What Does a Developmental Psychologist See in a 40th Class Reunion?

When I told people I was going to my 40th high school reunion, I might as well have said I was jumping off a cliff. Almost across the board, the reaction was shock, though the reasons varied. Granted, I hadn’t been in touch with my classmates, so some degree of surprise was legitimate. But my friends and family also projected their own reasons: high school had been the “worst time of their lives”; that they had never “fit in”; they didn’t want to open their present lives to judgment. But I’m a developmental psychologist, and I wanted to understand what a reunion ritual might mean. Nothing is more interesting to me than discovering how children grow up and their lives turn out.

As the date approached, I finally became apprehensive myself. Most of us had been together since kindergarten, but what if I didn’t recognize people after forty years? After all, I now have silver hair and 40 additional pounds; others would also have changed. Or what if we didn’t have anything to talk about? How would I react to an old “flame,” or he to me? Could I finally uncover the story behind a friend who had so traumatically “dropped” me in sixth grade? When nervous jokes started showing up on the Facebook reunion page, I saw that I wasn’t the only one with anxiety. I recruited a childhood friend to go with me.

“I’m only doing this for you, you know,” Vic joked when she greeted me at my hotel. Our mothers went to high school together and been friends long before we were born. Vic remembers the fuzzy socks I wore in second grade and how my father had carried me into school in his arms when my broken leg was in a cast. I remember making vinegar and baking soda volcanoes at Vic’s house and singing soprano next to her in choir.

We arrived at the Curling Club (home to the winter sport of sliding granite stones on ice) to a frenzy of slightly boozed-up greetings. About a third of my class of 140 was there. A current of excitement crackled through the crowd—hails from across the lawn; flying wisecracks and boisterous teasing; and enthusiastic, if somewhat self-conscious, hugging. It was a relief to find my old friend Dave, who was just as unruffled as I’d remembered him—a straight shooter, unperturbed by his surroundings. He had worked for a time for my father, a milkman; his mother had been my beloved third grade teacher. I was happy to meet Dave’s wife, and a meaningful conversation ensued about parents, illness, children, and more.

Sociologist Vered Vinitzky-Seroussi has observed that high school reunions can trigger a sudden threat to one’s identity. In the space of a short gathering, we are called upon to reconcile past expectations with our present reality, among people who shared that past. At my reunion, the actual list of predictions that our peers had made about each other 40 years ago hid amidst the memorabilia. “Diana will run a computer dating service,” it read, and the old memory of craving connection amidst my chaotic environment flashed. Other predictions were equally unpredictive: that a high school romance would end in marriage (it didn’t) or that a career would peak in a grocery store stockroom (it didn’t); and predictions for women centered on marriage and children. Predictions can be entertaining, but since these weren’t about activating our best future selves, I regretted their presence. Reunions are not just happy gatherings, Vinitzky-Seroussi writes. They “telescope the life course” and create pressure to evaluate, or protect, or project our choices, often in the space of a very short, catch-up conversation.

But this was not our tenth or even twenty-fifth reunion, the early ones that Vinitzky-Seroussi studied. This was our fortieth, a time when life achievements are behind for most of us and some are even looking toward retirement. Fortunately, I felt well-anchored in the present, and I think others did, too.

The conventional wisdom about reunions is that people can surprise you, and I found that to be true. Who would have known that the quiet boy in the back of the band would be a pillar of the community as the trusted funeral director? Or that the guy who seemed lost in high school would be so crisp and successful at 58? Psychologists use the terms “equifinality” and “multifinality” to describe how very different paths can lead to similar outcomes, or, conversely, how similar paths can lead to very different outcomes. At the same time, our perceptions of what’s important changes, too: The kids who once dominated in popularity might now appear boring and superficial, and the former “outsiders” often turn out to be the really interesting ones. And yet when I asked Vic if she recognized everyone, she replied, “Not so much from their faces, but their energy—it’s the same.”

Even though we all shared a large part of our pasts, we couldn’t have truly known each others’ lives while we were children. A few kids had seemed to sail through with equanimity—they ran the student council at school and collected maple syrup at home–but even then, there were hints of malaise. I knew that it wasn’t right that the gentle, deer-like boy who sat in front of me in seventh grade homeroom smelled like alcohol and cigarettes. Another child was rumored to have been abused, though there was no action taken to protect her. I was a high achiever but suffered with parents who were in constant conflict; they struggled with mental health and substance use issues. Many parents were alcoholics before the disease was even named.

Psychologists now know that adverse childhood experiences (ACEs) are predictive of later physical and mental health problems, including heart disease, depression, and suicidality.  Research suggests that about a third of kids are lucky enough to escape trauma, but about a quarter suffer such high doses that it affects brain development, immune and endocrine functioning, and can create mental and physical disease systems that reduce the lifespan by an average of 20 years. How different might many students’ lives have been if an adult had recognized their feelings and had the skill to approach them and say, “You look down. What’s going on, and can I help?” Today, innovative schools throughout the country are feathering emotional skill development into their academic curricula, and studies show that both individual kids, and the school as a whole do better. Pediatricians, too, are beginning to screen for ACEs and offer early intervention services to families and children at risk.

Childhood is not easy, even at the best of times, and middle school is an especially stressful period. Conventional wisdom used to hold that it was the changing sex hormones that made kids “crazy,” but scientists now understand that puberty kicks off changes in the brain that make youth more emotionally sensitive, more sensitive to their social world, more willing to take risks, and more vulnerable to mental illness and addictions. Combine all of that with changes in schools, new peer groups, or family troubles, and you quickly get a pile-up of stressors that can be overwhelming.

Jockeying for status in peer groups begins as early as the fifth grade, and, in my day, peer dynamics were raw and lacking any guidance. Consistent with the research, it was the male athletes and the conventionally pretty girls (especially cheerleaders) who were conferred high status, and kids who were “different” were often marginalized—through teasing, exclusion, and gossip. Girls who physically matured earlier than average, or boys who matured later than average, were at greater risk, just as they are today. Too tall, too skinny, too heavy, too awkward, too shy, too country, too slow…the “faults” can be endless. 

