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What is normal, what is not? Parenting is a mammoth task, and brings with it a lot of uncertainty as to what is actually within the norm, and what may need more urgent attention. I shall therefore attempt to sketch a picture of what is considered normal, with initial focus on the first few months of life, which are particularly panic-provoking! This includes a few words on the dreaded “C-word”…Colic. I shall then go through system by system what may go wrong and when to seek help. As a paediatric allergist, I have a particular interest in allergy prevention strategies, hence shall attempt to dispel a few myths and iron out some truths about what we can do to reduce allergies in the offspring. What is normal in the first few months? The first few months of parenthood are particularly tough as you take full responsibility for a precious but needy little baby, and have to function on minimal sleep. My advice: accept all the help you can, don’t set your expectations too high, and don’t expect your baby to fit into a mould! This is “survival time” for all- the enjoyment of parenthood will come! For the first 3-4 months babies’ brains and tummies are still very immature. This time has been dubbed the “fourth trimester.” The baby is not yet able to manipulate you hence it is not really possible to “spoil” a baby during this time. However, routines can be established from an early age and it is useful to try have a baby in some kind of a routine of sleep, feeding and play by 12 weeks or so if possible. The predictability of a routine helps you as well as other caregivers as well as your baby. Remember to be flexible and especially adaptable at times of travel, sickness and immunisations when the routine may be disturbed for a while. The first few months are vital for establishing a bond with your baby and a relationship of trust- the baby needs to know that “warmth and food and cuddles will come my way when I need them.” Remember that it is normal for a baby to cry as it is its only way of communicating. Crying increases from an average of about 1 hour a day at birth to 2-3 hours a day at 6 weeks, then slowly decreases again to about 1-2 hours a day at 3 months. Remember this “crying curve” when you are tearing your hair out at 6 weeks post birth! Gripes and Groans in the first few months The immature gut during the first 3-4 months means that most babies have gripes and groans to varying degrees. “Colic” by definition is excessive crying of more than 3 hours a day, more than 3 days a week, typically from 2-3 weeks until 3-4 months of age. Truly colicky babies by definition are thriving and usually have a pattern of an unsettled period, typically (but not always) in the early evening, when they cry inconsolably and may draw their legs up in discomfort. Although the specific cause of colic is rather mysterious, the general feeling is that it may be caused by an immature gut and immature nervous system (oversensitivity). Colic does not cause long term harm or distress to the baby. Simple measures such as winding the baby carefully, holding them upright with gentle pressure on the tummy, movement, driving, “white noise”, wind drops and probiotic drops may be useful. More potent colic mixtures can be sedating hence should be used sparingly only for “crisis” times once or twice a day after discussion with your clinic sister or doctor. Individual colic “medications” do not have a great success rate, and each one may work in only about a third of patients. Therefore, if they do not make a difference after a week or 2, stop them. Time is the great healer for colic, but this is hard to accept when you have a little baba crying 24/7! Some cases of excessive crying and discomfort may be caused by reflux of acid and milk into the throat, lactose intolerance and cow’s milk protein allergy. Please discuss concerns of with your clinic sister and doctor, especially if there is excessive vomiting, constant crying, inadequate weight gain, severe nappy rash, or chestiness. On that note, most babies vomit as they have an immature valve at the top of their stomachs which lets milk go up again. This is normal. Vomiting, in fact, only peaks at 4 months. However, if the vomiting seems excessively painful, the baby back-arches a lot, refuses to lie on the back, and is extremely miserable after feeds or fusses excessively during feeds, reflux “disease” should be considered and discussed with your healthcare practitioner. Stools During the first few days of life the baby passes meconium, which is a black or dark green stool of “marmite” consistency. After a few days, stools change. Breastfeeding stools are normally mustard yellow with white “seeds” of curdled milk. Breastfed babies have a wide variety of stooling habits. In the first few weeks they tend to pass stool after most feeds. After a few weeks they settle into a pattern which is widely variable: from 7-8 stools per day to one stool per week- this is all within normal limits. Babies on predominantly formula feeds should ideally pass stool at least once a day. Babies often groan and strain and become red in the face when they are passing stools- this is normal unless accompanied by painful crying. If you are concerned about constipation- (if stools are infrequent or unusually hard or painful to pass) please consult your doctor. Sleep Sleep is always an issue in families with young kids. We won’t go into detail here as every child and family is so different. Don’t expect miracles before 6 months- the young baby is programmed to require night feeds which can be normal until 8-9 