From the day they are born, babies’ motor movements and their social and emotional abilities steadily unfold and develop alongside their physical appearance. These changes, most of them completely normal, may still concern their mothers and fathers. An alteration in the shape of their baby’s head is an example of physical development that worries parents, according to Brazelton, a pediatrician and a child psychiatrist. A variation in levels of alertness is an example of a behavioral change in babies that confuses some parents. Some developments are subtle, like when a baby tracks its mother’s movements out of the corner of its eyes, while others – like smiling and laughing out loud – are dramatic and surprising to parents. When certain changes occur, or fail to occur, parents become anxious and worried, according to Brazelton. The list of parental concerns is long. They worry whether the baby will be able to grow teeth, sit, crawl, walk, talk, or develop a normal level of intelligence.
In his book Touchpoints – Birth to Three, Dr. Brazelton identifies certain stages in infant and child development where parents may need greater guidance in understanding what is happening in the life of their babies and toddlers, and outlines what clinicians can do to support them. Brazelton points out that every parental worry is an opportunity for the medical practitioner to explain what is going on in the body and the mind of the baby, and whether it is an expected but transient physical or emotional occurrence. Parents who understand what is causing a particular behavior in their children are generally eager to become part of the solution and participate in prescribed remedies, explains Brazelton. Part of what is driving the behavioral changes in the newborn is their maturing nervous system, as well as their developing desire to assert autonomy, in violation of the mothers’ natural tendency to remain in charge. Therefore, the more the mother tries to restrain the infant, the more the infant pushes back against the mother. Learning how to respect, recognize, and support what the infant is trying to accomplish is necessary for parents and children to develop good relationships.
Brazelton points out that parents should not expect their newborn to develop along a smooth upward slope. Setbacks can occur as the infant moves from one level of skills to a higher level. Sometimes a baby who has been walking for few days may abandon that achievement which the parents were so proud of and resume crawling. Giving parents an understanding of why retracing old steps in this way may not only be necessary but also healthy gives them peace of mind as they continue to raise and care for their children. Any parental concern is what Brazelton terms a touchpoint, providing an opportunity for the practitioner to give an insightful medical opinion, thereby enhancing parental understanding as well as alleviating their anxiety. Where necessary, he suggests, the clinician should preview the child’s unfolding development to parents so that they can be prepared for the normal behavioral changes. Being upfront with parents on what to expect in their newborn as it learns to sit up, crawl, and eventually walk is essential.
Although every pediatrician has their own style of interacting with children and their families, framing parental concerns and challenges encountered in child development in such a concise manner requires a tactful and knowledgeable approach. What each pediatrician brings up and discusses during routine office visits with families depends on his or her level of clinical experience, as well as their interest in child social-emotional development – an area which I feel many pediatricians have shied away from. But in addition to measuring the growth in height and weight of newborns and children, Brazelton reminds pediatricians and other practitioners to address this area of their social-emotional growth, as well as related parental concerns in this domain.
Anticipatory guidance – discussing with and preparing parents for what to expect in the growth and behavior of their children as they mature – is not a new concept. However, I believe that Dr. Brazelton has done much to not only revive that practice but enhance it, by pinpointing several problem areas (“touchpoints”) and offering excellent remedies, including how to dialogue with parents in an effective team approach.
Reference: Brazelton, T. “Touchpoints: Birth to Three . Edited by J. Sparrow.” (2006).
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