Donna Karl, MS, APRN, BC, is a nurse, educator and researcher at Children's Hospital Boston. She and her pediatrician colleague, Dr. Connie Keefer, have just published "Use of the Behavioral Observation of the Newborn Educational Trainer for Teaching Newborn Behavior." This article describes The BONET (Behavioral Observation of the Newborn Educational Trainer),"a learning aid that educates clinicians aboewborn behavioral organization, self-regulation skills, and interactive capabilities."(1)
Donna and I have been reading each other's work for a number of years and have recently corresponded about The BONET and The HUG. I appreciate the following story she shares with me today!
"As you, I love the work of facilitating parents' interest in their newborns and their understanding of how to interpret and respond to them. I know that there is evidence that early maternal-child programs are associated with improved outcomes in parenting, reduced abuse and neglect rates, and better school performance in children. If I didn't believe that what I do, even in the first few days of a baby's life, helps the family over the long haul, I'd not bother with behavioral interventions.
An example of the value of this intervention happened just today. I had a primip mom whose baby was extremely fussy. Mom began by telling me that when other people were around he was quiet, but he cried when he was with her. She recently had a large, excited family visiting the hospital, passing the baby around and talking loudly as he "slept." After they left and she was alone with her son, he cried inconsolably. She interpreted this behavior as meaning that he was relaxed and peaceful when the family was around, but upset and unable to be comforted with her. The truth was that he was closing down to protect himself from the visitors' commotion. Left exhausted by this commotion, he cried inconsolably from overstimulation when he was alone with her.
I showed her how to distinguish between close down (eyebrows knitted with eyes closed and fists clenched) and sleep. When we first started talking, her baby was closed down, but as she held him he relaxed and his face and hands lost their tension. We also talked about calming methods--an infant carrier, white noise, swaddling, sucking, vestibular stimulation. We wrapped him snuggly together and I showed her the "head and hiny hold," a vestibular calming maneuver. She practiced this maneuver, first being afraid to move him, then gaining more confidence, and finally succeeding in quieting him.
We also talked about temperament and how some babies need more help protecting themselves from stimulation and calming down.
By the end of the day, Mom was saying that she had had some quiet moments with him noticing that his face had been relaxed and not tense. She said that she was going to protect him from too much exposure to the extended family and had even engaged her mother to help her do that. Both were on board. Finally, she added that her mom had just told her that she herself had some of the same behaviors as a newborn. This revelation seemed to further relieve mom.
There was nothing profound about this intervention--not rocket science, as they say. You and I both do it every day. But by the afternoon, this mom was visibly less anxious and talking about her small successes in consoling the baby during the day. How can a change like this, regardless of how ordinary, not make some difference in the first few days? Of course, there are no guarantees. But hopefully, this mom will be able to build on her early "successes" in reading the baby's cues and responding to them and, eventually, go down a path of responsive parenting. She has also agreed to a referral to a home-based support program."
(1) JOGNN (2011) 40: 75-83.