A Word About Fussy Babies

"There is really no such thing as crying babies. They are simply angels singing out of tune. "
Glenn Latham

Three things are sure: death, taxes, and fussy babies. With no other way to express themselves, babies must fuss to make their need for attention known. We can be thankful they know how to do that. Without that ability, it is doubtful many of us would have made it beyond infancy.

As with adults, however, babies often go beyond what is necessary to make their need for attention known. Before long, babies will fuss just to get the attention; no compelling needs exist. In fact, the attention parents give their babies to eliminate the fussing is usually the very thing that encourages the fussing. Fussing then becomes a conditioned response to parental attention.

In this chapter I discuss ways of decreasing fussy behavior in three situations: (a) general fussiness, (b) bedtime/naptime fussiness, and (c) the colicky baby. The methods I am suggesting are supported by research reported in the Journal of Applied Behavior Analysis, and Behavior Research and Therapy.

General Fussiness

Parental attention is a powerful reason for babies to fuss. Being picked up, held close, patted, cooed to, walked about-these are all very pleasant sensations which, when given by parents and care givers as a response to fussiness, will certainly encourage more of it. In fact, it isn't at all unusual for babies to learn to crave this warm and tender attention and will do about anything to get it. (Can you blame them!) In fact, they will cry their little lungs out in an attempt to get it, and once they get it they often keep crying to make sure they don't lose it. (They're not so dumb!) What we often observe, therefore, is babies who will fuss for no apparent reason, and continue to fuss even when every effort has been made to comfort them. This circumstance frequently wears on parents' (and care-givers') nerves. They become frustrated, angry, desperate, at wits end, then POW!-the child gets it!, when, in fact, the child was only doing what he had been taught would get him what he wanted: attention. Well, there is a better way of handling fussy babies.

To begin, when a baby fusses, don't think of it as a "bad baby." There is no such thing as a bad baby! All babies are good. Never forget that. Babies are as good when they fuss as when they don't fuss. ALL BABIES ARE GOOD. (Ah, that you and I could say that of ourselves!) They are good in the sense that they have inherent value, they do not purposely violate other's rights or violate standards of decency. I urge you to never refer to, or say to, a baby "Bad baby!" True, a baby will cry and fuss, but that's simply age-typical behavior. When a baby fusses, it is simply its way of saying, in very primitive language, "I need attention," or "I want attention."

Let's say he needs attention. This is fairly easily determined. Check his diaper, see if he's hungry, make sure he isn't too hot or too cold, check his clothing and bedding to see if his ability to move around is hampered, look for signs of illness-in other words, see if he needs comforting, then meet those needs. If every effort is made to make him comfortable-he's fed, changed, well, etc., but no amount of holding, cuddling, cooing and so on will console him, gently put him in his bed and let him do his fussing there. If he cries long and hard, don't worry about it, so long as his NEEDS have been met. I suggest you time how long he cries. If in the past, he has gotten lots of attention for crying, he might cry quite a long time before quitting. I've timed babies who have cried up to 32 minutes without stopping, and I am familiar with the work of others who have timed babies who have cried for 45 minutes! That's a long time to listen to a baby cry, so turn your attention to other things as much as possible. (By the way, this is called planned or purposeful ignoring.) Don't pace the floor wringing your hands and feeling terrible about being such an insensitive, neglectful parent. You are neither. You are helping the child out of some behavioral patterns that could make his life unhappy later on.

