooth body movements
Following voice and face
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Kelly et al. 2003
Engagement Cues
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Disengagement Cues
Turns away Looks awayu s a ay
Pushes, arches away
Crying
Choking, coughing
Extending fingers stiff
oo s a ay
Faster breathing
Yawning
Hand to ear
GrimaceExtending fingers, stiff hands
Falling asleep
Grimace
Glazed look
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Kelly et al. 2003
Disengagement Cues
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Understanding Infant Cues
Infants must learn to give readable cuesN b i fli iNewborns may give conflicting cues
Caregivers must learn how to read their infant’s cuesInteractions can have both type of cues within a short period of time
Disengagement cues are not specific – can be misleading
Over time, both babies and caregivers will learn to use cues to communicate!
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Clustered Cues
Clustered Cues are cues commonly used together to indicate a specific needto indicate a specific needExamples:HungerFullness/SatiationFatigue
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Clustered Cues: Hunger
Clenched fingers & fists over chest & tummyFlexed arms & legsRootingFast breathingSuckingSucking noises/motions
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Message: A hungry baby will give several cues together to alert caregivers
Relationship between States and Cues
Infant’s State
Ability to respond to environment
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Cues infants give to communicate what they need
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Key Messages for Parents
Cues are simplistic d NOT ifiand NOT specificParents may need to “play detective” to figure out what their babies are trying to tell themWhen babies’ cues are not addressed, they “escalate”y
For most healthy term babies, feeding cues are obvious
Secrets of Baby Behavior
Infant CryingInfant Crying
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Crying: Babies’ “Super Power”
Crying results in a sound that affects the nervous system inaffects the nervous system in most adultsDrives adult activity!
Needs to be stressful in order to motivate caregiverM t b l d tMust be loud to rouse sleeping caregiversImportant skill
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
St. James‐Roberts 2001
“Normal” Crying
ALL infants cry Crying is used to communicate needs
Many newborns cry more than older infants as they adapt to their new postnatal environment and struggle to provide readable cues
As adults respond to cues and babies refine their cues, crying lessens – any responsive caregiver can assist in this process
Hiscock H. 2006; Nugent 2007
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Assessing Crying: Challenges
Parents perceive crying as continuous even though babiescontinuous even though babies typically cry in short bursts
Tolerance for crying may influence perceived duration
Ability to calm a crying baby y y g yassociated with parenting confidence
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Green 2001; Leavitt 2001
Why Do Babies Cry?HungerDiscomfort/PainDiscomfort/PainDistressFatigueOverstimulationFrustration Unfamiliar sensationsDistractionsFear
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Hiscock 2006; Nugent 2007
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Is There a “Hungry Cry”?
How can caregivers tell when a crying baby is hungry?g yHungry babies might cry but they will ALSO bring their hands to their face, clench their hands, flex their arms and legs, root, make sucking motions and noisesAll these behaviors together help us know when a baby is hungrybaby is hungryAll hungry babies should be fed!
