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What do babies and young children really need? For the first time, two famed advocates for children cut through all the theories, platitudes, and controversies that surround parenting advice to define what every child must have in the first years of life. They lay out the seven irreducible needs of any child, in any society, and confront such thorny questions as: How much time do children need one-on-one with a parent? What is the effect of shifting caregivers, of custody arrangements? Why are we knowingly ...
What do babies and young children really need? For the first time, two famed advocates for children cut through all the theories, platitudes, and controversies that surround parenting advice to define what every child must have in the first years of life. They lay out the seven irreducible needs of any child, in any society, and confront such thorny questions as: How much time do children need one-on-one with a parent? What is the effect of shifting caregivers, of custody arrangements? Why are we knowingly letting children fail in school? Nothing is off limits. This short, hard-hitting book, the fruit of decades of experience and caring, sounds a wake-up call for parents, teachers, judges, social workers, policy makers-anyone who cares about the welfare of children.A Merloyd Lawrence Book
The Need for Ongoing
Although consistent nurturing relationships with one or a few caregivers are taken for granted by most of us as a necessity for babies and young children, often we do not put this commonly held belief into practice. The importance of such care has been demonstrated for some time. The films of René Spitz and the studies of Spitz and John Bowlby revealed to the world the importance of nurturing care for the physical, emotional, social, and intellectual health of children and the dire consequences of institutional care. Other pioneers, such as Erik Erikson, Anna Freud, and Dorothy Burlingham, revealed that to pass successfully through the stages of early childhood children require more than a lack of deprivation; they require sensitive, nurturing care to build capacities for trust, empathy, and compassion.
More recent studies have found that family patterns that undermine nurturing care may lead to significant compromise in both cognitive and emotional capacities. Supportive, warm, nurturing emotional interactions with infants and young children on the other hand, help the central nervous system grow appropriately. Listening to the human voice, for example, helps babies learn to distinguish sounds and develop language. Interactive experiences can result in brain cells being recruited for particular purposes—extra ones for hearing rather than seeing, for instance. Exchanging emotional gestures helps babies learn to perceive and respond to emotional cues and form a sense of self. Brain scans of older individuals show that experiences that are appropriately emotionally motivating and interesting harness the learning centers of the brain differently from experiences that are either over- or understimulating.
Deprivation or alteration of needed experiences can produce a range of deficits. When there is early interference with vision, for example, difficulties have been observed ranging from functional blindness to problems with depth perception and spatial comprehension. Emotional stress is also associated with changes in brain physiology.
In general, there is a sensitive interaction between genetic proclivities and environmental experience. Experience appears to adapt the infant's biology to his or her environment. In this process, however, not all experiences are the same. Nurturing emotional relationships are the most crucial primary foundation for both intellectual and social growth.
At the most basic level, relationships foster warmth, intimacy, and pleasure; furnish security, physical safety, and protection from illness and injury; and supply basic needs for nutrition and housing. The "regulatory" aspects of relationships (for example, protection of children from over- or understimulation) help children stay calm and alert for new learning.
Research with newborns by one of us (T. B. B.) shows that a newborn baby will attempt to keep himself under control in order to look and listen to cues around him. He will put together four midbrain reflexes—tonic neck, Babkin hand to mouth, rooting, and sucking—in order to stay alert. If he cannot succeed, and loses control, he will use the human voice or touch to reinforce his effort to regulate his "state" toward alertness.
By eight weeks of age, this same research shows, he will be able to distinguish and respond differentially to his mother's versus his father's versus a stranger's voice and face. He is quietly alert to his mother, ready for a playful interaction with his father. Each of these important people will have learned his rhythms and cues and he will have created an expectancy to react appropriately with them. These are the ingredients for a strong sense of self-esteem in the future, and for the motivation for learning later on. In addition, this learning is fueling his ability to maintain impulse control for the future. The most important learning in the early years is provided by human interaction. Objects and learning devices do not compare.
One of us (S.I.G.) has shown that relationships and emotional interactions also teach communication and thinking. Initially, the infant's communication system is nonverbal. It involves gestures and emotional cueing (smiles, assertive glances, frowns, pointing, taking and giving back, negotiating and the like). From these, there emerges a complex system of problem-solving and regulating interactions that continue throughout the life of the individual. Even though this nonverbal system eventually works in conjunction with symbols and words, it remains more fundamental. (For example, we tend to trust someone's nonverbal nod or look of approval more than words of praise, which are sometimes misleading; and we shy away from a person with a hostile look even if the person says, "You can trust me.")
