Supporting parents and babies using the

Registered charity number 1086814
Supporting parents and babies
(0-3 months)
using the Brazelton approach
(NBAS and NBO)
Joanna Hawthorne, Ph.D.
Psychologist
Director and Trainer,
Brazelton Centre in Great Britain
Associate, Centre for Family Research, University of Cambridge
www.brazelton.co.uk
Pen Green, 7th March, 2014
Brazelton Centre in Great Britain
registered charity number 1086814
• Launched June 1997, Addenbrookes’s Hospital,
Cambridge by Dr. Brazelton and Dr. Kevin Nugent
• Co-founders – 6; Trustees – 4
• Since 1997: Training in the Neonatal Behavioural
Assessment Scale (NBAS)
• Since 2009 :Training in the Newborn Behavioural
Observations (NBO)
• Department of Health - Healthy Child Programme, 2009
NBAS recommended as intervention in the newborn
period
Our goal is to promote healthy
parent-infant relationships
How can practitioners support parents with
their new baby?
• Form a relationship with the parents by
sharing observations of the baby together
• Understand the baby’s language – their
behaviour
Questions parents ask:
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Can my baby see?
What can she see?
Does my baby recognise my voice?
What kind of stimulation do babies need?
How do I know when she is hungry?
How much will she sleep?
Is there something wrong if my baby cries a lot?
What can I expect over the next few weeks?
What are newborns doing?
• Imitation and understanding other’s minds
(Meltzoff)
• Making meaning of the world (Trevarthen)
• Learning from relationships about emotional
states – their own and others
• Learning about familiar people around them
• Learning to self-regulate
Importance of reading baby’s cues
The importance of providing parents with
information on their child’s behavior and
development so that they can respond
appropriately to their infant’s cues has been
well documented (Als, 1993; Taffe Young et
al. 1998).
JK Nugent, 2006
Tools – NBAS and NBO
• Neonatal Behavioural Assessment
Scale (1973) Brazelton and Nugent
Newborn assessment 0-2 months old
• Newborn Behavioural Observations
(2007) Nugent, Keefer, O’Brien, Johnson
& Blanchard
Relationship-building tool 0-3 months old
Historical background
• In 1950’s the newborn baby was
thought of as a ‘blank slate’ – a
reflexive organism
• Three decades of research have
shown that from birth, babies have
many capabilities
• Babies are competent social partners
The newborn period- a new view of the newborn baby
the contribution of T. Berry Brazelton (Nugent, 2006)
• The competent infant
• The organized infant
(4 systems)
• The social infant - the
infant as actively
engaged in
transforming her own
environment from the
beginning
• The infant as an
individual with her own
unique set of
dispositions and
sensibilities
The Competent Newborn
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Competent in all five modalities (taste, smell, touch, hear, see)
Can visually track (Dannemiller and Friedland, 1991; LaPlante et al.
1996, Meltzoff and Moore, 1999)
Can hear and locate sounds (Muir and Field, 1979; Moon and Fifer,
2000)
Can habituate (Hood et al, 1996; Slater et al. 1984)
Can recognize mother’s voice and smell (deCasper and Spence,
1991; Schaal, 1998; Spence and Freeman, 1996)
Can discriminate mother’s face from stranger (Pascalis et al. 1995)
Can recognize emotional expressions (Field, 1984)
Look significantly more at a face with direct gaze than at a face with
averted gaze (Faroni et al (2001).
Nugent, 2006
Baby behaviour means
something
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No behaviour is random
Behaviour has a meaning
Behaviour is the baby’s language
Babies have excellent memories and learn
very fast
Baby’s signals and cues
•Need to be seen in context
•What do the signals mean for the
individual baby?