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Sumner 1994
Caregivers can help crying babies (who have been fed) by:
Promoting self‐soothing skillsLetting babies suck on their hands
Showing their faces to babies
Using “repetition to soothe”Speaking softly over and over
Holding, rocking, stroking the baby over and over
Babies will take longer to calm down if they are very young or very upset Kelly et al. 2003; Nugent 2007
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Persistent Crying: Definition
Persistent crying is sometimes called “colic”Colic = crying for 3 hours/day, more than 3 days/week, for more than 3 weeks, but term is used inconsistently Affects about 20% of the 0 to 3‐month population
“Persistent crying” refers to daily inconsolable crying
P i t t i ti t d it i ff tPersistent criers continue to cry despite caregiver effortsOnly 25‐30% of persistent criers have problems with digestion ‐ obvious signsMedical concerns should be ruled out
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Fox 2001; Hiscock 2006; Armstrong 2000; Keefe 2006
Persistent Crying: Good News and Bad NewsThe good news
95% f i t t i h lth d th i i95% of persistent criers are healthy and thrivingMost persistent crying improves by the time the baby is 12 weeks old (only about 8% continue to cry excessively after 3 months)
The bad newsIt can take 12 weeks before the persistent crier improvesIt can take 12 weeks before the persistent crier improvesNo “standard” solution due to multi‐factorial etiologyPersistent crying is associated with maternal depression and child abuse
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Hiscock 2006; Murray 2001; Douglas 2010
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Persistent Crying: Reasons
Infant is sensitive to stimulationLow threshold or heightened response
Infant can’t self‐soothe or regulate statesInfant can’t provide readable cuesInfant illness, injury, or GI problemsC i i h i f ill bi h i b h iCrying with signs of illness or a big change in behavior should be investigated by the doctor
Parents may need referral for professional helpSt. James‐Roberts 2001; Hiscock 2006; Keefe 2001
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Persistent Crying: Tips for ParentsGet support
Learn about infant cryingLearn about infant crying
Address cues early
Reduce stimulation OR increase repetitive stimulation
Maintain routines (keep stimulation and rest times similar throughout the day)rest times similar throughout the day)
Learn soothing techniques
Know when to take a break
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Keefe 2006; Keefe 2001
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Crying Case Study
Jose is 3 ½ weeks old. His parents report that he cries inconsolably everyreport that he cries inconsolably every evening from 6 to 9 pm then sleeps peacefully for several hours. The rest of the day, he cries only sporadically.
What could be the cause(s)?
What advice would you give his parents?
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Messages for Parents
Crying doesn’t always mean hunger look formean hunger – look for hunger cuesRespond to cuesPredictable crying (like late afternoon) might be overstimulationoverstimulationUse repetition to soothe if baby is still upset after fixing the problem
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Key Messages: Persistent Crying
Parents can be taught soothing techniques, though soothing should not be overemphasizedsoothing should not be overemphasizedSoothing techniques should be tools given to parents as part of an overall strategy to promote positive interactions
Parents often attribute persistent crying to GI issues but
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
other factors are more commonParents need to know more about these factors and coping skills
Secrets of Baby Behavior
Infant SleepInfant Sleep
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Misconceptions about Infant Sleep
Many parents thought babies would either sleep through the night OR wake up all night longsleep through the night OR wake up all night long “Good” babies sleep through the nightIf babies do not sleep through the night, they will “wake constantly”
Goal becomes to “fix” the infant’s sleep “problem,” not to address normal sleep deprivation related tonot to address normal sleep deprivation related to the infant’s need for care in the night
Heinig 2006; UC Davis Human Lactation Center (unpublished); Wolfson 1992
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Infant Sleep States
Active Sleep is Light Sleep Quiet Sleep is Deep Sleep
Important for brain development
Dreaming results in REMImages stimulate brain functionBlood flow to the brain
Important for the brain to rest and recover
No dreaming Memory developmentBlood flow to the brain
is increased, bringing nutrients to active brain cells
Memory development and growth
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Peirano et al. 2003; Barnard 2010; Heraghty et al. 2008; Graven & Browne 2008; Nugent 2007
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Infant Sleep Cycles
Infants cycle through active sleep, quiet sleep, and wakingwakingInfant cycles are 50‐60 minutes long (adult cycles are 90 minutes long)
Total sleep duration varies greatly; in a 24 hour period:Newborns sleep 16‐17 hours
2‐12 month old infants sleep 13‐14 hours
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Heraghty et al. 2008; Peirano et al. 2003; Rosen 2008
Newborn Sleep/Wake Cycle
Newborns start sleep in Active Sleep, dreaming for 20‐30 minutes, and
Wake
move to Quiet Sleep ½ of their sleep in Active Sleep, ½ in Quiet SleepInitially, newborns will wake with each cycle (every 1‐2 hours)
Small stomachs = frequent feeds
Active SleepQ
uiet
Sleep
Small stomachs = frequent feeds
Infants who are sensitive to position changes may wake up easily when put down in Active Sleep
Heraghty et al. 2008; Hoppenbrouwers et al. 1988; Peirano et al. 2003
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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2‐Month‐Old Sleep/Wake Cycle
Infants begin with shorter periods of Active Sleep then move into Quiet Sleep
They start to have longer quiet sleep periods at night
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Parmelee 1964
Older Infant Sleep/Wake Cycle: 3+ months
Sleep patterns become more consistent over timeconsistent over timeMore likely to fall asleep into Quiet Sleep (just like adults)Sleep patterns follow the light‐dark cycleAble to sleep longer stretchesAble to sleep longer stretches during the nighttime
Heraghty et al. 2008; Jenni and LeBourgeois 2006; Peirano et al. 2003; Parmelee 1964
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Longest Stretch of Sleep Increases with Age
2‐6 k
• Able to sleep 2‐4 hours at one time
wks.