Kids naturally form and re-form friendships, but without real social skills, the process can be excruciating. In sixth grade, I was shattered when my best friend of six years decided one day to simply stop talking to me. While it’s natural for a child to feel ready to find new friends, this particular friend had had no skills with which to explain her needs. Her silent treatment left a mark, and I used it both as a cautionary tale for my own children and an illustration in the college courses I taught on teen development. Research now shows that humans are such intensely social creatures that social ostracism lights up physical pain pathways in the brain; it can be more damaging than even physical abuse. Sometimes, I imagine how our friendship “breakup” could have gone differently, had we had the social skills kids can learn in school nowadays to navigate peer conflict. Though my well-being is no longer affected by that experience, I was curious to know my former friend’s side of the story. Yet when we greeted each other at the reunion, we didn’t get much beyond a hello. I took that to mean that it was not likely to be the place—or perhaps the person—where such a conversation could happen.

“Humans are storytelling, story-loving creatures,” says psychologist Matthew Lieberman, author of Social Brain, Social Mind. One of the most powerful ways we understand the experience of being human is by constructing a narrative of our lives. Young children begin this process as soon as they learn the word “I,” and parents begin telling them stories about when they were little. And at the other end of lifespan, elders engage in a “life review,” telling and retelling their stories to help them make sense of their lives.

Reunions—where our past selves meet our present selves—can be a special opportunity to re-weave our stories. I observed it happening all evening. One woman who had seemed defiant and tough in junior high apologized to the PE teacher, telling her that she hadn’t meant to be the teacher’s “nemesis” but in fact was a military kid who got moved around a lot.

“I never knew that,” the teacher breathed, empathically.

A man who had been a geek before geeks were cool enthusiastically shared that he was an inventor, held patents, had designed a part of the space shuttle and a medical device, and had made millions doing so.

A friend divulged her confusion about some same-sex experimentation that had gone on at a childhood sleepover. Of course there had been no framework for normalizing that, or even language to name it.

I, too, had a story to revise. When a popular biology teacher’s name came up, I shared that six years after we’d graduated, he had prevented my Lutheran church from marrying me and my husband, because my husband is from India. “He’s not a good guy,” I grumbled about the teacher.

The life stories flowed, from what it’s like for a Minnesotan to be transplanted to the Deep South, to taking care of grandchildren, to being the youngest in a senior citizen woodworking shop, to losing a child. There was a lot of loss and growth to process, as well as joy to celebrate.

One evening is not enough time together to truly span 40 years; it’s just a sliver of reality. But I happily put new numbers and email addresses into my phone. I want to keep up with some old friends, and I discovered new ones that I’d missed earlier.

And that old flame?

“I learned from you,” he told me. “Your family had high expectations, and I craved some of that.”

“You sheltered me at a stormy time,” I replied, remembering his laughter and easy-going manner.

Class reunion? For me, at least, it wasn’t so scary. What we went through together mattered, and bearing witness to one another’s stories—from our shared past and the years that had followed— felt like a good way to honor that.

 

 

 

 

 

 

How To Soothe a Crying Baby

My most exhausting parenting memories have to do with being unable to soothe a crying baby. My husband and I had two children three years apart, on our own, thousands of miles away from our families. We were both in the startup phases of our careers, and so we took turns: We swaddled the babies, walked the hallway, put them on the dryer, swayed to music, drove in the car, used pacifiers, sat in a steamy bathroom, and rocked in the rocking chair. For a couple of years, I was so tired, I could hardly string complex sentences together at work.

New parents know this drill. And there are two big questions that arise pretty quickly: “How do you get it to stop?” and “When can we start letting the baby ‘cry it out’?”

My own childhood was not a great guide. I grew up in a time and place where the attitude toward crying even among normal parents could be summed up by the dictum, “Quit your crying,” and “I’ll give you something to cry about.” I wanted to take a different path.

Developmental science, though, was a good guide:

photo credit: depositphotos.com

photo credit: depositphotos.com

Crying in the first three months of life

In 1972, Johns Hopkins University researchers Sylvia Bell and Mary Ainsworth conducted a groundbreaking—and now classic— study on infant crying. For two-to-four hours at regular intervals across the first year of life, they went into the homes of 26 mother-infant pairs and took continuous notes on baby-mother interactions. What they found was important news: Babies whose mothers responded consistently and promptly to their babies’ cries in the first three months of life cried less often and for shorter duration in the subsequent months.

These responded-to babies also transitioned more quickly to other, non-crying modes of communication, like facial expressions, gestures, and vocalizations, later in the first year. (A more recent review of studies of infant crying linked less crying to better language skills.)

What about the babies whose mothers didn’t respond to their cries? Some mothers  believed that if they responded, their babies would be encouraged to cry more, becoming more dependent and demanding—in a word, “spoiled.” This view is rooted in advice from the 1920s-‘40s from behaviorists like John B. Watson and promoted by the U.S. Children’s Bureau of Infant Care. Their opinion was that parents should have an emotionally detached, businesslike relationship with their children. An entity as powerful as the federal government advised that parents should not pick up their children between feedings, lest the baby become a “spoiled, fussy, and household tyrant” who makes a “slave of the mother.”(1) This advice was not based on scientific evidence, but extrapolated from operant conditioning and what was understood about the power of positive reinforcement. Today, nearly 100 years later, that advice has been hard to eradicate.

A predictable pattern

 Babies’ cries are important signals, their only communication device in the beginning. The cries are part of a stone-age “operating system” that are designed to draw the caregiver close for protection and survival and to help manage the body, brain, and feelings at the time of greatest helplessness. Just how the caregiver responds to those signals is important for wiring up a nervous system that will be as calm, organized, and integrated as possible; in other words, it’s foundational for later growth and development.

