The Fussy Baby Site

Is There Really Such a Thing as a High Need Baby?

High Need Baby: Origins and Research

A common theme among parents who frequent this site and my Facebook page is that family and friends just don’t ‘get’ what it’s like having a fussy baby. They may assume the baby’s parents are overreacting to normal baby behaviour, or that the baby’s excessive crying and fussiness is the result of poor or misguided parenting choices.

However after running The Fussy Baby Site since 2007, I can honestly tell you this: there are some babies who are just much, much fussier and more ‘high maintenance’ than others. And generally speaking, parents are not exaggerating, are not overreacting, and their babies aren’t fussy because of how they’re being parented.

Because of these misconceptions, one of my main goals over the past few months has been to start spreading awareness of the term ‘high need baby’.  I realize, however, that simply hearing me (a complete and random internet stranger) say there really is such a thing as a ‘high need’ baby isn’t enough for most people (and I don’t blame them…I don’t believe everything I read on the internet either).

So I thought it would be helpful to explain a bit of the origin of the term ‘high need baby’, as well as the research that supports the concept.

The Origin of the Term High Need Baby

Many parents are aware that the term originated with well-known pediatrician and attachment parenting guru William Sears. Most of what we know about the characteristics of high need babies is through his website (particularly his articles 12 Features of a High Need Baby), and his book The Fussy Baby Book: Parenting Your High Need Child From Birth to Age 5.

In his article What High Need Means – A Story About Our High Need Baby, Dr. Sears tells of how their 4th child, Hayden, was completely unlike their first 3, who were relatively ‘easy’ babies. Hayden needed constant holding and attention, which led them to adapt their parenting style to include frequent breastfeeding, baby wearing and co-sleeping.

The terms ‘colicky’ and ‘fussy’ didn’t seem to adequately describe her behaviour, as she didn’t appear to be in pain, and she was relatively content as long as she was being held. It wasn’t until years later, after working with many parents dealing with similar behaviour that they came up with the term ‘high need baby’.

He writes: “In my pediatric practice, I discovered that the term “high need child” was P.C. — psychologically correct. By the time drained parents came to me for counseling about their demanding baby, they had already been on the receiving end of a barrage of negatives: “You hold her too much,” “It must be your milk,” “She’s controlling you.” All relayed an underlying message of “bad baby and bad parenting.” They felt it was somehow their fault their baby acted this way. As soon as I would pronounce the diagnosis “high need child,” I could see a look of relief on the faces of the parents. Finally, someone had something nice to say about their baby. “High need” sounds special, intelligent, unique, and it shifts the focus to the baby’s personality, relieving parents from the guilt of believing that their baby acts this way because of their parenting.

The “Difficult” Baby: What We Used to Call High Need Babies

While the term ‘high need’  was originally coined by Dr. Bill Sears, there have obviously been ‘difficult babies’ from time immemorial. In previous generations, babies that cried frequently, were difficult to soothe and difficult to schedule were perhaps referred to in a variety of ways:

“He was always a sensitive child.”

“We figured she was allergic to my milk.”

“He suffered from colic until he was 2 years old” (not possible, by the way)

If we look back to some important academic research on personality carried out beginning in 1956 by Thomas, Chess and Birch, we see the concept of the ‘difficult child’ was starting to take on steam. Their research, which followed 141 children from birth through to elementary school, looked at various personality traits, and the extent to which the children exhibited the following 9 traits:

  1. The level of motor activity
  2. The regularity of functions such as eating, elimination, sleeping and wakefulness
  3. The response to a new objects or people (do they accept it or withdraw)
  4. The adaptability to changes in the environment
  5. The threshold or sensitivity to stimuli
  6. The intensity of responses
  7. The child’s general mood or disposition (cheerful, grumpy, serious, friendly, etc.)
  8. How distractible the child is
  9. The attention spam and level of persistence they display when engaged in an activity

Each infant was then rated on each of these traits, and a behavioural profile (or temperament type) emerged. They found that, according to these traits, most infants fell into one of three categories: The Easy Baby, The Difficult Baby and the Slow to Warm up Baby.