months of age. Thereafter, demanding a milk feed is usually not a nutritional issue but a comfort “prop” to help them fall asleep again. Teaching a child to self soothe is an important tool to impart on your young one and can be done from about 4 months of age. They may need a comforter such as a special blanket, soft toy or dummy (or a combination of these) to help them fall asleep. Babies are generally reasonably easy for the first 10 days or so then may become more difficult as colic and wind sets in. Their sleep requirements are high (about 16 hours a day in total for the first few weeks), gradually settling into a pattern of approximately 3 naps per day by 3 months of age. If possible, some naps should be more than 40 minutes long to provide restoring sleep. At night time they will continue to wake 3-4 hourly for feeds for the first few weeks; by 3 months there is often a longer “stretch” of sleep during the night of 5-6 hours. Remember that the safest sleep position for your baby is on the back. The “back to sleep” campaign in the UK has seen the rate of cot deaths halve over only a few years. If the family is really not coping with the interrupted nights, or if there is a sudden change in sleep pattern, it is worth having the child looked at to make sure there is not a physical ailment disrupting the sleep. The routine and feeding pattern should be examined to make sure the daytime sleep and feed requirements are being met. There are a variety of forms of sleep training available, from controlled checking to gentle gradual separation techniques- please discuss with your clinic sister or doctor before embarking on these. If a child is unwell or going through a stage of separation anxiety, it is not a good time to sleep train. Remember that “this too shall pass” and that most children- even the worst initial sleepers- sleep very well by the age of 5 or 6 years. Feeds Initial feeds should be 3-4 hourly during the day, and on demand at night. Some babies only manage 2 hours in between feeds initially- this should stretch once they are able to drink more at one time. Breastfeeding is ideal for babies for several reasons including cost, convenience, allergy prevention and to boost their immune systems. The clinic sisters have vast experience with breastfeeding, please consult them for advice if you are battling. However, not all mothers manage to breast feeds or have insufficient milk- nothing to feel guilty about. There is a vast choice of formula milks and the approximate volume that a baby needs for the first few months is 150 mL milk per kg per day (divide this volume into the number of feeds per day). For example, a 4 kg baby on formula milk who feeds 3 hourly needs approximately 150 x 4= 600 mL per day; ie approximately 75 mL per feed every 3 hours. (8 feeds per day) Some babies need less milk, some need more- the best way to judge is by their weight gain. For this reason we plot babies’ weights on the growth chart regularly to make sure they are not falling off the growth curve. Babies lose weight during the first few days of life- loss of up to 10% of their birth weight is normal. The baby should regain its birth weight by 2 weeks of age. After that, for the first 3 months or so weight gain should be between 150-350 grams per week. After 3 months it slows down somewhat. Solids can be introduced any time from 4 months (17 weeks) onwards. Throughout the first year of life milk is the most important component of the infant’s diet, and even on 3 solids meals a day, during the first year the infant requires at least 450-600 ml milk per 24 hours. After the age of one, milk can be cut down gradually to 300-500 mL per day- overfeeding with milk after a year of age will interfere with an appetite for solids and may lead to problems such as anaemia. From about 14 months or so many toddlers notoriously go through a fussy eating stage-their growth curve naturally slows down and the world around them is SO much more interesting than food! It is therefore important to try and introduce a great variety of foods to the toddler before the fussy stage begins. Developmental Milestones Every baby develops at a slightly different pace, but generally the sequence of development is similar. Stimulation of a baby’s development will be covered by my colleagues. As soon as the baby starts fussing and seems fed up, stop with the stimulating process so that they can calm down in preparation for the next nap. Below are basic milestones typical at different ages. Remember each child develops at a different pace, and individual babies may be advanced in a certain area e.g, grabbing and mouthing yet a bit slower in other areas e.g. sitting/crawling. If your child is lagging behind significantly please consult the paediatrician: the sooner delays are picked up, the quicker we can intervene to find a diagnosis and treatment. Developmental milestones Age Gross Motor Skills Fine Motor Skills Hearing and Language Development Visual Development Personal/Social Birth Very little head control Hands are closed and grasp reflex present Startles to loud noises -Eyes close in response to bright light -Best distance of vision is about 30 cm away -Black and white vision Cries 6 weeks Moderate amount of head control -Can make tight fists -Places hands in mouth -Responds to sounds by calming, startling or crying -Starts making cooing sounds May follow slow moving objects through 90 degrees Begins to smile in response to familiar face or voice 3 months -Very little head lag -Can lift upper body and head when lying on tummy -Leg kicking and stretching -Standing reflex develops (pushes down on