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When one’s baby is unsettled, lack of sleep, or plain exhaustion, is often not considered, as we are too busy looking for a ‘physical’ reason for our baby’s distress. When we have good sleep, we take it for granted, but for those who are sleep-deprived, the word torture takes on a new meaning. It is no different for babies. An over tired baby is frequently a fractious, over stimulated baby. Sensory overload is one of the most common causes of unsettledness in babies. So your unsettled baby may in fact be an over stimulated or overtired baby. How the sensory system works The behaviour displayed by a baby when stimulated will differ depending on the manner in which the stimulus is interpreted. Each sense (hearing, sight, touch, smell, taste, movement, sense of space, and body functions) works with the others to form a composite picture of what is going on around us . Sensory integration is the critical function of the brain that is responsible for producing this picture. For most of us, effective sensory integration occurs automatically, unconsciously, and without effort. However, many babies, especially those born prematurely, may have difficulty in ‘processing’ too much sensory stimuli due to immaturity of the brain. What happens when your baby is stimulated? When a baby is exposed to sensory stimuli, one of three things may occur: The infant may interpret the stimuli as non-stressful and respond to the stimuli appropriately. The baby will display approach signals.These signals indicate that she is in control, and is neurologically well-organised. These signals invite interaction. They include: smiling or mouthing with an ‘ooh’ face soft, relaxed facial expression cooing relaxed limbs smooth body movements with minimal activity. This is the ideal time to interact with and to stimulate your baby. The baby experiences stresswhen exposed to the stimuli, but is able to produce a behaviour that decreases the effect of the stress on the nervous system. At this point, the baby still has the ability to self-regulate. However, if the stress/stimuli continue, the nervous system becomes unstable, resulting in a stress reaction such as crying. Warning signals that the baby is becoming overloaded include: hand on face sucking fisting clasping of the foot leg bracing bracing body against sides of the crib, or into the mother’s neck assuming a foetal position shifting to a drowsy state These signals must be interpreted as a warning message that the infant may be reaching maximum tolerable stress levels. This is the time to allow your baby some space or to go to sleep, and to avoid any further stimulation. The stimulation stresses the infant to such a degree that the infant becomes unable to overcome the effect of this stress by self-calming. This happens when the stressful input (stimuli) simply exceeds the infant’s ability to compensate. Signs of a ‘stressed’ baby include: gaze aversion, or gaze locking (glassy eyes, gape face) irritability lack of alertness finger splaying/saluting squirming, sitting on air frantic, disorganised, jerky movements tongue thrusting yawning, sneezing and hiccupping gagging or spitting up arching of the back colour changes, - paleness, mottling, flushing or cyanosis (bluish discoloration of the skin) changes in vital signs (heart rate, respiratory rate). These signs are often misinterpreted as colic or boredom. However the sensory system at this stage is in such disarray that the baby is unable to self-calm and will cry inconsolably. What can you do? This is the time to: modulate the environment (remove stimuli) encourage hand-to-mouth activity, or non-nutritive sucking (dummy) encourage finger grasping swaddle or place in a sling allow the baby to ‘nest’ into a foetal position Important points Babies who are constantly over-stimulated, and / or deprived of ‘quiet time’ will often be in a state of ‘stress’, and will be hard to put to sleep. It is of great importance to avoid over-stimulation and to let babies sleep as much as they need to. It is important to remember that babies’ sleep cycles are determined by their awake times. To avoid babies’ becoming over stimulated and overtired, it is crucial that they are put to sleep whilst still happily awake! For guidelines of age appropriate awake times for your baby, please refer to the article on the website. By Ann Richardson

Reflux really does play havoc with our baby’s sleep and causes them to fuss more and may even result in feeding issues at times. Here are a few tips to help you cope with reflux: Occasionally reflux is related to lactose intolerance and it is worth just trying to rule this out. If you are breastfeeding, cut out dairy in your diet for a week and see if that helps. If you are using formula, try a lactose free or soya variety. Use the Losec as it really does help. Feed in a quiet sensory environment and keep your baby upright after the feed. Over stimulation causes increased likelihood of positing, as does lying horizontal. Raise the head of your cot mattress with a wedge and let your baby sleep on his tummy when you are around. • Make sure you stick to the awake time appropriate for your baby’s age as he may be over stimulated and thus not falling into a deep sleep. Don’t worry about holding your baby to help him sleep, you cannot spoil your baby at this age. But whenever he is comfortable enough to be put down, put him down to sleep. Once he is asleep use white noise and a weighted blanket to help him sleep a little deeper.

