Dr. Spock's the First Two Years: The Emotional and Physical Needs of Children from Birth to Age Two

READING YOUR BABY’S CUES

Babies can express their feelings and needs in many ways. Learning to read your baby is very important, especially for parents who want to respond to their baby’s needs appropriately. Crying is a major source of communication that the newborn baby has. So in one way, it’s a very healthy sign that your baby can cry and let you know that he needs you. The bond between the parent and baby may be deepened if parents are sensitive to their baby’s cries, gestures, and behavior in general.

I feel that it is very important to learn to listen to your children. You can learn to listen to your baby even at its very early age. Listening means focusing your attention, not in a worried way, but in an observing manner. You want to learn what your baby wants and needs. You can read books and articles but the main way you will learn about your baby is to be observant in a meaningful way. That means spending time looking and listening to your baby, not just feeding and cleaning him, and putting him to sleep, but also keenly focusing your undivided attention to him. And then trusting yourself. Because you do know more than you think you do.

Crying: An Early Form of Communication with Parents

The first signal you’ll get from your baby may be a cry. In the early weeks this will probably come when the baby is hungry and later will include not only being hungry, but also being wet, or uncomfortable. If your baby cries during the first few weeks, then you can respond by feeding her without a fear of spoiling her. She may be hungry before her feeding time, but that’s okay. In the early weeks, the baby will need to feed often and may or may not go by any set schedule. Let your baby be the guide as to how often she needs to feed.

She may also cry if she is uncomfortable and needs to burp after a feeding. You can gently pat her on her back as you put her over your shoulder to see if she can burp up any air she may have swallowed during feeding. You should trust your own instincts, and watch for a pattern in the baby’s crying. You will soon learn to “read” your baby’s cry, and distinguish a cry of hunger from a cry of pain.

Some babies cry more during the day, others at night, and some cry without regard for the time of the day or night. Patterns of crying among individual babies often reflect the baby’s own “temperament” — her emotional reaction to a new situation, her activity level, and attention to people and things around her. Many of her emotional responses are a reflection of the way her unique brain has been “wired” to respond to different situations. I have found that many parents learn to respond to their baby with greater comfort when they know about different patterns of crying.

Baby Colic

When a baby cries regularly in the late afternoon, or evening, and cries about the same time everyday, we call it colic. Most colicky babies cry for over three hours in each twenty-four hour period. The colicky baby appears to be in pain with a distended tummy and gas. Colic usually starts at about two to four weeks of age and will last during the first three months, then will go away. The crying in some colicky babies begins after the feeding when they may have been either overfed or underfed. Extended crying before the feeding is seen with a hungry baby. A baby with colic gains weight at the expected rate and has a normal examination. Colic can occur in both breast-fed and bottle-fed babies.

Most parents feel very guilty and think they are doing something wrong. When your baby’s clinician has examined your colicky infant and found nothing abnormal, you can be assured that your baby is healthy.

Changing the formula rarely helps. Use of caffeine drinks or lots of chocolate by a nursing mother may cause excessive crying; eliminating these foods decreases the crying. Occasionally, the colic may be a sensitivity to proteins from cow’s milk consumed by a nursing mother; before eliminating milk in their diet, nursing mothers should consult their baby’s clinician. In many cases, offering a pacifier will be helpful. And you may find that the baby is more comfortable on her stomach. Other colicky babies seem to be comfortable being picked up, held, rocked calmly and quietly, or being placed in a crib with a light blanket wrapped comfortably around the body. Some babies are colicky as a result of too much stimulation in the home. Less noise, quiet soothing music and being careful not to overstimulate your baby will be helpful. The soothing noise of a hair dryer or vacuum cleaner placed near the baby’s crib will settle some colicky babies.

Remember, you don’t have to be afraid of spoiling the baby by picking her up at this age. An older child may become demanding at a later age, and use crying as a way to manipulate his parents to get what he wants. But a young baby during the first three months of age is not spoiled when he cries. He is crying because he needs something, not because he wants to control his parents. (That comes at a later age.) You can take a baby’s early cries as a genuine cry of distress and discomfort, and respond without any fear that you might be spoiling him.

Periodic Irritable Baby

A baby who regularly cries at a certain time of day (usually late afternoon or evening), and is not distended (as is the colicky baby), is called a periodic irritable baby. Usually this crying will correct itself after three months of age. The baby does not seem to be in pain, and her cries are usually less painful than with colic, but still at a regular time.

You may find that the periodic irritable baby can benefit from being held, or walked, or rocked. She may be comforted by another feeding. Or simply a pacifier in her mouth will give her comfort.

Fretful Baby

A fretful baby is one which is fussy off and on during the day or night. She doesn’t cry at any regular hour, she doesn’t seem to be in pain, and usually her tummy is not distended. Your fretful baby may have a harder time adjusting to a schedule. Usually they fuss the first three months, but soon become adjusted to the outside world and calm down later. It seems their nervous system as well as young digestive system have a period of adjustment the first three months.