a surface with legs when held up) -Hands held loosely -Inspects hands and grasps objects that are place within hands -Can bring hands together -Recognises and responds to parents -Coos and gurgles -Blows bubbles Follows objects moving up to 180 degrees in the field of vision -Smiles spontaneously -Develops facial expressions to show basic emotions -Recognises mother’s face and scent 6 months -Supports head well -Can support upper body with hands when lying on stomach -Sits with support -Can roll over -Reaches for and grasps objects -Places objects in mouth -Transfers objects from hand to hand -Responds vocally when spoken to -Uses sounds such as squealing or laughter to express emotions -Uses repetitive monosyllabic sounds like bababa Can move eyes in all directions Recognises toys 9 months -Sits without support -Crawls on stomach and then on hands and knees -Starts to pull body into a standing position -Can pick up, shake and drop small objects -Grasps food and places in mouth -Holds a bottle Begins to point Starts imitating sounds -Stranger anxiety- Knows and trusts a limited number of caregivers -Recognises own name 12 months -Cruises around furniture -Starts to walk (walking may take up to 18 months) -Begins to throw objects -Good pincer grip -Holds 2 objects and bangs together -Still mouths a lot -Speaks 2-3 words -Makes sounds at toys Picks up tiny things from the ground -Searches for hidden or fallen toys (0bject permanence) -Waves goodbye, - points -Shakes head 15 months -Walks steadily -Starts to climb Stacks 2- 3 blocks Speaks 3-4 words -Has temper tantrums when frustrated -Becomes attached to a soft toy or other object 18 months -Walks steadily. -Runs -throws ball underhand -kicks -Scribbles -Stacks 3-4 blocks -Speaks 6-8 words -May have some 2 word phrases As above -Starts to use fork and spoon -“reads” picture books on his own 24 months -Runs -Jumps with 2 feet -Walks down stairs one foot at a time -stacks 6 blocks -scribbles -may still use both left and right hands to draw -Names at least 6 body parts -Uses 2-3 word sentences -Half of speech understandable -Starts to learn some colours Adult visual acuity -Asks “why?” -Begins to show interest in playing with other children but finds it difficult to share. Play is often in parallel -Helps with dressing -Uses fork and spoon 30 months -Jumps easily -Balances on one foot for a few seconds -Walks down stairs with alternating legs -Draws vertical line and circle -Pencil grip starts to develop -Handedness becomes evidence -Able to name some colours and shapes -2-4 word sentences -Able to recite name -Able to brush teeth with assistance -Washes and dries own hands 36 months -Hops on one leg -Rides a tricycle -Copies a circle -Shows definite handedness -3-4 word sentences -Able to follow 2-3 word commands -Starts to play with other children -can name a friend -Able to help with dressing Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

Allergy prevention strategies Allergies of all sorts (asthma, hayfever, eczema and more recently food allergy) have increased dramatically over the past few decades, and we find ourselves in the middle of an “allergy epidemic.” A child without any family history of allergies is now at approximately 15% risk of developing an allergic condition within the first few years; if one parent has an allergic condition, the child is at 40-50% risk of allergies, and if both parents are allergic, this increases to 60-80%. Having a sibling with allergies also carries an increased risk of allergic conditions developing. There are many confusing messages on allergy prevention- the following are the ones with Scientific backing that we currently recommend: During pregnancy Eat healthily and don’t smoke No need to cut out on any food groups for the sake of allergy prevention- it does not reduce allergy in the offspring Try eat 2 or more portions of oily fish per week If you are unable to eat that amount of fish, then consider taking omega 3 supplements Consider taking probiotics in the last trimester if your child is at risk of allergies (ie if there is a family history of allergy in parents or siblings) Feeding the newborn baby Breast milk is best and has allergy prevention properties The Department of Health recommends exclusive breastfeeding until 6months of age. Prolonged feeding over 6 months has no further allergy prevention properties (but of course has other benefits) Continuing to breastfeed whilst the first solids are introduced has some benefit In high risk babies consider giving a daily probiotic and prebiotic for the first 3-4 months (no absolute proof of this yet- but looks promising) Solids introduction Solids should be introduced when the child shows signs of readiness. There is no evidence that delaying solids prevents allergies- in fact it may increase allergies After 6 months you do not need to hold back on anything – you can give dairy, peanut, egg, wheat. Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

