Newborn Screening

Helping New Parents Understand & Connect with Baby from the Beginning:An Interview with Pediatrician & Author Dr. Harvey Karp

Harvey Karp, M.D., is a nationally-known pediatrician and child development specialist. He is an assistant professor of pediatrics at the UCLA School of Medicine and commits his full-time efforts to writing and lecturing. Dr. Karp received his medical training at the Albert Einstein College of Medicine and is the author of The Happiest Baby on the Block, which has also been developed as an educational DVD and a series of classes for parents. He is also the author of the book and DVD, The Happiest Toddler on the Block. Dr. Karp’s work has been endorsed by the former Surgeon General, the co-founder of Lamaze, La Leche League, Attachment Parenting International and is being used in the state of Pennsylvania’s Breastfeeding Promotion Initiative. He has been featured by the New York Times and Associated Press and has appeared on CNN, ABC World News Tonight, The Dr. Phil Show and many other TV and radio programs. More than 1,400 educators have enrolled in certification training to teach Dr. Karp’s “5 Ss,” at hospitals and clinics throughout North America.

Q. In your work with families, what difficulties do you commonly see new parents struggling with?

A. All babies cry, but most new parents have little or no experience soothing them and few people to turn to for help. Many new moms and dads are bewildered by their newborn’s fussiness, and it is not unusual for them to have a hard time learning how to soothe and connect with their babies in the way they would like to. When a new parent has tried everything they know of to help a screaming baby relax, with limited results, it can be very frustrating and a source of worry. I also see many new parents who are struggling with sleep issues. They are typically sleep-deprived themselves, and they are concerned about establishing good sleep habits with their babies. New moms and dads often wonder if they will ever rest again! All of this can have an impact on how parents and newborns are able to bond with each other and settle into family life together.

Q. What do you tell frazzled parents who want to soothe and bond their new babies?

A. I have found that giving parents a developmental perspective empowers them and helps them learn to calm and connect with their newborn. First, I help them understand the profound differences between the brain of a three-month-old baby and that of a newborn. I discuss with parents the concept of “the fourth trimester,” in which the baby is still developmentally very much like a fetus, and will respond to the same types of soothing that he or she experienced in utero. The fact is, during the first few months of life, babies undergo massive developmental changes, and newborns have very different needs and behaviors than older babies. Inside the womb, fetuses are continually fed, jiggled, cuddled and shushed (the sound our fetuses hear is louder than a vacuum cleaner…24/7). But once they’re born we leave them alone, in almost total stillness, for hours a day. It’s no wonder so many babies have trouble adjusting during those first three months. If new parents can help ease their newborn through the huge transition into the world during those first three months by creating an environment that mimic life inside the womb, it generally means a calmer, happier baby whose cries can be soothed and who can sleep soundly. I teach parents about the “calming reflex,” the virtual off switch for crying that all babies are born with. Parents can turn on this switch by recreating the coziness, the sounds, and the rhythmic motions of the womb. In turn, the parents feel more confident and capable when they learn that they can help their baby through this period of adjustment.

Q. Are there specific techniques new parents can use to soothe babies during the early months?

A. There are several techniques that effectively trigger a baby’s innate “calming reflex.” I call the main five techniques the “5 S’s” and I teach them to new parents who want to help their newborn relax, calm crying spells quickly, and sleep an extra one to two hours each night:

