Nurse Pam Creger flips through a stack of photographs until she finds the right one - the black-and-white image of a 3-day-old boy with a strong resemblance to Mr. Magoo.
To the untrained eye, the baby looks perfectly normal, wide-eyed and awake. His crinkled, animated expression seems to reflect character, stamina.Not necessarily so, says Creger, an expert in baby body language.
"This baby is stressed out," she says. "He looks cute, but he's tired and unhappy."
Splayed fingers, blotchy, wrinkled skin and droopy eyes. The infant, born with respiratory problems, showed another sign of distress: he was too weak to cry, she said.
At the Children's Hospital in Denver, Creger teaches parents of high-risk and sick newborns how to read their baby's body movements. Studies have shown that when stress is reduced, a sick baby has a better chance at recovery.
"We look at the way a baby looks, acts and moves as his primary form of communication," Creger says. "Every baby is different."
Interpreting a baby's "behavioral cues" is often a matter of trial and error, Creger says. Splayed fingers, outstretched arms and legs in the air, wrinkled foreheads, droopy eyes, and skin discolorations are obvious signs of baby discomfort.
But what calms one baby could unnerve another.
A mother's soft lullaby can sometimes irritate the seriously ill newborn and rob him of the sleep so vital to his recovery, says Creger. "Rubbing a leg or stroking a baby is something all parents instinctively want to do, but it may also be more than a (stressed) baby can handle," Creger says.
Even the energy required for visual stimulation from a suspended mobile could "push him over the edge," she says.
Unlike a healthy, full-term baby, a premature infant who is startled in his crib by a bump or strange noise often lacks the ability to settle down.
Even if the baby won't tolerate being touched, he may respond positively to certain "organizing reflexes" that help him regain control.