Cries run the continuum from gentle fussing that might start quietly and build up toward discomfort, hunger, or boredom, to loud, high-pitched cries that may be followed by breath-holding that signals alarm, danger, or pain. And there is everything in between.

Babies' cries are both similar and unique. Digital acoustical cry analyses captures qualities like frequency, energy, and signal-to-noise ratio and show that a pain cry has a different pattern from other cries (it’s high-pitched, loud, and sudden, with some breath-holding). Each individual baby’s cry also has a unique “cryprint.” That cryprint is something many caregivers recognize; that is, they know their own baby’s cries from that of other babies.

Though every baby is a little different, “normal” crying in the first three months of life follows a fairly predictable pattern:

  • Crying tends to start up at around two weeks after birth, peak at around six weeks, and gradually decline and stabilize at around three-to-four months. The six-week peak is seen in many cultures (and even in chimpanzee babies):

Each line represents a separate study of crying. Reprinted with permission from Barr, R.G., (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

Each line represents a separate study of crying. Reprinted with permission from Barr, R.G., (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

  • Most young babies have a fussy period. In newborns it’s often around midnight, whereas in older babies, it’s more often in the late afternoon or early evening. Extra holding, cuddling, or swaddling can help.

  • According to the American Academy of Pediatrics, two-to-three hours of crying a day is normal for babies in the first three months of life.

Why do young babies cry?

photo credit K. Merchant

photo credit K. Merchant

Babies under three months cry for many reasons: They’re hungry, they’re uncomfortable, they’re in pain, they’re too warm or too chilly, they want more or less stimulation, they’re wet, they’re transitioning from being asleep to being awake, they don’t like a hard surface or a scratchy fabric, and the list goes on.

For an exhaustive list of possible reasons for crying, and corresponding soothing techniques, see this list at reflux.org.

In addition, some babies just cry more than others, according to pediatric psychiatrist Barry Lester of Brown University, who has seen thousands of babies in his Colic Clinic at the Brown University Center for the Study of Children at Risk. Each baby has a distinct personality and a unique temperament that, in the beginning, have little to do with parenting. Some babies are reactive and easily upset, he says, and once they get wound up it’s hard to help them calm down. On the other hand, some reactive babies are easy to soothe and may even self-quiet after their parents back off for a bit. Some babies are not particularly reactive but are still hard to soothe; so for those babies, it takes longer to trigger crying, but once they start, they’re  hard to bring down.(2) And some lucky parents have babies who are just “easy”; they don’t cry much, and they’re easy to soothe when they do start.

Sometimes there is a mismatch between the baby’s needs and the parent’s ability to respond. Less experienced, first-time caregivers as well as those with less support, can easily overreact. Or caregivers may have personalities, feelings, or beliefs that get in the way of reading their baby’s signals, intentionally or unintentionally. For example, studies show that caregivers with restrictive attitudes, insufficient empathy, or a high stress response respond less well to their babies. On the other hand, too much empathy, e.g., taking on the baby’s cries as evidence of unbearable suffering, can lead to “empathic distress” in the caregiver, and in an attempt to control their own strong feelings, they might withdraw, or become overly-intrusive. Fortunate parents who’ve had positive childhood experiences—or who’ve come to terms with difficult ones—tend to find it easier to respond more sensitively to their babies’ cries.

Depressed caregivers have the hardest time responding to their babies, putting babies at greatest risk for poor outcomes. Pediatric psychiatrist Barry Lester writes that babies are highly attuned to their caregivers’ feelings, and as a result may even cry more in an unhappy environment.(3) Depression can appear in many forms, from the mild depression arising from parenting pressures and lack of sleep to full-blown, biochemical, post-partum depression. We also know that being unable to soothe a crying baby can itself trigger feelings of helplessness and depression. Sooner or later, almost every parent will break down in tears because no matter what she does, she can’t stop her baby’s crying. I remember being trapped in an airplane seat for four hours with hot tears leaking down my cheeks when I couldn’t soothe the baby in my arms. (I later learned that she had an ear infection, but there was nothing I could do in the moment except rock her gently in my arms and whisper calmly in her ear.) It is a humbling, exasperating feeling—and it’s important that parents not blame themselves, Lester urges.

Some babies cry in the first three months for no reason that professionals can understand. Psychologists and pediatricians refer to this as “endogenous” crying, meaning simply that the source is internal. Endogenous crying is uniquely human, according to Debra Zeifman, psychologist at Vassar, in her review of research studies on crying. Even our close relatives the chimpanzees stop crying when their needs are met or they’re picked up; only humans seem to have the kind of crying that can perpetuate itself regardless of the trigger.

Endogenous crying seems to resolve at around three months, when it becomes more “exogenous,” or linked reliably to external triggers. This shift from internal to external coincides with other developmental shifts, suggesting that there is a maturation of an underlying system—a “forebrain inhibitory mechanism,” or some aspect of the central nervous system—at around three months. For example, also at around the three-month mark, endogenous smiling is replaced by more social smiling, stimulated by a familiar face; newborn reflexes disappear and are replaced by more voluntary behaviors; the sleep-wake cycle settles down into a more predictable rhythm, and there are changes in EEG patterns.

And finally, in rare cases, some babies’ distinct cries (often very high-pitched or poorly phonated) may reflect underlying neurological disturbances. Scientists are working to develop acoustical cry analyses that can predict later developmental disorders such as autism.

But one important reason babies cry, Zeifman says in a vast review of studies of infant crying, may be that they have been left alone.

Holding, carrying, feeding: What’s the evidence?

Babies in Western cultures, says Zeifman, spend an exceptionally large amount of time alone compared to babies in less developed cultures. Western parents for the most part are discouraged from physical closeness and frequent feedings, and they’re often encouraged to ignore their baby’s crying. Western babies are carried an average of about 30% of their waking hours, compared to 80-90% of waking hours for babies in non-Western cultures.

