Separation anxiety in babies 7 – 9 months

Intro
Welcome to Sense by Meg for the podcast that’s brought to you by Parent Sense, the app that takes guesswork out of parenting. If you are a new parent, then you are a good company. Your host, Meg Faure is a well-known OT infant specialist and the author of eight parenting books. Each week we are going to spend time with new moms and dads just like you to chat about the week’s wins, the challenges, and the questions of the moment. Subscribe to the podcast, download the Parent Sense App and catch Meg here every week to make the most of that first year of your little one’s life. And now meet your host.

Meg: Welcome back mums and dads, I’m Meg Faure. I’m an occupational therapist and I am very passionate about little ones, about getting them to sleep well, about having them feed nicely and develop optimally. And you know, a lot of people ask what an occupational therapist is and what we do and it’s all about function, so if you are old, we’ll be making sure that your function is optimal after your hip replacement or if you’re losing your mind. So we work with people of all ages and stages and the age and stage and the function of an infant is really around three main things and that is sleep, feeding and play. And so a lot of what we talk about in the podcasts with me is actually feed, sleep and play and development. Each week we are joined by a guest and it is very often Cassidy. She’s the mom of Max, her first little boy who is now about 29 weeks old. Is that correct Cass?

Cass: Yep, he was 29 weeks yesterday.

Meg: That’s incredible. And we have followed Max’s journey all the way through from when he was really tiny in neonates and all the way through and he’s really quite a remarkable boy. Of course, we all know that about our own children, that they’re absolutely remarkable. But it’s been wonderful to follow Max’s journey and so thanks again for being back with us Cass.

Cass: No, that’s a pleasure. Thank you. I’m really looking forward to today.

Meg: Oh dear. Are you going to tax me?

Cass: Well, I don’t know. I don’t know. We’ll see.

Meg: Okay, well tax. I’m gathering that there’ve been a couple of big challenges these week, so, I’ll tell you what I wanted to have a look at the app and how his function and  how he kind of responds to everything in the app. And for those of you that don’t have the app, the app is called Parent Sense; it is a complete look at your baby’s day, sleep, feeding and play. And today I asked Cass, if we could actually go through the app and use the app to bring back all the questions. Now, on the bottom part of the home screen and we are recording this in the evening actually, I can see that Max has just settled to sleep, and when I ask Cass if that was true, Cass, is he asleep?

Cass: Do you know what? I’m going to do a live check on the monitor; he is currently doing his goodnight tour of the cot. So he’s going rolling all around with his comforter but not crying, not making any noise, and eventually he’ll go to sleep.

Meg: Okay, so now you’ve got half of the mums who are listening to this podcast completely green with envy because that’s exactly what little ones should be doing at this stage. No baby falls asleep as their head hits the pillow, at least they shouldn’t, and so for most babies they are self-soothing to sleep well hopefully they’re self-soothing to sleep and that is exactly what Max is doing. He is using his tour of the bed to get himself acquainted to his bed space until he’s ready to fall asleep. That’s quite incredible.

Cass: Yeah, no, he is very good. And actually I was a bit worried about bedtime this evening because as of so often the case, something came up today. So we were invited for a play date with some people who are over on the Island and have little ones who are actually about a year older than Max. So they’re at a different stage, and so it was in line with their routine and it didn’t fit in with Max’s routine. So I had to do some juggling to try and make it work, but what it meant was that he actually woke up in time for the play date at four o’clock. It is now quarter to seven and he should have really been going to sleep ideally about half an hour ago, maybe out of [inaudible 04:05] 15 minutes ago, but I had to get him back fed, bathed and then to bed.

Meg: No, the juggle is real here. That was fitting in a lot between the last sleep of the day and his bedtime.

Cass: And it’s not usually like that.

Meg: No, of course.

Cass: You know, obviously sometimes these things happen. So I was a bit worried about bedtime and actually I can spot there is a problem occurring because he’s left his comforter at one end of the cot.

Meg: And he’s gone to the other.

Cass: … gone to the other end. So, I am fully aware that today’s bedtime is going to be more challenging because he has that little bit more over tired.

Meg: He is overtired, and for other people who are interested in knowing about this; at the top left of Max’s screen on the app it says that his awake time should be about two to turn a quarter hours and that last awake time of the day, actually we typically stretch it a little bit longer than that because they actually need to be a little bit more tired just before bedtime for when they go down. So we’d normally say two and a half hours, which means that if he was going to sleep at quarter to seven, he should really have been awake at about quarter past four. And you said he woke up at four?

Cass: He woke up at four, but as you say in that awake window he’s had a play date.

Meg: There was a lot going on.

