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.

Well my calendar says it’s only a few sleeps until Christmas and yet I feel like I’m still somewhere in October! Do you have that feeling too? Perhaps those of you with newborns who are fussy or not sleeping will feel like all the days are blending into one - with or without the Christmas craziness around us.

I’m amazed and somewhat cross at myself to see that the last time I posted a blog for you was weeks ago! However, I know those of you who have had babies in that time will find the swaddling information in the last blog useful.

I have not even bought Pompey a Christmas present (that’s a picture of him, by the way, not me!), let alone my family, and I still have many wonderful patients to see over the next two days. With that in mind, I’m going to rest on my blogging laurels for a short time and encourage you to visit archived posts. Perhaps you many even find one you have not read or would like me to provide more information on? Please leave a comment too! (Click on comment hyperlink at the bottom of each blog).

·         Autism

·         Childhood Eczema

·         Colic

·         Dad’s and Depression

·         Diarrhea and Gastro

·         How much sleep does my baby need?

·         Intuition

·         New fathers and fussy babies

·         Swaddling

·         Swine flu

·         Your baby’s tired signs

Dr Harry  : )

PS. Oh, Santa has just brought me an early Christmas present… My very own facebook page! Come and join me at www.facebook.com/drharryz  I’d love to see you there!

I love a good swaddle! Settling your crying or fussy baby can be difficult and swaddling (tightly wrapping) helps.  I know wrapping to be a wonderfully effective tool for parents and babies in the first few months of life and I share this with new parents in hospital. Many other health professionals do, as well.

Swaddling is an age-old child care practice that has been used across countries, continents, cultures and communities. Even the infant Jesus Christ was wrapped in ‘swaddling cloths’. There is a great deal of medical research and evidence that proves the benefits of swaddling, including:

·         Swaddled babies wake up less and sleep longer

·         Swaddling keeps sleeping babies on their backs and reduces the risks of SIDS

·         Swaddling helps babies feel safe, secure and calm

Babies can be swaddled from birth until the time when they can roll over independently (usually between 4 and 6 months of age), so it is a useful tool for those early, unsettled months. Swaddling has calming and soothing effects on babies and promotes a feeling of warmth, safety and security. It has the capacity to do this for several reasons:

·         Swaddling mimics the confined womb environment (remember, your new baby is used to a pretty confined space in the womb!)

·         Swaddling reduces arousal from the startle reflex (Moro reflex) and external stimulation. (Babies often wake themselves with sudden jerking movement of their arms and legs. Swaddling helps keep things all together!)

·         Swaddling reduces your baby’s irritability and crying. (In medical studies, swaddling has been associated with significant reduction irritability and crying and was shown to be more soothing than massage or sucking.)

·         Swaddling results in better sleep for your baby - and then for you! (Experience and research clearly demonstrates that swaddled babies arouse less and sleep longer.)

A common misconception of swaddling is that it should not be too tight. Not true! Feel confident to swaddle your baby very snugly to ensure the wrap does not come undone. To be sure that your wrap is just the right tightness, a good rule to follow is to think of sliding your hands inside your jeans pocket. Your baby’s wrap should be firm, fitting and secure, just as your hand feels when inside the pocket of your jeans.

Answering recent concerns, the hot off the press editorial To Swaddle or not to Swaddle, from the reputable Journal of Paediatrics, looks at the currently available information on swaddling. It concludes that the advantages of swaddling outweigh the risks, if any.

When combined with recognising your baby’s tired signs swaddling is one of the easiest and most rewarding of settling strategies. Together with sound and movement, swaddling will not only helps your baby, but it will give you confidence as well. When you can successfully calm and soothe your baby with a swift, snug swaddle; take a moment to congratulate yourself!

I see hundreds of parents every year with young babies. Many of those parents are sleep deprived and exhausted. They look for rules in the attempt to find much needed sleep.

As health professionals we can give reassurance whether or not everything is okay in a health assessment. However, I am concerned that parents are being put under added pressure of UNDERSTANDING their baby’s cries and reading every conceivable publication to find the rules on what to do about it.

As a Paediatrician (and a dad of 4 who has been there!) I suggest parents trust their intuition more and expect less of the brain strain of processing a plethora of information. Don’t expect your head to translate responses that your instinct can do better. Follow your heart.

Sure, take in the interesting stuff presented in books, magazines and the media. If it strikes a chord within you, there is probably something relevant to you and your baby. It is good to identify and reflect, but not berate and feel pressed to absorb more. Experience and intuition will help you as much as all the information.

Seek guidance from a health care professional who you trust when you need to. Listen to guidance that is offered, but remember they are only guideposts. Nothing in parenting is concrete. Just when you think you have it worked out, something will change - baby’s illness; holidays; back to work; crises, both minor and major.

You will need to adjust and readjust your parenting barometer. To do this you need to trust your intuition. Yours…as a mother or father. You have known your baby 9 months longer than anyone else. Take a breath and feel confident in your understanding of what is right for you and your baby. But don’t flog yourselves with the imperatives, must-do’s and essential knowledge. You know your baby.

