Scenario 1

Craig’s parents take him to the pediatrician to make sure there is not a medical issue. Craig seems to cry most of the time, unless he is eating or asleep. They begin to feel anxious,  like they are not doing the right thing to comfort him. The doctor says he is healthy and to give it some time, but they begin to question whether they will be good parents.

It is important to recognize that adoptive parents go though many of the same stress points that parents who give birth to their children go through. Lack of sleep and increased family responsibilities can be compounded with adoptive families if there wasn’t much notice before placement or if there is limited maternity/paternity leave offered through work.

Look for support during this time of transition. Turn to your adoption counselor, other trained counselors or therapists, or adoption support groups. While stress and lack of sleep is normal with a new baby, it helps to talk out your experiences and feelings with people who understand. They can also help determine if what you are going through is fairly typical or actually post adoption depression.

When we brought our daughter home from the hospital, we spent a lot of time holding her and feeding her. I wore her in a baby carrier as much as possible to provide close contact. I took off of work for three months and my husband was able to take off for four weeks. It took us awhile to get to know our baby. We just stayed calm and realized it would take some time to learn her cues. We did learn them though and became more confident every day we were with her.

Consider infant massage. It creates a bond between you and your baby, creates a calm and relaxing atmosphere, and gives you a special time together. It improves digestion, circulation, and muscle tone. It stimulates the skin and increases oxygen and nutrient flow. Many hospitals provide infant massage classes but here are some basics:

  • Find the best time for you and your baby, usually that’s when the baby is quiet and alert.
  • Start with the legs. Use long, firm strokes, repeating it 5-8 times.
  • You may use oil.
  • Massage for about 15 minutes, watching the baby for signs of engagement or distress.

 

Engagement signals include opening eyes, smiling, reaching, moving arms and legs, and babbling. Distress signals include yawning and falling asleep, crying, hiccupping, arching the back. Stop the massage if the baby is exhibiting stress signals.

Primary Tasks & Milestones
The primary developmental task in a child’s first year of life is to learn that the world is a predictable and reliable place. This is achieved by attachment with a primary caregiver who provides loving nurture, and meets the baby’s needs consistently. A caregiver who provides attention and affection, takes pleasure in interacting with the child, and who responds to his cries, encourages the process of attachment at this stage.

The physical goals for a child in the first year are to gain muscle control over their bodies: smiling, grasping, walking and vocalizing. These tasks are subject to delays if the primary task, attachment, is impeded in some way. Children who do not receive consistent nurture in the first months of life may find themselves several months behind on normal developmental milestones such as sitting up, standing, walking, and even making eye contact.

Observation Checklist: What to Look for in Assessing Attachment and Bonding: Birth to One Year

Does the child:

  • appear alert?
  • respond to people?
  • show interest in the human face?
  • track with his eyes?
  • vocalize frequently?
  • exhibit expected motor development?
  • enjoy close physical contact
  • signal discomfort?
  • appear to be easily comforted
  • exhibit normal or excessive fussiness?
  • appear outgoing or is he passive and withdrawn?
  • have good muscle tone?

Does the parent:

  • respond to the infant’s vocalizations?
  • change voice tone when talking to or about the baby?
  • engage in face to face contact with the infant?
  • exhibit interest in and encourage age appropriate development?
  • respond to the child’s cues
  • demonstrate the ability to comfort the infant?
  • enjoy close physical contact with the baby?
  • initiate positive interactions with the infant?
  • identify positive qualities in the child?

Explore options for what Craig’s parents could do in this scenario and the effect it will have on attachment.

Result:
After talking with their counselor, they feel relieved that their feelings are normal and they take some of the pressure off. They focus on some techniques the counselor suggested to facilitate bonding, including infant massage every night before bed. It helped to calm Craig down and it was a joyful and relaxing experience for the parents.

Insight:
The post-placement period is a time of transition for everyone in the family. Their counselor is available to help them through this time. They should take advantage of this additional support. Attachment is a dance that parents and children will learn together, but it might take some time. This is a normal experience.

Result:
They try to wait it out, but Craig continues to be fussy. They feel confused about why they can’t comfort him.

Insight:
Some of Craig’s behavior is typical for a baby going through a transition, and if they wait it out, it might work itself out. But there are many proactive things they could be doing to facilitate bonding and ease the transition for Craig, such as peek-a-boo games, talking, singing, lots of cuddling and giving Craig soothing baths as a family.

Result:
They continue to experience concern over attachment with their baby and their ability to comfort him. Tension begins to mount in their relationship with each other as well. They are not sleeping well and are very stressed.

Insight:
Babies pick up on their parent’s emotions and stress level. The more stressed and tense they feel, their baby will feel that as well and become more distressed themselves. Craig is not learning how to be soothed or soothe himself because his environment is stressful.

