Fussy Baby Checklist

Unfortunately for a small percentage of babies, the irritability does not disappear and they give their moms and dads a hard time for much longer. These babies may have what we call a regulatory disorder. This occurs due to difficulties in processing sensory input

These babies are more sensitive than normal to sensory input and do not integrate it adequately. This leads to extreme fussing; poor sleep habits, feeding issues and emotional irritability.

The checklist below is useful if you are concerned that your baby is significantly more irritable than average and may have a problem with processing sensory input.

If your baby is over six months of age and displays at least two of the following problem areas, you may wish to have him assessed by an occupational therapist who treats babies and who specializes in sensory integration, to ascertain whether he has a regulatory disorder.

1. Sleep disturbances.
   
   • Your baby takes over 30 minutes to fall asleep, even after calming techniques and bedtime routines have been enacted.
   • Frequent wakings (more than two) in the night, that are not nutritionally necessary or not related to habitual night feeds.
2. Difficulty self-consoling. Your baby is unable to self-sooth and once upset, he requires extreme efforts to calm down. You find yourself spending from two to four hours a day over a period of three weeks or longer, attempting to calm your baby.
3. Feeding difficulties.
   • Does not have an established, regular feeding schedule.
   • Demonstrates distress around the process of feeding, with regurgitation and spitting out of food, particularly when eating textured or lumpy foods.
   • Eats only soft foods.
   • Had difficulty latching on to the breast for longer than five days as a newborn.
   • Will not tolerate the change from breast to a rubber or silicone teat.
4. Distress with changes in routine. Your baby fusses when the routine changes
5. Distress with routine care-giving and play experiences which offer a sensory challenge. Your baby responds by crying, withdrawal with at least three of the following:
   
   
   • Resists cuddling, pulls away or arches
   • Resists being swaddled
   • Distressed at having face or hair washed
   • Hates the car seat
   • Resists being placed in certain positions (e.g. on back or stomach)
   • Avoids touching certain textures or getting hands messy
   • Doesn’t want to wear clothing or wants to wear too many layers or very warm clothes
   • Fear of being swung in air or involved in boisterous play
   • Is startled or distressed by loud sounds (e.g. vacuum cleaner, door bell or barking dog)
6. Emotional instability: Fussiness, irritability, negative mood state, tendency to rapidly escalate from contented mood to distress without an apparent antecedent cause.
   If your baby is very irritable and you are battling to cope with his demanding nature, seek support. You should also get to the root of the problem with assistance from an OT in your area, who is specialised in sensory problems in infants.

Adapted from:

• Criteria for inclusion in research by DeGangi, et al (1996)
• Diagnostic Classification: 0 – 3 manual