secrets of behavior acknowledgement...jan 07, 2014 · dreaming babies wake easily. quiet sleep ......

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Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.

SECRETS OF BABY BEHAVIORJane Heinig, Jennifer Bañuelos, Jackie Kampp, Jennifer Goldbronn, Luz Vera Becerra, Kerri Moore – Presented by Deborah Schy

Acknowledgement

This work has been funded at least in part with Federal funds from the U S Department ofFederal funds from the U.S. Department of Agriculture, Food and Nutrition Service. The contents of this presentation/publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U Sorganizations imply endorsement by the U.S. Government.The Fit WIC Baby Behavior Study was funded by a USDA WIC Special Projects Grant (2006‐2009).


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Baby Behavior Overview

USDA Fit WIC Baby Behavior StudyUSDA Fit WIC Baby Behavior Study BackgroundPurposeStudy DesignOutcomes

Baby States, Cues, Crying, and SleepTeaching others about Babies!


WIC Materials Available Online

All of the study related Baby Behavior l (h d ) dmaterials (handouts, posters, etc.) are posted

on the Fit WIC website (USDA Food and Nutrition Service)

http://www.nal.usda.gov/wicworks/Sharing_Center/statedev_FIT.html

California Baby Behavior CampaignmaterialsCalifornia Baby Behavior Campaign materials available from CA WIC website

http://www.cdph.ca.gov/programs/wicworks/Pages/WICCaliforniaBabyBehaviorCampaign.aspx


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Important Baby Behavior “Secrets”

Babies are driven to learn, socialize, and connect with people around themwith people around themThis instinct is crucial for survivalCan be frustrating when they are unable to do this “job”

Babies always have a reason for the things they dok h hWe may not know what the reason is…

We may not like the reason…But there is always a reason


Secrets of Baby Behavior

Infant StatesInfant States


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What is an Infant State?

State: Reflect an infant’s level of arousal and ability to respond to stimuliand ability to respond to stimuli.Groups of behavioral and physiological characteristics that occur together, including: Body movementEye movementBreathing (rate and intensity)Ability to respond


Barnard 2010

Infant States

Crying

Irritable

Quiet Alert

Drowsy

All babies move through these 6

states…

…but not always in a predictable way!

Intensity

Active Sleep

Quiet SleepCreated by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.

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Crying

Jerking Motions

Color Changes

Tight Muscles

Rapid Breathingg

Takes time to respond

Tears


Key Message: Crying is stressful for parents but it is an important communication tool for babies

Irritable

Lots of body and facial movement

Irregular breathing

Resists interaction

Sometimes fussy

Sensitive to what’s going on inside andgoing on inside and around them

Common before feeding


Key Message: Babies are driven to socialize and learn and get irritated by distractions or overstimulation

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Quiet Alert

Little body movementEyes open and wideSteady, regular breathingHighly responsiveWants to learn and play interactiveplay – interactiveTiring! This state requires effort to control.


Key Message: Moms feel rested, but babies work hard during quiet alert periods

Drowsy

Variable movementIrregular breathingOpen and closes eyesEyes glazedTakes time toTakes time to reactEasily startled


Key Message: Babies will give signals when they need to rest. Some babies get irritated when they feel drowsy.

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Active Sleep

Head and body movementIrregular breathingFacial twitchesRapid eye movement (REM)Easy to wake


Key Message: Dreaming is important but dreaming babies wake easily.

Quiet Sleep

No body movementRhythmic breathingBursts of suckingStartles, but does not wakeDoes not respond to stimulationHard to wake


Key Message: Babies also need deeper sleep to rest and recover. Babies move very little in quiet sleep.

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Changing States

Babies can move through the states on their own, but sometimes they will need a caregiver’s help moving from one state to another

Use different positions, touch, & wordsWill take longer if very drowsy or in deep sleep

Address the child’s needs – see if change in position or circumstances helpsRepeat actions or words over

Variety to Waken Repetition to Soothe

they will need a caregiver s help moving from one state to another…

p pCan take up to 10 to 15 minutes for very young infants to wake up enough to eat well

pand overMay take time if infant is very upset

Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

Barnard 2010

Key Messages for Parents

The image part with relationship ID rId3 was not found in the file.