Managing cracked and bleeding nipples This is a common reason for throwing in the towel with breast feeding due to excessive pain and discomfort with feeding. The most frequent cause of cracked nipples is incorrect latching of the baby’s mouth onto the nipple. Thrush (see above) can also cause very painful nipples. Make sure that your baby is latched onto the breast correctly, with both top and bottom lip in a snug seal around your nipple. Your pain level will indicate to you if your baby is latched correctly or not! To release the suction on your beast so that you can take your nipple out of his mouth, insert your finger into the corner of his mouth and gently withdraw your nipple from his mouth, and try to relatch him successfully. Using a nipple shield (available from your pharmacy or baby shop) during feeding gives cracked and bleeding nipples time to heal. Speak to your clinic sister or doctor to recommend a nipple cream to assist with healing. Exposing your nipples to some sunlight also helps to hasten healing (easier said than done!). Expressing breast milk and offering it to your baby from a spoon or a bottle is also a way to let your nipples heal whilst continuing to breast feed. Is my milk strong enough? Don’t listen to old wives tales about your milk being too strong or too weak. It is not the quality of the milk that makes the difference, it is the quantity. Some moms just do not have enough milk to satisfy their baby. This is why it is important to weigh your baby frequently to ensure that she is growing adequately. If your baby is gaining weight, having at least 6 wet nappies a day, and is relatively happy in between feeds which may be very frequent in the early days, lengthening to a few hours after a few weeks; then you can rest assured that you have enough milk. However, your stress and anxiety, a poor diet and inadequate fluid intake all play a part in hampering breast milk production. Make sure you are eating enough protein, such as meat, eggs and beans (you need to increase your protein intake three fold whilst breast feeding), drinking at least a liter of fluid a day and that feeding times are relaxed and calm. The main hormone that ensures adequate milk production (oxytocin) is controlled by emotions, so if you are anxious and upset at feed time, this important hormone will be affected, and you will produce less milk. Managing sore and engorged breasts This typically happens around day 4 after delivery (slightly longer after a caesarian birth). Most new moms are usually at home by now and do not have the support and care of the nursing staff in the maternity units to help them through this difficult time. Your breasts will become full and heavy, and excruciatingly tender to the touch. In some instances, they become rock hard, hot and sore. This is what is commonly known as “milk coming in”. It usually settles after 72 hours. Feed your baby on demand, as normal, and don’t be tempted to express your breasts to make them emptier and softer – all you will do is encourage more milk to be produced! Place cabbage leaves in your bra (they really do work), rub arnica cream or oil onto your sore and swollen breasts, and take an anti-inflammatory medication to help with the pain and swelling (ask your pharmacist, clinic sister or doctor to recommend one that is safe for breast feeding). Applying ice packs also helps with the pain and inflammation. Persevere, it will get better – just give it some time, and don’t expect your breasts to settle down for at least a few days. By Sr Ann Richardson Sr Ann Richardson is the author of Toddler Sense and also co-authored Baby Sense and Sleep Sense. She is a qualified nurse and midwife and has worked in the midwifery and paediatric fields for 30 years. For more information from Sr Ann Richardson go to www.toddlersense.com or email her at info@toddlersense.co.za

You are your baby’s foundation of security and trust, and the solid base from which they will explore the world of social interactions. Your role as primary caregiver is to be your baby’s first and most important, available, attentive and loving social partner. How babies develop and organize their sense of self and how social development unfolds, is dependent on their individual differences together with the unfolding relationship between baby and primary caregiver. A predictable, consistent, loving, ‘tuned-in’ parent creates not only a sense of safety, but also a positive sense of curiosity and confidence to explore new physical and social environments. Individual differences Each baby has a unique sensory processing style, an individual way of perceiving and thus experiencing their world. For a baby who is sensory sensitive, they can become overwhelmed by certain noise, touch, movement, light or too much sensory input. They may have difficulty staying calm and regulated with change in routine, environments, people or experience. These babies may need more time and extra support n order to be ready for social interactions. Informal family gatherings, friend groups and structured baby groups are all beneficial for parents to connect, learn and share their experiences. Introducing babies to new people and social settings when they are ready will encourage them to feel safe and confident with others too. Guidelines for social readiness: In the first 3 months, babies are learning to organise sensations and adapt to being in the world. Caregivers learn to read their babies’ signals, body movements and rhythms. They learn what is overwhelming, what comforts and what helps their baby recover from distress, so they can attain a calm alert state to become available to take in the world. Consistent and predictable care-giving lets babies know that they will be safe and protected at this stage. Trust gives babies a sense of security which allows them to take an interest in the caregiver, their first important social interaction. Between 3 and 6 months, babies are generally more regulated, calm and alert and thus available for engaging. The caregiver and infant take more interest in one another and an emotional bonding occurs. Mirroring of facial expressions, sounds, smiling and gazing at one another becomes part of this growing intimacy and falling in love. This warm relationship gives babies a secure