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Cries of Hunger

Hunger is the most common cause of crying in the early months. The baby has no other way to communicate his needs to eat except to cry. He may be hungry if he nursed at only one breast or took only half of his formula during the last feeding. He may wake up crying if he has outgrown his formula or his mother’s milk and needs more to eat as he grows. He may want to be fed more often during certain hours.

You may be on a regular four-hour schedule or you may be feeding according to his desires. In any case, you should not try to feed the baby every time he cries. Try to wait a few minutes, or use a pacifier, if it’s just two hours or less since the last feeding. If it’s been longer than two hours, or if the last feeding was incomplete, then you may want to feed sooner.

Hypertonic Baby

A hypertonic baby is very jumpy and doesn’t relax well. This baby is bothered by sudden movements, loud noises, and sometimes is very uncomfortable in a tub bath. She may also have symptoms of colic or periodic irritable crying. If you suspect your baby is a hypertonic one, then she may be comforted by swaddling her in a receiving blanket. She will enjoy a sponge bath more than a tub bath. And you will want to keep the noise down. And have few visitors and the least amount of sudden movement for her.

Crying Associated with Diaper Rash and Teething

Some babies with more sensitive skin will cry when they are wet, especially if they have a sore bottom or a rash. If you think that your baby’s crying starts up when she is wet, the diaper may be changed as soon as the baby wets it. Even disposable diapers, although they are more absorbent than cloth diapers, should be changed to prevent skin irritation if you discover that your baby settles after a change.

When fretfulness and crying are associated with drooling and biting, your baby is communicating signs of teething. The behaviors associated with the eruption of baby teeth may take place from the age of three or four months until two and one-half years of age. The baby will want to put things in his mouth: his fist, his toys, or anything he can put his hands on.

It’s good to recognize the signs of teething because it goes on for several years. Healthy babies respond to teething in dramatically different ways. Some babies manage teething without much fretfulness. Others may be very wakeful during teething.

You might want to provide some safe chewable objects such as rubber teething rings. (Be careful that the toys you provide aren’t thin brittle plastic which can break off and be swallowed.) You may find that rubbing the baby’s gums is soothing. Some teething can also cause loss of appetite and crying during the night. A brief nursing can sometimes put the baby back to sleep.

Responding to Your Baby’s Cry: A Few Specific Suggestions

There are a variety of ways you may want to respond to your baby’s cry. Babies are different in their response to different interventions by parents. Through practice, you will learn about your baby’s response to different kinds of treatments at home.

1. Go to the baby and pick her up. And you can do so without fear of spoiling at this early age.

2. You may already know that she is hungry, and offer her the breast or bottle. If she has just recently had a feeding, you may offer her a pacifier and postpone the feeding for a while.

3. Some babies will benefit from walking or gentle rocking and go back to sleep. Others will calm down if they are wrapped or swaddled in a blanket.

4. Some parents take the baby for a walk in the stroller or a ride in the car.

5. If the baby seems in pain, then you can try placing her on your knees and use a gentle jouncing.

6. If you are very careful to use warm and not hot water, you can place the baby on a warm water bottle with a diaper or towel for protection.

7. You may use music or sing to a fussy baby.

Though no research has yet revealed the cause of fretfulness or colic, speculation has focused lately on the contrast between traditional societies in developing countries in which there is nearly constant bodily contact between mother and infant and very little crying, and our industrial society in which the infant is insulated from mother in a crib and, as far as possible, from sounds, in a separate room. This suggests that parents should not be worrying about spoiling in the first three months but should try carrying the fretful or colicky baby in a canvas or cloth carrier, or swinging her in a mechanical swing or be treating her to music, not just when fussing but during much of the day.

It’s best if you don’t exhaust yourself. Your baby may be fatigued also. Just remember that babies usually grow out of this crying period after the first three months. And you shouldn’t blame yourself, or feel guilty, if your baby has any of these crying characteristics. You should be better able to understand your baby’s cries after some careful listening and more experience.

Is the Baby Sick?

Usually a baby can become very irritable just before coming down with a cold or an infection of some kind. You can take the baby’s temperature, and if there is a fever, then report this to your doctor. The baby may have a runny nose, a cough, loose bowel movements, vomiting, or other symptoms. This crying is different since it has these other symptoms to go along with it. You should watch your baby closely for any changes in the stools, or changes in temperature, or changes in eating habits. You should report all of these symptoms to your doctor, who will advise you as to how to take care of your baby.

Sucking

Babies love to suck. They suck not only for feeding, but for the pure joy of sucking. You may observe this vigorous response immediately after birth when a baby is breast-fed while its mother is still on the delivery table.

The best way to satisfy your baby’s sucking needs is to provide a long enough feeding time to satisfy not only hunger, but also the need to suck. Breast-feeding usually takes care of this problem if the baby is allowed to nurse until he is satisfied. Usually twenty minutes is enough time to satisfy both hunger as well as sucking needs. If you bottle-feed, make sure the holes in the nipples are not so large that the baby finishes the milk in say ten minutes, but hasn’t had a chance to satisfy his sucking needs.