In March 2010, a warning was issued on the use of ‘bag-style’ slings in the USA. This was based on a study that was looking into the safety of these slings due to injuries and deaths of baby’s whist in these slings. Infant safety is no doubt the most important issue to any person working with babies, advising on infants and developing products. It is important to note a few facts: firstly slings are enormously beneficial to babies as well as being convenient for parents. Using one of a multitude of safe style slings according to the instructions, one should not see any risk to babies. Benefits: Baby wearing is one of the most wonderful ways a mother can nurture her baby. Over thousands of years and in most cultures women carried their babies in slings. Sadly this tried and trusted method went out of vogue in the 1900’s when modern prams (made popular by Maclaren in 1965) became a fashion item and were used with ease on smooth surfaces like pavements and in shopping centres. Sadly babies lost out on the benefits of being carried and nurtured close to their mom. In recent years we have seen a trend back towards natural methods of childcare and sensory based parenting. Research by respected baby care medical experts such as Urs A. Hunziker MD and Ronald G. Barr MDCM, FRCP(C), Dr. Maria Blois amongst others supports the numerous benefits thereof. Babies who are carried in a sling are conclusively calmer than babies who are not<1>. Other benefits include: Social benefits – the baby is at the parent’s level, reading signals and seeing the world with the parent. Bonding – the parent has a greater opportunity to read the baby’s signals and connect with the baby at close proximity Developmental – the vestibular input provided by slings facilitates motor development of tone, balance reactions and later motor milestones Breastfeeding Language development – the baby and parent communicate more and benefits may be seen in verbal IQ Due to the rise in popularity of sling carriers over the past few years there are more and more available on the market a few of which are not safe. These slings have elasticised edges or drawstrings that pull the fabric over the baby. They are deep sling bags that position the baby low on the mother’s body. Using slings safely: When choosing a sling, a mother must look for a ring sling, mei tais, wrap or pouch sling all of which do not pose the risks that are being highlighted. These slings are simple, without ties and gimmicks. This style of slings are frequently tested and approved by a standards organisation in the USA and EU. Critical elements in slings are: Soft, lightweight, single layer cotton fabric. No fleece, no polyester, no thick fabric Tested rings or clips No padding in the body of the sling No drawstrings or ties around the edge of the sling Obvious safety instructions on the wash care label Critical elements in using slings: Ensure the baby’s face can be seen and that breathing is not hampered in any way Wear the baby high up on the chest above the level of the mother’s belly button Do not place the baby in the sling swaddled or wrapped in blankets Do not wear the sling under the parent’s clothes Ensure that the baby is tightly secured in the sling with the back well supported Regularly monitor baby’s temperature and position What are the dangerous activities to avoid while carrying your baby? There are a few precautions you should bear in mind for any baby sling or pouch. Do not drive with your baby in the sling. Do not drink or eat hot substances over your baby’s head. Do not do strenuous exercise with your baby in a sling. To ensure there is no risk of the sling strap slipping through the rings, make sure that at least 7cm of the strap is showing below the rings.

