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Is Your Fussy Baby 'High Need?'

Is your baby fussy and demanding? Does she cry intensely without the ability to self-soothe? Infants with characteristics like these may classify as "high need" babies, a term coined by Drs. William and Martha Sears. Read on for stories of high need babies and tips from the experts on how to tell if your little one falls in this category.



high need baby; fussy baby; fussy behavior; temperamental infant   Meghan Friedland of Fairfield County, CT, noticed that her daughter Lily, like some other babies, exhibited signs of colic from age six to eight weeks, crying nonstop for two to three hours a night. "Nothing would console her-not a bath, not a ride in the car, not a swing, sometimes not even nursing," Friedland said. But she also noticed that as Lily got older, her temperament was often different from other babies; she craved human contact, often did not let anyone else hold her, and demanded constant stimulation and interaction. Car trips also bothered her: she would cry so intensely she would even sweat through her clothes.

   Concerned about her discomfort, Friedland consulted her doctor, who also noticed that the baby was extremely alert and didn't like to be restrained. The doctor assured her that things would be different perhaps after one year of age when the baby could be turned around facing forward in the car. Friedland often felt alone in what she was going through. At her Mommy and Me support group, other babies sat still in a carrier or on a blanket, while Lily wouldn't stay in hers. Friedland was the only one standing up, rocking and swaying Lily back and forth to try to soothe her. The other mothers, who didn't relate, suggested calming strategies that never worked on Lily-that, in fact, only made her cry more.  

   Friedland finally found reassurance that she wasn't doing anything wrong when she read excerpts from The Fussy Baby Book by pediatricians Drs. William and Martha Sears. The doctors coined the term "high need baby" to describe a baby whose fussiness goes beyond bouts of inconsolable crying, to actually exhibiting a temperament or personality where they crave more attention and interaction than most babies. (See sidebar for key behaviors common to high need babies.) The term is meant to be positive, describing a baby who's not sick or difficult, but rather very communicative in expressing his need for more reassurance, and in fact, a baby who's simply just exhibiting his own unique personality. Many of these babies are very alert and require stimulation. "She got bored easily," Friedland said about her daughter. "She never wanted to just sit still and look around the room. She seemed to be in a leaning forward position in my arms, kicking her legs and gesturing forward with her arm as if to say, 'go-go-go - I want to see that!'"

   Dr. Hai T. Cao, Attending Physician in the Pediatric Department at New York Methodist Hospital in Park Slope, Brooklyn, says that while he doesn't specifically diagnose babies as high need, there is a spectrum of behavior parents need to be aware of so they can help their babies. "I believe the whole purpose of the term is to clue parents into when their child might be at the higher end of the needs spectrum. Having a baby with nine of 12 characteristics might take more energy out of parents than a child who exhibits two of 12," he explains. "This doesn't necessarily lead to a 'cure' for the situation, but it will reassure parents that they aren't going crazy and losing perspective. Not everyone has the pie in the sky experience from their babies, and it is nice to know that they didn't have any control over that."

   Parents of fussy babies are often faced with unwelcome judgment from people who disagree with their parenting styles. "I felt judged and constantly felt like I needed to make excuses," says Tamara Jenkins*of Rockland County, NY, who identified with many of the high need characteristics when caring for her daughter, now 10 months. When her baby's crying didn't stop after three months, she knew something was different. Eventually her daughter was diagnosed with gastroesophageal reflux, a common cause of irritability. Colic and hyperthyroidism are other medical conditions that cause similar behavior and need to be ruled out among fussy babies.

12 Features

of a High Need Baby


By Dr. William Sears, M.D., and Martha Sears, R.N.


