babyshrink.com

Hi Dr. Heather,

Jennifer

Dear Jennifer,

I’m so glad you are aware of this crucial aspect of your baby’s cognitive development. I think most parents would be happy to have a “mellow and easy” baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important “give and take” and communication that he needs to trigger important aspects of his development. He needs to engage with you and play “Baby Games” in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?

I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it’s also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic “give and take” in the parent/infant interaction, and in the ability of a baby to pick up on his parents’ feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.

That said, there are many things that ALL parents can — and should — be doing to maximize this incredibly important time in a baby’s development:

Carefully watch your baby’s sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he’ll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby’s best expert; try to figure out when he’s most approachable.

Then, make a conscious effort to play “Baby Games” during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.

Don’t give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for “Baby Games”. Give him time and keep trying.

Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can’t help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there’s a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.

Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents’ detective skills to determine WHICH senses your baby tolerates — and DOESN’T tolerate — very easily. Use this information to “fine tune” your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I’m quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she’s much more likely to stay engaged in our “Baby Game” than if I coo or talk back to her. Eventually, she’ll develop the ability to tolerate my voice as well. But until then, I’ll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.

I also double-checked on the expected timeframe of infant response to parents’ voices, and most authorities agree that this isn’t regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.

Now, I’m not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son’s development. Over time, you can judge his progress and if you’re not satisfied, have him evaluated by the program you mentioned in your city. If they’re not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I’m a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there’s nothing really atypical with your child.

And I can’t stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few “rounds” of interaction between you and your baby at this age. Over time, you’ll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently “hatched” — our psychological term for the opening of awareness that marks the end of the “squirrelly newborn” phase. So manage your expectations accordingly.

Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you’ll write back to update us on your progress!

Aloha,

Dr. Heather
The BabyShrink

I’ve written before about the confusion and difficulty around the diagnosis of Autism in young children (before the age of 3).

My regular readers know that I’m a strong proponent of Early Intervention screening, and also of early intervention therapy services. This means having your local Child Development center see your child BEFORE the age of three, should you have any concerns about her development, social interaction, or communication skills.

But you also know that I am loathe to jump on the autism-hysteria bandwagon. I worry that there are many other problems that are being missed because we’re jumping to the Autism diagnosis too quickly. Issues of sensory, cognitive, medical, environmental, or even genetic problems can be missed when a diagnosis is made too quickly. Also, the range of child development is so wide, that what can SEEM abnormal may not be. And I blame my field; many of us are so concerned about the number of developmentally delayed children out there, and so few of us are adequately trained to truly evaluate for Autism in the early years, that too may children are mistakenly diagnosed as Autistic. And then their REAL problems go undetected — and untreated.

If I had a million bucks (or ten) I’d start a training foundation centered on the intensive training of Early Intervention clinicians in the detection and treatment of Autism-related conditions — and other problems that might SEEM like Autism, but are NOT. We need a nation-wide (heck, world-wide) training initiative so that psychologists, pediatricians, speech and language therapists, occupational therapists, special instruction teachers — indeed the whole range of Early Intervention professionals — can get the advanced training we all need in this very specialized area.

In the meantime, you can read this very interesting article at Time.com summarizing some of the newest research on signs of Autism in the very young infant. It also helps to explain why this is truly a very difficult disorder to diagnose in the early years. And if you missed it, there’s also a link to a popular post of mine on the diagnosis of Autism.

Click here for the Time.com article, and

click here for my own article on Autism.

Aloha,

Dr. Heather
The BabyShrink

Nancy Peske, co-author of Raising a Sensory-Smart Child: A Practical Handbook for Helping Your Child with Sensory Integration Issues, has been so generous in her support of BabyShrink. Last time, Nancy told us about what it’s like to have a baby with sensory issues. Today, she’ll tell us about how we can begin to sort out our baby’s sensory preferences.

Dr. Heather: Tell me about the “detective process” that parents must go through in order to figure out their baby’s sensory issues. It starts out being a vague sense of something wrong, or just having a “difficult baby”. How do parents start to narrow down the issue to find what’s really going on? What do they need to observe or record? What can parents do to better understand their baby?

Nancy Peske: There are different "detective" methods. For me, it was simply a matter of tuning in to my own senses. I have mild sensory issues, as many parents of kids with sensory issues do, so when my son would fuss or show signs of anxiety, I would automatically think about the sensory environment, focusing on anything that was unusual or perhaps intense: lighting, smells, background noise, wind, temperature, and so on.

Journaling can be very helpful. Write down what your child did each day, and at what time, including what he ate, when he was cooperative and happy and when he was miserable and uncooperative. One mom told me this helped her realize that she was keeping her child too busy, not giving him enough quiet, unstructured time. Another told me she realized her daughter was always cranky if she went more than 3 hours between snacks or meals. If there’s a sudden change in behavior, look at what might have changed. Always consider sleep, nutrition and eating, and external stress as well, from seasonal allergies and the sniffles to a substitute teacher at daycare that the child isn’t yet comfortable with.

Focus, too, on when your child is unusually comfortable with a situation that would normally bother him and try to determine what’s different. A mom told me her toddler suddenly wasn’t agitated about his evening bath, and she realized the one thing she’d done differently was keeping the door closed while running the tub. Apparently, the harsh sound of water hitting porcelain was what had been agitating him, so after that, she always ran it with the door closed and he was fine with baths.

You can also run down the list of senses as you try to analyze what’s working or not working in the environment for your child. Consider sight–is there a lot of visual clutter in the room overstimulating him? Is the lighting too bright or unusual in some way? Are the colors or contrasts too intense? Is it an unfamiliar sight-the yogurt container change its look and now your toddler won’t eat the yogurt? (Hint: try not to serve kids foods from the container to prevent this!) Think about sound, from background noise to volume, to direction of sound (is it behind her? does she think that the rumbling truck outside might be coming toward her?) and quality of sound (stringed instrument vs. brass instrument, someone singing on a recording vs. someone singing live). Touch–this involves textures, temperature, wet vs. dry, and amount of pressure on the skin. Keep in mind that eating is very tactile, involving skin in the mouth. Your child may eat only one brand of mac and cheese and insist that the sauce not be too runny or thick. Taste and smell–children can be exquisitely sensitive to differences in taste or crave strong smells or tastes. Don’t forget movement and body awareness. And finally, remember that transitions and getting used to new sensations are difficult for children. A child who just came out of a car that was driving on hilly roads may need a good, long stretch of lying on the ground or sitting quietly to regain her equilibrium after that vestibular stimulation. Leave extra time when shifting activities, and give plenty of warnings, so that your child’s atypical nervous system has a chance
to adjust to the change.

If you recognize that your child is processing sensory information atypically, that doesn’t necessarily mean you need professional help. Simple accommodations for her differences, and gently encouraging her to try new activities that will broaden the range of sensations she’ll tolerate and help her system function more typically, may be enough to make her feel more comfortable in her world. However, if sensory issues interfere with learning, socializing, and eating to a degree that’s concerning and significant, more help is probably needed. A pediatric occupational therapist trained and experienced in dealing with sensory issues, who has worked with children your child’s age, can be extremely helpful.

Aloha,

Dr. Heather
The BabyShrink