sense of self to prepare them to take interest in the world. At around 6 – 9 months, babies stable head, body and sitting balance enables them to engage with the world. Babies become more purposeful and communicate with body movements, gestures and sounds. Caregiver and baby begin to experience more positive pleasurable interactions as they recognise these familiar patterns of back and forth rhythmical exchange and use them ins ocial play such as peek a boo. Initially, the parent’s lap gives baby a safe and secure platform to gaze outward at the world. The parent is still available to monitor excessive stimulation and be attuned to their baby’s individual signals and needs. The trusting relationship now allows baby to begin to turn his attention to the outside world, with curiosity and anticipation. Babies at this stage take a great interest in family members and other people. Around 9 months, babies soon move from the lap to the floor as they learn to crawl and become more purposeful in exploring their world. This increased distance between baby and caregiver also facilitates the emergence of a sense of self separate from the caregiver. This developing awareness of difference between self and mother leads to awareness of difference between mother and another person. As a result, babies around this age can become vulnerable and wary of strangers which is called “stranger anxiety”. Around 9 to 14 months, the baby’s growing sense of purpose, curiosity and motor competence allows them to crawl or walk away from the secure base of their caregiver. They are growing in independence in discovering their own view of the world. This new feeling of independence can be scary for the toddler and therefore the secure, assuring home base of caregiver continues to be important as they explore their social interactions with others in what we call parallel play where babies play alongside one another, watching, following, exploring and copying one another. Babies’ curiosity and independence prepares them for the next leg of their journey toward confidence and social development. By Kate Bailey, mother of three, Occupational Therapist and designer of the Moms and Babes program.

Handwriting, pencil grip and fine motor skills are some of the most common reasons for referral to occupational therapy intervention in children preparing for formal school. You can prevent this problem by following simple and easy steps from your child’s baby years. There are two types of motor skills: fine and gross motor skills. Fine motor skills generally refer to actions performed by the fingers, wrists, hands, lips, tongue and toes. It includes pencil grip, cutting, manipulating small objects, buttoning, tasting, grasping. Children may have difficulty with these because of a specific problem such as sensory processing disorder or a naturally slower progression of development. Most of the skills mentioned, are expected of an older pre-school child, so why be concerned about it while your child is a baby? You can have a look at the Hierarchy provided below. The fine motor skills develop in a predictable pattern as from baby years. The young baby, of 2 – 3 months old, bats at objects, then progresses to grasp, to release, to transfer and to manipulate objects. Of course the mouth is included in most of these explorations which is important for the development of lip and tongue movements. You can ensure that the foundational skills are well-developed in your baby. The easiest way to encourage effective eye movements, head control (strong neck muscles), shoulder control and hip and trunk stability is to use tummy time as often as possible. Tummy time encourages the child to use the important neck muscles to lift the head. As the baby wants to see more of the environment the baby uses the arms to push the head to a higher position. This encourages weight bearing on the hands which encourages strong shoulder muscles to support the arms and the development of a mature pencil grip. When the baby reaches to objects and toys in this position, rotation of the trunk is encouraged which strengthens the trunk muscles and prepare the baby for rolling, sitting and eventually for an effective, upright posture. An upright posture is essential to support the shoulders, arms, hands and fingers when writing. Once babies can sit independently they are using the hands to reach for objects, to manipulate objects, to mouth objects, to grasp, to release, to throw, and to transfer objects form one hand to the other. By reaching for objects they also start to cross the midline of the body. All of these actions prepare the baby for the complex tasks of fine motor skills, and to use the two hands in a coordinated way. Activities such as cutting, using a knife and fork, buttoning, and many more rely on the ability to use the two hands in a coordinated way. You might watch your baby on the floor, trying to keep the head up, trying to move, trying to reach for objects and you might experience a strong feeling to help. However, reconsider and provide the opportunity for a little “work out” before you step in to “help”! Keep the important skills which are developing in mind and enjoy the journey of growing and developing more skills with your child as if the baby is an athlete in training. Of course, sitting in a stroller or car chair will not develop many of the above mentioned skills. The pre-crawl stage can be very challenging as the baby wants to move and is frustrated. At this stage they are often not interested in manipulating objects for long periods of time as their body is getting ready to move. This urge is strong