Sleepy babies need lots of stimulationof stimulation Using the same actions and sounds over and over will calm overstimulated babies

h ld bParents should be patient

Listen for a change in the cry for a few minutes before trying something else

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Infant CuesInfant Cues


Types of Infant Cues

Infant cues are specific behaviors (movements, noises etc) babies use to communicate whatnoises, etc) babies use to communicate what type of interaction, if any, they needEngagement cues – behaviors that indicate that a baby wants to interact

Disengagement cues – behaviors that indicate that a b b d hi b diffbaby needs something to be different


Kelly et al. 2003

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Engagement Cues

Looking intently at face Eyes openoo g e y a ace

Rooting

Feeding sounds

Smiling

Smooth body

yes ope

Face relaxed

Feeding posture

Raising head

Following voice andSmooth body movements

Following voice and face


Kelly et al. 2003

Engagement Cues


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Disengagement Cues

Turns away Looks awayu s a ay

Pushes, arches away

Crying

Choking, coughing

Extending fingers stiff

oo s a ay

Faster breathing

Yawning

Hand to ear

GrimaceExtending fingers, stiff hands

Falling asleep

Grimace

Glazed look


Kelly et al. 2003

Disengagement Cues


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Understanding Infant Cues

Infants must learn to give readable cuesN b i fli iNewborns may give conflicting cues

Caregivers must learn how to read their infant’s cuesInteractions can have both type of cues within a short period of time

Disengagement cues are not specific – can be misleading

Over time, both babies and caregivers will learn to use cues to communicate!


Clustered Cues

Clustered Cues are cues commonly used together to indicate a specific needto indicate a specific needExamples:HungerFullness/SatiationFatigue


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Clustered Cues: Hunger

Clenched fingers & fists over chest & tummyFlexed arms & legsRootingFast breathingSuckingSucking noises/motions


Key Message: A hungry baby will give several cues together to alert caregivers

Relationship between States and Cues

Infant’s State

Ability to respond to environment


Cues infants give to communicate what they need

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Cues are simplistic d NOT ifiand NOT specificParents may need to “play detective” to figure out what their babies are trying to tell themWhen babies’ cues are not addressed, they “escalate”y

For most healthy term babies, feeding cues are obvious


Infant CryingInfant Crying


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Crying: Babies’ “Super Power”

Crying results in a sound that affects the nervous system inaffects the nervous system in most adultsDrives adult activity!

Needs to be stressful in order to motivate caregiverM t b l d tMust be loud to rouse sleeping caregiversImportant skill


St. James‐Roberts 2001

“Normal” Crying

ALL infants cry Crying is used to communicate needs

Many newborns cry more than older infants as they adapt to their new postnatal environment and struggle to provide readable cues

As adults respond to cues and babies refine their cues, crying lessens – any responsive caregiver can assist in this process

Hiscock H. 2006; Nugent 2007


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Assessing Crying: Challenges

Parents perceive crying as continuous even though babiescontinuous even though babies typically cry in short bursts

Tolerance for crying may influence perceived duration

Ability to calm a crying baby y y g yassociated with parenting confidence


Green 2001; Leavitt 2001

Why Do Babies Cry?HungerDiscomfort/PainDiscomfort/PainDistressFatigueOverstimulationFrustration Unfamiliar sensationsDistractionsFear


Hiscock 2006; Nugent 2007

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Is There a “Hungry Cry”?

How can caregivers tell when a crying baby is hungry?g yHungry babies might cry but they will ALSO bring their hands to their face, clench their hands, flex their arms and legs, root, make sucking motions and noisesAll these behaviors together help us know when a baby is hungrybaby is hungryAll hungry babies should be fed!


Sumner 1994

Caregivers can help crying babies (who have been fed) by:

Promoting self‐soothing skillsLetting babies suck on their hands

Showing their faces to babies

Using “repetition to soothe”Speaking softly over and over

Holding, rocking, stroking the baby over and over

Babies will take longer to calm down if they are very young or very upset Kelly et al. 2003; Nugent 2007


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Persistent Crying: Definition

Persistent crying is sometimes called “colic”Colic = crying for 3 hours/day, more than 3 days/week, for more than 3 weeks, but term is used inconsistently Affects about 20% of the 0 to 3‐month population