When there are secure, empathetic, nurturing relationships, children learn to be intimate and empathetic and eventually to communicate about their feelings, reflect on their own wishes, and develop their own relationships with peers and adults.
Relationships also teach children which behaviors are appropriate and which are not. As children's behavior becomes more complex in the second year of life, they learn from their caregivers' facial expressions, tone of voice, gestures, and words what kinds of behavior lead to approval or disapproval. Patterns are built up through the give-and-take between children and caregivers. Importantly, along with behavior, however, emotions, wishes, and self-image are also coming into being. The emotional tone and subtle interactions in relationships are vital to who we are and what we learn.
Relationships enable a child to learn to think. In his interactions, the child goes from desiring Mom and grabbing her to saying "Mom" and looking lovingly. He goes from "acting out" or behaving his desires or wishes to picturing them in his mind and labeling them with a word. This transformation heralds the beginning of using symbols for thinking.
Pretend or imaginative play involving emotional human dramas (e.g., the dolls hugging or fighting) helps the child learn to connect an image or picture to a wish and then use this image to think, "If I'm nice to Mom, she will let me stay up late." Figuring out the motives of a character in a story as well as the difference between 10 cookies and 3 cookies will depend on this capacity.
The ability to create mental pictures of relationships and, later, other things leads to more advanced thinking. For instance, a key element essential for future learning and coping is the child's ability for self-observation. This ability is essential for self-monitoring of activities as simple as coloring inside or outside the lines or matching pictures with words or numbers. Self-observation also helps a person label rather than act out feelings. It helps him to empathize with others and meet expectations. The ability for self-observation comes from the ability to observe oneself and another in a relationship.
We have thus come to understand that emotional interactions are the foundation not only of cognition but of most of a child's intellectual abilities, including his creativity and abstract thinking skills.
This recognition of the role of early emotional interactions in intellectual functioning is not the same as Howard Gardner's important idea of separate, multiple intelligences, or Antonio Damasio's research on the brain which suggests that emotions are important for judgment but somehow separate from academic capacities or overall intelligence. We do not see these as separate. Jean Piaget, the pioneering cognitive psychologist considered the child as a causal thinker once he can learn that pulling a string brings the sound of the ringing bell. However, this is not the child's first opportunity to learn about causality. A baby's first lesson in causality occurs many months earlier, when he learns that a smile brings a responsive smile of delight to his parent's face. The child then generalizes this emotional lesson to the physical world. We have been able to identify how affective or emotional interactions lead the way at each stage.
Emotions are actually the internal architects, conductors, or organizers of our minds. They tell us how and what to think, what to say and when to say it, and what to do. We "know" things through our emotional interactions and then apply that knowledge to the cognitive world.
For instance, when a toddler is learning whom to say "hello" to, he doesn't do this by memorizing lists of appropriate people. Experience leads him to connect the greeting with a warm friendly feeling in his gut that leads him to reach out to other people's welcoming faces with a verbalized "Hi!" If he looks at them and has a different feeling inside, perhaps wariness, he's more likely to turn his head or hide behind your legs. We encourage this kind of "discrimination" because we don't want our children to say "Hi!" to strangers. We want them to say hello to nice people like Grandpa. If a child learns to greet those people in this way, he will quickly say "Hi!" to a friendly teacher or to a new playmate. He carries his emotions inside him, helping him to generalize from known situations to new ones, as well as to discriminate or decide when and what to say.
Even something as purely academic and cognitive as a concept of quantity is based on early emotional experiences. "A lot" to a three-year-old is more than he wants; "a little" is less than he expects. Later on, numbers can systematize this feel for quantity. Similarly, concepts of time and space are learned by the emotional experience of waiting for Mom, or of looking for her and finding her in another room.