  • Intense
  • Hyperactive
  • Draining
  • Feeds frequently
  • Demanding
  • Awakens frequently
  • Unsatisfied
  • Unpredictable
  • Super-sensitive
  • Can't be put down
  • Not a self-soother
  • Separation sensitive

   "My daughter was waking every hour, then every one or two hours. She still does this often," Jenkins explains. "She was sleeping about four hours a night (not in a row) and then taking very brief naps." Many sleep difficulties occur in high need babies because they are alert and sensitive to their surroundings. But Jenkins' daughter's overall temperament was also different from other babies. Jenkins says her baby is very intense in all that she does. "She can play independently, but wants your attention and what she wants when she wants it." She adds that she didn't see this as negative, as the baby is also happy and fun and has "quite the personality." But her daughter is also separation sensitive. "She won't go to anyone besides me or my husband without crying or screaming," says Jenkins. "Sometimes if we leave the room, she freaks out and has to be with us all of the time."

   Yet for parents who react to every cry, hold their babies all day long, and make accommodations for fussy behavior, is it possible that high need babies sense their parents' tensions and respond with more high need behavior? Jenkins says that this is what her parents and in-laws thought because of the way she was interacting with her baby. "They were very critical and upset with me, and felt that my behavior was causing her behavior," she said.

   Not so according to developmental psychologist Dr. Janet E. Fischel. "It's a bi-directional event and parents have to get to know what works for their babies in what situations." Dr. Fischel, who is also a professor, vice chair for education, and the director of Developmental and Behavioral Pediatrics at Stony Brook University, says that parents simply aren't capable of responding to every single need, but they should work hard to differentiate between a fussy cry and a cry that calls for an actual need to be resolved like hunger, sleep, or a diaper change. "Babies learn bits and pieces of self-organization, self-soothing, and ways to regulate themselves, but even easy babies are not very good at it early on," she says.

   To what extent should a parent accommodate and respond to her baby's need to be held or consoled? "A few would say things like, 'But aren't you spoiling her by rocking her to sleep every time? You have to just let her cry it out!'says Friedland. "I do not have it in my heart to ignore my baby's is the only way she knows to communicate."

   In fact, Dr. Bernard P. Dreyer, Director of Developmental Pediatrics at NYU School of Medicine, says that during the first year and a half, babies need their parents to pick them up every time they cry. "It makes the baby feel safer and more secure." Dr. Dreyer also says that it's simply not possible to spoil a baby at this young age, and he recommends his patients hold their babies frequently. "Babies like to be held, cuddled, and rocked, and they need that kind of connection."

   Dr. Fischel, who doesn't view Dr. Sears's work as rigorously scientific, says it's very important to educate parents about the differences of the high need baby, as this is more a complex issue. Parents should remind themselves that babies have varying degrees of temperament and what works for someone else's baby may not work for theirs, she says. "If a pediatrician thinks that the parents are doing a good job to problem solve and figure out the puzzles, then parents shouldn't be overly sensitive to others' criticism."

   Being educated and working with a pediatrician to determine the specific triggers that intensify the baby's symptoms are positive first steps. Pediatricians can help implement techniques, which may help ease baby's discomfort and make the transition into toddlerhood smoother.

   Although the high need baby can present challenges for parents during infancy, experts suggest that it does get easier. As they age, children naturally become more independent and crave the ability to do more for themselves. And if the parent has been very attentive to their needs, the outcomes are hopeful. However, if the fussy behavior escalates and continues into toddlerhood, testing for other conditions such as ADHD and autism should be explored.

   "Since they're secure in their relationships with their parents, as they're able to separate, they will actually separate more easily and be less demanding," says Dr. Dryer. "The purpose of nurturing babies when they're young is also to encourage their independence as they get older."

   Dr. Cao points out that one thing parents do have control over is the ability and insight to ask for help when circumstances become overwhelming, and suggests recruiting family members and taking short breaks. "The term 'high need' is really coined for the benefit of parents, so they can assess whether or not they are doing everything they can for their child and themselves." By accepting the idea that every baby is unique and babyhood is a temporary period in the life of a child, parents may be more equipped to deal with the behavior. And never forget to look on the bright side, Dr. Cao says. "All kids are different, and some will present challenges at three months, while others wait until their teens to spring it on you!"


*name has been changed



Think your baby might classify as high need? Need someone to talk to or compare behaviors? Click here for a list of parent support groups in your area.