6‐8wks.
• Sleep becomes more concentrated during the nighttime as baby is more awake during the day
3 mos.• Able to sleep up to 4 hours at one time, typically the longest stretch will be during the nighttime
Baby’s Ag
e
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
6 mos.• Able to sleep up to 6 hours at one time, 90% sleep 6 hours regularly
Coons and Guilleminault 1984; Goodlin‐Jones et al. 2001; Jenni and LeBourgeois 2006; Peirano et al. 2003; Adams 2004
Reasons for Excessive Waking
Baby’s body is immature – can’t maintain sleep state or tune out stimulationor tune out stimulationBaby is not getting enough to eatIllness or injuryTV in room (or other intermittent stimulation)Caffeine or meds (breastfeeding mothers)Change in routineMay need to refer to MD
Goodlin‐Jones et al. 2001; Barnard 2010; Trachtenbarg and Golemon 1998; Sadeh and Anders 1993; Tirosh et al. 1993; Nugent 2007; Lawrence 2010; Liston 1998
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Infant Feeding and Sleep
Breastfed infants have more Active Sleep More likely to wake up if uncomfortable or need y pparental assistanceReduced risk of SIDS, may be linked to ability to awaken more easily
Promote Active Sleep by putting babies “back to sleep” or using pacifiers (formula‐feeding moms)Breast milk is digested more quickly than formula –g q ybest for development and growthHowever, no significant difference in maternal sleep by feeding method
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
McVea 2000; Horne et al. 2004; Rosen 2008; Montgomery‐Downs et al. 2010
Key Messages: Infant Sleep
Infant sleep patterns change. As infants get older:They sleep for longer stretches
Will be more likely to fall asleep in Quiet Sleep
Encourage caregivers can look for signs of Quiet Sleep before laying baby down
Active sleep and night waking are beneficial p g gBabies wake more easily when in Active SleepWaking may be essential for survival
Dreaming is important for brain developmentCreated by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Secrets of Baby Behavior
Caregiver‐Infant InteractionsCaregiver Infant Interactions
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Basic Assessment of HealthyCaregiver‐Infant Interactions
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Successful Interactions take 3 Steps
Caregiver needs to LOOK at the baby
Caregiver needs to RECOGNIZE what the baby needs
Caregiver needs to know how to RESPOND appropriatelypp p y
Schiffman 2003
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
The UCD approach is a simplification of NCAST intervention
Look
Wh tWhat are some reasons that caregivers would not be looking at their babies?
What environmental changes need to be made to promote interaction?
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Recognize
Caregivers who don’t recognize their babies’ cues will seem frustrated with their babies’ behaviorwill seem frustrated with their babies behavior“She cries all the time.”“She’s constantly hungry.”“My mom says I should just let her cry.”
Parents believe behavior is “random” or “comes out of nowhere”out of nowhere
They may assume that their babies are thinking like older children or adultsThey may be concerned about “spoiling” the baby
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Respond
Caregivers who respond inappropriatelyd l b f d h b bRespond to almost every cue by feeding the baby
Get frustrated if the baby does not react immediately
May result in interactions that make things worseEscalation of cues, crying, and increased stress
Barriers to appropriate responseBarriers to appropriate responseLack of knowledgeLack of confidence, comfort
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Promoting Positive Interactions
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Promoting Interactions
InformInform
ValidateValidate
EngageEngage
The UCD approach is modified from the Newborn Behavioral Observation.
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
RelationshipsRelationships
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Engage and Validate
Say something nice about theSay something nice about the baby (it will be easy!)