Words also derive their meaning from emotional interactions. A word like justice acquires content and meaning with each new emotional experience of fairness and unfairness. Even our use of grammar, which the noted linguist Noam Chomsky and others believe is largely innate and needs only some very general types of social stimulation to get going, is based in part on very specific early emotional interactions. For example, we found that autistic children who did not use proper grammar and repeated only nouns, like door, table, and milk, could learn correct grammatical forms if we helped them first become emotionally engaged and intentional. At the point where they learned to experience and express their desire or wish (for example, when they pulled us to a door to open it), they began properly aligning nouns and verbs ("Open the door!"). Infants and toddlers without significant challenges engage in these purposeful emotional interactions routinely; perhaps because they are so routine their importance for grammar and language has been missed.
Not only thinking grows out of early emotional interactions, but so does a moral sense of right and wrong. The ability to understand another person's feelings and to care about how he or she feels can arise only from the experience of nurturing interaction. We can feel empathy only if someone has been empathetic and caring with us. Children can learn altruistic behaviors, to do "the right thing," but truly caring for another human being comes only through experiencing that feeling of compassion oneself in an ongoing relationship. We can't experience emotions that we never had, and we can't experience the consistency and intimacy of ongoing love unless we've had that experience with someone in our lives. For some it may be a grandmother or an aunt, or it may even be a neighbor, but it must be there. There are no shortcuts.
An ongoing, emotional, nurturing relationship with a baby and toddler enables us to engage in interactions in which we read and respond to the baby's signals. This basic feature of caring relationships between a baby and a caregiver who really knows her over the long haul is responsible for a surprisingly large number of vital mental capacities. These "reciprocal interactions" teach babies how to take initiative. As pointed out earlier, they do something and it makes something happen. This is also the beginning of learning to think purposefully or causally. A sense of self, will, purpose, assertiveness, and the beginning of causal logical thinking all occur through these wonderful reciprocal interactions.
By 2-3 months, a baby and her parent will have been through 3 levels of learning about each other. In stage 1, the parent learns how to help the newborn infant maintain an alert state (1-3 weeks). In stage 2 (3-8 weeks), in the alert state she will produce smiles and vocalizations which are responded to by the adult. In stage 3 (8-16 weeks) these signals are reproduced in "games" (Stern) in which vocalizations and/or smiles are reproduced in bursts of 4 or more, imitated by the adult, in a series of reciprocal bursts or "games." Rhythm and reciprocity are learned in these games.
By 4 months, the baby will have learned to take control of the game, and to lead the parent in them (Margaret Mahler called this "hatching"). Thus, autonomy comes to the surface within these games.
Something else is also occurring. Through these reciprocal interactions the child is learning to control or modulate his behavior and his feelings. We all want children who are well regulated or well modulated, that is, who can be active and explorative some of the time, concentrate and be thoughtful and cautious other times, and joyful yet other times. We want children who can regulate both their emotions and their behavior in a way that is appropriate to the situation. We admire adults who are able to do this.
The difference between children who can regulate their mood, emotions, and behaviors and children who can't—for whom the slightest frustration feels catastrophic, whose anger is enormous and explosive—lies in the degree to which the child masters the capacity for rapid exchange of emotions and gestures. When a child is capable of rapid interactions with his parents or another important caregiver, he is able to negotiate, in a sense, how he feels. If he is annoyed, he can make an annoying look or sound or hand gesture. His father may come back with a gesture indicating "I understand" or "OK, I'll get the food more quickly," or "Can't you wait just one more minute?" Whatever the response is, if it is responsive to his signal he is getting some immediate feedback that can modulate his own response. He gets a sense that he can regulate his emotions through regulating the responses he gets from various environments. We now have a fine-tuned system rather than a global or extreme one. The child doesn't have to have a tantrum to register his annoyance; he can do it with just a little glance and a little annoyed look. Even if his mother or father doesn't agree with him or can't bring that food right away, they are signaling something back that gives the child something to chew on while he is deciding whether to escalate to an even more annoyed response. Even if he does escalate to a real tantrum, this extended sequence is preferable to going from 0 to 10 in one second. All the different feelings, from joy and happiness to sadness to anger to assertiveness, become a part of these fine-tuned regulated interactions, in a pattern of subtle nuances rather than an all-or-nothing pattern.
