The Happiest Baby (THB)
The information in this program outline is provided by the program representative and edited by the CEBC staff. This program has been reviewed by the CEBC in the following Topic Areas:
About This Program
Target Population: New parents, grandparents, teachers and healthcare professionals
For parents/caregivers of children ages: 0 – 0
THB explains that the current culture’s conceptualization of the first three months of life is flawed. In many ways, newborns are not fully ready for the world at birth, they still need a protected environment filled with rhythmic, monotonous, entrancing stimulation...a fourth trimester. It teaches five simple methods of activating the “calming reflex” by imitating the uterine sensory milieu - the "5 S's" - Swaddle, Sidestomach position, Shush, Swing, Suck. Laboratory research has demonstrated that elements of this program, including swaddling, sound, and movement, improve the quality of sleep and promote greater arousability, which may protect against Sudden Infant Death Syndrome (SIDS). This program promotes good parent-infant bonding and aims to assist in the prevention of a number of severe and life-threatening consequences of infant crying. These consequences are marital stress, Shaken Baby Syndrome (SBS), Post-Partum Depression (PPD), Sudden Infant Death Syndrome (SIDS), excessive use of Emergency Room/physician time, overly aggressive medical evaluation and treatment for Gastroesophageal Reflux Disease (GERD), and perhaps even in the prevention of obesity.
The overall goals of The Happiest Baby (THB) are:
- Promote good parent-infant bonding
- Assist in the prevention of a number of severe and lifethreatening consequences of infant crying such as marital stress, Shaken Baby Syndrome (SBS), Post- Partum Depression (PPD), and Sudden Infant Death Syndrome (SIDS)
The essential components of The Happiest Baby (THB) include:
- Ideally taught prenatally to a couple or class of up to 6 couples
- Certification of all educators in THB program
- Provide all patients/clients with THB DVD + the Soothing Sounds White Noise CD (many programs also provide a large swaddling blanket)
- Teach the concepts of the “missing 4th trimester,” the “calming” reflex and the 5 S’s
- Parents are informed about Shaken Baby Syndrome (SBS) and are advised to walk away or get help if they feel they are losing patience or getting angry, but in general parents who get THB training develop great competence during the first week or two of a baby’s life. This allows them to be very good at calming the baby before the colicky crying period begins to trigger such frustration and anger.
- Discuss and demonstrate precisely how to do each S (the technique is critically important to avoid mistakes and frustration and to allow the intervention to be maximally effective)
- Have parent demonstrate their competence on a doll or their baby
- Have the parent use the white noise CD at home during crying bouts and all sleep periods
- Have the parents re-watch the DVD after the baby is born…during early crying episodes…and in the presence of any other adults/teens who will be helping care for the baby:
- This reemphasizes the important points of the technique at the “teachable moment.” It also helps prevent incorrect application of the principles and mitigates the State’s or the organization’s liability by making THB DVD the last information given.
- Emphasize the importance of skill building and boosting the competence of male caregivers:
- Men are excellent baby-calmers. This program has been included in the curriculum of the National Fatherhood Initiative.
- Can be used in programs for high-risk babies/families (e.g., NICU, drug withdrawal, low SES), teen parents, fatherhood programs, military, Postpartum Depression sufferers, Shaken Baby Syndrome prevention, foster or adoptive parents, and training Pediatric Nurse Practitioners, nurses, lactation consultants, housestaff, child life workers, etc.
The Happiest Baby (THB) directly provides services to parents/caregivers and addresses the following:
- Expectant parents or parents of newborns, especially those who experience crying babies, sleepless babies, breastfeeding failure (women unable to feed because the baby is crying or who want to give up nursing because the baby has begun to fuss more), etc.
A single 90-minute class prenatally; may offer a follow-up postnatal class (or just postnatally if the population cannot be captured prenatally), all participants receive two parenting tools (an educational DVD and a CD of white noise; add a 90-minute home visits and/or telephone follow-ups for high-risk patients
One class for most new parents; a home visit and follow-up phone calls at one week, three to four weeks, and six to eight weeks post-partum for high-risk parents
This program is typically conducted in a(n):
- Adoptive Home
- Birth Family Home
- Community Agency
- Group Home
- Outpatient Clinic
- Residential Care Facility
This program does not include a homework component.
The Happiest Baby (THB) does not have materials available in a language other than English.
Resources Needed to Run Program
The typical resources for implementing the program are:
Room to hold class in
Minimum Provider Qualifications
One year of patient/parent education experience or a medical professional degree
Education and Training Resources
There is not a manual that describes how to implement this program; but there is training available for this program.
