This week, we’re delighted to have got the chance to speak with Dr Suzanne Smith, founder of and programme advisor for the ICON programme which aims to provide information to parents and professionals on coping with baby and infant crying.  Coping with a crying baby is one of the toughest aspects of new parenthood, and it’s therefore one of the core elements of baby care advice that we include in the DadPad and DadPad app, and the advice that we provide is based on the ICON message.

Hi Sue.  Thanks for taking the time to talk with us.  For those who have not yet heard of it, can you please give us a quick overview of what ICON is about and how it works?

ICON: Babies cry, you can cope is a programme delivered by a variety of health professionals to parents and carers of new babies.  The aim of the programme is to educate parents, support them to cope with a baby that is crying and to understand that all babies start to cry more from about 2 weeks of age, reaching a peak at about 6-8 weeks and gradually subsiding by 4-5 months of age.  Our aim is that, by helping parents cope with crying, it will help prevent Abusive Head Trauma in babies which we know is often triggered by a parent who loses control with a crying baby and shakes them.

To reinforce the message and to reach as many people as possible, ICON is promoted through a vibrant social media campaign that includes a series of short animated videos.

Where did you get the idea for ICON, and its interventions, from?

As a Registered Nurse and Health Visitor who has specialised in child protection since the mid 1990s, I saw first-hand the devastation that Abusive Head Trauma causes to babies and families.  I was keen to explore how to prevent it and started to research the topic.  My PhD focused on the prevention of Shaken Baby Syndrome, as it was known at the time.  In 2016, I was lucky enough to be granted a Winston Churchill Memorial Trust Fellowship and travelled to USA and Canada to see how the prevention programmes that I had researched for so long were being put into practice.  I had some ideas about what I wanted a programme to look like before I went, but seeing it first-hand made all the difference.  When I came home, I weaved together the best bits of all the programmes I had seen into something I thought would be easily integrated into an effective and efficient UK health service programme.

We have a group of professionals and a group of parents/family members who comment on and approve all the ICON materials.

What is the key ICON message?

ICON stands for:

• Infant crying is normal and the crying will stop.
• Comfort methods will sometimes help and the crying will stop.
• It’s OK to walk away for a few minutes if the baby is safe and the crying is getting to you.
• Never ever shake or hurt a baby.

This simple message is delivered soon after a baby is born, before discharge from hospital, and is accompanied with a leaflet.  The message is repeated several times by a Community Midwife and Health Visitor as a reminder, until the baby’s 6-8 week check (when the crying is likely to be at or reaching its peak) when the GP goes through the message again.

Can we look at each of those four elements in more detail with you please?

I – First of all, let’s look at infant crying. Is there a general pattern here?

Research shows that all babies start to cry more from 2 weeks.  It reaches a peak at 6-8 weeks and starts to gradually reduce.  There may be a reason for the crying, and we encourage parents to check the basics (e.g. is baby too hot, cold, hungry, wet or dirty, or are they ill? etc).  Sometimes, though, the baby cries for no apparent reason and it can be really frustrating and upsetting for parents who think they are doing something wrong.  Not all parents or professionals know about this normal peak of crying.  Knowing about it helps parents cope with it because they know it might not be anything they are doing wrong and they know it will pass.

C – Comfort methods are next. What are some of your key suggestions on how parents can try to comfort and calm a crying baby?

On our website, we have a section all about comforting methods.  There are a variety of different things parents can try e.g. singing/humming, holding baby skin-to-skin, gentle movement, going out for a walk, lying baby across your lap on their tummy and rhythmically tapping their back, having a repetitive sound playing, putting baby to the breast or offering a dummy.  The thing is that some things work sometimes and not others.  You might think you’ve cracked it but it doesn’t work next time you try it.   It can be really frustrating but it is important to stay calm.  Let someone else take over if you are getting exhausted or frustrated – that doesn’t make you a failure; it means you are a responsible parent.

O – The “OK to walk away” message might be surprising to some. Why is it included and how should a parent carry this out safely?

This is giving parents the permission to recognise when their reserves are running low and they can feel frustration interfering with how they are interacting with their baby.  It happens to all of us who are exposed to a crying baby after a while and is normal.  It is important for parents to recognise when they are feeling frustrated and they need to calm down; staying in the same room listening to the crying isn’t going to help.  As long as the baby is safe in their cot as per normal safe sleep advice, if that feeling of frustration is rising to the surface, it’s not helping the baby or you.  Walking away gives you a few minutes to take a beat, a few deep breaths, get a cup of tea for example, put some headphones on and listen to your favourite music, call a friend if possible and ask them to come round.  After a few minutes, go and check on the baby.  This is always going to be better than letting that frustration get the better of you.   Getting angry with your baby is not going to help and will make things worse, so when that feeling starts to rise, you are not being less of a parent by checking your baby is safe and walking away to calm down for a few minutes.  It’s OK!