If a child is not learning to engage in this fine-tuned interaction, he doesn't expect his emotions to lead to a response from his environment. The emotions consequently exist somewhat in isolation and simply get bigger. The child is driven to use more global responses of anger or rage or fear or avoidance or withdrawal or self-absorption. Very young babies are prone to these more extreme reactions in the early months of life. When they cry, they cry very hard and loud because they are frustrated until we help settle them down. This has certain similarities with what has been described as the flight/fight reaction, which is a more global reaction of the human brain. But children are not limited to flight-or-fight reactions. They can have a variety of global reactions: global rage, avoidance, withdrawal, self-absorption, fear, or impulsive action.
By the time a child is talking at age 2 and 2 1/2 he should already have the capacity to be involved in long chains of interaction (reciprocal interactions) involving his different emotions, feelings, and behaviors. These are built on the earlier patterns laid down at 2-4 months. Children without this capacity operate in a catastrophic or extreme manner, having extreme meltdowns or tantrums or getting carried away with their excitement and joy, or anger or sadness, or even depression. Often, these extreme reactions are out of proportion to the events of the moment. They suggest that some parts of the child's feelings, mood, and behavior didn't have a chance to become regulated through reciprocal interactions. Families have different capacities to get involved in negotiations around certain behaviors and feelings. Some interact well with one another around assertiveness and anger, but not as well around sadness or sense of loss. Others are just the reverse.
The earliest patterns of parent/infant communication lay the groundwork for the later patterns. As children learn to regulate their behavior and feelings they can then go to the next level and problem-solve with the feelings and actually try to change what's happening in their environment. If something feels unpleasant, they can do things to change the situation and the feeling. If it is a pleasant feeling, they can change their environment to bring on more of those feelings. So by 18-20 months children already have lots of experience in trying to lessen those conditions that make them feel sad or angry and to increase those conditions that make them feel happy. Then, as they progress further up to age 2 or 2 1/2, they can form images in their minds—what we call symbols or ideas—and actually label the feelings that have come under fine regulation. We see this in the pretend play of children when they create scenes where there is anger, happiness, or sadness. Children who are well regulated have more details in their dramas. There is more subtlety to their feelings. Children who are more extreme in their reactions, in contrast, have more global patterns in their pretend play. At yet at a further level, they can begin reasoning about their feelings, figuring out why they are happy or sad or joyful. This occurs between ages three and four. As they get older, they can reflect on these feelings and understand them in the larger context of their peer relationships. They can recognize the gray area of feelings. As they become older this capacity for reflective thinking about feelings gets stronger and stronger.
Interactive emotional relationships, therefore, are important for many of our essential, intellectual, and social skills. This type of interaction is also central when we are trying to help children with special needs. Often, creating opportunities for long, empathetic, nurturing interactions around the child's different feelings can go a long way to helping a child learn "regulation" even when it isn't there in the first place.
The notion that relationships are essential for regulating our behavior and moods and feelings as well as for intellectual development is one that needs greater emphasis as we think about the kinds of settings and priorities we want for our children. The interactions that are necessary can take place in full measure only with a loving caregiver who has lots of time to devote to a child. A busy day-care provider with four babies or six or eight toddlers usually won't have the time for these long sequences of interaction. Similarly, a depressed mom or dad or an overwhelmed caregiver with five children or parents too exhausted at the end of the day may not have the energy for these long patterns of interaction and negotiation.
TBB: We first learned the power and importance of interactive relationships while using our neonatal assessment. When we started, nobody thought we should interact with the baby. In the past, we just let the baby lie there and observed him. That allowed us to believe that "babies don't see or hear"—crazy notions. As soon as we began interacting with the baby, holding him to alert him, cuddling him to soothe him, we saw that you could reinforce the baby for doing fantastic things. We saw "Here is an interaction that the baby stores." Then along come the mother and the father, each treating the baby differently, and he stores those differences and reflects them back by six to eight weeks with different responses. These emotional responses grow from ongoing interactions with consistent caregivers and are the key to future development.
SIG: We can now make a case that it's this early reciprocal dialogue with emotional cueing, rather than any cognitive stimulation like flash cards, that leads to the growth of the mind and the brain and the capacities to reason and think. Both emotional and intellectual development depend on rich, deep, nurturing relationships early in life, and now continuing neuroscience research is confirming this process.