and necessary for motivation to get going and to crawl. To put baby in a walker doesn’t encourage crawling. Crawling is important as the left and right side of the body have to move in coordination, laying the foundation of many other skills, including the development of a dominant side. You can put your baby on the tummy on a blanket on the floor in your house and pull him through the house on all the uncarpeted floors. The baby has to hold on, strengthening hand, arm and shoulder muscles. This will give the baby the enjoyment of movement for a short period of time and will strengthen the muscles needed for crawling. To encourage the development of a mature pencil grip, the baby has to develop other grips. These are: Before the baby holds a pencil or crayon, the palmar grip is the favourite. The baby grasps an object with the hand and all the fingers, as you would do when you hold a tennis ball in your hand, closing all your fingers around the ball. The cylinder or fisted grip is usually the first one used to hold a pen or crayon. The thumb is on one side of the pencil and the other four fingers around the pencil from the other side. At about 2 – 3 years these two grips develops into different grips which will not be discussed in this article – all are one or other variation of a clumsy mature grip. The important thing to remember when you want to encourage the development of your baby’s hand writing skills in later years is tummy time and the opportunity to manipulate many different objects. -------------------------------------------------------------------------------------------------------------------------- Marga Grey is the author of Sensible Stimulation. She is an occupational therapist who practised in South Africa for almost 30 years, working mainly with children and their families. She presented many workshops to parents, teachers and therapists and through her work realised the importance of the first three years as a foundation for development. This was also her field of study for a Master’s Degree from Wits University. She currently lives in Queensland, Australia where she works in a multi-disciplinary private practice, providing therapy to many children from 0 – 18 years. She is also the developer of CoordiKids, online programs to encourage the optimal development of children. For more information from marga Grey go to her website or email her at info@sensibleparenting.com.au

Wouldn’t it be great if your baby came with a manual! One of the hardest tasks of the early days is to understand your new baby’s language. While each baby is unique most babies shared a common unspoken language in the early days. Reflective function or the ability to read and understand your baby and respond appropriately is the most important skill of early mothering. By reading your baby well you will know what he is feeling and thus how to respond. Your baby will feel secure in the knowledge that he is understood and bonding is enhanced. If your baby is feeling happy and ready for interaction, he will make eye contact, coo and smile (if he is old enough). When your baby shows these signals, you know that stimulation and interaction will be well received. In this state, the calm alert state, your baby will be making connections in his brain and learning will occur optimally. Your baby is happy and calm. On the other end of the continuum is the crying state. This signal is obvious and no explanation of what crying sounds like is needed. Your response to the cry will determine how long your baby will cry for. When your baby cries, first respond by asking why: Is he hungry? – feed if three to four hours have passed. Younger babies or those not gaining weight may need more frequent feeds. Is he comfortable? – look at the temperature of the room and whether your baby is appropriately dressed. Is he ill? - if your baby has been the a cheerful fellow and the crying is excessive or out of character, take him to your doctor to rule out illness Is he tired? – babies need to sleep very frequently. Be sure to watch his awake times and put your baby to sleep frequently before he becomes overtired. Reference Baby Sense for how long your baby can be awake between sleeps for his age. Is he over stimulated? – this is the most common cause of crying and requires you to remove him from the stimulating environment and give him down time with calming activities. Long before your baby starts to cry due to over stimulation he will give warning signals that he has had enough. A new born will descend to crying and a toddler to chaos if you miss these signals. By watching for your baby’s signals you can respond before he begins to cry: Sucking hands Looking away and loosing interest in toys Holding hands together in the midline Grizzling or moaning Arching his back Pushing you or a toy away These warning signals are important forms of communication that help your baby keep himself calm and well regulated. When you see these signals, help your baby calm himself by letting him suck on his hands, giving him a dummy or removing him from the busy environment that is stressing him. You baby may also be tired and need to be put down for a sleep. Watch for your baby’s precious signals and respond appropriately, giving him the security that you respond to his needs. By Meg Faure