Say something nice about the baby’s ability to communicate with that caregiver
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
What to say to parents…
“Aren’t babies amazing, they can to tell us what they want with their bodies and their noises….”Help them see what theirHelp them see what their babies are telling them
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Provide Basic Information: “Recognize”
Describe the cue being given, when it is used and how it differs from other cuesused, and how it differs from other cues
Support the caregiver as she tries to recognize her baby’s cues by asking her to verify your perception or ask for h idher ideas
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Provide Basic Information: “Respond”
Help caregiver check for obvious reasons ‐ diaper, hunger etchunger, etc.
Not obvious? Help caregiver to look for patterns of engagement or disengagement cues to guide response
Play detective to identify reason(s)
Still crying? Repetition to soothe
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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What to say to parents…
“I ’t it d f l th t b b t ll h t“Isn’t it wonderful that your baby can tell you what he wants? Every baby is different but it looks like your baby wants you to….”
Support the caregiver’s efforts to respond
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Teaching Parents about Cues, Crying, Sleep
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Teaching Baby Behavior: Tips and Tools
Timing of messages is importantimportant Consider the needs of your target groupKeep messages simple and immediately lrelevant
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Timing of Messages: Prenatal
Prenatal P ti SlPreparation: SleepTypes & PurposeChanges
Preparation: Crying Crying = communicationImportance of cuesImportance of cues
Newborn behaviorDay 2Limited skills
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Timing of Messages: Postnatal
PostnatalD t il d i f tiDetailed information on cues – can verify with their own infantsCrying – reassuring and referring as neededSleep – emphasize changes and purpose of sleep patterns
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Consider Your Learner
Who are you talking to? P t/ t t thPregnant/postpartum motherFatherOther family members
In what setting?Hospital WIC clinicChildbirth/breastfeeding class
What are the caregivers’ circumstances?Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Keep it Simple & Relevant
Important to provide simple messages (caregivers are often tired and overwhelmed)are often tired and overwhelmed)Messages must be relevant to the caregiver’s needs and concernsWhat do they need at that moment?
More than one source is bestConsistent messaging needed across settings (WIC, nurses, doctors, etc.)More exposure = more learning
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Secrets of Baby Behavior
Newborn BehaviorNewborn ehavior
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Newborn Behavior
UC Davis Study: Maternal Request for Supplementation of Healthy Breastfed NewbornsSupplementation of Healthy Breastfed NewbornsParents were surprised & overwhelmed by their babies’ behavior
Parents were missing important information about BF
Parents had unrealistic expectations about newborns and parenting that resulted in requests for formula as part of efforts to fix their babies’ “problems”Biologically normal behaviors were seen as problems
DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Day 1: The “Good” Baby
Heightened alert state in the first 2 hours followed by longer2 hours, followed by longer periods of sleep (over next 24 hours)
Parents will think: What a “good” quiet, sleeping baby!
And then…
Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
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Days 2 & 3: Everything Changes
Reality Sets in! There i dd h iis a sudden change in the baby’s behavior
Baby expected to be quiet and sleeping, but now…SOMETHING IS WRONG!
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Nugent 2007; DaMota et al. 2012
Days 2 & 3: Crying Increases
Crying seems constant when baby is awake:baby is awake:“We started the formula on the 2nd day…since he never stopped crying.”
“I just wanted to give him formula because he was crying and always awake.”
Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Days 2 & 3: Frequent Feeds
Baby is more alert & wants to feed very frequently:very frequently:“She was feeding every 2 hours and it was wearing me out and I could get a break when she went to the nursery.”
“He was constantly eating like every 45 minutes to 1 hour, I just couldn’t sit there and feed him so I moved him to a bottle.”
Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Day 2 & 3: Little Sleep
Sleep is sporadic & chaotic“She wouldn’t go to sleep but I knew she was still hungry, and then I would feed her a little bit [formula] and then she would go to sleep.”
Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Day 2 & 3: Overwhelmed by Environment
Baby is sensitive to stimuli, often over responsive to theoften over‐responsive to the environment“Every time that I tried to breastfeed, he would have a tantrum, become really angry. So then I thought ‘Why? Why shouldthen I thought Why? Why should I make him suffer?’”
Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Parents are Overwhelmed & ConfusedParents think there must be something wrong with their crying waking babytheir crying waking babySee formula and/or separation from the baby as the solution
May ask for supplementary formula or that the baby be removed from the room
Parents need the facts: why is their baby behaving the way he is? Is this normal?Parents need the information before day 2
DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
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How to Help Caregivers
Help parents be realistic and see value of their babies’ “talents”their babies talents Babies cry & wake for a reason
Let the infant be the guideFocus on cues
Address concerns about cryingAddress concerns about cryingTarget education to support persons as needed
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Newborn CuesNewborns vary widelyAbility to control their bodies
Sensitivity to stimulation
Early cues often confusing
When adults respond to baby cues, babies get better at using cues
Nugent 2007; Poblano 2007Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
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Newborn Engagement
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Newborn Disengagement
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
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Newborn Crying
May seem constant while baby is awake
Sensitive to stimuli, over‐responsive to environmentParents should watch for cuesto prevent overstimulation
Likely to cry when hungry andLikely to cry when hungry andare hungry frequently
Nugent 2007Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Why Bottles “Work”
Bottle = quiet babyB b t llBaby must swallow –can’t make noise“Sweet fluid” on the tongue triggers the sucking reflex
This can be explainedThis can be explained to parents
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
2/25/04
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Newborn Sleep: Day 1
The healthy newborn is alert in the first 2 hours after birth (unless heavily medicated or recovering from a traumatic labor/birth)After this period, a few hours of deeper sleep on the first day helps mom recover and baby to conserve calories while feeding is establishedMost babies struggle to stay awake on the first day, even while they are feedingy, y gImportant to practice feeding during the first couple of hours and each time the baby becomes alert
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Nugent 2007; Peirano et al. 2003
Newborn Sleep: Days 2 and 3
More alert + frequent feeds = Less sleepSensitive to stimuli, wake easily
Sleep is erratic
Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.
Nugent 2007; Peirano et al. 2003
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Promoting Newborn‐Parent Interaction in the Hospital: CuesPromote positive interaction between newborns and parents by helping parents understand theirp y p g pbabies’ cues. If the baby is awake, look for cues.If the baby is trying to engage the caregiver, point out what you see. She is showing you she wants to connect with you. Interacting is hard work so she can only do it for a few minutes before she needs a rest.If the baby is disengaging, point out what you see. She is trying to communicate to you that she needs you to do something for her, let’s see if we can figure out what she needs…
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Promoting Newborn‐Parent Interaction in the Hospital: SleepIf the baby is dreaming, point out what you see:L k h L l ’ lid i th t h iLook how Lulu’s eyelids are moving, that means she is dreaming and her brain is working hard to develop. Lulu will be easy to wake up when she is dreaming.
If the baby is in quiet sleep, point out what you see: See how still Lulu’s face and body are? In quiet sleepSee how still Lulu s face and body are? In quiet sleep, she’ll be less likely to wake up but you’ll see she will start dreaming again very soon because dreaming is so important for her.
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
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Promoting Newborn‐Parent Interaction in the Hospital: Crying
Acknowledge the parents’ feelings and be calm and reassuringand reassuringI know youmust feel overwhelmed when Jack is crying, but Jack is very sensitive to his new environment as well as all the new sensations inside his body.
Empower parents by giving them tools to deal with the baby’s crying and wakingCrying is a very powerful way Jack let’s you know that he needs something. Do you see the cues we talked about?Help the parents use “repetition to soothe” as needed.
Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.
Key Messages for Parents of NewbornsOn day 2, baby will wake and demand feedsdemand feedsLatching takes practice – expect quick improvementMoms feel changes in breasts after discharge
b b hBabies use cues – get better with response
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Parents get overwhelmed if you make baby behavior too complicated
Simplify
too complicatedIdentify cues/signs that the baby is already exhibiting or that parents are most likely to see
Every contact can be a “teaching moment” (use baby as guide)
Promote and support interaction rather than focus on infant developmenton infant developmentConsistent messaging is important