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, January 16, 2017

Protesting Trump's Inauguration with Action: Baby Steps

While protests occur across the country in multiple forms around the inauguration, I will be ensconced at a 5-day Group Relations Conference. While perhaps what I write will come across as justification for my absence from these events, I see this activity as representing a protest of a different kind.

 I am attending the conference as part of my new job offering a range of supports in our local community for the parents of newborns aimed at fostering healthy relationships from the start of life.  

In these troubling times, in addition to gathering in large numbers to show our opposition to the many deeply concerning things our incoming president says and does, I hope that taking small steps every day to support human connection will promote positive change.  The following story from my behavioral pediatrics practice offers an example of one such baby step.

Bonnie's face, darkened by fatigue, communicated sadness bordering on despair. Living in poverty and alone in caring for her two-week-old daughter Jasmine after the baby's father abandoned them, she hobbled into my office, barely managing the weight of the sleeping infant bundled in her carrier. Bonnie slumped into a chair, unleashing a string of worries about her daughter's health and her precarious living situation. 

Referred to me by a wise colleague who saw the vulnerability in this pair, their needs seemed overwhelming as I sat quietly, thinking of how best to use our 50 minutes together. I suggested we see what Jasmine could tell us about herself. With Bonnie nodding her assent, I reached for my NBO toolkit.

Early in his work as a general pediatrician in the 1950s, T. Berry Brazelton, recipient of Obama's Presidential Citizen's Medal, observed the tremendous capacity of the newborn infant for complex communication. Research based on these observations led to development of the Neonatal Behavioral Assessment Scale (NBAS). The scale changed the way both child development experts and pediatricians understood babies. The Newborn Behavioral Observations System (NBO), a relationship-building tool that has as its core an opportunity for listening without judgment, is a clinical application of the NBAS developed by psychologist J. Kevin Nugent and colleagues. 
While Bonnie held the sleeping Jasmine in her arms, I performed what are referred to as the "habituation items" of the NBO. These examine a young infant's ability to protect sleep. When I shone a light in her face and she barely flinched, Bonnie proudly proclaimed, "She's a great sleeper."
Next we sat on the floor and, as Jasmine roused herself from a deep sleep, we described our observations about her movements. "She's so strong!" Bonnie exclaimed. Her mood shifted gradually as she saw how Jasmine supported her head while we held her in a sitting position, and then made rudimentary crawling movements when we placed her on her belly. (As always, I used this as an opportunity to counsel about having the baby sleep on her back.) 
By the time we moved on to the orienting items and observed how Jasmine turned to her mother's voice and followed a bright red ball, Bonnie was positively joyful. When she stood at the front desk to schedule a follow up appointment, her transformed mood seemed contagious as office staff and other waiting families admired Jasmine and shared in Bonnie's exuberance. 
The poverty, isolation, and stress plaguing this mother-baby pair remain. Addressing these problems will take both time and broad social change. But in light of the 700 new connections per second a newborn brain makes in the context of caregiving relationships, these 50 minutes could hold great significance.
I see this visit as a kind of metaphor. In parallel with large-scale vigilant attention to the actions of the incoming administration, we must also value taking even the smallest actions every day against forces of hate and intolerance, moving our world in the direction of love and human connection.