How to handle a beastly baby

Mothers of unhappy toddlers can feel inadequate, desperate and depressed. But help is at hand, hears Joanna Reid

At five weeks Rachel Hendricks's baby got colic and for the next four months screamed inconsolably from 4pm until 2am. "One day she was crying and crying and there was nothing I could do for her. I was frightened I was going to hurt her so I shoved her in her cot, went downstairs, shut myself in the kitchen, turned on the TV, the radio and the extractor fan. And I could still hear her. I just sat there and screamed and burst into tears."

Mrs Hendricks kept her problems well hidden from friends: "People would drop in and say `How are you?', and you want to say, `I'm not all right', but you don't, you say, `I'm OK. Everything's fine'." She told her health visitor she was having difficulties and was referred to her GP. He prescribed tranquillisers which made it difficult for her to get up at night to feed her baby.

The underlying assumption of much of today's babycare literature is that the mother is responsible for almost every aspect of her baby's behaviour, from satisfactory sleeping patterns to reaching developmental "targets", as well as laying the foundations for future emotional security and intellectual achievement. The mother influences the baby, not vice versa, and the baby is finely tuned to respond to every last nuance of her behaviour.

So it is refreshing to find research showing that infants' behaviour can also affect mothers. Dr Lynne Murray, MRC Senior Fellow at Cambridge University, found that irritable babies - who are very easily upset and then extremely hard to soothe - significantly increased the likelihood of their mothers becoming depressed.

She has found that around 17 per cent of babies are irritable. In her study of more than 200 women and babies in Cambridge, babies were tested for irritability at 10 and 15 days after birth, before the time when postnatal depression usually sets in. When the mothers' psychiatric state was assessed at six weeks after the birth, she found that infant irritability increased the risk of depression three-fold.

It may seem obvious that a screaming baby who will not be comforted is very depressing, but perhaps it would be less debilitating if women did not also feel that they were responsible for the crying. Dr Murray says that there seems to be a cultural belief that babies behave in certain ways because of the way the mother handles them. "Therefore if you have a baby who screams all the time, there's an implicit sense that somehow it's your fault - that you're being a bad mother because you ought to be able to do things to make the baby happy."

Dr Murray found that health visitors' concentration on the infants' progress, first with feeding and weight gain and then with a series of developmental checks, can exacerbate the problems of mothers whose babies do not conform to the "norm". "Women whose infants are easily distressed and hard to soothe may experience routine health visitor questioning as a form of policing," says Dr Murray. Mothers may perceive the advice they receive as "critical or even persecutory".

Now Dr Murray and a health visitor, Sheelah Seeley, have managed to establish a new six-week training programme for health visitors in the Cambridge area. All new mothers in the area are screened for depression at their health visitor's first postnatal visit and, where appropriate, offered once-weekly counselling at home for eight weeks. Health visitors are trained in cognitive therapy and offer a combination of non-directive counselling and also practical strategies to deal with particular difficulties with babies.

This new treatment programme, when compared with routine care, doubled the recovery rate for women suffering from postnatal depression (80 per cent compared to 40 per cent had recovered four months after the birth), and significantly reduced difficulties mothers experienced with their babies. A similar scheme in Edinburgh is also producing good results.

The tranquillisers Mrs Hendricks's doctor had prescribed were so strong that she could not physically get out of bed at night to feed her baby, so she stopped taking them. In the end her friends did help, allowing her to get out of the house and to feel less isolated. On one occasion they arranged a day out for her to see a Sophie Grigson cookery display.

"I'm a strong person with a supportive husband and friends," Rachel Hendricks says now. "I just wonder how people cope who aren't so strong. It would have been helpful to have been able to talk to someone who was detached. You can tell them things you cannot tell other people because you don't want to upset them, and you don't want them to think you are going off your rocker."

She struggled on for a gruelling year before she began to enjoy her baby and feel herself again - like many other mothers.

Those initially screened in Cambridge found it immensely helpful. They speak of the relief they felt when they were taken seriously and were able to talk about their worries. One mother, Jane Wise, commented: "The health visitor put my mind at rest that I wasn't going mad or being silly. After the session I started thinking about the other things that were bugging me, which I hadn't thought about before. I was able to put them in some kind of perspective."

Dr Murray was not surprised that the women seemed to benefit so much. "Unlike depressions at other times of life, this is a time when everyone wants to do their best for their child, so there is incredible motivation to make it work. If you can move things into a benign cycle, a baby is, of course, very rewarding - therapeutic, even," she says.

The Cambridge research and subsequent treatment programme probably works because it is a simple and carefully tailored intervention that caters for individual needs. Sheelah Seeley would like to see it adopted nationally. Mrs Wise said: "After three sessions I felt I could cope because I'd come to terms with why I was feeling so bad."

The mothers' names have been changed.