Help HUG Your Baby celebrate, and thank, Dr. T. Berry Brazelton on his 100th Birthday!

Twenty years ago I drank a gin and tonic on my back porch with Dr. T. Berry Brazelton. He was visiting his son at UNC and asked me for a last-minute visit to learn more about my Touchpoints work at SAS Health Care Center in Cary, NC. Several years later he called to congratulate me on my newly released HUG Your Baby DVD. "You did what I always wanted to do," he said. "You made the behaviors of babies accessible to parents!"

This famous pediatrician and Harvard professor reshaped the view of infants and children around the world--and changed my life forever. Every day I enter an exam room or living room to see a new parent, I practice what he taught me: to SEE, and to SHARE, a baby's behavior with her parents.

Many of you know of Dr. Brazelton's primary contributions: the Neonatal Behavioral Assessment Scale (NBAS) and Touchpoints. I was certified in both and spent decades "translating" them for primary care and lactation patients, and birth and parenting professionals, both in North Carolina and in 20 countries around the world.

The NBAS, used mostly as a research tool, looks ever so closely at an infant by evaluating 28 behaviors (on a 9-point scale) and 20 other neurological items (on a 4-point scale). This scale (highlighted in my HUG Strategies online course) has been used to illuminate the impact on a newborn, among other issues, of smoking during pregnancy, of newborn jaundice, and of skin-to-skin care. It also identifies challenging traits in a baby (such as frequent state changes, high activity level, or low interactive abilities) that can interfere with the developing parent-child relationship.

Dr. Brazelton's Touchpoints work (highlighted in my Roadmap to Breastfeeding Success online course) taught me how a surge in a baby's development can temporarily disorganize that baby's eating, sleeping, and/or general disposition. Parents who do not understand or anticipate such a change in behavior can feel more confused and less close to their baby, and may add formula or give up breastfeeding altogether.

We have LOTS to be thankful for as Dr. Brazelton turns 100! Join me in Boston if you can on April 23, 2018, to celebrate his life and achievements with hundreds of his fans! Click HERE for more info about the birthday gathering.

If you are unable to attend, please email me (jan@hugyourbaby.org) a short written tribute to Dr. B., and I will create a HUG Your Baby "thank you" gift to pass on to him.

"Touchpoints" and a One-Month-Old

As I enter the room Keema, Katherine and Roberta's robust one month old, is wiggling in Katherine's lap.  As I walk closer to these mothers, Keema  turns toward mother's breast. Mom looks tired as she leans over, picks up and undresses her daughter for her check up. 

Breastfeeding has gone wonderfully for the trio. As a full term baby, Keema crawled right up to Katherine's nipple within thirty minutes of birth. Lots of time spent skin to skin and frequent breastfeeding contributed an abundant milk supply.  She seemed predictable now and was sleeping for at least four hours at night. Mom was up for only two quick feeding during the night.

But now life is different. 

Keema is wiggling and squiring after only one hour of sleep. The baby nurses for for few minutes then drifts off to sleep again. Her nap also seems more unpredictable. She goes down, wiggles and squirms and fussies until Katherine puts her to the breast. Keema is more gassy now and her stools have become oddly green. Katherine and Roberta wonder if their baby is really hungry and might need some formula. "Maybe I don't have enough milk," Katherine say.

What an interesting example of when a "Touchpoints" has been misunderstood and actually creates a breastfeeding problem. 

"Touchpoints" is a time when a baby is having a developmental surge causing a change in her breastfeeding pattern. These times of change are predictable. Breastfeeding mothers can misunderstand this behavioral change and give formula or abandon breastfeeding. 

I took time to show these mothers The HUG video demonstrating the difference between Active/Light and Still/ Deep Sleep. Katherine laughed right away when she saw Active/Light Sleep. "That's exactly what she looks like!"

And in the case, frequent "Snacking" by this one month old was causing symptoms of "Lactose Overload": increased gassiness and green stools. The condition quickly resolves when Katherine follows this advice: 

• Watch for Active/Light Sleep. Let the baby wiggle and squirm a few minutes and baby will probably return to Still/Deep Sleep. 
• Breastfeed fully from one breast to get the higher calorie (and lower lactose) at each feeding.

Within only three days, Keema's stools are back to yellow and gassiness has resolved. Even more exciting, these moms have watched their little one wiggle from Active/Light back to Still/Deep Sleep. Mothers and baby are both sleeping better. 

HUG Teaching: What's a "Lovie"?

Baby cuddles up with her "Lovie"

The HUG Your Baby's Roadmap to Breastfeeding Success (now available in English, Korean, Japanese, Italian and Spanish) makes mention of “using a ‘lovie’” at nine months and at twelve months to help babies through the developmental challenges of those time periods. (See Roadmap at bottom of blog).