Cass: Yeah, exactly. He’s had a play date with other kids, he has to do solids and milk and be driven. So, I think it’s just been too much, but to be honest, he’s also been a bit of a nightmare today.

Meg: Okay, tell us what he got up to.

Cass: Well, it all started when unfortunately on a Tuesday he is usually with my mom and unfortunately my mom woke up and she wasn’t very well and he is usually with my mom on a Tuesday because I work. And so, I had meetings in the diary and unfortunately, you know, my mom called and she said I just can’t, I’m not very well. So I had him and juggling work today and I don’t know if it’s because he could sense therefore that I was just juggling, or if it was just pure coincidence; but I could not put him down without him…At one point he sat after he woke up from one of his naps, Max never cries in the day really, and I know that that’s probably not what a lot of mums want to hear, but he’ll shout a bit, but he never cries with tears in the day.

And he sat on my knee after one nap and just sobbed full tears coming down his face. And I was just, what’s wrong with you? You’re fed, you’ve slept, you know it’s okay. And I gave him cuddles and as I was cuddling and he spotted a toy over his shoulder and was distracted and then was fine. So, you know, put him down but he’s just been a bit like that all day. And as I say, I don’t know if it’s coincidence or because he could pick up that I was trying to juggle too many things. And then, of course, I had to work his routine around his play date, which usually his sleep is at four

Meg: And he’s awake by 4:30.

Cass: Yeah. So, it was just one of those days where it was a perfect storm of things not quite working out. And so sometimes those days happen, and we are very lucky that they are few and far between but it’s exhausting. When you have so much to do, that’s the days that they feel they can’t be put down.

Meg: I think it’s a couple of things. I definitely do think the little ones pick up on it, you know, like we trying to put them down. So instead of taking that little bit longer to get them settled with something, we kind of want to move on quickly so that they can get on with it, so we can get on with something. Same as when we try to put them to sleep, we just kind of want to put them down and walk out the room quickly because we’ve got to get onto something and they just do pick it up because when we are more leisurely and we take our time that the separations are easier, that definitely could be part of it.

The second thing is that sometimes when you have a very unsettled day like this, two days later there’s a tooth that pops out, or there’s a little rash that appears, or a little fever that breaks at night, and I can remember that happening so often with my kids and I would be losing my cool with them and I just…You know, just stop it now. You know, just stop the pressure and the next day there’s all this guilt around, Oh my gosh, they were just not feeling great. So that could be the second.

And then the third, of course, is that sometime between seven months and nine months he’s going to start to learn object permanence and that’s when separation anxiety sets in. And for those of you who have heard, I think I’ve spoken about separation anxiety before on these podcasts, but for babies, the object of their love is their mother usually, or their primary caregiver, sometimes their dad if that’s primary caregiver. And so, we call that the object, and throughout their life they think that the object in their young life is part of them and is them. And so whatever they’re feeling and thinking you feel as well, that’s just what they think. And then at some point they learn what we call object permanence and that is that the object exists outside of them and when they learn that separation anxiety fits in because then they want to quickly call the object back the minute the object tries to put them down and so on.

Meg: And so you start to have a really clingy, needy little one and it typically happens as I said, between seven and nine months is when it starts and it usually takes a few weeks to resolve and in that time you can have sleep upheavals and certainly some more irritability.

Cass: Yeah, so a couple of things on that. One thing that’s been quite amusing but not really is he does seem to, for the first time he started to get really upset if you take something from him. So for example, he loves his watering can in the bath, but at the end of bath and we take the watering can away, we then have…

Meg: A scream comes in.

Cass: We haven’t had before, so we’ve decided maybe the watering can will just have to go on holiday for a little bit because it’s only over the watering can. He’s got boats and things like that. We’ve also been laughing, because for some reason, and I don’t know if you’ve got a magical answer, but in the last week he has been waking up at about half 10, half 11 at night and being really upset. You know, usually he will wake up and we’ll give him a feed and he’ll go back to sleep and it’s all over in 15 minutes but he’s been waking up and so it’s not time for a feed. So we’ve been leaving him for a bit then going in giving him a bit of a cuddle or sometimes we’ve given him Calpol because we’ve thought maybe he’s teething and he’s in pain. And the only reason I thought it could be separation anxiety is because from when we go in, it then build.