“Persistent crying” refers to daily inconsolable crying

P i t t i ti t d it i ff tPersistent criers continue to cry despite caregiver effortsOnly 25‐30% of persistent criers have problems with digestion ‐ obvious signsMedical concerns should be ruled out


Fox 2001; Hiscock 2006; Armstrong 2000; Keefe 2006

Persistent Crying: Good News and Bad NewsThe good news

95% f i t t i h lth d th i i95% of persistent criers are healthy and thrivingMost persistent crying improves by the time the baby is 12 weeks old (only about 8% continue to cry excessively after 3 months)

The bad newsIt can take 12 weeks before the persistent crier improvesIt can take 12 weeks before the persistent crier improvesNo “standard” solution due to multi‐factorial etiologyPersistent crying is associated with maternal depression and child abuse


Hiscock 2006; Murray 2001; Douglas 2010

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Persistent Crying: Reasons

Infant is sensitive to stimulationLow threshold or heightened response

Infant can’t self‐soothe or regulate statesInfant can’t provide readable cuesInfant illness, injury, or GI problemsC i i h i f ill bi h i b h iCrying with signs of illness or a big change in behavior should be investigated by the doctor

Parents may need referral for professional helpSt. James‐Roberts 2001; Hiscock 2006; Keefe 2001


Persistent Crying: Tips for ParentsGet support

Learn about infant cryingLearn about infant crying

Address cues early

Reduce stimulation OR increase repetitive stimulation

Maintain routines (keep stimulation and rest times similar throughout the day)rest times similar throughout the day)

Learn soothing techniques

Know when to take a break


Keefe 2006; Keefe 2001

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Crying Case Study

Jose is 3 ½ weeks old. His parents report that he cries inconsolably everyreport that he cries inconsolably every evening from 6 to 9 pm then sleeps peacefully for several hours. The rest of the day, he cries only sporadically.

What could be the cause(s)?

What advice would you give his parents?



Crying doesn’t always mean hunger look formean hunger – look for hunger cuesRespond to cuesPredictable crying (like late afternoon) might be overstimulationoverstimulationUse repetition to soothe if baby is still upset after fixing the problem

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Key Messages: Persistent Crying

Parents can be taught soothing techniques, though soothing should not be overemphasizedsoothing should not be overemphasizedSoothing techniques should be tools given to parents as part of an overall strategy to promote positive interactions

Parents often attribute persistent crying to GI issues but


other factors are more commonParents need to know more about these factors and coping skills


Infant SleepInfant Sleep


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Misconceptions about Infant Sleep

Many parents thought babies would either sleep through the night OR wake up all night longsleep through the night OR wake up all night long “Good” babies sleep through the nightIf babies do not sleep through the night, they will “wake constantly”

Goal becomes to “fix” the infant’s sleep “problem,” not to address normal sleep deprivation related tonot to address normal sleep deprivation related to the infant’s need for care in the night

Heinig 2006; UC Davis Human Lactation Center (unpublished); Wolfson 1992


Infant Sleep States

Active Sleep is Light Sleep Quiet Sleep is Deep Sleep

Important for brain development

Dreaming results in REMImages stimulate brain functionBlood flow to the brain

Important for the brain to rest and recover

No dreaming Memory developmentBlood flow to the brain

is increased, bringing nutrients to active brain cells

Memory development and growth


Peirano et al. 2003; Barnard 2010; Heraghty et al. 2008; Graven & Browne 2008; Nugent 2007

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Infant Sleep Cycles

Infants cycle through active sleep, quiet sleep, and wakingwakingInfant cycles are 50‐60 minutes long (adult cycles are 90 minutes long)

Total sleep duration varies greatly; in a 24 hour period:Newborns sleep 16‐17 hours

2‐12 month old infants sleep 13‐14 hours


Heraghty et al. 2008; Peirano et al. 2003; Rosen 2008

Newborn Sleep/Wake Cycle

Newborns start sleep in Active Sleep, dreaming for 20‐30 minutes, and

Wake

move to Quiet Sleep ½ of their sleep in Active Sleep, ½ in Quiet SleepInitially, newborns will wake with each cycle (every 1‐2 hours)

Small stomachs = frequent feeds

Active SleepQ

uiet

Sleep

Small stomachs = frequent feeds

Infants who are sensitive to position changes may wake up easily when put down in Active Sleep