Crying is a primitive and piercing sound that is bound to get any mom or dad’s attention. When our baby cries, we naturally react to stop the crying. However it is important to understand why our baby is crying as well as responding to stop the crying. When searching for the reason, eliminate basic needs first: hunger tiredness discomfort caused by a dirty nappy, cramps, bloating, reflux, constipation, etc medical conditions When you have ruled out all these possible causes but the crying doesn’t stop, it is understandable that you may begin to feel desperate and at a loss for what to do for your baby. It is important to know you are not alone. In the first 12 weeks of life many babies spend some hours each day fussing and crying. This unexplained crying in the early days has been commonly known as ‘colic’. For many years it was thought that the crying was caused by abdominal discomfort or cramps but recent research shows that it is more a factor of the young brain’s inability to deal with stimulation. Your baby’s ability to filter out stimulation in the world develops over time. In the first two weeks, we hypothesize that your baby’s brain protects him from excess sensory info. During this time your baby is probably an angel, crying very little and sleeping a lot. But at around ten to fourteen days, this protection dissolves and your baby’s brain must start to filter out sensory stimulation on its own. Of course, being immature, it can’t and so your baby reacts to the world with sensory overload. From being that angel who slept all the time, he suddenly is more alert and fusses. He may cry for an hour every evening or as much as three hours day or night. This daily crying usually peaks at around 6 weeks and by 12 weeks the fussy period is over. The best way to prevent excessive crying in the first three months is to limit stimulation and keep your baby’s world calm. So how do you calm your baby who is already crying and unplayable due to overstimulation? Swaddle your baby – the deep pressure and containment provided by a swaddle is the best calming measure. Your overtired baby will then no longer be bothered by his flailing arms and will feel calmer when swaddled Decrease stimulation – do not over stimulate your baby when he is already fractious. Take him to a dim room with quiet lullabies instead of swinging him through the air to make him laugh. Hold your baby and carry him – do not worry about spoiling your newborn, as babies up to four months old do not form habits. However, they do have sensory needs and movement such as that provided in a sling is a great way to calm colicky newborn or fractious toddler alike. Lie with your baby on your chest – when the wheels are falling off, and mum and baby are falling apart, Dad can be a great support. Take your little baby and lay quietly with him on your chest and sooth him with your calmness and gentle touch. White noise – white noise provided by water, a radio tuned to static or a white noise CD/MP3 are wonderful sounds for calming babies. If possible play white noise at the volume of your baby’s cry and he will calm down. By Meg Faure

The golden question: “When should my baby sleep through?” is one that needs answering as it determines what is reasonable to expect from your baby. Sleeping through is not just a luxury, it’s a developmental necessity. Both for you and your baby, a good night’s sleep is important. Firstly, it needs to be pointed out that sleeping through constitutes sleeping 10 or more hours at a stretch. This would mean that if your baby’s bedtime is between 6 pm and 7pm (as it should be) that could mean a waking at 4 am to 5 am. Many babies will go back to sleep after this time with a feed or a cuddle. If your toddler wakes for the day at this time, keep interactions muted and take him quietly into your bed with you and see if he will fall back to sleep. Under 6 months of age babies have nutritional needs at night that systematically decrease as the baby gets older. Having said this, some babies sleep do through the night as early as 3 months of age but many of these will experience disruption once again between 4 and 6 months. Most babies should be expected to sleep through the night by seven months old. Like other developmental milestones, sleep has certain norms that obviously are flexible as with any other milestone. The following are the norms for sleep at night: 2 – 6 weeks – one 4 – 5 hour stretch between night feeds and 3 hourly thereafter 6 - 12 weeks - one 6 – 7 hour stretch between night feeds then 3 hourly through the night 3 – 6 months - 10 – 12 hours at night 6 – 12 months - 10 – 12 hours at night 3 – 5 years old 11 hours per night as day sleep is dropped If your baby is ill he will not sleep through and will wake for comfort. If you have a low birth weight, premature or a baby with failure to thrive, he will not sleep through until later than other babies. If your baby learns to self sooth for incidental night wakings, i.e. those without organic causes such as hunger or illness, he will be a good sleeper. Even good sleepers who are sleeping through by 6 months old will occasionally suffer disrupted sleep for a few nights, but after the cause such as teething, hunger or illness is resolved, will return to being good sleepers. Broken sleep is debilitating but if your baby is young, hang in there it won’t be long before you see the light. If your baby is older and is not sleeping through you need to go through the process of elimination to establish why your baby is waking. Thereafter you may need to help your baby learn strategies to fall asleep independently so you can get a good night’s sleep. By Meg Faure