Craig’s parents choose option B and decided to keep their feelings to themselves. Three weeks later…

Scenario 2

Craig, now 4 weeks old, has begun to settle into his new family. His parents have a large extended family and three family parties coming up this weekend. When they attend the first party, they notice that even though he has just woken up from a nap, Craig falls right to sleep. When he is held by others he turns his head away and becomes restless.

It takes time and consistent attention for a child to form an attachment. When the child first comes into the home, it is important to keep the number of caregivers to a minimum. One parent should be identified as the primary caregiver and should do all the holding, feeding, and should spend as much time with the child as possible.

Although it is tempting to introduce a child to his extended family right away, he needs to know that his parents are the ones who are going to meet his needs on a daily basis. It is important during the transition period that he doesn’t begin to feel attached to other individuals who will go away again. Once the child has learned to trust and attach to his parents, he will be able to transfer his affections to others.

Our family and friends were so excited when we brought our baby home. They all wanted to come over right away! They had shared in our adoption journey and now shared in the joy of us becoming a family. We didn’t want to hurt anyone’s feelings, but we knew it was best that we be the ones to meet our baby’s needs and we didn’t want to overwhelm our daughter either. We found the best strategy was to educate our friends and family about the attachment process. We shared what we learned about bonding with our baby. Everyone was very respectful once they understood our point of view. We slowly introduced everyone to our daughter and everyone was so patient waiting their turn!

Establishing consistent routines should be done as soon as your baby joins your family, and should be maintained and modified as your baby’s development progresses.

  • Limit number of caregivers during the transition period.
  • Establish predictable schedules around feeding, bathing, naptime, and bedtime.
  • Make rituals around feedings, bathtimes and bedtimes. Do the same things in the same order each time.
  • Ensure that both parents are participating in baby’s routine care. If one parent returns to work, he or she should participate in evening care to ensure both parents are establishing attachment.
  • Avoid scheduling major life events like moving to a new home or adding another family member until your baby is settled.

Primary Tasks & Milestones
The primary developmental task in a child’s first year of life is to learn that the world is a predictable and reliable place. This is achieved by attachment with a primary caregiver who provides loving nurture, and meets the baby’s needs consistently. A caregiver who provides attention and affection, takes pleasure in interacting with the child, and who responds to his cries, encourages the process of attachment at this stage.

The physical goals for a child in the first year are to gain muscle control over their bodies: smiling, grasping, walking and vocalizing. These tasks are subject to delays if the primary task, attachment, is impeded in some way. Children who do not receive consistent nurture in the first months of life may find themselves several months behind on normal developmental milestones such as sitting up, standing, walking, and even making eye contact.

Observation Checklist: What to Look for in Assessing Attachment and Bonding: Birth to One Year

Does the child:

  • appear alert?
  • respond to people?
  • show interest in the human face?
  • track with his eyes?
  • vocalize frequently?
  • exhibit expected motor development?
  • enjoy close physical contact
  • signal discomfort?
  • appear to be easily comforted
  • exhibit normal or excessive fussiness?
  • appear outgoing or is he passive and withdrawn?
  • have good muscle tone?

Does the parent:

  • respond to the infant’s vocalizations?
  • change voice tone when talking to or about the baby?
  • engage in face to face contact with the infant?
  • exhibit interest in and encourage age appropriate development?
  • respond to the child’s cues
  • demonstrate the ability to comfort the infant?
  • enjoy close physical contact with the baby?
  • initiate positive interactions with the infant?
  • identify positive qualities in the child?

Explore options for what Craig’s parents could do in this scenario and the effect it will have on attachment.

Result:
Craig seems fussy and restless at the parties. After each party, it takes a little while but he calms down once the family gets home.

Insight:
They are aware that Craig is not responding well to the crowd, so they limit the amount of time they stay, but Craig is still giving signs that he is over-stimulated and needs a quieter environment.

Result:
They return home with Craig and he seems to relax. They spend a lot of time feeding him, cuddling him, and gazing into his eyes. The surreal feelings from when he first came home start to disappear and they feel a genuine love for him and feel securely that he is their son.

Insight:
They are practicing a very important tool of attachment, being attuned to their baby’s needs. When a baby is over-stimulated, common signs include blinking, turning away or shutting down and going to sleep. They spend some quiet time with Craig learning his cues and meeting his needs. Craig learns security.

Result:
Craig takes the entire evening to settle down once the family gets home. He wakes up frequently throughout the night. He is even fussier than before and they feel like they just can’t get it right.

Insight:
When a baby becomes very over-stimulated it might take them a long time to settle down. They are ignoring all of Craig’s cues to what he needs. They are also allowing other people to meet his needs instead of continuing to show him that they are his primary caregivers by being the only ones to offer him food and comfort.

