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.

Sunday, December 4, 2016

Can We Restore Empathy and Heal Our Country by Listening to Babies and Parents?

In his extraordinary new book Hillbilly Elegy, J.D. Vance generously offers his personal story to help us gain insight into why so many people in our country feel unheard and left out. When I was about two thirds of the way through the book, in conversation with my millennial daughter, I said that it seemed there was a kind of intergenerational transmission of trauma, with magnified effects in each successive generation who experienced domestic violence, substance abuse, and other forms of developmental disruption.

Thus I was surprised when later that day I got to the end of the book and found Vance came to a similar conclusion. He references the Adverse Childhood Experiences (ACE) study. I describe the study in my forthcoming book where I show how these experiences get into the body and brain (and how to help when they do.)
The ACE study provides abundant evidence of the long-term effects of early exposure to a range of negative experience, including not only abuse and neglect but also parental mental illness, substance abuse, divorce, and domestic violence.
The effects are far-reaching, with significant increase in not only mental and physical illness, but also teen pregnancy, incarceration and other social problems. Vance writes:
ACEs happen everywhere, in every community. But studies have shown that ACEs are far more common in my corner of the demographic world.
Referring to people’s wish for a “magical public policy solution,” Vance offers a number of suggestions about how to address this problem. While he feels that there is no one solution, he recognizes that the problem has its origin in homes and in families.

Coincidentally, the day before I finished the book I had participated in an extraordinary meeting via Zoom with researchers from all over the world who are studying the effects of the Newborn Behavioral Observations (NBO) System, which offers one possible solution. It is a brief intervention designed to listen to baby and parents together.

The first days after the birth of a baby, when both a mother and father’s brain are bathed in oxytocin, present an opportune moment for intervention. The newborn’s brain makes as many as 700 connections per second as he or she learns to adapt to the outside world. During this period new identities as parents take shape and relationships are transformed.

At the meeting I “met” a colleague from Australia, Susan Nicolson, who has succeeded in implementing this intervention at a hospital with 8,000 deliveries a year. In an article she describes this process. Prior to presenting their idea to the hospital board, they had conducted a small study with teen mothers using a brief intervention with elements of the NBO added to routine hospital maternity care. 

The study showed significant differences in the way these mothers interacted with their babies, with more positive engagement and joyful play. The intervention seemed to open their minds to being curious about their baby’s experience. This stance of curiosity has been demonstrated in extensive research to be associated with emotional regulation, flexible thinking, empathy, and overall mental health.

They shared their findings at the hospital board meeting. Nicolson writes:
With the consent of a small number of study participants, some video snippets of mother–infant interaction were shown to board members at that meeting. The videos of young mothers and their babies interacting with each other at home proved as much of a call to action as the study findings did. As one board member put it, “We don’t usually see what happens to families after we help them get through pregnancy and birth safely. I was so moved, I had to ring my mother and talk about it.”
Nicolson offers a public health perspective on her work, suggesting that universal integration of the NBO would support parent-infant relationships in a way similar to the World Health Organization/UNICEF-accredited “Baby-Friendly” hospitals support of breastfeeding.

A growing body of evidence from NBO research worldwide suggests that large scale implementation could have a significant impact on postpartum depression, parenting stress, and a range of other factors that have potential to derail healthy development.

In our small rural community in western MA, we plan to train a range of people who interface with infants and parents in the NBO, including maternity nurses, home visitors, pediatricians and early intervention workers. Our hope is to build a model that can be applied to rural communities throughout our country.

So how does this idea related to the problem Vance identifies? Broad swaths of our population do not feel heard. Our current political climate suggests that we are all having difficulty listening to each other. While clearly other supports would need to follow in its wake, starting all lives with 30 minutes of focused attention on listening might just be the thing that helps lead us on a path to healing. 

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