Anthropologists think that continuous holding may have been a strategy to reduce infant mortality, the risk of which has been lowered dramatically in the West. Yet, practices that distance caregivers from their infants, many anthropologists and psychologists say, may contribute to more crying. In Why Is My Baby Crying?, Barry Lester points to a survey of over 180 societies that found that babies cried less when they were carried.(4)

In a randomized control study (the gold standard of studies) of supplemental holding, 99 Canadian mothers were randomly assigned to either hold their babies a minimum of three hours throughout the day (whether they were crying or not), or to a control group (where babies spent extra time in front of a mobile or abstract shape). At six weeks of age, when crying normally peaks, the extra holding had the greatest impact—reducing overall crying by 43% and nighttime crying by 51%.  Extra holding made a smaller but still positive difference later, at four, eight, and twelve weeks as well.

Supplemental holding reduced crying compared to a control group. Reprinted with permission, from Hunziker, U.A. & Barr, R. G. (1986). "Increased carrying reduces infant crying: A randomized controlled trial." Pediatrics, 77 (5), 641-648.

Supplemental holding reduced crying compared to a control group. Reprinted with permission, from Hunziker, U.A. & Barr, R. G. (1986). "Increased carrying reduces infant crying: A randomized controlled trial." Pediatrics, 77 (5), 641-648.

When babies are carried, held, or worn, mothers can sense early on when something is wrong, and attend or soothe before a cry even erupts. There is no known downside full-time carrying to babies, either to their health or their psychological outcomes. Carrying and holding is, however, a lifestyle challenge in Western cultures—it is not easy for babysitters, daycare providers, or working parents to provide that extra holding to individual babies. However the benefits of it should just be more proof that we need better policies to support parents since it is unlikely that we’re going to change the way babies’ nervous systems and brains develop!

Feeding intervals also reduce crying in young babies. For example, a correlational study of two American subgroups—one from La Leche League and one control group—found that frequent feedings reduced crying in babies who were two months old but did not make a difference for four-month-old babies.

Given that more holding and more frequent feedings help the youngest babies cry less and be more comfortable, it may be possible that the amount of crying in young babies may be more flexible than we think, more amenable to care practices. If we place infants in playpens and cribs and don’t co-sleep, we may miss the early cues that babies are in distress. In Why Is My Baby Crying?, Lester goes so far as to say that Western caregiving practices actually train babies to cry. When we leave babies physically apart from caregivers until they cry, babies get the message “If you want me, call me.”(5)

Crying it out?

photo credit: K. Merchant

photo credit: K. Merchant

Some babies do defy the norm and stop crying when left to “cry it out.” In fact, a follow-up study to Bell and Ainworth’s classic 1972 work found that a few mothers who ignored their babies had babies who cried less. However, most researchers critique those findings on either methodological grounds or as a sign of “giving up” on the baby’s part—a despair and withdrawal that could ultimately lead to detachment. Modern baby gurus like pediatrician and author William Sears and psychologist Penelope Leach agree. Sears says that when caregivers let babies “cry it out,” babies  can lose trust in the “signal value of the cry” and maybe even in the caregiver relationship. Leach says that leaving a baby to cry it out can activate such high levels of the stress hormone cortisol and can deplete levels of oxygen that it can be toxic to a baby’s brain. “Crying it out” also undermines the important “serve and return” interaction that is the earliest basis of cognitive development.

A 2002 report summarizes the physiological changes that can happen when babies are left to cry hard:

  • Heart rate rises; there can be tachycardia, i.e., racing heart. Blood pressure increases by 135%.

  • Oxygen levels go down.

  • Blood pressure in the brain becomes elevated.

  • Stress response is activated, with elevated levels of cortisol. If uninterrupted, this creates a cascade of effects that can eventually damage the developing brain, affect the genes that regulate stress, damage the hippocampus, and result in later problems with learning, memory, attention, and emotion regulation.

  • Prolonged crying can lead to aerophagia, or air-swallowing, causing pain and problems with digestion.

  • Energy reserves are depleted due to rapid motor movements.

  • White blood cell count increases with vigorous crying, suggesting the body is preparing a survival response.

What about colic or crying that won’t stop?

Estimates of colic vary, from 10% to about 20-40% of babies in Western societies. Most pediatricians diagnose colic on the Rule of Threes: crying for more than three hours a day, for more than three days a week, for more than three weeks, in a baby that is otherwise healthy. But pediatricians don’t have any solutions; they simply  encourage parents to persevere until the colic runs its course, usually by around three months of age. The real risk of colic, they agree, is the stress it exacts on caregivers, placing those babies at high risk for abuse (and even shaken baby syndrome) when parents “lose it.”

As the Founder of the Colic Clinic, Barry Lester is the nation’s leading expert on colic, and he takes a strong stance. “Crying is normal,” he writes. “Colic is not. People who say that colic is normal not only are wrong; they also are doing a huge disservice to families who have colicky babies.”(6) In Why Is My Baby Crying, he defines colic as “an identifiable cry problem in the infant that is causing some impairment either in the infant or in relationships in the family.”(7)

His colic symptom checklist includes:

  • A sudden onset of crying—the episode seems to come out of the blue

  • A change in the quality of the cry (more towards pain

  • A change in the physical body—pulling legs up, doubling over, tightening of muscles;

  • The baby is inconsolable

The full checklist along with a cry “diary” can help caregivers and pediatricians problem-solve the excessive crying. Though the cause of colic is unknown, Lester has in some cases identified gastroesophageal reflux disease (GERD), pain, food allergies, and other sensitivities. But there is no predictable common theme, and most often, no cause can be identified. Yet families still need help, since colic can pose some developmental risk and family relationship problems due to the stress it creates.

