Thursday, August 15, 2013

Four Month Monsters: why babies change their behaviour at this age and why they DON'T need solids yet!

She is the delight of our lives - charming, endearing, bringing smiles wherever she goes.

She is a happy, contented baby who hasn't got a worry in the world.

But, on Monday, everything changed.

Charlie turned - FOUR MONTHS OLD!

And after all my years of experience around babies, I know that just about all the wheels are about to fall off, big time! Luckily, so does her mother, after observing alongside me as I supported mothers.

If there is only one thing I know, then it is to expect the unexpected between ages 4 and six months. Just when the clouds begin to clear after the early daze, your life starts to have some pattern and your baby becomes more confident, interacting and enjoying life - Mother Nature shifts things up a gear and it all goes back to square one again!

Read any parenting forum, listen in at mothers groups, you'll soon see a pattern:

"My baby was sleeping X hours at night, but suddenly he is waking every hour or two again! Help!"

"I am worried I don't have enough breastmilk - she only feeds for a few minutes and comes off and I just can't get her back on. She drinks Xmls if I give her a bottle. How can I increase my supply?"

"He is so needy - I can never leave him to play more than a minute; I can't get anything done! Mum says I have spoiled him."

"I had to start him on solids - my milk wasn't good enough. He was constantly sucking his hands. He watched everything we were eating and was grabbing things off my plate! He started waking more at night - and the nurse said he hadn't gained very much weight this month."

"I think she is teething - she cries when I offer the breast, like it is hurting her mouth. Or maybe I have run out of milk? My friend said she needs real food - my milk isn't enough any more. But my mum says she is manipulating me and that's why she wakes so much at night, she should be sleeping through by now. I am just really confused"

"I have to go back to work next week but my baby refuses the bottle. He took it okay when he was a newborn but now he just screams and pushes it away."

"I think he is weaning himself, he just doesn't seem interested in the breast anymore. He is okay at night but during the day, he just won't stay on. He sucks for a little while but then that's it. I have to give him formula to make sure he gets enough to eat."

There really are identifiable "problems" that we see in this age group that are actually all part of a baby's development but are often poorly-explained or attributed.

Distracted feeding: 
From breastfeeds that took up to an hour or more, with a baby who attached to the breast and only came off one side to switch to the other, around four months, babies begin to notice that the world doesn't stop while they eat and they keep stopping to check in case they miss something! Their growing brain, up until now, hasn't given much attention to distractions during feed times: I have watched a newborn steadily feed on, despite a hammer drill starting up only metres away! TVs can blare in the background, conversations roar, appliances scream and the younger baby just sucks away, oblivious! They aren't tuning anything out, they just have no idea it might concern them. But now - in the period before they develop the ability to screen out unwanted distractions, they respond to every single one. Someone opened a door - oh, did you want me to smile at you? The cat walks along the couch - hey cat, looking for me? Mummy opens a new page on her mobile device - ooh, bright lights, look! Big brother plays with his toys - what was that? Basically, let alone tune anything out, they tune everything in!

What you can do:

  • Accept that daytime feeds are less effective, so more nighttime feeds might be needed.
  • Minimise the distractions you can control and accept the impact of those you can't.
  • Be reassured that babies at this age are very efficient feeders and get lots of milk in those short feeds.
  • Look forward to the next stage of development, when distractions aren't so interesting.

Short attention span and easy frustration:
Just a few weeks ago, it was all about the hands - reaching, grabbing, holding. Now that those skills are fairly well achieved, babies can be frustrated when they fail. The missed swipe at a dangled toy is irritating, not challenging. The dropped toy is frustrating, not forgotten. the attempts to roll are tiring, not fun. Some babies are born to be upright, wanting to sit, stand, move - but their development is far behind their expectations and they need adult support to do what they desire. Tummy time gets boring, as does lying on your back. The swing was fun this morning but now it isn't. Looking at the wall no longer cuts it. Don't pick me up, I want to lie down. Don't lie me down, I want to be carried! ARGH! I am a growing brain trapped in a stalled body - help!

What you can do:
  • Accept that this is a frustrating stage for your baby and support him as he goes through it.
  • Set up play stations that you can move her between across the day, as boredom hits.
  • Wear your baby in a carrier or sling when you have stuff that must be done - he will like the view.
  • Try not to add your own frustrations! There is no point both of you getting upset!
  • Remember development comes in stages and this too will pass. Independent moving is just around the corner!
Increased appetite and interest in eating:
With all that is going on in both brain and body, it is to be expected that your baby may want more of all that he gains at the breast: more energy, more relaxation, more comfort, more reassurance. As always, your body continues to make all the milk he needs and, even though his feeding behaviour may have changed dramatically, you can be confident you will continue making exactly what he needs - after all, nature intends babies to breastfeed for years, not months, so there is no reason to anticipate failure. 