N – Finally, of course, we should never shake a crying baby. Can you please explain why you flag up this – perhaps, to many people, obvious – point in the ICON advice?

We know that most babies who are shaken are shaken because parents/carers have become frustrated with their baby’s crying.  The damage caused by shaking a baby is not well understood by everyone who may think that they are not causing much damage.  But it can very quickly cause major brain injury, bleeding behind the eyes and bone injuries.  We encourage parents to share the information with everyone who will be caring for their baby because not all babies who are shaken are shaken by their parents.  Our hope is that, by providing more parents and carers with the information about coping with crying and also by raising awareness of the dangers of shaking a baby, more people will recognise what is happening when they start to lose control, will remember the ICON message, and will walk away and calm down.

Does ICON include any specific, targeted advice or resources for dads?

The ICON message is targeted at all parents and anyone who is looking after a baby, and obviously that includes dads.  It is important that ICON is delivered to men, dads, male surrogates, male carers as we know that most babies who are shaken are shaken by men.

The intervention points, especially the hospital-based intervention, are designed to particularly reach dads; most men will be there at delivery and before the baby is discharged home with the mother.

The social media campaign is also particularly designed to engage dads and men generally.  Dads will find the videos helpful and will be able to relate to the animated characters.  The ‘I am Unshakeable’ video particularly appeals to men:

What about babies born prematurely?  Is there any specific crying-related advice for their parents?

As with all babies, it’s also the case that babies who are born prematurely start to cry more 2 weeks after the date they were due to be born.  This sometimes comes soon after they have been discharged.  Parents of premature babies sometimes find that it comes as a bit of a shock when baby has been so quiet and content on the neonatal unit.  We have a leaflet just for premature babies which can be given to parents on the neonatal unit.  As these babies are particularly vulnerable, there are a few extra things in there about seeking medical advice but also providing some reassurance that, if there is nothing medically wrong, 2 weeks after their due date, premature babies can also start to cry more.

How has the current COVID-19-affected climate impacted on your work with ICON?

We know that child abuse, and abusive head trauma, increases at times of stress and financial hardship.  COVID has brought both into the lives of all of us.  In response to this, NHS England included the hospital based element of ICON in their COVID emergency planning and it was pushed out to all maternity units.  Nearly 50% have used the resources that were provided to hospitals.  It is more important than ever for parents to get support to cope with a crying baby and NHS 111 have integrated the ICON message into several of their pathways.  NHS England North and NHS England East and West Midlands have commissioned the use of ICON across their regions, recognising that the impact of COVID is not going to be short-lived and the importance of providing parents with as many resources as possible to cope during these stressful times.

Finally, what plans do you have for ICON in 2021?

The second phase of ICON, as included in my original report from my Fellowship, focuses on secondary agencies who come into contact with families with babies.  This includes social work, police, and drug and alcohol services, for example, who are likely to come in contact with families already under a degree of pressure and where babies are vulnerable.  We are also working in partnership with the School and Public Health Nurse Association in driving forward a plan to bring the ICON message to high school children in their role as siblings, aunties, uncles, babysitters and, for some, in their role as parents.  The earlier the ICON message is normalised for parents/potential parents and anyone who cares for babies, the better.  For this reason, we are also keen to strengthen our partnership with DadPad!

Other plans include working with specialist hospital trusts, like Alder Hey, where families often miss out on the routine antenatal and postnatal intervention points.  Plans are underway to take this forward in 2021.  Another group who can miss out on traditional health service delivery are military families and we have plans to do a campaign for our service families.

We have some plans to develop a series of touchpoints with drug and alcohol specialist services to reinforce the message to families in touch with those services, we have had some early meetings with colleagues in Scotland to look at piloting ICON across the border, and The National Institute of Health Research has put up a large grant for the evaluation of ICON which will be awarded this year with plans for the evaluation to begin in 2021.

We are also keep our eye on emerging research findings and have ensured that our future focus is evidence-based.

So there’s a lot going on – and we will be appointing a co-ordinator and admin support to take us through to the next phase of ICON: Babies cry, you can cope.

We’re really grateful to Sue for taking the time to talk with us, and share all this useful information.  If you want to know more about the ICON message, you can download a copy of their leaflet and a poster which clearly sets out the ICON message; these resources might be useful for you to keep as reminders for yourself and your partner, but also for sharing with other new parents that you know as well as with others (e.g. grandparents, babysitters, etc) who might be caring for your baby for you at some point.