So we go in, he’ll be in our arms, he won’t fully settle but al eventually settle and then we’ll put him down and then suddenly we’ve raised an octave, or series of decibels. And actually the other night I brought him into our room, because when we left his room he seemed to calm down and we were a bit at the end of our tether and we brought him into our room, which is something I never really wanted to do, but you end up doing the things you don’t want to do and put him down in between us. And he sort of cued for a bit, looked at us, you know, played with our noses and then fell asleep. So, I immediately picked him up and put him back in his cot and he kind of woke up, made a bit of a noise, but then slept through for the rest of the night. So, from half eleven till half five, so I thought if it was separation anxiety, I felt once he’d kind of realized that I’d put him back in his cot, he would’ve woken up and had a problem. But he didn’t, if it was pain he wouldn’t have just settled when he was between us. If he was hungry he wouldn’t have…So I just don’t know what it is, but he’s been waking up and getting really upset.

Meg: Is this fairly consistent Cass? Is it every night at the moment?

Cass: The first time we did it was actually last Wednesday. It’s now Tuesday, and it’s been four nights out of six.

Meg: Okay.

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Meg: It does sound to me like we’ve moved towards separation anxiety, which for his age is appropriate. So he is almost seven and a half months now, certainly, probably is that, so a couple of things that you need to do. First of all he’s got his doo doo blanket,  so for anybody else who’s little ones don’t have a duty blanket or an attachment object, they that helps immensely. And that actually, Cass, can also help in the daytime one. So I know that you have limited his duty blanket to his bed, but he can actually have it in the day as well, that sometimes helps.

Cass: I introduced it actually; I needed him to sleep before the play date today, so I brought it in the car and gave it to him in the car seat and he slept.

Meg: Yeah. So, I think you can start to use that more flexibly. The next thing is you need to start playing some separation games and one of the best separation games is peekaboo. Just where you hold up a towel or something large enough that your whole face is covered and you drop it and you say peekaboo, and of course it becomes their favorite game too after a while where they…

Cass: Yeah, he loves that.

Meg: He loves peekaboo, that’s brilliant. And it’s a great way for them to learn that you’re still there even though he can’t see you. Then another one is to actually, when he is sitting on the mat in the lounge, crawl around the side of the couch or the sofa and kind of call to him, where are you Max? Where are you Max? And then come round and go, “Boo, there I am.” You know, and then go away from him around it. He’s not crawling yet, so he’ll watch you go and then come back and those type of games actually teach him that you still exist even when he can’t see you.

And then the third thing is to start calling to him, when you’re out of the room. So if you have to go and make his bottle in the kitchen and he’s in the lounge, now call to him, talk to him so that he knows actually that your voice is there and that your voice can provide comfort and then do the same in the middle of the night. So, first listen to him at 10:30, see what he does and then hopefully he’ll resettle. If he doesn’t, then call to him, “Go doo doo.Where’s your doo doo, Max?” Or whatever it’s that you say to him. It probably won’t settle him, but it starts to teach him that actually that’s all he going to get, just a little shout back, so that’ll settle and I would start doing those kind of strategies as much as you can.

Cass: Yeah. And actually the app, we were talking about it earlier, but if anybody doesn’t use it, it gives a daily sort of activity of things to do for that developmental stage. And recently it’s picked up, I’ve noticed sort of those sorts of games and things like that. And I think it’s also either I’ve heard you mention it or I’ve read it in the app, that’s really important to say goodbye every time you’re actually going.

Meg: Exactly, very important.

Cass: Things like that. So we’ve been doing all of those things and we’ve actually played peekaboo with him for a long time since he, you know, before he really even knew what know was going on. So, I don’t know if we’ve been doing all of those things, is this just something that’s going to happen anyway but it will hopefully have less of an impact because we’ve been doing those things?

Meg: Yeah.

Cass: Or, have we not been doing them enough and that’s why it is happening.

Meg: No, no it’s definitely not that. It’s got to do with the fact that that’s a life stage they move through and we have to be quite conscious about it as parents. So, we just need to increase the amount of activities we are doing. Another really nice activity that I talk about and particularly for toddlers who are experiencing seperation anxiety is called Watch, Wait, and Wonder. And that’s a little activity where you just set your cell phone aside, hundred percent focused, 15 minutes of just focused play and that tends to really help them as well.

Cass: And actually I’ve started doing that with nursery rhymes and sort of sitting him, because now he’s sitting as well, sitting him opposite me on the floor. We both sit there and I do sing nursery rhymes to him and that sort of thing, which he’s responding to really well. And I think, if anybody can hear me in the house, the amount of times in the day I found myself shouting from the kitchen. “You’re all right.

Meg: Exactly.

Cass: So come my tagline, because it does seem to be sort of when we leave the room a bit, so I do think it’s separation anxiety. And so is that normal that it wouldn’t necessarily be every night? Because for example last night, I watched him rolling around, he woke up and I thought, “Oh no, here we go.” We’ve got an hour of, you know, upset and he actually just was fine last night.