Use of a “lovie” may have cultural roots in countries like the USA, where maternity leave is minimal, availability of extended families is limited, and returning to work is necessary for most young mothers who have bills to pay. However, this practice is grounded in well-established child development theories and is offered as one possible “tool” for mothers wanting to extend breastfeeding duration. (Additional critical steps to achieving the international goals for exclusive breastfeeding are reviewed in other HUG Your Baby blogs.)

Child development literature is conclusive that babies must have attentive, responsive care from family during the first year of life so that the rapidly growing brain develops to its full potential, laying the foundation for lifelong, healthy emotional attachment and psychological growth. Learning to read a baby’s feeding cues, to notice early signs of over-stimulation, to respond toinfant crying, and to appreciate a baby’s active and deep sleep cycles are all important tasks of sensitive parents who seek optimal parent-child attachment and want the best for their child.

As a securely attached baby approaches his first birthday, a parent will begin to see proof of her baby’s important mental development. A mother might notice her baby glance over to her or her partner when a neighbor picks up the baby—a behavior that displays an important cognitive achievement called “social referencing.” As months go by, “stranger anxiety” (also known as “separation anxiety”) replaces the more “polite” social referencing. This baby now clearly knows that “those people are my parents” but “you are not!”

By nine months the baby initiates games that reflect a new surge in her mental capacities. She squeals with delight when she drops a spoon and sees Mom retrieve it. She laughs uncontrollably when her brother plays “hide and seek,” or she giggles triumphantly when her father plays “peek-a-boo.” These games demonstrate the baby’s cognitive growth toward “object permanence”: the concept that “things that go away can come back.” This developing object permanence also contributes to increased stranger and separation anxiety.

The work of Dr. T. Berry Brazelton helps us understand that a surge in a baby’s cognitive, social or physical development typically causes temporary changes in a baby’s eating, sleeping or general behavior. (CLICK HERE to learn more about his theory of Touchpoints). Suddenly the world seems bigger to the young child, and thus, momentarily, a bit more frightening too.

The nine-month-old who had been sleeping through the night may now wake up more often and cry for her parents. Parents who do not know about, and anticipate, this normal change in development might believe the baby is hungry. If babies have been sleeping five to eight hours at night without eating, they do not now need more nighttime calories. Nevertheless, formula-feeding mothers might give a new nighttime bottle and breastfeeding mothers might resume more frequent nighttime breastfeeding.

Adding nighttime bottles and calories to the diet of a formula-fed baby can contribute to overfeeding and obesity. Though it is believed that breastfed babies[i] will not overeat, they may temporarily shift daytime calories to the nighttime if increased nighttime breastfeeding is offered.

Although giving more calories at night is not necessary, some mothers prefer to use breastfeeding to comfort her child. Certainly, breastfeeding is a source of both nourishment and nurture for every child. However, other breastfeeding mothers may be exhausted by the return of frequent nighttime awakenings, may worry that they now have insufficient milk, and may even consider weaning. 

This is when the “lovie” can be useful.

Parents can incorporate a small blanket or stuffed animal (i.e., a “lovie,” or "transitional object" in the professional jargon) into their cuddles with the baby throughout the day. Within a few days the baby will associate the closeness she feels with her parents with this sweet “lovie.” Then, when the baby needs her parents at night, the mother or father can comfort the child without feeding him by cuddling him up with his “lovie.” After a week or so of more frequent night time awakenings, most children become accustomed to the world of “object permanence” and resume their regular sleep patterns.

The next important Touchpoint, or developmental step, occurs when a baby begins learning to walk (at around one year of age). Babies this age again show disruption in their eating, sleeping or general behavior as they strive to become upright! The “lovie” can be used again to help comfort this child back to sleep without adding nighttime feeds. Of course, increased nighttime breastfeeding (as a comforting technique) may be the best option for some, but not all, mothers.

Parents who have chosen to add more nighttime feeds or breastfeeding might wonder how to get back to a regular, daytime eating pattern. Every few days a formula-feeding mother can cut in half the amount of formula in each bottle and incorporate the “lovie” into the nighttime feeding routine. A breastfeeding mother can cut in half the duration of each nighttime feed, as well as use the “lovie.” Usually, within a week or so, the baby will no longer require extra calories at night.  And after the developmental surges of separation anxiety and learning to walk have passed, the baby can continue to use the “lovie” to help him return to a good night’s sleep.

The HUG Your Baby Roadmap to Breastfeeding Success suggests,
"Incorporate 'Lovie'" into breastfeeding routines at nine and twelve months.

---

[i] Recent research suggests that babies fed pumped breast milk mostly by bottles may run the same risks of overeating and obesity that apply to formula-fed babies.

