Katie ImborekKatie Imborek, MD  

Fussy babies can make life miserable at times. So what can parents do? Several University of Iowa Stead Family Children’s Hospital doctor teach moms to stimulate baby’s calming reflexes for better sleep patterns and happier wake times. Among them are family medicine specialist Katie Imborek, MD, and clinical pediatrician Dayna Miller, MD.

“Our teaching tools include baby dolls as well as hands-on demonstrations with fussy babies,” Imborek says. Specifically, she and Miller use “Happiest Baby on the Block” principles developed by Harvey Karp, MD, a best-selling author/pediatrician at the University of Southern California.

The premise is that babies are born three months early, but with good reason.

Dayna MillerDayna Miller, MD  

Imborek and Miller explain it this way:
Our brains are so big and thus our head is so large at birth, that it becomes dangerous to wait any longer than nine months. The average size of a baby’s head at birth is nearly two thirds the size of an adult’s (it would be like giving birth to a baby that was three feet long and weighed 80 pounds!). At nine months, a baby’s brain becomes so big it becomes dangerous to wait any longer. Indeed, all babies are born with amazing survival reflexes like sucking, grasping, and crying. However, it is not until they are four months old that they finally become skilled at cooing, laughing, sucking their fingers, and other self-calming tricks. The calming techniques proven to be effective in the first three months are successful because they simulate the environment of the mother’s womb.

Five ‘S’ techniques for fussy babies:
On average, infants in the first three months of life are fussy for 60 minutes per day. There are some infants that seem to be more sensitive to this new world that they have entered too early, and may cry even more and be labeled as “colicky.” Colic starts at week two, peaks around week six and usually ends by three months. The most widely accepted definition for colic is a baby crying or three hours per day for three days per week for three weeks in a row.

Colic and fussiness are the results of this “missing fourth trimester.” Babies with challenging temperaments can throw themselves into spirals of crying and carrying on. They do not become proficient at self-calming techniques until four months of age when they start effectively and reliably cooing, laughing, and sucking their fingers.

Until then, there are specific calming techniques that, if done properly, can help infants calm down and sleep. “There is always concern for spoiling your baby,” Imborek says. “We all know of children who are spoiled and vow that our children will never be. I am sure that you have heard the stories of babies wanting to be held more after Grandma spends a week with them and gets ‘spoiled’ by the constant attention. But there is no evidence a baby can be spoiled at such an early age. They cannot differentiate between need and want at this stage. It is not manipulation; they NEED you to help them transition to the time they can calm themselves.  The best way is to recreate the place they so comfortably lived for the previous nine months, the uterus. It was a warm, snuggly, loud, bouncy place where they had food 24 hours a day. With a few tricks, you can make your baby feel as safe and secure as she did inside your belly. The secret of imitating the uterus is by performing all 5 S techniques in the correct order, and the proper manner. Together these actions turn on the calming reflex.

1) Swaddling
Swaddling is a time-tested trick known to soothe babies. The purpose of the swaddle is to mimic the tight confines of the womb that surrounded the baby for 24 hours a day until he was born.  This doesn’t by itself trigger the calming reflex, but keeps that baby from flailing and allows the other S techniques to work. During the fourth trimester, babies cannot smoothly control where their arms and hands are in space. They cannot reliably bring their hands to their mouths to suck on their fingers. Their erratic movements can actually cause them to wake themselves up and contribute to the cycle of crying once it has started. Although many babies may resist swaddling in the first few moments, they will usually calm down after they have been swaddled. Swaddling can be done with a blanket, as long as it is done tightly and correctly to keep the baby safe from loose blankets. Another option is a Swaddle Sleep Sack with velcro. This is available in many stores.

2) Side/Stomach position
One of the reflexes babies are born with is the Moro or startle reflex. When a baby is on her back, a number of seemingly insignificant stimuli can cause her to startle and fling her arms out to grab onto you as if she is being dropped. By putting her onto her side or stomach, it turns off the sensors in her brain that cause the reflex to occur and helps her calm down. There may also be some additional calming that occurs when there is pressure against the baby’s tummy. There are a number of ways to do this, including holding the baby in similar positions as if the baby was being breastfed or putting the baby up to your shoulder. This step in the calming reflex is important to get babies to break the cycle of fussiness. However, it is vitally important that once they are calmed and ready to be put to bed, they should only sleep on their backs to prevent Sudden Infant Death Syndrome (SIDS).

3) Shhhhing your baby
The uterus was a loud place for your baby. The volume was 80 to 90 decibels, which is even louder than a vacuum cleaner. The constant and rhythmic whooshing of the blood flow in the uterus is in stark contrast to the excessive quiet that we enjoy when sleeping. Just like babies can cry with over stimulation, they can also cry from under stimulation or sensory deprivation without the noise and volume they were accustomed to.  To shush your baby, place your mouth close to his ear, two to four inches away. Purse your lips and make a shushing sound.  Raise the volume until it matches the noise of the baby’s crying.  As he quiets down, you can as well. This should work quickly, however if he needs constant shushing to really do the trick and help him fall or stay asleep, you can try a hairdryer, vacuum cleaner, bathroom exhaust fan, white-noise machine, CD with recorded sounds, radio or baby monitor static

4) Swinging
Swinging mimics that constant motion that your baby was in while in your uterus.This is why parents have stories about taking car rides at 3 a.m. or putting the car seat on top of the dryer to get the baby to finally sleep. There are a number of ways to use motion to calm your baby, including baby slings and carriers, infant swings, rhythmic pats on the back or bottom, rocking in a rocking chair, vibrating bouncy seats, bouncing on an exercise ball, etc. The key to all of these is to start out fast and jiggly with small movements, not more than two to three inches each way.  Ultimately, this works because of the activation of motion sensors in the baby’s head, so it is important that the head jiggles more than the body. When holding your baby usually in a side/stomach position, allow your hands to relax around his head so it wiggles ever so slightly back and forth, like gelatin quivering on a plate. Similar to the Shusshing sounds, you have to match your baby’s vigor and follow his lead. The harder he is crying, the faster and more vigorous that you jiggle. This is often a technique that is difficult for parents because on the one hand we have discussed how vulnerable newborns are in the fourth trimester, and now for the calming reflex to work properly, you have to use more force than you would expect.  For parents who have never done this, often there is concern about shaken baby syndrome.  The difference is that the jiggle is tiny. His head moves no more than 2 inches from side to side and always stays in line with his body. Shaken baby syndrome is the result of a severe whiplash injury where the head goes in one direction when the body goes in another. That being said, if you are angry and out of patience, never shake, or even jiggle your baby. The safest place for him is crying in his crib while you take a 10 to 15 minute break.

5) Sucking
Sucking is the technique that finally lets your now-calming baby to drift into sweet dreams.  Sucking is one of the powerful reflexes that he is born with to survive. He uses this reflex to eat up to eight to 12 times a day. And he also uses it as a self-calming tool. Eventually, by four months of age, he can finally direct and keep his fingers, and anything else he gets his hands on, to his mouth.  But in the fourth trimester, a pacifier will be an easier tool to use to help him calm down.  It is best to wait until breastfeeding has been well established, at least two to three weeks, until starting the pacifier.  Usually this is not a problem, as these first few weeks are not prone to colic.  One of the frustrations that parents often have with the pacifier is that newborns find it very difficult to keep the pacifier in their mouths.  The trick to teaching him to keep it in his mouth is by tugging on the pacifier slightly 10 to 20 times a day when he is calm.  This will encourage him to suck harder to keep it in his mouth and train him to keep it in their mouth for longer periods of time.


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