Sucking helps babies relieve physical as well as emotional tension and can calm a fretful baby. Sucking the thumb sometimes helps a baby satisfy this need and should not be denied. You might have seen your baby suck her thumb at the time of an ultrasound examination during pregnancy! Some parents find a pacifier is satisfying and will discourage thumb sucking. And the pacifier can more easily be given up at age three to four months than thumb sucking. There are some fussy babies who seem more alert and tranquil when sucking a pacifier during the first year of life.

If you are nursing and choose to offer your baby a pacifier, wait a week or two until the baby has learned to nurse effectively. When some nursing babies are given a pacifier in the first few days after birth, they may find it difficult to learn to suck at the breast.

Reaching Out

If your baby reaches out for you, then she probably wants you to pick her up — and this doesn’t mean that you are spoiling her. She needs to have contact with you during these early months by picking her up, holding her, gently rocking her, talking to her, or walking her.

If she holds her arms out to you, with or without crying, she needs to be responded to — and all parents will want to respond to the outreaching arms of their baby. Sometimes this reaching out may come in the middle of changing a soiled diaper, and this could delay your response somewhat. But this is only temporary and won’t cause her to become upset if the baby knows that you will eventually respond to her.

Kicking Legs

If your baby is kicking his legs in glee in the bath, and smiling and cooing, then you can rest assured the baby is enjoying his bath. Your response can be to continue his bath and let him play in water. Some babies kick when they feel excited, such as anticipation of the upcoming feeding. Usually the kicking is also joined by hand waving and head movements.

Some kicking also may occur when the baby is crying or fretful. I’d say the kicking alone is not enough to say what kind of response is necessary. It would depend on what else is going on with the baby. Is she crying and kicking, or smiling and kicking? Does she enjoy kicking? If so, then no response is necessary.

Grunting

Some signals or signs may have no particular meaning, or mean different things at different times, depending on what else is going on with the baby at that particular moment.

For example, most babies make grunting sounds occasionally. These are squeaks or throat-clearing sounds. She may be listening to her own sound and enjoying it. She may be imitating your voice. She may be grunting with pleasure. At another time her grunts may be with stomach pain or a wet diaper. I think in this case you would want to see how your baby is in general — not just go by the grunt alone. She will have an expression on her face which also should give you a clue. And she may grunt in her sleep, as if she were dreaming; or she may happily grunt when she is awake and anticipates being fed. Each time would mean a different response from you, depending on the circumstance. At about two months of age, she will develop a cooing sound which comes from the back of her throat; this is the first real sign of her learning to use language.

High-pitched Squealing

When babies first realize they can make a sound, they may repeat it over and over with glee realizing they have made this wonderful new noise. Some babies will make a high-pitched squealing sound, and listen to see if they can do it again. The high-pitch seems to excite them, and what makes it more exciting is when the parents respond. A happy baby can entertain themselves endlessly by producing these early pre-language sounds. These sounds often do not require a response. Some parents enjoy repeating the sound themselves to keep the baby company in her search for verbalizing in a nonverbal way. Just noticing and talking back, and showing your appreciation is enough in most cases.

The Parent’s Response

Most parents are thrilled when their babies begin giving signs of being more grown-up. After weeks of mostly sleeping and eating, your baby will begin making sounds and gestures that may indicate the baby’s disposition.

The main thing to remember is that any response that you give is appreciated by the baby. When parents smile, talk, and pick up the baby, then the baby learns to give more of these signs and develops others. The main thing is to give attention in a loving and kind manner, rather than focusing on how to analyze every squirm. The analysis of every signal is less important. The fact that you are there and that you are eager and excited about your baby’s behavior, and you show it in your expressions and tone of voice, is more important. If you are too worried about how to figure out every grunt or gesture, your worry will overshadow your warmth, tenderness, kindness, and excitement. Your enthusiasm to any response will be more valuable than the exact “what exactly did you mean by that?”

Happy to Crying

Babies can go from being happy one minute to crying the next. And they can stop crying and be happy again just as quickly. Their moods can vary from one moment to the next. It’s good to know that your baby’s sadness at one moment can be changed so fast if you observe and see why she is sad. Some babies will be happy the second they feel relief from their hunger. Others can be screaming one moment, and instantly stop as soon as you pick them up. They have a tendency to turn on the sobs when they can’t communicate any other way. But they are easily satisfied as soon as you respond appropriately. If they can switch so easily from one mood to another, then you can take advantage of this, knowing she will forgive you easily for putting her down to change a diaper. As soon as you respond, she will give you instant feedback if your response has been the right one.

Enjoy Your Baby

The main thing to remember is to enjoy your baby. All of the cooing, grunting, pre-verbal sounds, and other means of communication are wonderful ways to enjoy your baby. You can easily instill in her a sense of self-enjoyment by showing your own enjoyment at all that she does. A baby will get the sense that she is worth noticing and is loved. She will feel good about herself and gain self-confidence even at this early age, if you give her the response that she needs. Just being there for her is the first and best response. The more you are with her, the more you will learn how to read out her signals and respond accordingly.

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