Eventually, the child will stop. Wait between 30 and 45 seconds. (Studies have shown this to be a reasonable range of time: 30 seconds for tiny babies on up to 45 seconds for older babies. But anywhere within this range is okay-even for tiny babies.) If the child has not cried or fussed during that time, quietly pick him up and tenderly hold and caress him, or just pat him a moment while he lays or plays quietly. If he fusses or cries at all before the 30-45 seconds are up, wait until he stops, then restart the timing. You must not pick him up or attend to him until he has been quiet for the required time (30-45 seconds). Heart rending cries of a tiny infant, or appeals to "Mommy, Mommy," "Daddy, Daddy" accompanied by pitiful sobs should not weaken you. Do not give in before the child gives out! After the child has been quiet for 30-45 seconds, as you pick him up, do not be effusive-gushing all over the child with affection and verbal outpourings. Be loving and tender and quite natural. If the baby starts fussing again, gently put him back in his bed, say no more than "It's okay. You'll feel better soon," then calmly leave the room, close the door quietly, and start the process all over. A graph of your timings will probably look something like this:

At first, there will very likely be an increase in crying/fussiness, but the baby will gradually cry and fuss less and less once he has learned that when he is crying and fussing he is doing it alone, but when he is content, he has company-warm, snugly, gentle company. When the baby is content, have him in your company where he can see you and hear you and where you can occasionally give him a pat, a hug, a kiss, and a gentle, affectionate word. When doing this, follow these three simple guidelines:

1. Be composed. Give the attention in a very easy-going natural way. Use a calm voice and smile.
2. Be timely. The encounter shouldn't take more than a few seconds: 3-5 seconds. You don't want the encounter to turn the child's interests away from what he is doing. Rather, it should reinforce what he is doing: "You are having a lot of fun playing with your toys!"
3. Be brief and descriptive. Say only a few words, if you say anything at all, and use words that describe the behavior that is getting attention. As with the amount of time the encounter takes, too many words can be distracting. A gentle touch, accompanied by, "You are such a happy baby" or "You are playing so nicely with your toys" are altogether sufficient. In 12 words or less you can briefly describe what the baby is doing that has brought him your attention. Once that is said, move on to other things. (Again, an example of purposeful/planned ignoring.)

Having said this, I hasten to add that from time to time it is appropriate, in fact critical, that the baby be picked up for longer periods of time during which you would read to him, sing to him, play with him, rock him. Just enjoy him, and let him enjoy you. However, the baby should be picked up only when he is not crying, unless, of course, he needs attention. After 15 to 20 minutes, when you are ready to put the child down to continue his play, do so in a gentle, loving, matter-of-fact way then go on about your activities. If the child fusses for a bit after having been put down, and you are sure his needs are all met, ignore the fussing. If it continues for more than 20 to 30 seconds, and particularly if it becomes intense, gently pick the baby up, quickly check the diaper and look for other things that might be causing the distress. While doing this, say nothing to the child. Once assured that all is well, gently place the child in his bed, and if you want to say anything, say only "It's okay. You'll be happy soon," then leave the room. If the child goes to sleep, that's fine. Let him sleep. If he stops crying within 30 seconds, feel free to pick him up and let him play in your company, as I have already described.

To be sure these procedures are carried out properly, especially if parents are inclined to become angry and upset when the baby cries, I strongly suggest they be practiced using a doll. Have a spouse, an older child, a friend help simulate the behaviors of the baby. They can even be the ones who do the crying in behalf of the doll. I am not being facetious in suggesting this. Simulating a circumstance, then responding to it in a role-playing setting with feedback from an observer, is a powerful, efficient, and risk-free way to learn a new skill. Airplane pilots learn many-if not most-of their skills in simulators where they can make mistakes without sending themselves and a plane load of people to their untimely deaths. In learning circles, it is called "preventing the failure of the first attempt." Doctors learn this way to prevent them from killing their first patient. Engineers learn this way so their first bridge won't collapse under a load of traffic. And parents can learn this way just as well and for reasons that are altogether as important.