Colicky babies are more likely to have difficult temperaments and feeding and sleeping problems, all of which can interfere with the settling of the nervous system in the first three months. Their cries and heart rates are different from those of normal babies. They are at risk for behavior problems in preschool as well as attention deficit, hyperactivity, sensory integration, and emotional reactivity.(8)

photo credit K. Merchant

photo credit K. Merchant

Colic can take away the joy of parenting and make caregivers feel helpless and incompetent, despairing, and even angry and hateful toward the baby. It’s helpful if caregivers can know the amount of crying they can handle (their “safe cry zone,”) and what strategies they can use when their coping starts to fail—deep breathing, soft music, walking, rocking—so that they can continue to respond calmly. But when the stress rises, it’s imperative that someone else be recruited to hold the baby and give the parent some relief. This is not always possible, of course, especially for single parents, but it’s important that caregivers find some way to care for themselves as well as their babies’ crying, Lester says.

Crying in later infancy.

Crying in the first three months of life is about regulating bodily needs, wiring up the nervous system, and feeling close to and safe with a caregiver.

Crying later in infancy becomes more complex, as it’s also related to a baby’s growing cognitive and emotional capacities. The graph below shows crying data from several studies over the first two years of life.

Reprinted with permission from Barr, R.G. (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

Reprinted with permission from Barr, R.G. (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

  • At around six to nine months, crying due to stranger wariness emerges. This is a normal, healthy sign that a baby understands who her “person” is, though again, different babies have different temperaments and will express more or less concern. Anthropologists think that stranger wariness served an ancient but important safety purpose of removing a baby from an incompetent or unsafe caregiver and reuniting the baby with her safe person. Very often the chosen caregiver that the baby attaches to is one specific person, even when multiple adults have cared for the baby. The baby might look at, reach for, or cry for her person when others are present, and then quiet as she is enfolded into safe arms.. But again, babies vary, and some attach just fine to multiple caregivers.

  • At around nine to twelve months, fear of strangers and fear of separation from a caregiver can peak crying again. This reflects a healthy cognitive growth; the baby can now anticipate the feeling of being alone, and she knows that crying is a kind of tether to the caregiver. This might especially coincide with dropping off at daycare, and skilled providers should be able to offer age-appropriate soothing.

  • Walking at 12-18 months can precipitate another burst of crying. As toddlers’ mobility carries them farther away from the caregiver, perhaps into a different room, they may suddenly realize that they are at sea.

  • Crying has another burst at around two years of age, when a baby’s growing sense of self and control over their own body meets thwarted goals and frustration. This coincides with the cognitive ability to plan action, to have deliberate wishes and intentions. As many developmental scientists say, this crying is not about the parents; it’s about the baby’s healthy growth.

How to soothe a crying baby in the first few months of life

photo credit K. Merchant

photo credit K. Merchant

The scientific evidence is clear: Responding to a baby’s cries in the early part of life is important to the baby’s well-being, establishment of a healthy nervous system, and subsequent growth. The hard part is to figure out how! Once a baby's obvious needs are ruled out, extra holding, frequent feedings, and the skin-to-skin contact of kangaroo care go a long way toward reducing crying. Putting on your own oxygen mask first—activating your own calm response—is crucial, and so is recruiting the support of other caring adults. Ideally parenting is not a solo activity, and we are all invested in the outcome!

Here are my favorite resources for techniques on how to soothe a baby:

  • For a long list of options, see Coping With a Crying Infant by Jeanne Clarey Bruening.

  • Harvey Karp’s book, The Happiest Baby on the Block, summarizes five steps for effective soothing: swaddling, holding, making a shushing sound, gentle jiggling while supporting the head, and sucking. For a shortcut, here’s a video.

  • Here’s how to swaddle a baby. As I write this, a new study has linked swaddling to sudden infant death syndrome (SIDS). However, it’s difficult to interpret the limited results. Deaths occurred most often when babies were on their stomach, less on their sides, and least on their back, all of which is true of SIDS when babies aren’t swaddled. Caution should be taken to swaddle correctly. Follow guidelines for back sleeping, and consider other options for infants older than six months (when the risk of SIDS doubled).

  • Pinky McKay’s book, 100 Ways to Calm the Crying, is a compassionate, respectful collection of ideas. It will soothe just in the reading!

  • Barry M. Lester’s book, Why Is My Baby Crying? The Parent’s Survival Guide for Coping with Crying Problems and Colic, written with Catherine O’Neill Grace, is a reassuring read for caregivers struggling with colic. He validates that parents who have babies with crying problems deserve and need support, and he has good diagnostics and suggestions. His Colic Clinic is in Providence, RI.

  • Here are twelve basic reasons babies cry, and how to soothe them, from The Baby Center.

  • Here is a Temperament Tip Sheet to consider the range of preferences for babies of different temperaments.

Conclusion

A final thought: Babies are born in a very immature physical state, with nervous systems and brains and bodies that have a long way to go—25 years, really—until they reach maturity. Parents and caregivers have to be flexible and adaptive in supporting the child’s current developmental needs. Different kinds of responses are important at different ages. For young babies, consistent affectionate responding is about meeting their physical and psychological needs, calming and integrating the nervous system, and creating a loving and trusting foundation to the relationship.

As babies grow—one to two years old and beyond—it may not be appropriate or even possible to soothe every cry. In fact, small bits of manageable stress in the presence of a caring adult help to “inoculate” a toddler for some of life’s vicissitudes and realities. But this is a gradual on-ramp, with a supportive adult. Later, new factors become important for parents to consider, like the development of language and cognition, the neurological ability to inhibit oneself, and the scaffolding of emotional skills. 

Whatever the age, a good cry can always go a long way toward letting off steam, communicating, and healing.

 

Notes

(1) U. S. Children's Bureau of Infant Care. Care of Children Series No. 2. Bureau Publication No. 8 (Revised), 1924. As cited by Bell, S. & Ainsworth, M. (1972). Infant crying and maternal responsiveness. Child Development, 43 (4), 1171-1190.

