Know your baby
Babies can tell us who they are and what they need if we can recognise the signs, according to Irish psychologist Dr Kevin Nugent
IT IS NOT the first time I laid eyes on my eldest child in the delivery room that I remember most clearly, but rather a moment some hours later when it was just him and me alone in the hospital room.
The exertion and mess of labour were over, my husband had gone home and I was about to climb into bed for much needed rest. I stood looking down at my peacefully sleeping baby in the cot beside me, his perfectly formed face a little battered from the momentous journey.
A surge of love, undoubtedly mingled with relief that we had both arrived at this point in good health after months of wondering and worrying, almost took my breath away. I had discovered new heights of happiness, which I believe only parents are lucky enough to access.
Dr Kevin Nugent, a Boston-based Irish psychologist specialising in the development of newborns, sees the transformative power of infants over and over again in his work. “I thought in the past that parents change babies, but babies change parents,” he says.
Babies work on us from day one, not just by looking cute, but through a wide range of what he calls “stunningly precocious communication strategies”. They are telling us who they are and what they need, if only we have time to stop, listen and can recognise the signs.
Nugent is passionate about helping parents understand their baby’s cues, so that they can respond appropriately and build a joyous relationship. There are few things more anxiety-inducing than having a bawling baby in your arms and not knowing what the problem is and what to do.
It is very stressful for the baby too. Biologically, babies expect to be cared for and he has seen the beginnings of depression in babies of just three or four weeks when their needs are not being met.
“They are almost puzzled because there is no match between what they need and what they are getting.” The key is to find that match for a mutually satisfying relationship between parent and infant and lay down rock-solid foundations for a lifelong attachment.
The day Nugent first witnessed a newborn’s readiness and capability to engage with her environment, and the dramatic effect it had on her mother, was a turning point in his own life. It came while on a ward round in a Boston hospital with a pioneer in infancy research, Dr Berry Brazelton.
Fresh to his career in psychology and not yet a father, Nugent was astounded by the day-old baby’s ability to lock her eyes onto a bright red ball held out by Brazelton and to track its movement. When the doctor talked to baby Sarah, calling her by name, her eyes widened and brightened.
The watching mother’s reaction also made a deep impression on him. She was overcome by her baby daughter’s responses, her eyes filled with tears and she held the baby close to her breast, repeating her name and suddenly oblivious to the crowd of white coats around her.
“I was struck by the strength and tenderness of the mother-infant bond. It was as if this mother had just discovered the sheer depth of her feelings toward her baby,” he writes in the introduction to his latest book, Your Baby Is Speaking to You, a visual guide to the behaviours of newborn babies and what they mean.
He traces his interest in infant development back to that moment, more than three decades ago. He also realised at the time how his responses to baby Sarah in the ward that day were an echo of his childhood. The eldest of five children growing up in Mullingar, Co Westmeath, he was just 11 when his mother, who suffered from multiple sclerosis, died.
“I was totally lost and feeling abandoned,” he recalls. “At that time, you can imagine, not many people talked about it. You were left in a terrible abyss, trying to understand it.”
He took responsibility for looking after his baby brother, Joe, who was only a few months old. Looking back, he sees how caring for this infant was “a rebirth for me”.
“He brought out something of hope in me – that there was a future. It helped me overcome my sense of desolation. I had forgotten about that until the moment with Berry and I saw the effect the baby had,” he explains in a gentle voice.
Nugent went on to specialise in the study of newborn babies and co-authored with Brazelton the Neonatal Behavioural Assessment Scale, which is used in many hospitals. He is now director of the Brazelton Institute at Children’s Hospital, Boston where he and colleagues developed a simpler, Newborn Behavioural Observations (NBO) system, designed to build a profile of a baby through a set of 18 different observations and manoeuvres to explore responses.
NBO is not diagnostic, he stresses, but rather a relationship-building tool. “It is simply to help parents see what this little baby is trying to say to them.”
He is sure it captures the core of the child – “I know it sounds outrageous,” he says with a smile over coffee in a Dublin city centre hotel. But he can examine a baby and, in some cases, be sure it is going to be very easy for parents and in other cases know that a baby is going to be very challenging.
NBO enables you to see the baby very much as a person, he explains, with individual strengths and vulnerabilities. How does the baby protect his sleep? Can he develop good wake-sleep patterns, which are so crucial in the first few weeks? What makes him cry and what does he want when he cries? When he is alert, how open is he to social interaction and what is too much?