Home: Dr. Brazelton's "Eye-Ball Exercises"

“Eye-ball exercises” is a HUG Your Baby technique that we teach in order to see more of a baby’s behavior, to notice more of a parent’s interaction, to “Gaze and Engage” more intentionally with the lives before us. I am hopeful that my own vision will sharpen as my husband, Jim Henderson, and I travel from country to country this year and meet young families.


As Jim and I begin our travels, it seems prudent to read of the experiences of my greatest mentor, Dr. T. Berry Brazelton, in his new memoir, Learning to Listen: A Life Caring for Children. As we fly toward Kona, Hawaii, I am delighted to read how Dr. Brazelton practiced what I call “eyeball exercises” while he and his family visited with Mayan (Zinacanteco) families in Chiapas, Mexico, in the early ‘70s. His fourteen-year-old daughter, Kitty, facilitated Dr. Brazelton's access to the lives of mothers and babies in a culture that restricted visits by non-family males to order to protect their child from a potential “evil eye.” Enjoying the local fashion in dress and head gear, Kitty was her father’s “ticket” into these home.

There he witnessed a Zinacantecon birth—along with sixteen relatives, chickens, and dogs, all “there for” the laboring mother. The mother was completely quiet, but with each labor pain, the attendants, and animals, all groaned, howled and crowed through each contraction. A healthy baby boy was born.

With intention to keep a newborn calm, the baby was put to the breast with every wiggle—up to 90 times in a day! The goal of a docile baby was further reinforced by being held in close proximity to the mother for several months and later wrapped in a robozo (effectively swaddled) for several more months to protect him “from losing his soul.” Never put to the floor to practice crawling or standing, the babies were noted to have a temporary delay in motor activity yet walked, as North American children did, by thirteen to fifteen months. However, the Zinacantecon children had REMARKABLE alerting ability and sensitivity to visual and auditory stimuli. With muscle activity restricted, Dr. Brazelton could get a newborn to visually follow a moving toy or his face for a full 30 minutes—a feat he had never experienced with a North American baby.

Here comes that perennial “chicken or egg” story. Do genetics convey characteristics needed for success in a culture, or do parents reinforce (beginning with the newborn) the values and needs of that culture? Dr. Brazelton writes, “We came to realize through our developmental research, that culture not only transmits the content of socialization, it transmits processes of learning and teaching that maximize cultural continuity and minimize deviation.”

Of course I must avoid making general assumptions from unique observations. But appreciating what behaviors are noticed by a parent, how that parent responds to her baby, and what those behaviors mean in different cultures will be of interest to Jim and me as we set eyes on foreign lands and engage with the families we will encounter.

"Touchpoints" in Everyday Life

As I enter the room Keema, Katherine's energetic eleven month old, is standing beside mom's chair. As I walk into the room Keema momentarily turns toward and glances at her mom before reaching a chubby hand in my direction. She takes two wobbly steps toward the exam table where she then goes on about her business of exploring the chair, nearby drawer, and rolling stool. I seem to bore her right now.

Mom looks tired as she leans over, picks up and undresses her daughter to show me her summer-time diaper rash. Keema twist and squirms on the table communicating quite clearly that she was not done with her investigation of the room and her practice walking.

The diaper rash is easy to care for. Hearing and responding to mom's concern about her daughter's behavior is more challenging.

Katherine describes a long weekend in Richmond at her favorite family reunion. She explains that her family reunions get bigger every year as sisters, cousins, and nieces become new moms. Last year Keema had gone as a newborn and mom had enjoyed the extra attention she and the baby has gotten as well as the special rest she had received in this community of loved ones.

This vacation was different. Keema would go to bed as usual, then cry 2-3 times at night (something all family members did not appreciate!) Mom would find her standing in her crib "looking like she was really mad 'cause she couldn't figure out how to lay back down." Katherine has already appreciated that her girl was "strong willed and has a mind of her own." But Katherine explains that her daughter seemed more out of sorts this past week and did not call forth the same adoration for family members as mom had experienced the year before. "This reunion seems more like 'work' than 'vacation' and I'm just plain worn out."

This is a Touchpoints moment and an opportunity for me to connect significantly with this mom . As I watch Keema toddle around the room I reflect on her activity. "She has that wide-based gait of a new walker and hold her arms rather stifly in order to keep her balance. She almost lunges from one hand hold to the next and doesn't mind a few tumbles to the floor, " I say. Mom giggles at all the details of this newest milestone and perks up quickly as I go own to explain the concept of how a developmental surge like this almost always impacts a child sleep for a week or two. We discussed the how mom could help her practice getting back down from standing during the day so her girl would not be so frustrated at night. In addition we discussed that "A, B, C" (Attention that is Boring AND Caring") approach to night-time parenting of the toddler. (See upcoming blog on this "A,B,C").

