Shhh…. UCLA pediatrician develops the ‘Cuddle Cure’ to calm colicky infants
If your infant is wailing inconsolably, your focus is kind of fragile so we’ll go straight to the point:
Dr. Harvey Karp, a Santa Monica pediatrician, says he has found the holy grail of parenthood — a method to make even colicky babies stop crying and calm down.
What he calls the “Cuddle Cure” or the “5 S’s” consists of these steps: Swaddling, holding the infant on his side or stomach, saying “Shhh” loudly in the baby’s ear for white noise, swinging (or jiggling) the infant and giving him something to suck on.
Now isn’t that easy?
Actually, as Karp explained this week to a group of test parents in the P-I lunchroom, “Like any other skill, it does take practice and it is very exacting.”
But when it works, the result is nirvana for stressed-out parents of infants under 3 months of age — the period when colic strikes.
Karp explains his calming technique and the rationale behind it in his new book, “The Happiest Baby on the Block: The New Way To Calm Crying and Help Your Baby Sleep Longer” (Bantam, 267 pages, $21.95).
Recognizing the huge market for a crying cure, Bantam paid Karp a $1.1 million advance — reportedly the highest ever for a first-time parenting author. The deal includes a follow-up book, due in September 2003, on communication skills for parents of toddlers.
Bantam missed the boat, however, in declining to distribute Karp’s accompanying video, which shows him demonstrating his techniques at a mother’s group.
Seeing is believing, and the steps are easier to grasp after you watch the gentle baby doc carry them out. The $18.95 video, shot by Karp’s wife, is sold on his Web site, www.thehappiestbaby.com. It’s also available in DVD format for $25.95, with extras like white-noise tracks.
According to Karp, one in six families takes their infant to the doctor because of problematic crying, which can last for hours on end.
By “crying,” we mean high-pitched, red-faced emissions that can go beyond wailing to outright shrieks, often for no discernible reason. Studies show that a baby’s piercing cry can jolt a parent’s nervous system like an electric shock, which is why colic — the prolonged, unexplained crying of infants — is so hard to take.
Karp, 50, an assistant professor of pediatrics at UCLA’s medical school, began studying colic in earnest in 1980 during a child-development fellowship. As a member of the UCLA Child Abuse Team, he treated several severely injured babies whose parents had committed “horrible acts of abuse” after being unable to calm the infants’ persistent screaming.
Most parents don’t go that far, fortunately. But they’re so desperate to soothe their baby’s distress that when nothing works, they may feel like joining their baby in a good wail. That’s where the Cuddle Cure comes in.
Karp’s premise is that infants need a “fourth trimester” to finish developing — a luxury denied because of the biological imperative for babies to hurry up and be born before their heads grow too large for safe passage.
Some laid-back newborns sail through these early weeks without much trouble. But Karp says fussy infants get overwhelmed after about two weeks of age, the period when colic’s window of opportunity opens. At that point, they’re alert enough to notice environmental stimulation but they can’t calm themselves.
Parents’ job is to trigger the baby’s “calming reflex” — a term Karp coined — by doing the above-mentioned “5 S’s.” The tight swaddling, swinging and other prescribed interventions simulate a “fourth trimester” in the womb to keep the infant comfortable while his brain matures a bit.
“It literally turns on a reflex,” he said, likening it to a doctor’s tap on a knee with a soft hammer.
Karp created the Cuddle Cure after learning some key points about colic. His first “ah-ha” came when he learned about the huge neurological differences between newborns and 3-month-olds, the age when colic stops.
His second epiphany was learning that colic is absent in some cultures, including the Bushmen of Botswana and the villagers of Bali. There, mothers hold their infants around the clock, feed them often and jiggle and rock them. In other words, Karp says, they simulate a fourth trimester in the womb.
We put Karp to the test with four local infants. Three of the new mothers were from a support group run by the Program for Early Parent Support. Another mother had once sought advice through the Swedish Parent Information Line for her baby’s fussiness, which has since improved.
That mom, Julie Robinson-Jasper, told Karp she long ago stopped swaddling 3-month-old Isaiah because he would squirm and kick off the blanket.
Karp has heard this complaint before. He said parents give up too soon because they’re not swaddling correctly and they think that swaddling by itself is supposed to cure crying.
At first, he said, some babies will cry harder as you swaddle them, but then they settle down and become more receptive to the remaining steps of the Cuddle Cure.
But, he added, “You have to swaddle a baby with their arms down (so they don’t pull the blanket loose). We’re so namby-pamby about it. It has to be tight, tight, tight.”
In fact, if there’s one thing that undermines parents’ success with this method, it’s timidity. Parents need to match their babies’ intensity, Karp said. If the baby is crying softly, a gentle rock and “shhh” might do the trick. But if a baby is really letting loose, the parent has to jiggle faster and “shhh” louder.