Nugent and his wife, Una, are in their homeland for a holiday, during which the Children’s Research Centre in Trinity College Dublin last week marked the publication of his book in the US with a reception. It is a visually stunning collaboration with photographer Abelardo Morell who, over a year, captured images of babies as Nugent conducted NBO sessions.
The final selection of full-page black and white photographs (three of which are on these pages) illustrate infant behaviours and expressions, while the text explains what they mean in terms of a baby’s growth and development.
Crying is the clearest form of communication, although it can signal different things – hunger, pain, discomfort, exhaustion – and parents have to learn to interpret. The subtlest colour change, tremors, startles, frowns, furrowing of the brow, tightening of the toes, all say something about a baby’s personality and temperament.
Nugent sees so many anxious parents, he wanted to make the knowledge of NBO accessible to them – and, indeed, extended family – so that they could “pull back and enjoy their babies”.
Professionals in maternity hospitals use NBO to help predict what support parents may need in those vital, early months. While they target those considered at risk, no group has a monopoly on being “at risk”, he points out.
Educated professionals “can be totally knocked off their pedestals” by the arrival of a baby, who does not conform to their expectations. If they are given a chance to recover from their initial shock, they can, with the right support, begin to develop a sense of joy and delight in the baby. “I think knowledge does not make them more anxious but liberates them.”
Nugent recalls a day when a baby was being discharged from the neo-natal care unit and the chief nurse called him in to examine the infant before his mother, who was there on her own, brought him home.
The baby had low muscle tone, but at one stage opened his eyes and was very responsive to Nugent. “I said to the mum, ‘Would you like to call his name?’ She called him and he turned and looked her in the eye. She picked up her son and kissed him and said, ‘You know me!’.
“It was dramatic because I only found out afterwards that the baby had a diagnosis of Down syndrome.
“It was as if the veil was pulled away and she was seeing for the first time that she could get to know this little baby. He was not just a diagnosis, he was a person. He was no longer a baby with Downs, he was her baby. At its best, that is what NBO can do.”
One study suggests that the use of NBO reduces the risk of post-natal depression – “my interpretation is that the baby joins us in the cure as a therapeutic partner”, he says.
At a time when there is a proliferation of parenting gurus in the media, Nugent is very clear that he is not in the business of giving advice.
“The moment you give advice, the door is closed. You take away the opportunity for parents to grow into their own skins as parents” – taking into account their needs, their baby’s needs and the cultural preferences of the society in which they are living.
The goal is to “validate” the parents and help them see how their baby is the ultimate guide to what they should be doing – rather than the mother-in-law, sister Sue or Auntie Maureen, whose babies would have been different. “I would like parents to develop their own sense of confidence that they know their baby.”
He also wants to impress on fathers, in particular, the importance of those first days, weeks and months. Some men think they will only establish a relationship with a child when they can start kicking a ball around together in the garden.
“By the time your baby speaks his first word, a lot of water has gone under the bridge,” Nugent says. The possibilities for relationship-building are still there of course, but it is in the first few months that the most formative part of the relationship is consolidated.
An author of at least eight academic books, this is Nugent’s first non-academic book and it is the one that has given him the greatest pleasure. He is gratified by the public response.
My only issue with the book is that it really should carry a health warning on the cover for those whose children are past the baby stage: “Opening these pages can make you seriously broody . . . ”
Your Baby is Speaking To Youby Dr Kevin Nugent with photographs by Abelardo Morell is published in the US by Houghton Mifflin Harcourt.
Hand to mouth:
A baby's "remarkable ability" to get his hand or fist into his mouth -even when he is not hungry - is no random movement. He may do it when he is upset and then settle himself by sucking on it, enabling him to remain alert and examine his surroundings. By this simple act, "your baby is showing you how competent he is and how, even in these early days, the urge to explore his new world is paramount", writes Nugent.
Overstimulation:You might mistake the little boy's wide-eyed stare for a look of surprise or intense interest, but in fact he is saying "back off". A slight turning away of the head, arched eyebrows and too-wide eyes are all signs, according to Dr Kevin Nugent, that he is overstimulated.
Cuddly baby: Many babies are naturally cuddly and as they nestle into your neck, the physical contact stimulates a release of oxytocin - often referred to as the "love hormone" - in the endocrine system. This starts a reinforcing cycle, Nugent explains, as the oxytocin encourages the parent to prolong the contact, which in turn releases more oxytocin. However, parents who find that their newborn seems to resist cuddles by going rigid, should not take that as rejection. It is just a matter of finding another way of sharing physical contact that suits the baby's style and disposition.