I am happy to report that we are at the 5-week mark with baby #2. In virtually every way baby #2 has been much easier than baby #1. Mostly we attribute this to less trial and error parenting on our part rather than any major difference between the two. We hope our first son can forgive us someday.
One thing that we have kept our eye on is the 5-weeks mark. If you remember from one of my previous posts on crying, peak fussiness happens in babies around the 5-week mark. The fussiness is in large part a result of two factors…
Waking from the post-delivery slumber
The first factor results from the process of delivery and transition to life outside the womb. This is exhausting for most babies and they spend the first few weeks recovering. Thus most parents find that they may struggle even to keep their baby awake for a full feed. Around 2-3 weeks this starts to change and most parents will note their baby is much more awake (although still sleeping on average 16-20 hours a day).
Baby’s neuro-developmental stage
The second factor is developmental stage. Babies are very good at moving their arms and legs in the early weeks. However their relative control of that movement is limited. Think about things from the baby’s perspective. When they are awake there are these arms with hands and fingers that are constantly flying around, sometimes hitting them in the face or eyes. Eventually babies realize that those fingers might be nice to use from some non-nutritive sucking. However, getting those fingers in the mouth is a monumental task. Frustration is expressed the same in all babies – fussiness and crying.
The Good News
Remember though that things do get better. As you can see from the chart below, fussiness tends to peak around 5-weeks of age. Each week after that it tends to decease a little. By 12-weeks it in minimal. Thus when parents have an idea of what to expect, they can dismiss the thoughts of… “Oh my! Is this going to last forever?”
Normal fussiness during the peak fussy period is 2-4 hours a day. It generally is not a constant 2-4 hours, although there is likely to be a time of increased fussiness. For most babies this is in the early evening hours. For babies that are fussing more than the standard 2-4 hours /day here are a few considerations
Is your baby hungry? The best way to assess this is by monitoring the number of wet and dirty diapers. For breast fed babies this is roughly one of each per feeding (around 6-8 per day). As the weeks go by the number of dirty diapers will decrease but the number of wet diapers will stay pretty consistent.
The other parameter to follow is weight gain. Babies normally lose about 10% of their birth weight the first few days after delivery. Once feeding is well established (around 3-5 days) babies gain about 5-6 ounces per week. They are typically back at their birth weight around10-14 days. Since many pediatricians will see your baby a few days after discharge and then again at 2 weeks, this gives you two opportunities to correlate their weight gain with other observations… like wet diapers, dirty diapers, and the amount of fussiness.
Does your baby spit-up often? The fancy medical term for this is reflux. This is irritating for a variety of reasons to many babies and often the source of fussiness. Click here to read more about spitting-up or relfux.
Babies who get too little sleep, ironically have a hard time sleeping. This is a cycle that can easily spiral out of control. Sleep begets sleep and an over-tired baby is definitely a fussy baby. We had this problem with our first son but have been very proactive with son #2. Check out this book for help with the “over-tired baby.”
This is another frequent problem for babies in the early weeks. It turns out babies are not born knowing how to poop. Some babies figure it out right away. Others struggle with it for a few weeks. Constipated babies are fussy babies. Click here to read more about constipation in babies.
If you have ruled out all the things above, then there is the distinct possibility that you are dealing with colic. What is colic you may ask? Well that is an excellent question. Colic basically means abnormal fussiness in an otherwise normal baby. Some people attribute it to gas. Others to something in mom’s diet. The truth is no one really knows what colic is. We just know it tends to start around 3-5 weeks and generally resolves 4-6 weeks later.
If you do an internet search for colic you will find all kinds of home remedies and other “potions” for colic. The most common that I see used are gripe water and simethicone drops. There is no evidence that either is in anyway effective. They are both pretty harmless though and some parents swear by them. So if you are at the end of your rope and want to try either for your fussy baby, I say give it a shot. Just remember… no matter what you do things will probably be better in a few weeks (although it may seem like months).
Dealing with Fussiness
I give the same advice over and over and try to follow this advice at home. The most important principle to understand is that frustrated and exhausted parents have a much harder time helping a fussy baby. Thus parents must be systematic and strategic in their approach to fussiness.
Have a plan
You should come up with a solid plan for how you will soothe your crying baby. Pick three different strategies (rocking, pacifier, holding, etc.) and spend 5 minutes with each strategy. If baby soothes then great! If not, at the end of 15 minutes baby goes back into bed and spends roughly 10-15 minutes crying.
After the allotted 10-15 minutes of crying, if things are no better, then it is Dad’s turn. He should try his three strategies (not necessarily the same strategies) over 15 minutes, again placing baby back in bed if things are no better. Repeat the cycle over and over again until baby is asleep or it is time to eat again (which I generally suggest is after 2 hours for a very fussy baby).
It is critical that mom and dad alternate and rest between the various rotations in place where they can tune out (i.e NOT HEAR) all the fussing. Otherwise neither mom nor dad get any rest and this is a recipe for disaster.
Go for a Drive
One thing that many parents discover is that a fussy baby will sleep in a moving car. Take note though – I said a moving car. Do not put your baby in a car and go sit in rush hour traffic. If you have access to a highway where you can drive for 30 minutes to an hour without stopping, you may find this is just what you need. It will often soothe baby to sleep, you can take in some relaxing music, and your partner gets to stay at home with the temporary bliss of silence.
The Breaking Point
Everyone has a breaking point. A point where you just cannot stand it any more. This is a fact. It does not make you a bad parent or say anything about your parenting skills. No one can stand a crying baby forever. If you reach your breaking point, and most parents will at some point, know what to do.
Put your baby in a safe place – like their bed or the car seat, and go some place where you cannot hear them (like outside). Take a 30 minute break and gather yourself. The worst thing you can do it try to care for a fussy baby when you have passed your breaking point. Trust me babies can scream their head off for 30 minutes with any serious consequence to their long term outcome. However parents that “lose it” can unintentionally hurt their babies out of frustration. I do not see it all the time – but I do see it.
Ask for Help
Grandparents, siblings, friends, and even neighbors are excellent resources. Don’t be afraid to use these resources during the tough times over the first 6-8 weeks.
Despite the fact that I routinely tell parents never to take their children to the ER, the extremely fussy baby is one patient that I am always willing to see. Mostly I just provide parental reassurance. However, I would much rather talk these parents through this difficult time than have them stay at home getting more and more frustrated. Try the things I mentioned above, but if all else fails give your doctor a call or visit the local pediatric ER (always avoid the adult ER when possible).