(2) Lester, B. with Grace, C.O. (2005).  Why Is My Baby Crying? The Parent's Survival Guide for Coping with Crying Problems and Colic. NY, NY: Harper Collins, p 89.

(3) Lester, p. 73

(4) Lester, p. 88

(5) Lester, p. 92

(6) Lester, p. 1

(7) Lester, p. 69

(8) Lester, p. 58

 

 

 

 

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What Newborns Need for a Healthy Psychological Start

When I was a new mom, there were plenty of books about how to physically care for a newborn: how to swaddle, how to change a diaper, and how to treat skin conditions.  But there was next to nothing on how to care for a newborn’s psychological well-being. What’s important for infant mental health? Erik Erikson, the famed psychoanalyst of the sixties, recommended eye contact for the foundation of newborn trust—so I spent a lot of time looking at my newborn baby girl.

That’s a start.

photo credit Sugarplum Photography

Since then, developmental scientists have learned a lot about what gets babies off to a good psychological beginning. And it’s deceptively simple: It’s about breath and heart; rhythm and timing; paying attention.

States

For nine months of pregnancy, the mother’s body provides everything a baby’s body needs: nutrition, oxygen, temperature control, and waste management. When the two bodies separate, the baby’s body has to learn to regulate all of these processes itself…amid myriad new sensations like sights, sounds, tastes, temperature fluctuations, restrictions, movements, and more. The simple coordination of the first breath with the heartbeat is itself a wonder of biological engineering.

As the baby’s body takes over its own bio-rhythms, it rapidly cycles through different states. In the space of one-and-a-half to two hours, the baby turns a tight schedule that keeps parents on their toes and is completely at odds with an adult sense of time. But how parents respond to these changing states forms a foundation for the baby’s later psychological and social development.

Generally speaking, there are six states, with transitions in between:

photo credit Nancy Kohli Haté

photo credit Nancy Kohli Haté

  1. Deep sleep: The baby sleeps quietly without moving, and breathing is regular

  2. Light sleep: The baby might move, may have irregular breathing and even startle at noises, or may experience eye movements in the dreamy sleep of REM sleep (rapid eye movement). Babies can cycle between deep and light sleep, even within an hour. Sometimes, in the first few months of life, babies wake between the deep and light sleep cycles and have difficulty returning to sleep. (Newborns sleep about 16 hours a day, and about half of that is in REM sleep.

  3. Drowsiness: In the transition between waking and sleeping (e.g., waking up, or conversely, going to sleep), the baby’s eyes may open and close, or even roll back. The baby might stretch, yawn, or doze.

  4. Quiet alert: The baby’s face is bright, eyes are open wide, and the body remains quiet. This is time when the baby takes in her environment on her own terms. She might be looking, or staring, or simply quietly focusing on what she sees, hears, or senses. This is a good time to give babies their space, to let them get used to feeling comfortable settling alone.

  5. Active alert: The eyes are open and scanning and alert, and both the facial expressions and body are medium-active. Babies are especially open to social interaction in this state, so this is a good time to gently engage with the baby, talking quietly, singing, touching.

  6. Crying/fussy: A baby cries, screams perhaps, and the whole body and soul can become quite stressed and disorganized. Babies are born nearly helpless, so crying is the best signaling system to recruit outside help to regulate a need. With experience, parents soon anticipate the various needs—to eat, to be comforted, to be changed, to warm up or cool down, for more or less stimulation, to be eased into sleep.

photo credit Rohan Haté

photo credit Rohan Haté

 The underlying biology: oscillators and pacemakers.

Scientists have so far pointed to two biological mechanisms that underlie infant states and that have implications for later psychological development: 

  • The oscillator controls the sleep-wake cycle. It develops in a fetus at about 30 weeks in utero, in a region called the suprachiasmatic nucleus, which is in the hypothalamus just above the brainstem. Even in utero, a fetus begins a tiny sleep-wake cycle: researchers and mothers alike notice that in the last trimester, the fetus is more active at some times and in quiet sleep at other times. The cycle is short (called an ultradian rhythm), but after birth it begins the long march toward a circadian rhythm—one that harmonizes with the light and dark cycles of a 24-hour period. Before birth, the sleep-wake oscillator is sensitive to conditions in the fetal environment, like the maternal hormone melatonin as well as the intrauterine environment such as mother’s diet and exposure to light and dark. After birth, postnatal practices like the skin-to-skin contact called kangaroo care are related to longer periods of alertness and more organized sleep-wake cycles.

  • The cardiac pacemaker regulates the pace of the heartbeat and coordinates the heartbeat with the breath to alternately activate (in-breath) and calm (out-breath) the heartbeat. This is part of the autonomic nervous system (ANS) that originates in the brain stem and connects many organs in the body—the heart, lungs, eyes, glands and digestive tract. The ANS is roughly divided into the sympathetic nervous system (SNS), which goes on metabolic alert when the baby is in need or distress, and the parasympathetic nervous system (PNS), which calms and soothes and restores the system once again.

Developmental scientists have become especially interested in the calming system arising from the vagal tone. The vagus nerve is the 10th cranial nerve, a complex web of connections from the brainstem and reaching throughout the body that control and put the brakes on stress, shifting bodily resources away from fight or flight and back to “restore and grow.” Like the oscillator, vagal tone is also perceptible in the third trimester, around 33-35 weeks gestational age. After birth, it, too, is enhanced through the skin-to-skin contact of kangaroo care and even infant massage. Not surprisingly, sensitive care encourages a strong vagal tone.

Synchrony: the dance between caregiver and newborn.

 A new parent’s first challenge is to figure out how to react to a baby’s changing states. Granted, there is physical care involved—changing diapers, dressing, bathing, feeding, and more. But it is the process of joining a baby’s rhythm—not just physically, but psychologically, in harmony—that is most important for creating a strong psychological foundation. Psychologists have given this process many names: responsive care, attunement, and co-regulation.