Parenting is an evolution from embryo to baby to child to adolescent and into adulthood. There are common threads of understanding and community norms, but no one rule or language. Trust your instinct during that evolution of physical, social, emotional, cultural needs. Trust that what feels right for you and your baby is the right way.

Intuition rules.

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!

Did you know eczema affects 10 to 20% of children? I see many children in my Pediatric practice who are suffering from its effects. Not only is eczema a common condition, but it’s distressing and prone to complications (such as infection and bleeding). Children with eczema (and their parents) will also know that it is often associated with other difficulties such as poor quality sleep due to constant itching, scratching and bleeding.

These issues make life difficult and I believe both the community and health professionals understate the impact of eczema on children and their families. Affected children often scratch at night and therefore sleep poorly. This in turn can lead to impaired growth, development, concentration, appetite and even learning.

Our management of childhood eczema has been somewhat ‘light on’. We tell each other that he’ll grow out of it or its ok she won’t develop any scars. While this is true, what we should also be doing is working hard to treat the condition effectively, and ensuring that sleep and lifestyle are minimally affected.

We know the following are triggering factors for an eczema flare up:

·         Overheating

·         Dryness

·         An illness, like the common cold or gastro

·         Emotional stress

·         Sleep deprivation

·         Secondary bacterial infection of the skin

·         Irritants (such as soaps or nylon)

·         In some children, exposure to certain allergens

       such as egg, cow’s milk, wheat

All children with eczema respond differently, however I always recommend the following treatment guidelines:

·         Moisturize, moisturize, moisturize…paraffin or sorbelene are good

·        Keep your child cool. Try not to over-clothe them and, where possible,  keep their environment cool

·         Use bath oil rather than soaps

·         Avoid or reduce exposure to allergens if you can

·         Treat secondary bacterial infection aggressively with antibiotics (infection is suggested if the lesions have become weepy)

·         Don’t be afraid to use corticosteroid ointments (rather than creams) prescribed by your doctor. Better to treat the condition aggressively from the outset and then complications and chronic problems less likely to occur. Continue steroid ointments for 3 days after resolution of eczema inflammation.

·         Consider using wet dressings at night to for severely affected areas to reduce inflammation. This will keep the skin cool, moist and protected from scratching

If you are a parent with a child who has eczema you’ll no doubt be familiar with many of these suggestions. Other useful information can be found here. You may even have some of your own strategies that you could share? I’d love to hear.

While the outlook for childhood eczema is variable (children with multiple allergies generally have more severe and longer lasting eczema) the good news is most infants and children grow out of eczema by primary school. Also, long-term complications (such as scarring) are rare indeed. So hang in there everybody, there is light at the end of the eczema tunnel.

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!

By the Chinese Zodiac Calendar, 2009 is the Year of the Ox. Forgive me for thinking it is the year Two thousand and Swine. Turns out we are not only in a global economic meltdown, but also a pandemic of panic. Not a day has passed in recent months that we do not hear updates about Swine Flu. How many new cases, government responses, expert opinions, media sites and the now, sadly, deaths.

In context, H1N1 Influenza 09 (Human Swine Flu) is still a ‘flu in a teacup. Ordinary Influenza A is more dangerous, and always has been. The World Health Organization’s decision to raise the pandemic alert level to Phase 6 is not a response to the severity of illness caused by the virus, but a reflection of its rapid spread.

So what can we do to help? How do we prevent Swine (or any other) flu from reaching our home? Simple measures are the best and no different from any other pandemic or seasonal influenza:

      Wash your hands often and well

      Stay away from sick people and crowded areas if there is an influenza outbreak in your area

      Cough and sneeze into a tissue

      Keep your immune system healthy with lots of sleep, exercise, water, good food and less stress.

Sound familiar? This is probably the same advice given to you by your mother to prevent spreading the latest cold or flu when you were a child!

While the current outbreak of Swine Flu should not be dismissed as unimportant, we need to keep it in perspective. Deaths from Swine Flu are a reality. However they tend to be in those patients with predisposing factors. Chronically ill children (and elderly people), perhaps with ongoing lung or heart problems, are more prone to influenza, swine or otherwise. These vulnerable areas of the population (including those who are pregnant) should be vigilant. Alert but not alarmed, as they say.

 To deal with the panic and inevitable media-hype that surrounds us with Swine Flu:

      Stay informed and link to credible information

      Don’t panic or buy into the fear

      Be sensible and use simple preventative measures

      Be vigilant if you are pregnant or care for vulnerable people

There is no vaccine for Human Swine Influenza as yet. Unfortunately, neither is there one for panic. I am pleased to read in the Medical Journal of Australia that people’s level of anxiety surrounding H1N1 is decreasing and I encourage us all to continue protect ourselves from the contagious nature of both panic and swine flu.