Claudia M Gold M.D.

Child in Mind

Focus On What Parents Do Right, Not What We Do Wrong

Can we harness pediatrician T. Berry Brazelton's hopeful message?

Posted Mar 18, 2018

As our nation mourns the passing of renowned pediatrician T. Berry Brazelton, hearing his voice through the outpouring of articles, video clips, and conversations on social media feels like a balm for the soul.  In these trying times, his simple shift from learning "what's wrong" to listening for "what's right" in a child and family seems very much needed. 

In his 50 years practicing pediatrics, he saw up close the ways parents can struggle. With his profound observation that leaps in development are preceded by periods of disorganization, he helps us to see that the struggles are not to be avoided, but to be embraced and worked through. In collaboration with developmental researcher Ed Tronick, he showed how we learn and grow by repair of the countless inevitable disruptions in relationships. Together they offered "evidence" of pediatrician D.W. Winnicott's observations of the "good-enough mother" who facilitates her infant's growth and development by failing to meet his or her every need. Our very imperfections propel development forward in a healthy direction.

It seems somehow fitting that he died the same day as Stephen Hawking, who said, “Without imperfection, you or I would not exist.” One person on social media commented that Brazelton was to babies what Hawking was to the cosmos. 

 In a way that was revolutionary at the time, he called on us to protect time to listen to every new baby's unique voice. He was among the first to recognize the newborn infant's tremendous capacity for connection and communication. In a beautiful video clip shared on the Facebook page of Mind in the Making he describes his Newborn Assessment (NBAS) as "the most important thing I ever did for the field." He describes its origin in his observations of his own children that led him to recognize that "each child shaped the environment around them." He says, "My goal was to share the neonatal assessment with parents so they understood what kind of person they were getting." He describes parents asking,  "How am I going to know what kind of person this is?" and he observes that, "as soon as they play with the baby, they know." The idea the newborn infant is fully connected and available to play is one we need to hold front and center. 

In collaboration with Dr. Kevin Nugent, Dr. Brazelton's newborn assessment was translated into a clinical tool termed the Newborn Behavioral Observations (NBO) system. By eliminating the word "assessment" the NBO emphasizes the non-judgmental aspect of our observations. Parenting inevitably comes with a hefty dose of guilt.  The NBO does not test the parent or the baby, but simply protects time to listen to both. 

In our rural community in Western Massachusetts, we are taking steps to carry out Dr. Brazelton's dream that "every parent will have opportunity to give his or her child the best future they can dream of." By integrating the Newborn Behavioral Observation into routine care at our local hospital, and training a wide range of practitioners who interface with infants and parents in the NBO we aim to give every newborn baby a voice.

A line in the New York Times obituary gave me pause. 

Nevertheless, Dr. Brazelton’s work never entered mainstream pediatrics and is not taught in most medical curriculums.

Sometimes a person's genius is not fully appreciated until after death. I am hopeful that the attention now focused on his brilliant observations, and his deep empathy for both parents and children, will have new life. 

The impact of his work extends well beyond pediatrics. Not only is it relevant for all individuals on the front lines caring for young children and families. The idea that disorganization- or what Dr. Tronick refers to as  "messiness" -is not to be avoided, but rather embraced, worked through, and repaired, may have profound implications for the way we live our lives. 

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