However, as the time for introducing other foods to your baby's diet approaches, he is starting to learn the skills and abilities needed to consume and digest them. You may start to notice the external ones - increased saliva production (which dribbles out of his mouth); practice movements of hand to mouth, as he gains the coordination needed to put food in his mouth; awareness and interest when others are eating, as he learns through observation. Internally, his digestive system is still not ready to process foods other than breastmilk and even though he might swallow them if they are pureed finely, they will mostly travel straight through, leaving little in the way of nourishment but challenging his immune system not yet prepared for them. Indeed, because they are interested in any activity that is new, babies at this age will enjoy the play of eating pureed fruits and vegetables, rehydrated rice cereal and anything else spooned into their mouth that the tongue thrust reflex doesn't successfully reject. Until relatively recently, four months was considered an acceptable age to begin solids but modern history has seen this occur as early as the first days or weeks of a baby's life! Luckily, we know now that not only are babies healthier if we wait until they are developmentally ready to eat other foods but by waiting until they are, we can skip all that pureeing and mashing that is required to liquefy foods enough to slip past that tongue reflex! 

Therefore, that is what our health governing bodies recommend we do:
Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed1 for the first six months of life to achieve optimal growth, development and health2. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.World Health Organisation Infant Feeding Guidelines
In Australia, it is recommended that infants be exclusively breastfed until around 6 months of age when solid foods are introduced. It is further recommended that breastfeeding be continued until 12 months of age and beyond, for as long as the mother and child desire. NHMRC Infant Feeding Guidelines 2012
 What you can do:

  • Continue to breastfeed as often as your baby needs, especially if he wants to feed more frequently. He knows what he needs and your body continues to listen to his feedback. Remember to look for the simple signs he is getting enough breastmilk - just as many wet nappies, normal frequency of bowel motions and normal growth and development for his age.
  • Avoid starting solids too soon - keep in mind no food other than your breastmilk will meet all his nutritional needs until around six months: cereals, purees and commercial baby foods may fill his tummy but could reduce how much valuable milk he can then fit in. Just because he can doesn't mean he should. If advice you are given is different to the above recommendations, be aware of the risks and question why you should go against these global and Australian guidelines.
  • Consider using the Baby-led Weaning (Solids) approach, which more naturally allows your baby to begin learning about foods and beginning to eat them.
Increased waking and changed nighttime feeding patterns:
Although it is normal and natural for babies to wake for breastfeeds during the night in the first year and beyond, it is also natural for adults to want uninterrupted sleep! In recent decades, the myth of self-settling infants and negative attitude to night feeds has led to confusion, conflict and guilt in a society that rates parenting ability by how soon a baby "sleeps through the night".

In reality, nobody "sleeps through". We all wake multiple times as one sleep cycle ends and another begins. We are disturbed by noises, movement and other external stimulus and we respond to feedback from our bodies to drink water, empty our bladder, adjust bedding, make ourselves more comfortable or stop a spouse from snoring! Babies are different only in their shorter sleep cycles and physical inability to independently do any of these things, plus the addition of a rapidly growing and developing body on duty 24 hours, requiring refueling day and night.

So, naturally, when developmental peaks happen, as they do around 4-6 months, night waking may increase. Not only do babies wake for feeds, but they may wake due to physical disruption as they try to roll or crawl in their sleep or mental disruption as a busy brain tries to process the input of the day. And once they wake, they need help to return to sleep in the way nature intended: feeding at the breast. In one shot, they get food, drink, relaxation, reassurance and quickly return to the next sleep cycle.

What you can do:
  • Accept that infant developmental stages can lead to sleep disruption and continue to do so beyond infancy.
  • Continue to meet your baby's needs by breastfeeding as often as they need, night and day.
  • Find ways to support your own sleep needs during the night and day, such as co-sleeping and naps.
  • Consider gentle parenting techniques that respect your baby and avoid stressful approaches that do not.
Weight gains, plateaus and those charts!
Recently, news reports have shown us some huge variations on the average human birth weight - babies born two or three times the size of most are always headline grabbing news! But, for the most part, the birthweight of human babies, born full-term to healthy mothers after normal pregnancies vary only within a few pounds of each other. Since the first baby was placed on the first scale, birthweight has given family something other than the child's gender and appearance to report and has really no more influence on the child's life than they should! After all, a foetus has to fit within its mother's womb and though we might all benefit from a longer gestation, we have really maxed-out the capacity when it comes to safely reaching the outside world!

