Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Monday, October 3, 2016

Listening to Parents and Babies: A Perspective on Colic

Recently I had the pleasure of spending the day with Nadia Bruschweiler-Stern, pediatrician, psychoanalyst and director of the Brazelton Centre of Switzerland, where she uses the Neonatal Behavioral Assessment Scale (NBAS) in her clinical work with infants and parents. 

T. Berry Brazelton, renowned pediatrician and recipient of Obama's Presidential Citizens Medal in 2012, developed the NBAS when he observed that all children come into the world with their own unique set of strengths and vulnerabilities. The NBAS has proved to be a valuable way to identify the child’s contribution to the parent-child relationship from birth.

Bruschweiler- Stern was visiting to the Austen Riggs Center (where I have been appointed as a consultant in Human Development) for presentations to the fellows, staff and the larger community.

While there were many wonderful aspects to her visit, a highlight came in the car ride from New York, where we had been together at a gathering of innovators in the field of infant-parent mental health, to the Berkshires. She told the following story. 

She had attended a presentation of on colic for an audience of pediatricians and nurse midwives. Presenters described the medical causes and treatments of colic; one then suggested that when a mother is distressed by her infant's crying she should be sent for psychotherapy. I told Nadia I would have been hypertensive listening to this; she described a similar experience of her hair standing on end. She imagined these nurse midwives going back to their practices and referring all these moms for therapy. She felt she had to do something.

After working to calm her pounding heart, she raised her hand and shared something like the following. "When a baby cries, he communicates distress. When a mother cannot soothe him, she experiences anxiety. Her distress may make it harder to read the baby's signals.  This mutual exchange is a normal process and does not represent a disorder either on the part of the infant or the mother." She told us that the pediatricians were dismissive, but the midwives, who knew what she was saying was true. all flocked to her. 

This simple vignette captured the complexity of a large body of research, much of it subsumed under the Mutual Regulation Model. It also offered an example of engaging (at least part of) audience in nonthreatening way to accept an alternative model that does not pathologize either the mother or the baby.

When we take time to listen and make sense of the experience of both infant and parent, rather than figuring out what is "wrong" with either, we help them to connect in ways that are helpful rather than harmful. Or in the language of developmental psychology, we help move them from mutual dysregulation to mutual regulation. 

In her afternoon presentation, Dr. Bruschweiler-Stern offered examples of this process, showing powerful videos of using the Neonatal Behavioral Assessment Scale to support connections among mothers, fathers and infants following the birth of a baby. 

These were vulnerable families, with a range of struggles with loss, depression, and stressed relationships. By taking time to listen to the baby with the parents and understand his or her unique capacities for communication, she was able to address these vulnerabilities right from the start, helping to set these babies on a healthy developmental path.


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