They write: “[W]e found another constellation of characteristics that described “difficult children”. These children are irregular in bodily functions, are usually intense in their reactions, tend to withdraw in the face of new stimuli, are slow to adapt to changes in the environment and are generally negative in mood. As infants they are often irregular in feeding and sleeping, are slow to accept new foods, take a long time to adjust to new routines or activities and tend to cry a great deal. Their crying and their laughter are characteristically loud. Frustration usually sends them into a violent tantrum. These children are, of course, a trial to their parents and require a high degree of consistency and tolerance tin their upbringing. They comprised about 10 percent of the children in our sample.

This ‘difficult-ness’, they determined, could be recognized in infants as young as a week or two of age, and continued into their elementary school years (and likely beyond; although the study didn’t follow these kids into adulthood). They also found that these traits emerged independently from how they were parented and from the personalities of their parents. 

Do High Need Babies Turn into High Need Kids?

It’s difficult for parents to come to terms with the fact that their baby’s excessive fussiness may be the result of temperament. Since temperament is relatively stable throughout our lives, to imagine that your baby will never really outgrow these traits can be disconcerting (to say the least).

In the study mentioned above, researchers found that while in most cases at least elements of temperament remained the same throughout the years, the child’s environment played a significant role in how the child ultimately was able to cope.

More recent research seems to confirm this theory. In fact, this research suggests that high need infants are so susceptible to parenting quality, that those who receive high-quality parenting actually end up with better first grade outcomes than formerly ‘easy’ infants. Researchers followed 1300 children from birth to age 5, and found that the mothers of high need infants who were cold or indifferent ended up having behavioural difficulties later in childhood. And those whose mothers responded to them with warmth and sensitivity? Teachers ended up reporting these were the kids who were most co-operative and most successful at school.

Later research looked at how parenting impacts these kids even later in childhood (up to age 11), and it confirmed the earlier findings: children who were difficult infants continue to be impacted by the quality of early parenting even at age 11.

According to Kate Anderson, instructor at the University of Victoria, newer research is beginning to indicate that temperament at ages 3-4 may actually be more indicative of later temperament than temperament during infancy. This means that so-called difficult or high need babies are not necessarily destined to be difficult or high need kids. She writes, “Temperament is not cast in stone but some traits are less likely to change than others. Interestingly, temperament in infancy has turned out not to be as strong a predictor of later personality than temperament at a slightly older age. As children grow into the preschool years, their traits tend to become more reliable indicators of an enduring personality style.”

Do High Need Babies Require a Different Parenting Style?

Many times parents are criticized for how they parent their ‘high need’ or ‘difficult’ child. Many parents find they end up parenting their baby in ways they never would have planned or imagined. And these methods, including babywearing, co-sleeping, and being diligent about keeping to a sleep routine, are sometimes thought (by others) to be causing the fussy behaviours.

In my experience, however, the exact opposite is true. Many parents never planned to practice the ‘attachment parenting’ method, however they ended up doing so out of necessity. Many parents first try other strategies, only to find they actually worsen their baby’s crying and fussiness.

In Thomas, Chess and Birch’s The Origin of Personality, they found that so-called ‘easy babies’ did well, regardless of parenting style, but that ‘difficult’ babies needed a more flexible parenting style. They write, “In general easy children respond favorably to various child-rearing styles…In the case of difficult children the handling problem is present from the onset. The parents must cope with the child’s irregularity and the slowness with which he adapts in order to establish conformity to the family’s rules of living. If the parents are inconsistent, impatient or punitive in their handling of the child, he is much more likely to react negatively than other children are. Only by exceptionally objective, consistent treatment, taking full account of the child’s temperament can he be brought to get along easily with others and to learn appropriate behavior. This may take a long time, but with skillful handling such children do learn the rules and function well. The essential requirement is that the parents recognize the need for unusually painstaking handling; tactics that work well with other children may fail for the difficult child.”

While it’s true that ‘difficult’ babies can grow into ‘difficult’ children, this research indicates that a flexible, adaptive parenting style (as opposed to a one-size-fits-all style) can benefit these ‘difficult’ children immensely.