Ruth Feldman, a psychologist at Bar-Ilan University in Israel and at the Yale School of Medicine, calls this coordinated interaction between caregiver and infant, “synchrony.” At first, she says, the relationship is biological: Pregnancy produces surges in the bonding hormone oxytocin in the mother, which primes her to attend to her baby (nonbiological parents generate oxytocin through interactions). In research studies, mothers with more oxytocin reported having more pleasurable feelings with their babies than mothers with lower levels of oxytocin. They were also observed to react in more sensitive ways, more often, to their babies’ behaviors.

In turn, as the baby is touched, or has skin-to-skin contact, or is breastfed, her nervous system is calmed, the biological clock organizes, and the vagal tone develops. Responsive, loving, warm care in the first weeks and months of life can even turn on or off the genes that regulate a baby’s stress.

Caring for a newborn changes parents' brains. As parents gaze at their newborn; talk gently; use soft, higher-pitched voices; and are positive, warm, and encouraging, their brain’s gray matter, or cell bodies, actually grow in the emotion and thought regions that support parenting behaviors.

Timing is important. In one of Feldman’s studies, when mothers appropriately chose the babies’ alert state to talk and touch their babies, the babies remained alert for longer periods of time.

[photo credits Kelly and Sahil Merchant, Mia Divecha]

The physiologies of caregiver and baby harmonize in the process. In one study, Feldman observed the heart rates of mothers and babies as they played with each other face-to-face. When the interactions were synchronized in an easy back-and-forth, the rise and fall of mother and baby’s heartbeats actually tracked each other, with a one-second lag. In other words, the mother—or any sensitive caregiver—helps to regulate a baby’s very heartbeat through loving, synchronous interactions. Feldman postulated that this is likely internalized by the baby as an “emotional sense of security that accompanies the child throughout life.” Other studies show that oxytocin levels, and even brain alpha waves, track between mother and baby in synchronous interactions as well.

Quick timing is also essential for soothing a distressed baby. In a now-classic study on crying, researchers Sylvia Bell and Mary Ainsworth at Johns Hopkins found that babies whose caregivers consistently responded quickly to their cries, cried less often and for shorter periods of time by the end of their first year.

Some parents need help synchronizing.

Many new parents intuit their babies’ needs—and/or learn to identify needs through observation—but others can benefit from some explicit coaching. Jenny Goyne is a postpartum doula who helps new parents through the stresses of the postpartum period and is especially dedicated to helping parents identify and work with their baby’s rhythms.

“I often encourage parents to just observe and watch their babies,” she says. For example, when the baby is quiet and content, she points out to the parent just how the baby is taking in her people and the world around her, and Goyne encourages parents to give the baby space to do just that. “Many parents feel they need to ‘do something,’” she says, “like sing a song, or entertain the baby, or exercise or stimulate them. There’s a lot of entertaining going on.”

“I remind them—this is all new to a baby. They’re just becoming aware of what’s around them and trying to make sense of all of it all. Babies, especially in the early weeks, also tire easily, and parents may not realize that when the baby looks away, or yawns, or begins to fuss or even cry, that they’ve had enough.”

photo credit Nancy Kohli Haté

photo credit Nancy Kohli Haté

Even breastfeeding can require some patience and self-restraint at first. It can take some time for the baby to find her way into it. In some cases, new mothers feel like they have to do something to make breastfeeding happen, which tends to stress the baby, and then the baby picks up on the stress and doesn’t want to eat. Many older mothers who are professionals and used to having answers just want to know what to do to make it work. “I often simply help them relax,” Goyne says. In other cases, mothers and babies benefit from coaching: some babies need coaxing to latch on, and there are strategies for making breastfeeding more comfortable for both mother and baby.  In some circumstances, breastfeeding is not even possible, so helping a mother come to terms with this may be important. “Conversations about what this means to a mother are important. There’s often a grieving process that needs to take place,” Goyne adds.

She also teaches parents to read the smaller nuances they might otherwise miss.

“Most people can tell the difference between smiling, crying, and sleeping, but we’re not so good at the subtleties of what babies are doing,” she says. For example, she points parents to the signs that a baby is about to transition between states, like the agitated movements or jerky motions or even hiccupping that can precede crying. Or the looking away that says she’s had enough. Anticipating babies’ needs can help keep their nervous systems organized for longer periods of time.

And then: Every baby is different.

“Babies don’t go by a book,” Goyne quips. “They have different temperaments. Some babies’ eyes are wide open. They’re taking in the world and are eager to interact. Others may be shy, or even a bit withdrawn. These babies need more space and perhaps less contact. The shy ones, especially, can make new parents feel insecure, sometimes causing them to work hard to get their baby’s attention, which can be quite overwhelming to a baby.”

“New parents might not realize that babies often enjoy having some time to themselves, to observe and experience the world without the parental filter,” says Goyne.

It doesn’t help that each practitioner tells a new parent something different. “The advice is not standardized,” she says. “You have to figure out on your own what works for your particular baby.” She supports parents in doing that by observing the baby and describing to the parent what she sees in terms of behavior and temperament, so that parents understand their own baby’s unique cues.

Some parents want to put the baby on a schedule to hasten the transition to “adult time,” but Goyne discourages that: “Babies don’t go by our clocks,” she says. “Many parents don’t realize that and think something’s wrong. They don’t know how to make sense of ‘baby time.’” Jenny’s job is done when parents gain confidence reading their baby’s signals—a few weeks for some, and up to three months for families with twins.

By three months, patterns of reciprocal interaction are well-established. By this time the baby starts to become skilled, herself, at initiating and sustaining interactions. She offers a social smile that makes the mom happy and the mom talks to her in return; the baby looks at an object in the distance and the father points and names the object; with a little encouragement from the baby, the grandpa excites her to screeching with silly play but quiets down when the baby crosses the threshold to being disorganized or upset. The adult is the baby's outsourced regulatory system.