- Harvey Karp, MD
The Happiest Baby, Inc.
phone: (310) 476-4440
fax: (310) 440-4401
Training is obtained:
At home: DVD and reading-based with a certification test requiring passage at the 90%.level
Number of days/hours:
Five days for 40 hours total
Relevant Published, Peer-Reviewed Research
This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.
Show relevant research...
The following studies were not included in rating THB on the Scientific Rating Scale...
McRury, J. M., & Zolotor, A. J. (2010). A randomized, controlled trial of a behavioral intervention to reduce crying among infants. Journal of the American Board of Family Medicine, 23(3), 315-322.
The study evaluated the efficacy of the videotaped instruction component of The Happiest Baby intervention program to reduce crying in newborns. Participants were randomly assigned to an intervention or control group. Control group mothers viewed a standardized videotape for normal newborn care. The intervention included watching a 30-minute instructional video and was assessed by mean hours per day of infant crying. Mothers recorded hours in a journal at weeks 1, 4, 6, 8, and 12. All participants completed the Parenting Stress Index (PSI) and Edinburgh Postnatal Depression Scale (EPDS) at weeks 6 and 12. Results indicated no statistically significant differences between intervention and control group mothers on infant crying or on PSI scores. Major study limitations included the short length of the intervention and relatively small sample size. Since it used only part of the intervention, it was not included in the rating/review process.
Paul, I. M., Savage, J. S., Anzman, S. L., Beiler, J. S., Marini, M. E., Stokes, J. L., & Birch, L. L. (2011). Preventing obesity during infancy: A pilot study. Obesity, 19(2), 353-361.
The study tested the independent and combined effects of two behavioral interventions (Soothe/Sleep – The Happiest Baby) and “Introduction of Solids”), designed to promote healthy infant growth in the first year. Mother-infant dyads were assigned to 1 of 4 groups: Happiest Baby and Introduction of Solids, Happiest Baby alone, Introduction of Solids alone and a no treatment control group. Measures utilized include Infant Behavior Questionnaire. The infants were also weighed as part of the assessment process. Results indicated that at 1 year, infants who received both interventions had lower weight-for-length percentiles and participants receiving both interventions had a mean weight-for-length in the 33rd percentile; in contrast, those in other study groups were higher first intervention only—50th percentile; second intervention only—56th percentile; control group—50th percentile). Limitations include sample limited to first-time mothers who intended to breastfeed, and limited minority participation making it difficult to generalize the findings to other populations. Since this study did not look at direct outcomes related to preventing child abuse and neglect, this study was not used in the rating/review process.
Harrington, J. W., Logan, S., Harwell, C., Gardner, J., Swingle, J., McGuire, E., & Santos, R. (2012). Effective analgesia using physical interventions for infant immunizations. Pediatrics, 129(5), 815-822.
The study evaluated the analgesic effectiveness of the Happiest Baby’s 5 S’s (swaddling, side/stomach position, shushing, swinging, and sucking) alone and combined with sucrose, during routine immunizations at 2 and 4 months, utilizing instructions from a videotape version of The Happiest Baby intervention program. Patients were assigned into 4 groups: 1) 2 mL of water 2 minutes before immunization and comfort by parent or guardian after immunization (Control Group), 2) 2 mL of 24% oral sucrose 2 minutes before immunization and comfort by parent or guardian after immunization (Sucrose Group), 3) 2 mL of water 2 minutes before immunization and physical intervention using the 5 S’s by researcher after immunization (Happiest Baby Group), and 4) 2 mL of 24% oral sucrose 2 minutes before immunization and physical intervention using the 5 S’s by researcher after immunization (Happiest Baby and Sucrose Group). Measures utilized were the Modified Riley Pain Score. Results indicated that The Happiest Baby intervention provided decreased pain scores and decreased crying time among 2- and 4-month-old infants immediately after routine vaccinations. These 2 groups had lower scores over time, followed by sucrose alone, then control. Study limitations included a disproportionate number of 2-month-olds compared with 4-month-olds, and may not be generalizable to other populations of patients. Since this study did not look at direct outcomes related to preventing child abuse and neglect, this study was not used in the rating/review process.
Franco, P., Seret, N., Van Hees, J., Scaillet, S., Groswasser, J., & Kahn, A. (2005). Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics, 115(5), 1307-1311.
Gerard, C. M., Harris, K. A., & Thach, B. T. (2002). Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics, 110, e70.
Karp, H. (2004). The “fourth trimester”: A framework and strategy for understanding and resolving colic. Contemporary Pediatrics, 21, 94-114.
Date Research Evidence Last Reviewed by CEBC: September 2013
Date Program Content Last Reviewed by Program Staff: May 2014
Date Program Originally Loaded onto CEBC: February 2008