It’s 2 a.m. and cries from the room next door begin again for the third time tonight. You have tried everything but nothing seems to work. You are at the end of your rope and pleading for just a few moments of sleep before you have to begin another long, stressful day. Will the crying ever stop?

Crying is a normal part of an infant’s everyday life. In fact, most infants cry two to three hours every day as a way to communicate with their caregivers. Up to 30 percent of otherwise healthy infants cry even more, a condition often called colic. In contrast, some babies cry much less than two to three hours a day. Many infants cry because they are hungry, sick, hot, cold, tired, in pain or in need of a diaper change. Sometimes, infants cry even though all of their needs have been met.

It is common for parents and caregivers to become frustrated, angry or feel inadequate when caring for a crying infant. These negative feelings often intensify during times of stress or if a parent or caregiver tries unsuccessfully to comfort a crying child. While frustration is a normal emotion for caregivers to experience, it is important to manage this frustration in a healthy and safe way.

Here are a few tips to help you keep your cool when the crying just won’t stop:

• Put the child in a safe, secure place, such as a crib, and leave the room. Give yourself space to cool down, but never leave the child unattended.
• Pick up the phone and call a friend, neighbor, relative or parent helpline. In many cases, these people will be willing to come to your home and offer assistance. If that is not the case, just talking to another adult can help calm your nerves.
• Walk with or carry the child to a trusted neighbor’s home and ask for help.

For the safety of your child, it always is important to monitor his or her caregivers. If you know someone who has difficulty managing anger or who handles children roughly, do not put your child in his or her care. If your caregiver reports excessive frustration with your child or an inability to deal with your infant’s crying, listen and make other arrangements for your child’s care.

A searchable directory of community-based resources for families is available on the Child Abuse Prevention Fund’s Web site at www.capfund.org.

FAST FACT: Children's Hospital of Wisconsin has seen an alarming record number (28) of cases of shaken baby syndrome this year. If you know a new parent who is tired or stressed, please share this information with them and help them find support. Shaken baby syndrome is devastating and can be avoided.

Lynn K. Sheets, MD, is the medical director of Children’s Hospital of Wisconsin’s Child Protection Center.

Babies spend a great deal of time sleeping. Parents and others who care for infants should be aware of ways they can help protect sleeping babies from injury and death.

Sudden Infant Death Syndrome is the sudden unexplained death of an infant younger than 1 year of age. This syndrome is rare and its cause is unknown. However, there are measures you can take to help reduce the risk of SIDS and to prevent other injuries.

One of the most important things you can do to reduce the risk of SIDS is to put babies on their backs to sleep in a safe sleep environment.

Co-sleeping is not recommended. An infant sleeping in an adult bed is dangerous and can result in death. Sleeping with a baby is especially dangerous when the adult is impaired by alcohol, drugs or fatigue.

Take these other sleeping tips into consideration:
•    Always place your baby on his or her back to sleep, for naps and at night.
•    Place your baby on a firm sleep surface, such as a safety-approved crib mattress, covered by a fitted sheet.
•    Keep soft objects, toys and loose bedding out of your baby’s sleep area.
•    Do not allow smoking around your baby.
•    Keep your baby’s sleep area close to, but separate from, where you and others sleep.
•    Consider using a clean, dry pacifier when placing your child down to sleep.
•    Do not let your baby overheat during sleep.
•    Avoid products that claim to reduce the risk of SIDS. Most have not been tested for effectiveness or safety.

FAST FACT: According to the Infant Death Center of Wisconsin, 15 Milwaukee children died from unsafe sleeping arrangements from January 2008 to June 2008.

Anne Harvieux is the program administrator for the Infant Death Center of Wisconsin. The center is a statewide program administered through Children's Hospital of Wisconsin.

The birth process may cause your baby’s head to appear slightly misshapen during the few days or weeks after he or she is born. This generally is normal because a baby’s skull is made up of several separate bones that are not yet fused together. The shape should improve within six weeks of birth. If you’ve noticed that your baby is developing a persistent flat spot or is born with a flat spot that does not improve, it could be a sign of positional plagiocephaly, also known as flat head in infants.

Positional plagiocephaly most often occurs when a baby sleeps or rests his or her head in the same position repeatedly. Other common causes include:
•    Decreased space in the womb, such as multiple births or breech position.
•    Premature birth.
•    Torticollis (tightness of neck muscles causing the head to tilt and/or turn one way more than the other).

What does positional plagiocephaly look like?
An infant’s skull may get flat along the back, one of the sides or may bulge out at the forehead. If you look at your baby from above, one of his or her ears may seem more forward than the other. From the front, the eyes, jaw and cheeks may be uneven between the left and right side.