Just how important this social connection is to a baby is demonstrated through the still-face experiment. Baby and mother face each other, cooing, talking, and touching, until the mother makes her own face stone-still and expressionless. The baby tries heroically to reengage the mother, even yelling and reaching for her, and when the efforts are futile, she falls apart in distress, sensing the connection is completely ruptured. When the mother reengages, though, the baby’s nervous system becomes calm, she smiles and re-engages, and the connection is restored.

The Goldilocks effect: Not too much, not too little, but good enough is best.

A cautionary note is in order for the overly-conscientious parent: Good enough is best. Within a normal range of interactions, babies, especially older ones, benefit from some variations in timings and styles. Babies get the gestalt of it. In normal human dialogue, mismatches and repairs are common. Infants get sensitized early to rhythm of these miscoordinations and interactive repairs, says psychologist Ruth Feldman at Bar-Ilan and Yale Universities.

Different adults have different kinds of rhythms, especially with older babies. For example, in research, fathers and mothers showed different kinds of interactive styles and different modes of co-regulation. With their five-month-olds, mothers typically played face-to-face and coordinated tiny, little interactions at a low-to-medium level of emotional arousal. They looked at things together, pointed, verbalized, and used gentle, affectionate touch. Fathers, on the other hand, were more exuberant: They laughed together and played physical games or games using objects. Their play was bigger, more open, and more exciting. They were just as synchronous, though, calibrating the back-and-forth between themselves and their babies; they were simply more emotionally intense and had different content. And mothers tended to be more synchronous with their daughters, and fathers with their sons, rather than the other way around. It's likely, though, that these kinds of patterns are not fixed but are flexible. The point is that babies can do fine with different styles of interacting.

It’s when the overall pattern is off that there is need for concern. Jenny Goyne described intrusive, anxious parents who feel the need to entertain a baby even when the baby is quiet and content. One study showed that these kinds of parents have higher activation in the amygdala, or fear regions of the brain in contrast to parents who are in synchrony with their infants and the reward regions (the nucleus accumbens) of the brain are activated. Psychiatrist Margaret Mahler has video footage of intrusive mother-infant pairs where the mother ignores the baby's signals that she wants to crawl or play her own way. When seen a year later, that baby is wrapped around the mother’s legs in anxiety, uninterested in exploring her world. Anxious mothers tend to miss the signals that their babies need space. In the process, they not only stress their babies; they also deprive them of the ripe opportunity to be content on their own, or to explore the environment on their own terms. 

On the other end of the spectrum, when mothers are aloof or depressed, they hardly engage at all in the normal back-and-forth that settles a baby’s nervous system. Maternal depression is predictive of some of the worst outcomes for babies. 

Important for future development.

Synchrony between caregivers and babies has lasting beneficial effects into toddlerhood and well beyond into adolescence, in almost every area that matters:

  • Emotion regulation, self-control, stress management: Feldman and her colleagues found that babies whose mother could follow their lead in infancy (3 months and again at 9 months), had better self-control at two years old than babies who did not have a synchronous relationship. This was especially true for babies with more difficult temperaments. Young children who’d experienced early synchrony were both more willing to pick up toys and put them away and more able to resist touching objects they wanted. Long-term studies show that early synchrony predicts lowered stress and better emotion regulation well into the teen years.

  • Social relationships: Babies who experience attunement with their caregivers become kindergartners who have more reciprocal, give-and-take relationships with their peers and they are better at resolving conflicts. As teenagers, they enjoy social relationships more and are more skilled at sustaining them.

  • Cognition: Two aspects of synchrony are particularly important to set the stage for optimal learning. One is the calm emotional state that is required for attention, learning and memory to happen. The second is the “serve-and-return” nature of the interaction, where babies learn cause-and-effect in their world, that the world is ordered, has governing laws, and is not chaotic. They become motivated only when they can make sense of the world and feel that they have some small bit of control and self-efficacy. Studies show that babies who experience synchronous relationships have higher IQs at two and four years old; their symbolic expressions—in language and play—are richer and more sophisticated; and their language refers more often to their own and others’ internal states, e.g., “I feel” and “You think.”

  • Attachment: Greater synchrony with caregiver in infancy is correlated with better attachment at one year, and fewer behavior problems at two years old.

  • Empathy: One study that followed babies from 3 months to 13 years old found that teenagers who had experienced synchrony with their caregivers as babies had greater empathy, suggesting that, as Feldman says, “synchrony sensitizes infants to the emotional resonance that underlies human relationships across the lifespan.”

You can’t spoil a baby.

photo credit Mia Divecha

photo credit Mia Divecha

New parents often wonder how soon their babies should become independent. The importance of the biological connection between sensitive caregivers and their babies should dispel those notions of independence. A baby cannot be spoiled, in fact the opposite is true. A baby needs a loving caregiver who gives her what she needs, on her terms, in order to wire up the major biological systems that create a foundation for later psychological and cognitive well-being. This synchrony is critical in the first month of life to organize and settle the nervous system, and it continues to remain very important in the sensitive period across the first year.

 

 

 

 

copyright Diana Divecha 2016

 

 

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Additional Resources

What do doctors screen newborns for? 

What are newborn reflexes?

Developmental milestones in the first month

Tips for grandparents of newborns

How to find a postpartum doula

Books on physical care of newborns and infants:

Mayo Clinic’s Guide to Your Baby’s First Year

Your Baby & Child, by Penelope Leach

The Essential First Year by Penelope Leach

Caring for Your Baby and Young Child: Birth to Age 5, by the American Academy of Pediatrics

The Baby Book, by William Sears

The Wonder Weeks, by Frans Plooij and Hetty van de Rijt

 




 

 

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