Parenting: it’s pretty hard isn’t it? One of the things I’ve noticed in the last few years is the tendency to try to find a medical cause for when things seem super tough. My informed amateur analysis of this is that we are often used to feeling competent and capable with most things. Then along comes a baby who might be super sensitive, high need, or difficult to understand, and it’s hard to believe that this is actually normal.
It’s almost as if we can’t reconcile our own competence, coupled with the mainstream narrative of babies behaving in a certain (usually predictable and low maintenance way) with the reality of a child who has needs that seem to be… well… a lot.
It’s kind of taboo isn’t it? Acknowledging that stuff is hard. Admitting that parenting is hard work. Harder than we thought. There’s something about this that makes a lot of people (and I’d put myself in this camp btw!) feel basically incompetent as a result of finding it so hard.
Imagine my delight to find a systematic review from fellow health visitor colleague Amy Dobson, who’s currently doing her PhD (shout out to another public health nurse nerd!!). Amy’s work was recently published in the Journal of Advanced Nursing, and I’ll give you a little flavour of it here, though I highly recommend you read the whole article – rather brilliantly titled: “‘Either something’s wrong, or I’m a terrible parent’: A systematic review of parent experiences of illness-related interpretations for unsettled babies”.
Amy generated two major themes from the review; the parent struggle to insert themselves into the identity of being a ‘good parent’ in the context of a little one who was very unsettled, and the search for an explanation.
The available literature in the review (which was mostly very good quality research) suggested that parents felt they should be able to explain, manage or control their baby’s unsettled behaviour. When they couldn’t, this was associated with feelings of guilt and failure. Parents felt responsible for their baby who seemed so fractious and apparently unhappy. This was coupled with complex feelings of simultaneous rage and empathy.
These complex and often opposing emotions are something I’ve come across in my own work, so I can really relate to this finding. Many of the parents hoped for a medical cause which would provide a reason for their baby’s behaviour and in turn reduce the feelings of guilt and failure. Again, I’ve seen this play out a thousand times in practice when parents almost seem disappointed that there is no obvious underlying cause. This isn’t because parents wish their baby was unwell or had a condition. It’s because their perception is that their baby DOES have a condition, and it simply hasn’t been found yet. In a logical world, if a baby is upset and cannot easily be consoled, it follows that there MUST be a problem doesn’t it??
And this leads onto theme 2: the search for an explanation.
Quite understandably, just as any brilliant parent who believes their baby is unsettled due to discomfort would, the parents represented by the ten included studies sought potential cures, treatments, opinions and causes. This search was often marked by disillusionment with health care professionals and a sense of being ignored or sent packing. Many parents went in looking for support but ended up getting advice that wasn’t always right. Due to the widespread mismatch between expectations and reality, more difficult infant behaviour was often pathologised and breastfeeding frequently got the blame – something I am all too familiar with. It’s why for many years I’ve called breastfeeding a sleep ‘scapegoat’. The general gap between reality and expectation led to a lack of certainty about how much crying was too much crying.
And if you’ve ever felt like you had to be ‘on-duty’ for your little one, this is something that the parents in this study also seemed to experience, with a sense of vigilance and hyper-awareness of their child, in their quest to understand the cause of the unsettledness.
This excellent review concluded by saying that unsettled infant behaviour caused a cycle of experiences: tricky infant behaviour + mismatched expectations > seeking help from HCPs > lack of certainty > hypervigilance and desperation. There were 2 proposed ways out of this vicious cycle: either a medical label, which externalised the cause of the behaviour and thereby alleviated the resultant guilt/blame/shame… OR… adjusted expectations, education and knowledge of normal behaviour and the spectrum of infant experience.
Amy finished by acknowledging that there are 4 key things we can take away:
1. Expectations of infant behaviour need to be managed and discussed sensitively
2. We need to normalise the continuum of baby behaviour, including more unsettled types without a medical cause
3. Listen and validate parents, recognise how difficult parenting is and in doing so reduce feelings of guilt and failure
4. Support parents to regain a sense of control by not dismissing or invalidating their experience, and being conscious of genuine red flags so that parents feel like they have been taken seriously, and nothing has been missed.
When parents feel heard and empathised with, they can then move on with adjusted expectations, and successfully insert themselves into the ‘good enough parent’ identity that is so often lost when caring for a baby who is unsettled. A medical label is the answer when there truly is a medical problem. But if there is no underlying cause, the message is that parents can still be supported to feel more in control of what is undoubtedly a difficult situation.
Bravo Amy for shining a light on this oh-so-common phenomenon.
If you’d like more science-based, always responsive sleep support, you may find my sleep guides helpful (0-18 month sleep guide, 18-36 month sleep guide, 3-6 years sleep guide), or my responsive sleep support class.