Mom laughs and rubs her baby's curly head. I can just imagine how this new information will play out at nest Sunday's mom-to-mom family brunch. This young mom will be the newest "expert" as she shares how these temporary "ups and downs" at night are just proof of her child's normal and dynamic development.

© HUG Your Baby 2010

"Touchpoints" in Everyday Life

As I enter the room Keema, Katherine's energetic eleven month old, is standing beside mom's chair. As I walk into the room Keema momentarily turns toward and glances at her mom before reaching a cubby hand in my direction. She takes two wobbly steps toward the exam table where she then goes on about her business of exploring the chair, nearby drawer, and rolling stool. I seem to bore her right now.

Mom looks tired as she leans over, picks up and undresses her daughter to show me her summer-time diaper rash. Keema twist and squirms on the table communicating quite clearly that she was not done with her investigation of the room and her practice walking.

The diaper rash is easy to care for. Hearing and responding to mom's concern about her daughter's behavior is more challenging.

Katherine describes a long weekend in Richmond at her favorite family reunion. She explains that her family reunions get bigger every year as sisters, cousins, and neices become new moms. Last year Keema had gone as a newborn and mom had enjoyed the extra attention she and the baby has gotten as well as the special rest she had received in this community of loved ones.

This vacation was different. Keema would go to bed as usual, then cry 2-3 times at night (somthing all family members did not appreciate!) Mom would find her standing in her crib "looking like she was really mad 'cause she couldn't figure out how to lay back down." Katherine has already appreciated that her girl was "strong willed and has a mind of her own." But Katherine explains that her daughter seemed more out of sorts this past week and did not call forth the same adoration for family members as mom had experienced the year before. "This reunion seems more like 'work' than 'vacation' and I'm just plain worn out."

This is a Touchpoints moment and an opportunity for me to connect significantly with this mom . As I watch Keema toddle around the room I reflect on her activity. "She has that wide-based gait of a new walker and hold her arms rather stifly in order to keep her balance. She almost lunges from one hand hold to the next and doesn't mind a few tumbles to the floor, " I say. Mom gigles at all the details of this newest milestone and perks up quickly as I go own to explain the concept of how a develpments surge like this almost always impacts a child sleep for a week or two. We discussed the how mom could help her practice getting back down from standing during the day so her girl would not be so frustrated at night. In addition we discussed that "A, B, C" (Attention that is Boring AND Caring") approach to night-time parenting of the toddler.

Mom laughs and rubs her baby's curly head. I can just imagine how this new information will play out at nest Sunday's mom-to-mom family bruch. This young mom will be the newest "expert" as she shares how these temporary "ups and downs" at night are just proof of her child's normal and dynamic development.

Understanding and Responding to a Touchpoint (Part II)

See Touchpoints (Part I) for the story of Martha and her nine-month-old, Molly, who is up many times at night, refusing her morning cereal, and grumpy and crying at childcare.

I had time to speak with Martha about the normal Touchpoints which occur during the first two years of a baby's life. Specifically, we discussed the "Separation (or Stranger) Anxiety" (as described by Piaget) that was plaguing Molly's (and Martha's) life right now.

Once Martha understood that Molly's behavior actually represented important growth in her baby's development, Martha seemed to relax. "But, are there things I can do to help both of us out?" Martha asked. And YES! there are.

Molly needs comforting as she passes through this phase of life, and Martha wants to respond lovingly but without creating new nighttime "habits." So Martha is keen on learning how to "wean" Molly from how much of you she needs at night!

When Molly cries the next night, Martha goes to her quickly, picks her up, but does not nurse her. She pats her back, speakes lovingly to her, and rocks her back to sleep. The following night Martha responds to the baby's cries quickly once again, but this time does not pick her up. Instead, Martha gently pats the baby's back and speaks quietly and reassuringly into Molly's ear. Molly calms down and returns to sleep. The next night Martha responds to her daughter again, but this time pats her back but without speaking. Again, Molly calms down and returns to sleep. Two nights later Martha responds to the baby's cry as usual but this time stands sweetly beside the baby's bed. The baby looks up and returns to sleep. The next night, and thereafter, Molly sleeps through the night.

Molly and Martha have returned to sleeping at night. In a few more days, Molly enjoys her morning cereal with a smile on her face and no longer cries when left at childcare. Martha is able to go to work with a smile on her face, and not be exhausted and anxious as she does her job.

What a wonderful job this duo has done! Molly seems invigorated by a newfound understanding of the world and her mom by a newfound understanding of her daughter. Martha reads up on that next Touchpoint (which begins when the baby starts to walk, around twelve months) and is determined to meet this challenge with the wisdom and confidence she is learning to have as a parent.

Read more on the Touchpoints philosophy and techniques.