Heraghty et al. 2008; Hoppenbrouwers et al. 1988; Peirano et al. 2003


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2‐Month‐Old Sleep/Wake Cycle

Infants begin with shorter periods of Active Sleep then move into Quiet Sleep

They start to have longer quiet sleep periods at night


Parmelee 1964

Older Infant Sleep/Wake Cycle: 3+ months

Sleep patterns become more consistent over timeconsistent over timeMore likely to fall asleep into Quiet Sleep (just like adults)Sleep patterns follow the light‐dark cycleAble to sleep longer stretchesAble to sleep longer stretches during the nighttime

Heraghty et al. 2008; Jenni and LeBourgeois 2006; Peirano et al. 2003; Parmelee 1964


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Longest Stretch of Sleep Increases with Age

2‐6 k

• Able to sleep 2‐4 hours at one time

wks.

6‐8wks.

• Sleep becomes more concentrated during the nighttime as baby is more awake during the day

3 mos.• Able to sleep up to 4 hours at one time, typically the longest stretch will be during the nighttime

Baby’s Ag

e


6 mos.• Able to sleep up to 6 hours at one time, 90% sleep 6 hours regularly

Coons and Guilleminault 1984; Goodlin‐Jones et al. 2001; Jenni and LeBourgeois 2006; Peirano et al. 2003; Adams 2004

Reasons for Excessive Waking

Baby’s body is immature – can’t maintain sleep state or tune out stimulationor tune out stimulationBaby is not getting enough to eatIllness or injuryTV in room (or other intermittent stimulation)Caffeine or meds (breastfeeding mothers)Change in routineMay need to refer to MD

Goodlin‐Jones et al. 2001; Barnard 2010; Trachtenbarg and Golemon 1998; Sadeh and Anders 1993; Tirosh et al. 1993; Nugent 2007; Lawrence 2010; Liston 1998


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Infant Feeding and Sleep

Breastfed infants have more Active Sleep More likely to wake up if uncomfortable or need y pparental assistanceReduced risk of SIDS, may be linked to ability to awaken more easily

Promote Active Sleep by putting babies “back to sleep” or using pacifiers (formula‐feeding moms)Breast milk is digested more quickly than formula –g q ybest for development and growthHowever, no significant difference in maternal sleep by feeding method


McVea 2000; Horne et al. 2004; Rosen 2008; Montgomery‐Downs et al. 2010

Key Messages: Infant Sleep

Infant sleep patterns change. As infants get older:They sleep for longer stretches

Will be more likely to fall asleep in Quiet Sleep

Encourage caregivers can look for signs of Quiet Sleep before laying baby down

Active sleep and night waking are beneficial p g gBabies wake more easily when in Active SleepWaking may be essential for survival

Dreaming is important for brain developmentCreated by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.

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Caregiver‐Infant InteractionsCaregiver Infant Interactions


Basic Assessment of HealthyCaregiver‐Infant Interactions


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Successful Interactions take 3 Steps

Caregiver needs to LOOK at the baby

Caregiver needs to RECOGNIZE what the baby needs

Caregiver needs to know how to RESPOND appropriatelypp p y

Schiffman 2003


The UCD approach is a simplification of NCAST intervention

Look

Wh tWhat are some reasons that caregivers would not be looking at their babies?

What environmental changes need to be made to promote interaction?


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Recognize

Caregivers who don’t recognize their babies’ cues will seem frustrated with their babies’ behaviorwill seem frustrated with their babies behavior“She cries all the time.”“She’s constantly hungry.”“My mom says I should just let her cry.”

Parents believe behavior is “random” or “comes out of nowhere”out of nowhere

They may assume that their babies are thinking like older children or adultsThey may be concerned about “spoiling” the baby


Respond

Caregivers who respond inappropriatelyd l b f d h b bRespond to almost every cue by feeding the baby

Get frustrated if the baby does not react immediately

May result in interactions that make things worseEscalation of cues, crying, and increased stress

Barriers to appropriate responseBarriers to appropriate responseLack of knowledgeLack of confidence, comfort


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Promoting Positive Interactions


Promoting Interactions

InformInform

ValidateValidate

EngageEngage

The UCD approach is modified from the Newborn Behavioral Observation.


