Scary? Yes (and I’m not just talking about the contents of those nappies or diapers!). There are three events that you may experience as a parent that, while harmless, may scare the living daylights out of you. They are:

• Breath holding episodes
• Reflux and choking
• Febrile convulsions

In the next 3 blogs I will address each of these frightening occurrences. Firstly… episodes of breath holding.

A provocative stimulus, such as a fright or unexpected pain, may cause your baby to hold their breath. It will generally go like this:

• Your baby will cry vigorously
• They will expel all of the air from their lungs
• Your baby will hold his/her breath and go blue

And if that isn’t scary enough for you…
• They may lose consciousness and have a short seizure

Sounds dreadful doesn’t it? And if you have experienced one of these episodes with your baby then you’ll agree it’s mighty frightening.

Babies and young children (up to about 4 to 6 years of age) may experience an episode of breath holding and if they hold their breath long enough to pass out it will be frightening and worrying for all. The good news is that any loss of consciousness will immediately cause your baby to stop crying and breathe again. (Phew!)

Can I reassure you that episodes of breath holding are, by and large, harmless and will not result in any long term complications. A panic attack for you, yes, but harmful to your baby, no.

As breath holding more commonly occurs in your presence, you will undoubtedly feel compelled to do something (who wouldn’t?). However, apart from maybe rolling them on to their side, you really need take no specific action. One again, there is nothing to worry about as no baby or child is able to consciously hold their breath long enough to cause any harm.
While I hope you never witness a breath holding episode with your baby, can I reassure you that if you do, your baby will be fine. Always seek medical advice if you are unsure or need reassurance (there’s more good information from the Royal Children’s Hospital here) but remember that breath holding is harmless and will cause not complications (other than your jangled nerves!).

It’s certainly been my experience as a Pediatrician that maternal depression highly correlates with infant irritability. A recent study published in Acta Paediatrica, “Infantile colic, prolonged crying and maternal postnatal depression” provides evidence supporting that association. To read this abstract, you can click here now.

I often wonder which comes first?

Does prolonged infant crying result in maternal postnatal depression? Could a mother’s low mood affect the temperament her baby? My view is that there is an interplay between the two. This research does conclude that “Both infantile colic and prolonged crying were associated with high maternal depression scores.” It is also true that depressed parents perceive their baby’s irritability more sensitively and intensively.

Correlation certainly does not mean causation, but in clinical practice I find that the best outcome is achieved by managing both the depression and the infant crying. Postnatal depression can be managed with:

• early recognition and diagnosis (even in the 21st century, postnatal depression may remain undiagnosed)
• practical and emotional support
• good nutrition, sleep, exercise and fresh air
• psychotherapy
• group meetings with other parents and a health professional expert
• antidepressant medication

Excessive infant irritability (crying for at least 3 hours a day, for at least 3 days a week and for at least 3 weeks) requires:

• a thorough health assessment by an infant nurse or doctor
• checking for an possible underlying physical disorder such as a urinary tract infection, inadequate nutritional intake and protein allergy
• using a variety of simple settling strategies such as SMS your baby (Sounds, Movement, Swaddling)

The good news is that both prolonged infant crying and postnatal depression are manageable. Both will improve with treatment, simple settling strategies and time.

PND and infant irritability are both common issues and remember:

• they are not your fault…you’ve done nothing wrong, and
• you are not alone.

Wonderful again this morning to have the opportunity to speak out about Dad’s and Post Natal Depression thanks to Today.

As I’ve previously blogged, it seems we have understated the effect of birth on fathers. Click here for the recent blog on new fathers and fussy babies.

So far just about all of us have heard of maternal postnatal depression (PND). However, we have little awareness and recognition of paternal stress and depression. My survey results highlighted the anguish and pain for fathers (as well as the delight, joy and love).

• The incidence of maternal PND is around 14%    Men may suffer from psychological distress after childbirth and birth-related PND is not a rare condition. Research findings here.
• The incidence of paternal PND is around 8%   
• We also know that in families in which mum has PND; fathers have about a 1/3rd likelihood of being depressed as well. Not a good combination!  
• PND can be serious. Even life threatening.   
• Dads generally don’t understand maternal PND (nor do mothers if it remains undiagnosed). As a result it can be difficult for dads to be appropriately supportive. Even the best fathers/husbands can become critical and judgmental of their depressed partners
• Dads like fixing things. They don’t get that PND can’t be fixed immediately. Dads feel powerless and helpless
• Crying, colicky, irritable babies feed in to this  cycle, causing frustration, loss of self confidence, and sleep deprivation   
• Dads don’t know how to deal with the unsettled, crying baby. If the baby is breast fed, what can the dad do to help?  

There are a number of tools out there and solutions are available:

• for us all to be aware of the problem. Research supports including fathers in strategies related to infant settling. An intervention/prevention approach to infant behaviour problems should include fathers
• the Australian Government has shown awareness of maternal PND with a $55 million 5 year program, including routine and universal screening.
• Information and awareness – October is Beyond Blue’s Anxiety and Depression Awareness Month
• better family and community supports with higher recognition of the issue of PND  
• less stigma associated with negative  parental-baby experience/depression  
• even better training of, and awareness by  Obstetricians, Midwives, Paediatricians, GP’s, Child Health Nurses   
• strategies and tools (dads love tools!) to settle a crying baby.   Research supports including fathers in strategies related to infant settling. A simple tool, Sounds for Silence can help mothers and fathers settle their baby. Demonstrated here and here.
• good non-judgmental individual or group counseling   
• medication

Dads’ distress and powerlessness has always concerned me. I’m pleased to  continue to highlight PND and fathers. The task of making life easier for parents should never be abandoned!