The “shhh” needs to be loud to cut through the baby’s shrieks and to mimic the sound level within the uterus, which, Karp said, is louder than a vacuum cleaner.
“One of the cool things about these techniques,” he added, “is men can do some of these things better than women. Dads are a little more willing to crank up the intensity.”
Nodding at her husband, Rob, Robinson-Jasper said, “He put Isaiah in a front pack when he was younger and mowed the lawn. It put him right to sleep.”
Because the babies’ hands are at their sides — which Karp jokingly insists is not a violation of their constitutional rights — they need a prop to suck. Chances are, a new baby can’t reliably get his thumb to his mouth anyway, so parents need to step in.
“When all else fails, the boob prevails,” Robinson-Jasper said.
Karp chuckled but said that can get a little hard on mom, which is why he recommends a pacifier for the first few months. Not all experts agree and some parents are philosophically opposed, but Karp said, “They’re not on the pacifier forever, it’s just a temporary tool.”
Megan Goetz, who was there with her 3-month-old son, James, wondered, “Do any of these techniques work when you’re trying to get them to sleep through the night?”
“Absolutely,” Karp said, adding that a white-noise machine can be a valuable addition to the nursery.
“They don’t get dependent on it,” he said. “After they’re older, you just turn it lower and wean them off it.”
As he spoke, Karp demonstrated how to wrap, hold, swing and “shhh” the babies in the room, who started fussing as the hour went on and lunchtime approached. Afterward, the mothers said they wished they had known about this technique when their babies were born.
Karp noted that the Cuddle Cure won’t override hunger, sickness or injury.
“If it’s not working for you,” he said. “you need to have your baby checked, because there may be a medical problem.”
What the experts say
Karp gets impressive results, but does his approach work in the trenches? A lot of parents, including celebrities who entrust their babies to him, say it does. Karp, aka Madonna’s former baby doc, has endorsements from Michelle Pfeiffer, Pierce Brosnan and other Hollywood types, which is a bit disconcerting in a book that begs to be taken seriously.
Most parents probably will give more credence to the endorsements of high-ranking academicians such as James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. Since the book’s publication, more academicians and clinical practitioners, including childbirth educator Elisabeth Bing, co-founder of Lamaze International, have spoken up enthusiastically about Karp’s baby-calming method.
“I thought it was excellent,” said Dr. Morris Green, director of behavioral pediatrics at Indiana University’s School of Medicine and a pioneer in the field.
“While I have not tested it myself, I think it will be very useful to a lot of parents,” said Green, author of a widely used pediatric textbook. “His message is very understandable to parents and it’s also supportive of them.”
However, renowned pediatrician T. Berry Brazelton, one of the authorities Karp acknowledges in his book, declined to endorse it, partly because of the book’s lack of original research.
“I thought it was just one more book,” Brazelton said, “but I don’t think it’s going to be a major contribution.”
He said Karp is a good pediatrician and his methods are probably OK, but he added, “I didn’t think he did the next step, which is if you do too much, you maybe overload the baby.”
Locally, only a few parenting experts had heard of the book, which is only weeks old. Two we polled were enthusiastic, but another was lukewarm.
“We’re very much in synch with each other,” said Elizabeth Pantley, a parent educator in Kirkland whose new book, “The No-Cry Sleep Solution” (Contemporary Books/McGraw-Hill, 255 pages, $14.95 paperback) also is on new parents’ reading list.
Pantley’s book covers a broader age range — up to 3 years old — and focuses more on sleep, but there are areas of overlap between their audiences. “We both are very respectful of babies’ needs and the natural biology of babies,” said Pantley, who had lunch with Karp while he was in Seattle.
Kathryn Barnard, a doctoral-level nurse who directs the University of Washington’s Center on Infant Mental Health and Development, said she disagreed with Karp’s conceptual framework and believes self-regulation is more complex than a simple reflex. She also said the method is unnecessarily rigid for ordinary babies, who should be free to move their arms and suck their thumbs.
“It seems to me it’s a method developed for the worst-case scenario,” Barnard said. “But I will admit that for some babies that have no ability to regulate themselves, doing it in his militaristic fashion might be the answer. If you’ve got a baby like that, try it.”
“I stayed up late reading it last night,” said Dr. Ken Komasaka, a West Seattle pediatrician with the Swedish Physicians Children’s Clinic.
“I thought it was quite good,” he said, adding that he plans to introduce it to new parents in his practice.
While Karp borrows from techniques that have been used piecemeal for years, his ability to explain them so well and to organize them into a conceptual framework is quite helpful, Komasaka said.
What about Karp’s admonition that his method has to be done just right or it won’t work? Isn’t that a setup for guilt? Perhaps, Komasaka concedes. “But for parents who have colicky babies,” he said, “they’re so overwhelmed by horrible emotions, I’m not sure this would make anything worse. All the things he recommends are reasonable things.”
Written by Cecelia Goodnow, originally posted on August 2, 2002, at Seattle Post-Intelligencer reporter