RelationshipsRelationships

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Engage and Validate

Say something nice about theSay something nice about the baby (it will be easy!)

Say something nice about the baby’s ability to communicate with that caregiver


What to say to parents…

“Aren’t babies amazing, they can to tell us what they want with their bodies and their noises….”Help them see what theirHelp them see what their babies are telling them


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Provide Basic Information: “Recognize”

Describe the cue being given, when it is used and how it differs from other cuesused, and how it differs from other cues

Support the caregiver as she tries to recognize her baby’s cues by asking her to verify your perception or ask for h idher ideas


Provide Basic Information: “Respond”

Help caregiver check for obvious reasons ‐ diaper, hunger etchunger, etc.

Not obvious? Help caregiver to look for patterns of engagement or disengagement cues to guide response

Play detective to identify reason(s)

Still crying? Repetition to soothe


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What to say to parents…

“I ’t it d f l th t b b t ll h t“Isn’t it wonderful that your baby can tell you what he wants? Every baby is different but it looks like your baby wants you to….”

Support the caregiver’s efforts to respond


Teaching Parents about Cues, Crying, Sleep


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Teaching Baby Behavior: Tips and Tools

Timing of messages is importantimportant Consider the needs of your target groupKeep messages simple and immediately lrelevant


Timing of Messages: Prenatal

Prenatal P ti SlPreparation: SleepTypes & PurposeChanges

Preparation: Crying Crying = communicationImportance of cuesImportance of cues

Newborn behaviorDay 2Limited skills


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Timing of Messages: Postnatal

PostnatalD t il d i f tiDetailed information on cues – can verify with their own infantsCrying – reassuring and referring as neededSleep – emphasize changes and purpose of sleep patterns


Consider Your Learner

Who are you talking to? P t/ t t thPregnant/postpartum motherFatherOther family members

In what setting?Hospital WIC clinicChildbirth/breastfeeding class

What are the caregivers’ circumstances?Created by the UC Davis Human Lactation Center. Copyright 2011 The Regents of the University of California. All Rights Reserved.

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Keep it Simple & Relevant

Important to provide simple messages (caregivers are often tired and overwhelmed)are often tired and overwhelmed)Messages must be relevant to the caregiver’s needs and concernsWhat do they need at that moment?

More than one source is bestConsistent messaging needed across settings (WIC, nurses, doctors, etc.)More exposure = more learning



Newborn BehaviorNewborn ehavior


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Newborn Behavior

UC Davis Study: Maternal Request for Supplementation of Healthy Breastfed NewbornsSupplementation of Healthy Breastfed NewbornsParents were surprised & overwhelmed by their babies’ behavior

Parents were missing important information about BF

Parents had unrealistic expectations about newborns and parenting that resulted in requests for formula as part of efforts to fix their babies’ “problems”Biologically normal behaviors were seen as problems

DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

Day 1: The “Good” Baby

Heightened alert state in the first 2 hours followed by longer2 hours, followed by longer periods of sleep (over next 24 hours)

Parents will think: What a “good” quiet, sleeping baby!

And then…

Nugent 2007; DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

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Days 2 & 3: Everything Changes

Reality Sets in! There i dd h iis a sudden change in the baby’s behavior

Baby expected to be quiet and sleeping, but now…SOMETHING IS WRONG!


Nugent 2007; DaMota et al. 2012

Days 2 & 3: Crying Increases

Crying seems constant when baby is awake:baby is awake:“We started the formula on the 2nd day…since he never stopped crying.”

“I just wanted to give him formula because he was crying and always awake.”


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Days 2 & 3: Frequent Feeds

Baby is more alert & wants to feed very frequently:very frequently:“She was feeding every 2 hours and it was wearing me out and I could get a break when she went to the nursery.”

“He was constantly eating like every 45 minutes to 1 hour, I just couldn’t sit there and feed him so I moved him to a bottle.”


Day 2 & 3: Little Sleep

Sleep is sporadic & chaotic“She wouldn’t go to sleep but I knew she was still hungry, and then I would feed her a little bit [formula] and then she would go to sleep.”


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Day 2 & 3: Overwhelmed by Environment

Baby is sensitive to stimuli, often over responsive to theoften over‐responsive to the environment“Every time that I tried to breastfeed, he would have a tantrum, become really angry. So then I thought ‘Why? Why shouldthen I thought Why? Why should I make him suffer?’”