Three steps to help your baby (older than 8 months) to use her dummy independently at night: At about 8- 9 months old you can expect your baby to be using the dummy at night independently. If your baby is waking you to put in the dummy at night, there are three steps to help your baby (older than 8 months) to use her dummy independently at night: Step 1 Each time she needs the pacifier during the day, put it in her hand – not her mouth. She must pop it in her mouth on her own. Step 2 Once she can do this in daylight hours, it’s time to let her do it at night. Each time she cries at night put the pacifier in her hand and she must pop it in her mouth. Be sure to always offer her doodoo blanky first. Step 3 Once she can put the pacifier in in the dark, guide her hand to it when she cries until she can get it on her own. Step 4 Put lots of pacifiers in the cot so she finds them on her own. Step 5 Leave her to fuss for 5 min before responding – giving her chance to sort herself out with her doodoo or pacifier. By Meg Faure

Its 5:30 in the evening and Mario has just had his bath. As Dad opens the font door, an ear-piercing scream is heard from within. Six-week-old Mario is exercising his lungs again in a ‘horror hour’ that Dad has come to know well in the past four weeks. In the first two weeks home Mario was such an angel but on the day he turned 12 days old he developed what the clinic sister calls ‘colic’. His mother had no idea that crying could be so loud and unceasing. She is feeling quite desperate and all the time the questions running through her head are: Why is he crying like this, How can I stop the crying and How many more nights of crying lie ahead? Why do babies get colic? Recent research has shown that colic is not due to immature digestive systems as has been previously thought but rather due to immaturity of the baby’s brain. New baby’s brains are very sensitive to all the sensory input in their environments. By late afternoon their brains reach a threshold level where they literally cannot deal with any more stimulation. So the smallest input, such as winds in their tummies or even that last feed of the day is sufficient to push them into overstimulation or sensory overload. And this results in crying. Each baby can tolerate different amount of stimulation. Some babies can cope with more stimulation than others without fussing. Other babies are more ‘high need’ and become over stimulated very quickly. These are the babies who are more susceptible to colic and whose colic lasts longer and is more severe. How to limit the crying? Most young babies cry to a greater or lesser extent in the early evening but it is how we handle the baby that determines whether the crying will last for 15 minutes or stretch into three-hour colic. Mario’s parents become somewhat anxious; anticipating a crying spell similar to the one they had the night before. They may start to wind him vigorously, trying to get up that elusive ‘wind’. The bouncing and patting only serve to further stimulate him. His parents then turn on the light and take him to the TV room so that they can be sociable while trying to calm him; which further exacerbates the problem. They try singing, talking, lying down, offering another feed, changing his nappy, holding him in various positions, until finally three hours later an exhausted Mario plunges into a fretful sleep. It was not that his parents tried the wrong strategies. In fact each of these strategies holds merit if the timing is appropriate. But at this time when Mario is over stimulated; a barrage of well meant attempts to calm him are likely to contribute to over-stimulation and exacerbate the colic spell. To limit the crying and prevent it from turning into a colic episode, parents can try the following strategies: In the first three months, don’t over stimulate your baby Have a daytime sleep routine. Under three months of age your baby should only be awake for an hour to an hour and half between sleeps. Watch for signs of overstimulation during the day and especially in the evening, such as irritability, squirming, arching, frantic movements, frowning, yawning, hiccups and blueness around the mouth. When you notice these signs, remove your baby from the stimulating environment and use calming strategies. Use sensory calming strategies such as; Swaddling Rocking your baby or putting him in a sling Just putting him down to sleep Sticking to 1 calming strategy for 5 min When will colic abate? Colic usually starts at two weeks and peaks at six weeks. By 12 weeks the baby is better able to deal with sensory stimulation and colic abates around this time. Mario surprises his parents a day after he turned six weeks with his first smile and somehow just that little happy signal makes the next 6 weeks of colic easier for his parents to bear. As hard as this period is for his parents, they can know that it will pass and that by the end of the first three months, they will be enchanted by their baby’s cuteness. References: Megan Faure & Ann Richardson, Baby Sense, Metz 2010 DeGangi Pediatric Disorders of Regulation in Affect and Behaviour Academic press 2000 By Megan Faure