  • Swaddling: The correct technique for swaddling full-term babies is with the arms down and firmly wrapped. This prevents newborns from startling themselves with flailing arms and recreates the snug, reassuring feeling they had inside the womb. Babies must never be overheated or have loose blankets in bed with them.
  • Side (or Stomach): While babies should always be placed to sleep on their backs for the prevention of Sudden Infant Death Syndrome (SIDS), parents can help calm a baby by using the newborn’s “feel-good” position. Holding a newborn on the side or stomach will trigger the “calming reflex” and will switch off the falling (or Moro) reflex. Holds such as the “reverse breastfeeding” are tried-and-true ways to cuddle and calm a crying baby.
  • Shhhh: A brisk, loud “shushing” sound triggers your baby’s calming reflex by mimicking the loud, rhythmic sounds a newborn is accustomed to hearing while in utero. While some parents hesitate to “shush” loudly, I remind them that quiet “shushing” often fails to soothe a crying newborn because the constant “wooshing” sounds inside the womb are as loud as a vacuum! Some parents find that their babies respond very well to other types of white noise, such as that generated by a white noise machine, radio static in between channels, or the sound of a hairdryer.
  • Swinging: Newborns are comforted by vigorous jiggly movements, similar to those they experienced in utero. Done just right, swinging can switch on a baby’s “calming reflex.” However, not just any direction or type of swing will feel familiar and soothing. A newborn is accustomed to having the head jiggled loosely, such as when the fetus rocks as a pregnant mother climbs the stairs. Some parents find success with placing their newborn in an infant swing, but I advise them to use the swing in a certain way to get the desired effect. For example, I suggest that they not place their newborn in the infant swing until he or she has already been calmed and swaddled snugly, and that they use the swing’s “fast” speed (with baby securely buckled in, of course).
  • Sucking: I teach new parents that sucking is the “icing on the cake” for a newborn baby. Sucking calms babies not only by satisfying their hunger, but by turning on their “calming reflex.” Suckling at the breast is the best way to provide this comfort to babies, but once the nursing is well established the baby may also suckle on a parent’s finger or a pacifier.

Q. Do some newborns respond more readily to these techniques than others?

A. Every baby is unique, and each has a unique temperament that may make soothing easier or more challenging. Some newborns can be calmed with just one of the “5 S’s,” but most newborns need several of these techniques to settle well. What I call the “Cuddle Cure” is the combination of all “5 S’s,” at the same time. In using the “Cuddle Cure,” I find that swaddling and the shushing are most important – so perfecting these two techniques is essential. I also remind parents that practice makes perfect, and that they will find these techniques more natural the more they use them. I also recommend some of the basic cures for infant fussing (such as massage, skin-to-skin contact and walks in the fresh air) that civilizations have found soothing to infants since ancient times. Finally, I give new parents basic information about some of the medical causes for infant crying, such as allergies, constipation, feeding problems and acid reflux. There are definite indicators that warrant a call to the baby’s healthcare provider.

Q. How does the information you share with new parents differ from the conventional wisdom and parenting advice of the past?

A. When I was a medical student in the early 1970s, my professors taught me that babies scream because of gas pains, and they believed that there were really only two valid approaches for soothing these infants: First, try the grandmotherly advice of holding, rocking and pacifiers. If that failed, the second response was to use medication. The three types that were commonly prescribed for infants were sedatives (such as phenobarbital), anti-spasm medication (to treat stomach cramps) and anti-gas drops (to help baby burp). By the late 1970s, these therapies were either abandoned or seriously called into question. Sedating babies was rejected as inappropriate, the use of anti-spasm medications was abruptly ended after several babies receiving them lapsed into coma and died, and anti-gas drops lost their appeal when they were found to be no more effective than water. My own perspective and thinking evolved dramatically when I was a fellow in child development at the UCLA School of Medicine in 1980. There, as a member of the Child Abuse Team, I consulted on several severely injured babies whose screams had driven stressed-out parents to commit horrible acts of abuse. I was outraged that our sophisticated medical system didn’t have a solution for helping parents help their babies with this terribly disturbing, yet common problem. I read everything I could find about colic, and I was determined to find clues to why so many children seemed to be plagued with this mysterious condition. The pivotal revelations came to me when I learned about how developmentally different newborns are from older babies, and when I learned about childrearing practices in other societies (in which several cultures around the world experienced virtually no colicky screaming). Once this new knowledge clicked into place for me as a pediatrician, I wanted to share what I had found to help new parents and their babies.

Q. What can healthcare providers and other HMHB partners in maternal-child health do to help make early experiences happier and healthier?

A. It’s crucial that healthcare providers and other professionals instill in new parents the confidence they need to do their job – to help their babies to thrive and grow, and to connect with their children in healthy, satisfying ways from the very beginning. We do a great service for children when we teach parents to trust themselves, despite the conflicting advice given by many baby experts that can cause a great deal of confusion. It is empowering to parents when professionals urge them to trust their feelings, to relax and remember that they are the latest in the unbroken chain of the world’s successful parents! All they really need is patience, support and a little information to be the very best.

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