Meg: Yeah, yeah. No it can happen randomly, it really can. So, it could be that it was just those four nights and that he’ll be fine tonight, so let’s hope for that one. Yeah, that’s brilliant. So in the app, I was just having a look at it, his  expected awake time, which is on the front of the app is two to two and a quarter hours, which means that he should be going down about two to  two and a half hours maximum between sleeps. Do you find that that works well for him?

Cass: So it’s interesting you say, I have found absolutely that that’s been perfect until about a week ago. I was putting him down and he just wasn’t going down so easily, and so I’ve played with the awake and actually stretched it a little bit and he is a dream to go down again. And I’ve taken your advice last week you were saying about giving an early lunch then a little bit of milk and he’s been doing an hour and a half sleep in his cot at lunchtime. So we’ve actually been able to therefore move towards, he kind of pretty much all the time goes down at nine o’clock. I keep it a shorter sleep from when he first wakes up. So it’s about 2 hours, 2 hours, 15 when he first wakes up then so he goes down back from say quarter to nine and then he’s waking up at about half nine and he’s going down actually then at 12 for his sleep.

Meg: So that’s perfect.

Cass: Yeah, so he’s usually falling asleep by the time I’ve taken him up, got him changed. It’s probably in just after 12 and then he’ll sleep till half past one and then he’ll have a four o’clock sleep.

Meg: Wow. Spot on, absolutely spot on routine. So for moms who are looking for routines for seven, seven and a half month old, that is absolutely perfect. That last sleep of the day, which is from 4-4:30 is going to be the sleep that’s going to be dropped next. That’s the one that he’s going to start to fight that at some point, or he’s going to start to fight bedtime and that happens at nine months. But in the next month and a half you and I will be chatting about what’s going to happen because now we’ve got to move to two sleeps and I’ll help you through that as well. That’s called a cusp edge, but the app actually does it for you anyway. It’ll tell you how to drop it, and in actual fact, if I look at his routine for tomorrow as an example, it doesn’t give you a time for the catnap, it just says short cat nap, catnap if needed awake by 4:30. And so, that’s exactly because we know what time he needs to go down, so that’s what time he needs to wake up. And then the other thing that I wanted to ask you about was his feeds. Is he still having the three solid meals and four milk feeds during the day?

Cass: Yeah, so because of this waking up earlier, we’ve been pushing it and pushing it and sometimes he hasn’t fed at all in the night, or sometimes the only way to settle him back down. We’ve waited till after midnight and then we fed him and he’s gone through till the morning. But we aimed to give him a feed with milk at about quarter to seven, seven, and whatever he has of that is usually not a full feed but we don’t leave it any later, that’s the time he has his feed. And then at about probably quarter past eight it tends to be he’ll have his breakfast, which is his favorite, he loves breakfast. Oh and last week we were discussing the pear and cardamom porridge, we hadn’t tried it yet, but we tried it the other day and he absolutely loved it.

Meg: That’s wonderful

Cass: So porridge is…Well, actually any breakfast he loves and then his feeds will be sort of 7, 11, 3, and then bedtime. And his solids are at about quarter past eight, half past 11, and then usually when he wakes up from his, at about four, or quarter to five.

Meg: Okay, brilliant. Gosh, he really is following everything by the textbook, which is wonderful. The other thing that it says on Max’s front page of the app is in the health block, it says he needs extra iron in his diet. So, the reason for that is that it’s by six months old, iron stores are depleted and there’s no iron in breast milk. There is actually iron in formula milk if it’s fortified, and then we also have to focus on giving him iron in his diet. Is that something that you’ve been managing to do?

Cass: Yes. So he is on formula but we have been looking at making sure that he has a lot of leafy greens, or…I mean to be honest, most of it comes from either, he hasn’t had so much red meat, although we have been this week doing more. I’ve made a meal for us and then pureed it and he’s had a version of it. So we did the curry from the weaning sense book, which was lovely and he enjoyed that. But actually on Sunday we had a huge family meal and there was lamb, potatoes, peas, sweet corn, all sorts of things. So, I just put it all into pot with a little bit of his milk and blended that and gave it to him and he actually ate that quite well. So he’s been having a little bit of red meat, but yeah, we have been trying to be aware of that and also trying to be moving him more away from when he first started having a lot of pureed vegetables, trying to make sure we’re getting some protein and things into there as well.

Meg:
Okay, excellent. Yeah and I actually see that on next week’s Sunday we’ve got the chicken liver supreme in the app for him and that is a great recipe.

Cass: Yeah, I’m quite looking forward to that because I love a little bit of chicken liver myself.

