May 2008

The MommyDocs
If Babies Could Talk: Understanding Nonverbal Cues

By Jamie Freishtat, MD & Rachel Schreiber, MD

All parents (including us!), whether they are first-timers or experienced moms and dads, wish that at some point during the first year their baby could just open his mouth and start telling them what was bothering him,or what exactly it is he needs. It can be very frustrating and confusing, trying to figure out what it is our child is “telling” us without the means to verbally express himself.

Adults communicating with other adults is rather straightforward. For the most part, we communicate through the written or spoken word. This allows us to express our thoughts and feelings, and then the person on the other end of the conversation reacts and responds accordingly.

What would happen if we lost the ability to communicate this way? It sure would make it a lot harder to know what someone else was trying to tell us. However, as time went on, we would learn other ways to figure out people’s needs, wants and thoughts.

Perhaps we’d become more in tune with our other senses, such as noticing the expression on someone’s face and the way she carries herself, or even how she smells. It is exactly these things that we parents need to focus on to better understand what it is our little babies are trying to “say.”

This is not an easy task. Babies are very mysterious little creatures who have an awful lot to communicate through nontraditional means. In fact, a lot of parents (and veterinarians) equate this to taking care of a dog or cat.

So we’re here to help “translate” some of a baby's more common thoughts, wishes and needs from her way of communicating into our way of understanding.

If I could talk, here’s what I’d be saying…

“I'm having trouble breathing.”

But I can't, so I may be doing this instead...

• I’m breathing fast. (Under 2 months of age, babies should not breathe faster than 60 times a minute, and over 2 months it should be less than that. Ask the doctor the normal range for a specific age.)
• I’m pulling in between my ribs, above my collarbone, under my rib cage or in the midline just below my neck, because it’s hard to get air in.
• My color changes to blue, purple, gray or dusky.
• I’m not breathing at all.
• I’m making unusual breathing noises such as wheezing (noises while breathing out) or stridor (noises while breathing in).
• My nostrils are flaring in and out, because it’s hard to pull the air in.
• I am nursing or taking the bottle poorly.

If I could talk, here's what I'd be saying...

I have a fever.

But I can't, so I may be doing this instead...

• I’m crying more than normal.
• I’m acting more cranky, not my usual self.
• I’m not eating/drinking my usual amount.
• I feel warm. Take my temperature rectally. Don’t worry, I won’t remember. If it’s 100.4 F (38 C) or above, and I’m less than 2 months old, bring me to the doctor right away. If I’m older than that, you may still want to call the doctor.
• I may or may not have other symptoms.

If I could talk, here's what I'd be saying...

I’m dehydrated. Take me to the doctor!

But I can't, so I may be doing this instead...

• I’m acting more tired, not responding like I should be, and/or looking out of it.
• I’m not making wet diapers on average of one or more every six hours.
• My lips and/or the inside of my mouth look dry or stringy, because I don’t have a lot of saliva.
• I am vomiting and unable to keep down fluids.
• I have too much poop coming out.
• I’m not making tears (if I’m old enough to have tears).

If I could talk, here's what I'd be saying...

I’m trying to poop, but nothing’s coming out. In other words, I’m constipated.

But I can't, so I may be doing this instead...

• I’m turning red/straining with bowel movements.
• You notice very small, hard poops in my diaper.
• I’m pooping infrequently with a hard consistency. I may even develop a small cut, called a fissure, around my anal opening, which may cause small amounts of blood on the outside of my poops. If you see this, let the doctor know.

If I could talk, here's what I'd be saying...

It hurts in my upper stomach area and chest. I have reflux.

But I can't, so I may be doing this instead...

• I’m spitting up with feeds. (This may be normal or abnormal.)
• I’m crying during and/or after feeds.
• I’m bringing up acidic stomach contents into my esophagus without spitting up which is still really painful, so I may have reflux even though I’m not spitting up.
• I’m arching my back during/after feeds.

If I could talk, here's what I'd be saying...

I have a diaper rash.

But I can't, so I may be doing this instead...

• I’m crying with diaper changes, especially when being wiped.
• I have redness and/or inflammation around my anal area and surrounding skin. Please put a protective layer of ointment such as A + D in between diaper changes to prevent rashes, and if a rash does start to appear, use a thick, medicated cream such as Desitin. If this doesn’t work, call the doctor.

If I could talk, here's what I'd be saying...

I’m getting a new tooth.

But I can't, so I may be doing this instead...

• I’m more cranky than normal for no apparent reason. I may wake up more at night (usually between 4 -10 months old for first tooth).
• I have an increased amount of drooling.
• I’m putting absolutely every possible object in my mouth in an attempt to soothe my gums. Keep in mind this happens developmentally around this time as well.
• I have puffy gums.
• If I have diarrhea and/or a low grade fever, it’s probably not from teething even though lots of people believe it is.

And let us not forget…

If I could talk, here's what I'd be saying...

I love you!

But I can't, so I may be doing this instead.....

Looking into my parents’ eyes around 6-8 weeks of age and flashing the most wonderful, goofy, gummy grin you’ve ever seen!

The MommyDocs, Jamie Freishtat and Rachel Schreiber, write regularly for Washington Parent. Visit their website, www.mommydocs.com for pediatric information, including live web chats, podcasts, health Q & A, and more.