Some Assembly Required

Is my baby O.K.?

Almost all parents experience some level of fear and anxiety when they step back into the house for the first time with a new baby from the hospital. They set the baby on the floor in their car seat and wonder, “Now what do we do?” Does the baby’s cry mean they are hungry? Sleepy? In need of a diaper change? Could the baby just be worried that mom and dad have not contributed the maximum to their 401K plan? (Just kidding.) Newborns, on average, cry 2-­‐3 hours per day. They are in a new and very stimulating environment that is different than the womb. Remember, it’s a learning curve for them, too. Be patient as time is your ally.

Parents have fears about everything being all right with their newborn and whether they are going to be able to tell if their child needs medical attention. After all, most of us have studied and been trained to do our daily jobs. Suddenly, the most important job of one’s life is upon us and we wonder if we will be good at it.

I remember the day that my son commented that even normal breathing in his first child worried him. Newborns do breathe in a periodic fashion where pauses of up to 10 seconds can be followed by rapid, short breaths. Most first-­‐time parents find this frightening. These “fears” are not pathological, such as those we will consider in our next section, and can still be brought to your pediatrician’s attention. Such calls should be welcomed and understood by your doctor. If not, think twice about whether you have selected the right place to receive your pediatric care. Reassurance about similar concerns will allow you to develop the confidence you will need and become more and more certain of your own abilities.

Sometimes parents have a medical reason to be extra anxious about an infant. Perhaps there is a family history of SIDS (Sudden Infant Death Syndrome), or the baby had to spend a brief period in an ICU (intensive-­‐care unit) for, say, respiratory problems. When such worries take up too much energy, parents can feel deprived of the very enjoyment of their baby they were looking forward to. In extreme cases, this excessive worry can lead to what is known as vulnerable child syndrome (Morris Green, 1964). A first-­‐time mother was well known to me as I was her pediatrician from the time of her own birth. As an adolescent, she was diagnosed and treated for an anxiety disorder. She seemed thrilled when her child was born, but over the first few months I received almost daily phone calls and frequent visits due to concerns about the baby’s breathing, color, spitting up, bowel movements, and a vague uneasiness about whether the baby was developing normally neurologically. For a short period of time, the parents decided it was best for a cousin to take over all care of the infant. There had been no special events in the woman’s pregnancy and no problems with the child’s birth. In fact, despite 15-­‐20 office visits during the child’s first six months of life, a true medical diagnosis was never made for any of the perceived problems. Fortunately, just making the diagnosis of vulnerable child syndrome, having a mother who was open to receiving medical treatment for an anxiety disorder, and allowing for some time pass, enabled this mother to enjoy her child in a healthier manner.

In another case, a young couple with a six-­‐month old chose me as their pediatrician. Not unlike our previous parent, this family had many “medical” concerns about their infant and followed through on them with countless office visits and phone calls. Despite numerous examinations and reassurances, the family continued this pattern of frequent visits without a significant diagnosis being made. I suspected this was a vulnerable child but could not pinpoint the reason. At one visit, I was alone briefly with the mother and asked if there was something in the couple’s history that I was “missing.” She told me that she and her husband had been pregnant once prior to their marriage and had chosen to place the child for adoption. Upon being made aware of this, I realized it was entirely reasonable for the parents to be more anxious and I also recognized that they may need time or some help to deal successfully with their feelings about the adoption.

Your pediatrician might suspect this diagnosis, but parents sometimes hide how difficult it can be to see their own child in a “normal” fashion. Thus, it can be a hard diagnosis for a pediatrician to make because it may seem judgmental. I have found that just acknowledging these feelings often allows a parent to move forward in a healthier fashion. In fact, it became my routine to discuss this diagnosis “preventively” with parents when, from my experience, I thought they might be at risk. An example would be in a baby finally going home after having to stay extra days in the NICU (neonatal intensive care unit). Parents really appreciated knowing that these feelings were common (“normal”) and most accepted the challenge to overcome them. Sometimes, a referral for counselling was necessary.

Is my baby OK? Managing anxiety is a common challenge for parents of a new baby. It is a major driver of physician visits and can lead to unnecessary medical testing and interventions. Parents need to recognize the sources of their anxiety as there is usually not something wrong with the baby. Most times, pediatricians need to simply listen and offer support rather than labeling these concerns with a diagnosis like reflux, food allergy, or milk intolerance. Your pediatrician will be alert to the signs and symptoms of true medical disorders and will be quick to order appropriate testing or refer your family to a pediatric subspecialist. But more times than not, your baby is OK and that reassurance from your doctor should be sufficient.