•Stand back and observe
•These behaviours are ‘built-in’
and need to be expressed
Infant Behaviour Research
Development of self-regulation during first year:
• Organising autonomic or physiologic
behaviour
• Regulating or controlling motor
behaviour
• Organisation of sleep and awake states
• Regulation of affective interactive or
social behaviour
Relationship-based intervention
• Positive preventative effects of relationshipbased interventions for infants and their
families
• The interventions are based on facilitating the
infant-family relationship and helping both the
child and the caregiver learn to adapt
successfully to each other’s individuality
• Strength-based, collaborative approach
Neonatal Behavioural Assessment
Scale (NBAS)
Developed by Dr. T. Berry Brazelton,
Paediatrician, Boston, 1973
•Uses positive model observing baby’s
strengths, not deficit medical model which
observes pathology
•Shows interactive abilities of baby
•Provides caregiving plan for baby
Neonatal Behavioural
Assessment Scale
T. Berry Brazelton and J. Kevin Nugent, 1973
• Systematic observation and neurobehavioural
interactive assessment producing a profile of
infant behaviour (birth - 2 months old)
• shows infant’s state changes, reflexes,
reactions to stimulation, social interaction,
habituation, state-regulation, self-quieting
• 53 scorable items; over 90% reliability achieved
Key concepts of the NBAS
•Interactive
•Not pass/fail
•To bring out the baby’s “best
performance” – show the baby’s
strengths
•Collaborate with parents
4 systems of behaviour
• Autonomic
• Motor
• State
• Social interactive
Task of the baby in the first year of life is to
regulate these behaviours
Behavioural States
(Brazelton and Nugent, 1995)
(State 4)
Deep sleep (State 1)
Alert
Light sleep (State 2)
Alert and active (State 5)
Drowsy
Crying
(State 3)
(State 6)
Habituation
• Watch how disturbing stimulation affects
the baby’s sleep states
• Can baby settle after he/she is disturbed?
• Strategies he/she uses to settle back to
sleep
Crying
• When baby cries, stand back for a few
seconds to watch if he/she uses any
strategies to help calm – e.g.
Hand to mouth, hands together across
chest, sucking, changing position, looking
at something.
• If baby needs help to calm, proceed with
consoling manoeuvres
NBAS/NBO are useful tools to look
at issues around:
• Sleeping – provides information about the
baby’s ability to cope with disturbances during
sleep, and get themselves back to sleep
• Crying – provides information about the baby’s
ability to comfort themselves
• Feeding – provides information about the baby’s
sucking ability and ability to stay in an alert state
for feeding.
Studies using Brazelton NBAS –
(1,000)
• Mothers felt more confident and were more
responsive
• mothers spent more time playing and talking
with their infants
• fathers more involved in their baby’s care at
one month
• premature babies had higher cognitive scores
• low-birthweight babies had higher
developmental scores at 4 years
The Newborn
Behavioural Observations
(NBO)
(Nugent, Keefer, O’Brien, Johnson & Blanchard, 2007)
• relationship-based, structured,
neurobehavioural observation-
enables practitioners to describe and
interpret newborn behaviour for parents
• record behaviours
• For babies 0-3 months old
The Newborn Behavioral
Observations (NBO) System
The NBO consists of a set of
18 neurobehavioral
observations
NBO items summary
• Habituation to light and
sound
• Muscle tone in legs and
arms and activity levels
• Reflexes: rooting,
sucking, hand grasp,
pull to sit and crawling
• Visual and auditory
Responsiveness: face
and voice, the red ball,
the rattle
• Crying and Consolability
• Self-regulation
Work at the Brazelton Centre UK
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Education
Research
Neurobehavioural development
Parent support and follow-up
Infant mental health initiatives – promoting
attachment
• Upskilling workforce about baby behaviour
0-3 months old
Research in the UK
•Wirral Child Health and Development Study -- Stress in
pregnancy and child outcomes; NBAS at 5 weeks; n=269
(Hill, Sharp et al.)
•Studies at the Cambridge Centre for Perinatal
Neuroscience, Cambridge University Hospitals – Dr.
Topun Austin - EEG, optical systems and NBAS to assess
brain function of brain damaged pre-term and full-term
infants; Dr. Simon Baron-Cohen – NBAS and MRI
•Studies: Institute of Psychiatry, London – postnatal
depression; eating disorders – NBAS at 6 days old; EUAIMS study: Autism-NBAS and MRI
Projects
• Survey in Wales – NBAS trained and generic
practitioners: Getting to know you: A community project
to help mothers with their newborn babies (Funded by
Laura Ashley Foundation)(Hawthorne, McGlynn, Redshaw)
• – mothers with NBAS trained health visitors showed less hostility,
more enjoyment in parenting and greater attachment
• Rosie Birth Centre and Romsey Mill Children’s
Centre, Cambridge – offering NBO/NBAS to parents
• NBO session evaluations – 400 parent questionnaires
– mothers felt more confident about reading their baby’s
communication signals.
Service provision
• Rosie Hospital Neonatal unit, Cambridge –
NBAS/NBO on discharge and follow-up of
babies under 30 weeks g.a.