Excerpted from THE IRREDUCIBLE NEEDS OF CHILDREN by T. Berry Brazelton, M.D. Stanley I. Greenspan, M.D.. Copyright © 2000 by T. Berry Brazelton, M.D., and Stanley I. Greenspan, M.D. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
|1 The Need for Ongoing Nurturing Relationships||1|
|2 The Need for Physical Protection, Safety, and Regulation||53|
|3 The Need for Experiences Tailored to Individual Differences||79|
|4 The Need for Developmentally Appropriate Experiences||115|
|5 The Need for Limit Setting, Structure, and Expectations||145|
|6 The Need for Stable, Supportive Communities and Cultural|
|7 Protecting the Future||177|
|The Touchpoints Model||183|
|Functional Development Growth Chart and Questionnaire||195|
|About the Authors||227|
These parents also mapped out the individual differences that I recorded in Infants and Mothers and Toddlers and Parents. Until then, most books on childcare offered a picture of a "normal" baby and left out all that we were learning about temperament. My work with newborns at Children's Hospital in Boston showed me how early we can spot these differences. It was there that I developed the Neonatal Behavioral Assessment Scale that is now used all over the world. When parents can see their babies as unique individuals, capable of amazing skills in the first few days, they are instantly hooked into a close relationship.
In my practice, it was a shock to learn that all parents weren't like mine -- I was blessed with very good parents -- but I also saw how they could be if they had the support they needed and an understanding of their child's development. Out of this grew Touchpoints, which uses parental vulnerability as an opportunity for outreach and intervention.
These days I see patients by referral only. I go across the country giving talks and am not around enough to cover a practice. I miss it terribly. My new book, The Irreducible Needs of Children, which I wrote with Dr. Stanley Greenspan, is about what every child needs to grow, learn, and flourish. And I'm hard at work, with Dr. Joshua Sparrow, on Touchpoints II, which takes up at age three, where the first Touchpoints left off.
It's harder to be a parent now than it was when I began in pediatrics, especially here in America. We are the least family- and child-oriented society in the "civilized" world. But we are also the country with the most resources to help us improve. When a new administration takes over in Washington, they will have the opportunity to put into place programs that provide preventive healthcare, optimize daycare, eradicate the negative implications attached to minority families, and support special-needs children and their parents. And we, because we have all been children and want the best for our own children and grandchildren, must help them. (T. Berry Brazelton)
An Interview with T. Berry Brazelton
Barnes & Noble.com: Is this your first collaboration with Dr. Greenspan?
T. Berry Brazelton: Yes, we've been friends for a long time, and I've worked with him at Zero to Three, an organization in Washington [that promotes the healthy development of young children]. We've compared notes for a long time.
B&N.com: Your book concentrates on the early years of a child's life.
TBB: Yes, we both feel that there are some things laid down in the first three years that are certainly able to be brought to light later on but would cost a lot more. Our constant bias toward the first three years is not only for the child but for the parent. There was a very strong [attitude] in this country that parents ought to be allowed to raise their children their own way. The trouble was, that ignored people who were poor or diseased and needed support like early intervention, preventive health care, childcare, parental leave. In the past 15 years, I've begun to think that every parent needs that support. We can no longer expect parents to face the kinds of stresses they're under. In my work, I've identified ten stresses that have increased since I was raising my own children.
B&N.com: What are some of those stresses?
TBB: One is the isolation that most families feel. They don't have their own families around them anymore, and they don't feel that they're in a community they can trust. They can't go next door for sugar or a babysitter. The next biggest stress is that both parents have to work in most families, and that means no time, no chance to sit back and evaluate what's going on -- things like that which are critical to a family's development. We've asked women to not only be nurturing but also be in the workplace ten hours a day. But we don't provide support for that -- decent childcare, a family-friendly workplace.
B&N.com: Should government get more involved?
TBB: Yes. I think there are four layers for involvement: the national government, the state government, businesses, and individuals. If all those four layers were responsive, we could make a go of all these things. We have an outreach program at the Children's Hospital here in Boston called Touchpoints, and we are training a multidisciplinary group from cities around the country who want change. People are really ready for it. We can't afford to ignore what we've done to families in this country any longer. You go to Europe and you see a very different setup.
B&N.com: What are the chances that these sorts of major changes will happen?