Bedtime/Naptime Fussiness

Virtually all babies, at one time or another, experience problems of sleeplessness and fussiness during bedtime and naptime. Most of these problems are maintained, and even made worse, by too much attention being given to babies while they are fussing. This simple three-step process will do wonders in eliminating bedtime/naptime fussiness and sleeplessness:

1. Establish a routine and stick to it. Critical to this routine would be time and place for sleeping/napping. You should be as consistent as possible: put the baby in his bed at the set time(s) each day. Other routine activities could include story reading, singing, listening to records, and so on. These should be quiet, calming activities.
2. Place the child in bed quietly, gently, and without fanfare. If the child cries or clings or protests, in calm control, and saying nothing more than "Good night" or "Sleep tight," place the child in bed and leave the room immediately.
3. Do not return to the room unless absolutely necessary. Except for danger, illness, or distress from entanglement in bed clothes or not being dry or fed, stay out of the room. If it is absolutely necessary to check the child do so in silence (don't say a word!), do so in as little time as is absolutely necessary, and do so with a minimum of light.

If the child is ill, follow the doctor's orders, but apprise him/her of the procedures you are using to control unnecessary crying and fussiness at bedtime/naptime. Unless otherwise directed by the doctor, proceed with the program as I have described it.

I want to emphasize the importance of point three: Do not return to the room unless it is absolutely necessary. In the study of human behavior we have learned that when behavior is attended to at irregular times, it is strengthened; it is more likely to reoccur in similar situations, and is more resistant to change. For a crying and fussing baby, this means that if a parent or care giver keeps trying to comfort the baby by intermittently going into his room and patting, hugging, holding him, and so on, the result is much more likely to be counter-productive than helpful. The child will fuss more and longer, will be up more often in the night and will sleep less and less well. This "intermittent reinforcement" of an undesirable behavior serves only to make the behavior less desirable and much more difficult to change.

As I stressed earlier in the case of general fussiness, it is terribly important that during the waking hours, there must be frequent and pleasant interactions between the parent/care giver and the child.

The Colicky Baby

Research indicates that between 10% and 40% of all babies experience colic. These data apply equally to male and female babies. Heretofore, the general consensus was unless a medical treatment was effective, the parents were "stuck" with a fussy baby until the baby outgrew it. Research recently reported in Behavior Research and Therapy has given new hope to parents of colicky babies. The findings, consistent with what I have already discussed here, have introduced a new variable, tape recorded music, as a form of treatment. Here's how it all fits together. While the baby is quiet, happy, and content, the parent should give it lots of attention, and play the music on a tape player. (Note: Giving attention intermittently for quiet, happy, and content behavior will have a powerfully reinforcing effect on the non-colicky behavior. You see, intermittent reinforcement works both ways: it will strengthen both appropriate and inappropriate behavior!) If the baby begins to cry, the music should be stopped and attention withdrawn. After 30-45 seconds of quiet behavior, the music and the attention resume. This simple strategy resulted in a 75% reduction of crying among colicky babies!

Akin to this is a similar device known as "Sleep tight." It simulates the vibration and sounds of an automobile traveling 55 miles an hour and attaches to the baby's crib. It is available from Sleep tight, Inc., 3613 Mueller Rd. St. Charles, Missouri

Now, a couple of closing thoughts. Occasionally, indeed rarely, a child will have a physical problem that will account for inordinate amounts of crying, a problem that is not easily discernible. If after using these methods precisely, a child's inconsolable crying continues beyond a few days, you should probably have the baby examined by a physician. But don't be too quick to conclude that medical attention is needed. Give this program long enough to have an effect, usually within 3 or 4 days.

Also, it is important to keep in mind that since babies fuss when they need to be fed, they shouldn't be left unattended until they quit fussing before being fed. But once feeding is over and the parent has spent some time holding and tenderly interacting with the child, the baby should be put down to play, sleep, or whatever. If he cries or fusses, but you know his needs are met, leave him alone and he'll soon become content. Since children vary so in their feeding behavior, if it seems that your baby fusses too frequently for food, call your pediatrician for advice on how often to feed him, then proceed as I have described here.

