IRRITABILITY OR CONTINUAL FUSSINESS
One of the most common symptoms of Neonatal Abstinence from any substance exposure is irritability. This is seen when infants are inconsolable with persistent crying, unable to self-regulate and/or whining and fussing. They may be fussy despite your attempts to comfort them. This irritability can interfere with sleep and feeding your baby. They are easily upset (dysregulated) and fussy. Some signs of this irritability in addition to crying/fussing include frantic sucking, clenching of their hands, hyper-extension (arching their back), or crouching/hunched positions. It is important to know that making sounds and how your baby moves their body is their primary communication since they do not have words. This communication (or baby language) is often called ‘cues’ and all babies have ‘I want to connect’ cues (smiling, cooing) and distress (I need a break or I need help) cues. All babies have both connecting and distress cues in their baby language. However, babies who are not going through abstinence or other medical conditions are not consistently fussy or irritable. Infants going through abstinence or have other medical concerns may be experiencing fussiness from the drugs in their system and/or from the impact of the drugs on their other systems (feeding problems - hunger or upset tummy; bowel problems - constipation or diarrhea; and/or sleep problems – lack of sleep or constant drowsiness). So it is important to determine the root cause of the fussiness (remember it could be more than one cause).
NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.
The SOOTHE Technique
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
First consider all the physical reasons for irritability and take steps to address those while you offer immediate comforting.
To soothe your baby one of the best calming strategies is the SOOTHE technique developed by Dr Kiti (a video demonstrating the soothe is available under TimeIn Parenting Strategies (TIPS) in this kit).
Swaddling is a very important and helpful tool in calming an infant (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking, and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
What are you asking from your baby right now – are you reading their cues and pacing yourself – you may be asking to much? Asking the baby to look and listen and watch you move at the same time. Watch to see what your baby can handle (they can look or listen but not both or they can watch you move but not if you are talking at the same time…)
What is the environment like? Is the baby overstimulated – remember a baby going through abstinence may react to things that may not seem overstimulating to you (they have a lot going on inside their bodies to deal with and things happening around them more to deal with…). Provide what we call a low threshold environment – low lighting, warm/swaddled, no noise/calming music (see music offered here in the kit that were developed specifically to not be overwhelming), limited movement or rhythmic rocking.
MAKE sure to read and respond to the baby’s cues to inform your intervention or interventions. Remember that sometimes you may need to help your baby learn to calm with step by step calming techniques.
MEDICAL
It is important to determine the root cause of irritability. If you are unsure you need to call your baby’s doctor.
Check to see if your baby is in pain. If you think that the baby is in pain you should call your baby’s doctor for assistance.
comforting techniques (offered in this kit)
Your baby may not be getting enough food
make sure your baby’s suck is productive (they are able to attain breastmilk/formula and swallow it)
If your baby is having trouble with a productive suck shorten the feeding intervals to not tire the baby out
You may need to put the infant on a schedule with frequent, less amount feeds; you may need to wake them to feed
Reduce the stimulation in the environment; lower lights, lessen noise, and use soft materials, make sure the room in a comfortable temperature (70-72 degrees Fahrenheit).
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
NURSING
It is important to determine the root cause of irritability. If you are unsure or symptoms do not go away you need to call your baby’s doctor office.
Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Change the infants position to make them more comfortable
Reduce the stimulation in the environment. Limit noise. Lower lights. Make sure the baby is comfortable (temperature and fabric).
Give the baby a warm bath.
OCCUPATIONAL THERAPY
Movement, especially if it is jerky and unwanted, can cause irritability.
Swaddle (helps to limit the movement and provide calming) Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.
Change the position – some positions may actually feel painful while the infant is going through abstinence. Be aware of what positions are more calming.
Look at all the senses – are they overwhelmed? They may need you to decrease artificial lighting, background noise and eye contact in order to calm.
Think about hearing (noise – even background noise might be increasing more irritation), touch (is your touch stimulating or is gentle but firm, fabric of clothing (soft textures) etc), movement (do they seek movement or does it make them more irritable) vision (is the light too bright or in their eyes, are you trying to make eye contact and they need a break right now). *note: eye contact is important but may be too much for an infant when they are irritable, during calmer moments reengage with eye contact.
SPEECH/LANGUAGE PATHOLOGY
Crying and fussing are communication. It is important to respond to the baby’s cries.
It can be that they are hungry. Often babies with NAS have trouble with their suck while feeding.
Babies feed to a rhythm, and the development of this coordination is called suck, swallow, breathe (SSB). They may need you to restrict their movement during feeding (especially if they have tremors or body shakes) so that they can focus their movement on coordinating their SSB and be able to feed better.
Shorter and more frequent feeds may be important to help them with endurance when they have trouble with their suck.
It will help to teach them to use a pacifier. Sucking is very calming to the nervous system. You will need to teach them to use a pacifier when they are calmer so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.
They can be overwhelmed by what is going on in the environment. Hearing background noise, talking, TV, radio, even the sound of lights – this, especially, when they are all happening at once can cause the baby to be fussy and cry.
Most importantly, read your babies cues to inform your strategy.