TBB: I was afraid that I wouldn't live long enough to see them happen, but I think they're beginning to. I feel a lot more optimistic than I did. I must say I'm biased about Hillary Clinton; I think she's been a major voice for a lot of this.
B&N.com: Is there a model we can follow -- one country or community that is successfully making changes, either with your ideas or others?
TBB: Hawaii has some wonderful programs; Minneapolis is another one. We have a wonderful setup in Napa Valley. North Carolina has changed things in a very powerful way; the governor is a very family-friendly person and has done a lot to help the childcare situation.
B&N.com: You often talk about daycare and the problems we have with it right now. Your conclusion seems to be that it can work, it just needs to be much better.
TBB: Well, it does work in places like France and Sweden. I think the first step is for the culture to accept it, and the next step is to back it up with funding. We need to bring people who are taking care of our children up to an acceptable level of society. Right now they don't have any status, and of course, they're not getting paid much.
B&N.com: One of the things you write about is the need for not just quality time but sheer quantity of time.
TBB: Ellen Galinsky in her book Ask the Children found that one of the things that kids valued was just sitting-around time -- just parents sitting around with them, not making "quality" of it. What kids really need is the assurance that the parent wants to be there. The fact that you can sit around and listen to them and play silly games with them, have "floor time," is maybe a little more important than some of the jazzed-up stuff. I find that very comforting.
B&N.com: Do you think anything about your book will stir up controversy?
TBB: I'd be surprised if it didn't. I think setting time limits always bothers people. I think that all of the points [we make in the book] are aimed at trying to give parents the backup to say, "An hour of television is enough -- what are we doing beyond that, except using it as a babysitter?" It's going to bother people, because parents have learned to be laissez-faire. But once they accept some of this and get into it, I think they'll find it very reassuring to have limits on their own behavior.
B&N.com: The book seems to speak to educators as much as to parents.
TBB: I hope that everybody who's taking care of children can recognize that it's speaking to them. There's a very deep-seated thing that goes on between educators and parents; it's called gatekeeping. Everybody that cares about a small child is in competition with everybody else, because they care so much. So if things go wrong, they blame each other. All of this works against cooperative backups for the child, which is what we all want to be aiming at.
B&N.com: You've been called the new Dr. Spock. How do you feel about that?
TBB: Ben was a good friend of mine, and he had his own power. So the only thing I mind is I don't want to take away from that power, even if I could. He changed the whole attitude of mothers back in the '40s about the fact that they could make their own decisions rather than being told what to do. That was a very big step for parents. He had a very important effect on the U.S. I picked up on it, and I hope I've added to it.
I think Ben changed things so somebody like me could come in and say, "Look, we need more discipline." The period in the '60s when nobody ever dared say no to their kids was a nightmare. I did a lot of training and research, went over to Harvard to become a professor, and have been doing research ever since. So that gives me a kind of credibility that's really important. I feel like I know what I'm talking about.
B&N.com: And you do! I've been reading Touchpoints since before my son was born.
TBB: You know that came from my own patients. They'd bring in all sorts of things about how their child had just learned something. And if I made a boo-boo, they'd tell me, there was no question about that. I had a very important working relationship with my patients here in Cambridge for about 40 years.
B&N.com: Your career has lasted some 50 years. Are you thinking of retiring?
TBB: Lord no, I would've done that a while ago if I was going to, but I'm just as involved now as I ever was. With Touchpoints intervention work, we're just gathering steam. We're going around the country all the time and will continue to. I love it. I think if I retired I'd go into senility in a very short time -- probably am already! [laughs] I really like working with young people, and if I retired, I'd have to live with people my own age, and I don't want to do that. [laughs] They're pretty dreary. All they talk about is what's wrong with them. Kids keep me on my toes.
B&N.com: If there's one single piece of advice a parent could come away with after reading The Irreducible Needs, what would you want it to be?
TBB: That you are a model for your child, and you better take it seriously. Love is certainly the first thing you should give, but discipline comes second, and it comes right on the heels. So don't forget it.
Posted August 25, 2009
Both authors have been in the pediatric area of their professions for many years and they use that experience to sum up their observations. This would be a great resource for parent education programs. It also helps in parent support programs for those who have special needs children.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.