Though I have focused attention on how to decrease fussy behavior and increase happy, contented behavior, the research upon which this approach is based has revealed other's significant benefits for parents and care givers that are certainly as important as the benefits experienced by the babies. When parents (and care givers) use these procedures, there is a significant increase in parental sleep, improved parent-child relationships, decreased risk of child abuse and the "shaken baby" syndrome, and improvements in children's waking/daytime behavior. While completing the final draft of this chapter, a tragedy occurred in my home town. A father, beside himself over what to do about a crying, inconsolable infant, in anger picked him up, shook him violently, and in a few moments, the child died. In a split second an out-of-control father put an end to his infant son's life. If you have any questions about how to handle a fussy baby, reread this chapter with great care. Don't allow ignorance to unleash savage rage on a helpless and perfectly innocent infant.

Figure 11. 1 shows the results of an experience I had recently working with a 5-week old infant who had become conditioned to cry inconsolably because of being picked up instantly while crying and subsequently being held almost continuously. You'll notice that crying-to-be-held behavior steadily decreased, while being-content behavior steadily increased.

Figure 11.1-Eliminating the Inconsolable Crying of a Five-Week Infant

Following are 20 "Tips to Cope with Crying," published by the Child Abuse Prevention Council of Ogden, UT. I recommend them wholeheartedly as things parents can do to console a fussy baby. If, after a reasonable time (usually no more than a few minutes), the baby continues to cry and fuss, follow the program(s) detailed above, as we are reminded by item 20, below. If, after a few days of the treatment suggested here, the child continues to cry inconsolably, see your pediatrician.

Tips to Cope with Crying

1. Walk or dance with the baby.
2. Rock the baby.
3. Bounce the baby gently in your arms or on a bed-a water bed is especially soothing.
4. Take the baby for a ride in the carriage.
5. Take the baby for a ride in the car.
6. Put the baby in a wind-up swing.
7. Turn up the music on the radio or stereo, run the vacuum or let the water run in the tub for a few minutes.
8. Offer the baby a "noisy" toy; shake it, rattle it.
9. Sing or talk in a quiet, sing-song way.
10. Put the baby in a soft front carrier, close to your body.
11. Lay the baby tummy down across your lap and gently rub or tap his or her back.
12. Lay the baby across a warm hot-water bottle on your lap or a bed.
13. Massage the baby's body and limbs gently; use a warmed lotion if the weather is cool.
14. Swaddle the baby tightly.
15. Feed and burp the baby one more time. Or offer a little warm water. In desperation, add a tiny bit of sugar to the water.
16. Offer a pacifier (the Nuk allows less air to pass in around the baby's mouth and so is better for a colicky baby) and hold it to the mouth if necessary.
17. Hold the baby close and breathe slowly and calmly; the baby may feel your calmness and become quiet.
18. Cross the baby's arms across the chest and hold him or her down on a bed with gentle, firm pressure.
19. Remove yourself and let someone else take over for a while. If a family member is not available, consider hiring a sitter for a short time.
20. If nothing, works, put the baby in his or her bed, close the door and turn up the TV or radio. For your own peace of mind, it's okay to check the child but do so in a way that does not reinforce fussy behavior.

Though it has nothing to do with fussy babies, and since I don't address infant problems, specifically, elsewhere in the book, I do want to pass on a word about what research has to say about preventing Sudden Infant Death Syndrome (SIDS). A recent major study reported that remarkably fewer SIDS cases were reported when infants were laid on their side or back, rather than on their stomach. A research finding well worth putting into practice at home!

NOW TO REVIEW

1. Through undo attention to crying and fussiness, babies can become conditioned to cry and fuss simply to get parental/care giver attention.
2. If a baby, whose needs have been met, continues to cry when left alone or will not be consoled, it might be a sign that medical attention is needed.
3. Babies will often increase the intensity of their crying and fussing in an attempt to get attention. This initial burst of displeasure is typically short-lived (a few to several minutes).
4. In the long run, babies are much, much more likely to be happy if undo attention is not paid to them when they cry and fuss.
5. Skilled parents produce happy babies. The primary responsibility for who is happy is-you guessed it!-that of the parents.