• King’s College Hospital , London– NBO
trained maternity support workers
• Middlesbrough – Baby Stars programme –
NBAS and NBO antenatal groups; postnatal
groups
• Tameside, Stockport, Barnstable, N. Devon –
NBAS and NBO trained community midwives,
nursery nurses, health visitors
Trained practitioners
Health visitors, psychologists, neonatal
nurses, nursery nurses, midwives,
occupational therapists, physiotherapists,
speech and language therapists,
neonatologists, psychotherapists,
psychiatrists, family support workers,
researchers, maternity support workers,
early years workers
Pre-training vs post-training
NBO questionnaires
Significantly different increase in
participants’ confidence in
describing newborn behaviour to
parents
Pre-training vs post-training
NBAS questionnaires
Significantly different increase in
participants’ confidence in most areas:
• Observing, describing, calming newborn
infants
• Helping parents learn what behaviour
means and respond to their infant’s cues
Responses to training course
NBO post-training questionnaires
“a lot, a great deal of new information gained
Reading infant’s cues 45%
Interacting with, providing guidelines for
parents 70%
Refining observation skills 87%
NBO as a relationship-building tool 100%
Responses to training course
NBAS Post-training questionnaires
“a lot, great deal” of new information gained
Reading infant’s cues 81%
Interacting with and providing guidelines for
parents 85%
Helpful component of training:
Refining observational skills: regulatory and
stress behaviours 97%
Questionnaires
How has it changed the way you work with parents and babies?
“It moved me away from medical model and focussed me on motherbaby relationship (and father-baby relationship)”
“Closer relationship with parents”
“More empowering – I listen more…to individual family needs…”
“I feel I am much more sensitive to both needs”
“ Shift to positive – a real connection – collaborative model. Inspires
confidence and I find time to really listen to mums and dads”
“It’s given a greater understanding of infant neurodevelopment which
allows better interaction with the baby, and a better understanding of
infant parent relationship and the way I can strengthen them.”
“The NBAS enabled me to work with mothers and babies at a much
earlier stage than previously”
“More able to share and understand their baby and her abilities and
personality, particularly with very young mothers and mothers with
mental health problems”
Questionnaires
Would you recommend training in the NBAS to others, and
why?
“Yes, definitely, feel it should be mandatory for all professionals working with
parents and infants”
“most certainly, it makes a difference”
“Yes, focuses attention on importance of early relationships”
“heightens: observation/awareness/interaction/individuality of care/ engaging
with parents”
“feel it should be mandatory for all professionals working with parents and
infants”
“Yes. All health visitors could have NBAS as part of their
training.Paediatricians could look at including the NBAS in the first
examination of all newborn. The more parents understand about their baby,
the btter for them as parenst and for the baby’s development”
“Yes! It has enriched my life and changed/improved the way I deal with babies
and parents, in a very positive and beneficial way”
Yes – more sensitive to baby and family, better practice, improves rapport with
families,… job satisfaction, a better you!”
Comments from both trainings
about working with parents
• “I learned how important empowering parents in
the care and communication with their baby can
change the parent-infant relationship”
• “A more detailed, shared observation of the
baby seems to make parents more
communicative”
• “Sensitivity for, and skill for directing parents’
attention to what their baby is doing in a nonjudgmental way”
Comments from parents after
the NBO session
(400 questionnaires)
• Parents felt they knew their baby better
• Parents felt more confident in reading their
babies signals and cues
• Parents felt trust in the practitioner who
carried out the NBO
Summary
• NBAS and NBO training helps
practitioners become more confident
in understanding newborn behaviour
and describing it to parents
• Provides shift in ways of discussing
behaviour with parents using a
positive model
Useful websites
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www.brazelton.co.uk
www.brazelton-institute.com
www.brazeltontouchpoints.org
www.oneplusone.org.uk
www.zerotothree.org
www.talktoyourbaby.org.uk
www.socialbaby.com
Training in the NBAS
• Two-day course
•Self-training phase: practice on 2025 full-term healthy babies with
mentoring
•Certification day – you assess 2
babies with Trainer (scoring agreement
to 90% for reliability)
•Receive NBAS Certificate
Training in the NBO
• Two-day course
• Practice on 5 babies with mentoring
• Send in 5 recording forms and 5 Parent
questionnaires for evaluation
• Feedback
• Receive NBO Certificate

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