How can positional plagiocephaly affect my baby?
Small differences are normal, but severe flatness may cause future problems. Since the jaw is connected to the skull bones, the jaw can become uneven as the skull gets flat. This could cause pain in the jaw and make it hard to chew and eat. Uneven eyes may cause vision problems. Uneven head shape makes it difficult for glasses and safety helmets, such as a bike helmet, to fit correctly.

Can I prevent positional plagiocephaly?
Fortunately, positional plagiocephaly usually is easy to treat. With appropriate intervention, it should be corrected by the time your child is 1 year old. Parents may try the following suggestions:
•    Alternate the direction your baby’s head is turned each time he or she sleeps.
•    Encourage your baby to look in all directions when he or she is awake.
•    Alternate the arm you use to feed or hold your baby.
•    Consider moving your baby’s crib to a different area of the room. If there’s something in the room that’s catching his or her attention, moving the crib will coax your child to look at it from another position.
•    Use items like bouncy seats and swings as little as possible. Use the car seat only in the car, not as a carrier or for sleeping.
•    Use an upright carrier (ex: Snugli® or Baby Bjorn®) instead of a stroller when out for walks.
•    Be sure your baby gets plenty of supervised “tummy time” during the day. Tummy time helps promote normal shaping of the back the head. In addition, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.

As babies grow, they typically begin to reposition themselves naturally. Talk to your pediatrician if you see your baby turning or tilting his or her head more in one direction or if you notice head flatness developing.

FAST FACT: Always place your baby on his or her back to sleep. This decreases the chance of SIDS by 40 percent.

Micki Klawes, MPT, is a physical therapist at Children’s Hospital of Wisconsin.
 

Proper hearing is essential to a child’s ability to develop speech and language skills, as well as his or her cognitive, social and emotional development. The first few years of a child’s life are particularly important. During this time, children learn to make sense of sounds via their ears, working in conjunction with their brains. The importance of these early years is what prompted many states to initiate hearing tests for all newborns. Early detection and appropriate intervention are key factors in eliminating or minimizing the negative impact of hearing loss.

Despite the importance of early intervention, on rare occasions parents still are told their child is too young for a hearing test. Very young children can be tested. Here are some of the more common tests:
 
Visual reinforcement audiology
This is a behavioral testing technique typically used with children between 6 months and 3 years old. In a special booth, the child is seated on a parent's lap with speakers situated on either side. An audiologist transmits speech and different pitches of sounds through the speakers. When the child hears the voice or sounds and looks in the direction of the sound, an animated, lighted toy appears. Using this type of visual reinforcement, the child eventually learns to look toward the source of the sound when he or she hears it, allowing the audiologist to evaluate the child’s hearing.

Conditioned play audiometry
This test typically is used for children between 3 and 5 years old. While wearing headphones, the child is encouraged to play a listening game. Different sound pitches are introduced through the headphones, and the child is taught to perform a task, such as putting a block in a bucket every time a sound is heard. If the child is willing and able, his or her ability to hear and understand speech also can be assessed by using a picture-pointing task or repeating words. By having the child wear headphones, the audiologist is able to determine the level of hearing in each ear.

Conventional audiometric testing
Most people are familiar with this test. It typically can be used with children age 5 and older. With headphones on, the child is asked to raise his or her hand every time different sounds or pitches are heard. In addition, the child’s ability to detect and understand speech is evaluated by having him or her repeat words.

Newborns, very young infants and some children with special needs, such as visual difficulties, cognitive or physical impairments, and/or behavioral issues, may not be able or willing to perform some of these tests. In these situations, audiologists rely on electrophysiological tests that do not require any responses from the child. These tests include auditory brain stem response evaluations and auditory steady state response testing. During these noninvasive and painless tests the child typically is sedated. Headphones generate a series of clicking sounds, and electrodes attached to the child’s head record neural responses. Using these tests, audiologists are able to obtain very good, objective estimates of a child’s hearing status.

If you have concerns about your child’s hearing, discuss them with your pediatrician. Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers comprehensive hearing tests by audiologists who specialize in working with kids.

FAST FACT: If you have concerns with your child’s hearing, don’t dismiss them just because he or she passed a newborn hearing screening. It is not uncommon for children to develop temporary hearing problems, such as fluid behind their eardrums, which require medical attention. On rare occasions, a progressive, possibly permanent hearing loss may develop that was not present at birth.

Catherine Holland, MS, CCC-A, is a pediatric audiologist with Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin.

 

Parents who are concerned with their child’s speech and language development may not know what to do or where to go for help. With the help of a speech-language pathologist, it is possible to evaluate both receptive and expressive speech and language skills.

Receptive skills include a child’s ability to listen and understand, and expressive skills include a child’s ability to speak and use language, such as sounds, gestures and/or words.