Just as you get it all right and think you are on the track to having a baby who sleeps through the night, you get one disturbed night of sleep and it sets you back big time! The question is: are there typical times that you should expect nighttime hiccups? Sleep and your newborn baby In the early days, most babies wake two to four hourly for feeds at night, especially breastfed babies. The night wakings gradually reduce and within a few weeks (usually at around 6 weeks of age) your newborn should start to stretch for one long stretch of five or more hours once at night. Usually the first stretch to develop will be from bedtime to around midnight, as your baby drops the late evening feed first. Don’t be tempted to wake your baby up earlier, to feed, in the hope that it will do away with the 2 am feed - they are usually too tired to feed efficiently and this can cause longer-term sleep problems! If you are having sleep problems at this age it is usually one of the following issues: Your newborn may have their day and night muddled up. Newborns can be too sleepy to feed well, fall asleep at the breast and therefore need to feed more frequently At 2-6 weeks, many newborns become more wakeful and hard to settle to sleep, especially during the afternoon and early evening. 4-6 months old From birth your baby will slowly and steadily begin to sleep for longer and longer stretches at night and you will have the satisfaction of the occasional longer period of sleep. But just as your baby pieces it together and is almost ‘sleeping through’, he will start to wake more frequently again. This happens as your little one begins to require extra nutrition at night, the milk feeds that used to sustain him are no longer doing so and you have three choices: Your baby needs nutritional support at night, so feed him when he cries if three or more hours have passed. Don’t be tempted to ‘dummy’ him because it will impact on sleep later if habits develop. In this way your little one will go back to sleep and wake again in 4 hours for another feed. This is a good idea if Your baby is less than 17 weeks You or your baby have confirmed allergies (in which case you should delay introducing a formula or solids) Offer a top up bottle at bedtime or if he wakes shortly after going down Introduce solids Give your baby a top up feed of formula or expressed breast milk in the evening. Treat this as a cluster feed just before bedtime Start looking at introducing solids – look at simple single grain and yellow veggies.8 months old At around 8 months old, your baby will start waking due to separation reasons or plain old habits. At this age your baby is working hard to establish object permanence – the awareness that you exist when he can’t see you. To decrease the effect of this milestone on sleep: Encourage a sleep soother such as the Baby Sense Taglet or dummy that can be used independently. Play separation games during the day – ‘peek a boo’ or hide and seek. Listen to your baby at night before going to him and see if he resettles on his own. If he cries, go to him, give him love and help him settle on his own with a doodoo blanky. Do not be tempted to feed him at night before 2am as this can lead to habits developing. Sleep and your baby 6m - 12m From 6 months, if your baby is on a full solids diet and has learnt to self-sooth, he can be expected to sleep through (10-12 hours without waking for a feed). After 6 months of age obstacles may presents themselves: If your baby is still waking is may be because he has developed a habit and expects to be resettled in the night in the same way as he falls asleep at bedtime. Alternately night wakings can be due to nutritional needs - your baby now needs specific essential fatty acids for brain development. These nutritional essentials are found in the fats in proteins. So now is the time to introduce protein in the form of dairy, meat, beans and chicken to your baby’s diet. At this age, teething can also disrupt sleep for a few nights. If your baby is definitely teething at night – and make this decision during day light hours when you can actually see the tooth. If there is evidence of teething, use teething powders or painkillers as necessary. Remember though that we tend to blame teething far too quickly and the reality is that it is rarely teething that is the problem and if so only for two to four nights as the tooth erupts. Separation anxiety also affects sleep especially around 8-10 months – as your baby develops object permanence, he may become insecure when you are not around. To decrease the effect of this milestone on sleep: Encourage a sleep soother such as the Baby Sense Taglet or dummy that can be used independently. Play separation games during the day – ‘peek a boo’ or hide and seek. Listen to your baby at night before going to him and see if he resettles on his own. If he cries, go to him, give him love and help him settle on his own with a doodoo blanky. Do not be tempted to feed him at night before 2am as this can lead to habits developing. Toddler years Toddlers are notorious poor sleepers. Your toddler will wander at night and come through to your room. In fact more toddlers co-sleep than newborns, according to recent research! Toddlers call for their parents at night due to night fears and boundary issues. To address this, leave a night light on and encourage your toddler to use a comfort object instead of coming to you. If your toddler repeatedly wanders into your bed at night you have three choices: Repeatedly walk him back to his bed – while this will be exhausting initially, your toddler will eventually learn that night wanders brings no joy. Let him climb into your bed and share a bed with him Find the sense-able middle ground – have a mattress under your bed that he can pull out and sleep on at night – this means your bed remains your own but your toddler has access to you at night. By Meg Faure