Craig’s parents choose option B and decided it was too soon to introduce him to such a  big social gathering. Four months later…

Scenario 3

Craig had started to sleep for long stretches at night, but all of a sudden he is waking frequently again. His parents have just returned to work and are worried about how their lack of sleep will affect their ability to work. Craig’s grandmother suggests just letting him “cry it out.” She says it worked for her children to just put them in the crib and not go back in the room “no matter what.” She says that way, Craig will learn to go to sleep.

Developing a night time routine is important to help your baby learn the cues that bedtime is approaching. Your routine should be consistent every night. Some families will take give their baby a bath, read a story, feed their baby and then put them in bed for the night. Whatever your routine may be, it is important that it is consistent and close to the same time every evening as well. Your baby will learn that these cues from you mean that they will be going to sleep soon and it will help make bedtime easier for baby and for you.

Our baby was still waking up several times throughout the night at six months old. We spent a few nights sleeping on the floor next to his crib. If he woke up, we rubbed his back and offered him comfort until he fell back asleep but we did not pick him up. Once he seemed to settle down more easily, we moved away from the crib, closer to the door for a few nights. Eventually we went out into the hallway but were still nearby if he woke up. After a week he could easily put himself back to sleep without our help. It was a tough week but it was worth it to teach him the ability to soothe himself.

Tools and techniques to help children sleep vary depending on the degree of attachment, and the child’s emotional age. A few to consider are:

  • Give the child a bottle and rock him to sleep.
  • Establish a bedtime ritual.
  • Read or sing to the child.
  • Stay with the child until he falls asleep.
  • Rub, pat, or touch the child’s back.
  • Provide a comfort object that belongs to or smells like the parent.
  • Provide soft, warm sleep garments like blanket sleepers or flannel bed sheets.
  • Put a sleeping bag on the floor beside your bed.
  • Look into if co-sleeping might be a good option for your family, always following safe sleep guidelines. Ask your pediatrician for more information regarding safe sleep guidelines for your baby.

Primary Tasks & Milestones
The primary developmental task in a child’s first year of life is to learn that the world is a predictable and reliable place. This is achieved by attachment with a primary caregiver who provides loving nurture, and meets the baby’s needs consistently. A caregiver who provides attention and affection, takes pleasure in interacting with the child, and who responds to his cries, encourages the process of attachment at this stage.

The physical goals for a child in the first year are to gain muscle control over their bodies: smiling, grasping, walking and vocalizing. These tasks are subject to delays if the primary task, attachment, is impeded in some way. Children who do not receive consistent nurture in the first months of life may find themselves several months behind on normal developmental milestones such as sitting up, standing, walking, and even making eye contact.

Observation Checklist: What to Look for in Assessing Attachment and Bonding: Birth to One Year

Does the child:

  • appear alert?
  • respond to people?
  • show interest in the human face?
  • track with his eyes?
  • vocalize frequently?
  • exhibit expected motor development?
  • enjoy close physical contact
  • signal discomfort?
  • appear to be easily comforted
  • exhibit normal or excessive fussiness?
  • appear outgoing or is he passive and withdrawn?
  • have good muscle tone?

Does the parent:

  • respond to the infant’s vocalizations?
  • change voice tone when talking to or about the baby?
  • engage in face to face contact with the infant?
  • exhibit interest in and encourage age appropriate development?
  • respond to the child’s cues
  • demonstrate the ability to comfort the infant?
  • enjoy close physical contact with the baby?
  • initiate positive interactions with the infant?
  • identify positive qualities in the child?

Explore options for what Craig’s parents could do in this scenario and the effect it will have on attachment.

Result:
Craig cries for over an hour. They feel stressed and overwhelmed by listening to him cry for so long. It doesn’t seem to be working. Craig is clearly distressed.

Insight:
While Craig may eventually go to sleep after crying for an extended period of time, he is still a young baby and they are still trying to build an attachment with him. It is important that Craig know that they will meet his needs. He needs someone to offer him comfort and start to help teach him how to self-soothe.

Result:
After a few nights, Craig settles down more easily and begins to sleep for longer stretches. On the fourth night, he goes back to sleep without crying at all.

Insight:
They have made strides in attachment with Craig. Their instincts not to leave him in the crib to cry are correct. He still needs help to meet his needs. By letting him cry for five minute but then returning to provide him comfort, rub his back and help him settle down, they are letting him know that they are there for him and helping him learn how to soothe himself. Part of attachment is the baby knowing that their parents might go away, but will always come back.

Result:
Craig starts to sleep longer stretches again, but his parents are not getting good rest. Craig starts to rely on being in the parental bed for sleep.

Insight:
For some families, co-sleeping is a positive experience and is an excellent way to bond with their baby. Parents must decide what is best for them. In this case, having Craig in their room is disruptive to their own sleep. They might try putting Craig in his crib, but going in to comfort him every five minutes until he falls asleep. It might take a few nights to help him learn more about soothing himself, but he will get the hang of it and his parents will get better sleep as well.

Craig’s parents choose option B and let Craig cry for short periods of time before returning to comfort him.