However, once born, we each depend on two things for our potential growth - nutrition and genetics. Unfortunately, modern society has tended to focus on the first to the detriment of the second. In efforts to reduce infant mortality and increase child health, our goal has focused on measuring input via growth but often overlooking the normal variation in human size. This imbalance was made worse when babies in the mid-late 20th century were measured against a scale based on the unnatural growth patterns of non-breastfed infants from a narrow population! Thankfully, this was amended with new growth charts, but old habits die hard and we are still a society that compares babies growth and expects equality.

In reality, we all come from families who tend to look very similar, not only in facial appearance, but body type. Short, Tall, Lean, Well-padded ;) Broad. Narrow. And after the early weeks of life, when most babies tend to be similar in size and shape, a few months down the track, genetic patterns begin to show themselves. The short, petite build of Asia. The long, lean one of Africa. Tall, broad northern Europeans. As we migrate and blend more and more, we come to forget the origins of our forebears, however they shine out when you assemble any group - and particularly when that group are children of the same age. Suddenly, there are inches in difference in height and noticeable variations in shape. We expect this in skin and hair colour but forget genetics are clearly visible in body shape and height as well.

So, when we start to compare our babies growth in weight and length, we start to see greater variations and they may start to appear during this time period. As babies go through growth spurts, they may seem heavier or lighter, taller or shorter when compared to others. Especially when we visually compare them all as they play alongside each other in a group! But when all we see is a line that rises or falls on a chart, we tend to see that line as "normal" and rate our babies against it.

What you can do:
  • Remember that your baby's weight and length are only part of the information used to assess your child's growth and development - don't be fooled into using them in isolation.
  • Keep in mind that growth happens in spurts - weight may increase one week, with length catching up the next. An assessment is only a snapshot of today and is an indication only.
  • Resist the competitive side of parenting - the reason your friend's baby is two kilos heavier than yours at the same age is more likely related to genes than parenting skill!
  • Understand that times of rapid development of the brain and central nervous system aren't measured on charts - milestones matter as much as measurements!
  • If your baby's growth slows, don't assume there is a problem with your breastmilk. The most likely cause is the baby - brain development, new mobility and increased activity might simply mean energy is being used elsewhere.
  • When in doubt, offer more chances to feed, keep on eye on those wet and dirty nappies and consider ways to increase breastmilk intake before adding formula feeds or early solids.

Of course, I use the term Four Month Monsters in the title of this post with jest! In fact, this can be a fantastic stage of your baby's life as they begin to show their unique personality and interact  with the world and everything in it! I love every minute of watching my granddaughter Charlie grow and develop and this next couple of months will be no exception. I just wish I had known more when my own three babies went through these stages, so I could have relaxed and gone with the flow. It is absolutely a very demanding time but also a time to be relished, for the next stage is mobility and suddenly, all those hours on the couch constantly breastfeeding are fond memories as you chase your baby throughout the day!



Jade Fenwick said...

Thank you thank you thank you. My daughter is just 5 months and this explains a lot and puts my mind at ease! Do you have a Facebook page? Would love to follow you.

Anonymous said...

Thanks for making me and other mums who cant breastfeed successfully feel like we are failing our child. With everything you and everyone advocates says we are putting our babies at a disadvantage because we can not breast feed. Go you for continuing to foster the guilt.

Yvette ODowd said...

Dear Anonymous - I am not sure which part of this article implies what you say. I spend my time helping mothers meet their own breastfeeding goals and supporting them through challenges. If you have read any posts on my blog, you will see that I place no blame on mothers who don't have a positive breastfeeding outcome - given better support, access to accurate information and offered the resources they need, many of those problems can be overcome (as they are in countries such as Norway, Sweden and other Scandinavian places). I lobby for improvements in breastfeeding support. But you aren't reading this, you have gone away believing what you believe and making judgements of your own.

Elizabeth Kearnan said...

Thank you so do much! It's like you wrote this after meeting my daughter! And I don't find the tone of the article to be demeaning formula feeders. It's just geared towards breastfeeding mothers and that's OK.

miss y d said...

Thank you! As a breastfeeding mother, experience from the past makes us feel like we are set up to fail, and the tone of your article comes through as clearly a reminder that we can do this! It's not an anti-formula feeding article, but instead a wonderful insight to what is going on with my little guy and nice to know my instincts are on the right track. Nice read.