Good question!

Last blog on tired signs, Annabel asked how much sleep should she expect her 9 week old to have? While specific advice is not possible in this format, there are some guidelines which can help parents figure out the answer to this all important sleep-question for their baby.

As a general rule, the following can be expected for how much sleep a baby may need:

• A newborn baby, in the first 2-3 weeks, will generally require 16 – 20 hours per 24 hour period. Feeding and sleeping are more predictable at this early age, but after 2 – 3 weeks things usually get tougher.

• After 3 weeks parents often find their baby sleeps less (approximately 16 – 18 hours) and cries more.

• 6 weeks may see your baby sleep around 15 – 16 hours each day.

• By 4 months babies may sleep 5 – 10 hours plus 2 naps of 2 – 3 hours each.

• A baby of 6 – 7 months can sleep through without an overnight feed, giving you anywhere from 6 – 12 hours, plus morning (1 – 2 hours) and afternoon (1 – 2 hours) naps.

• By 9 months the average sleep can be 11 – 12 hours overnight plus 2 naps, and by 12 months babies may sleep 12 hours with 2 daytime naps that may be shortening.

As you spend more time with your baby, you will understand more about your baby’s individual sleep needs, tired signs and patterns. It is useful to establish a routine for regular settling and sleeping. A Sleep Chart can help to get this started. Free here.

Remember, a fussy baby is extremely common… and when you are awake in the middle of the night with your baby – at 3 weeks old, 9 months or 19 years old – you are not alone! 

While babies cannot talk, when it comes to their most important requirements – the need for food, comfort and lots of sleep - they can communicate very clearly!

Ask any parent and they will tell you their new baby was soon able to tell them what they needed and when! Even the very youngest of babies can communicate when they are tired and need to sleep. And, no, it’s not necessarily through crying.

Most babies give quite clear signs and signals that they are tired. For new parents, recognising your baby’s tired signs is an important skill that will help you get your baby off to sleep with little fussiness.

Common signs young babies are tired include:

·         Changing facial expressions – relaxed to grimacing

·         Frowning and looking unhappy

·         Looking away from you or staring into space

·         Rigid, Jerky or tense arm, hand and leg movements

·         Fists clenched

·         Rubbing eyes and ears

·         Yawning

·         Crying, fussing, being unsettled – this is a late cue! Sometimes too late…

Early tired signs may be subtle and easy to miss. Certainly not as obvious as being completed unsettled, fussing or crying, crying, crying! Watching your baby and understanding their tired signs will help you know when it is best (and easiest) to put them to bed.

For babies, being tired and needing sleep is not just about the length of time they have been awake, so the signals that your baby gives you are a helpful and reliable cue that sleep is near! Observe your baby, trust your own knowledge and read the signs your baby is giving you.

When your baby shows some, or all, of the tired signs listed, it is sleep time! Some babies settle best when put to sleep at the first sign of being tired (such as staring into space) while others will need to be a little more tired before they are ready for bedtime. Trust yourself that you will learn and know your baby’s tired signs best.

Both you and your baby will be pleased that when they have ‘spoken’ about their tiredness, you have listened!

Baby with colic? High needs baby, crying baby, unsettled baby? Fussy baby? How do I soothe my crying baby? Baby not sleeping, helping my baby sleep, sleep deprived parents…

I could go on, but really it does not matter. Regardless of what label you put on it, or how you shape the question, this issue is the same. A fussy, crying baby is extremely common and for parents, this is hard, hard, hard.

Infact, infant irritability (excessive crying, colic, being unsettled) and sleep problems (difficulty settling, will not sleep, short sleeps) are two of the most common issues for which parents seek advice from their health professional. Almost all babies will have unsettled behavior at some stage and this presents an exhausting challenge for parents. Even so called ‘good sleepers’ will have fussy times. It’s true that if you are a parent pacing the floor with a crying baby, you are definitely not alone!

So how can we help? What do parents of fussy babies need? As a Pediatrician and father of four children all of whom cried alot as babies, I believe parents need uplifting reassurance as well as expert information. When it comes to matters of unsettled babies, there is much to be said and a wealth of useful (and not so useful) information to be sought. In fact, sometimes there is too much information! Complicated, contradictory and judgmental information. And so I have set myself a challenge…

To blog as many issues to do with sleeping, crying and fussiness as I can think of! Simple, clear, credible and relevant blogs just for parents. Here’s my list so far (but please let me know what you want to know):

·         Crying and colic (the causes of crying; controlled crying; myths about fussiness; excessive crying; managing colic…)

·         Settling issues (settling and burping; safe sleeping)

·         Sleep solutions (using a dummy or pacifier; crying babies and medication; settling a baby with sound, white noise, lullabies; swaddling a fussy baby)

·         Baby sleep information (your baby’s tired signs; baby sleep patterns; sleeping through the night; how much sleep is needed?)

·         Help for tired parents (crying and parental guilt; reassurance; parents intuition)

How’s that for a start? Pretty good, I think! Parents of fussy babies, watch this space for Dr Harry’s Crying Baby Chronicles!