Like the previous scary episode blog, breathe holding, febrile convulsions are:

• relatively common
• ultimately harmless
• dreadfully frightening for parents

So what is a febrile convulsion? Simply, it is a fit or convulsion while your child has a fever. The convulsion will generally involve sudden twitching of your baby’s limbs, loss of consciousness, eye rolling, unresponsiveness and cyanosis (blueness of the skin). Hence the scariness of it for anyone present! Parents who have witnessed their baby having a febrile convulsion sometimes report they felt their child was going to die. Frightening indeed.

There is extensive, credible information on Febrile Convulsions for to examine here (scroll down to “Febrile Convulsions”), Q & A factsheets and a short section in my Baby Settling and Health Guide however below are the key factors to know.

Febrile convulsions:

• are fairly common (occurring anywhere from 2 – 5% of children)
• are related to age (most fits occurring in a child aged 6 months to 5 or 6 years)
• generally only last 2-3 minutes (although your child may not wake up straight away and may be a little groggy or unbalanced afterwards)
• do NOT cause long term neurological complications (such as learning difficulties or brain damage)
• do not require you intervene other than rolling your baby onto their side afterwards (do not hold try to hold your baby still or put anything in their mouth)
• have a 30% of a reoccurrence (however this figure diminishes as your baby gets older)
• will look frightening and most likely scare you half to death! (That’s okay! Do your best to stay calm)

Even though febrile convulsions are harmless and result in an uncomplicated recovery, I do recommend a medical check afterwards. While the actual convulsion is harmless, finding the underlying cause of the fever is important – more important than both the fever and the febrile convulsion itself.

I also recommend a strong cup of coffee or chocolate injection for parents when everything has settled down. Febrile convulsions do not qualify as one of my top 3 Scary Baby Episodes for no reason!

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!).

As parents we have a tendency to blame ourselves when something goes wrong with our children. We believe we must have erred and we feel guilty. But this is not so. Often things are beyond our control, and we’ve actually done pretty well. We very rarely pat ourselves on the back for all the good we have done with our kids. However, it is time we reassured ourselves. Even though we are not perfect, we are in fact good enough.

The concept of a Good Enough Parent was introduced by Dr Donald Winnicott, a Paediatrician in the 1920’s. Winnicott carefully listened to and observed child and parent behaviour for many years. In the 1930’s he turned his attention to child psychology and for the following 30 years researched, amongst other developmental phenomena, the importance and effects of security objects. After decades of observation and experiential research he formed the view that parents need only be Good Enough for their children to be secure and happily develop and grow.

By Good Enough Winnicott referred to a parent who provides a secure, reasonably attentive environment for the child to grow and develop. Enough food, comfort, emotional warmth and love and yet the parent need not strive for perfection or anywhere near it. Winnicott asserted that children need to feel cared for and secure and do not look for faultlessness in their parents. Children look for love, acceptance, understanding and a sense of usefulness and belonging in their family and the world.

I support Winnicott’s assertions that Good Enough is good enough! Provided a home is safe and physical and emotional needs are met, our children do not need perfection. And yet, even when parents provide all of these basic needs (and more) they still feel guilt that they have not done enough.

The growth and development of children and babies is a complex and dynamic process. What others observe and judge from an external perspective tells very little of the truth and depth of an individual situation. Perhaps the scenarios below are familiar to you, your family or friends?

• At her playgroup, a 3 year old girl seems to snob the adults and the other children. She won’t co-operate or engage with the other children and acts oddly. Her mother feels terrible, guilty and responsible for her daughter’s unsociable behaviour. Little do the other parents know that she has Asperger’s syndrome.

• When a father enters a supermarket with his 4 year old daughter, she starts running around and being extremely disruptive. People glare at the girl’s father as if it’s his fault. They assume poor parenting has resulted in a badly behaved child. They do not know the girl has had a sleepless night with a persistent cough, a fever and is overtired.

• When dropping her baby off at childcare, a mother is sad and worried as her son cries out for her. The baby’s cries get louder as he is handed over to staff. The mother feels all eyes are on her and that other parent’s blame her for her son’s apparent difficult behaviour. The fact is that separation anxiety is a normal developmental stage for babies and most children will experience at some stage.

It is easy to judge and make assumptions from the outside and equally as easy to assume responsibly from the inside. The scenarios above illustrate this quite simply.

And so as parents we experience doubt (am I good enough?) and responsibility (it’s my fault). This in itself is not bad, provided it is not too intense.

We need to recognise ourselves as good enough parents. Forget about any guilt. When we remember this, confidence in our parenting and ourselves will follow.

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!