Parents are Overwhelmed & ConfusedParents think there must be something wrong with their crying waking babytheir crying waking babySee formula and/or separation from the baby as the solution

May ask for supplementary formula or that the baby be removed from the room

Parents need the facts: why is their baby behaving the way he is? Is this normal?Parents need the information before day 2

DaMota et al. 2012Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

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How to Help Caregivers

Help parents be realistic and see value of their babies’ “talents”their babies talents Babies cry & wake for a reason

Let the infant be the guideFocus on cues

Address concerns about cryingAddress concerns about cryingTarget education to support persons as needed


Newborn CuesNewborns vary widelyAbility to control their bodies

Sensitivity to stimulation

Early cues often confusing

When adults respond to baby cues, babies get better at using cues

Nugent 2007; Poblano 2007Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

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Newborn Engagement


Newborn Disengagement


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Newborn Crying

May seem constant while baby is awake

Sensitive to stimuli, over‐responsive to environmentParents should watch for cuesto prevent overstimulation

Likely to cry when hungry andLikely to cry when hungry andare hungry frequently

Nugent 2007Created by the UC Davis Human Lactation Center.Copyright 2011 The Regents of the University of California. All Rights Reserved.

Why Bottles “Work”

Bottle = quiet babyB b t llBaby must swallow –can’t make noise“Sweet fluid” on the tongue triggers the sucking reflex

This can be explainedThis can be explained to parents


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Newborn Sleep: Day 1

The healthy newborn is alert in the first 2 hours after birth (unless heavily medicated or recovering from a traumatic labor/birth)After this period, a few hours of deeper sleep on the first day helps mom recover and baby to conserve calories while feeding is establishedMost babies struggle to stay awake on the first day, even while they are feedingy, y gImportant to practice feeding during the first couple of hours and each time the baby becomes alert


Nugent 2007; Peirano et al. 2003

Newborn Sleep: Days 2 and 3

More alert + frequent feeds = Less sleepSensitive to stimuli, wake easily

Sleep is erratic


Nugent 2007; Peirano et al. 2003

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Promoting Newborn‐Parent Interaction in the Hospital: CuesPromote positive interaction between newborns and parents by helping parents understand theirp y p g pbabies’ cues. If the baby is awake, look for cues.If the baby is trying to engage the caregiver, point out what you see. She is showing you she wants to connect with you. Interacting is hard work so she can only do it for a few minutes before she needs a rest.If the baby is disengaging, point out what you see. She is trying to communicate to you that she needs you to do something for her, let’s see if we can figure out what she needs…


Promoting Newborn‐Parent Interaction in the Hospital: SleepIf the baby is dreaming, point out what you see:L k h L l ’ lid i th t h iLook how Lulu’s eyelids are moving, that means she is dreaming and her brain is working hard to develop. Lulu will be easy to wake up when she is dreaming.

If the baby is in quiet sleep, point out what you see: See how still Lulu’s face and body are? In quiet sleepSee how still Lulu s face and body are? In quiet sleep, she’ll be less likely to wake up but you’ll see she will start dreaming again very soon because dreaming is so important for her.


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Promoting Newborn‐Parent Interaction in the Hospital: Crying

Acknowledge the parents’ feelings and be calm and reassuringand reassuringI know youmust feel overwhelmed when Jack is crying, but Jack is very sensitive to his new environment as well as all the new sensations inside his body.

Empower parents by giving them tools to deal with the baby’s crying and wakingCrying is a very powerful way Jack let’s you know that he needs something. Do you see the cues we talked about?Help the parents use “repetition to soothe” as needed.


Key Messages for Parents of NewbornsOn day 2, baby will wake and demand feedsdemand feedsLatching takes practice – expect quick improvementMoms feel changes in breasts after discharge

b b hBabies use cues – get better with response

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Parents get overwhelmed if you make baby behavior too complicated

Simplify

too complicatedIdentify cues/signs that the baby is already exhibiting or that parents are most likely to see

Every contact can be a “teaching moment” (use baby as guide)

Promote and support interaction rather than focus on infant developmenton infant developmentConsistent messaging is important

secrets of behavior acknowledgement...jan 07, 2014 · dreaming babies wake easily. quiet sleep ......

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