In my experience, this adaptive parenting style may include:

  • Staying home most of the time to allow the child to stick to a sleep routine
  • Using ‘sleep props’ like pacifiers, holding or swinging to help their baby sleep
  • Carrying out elaborate sleep routines to help their baby get the sleep they need
  • Being flexible with solid foods; understanding that their child may be sensitive to certain tastes or textures
  • A more supportive and gentle style of discipline (as opposed to a harsh or inflexible style)

Although those who are viewing the parenting from the outside may think of these strategies as ‘spoiling’ or ‘letting the baby run the show’, in my experience, in the vast majority of cases parents have tried everything else and are using these strategies because it is the only way to survive.

What Should the Physician’s Role be When it Comes to the Care of High Need Babies?

A question that I and many other parents have struggled with is “How do I know if my baby is high need, or if there’s something wrong with him?”. This is an extremely valid question, and the purpose of this article isn’t to say that all babies who are ‘difficult’ are that way due to temperament.

A visit with your physician should always, always, always be the first course of action when you have a baby who fusses or cries frequently, or who has difficulties feeding or sleeping (whether there are physical symptoms present or not). Your doctor will be able to rule out other causes of fussiness including infant reflux or GERD or a food allergy or sensitivity.

However if your doctor has ruled out any physical causes (or the condition is being treated, and the high need behaviours don’t go away), it may be time to consider that your baby may simply have a temperament that is more intense, more demanding and more sensitive.

I have heard it suggested that high need babies are the ones who are able to be calmed and comforted when being held, and that babies who don’t settle even when being held may be in discomfort due to a medical condition. In my experience, I don’t believe this to be true.

I strongly believe there are varying degrees of ‘high need’: my son, for instance, was calmed by very little during his first 3 months. Holding, rocking, and distracting did little to stop the crying and screaming; and yet, right around the 3 month mark, we noticed a marked improvement in his fussiness.  To suggest that he had a medical condition which magically disappeared right at 3 months doesn’t sit well with me.

In any case, physicians who take into account a child’s temperament – yes, even an infant’s temperament – will have a far easier time giving parents an accurate view of what could be causing the fussing and crying.

From The Origins of Personality: “It follows that the pediatrician who undertakes to supervise the care of a newborn child should familiarize himself with his young patient’s temperament as well as physical characteristic. He will then be able to provide the parents with appropriate advice on weaning, toilet training and the handling of other needs as the child develops .

Final Thoughts

As the mother of a formerly colicky baby and high need toddler, I can say that in my experience, everything contained in the research above holds true.

Sammy’s first 3 months consisted of near-constant crying, screaming and screeching, difficulties breastfeeding and short, restless periods of sleep (for both of us!).  I would define this as the ‘colic’ stage. Right around the 3 month mark, we noticed a significant improvement in his demeanour…he no longer screamed all day. However by 4 months, I knew there something more going on. He still needed almost constant holding, entertainment, distraction and movement; but at least we had ways to calm him, and his sleep and feeding improved tremendously.

As a toddler, Sammy had the longest, most ear-splitting tantrums I had ever heard. Every aspect of our day-to-day lives was met with suspicion, frustration and/or tears, including getting dressed, getting into the carseat, going to the dinner table, putting away toys, washing hair, etc, etc, etc.

So you can imagine my fear and hesitation when I enrolled Sam in preschool at 4 years old. How would he do? Would he have tantrums at school? Would he have difficulties with transitions like ending snack time, starting crafts or putting on his shoes?

At the first parent/teacher meeting, I had no idea what to expect. Imagine my surprise when they told me, “Sammy is one of the most well-behaved little boys we’ve ever had in the school. We wish more kids could be like him.”

I say this not to brag, but to say that even the most fussy, difficult, high need, tantrum-y kids can turn out alright. At 7 years old, he is a well-behaved, pleasant little boy who excels socially and has learned to cope with his intense emotions. He’s still sensitive, and thrives when he has a predictable routine, but I would in no way describe him as difficult or high needs.

There is hope for the high need baby!

Do you have a high need child? Which characteristics does he or she display? Of if your child is older, did he or she outgrow their high need behaviours? 


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