Crying babies

[HyperSaurus, RN]

I've been trolling through a lot of the older threads here lately, just trying to soak up anything I can--Merenstein and Gardner is my friend.

Last night was my first night on my own (just doing feeder/growers right now). I have one infant who is a bit of an oddball--a bit 'neuro-y' as some other nurses have described her. When she's mad (and it's not hard to get her mad), she arches like crazy, some cortical thumbing has been noted, and she's really hard to console. She gets so frantic that she won't suck on her pacifier, instead she just continually roots. She doesn't nipple particularly well. She scooches herself out of her swaddle.

She sometimes calms with cuddles, tight swaddling, or being held in a 'centered' position (arms in, legs bunched up, upright against the chest), but not always.

It's hard not to get flustered with her (esp since I'm new and not particularly adept at methods of consoling or cuddling or even keeping that stream of soothing talk that other nurses do)

I'm not sure if I'm asking anything particular right now--is it normal to get flustered with a kid like that (I've seen references here to dreams of jumping out a window to escape screaming babies), or are there any good ideas to calm a baby?

[prmenrs, RN]

Lullabies work! You can put your iphone in a plastic bag, too. It's worth the $ to download something soothing on your phone if you can.

Thank you to your co-worker for her support!

[TiffyRN, BSN, PhD]

Staffing: a baby that requires more consoling like this one, should be staffed accordingly. Her nurse should not be juggling 3 other kids, plus admits and discharge teaching and God knows what all. . . Best wishes![/quote']

Our unit has (mostly, not always) gotten better about placing infants like this in otherwise lighter assignments. Even if the kid is not NAS, as the OP has illustrated, some chronics can be really difficult to console and require a lot of time.

[CountyRat]

I'm not sure if I'm asking anything particular right now--is it normal to get flustered with a kid like that (I've seen references here to dreams of jumping out a window to escape screaming babies), or are there any good ideas to calm a baby?

It would be abnormal for you to not feel the way you do. A lot of good suggestions here, and, posters are correct to point out that sometimes an assignment "break" is best, not only for the nurse, but also for the patient.

[mct1963]

Hi HyperSaurus RN,

Yes, it is very normal to get flustered with these infants. I have seen the increase in drug-dependent infants or neurologically damaged infants over the past decade. They are extremely difficult to console and contribute to nursing fatigue. On our unit, the nurse are rotated so they do not have these particularly difficult infants every shift. Just as I tell parents, sometimes you need a time-out, too.

An intervention that can be helpful is offering a 24% sucrose pacifier. Also, placing a few drops of 24% sucrose on the nipple can calm them enough to start eating, if the infant is really out of control and unable to start sucking on a nipple to feed.

Hope this helps!

[liketheairport]

You just have to be patient. Also, you really have to try to not get too flustered. Babies, like any other human being, can pick up on that and that can translate into being more fussy. I don't think it could hurt to see if you can get reassigned for a couple of days.

[Twinmom06, ASN, APN]

possibly a formula change (unless mom is pumping) - my daughter was that baby and all it took was a change to soy

[sunflrz321]

Like many of the commenters, when I first read your description, I thought this baby was going through drug withdrawals. I know a few years ago I worked at a hospital that had just started to get babies with opiate withdrawals, so they really didn't know what to do with them yet, or even how to identify the symptoms very well. They tried to treat the babies withdrawing from opiates the same way they have always treated the babies withdrawing from cocaine, and it didn't work. (This was a community hospital that is not magnet and was quite behind the times regarding Evidenced Based Practice). Make sure you know the differences between opiate versus cocaine withdrawals in neonates- study up on this if you aren't already familiar with it.

I agree with one of the other posters too that it sounds like the baby is in pain. So here I would start thinking about your consults and precautions. I would put a call in to your child life department- see if they can send some volunteers to hold the baby, or if they have developmental toys that might help. This baby is likely not gaining weight very well because he or she is spending so many more calories crying and moving and fussing than normal, so a nutrition consult could recommend a better formula - perhaps a soy formula or a formula with a different lipid base- and the baby will probably need a higher calorie formula also to compensate for the increased calorie spend. If the baby isn't on reflux precautions I would see if you can get an order for that. I would also make sure social work is heavily involved on this case- this child is going to require parents with extraordinary patience, coping skills, and a REALLY good support system.

And as far as getting flustered, a baby like this will make even the most experienced nurse flustered over time. Don't take it personally when you get flustered. Also, don't be afraid to ask for help from the consults listed above, and also from your peers and charge nurse.

[HyperSaurus, RN, BSN]

Back again. I had her again, but happily, her mother was rooming in (mom sleeps in one of our private rooms with her and does her cares). She's been a lot happier and calmer--mom puts her to breast or at least cuddles her every time she cries (the previous night I had her, mom was at home 2 hours away having a 'break' night and seeing her other children).

The other night, I couldn't do sweet-ease on her paci, I'm not sure if it was the mother's request, but it was specifically ordered not to use it.

[rn/writer, RN]

Not sure how old this kiddo is, but if mom smokes, she might have been going through nicotine withdrawal. I've noticed that breastfeeding seems to help with that, as they get a little nicotine in the milk. Definitely a mixed message--breastfeeding and smoking, but it does happen.

Glad to hear the little one is settling down.

[NicuGal, MSN, RN]

Then again, there are kids that are just screamers and you never figure it out...you just pray for the little buggers to go to sleep!!!

[Bortaz, MSN, RN]

And threaten the life of anyone that even walks NEAR the babies bed while she sleeps.

[TiffyRN, BSN, PhD]

And threaten the life of anyone that even walks NEAR the babies bed while she sleeps.

Oh, I just say "you wake it, you take it!" Usually scares people off.