Meg: It’s really a good one. It’s chicken livers, potato carrots, leak mushrooms, it’s a great recipe for little ones and full of iron. So yeah, there’s some lovely recipes coming up for him. That’s exciting.

Cass: Yeah, I’m really enjoying watching. I mean I don’t think I’ve ever given him a new flavor and he’s not pulled a face as though he absolutely hates it, but he then continues to eat it, so I don’t think he means to look like he hates it. It just…

Meg: Well it’s quite interesting, you know, it’s one of the reasons why we tend to advise weaning a little earlier. So between four and six months is because he is going to, within the next month or two, approach a period in which he starts to get more picky over what he’s eating because they just start to not want to experiment as much. And that’s why we try and get as many different flavors in as possible. Like for instance, you’ve done the curry and the livers and all of that sort of thing because then they’re more likely to take to them and you’ll see that a new flavor that maybe you haven’t added in before might be something that he then becomes a bit resistant to. So it’s good that he’s getting in all these wonderful flavor experiences at this age.

Cass: Yeah. And also is it normal that, you know, because he really does the quantity at times at breakfast, you know, I’ve almost had to give him some of mine because he’s still got his mouth open when his bowl’s empty. But he just has never had the same sort of reaction to lunch and dinner. He’ll eat, but it’s not the same as pleasurable experience, really.

Meg: Yeah, I’m so glad you mentioned that. There’s a little poem that goes with that. It’s called The babies eat like kings for breakfast, princess for lunch, and paupers for supper, and that is all babies. And that is because they’re actually intuitive eaters, so we should all eat like that. It’s the healthiest way to eat. But we have messed up, we’ve lost our intuition around meals and I’ve always said to mums, as long as you offer whole food, healthy food, seasonal food, and the appropriate amount of milk and no fruit juice. So those are the three principles; healthy food, the appropriate amount of milk and no fruit juice. As long as you do those three things, you can let your baby govern and rule their own appetite. So if he wants to eat double the amount for breakfast, you don’t have to worry about obesity at all because it’s whole food, it’s healthy food. If he wants to go to bed on a sniff of an oil rag and like literally nothing else, that’s also absolutely fine. So you don’t have to worry, you can let him be an intuitive eater and definitely let him eat as much as he wants to for breakfast for sure.

Cass: Okay, great. And the other thing, actually just very quickly, I saw a friend of mine yesterday who’s just started weaning and she said, oh, it isn’t the constipation, you know, it’s such a shame or it’s horrid for them. And another friend when she had started weaning said the same thing. And I’ve mentioned this before; Max has not had this at all. In fact, it’s actually exhausting he is doing little poos all through the day. And so, at first I thought, “Oh, for goodness sake,” but now I’m just a little bit worried that he possibly got some form of diarrhea. I mean, they’re not overly runny, they’re not, you know, loads. It’s like he’s gone from doing one big pair at the start of the day to doing two medium poos earlier in the day and then a couple of mini ones.

Meg: What is the consistency

Cass: More solid than it was when it was just milk, but they’re not solid.

Meg: All right. No, then that’s fine.

Cass: They’re thick, thicker.

Meg: Yeah, that’s fine. No, when we do worry is if those become very, very loose and frothy. And that can sometimes happen after they’ve been on antibiotics, for instance, they can develop a little or after they’ve had diarrhea, It’s actually called toddlers diarrhea. In those cases, we actually take them off dairy for a couple of weeks and then reintroduce dairy. It just helps him a little bit, but that’s not what he’s got at all. So, I would just be doing exactly what you’re doing. I wouldn’t worry about it. It will return to some sort of consistency, you know, regularity. But do offer water after every meal for sure. That would be important.

Cass: And he hasn’t had any signs of constipation, but I have been offering and he loves water. I think I’ve mentioned that before. I mean he now also, whenever I’m drinking my water, he’s like…

Meg: Wants yours too. Such a funny boy, such a personality, I need to see him again sometime, Cass.

Cass: I know. I think it’ll be so different. I think it was February, yeah, it was a couple of months ago that you last saw him, so yeah. He’s painting so much all the time.

Meg: Such a precious boy. Well Cass, thanks again for sharing Max’s journey. It’s absolutely delightful, it really is. And I think it must resonate with a lot of mums. He goes through things like textbook, so it’s awesome.

Cass: Good. Well I’m glad to hear that because sometimes when you’re doing it you think, oh my God, he must be the only baby that’s doing this.

Meg: No, hundred percent not, hundred percent not.

Cass: Thank you so much.

Meg: Thanks for this evening. Okay, cheers.

Cass: Thank you too. Bye bye.

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