Keep in mind that children learn at different rates. Watch for language skills that develop steadily, not whether they are fast or slow. Below is a list of basic speech and language milestones to look for, as well as some red flags, and the next steps to take if you are concerned.

A child’s common speech and language milestones include:

Six months
•    Babbles, laughs, coos.
•    Turns to look at new sounds.
•    Recognizes familiar people.

12 months
•    Uses simple gestures, such as waving, pointing and clapping.
•    Begins to understand the meaning of simple words and daily routines, such as eating and bedtime.
•    Follows some basic instructions.
•    Begins to imitate sounds and may say two or three words.

18 months
•    Uses 10 to 20 words.
•    Recognizes pictures of familiar people and objects.
•    Points out several body parts on self or a doll.

Two years
•    Has a vocabulary of at least 100 words.
•    Combines several words.
•    Understands simple questions and instructions.
•    Can be understood 50 to 75 percent of the time.

Three years
•    Sings simple songs and nursery rhymes.
•    Asks and answers simple questions.
•    Follows two- and three-step directions.

Four to five years
•    Identifies colors and shapes.
•    Can be understood 90 percent of the time.
•    Asks “who” and “why” questions.
•    Can retell a story.

When to seek help
Children who have one or more of the following issues may need to be evaluated by a speech-language pathologist.
•    No babbling, pointing or gesturing by 12 months.
•    Frequent ear infections with middle ear fluid.
•    No single words by 16 months.
•    Difficulty with or reluctance to imitate new sounds or words by age 2.
•    No two-word spontaneous phrases by 24 months.
•    Difficulty sucking, chewing or swallowing.
•    Poor voice quality.
•    Failure to answer simple questions and follow two-step directives by age 2½.
•    Stuttering that causes a child embarrassment, frustration or difficulty with peers.
•    Regression in language or social skills at any age.

Referral process
If you are concerned about your child’s speech-language development, discuss your concerns with your pediatrician. The Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers speech, language and hearing assessments for children from infancy through adolescence.

Susan W. Haessler, MS/CCC-SLP, is a pediatric speech-language pathologist at Children's Hospital of Wisconsin Clinics-North Shore.

FAST FACT: Parents don’t have to rely on the predictions of others or guess whether their child will be just like a friend’s and eventually catch up in language development. (“My son was slow, too. Now he won’t stop talking.”) If you are concerned about you child’s speech and language development, talk to your pediatrician or a speech-language pathologist.

Tips for keeping your cool around a crying baby

It’s 2 a.m. and cries from the room next door begin again for the third time tonight. You have tried everything but nothing seems to work. You are at the end of your rope and pleading for just a few moments of sleep before you have to settle into another long, stressful day. Will the crying ever stop?

Crying is a normal part of an infant’s everyday life. In fact, most babies cry two to three hours every day as a way to communicate with their caregivers. Many infants cry because they are hungry, sick, hot, cold, tired, in pain or in need of a diaper change. Up to 30 percent of otherwise healthy infants have colic, a condition defined as excessive crying that can be very loud and last for many hours each day.
 
It is common for parents and caregivers to become frustrated when caring for a crying infant. Frustration often grows during times of stress or if a parent or caregiver tries to comfort a crying child without success. While frustration is a normal emotion, it is important to manage it in a healthy, safe way.
 
Here are a few tips to help you keep your cool when the crying just won’t stop:
 
• Put the child in a safe, secure place, such as a crib, and leave the room. Give yourself space to cool down.
 
• Pick up the phone and call a friend, neighbor, relative or parent helpline. In many cases, these people will be willing to come to your home and offer help. If that is not the case, just talking to another adult can help calm your nerves.
 
• Walk with or carry the child to a trusted neighbor’s home and ask for help.

• Never shake or harm the baby in any way. Each year, more than 1,000 infants in the United States experience severe or fatal head trauma at the hands of an abusive caregiver. The kids who survive this abuse often suffer from brain damage, loss of sight or hearing, paralysis, seizures and learning disabilities.
 
• Learn breathing techniques to help calm yourself.  Breathing deeply and slowly can help you calm down. Practice deep, slow breathing when you are not in a stressful situation so that when your baby's cries frustrate you, you know how to calm yourself.
 
For your child’s safety, it is important to keep an eye on his or her caregivers. If you know someone who has a hard time managing anger or who handles children roughly, do not put your child in his or her care. If your caregiver reports a lot of frustration with your child or has a hard time dealing with your child’s crying, listen and make other plans for your child’s care.
 
Jennifer Hammel is the director of Children’s Hospital and Health System’s Child Abuse Prevention Fund.

FAST FACT: April is Child Abuse Prevention Month. Learn how you can keep kids safe and families strong by visiting www.blueribbonsonline.org.