Handle with Care

By Barbara Kolucki (Bakoluck@aol.com)
 

Much in the media, and in the growing amount of parent education about the first three to five years of life is about the growth and development of the child's brain and the variety of ways to stimulate the child's senses. In the West, these include, for example, audiotapes of classical music for babies, brightly coloured mobiles, all types of toys, suggestions of "100 games for your baby's first 100 days", etc.

Certainly, there are many clear benefits of the new brain research, parenting suggestions and products. First, the infant or young child is seen as more than just a physical body. The new view is holistic, emphasizing body, mind and soul.  Second, caregivers are learning about the inherent capacity of a newborn to think, see, feel and hear at birth (and even prior to) and her tremendous potential.  Third, for caregivers who are not as yet confident in their own ability to "play" as a grown-up, these resources can guide them to develop their playful side as well as their confidence in parenting.

There are, however, a few cautionary notes that are important to point out as more organizations and parents are exposed to, become convinced of, and begin the programs and practices of "Early Child Development" (ECD):

1. Every child is unique;
2. It is the relationship between infant and caregiver that is more important than any practice or activity;
3. The infant can and will guide us as to what she needs, wants and can handle; and
4. There must be a balance between activity and rest, comfort and stimulation.

These are not meant to negate the potential or effectiveness of ECD interventions, especially for full-term, healthy newborns and young children.  It is important for caregivers to be aware of the potential of their newborn and to gain increased confidence and skill in how, throughout their busy day, simple interactions with their baby can have a tremendous impact on the cognitive, physical, social and emotional development of that child.   What these cautionary notes do, however, is provide a balanced framework on which to build programs, interventions and media regarding ECD and children between the ages of 0-5 years.  And even more important - they guide us to follow the principle of "first, do no harm" with regard to fragile or at-risk infants.
 

Learning from others

The last 20 to 30 years have brought marvelous revelations about infants and young children. Not only can we track the development of the connections in the brain, but we can also see how the development of the fetus in utero prepares the child for a life outside the uterus. One of the many lessons learned has been that in the last trimester in the womb, together with the first year of life, the infant's brain develops at a rate faster than at any time in her life (Heidelise Als, "Earliest Intervention for Preterm Infants in the Newborn Intensive Care Unit", 1997). At birth and throughout the first three to four months, the infant's neurological system, as well as her body and brain, is getting organized and prepared to "take on the world". The nervous system is developing so that she will mature and be capable of receiving all the stimuli the world has to give to her and develop her full potential.

Research with babies born prematurely or those who are born small for gestational age (SGA) has shown us that often, the newborn is very vulnerable to outside stimulation. Too much light, noise or touch takes too much energy for these infants and can overwhelm them. Their body and brain might not yet be ready to accept a lot of stimuli. And babies who had a low threshold for stimulation in infancy also tend to have greater learning difficulties as five-year-olds, as well as problems in motor and social behavior. (Als, Duffy, McAnulty & Badian, 1989, Harvard Medical School and the Children's Hospital, Boston).

There are a significant number of fragile babies in the world. In the Western world, many of these are born prematurely or perhaps born full-term but exposed to drugs or alcohol, as well as those with particular impairments. In the developing world, fragile babies include those born with low birth-weight (lbw), very low birth-weight (vlbw) or those who, for a variety of nutritional, medical or emotional reasons are called "failure-to-thrive infants". Yes, most of the research data has been done in the western world, primarily through academic settings. But many of the leaders in this field hypothesize that the same caring principles and practices hold true for babies in the developing world. Newborn Intensive Care Units, together with Early Intervention Projects for children at risk, or with disabilities have allowed us to observe these fragile infants and to learn from them what they need, can tolerate and the ever increasing capability and strength they have when provided with individualized, developmentally-appropriate care.

If an infant is fragile, or born even a few weeks premature, her brain and body might not be ready for life outside the uterus. If these infants are bombarded with too much stimulation or interaction, they might be harmed. However, gentle, loving observation and attention can support this same infant and help her to "catch up" to the point where she not only survives but also thrives. In one research study, newborn babies "thin-for-height" showed more fragility, had difficulty making transitions from sleep to alert states, had irregular respiration, fisted hands, and stiff, guarded arms. However, when these infants were assisted with calm support, they would slowly open their eyes and become more relaxed and focused. The point is that some newborns are more fragile and at least in their first weeks and months, have difficulty "interacting" with a caregiver or other stimuli. (H. Als, 1982, "Toward a Synactive Theory of Development: Promise for the Assessment and Support of Infant Individuality").

Any infant is like a blooming flower or butterfly in a cocoon. They take time to blossom. And one cannot force development or maturation until the bud or cocoon has developed fully. A baby born a little prematurely, or one with a low or very low birth weight, is spending most of her time surviving. She needs good nutrition and rest in order to not only survive but thrive. And she also needs help in blooming or thriving - but in a gentle, caring way. It is important for us to know and understand this difference as we develop ECD programs, practices and media. We must "handle these infants with care".
 

All Infants Are Unique

All children are different. Therefore, there cannot be only one set of guidelines for all caregivers and all children. There are, of course, many commonalties just as there are predictable developmental milestones. But we must be cautious of any recipe for parenting. Some children thrive on and need more stimulation. Even some babies who are disabled seem to improve best when various systems receive increased stimulation. And it is also true that the environment can indeed influence the development of a child's body, brain, emotional and social development. But this does not always translate into a stimulating environment. Sometimes a baby needs less stimulation. Sometimes too much can be as detrimental as no stimulation at all.

Some babies are easy to care for. Others might be irritable. Some like to cuddle, others do not. Some babies' bodies are soft, other bodies are stiff and rigid. It is important to point out that in none of these instances are the babies bad. Babies cannot help who they are and how they behave at such an early age. Some babies get fussy if you handle or interact with them too much. Some babies like a lot of eye contact, hugs and movement. Others can handle only the most gentle touch. What might be comforting to one baby might not be to another. Their bodies and systems are different, and are all at different stages of maturation. What is important to remember is to acknowledge, accept and celebrate these differences. And to remember that each and every baby, girl or boy, disabled or not, has strengths. We can also learn some simple, general techniques which help us to observe and handle these differences. You can, for example, learn to comfort infants who get overwhelmed easily, or help infants to soothe themselves and learn how to do this on their own as they grow and develop.
 

Relationships Are Most Important

All babies might not be ready for stimulation and a lot of interaction. But every baby needs and wants to connect with her or his caregiver. Though important, it is not the technique, for example, of breastfeeding, massage, or the games that one plays with an infant or young child. It is the relationship that is the foundation for all development. Love, security and stability are necessary before interaction or activity can become meaningful. Relationships involve watching and listening to your child. They include reflecting on how you as a caregiver feel. It is "doing with" rather than "doing to". Relationship is the connection, the intimacy - it is you and your baby being present for each other.

This relationship is especially important if the infant is sick or fragile. Even babies can be prone to depression if they are never held, touched or spoken to. Even if a baby is in a medical setting receiving care, the love and relationship with the caregiver is as important as the nutrition and medical interventions. A loving hand on your child, a regular, soothing voice or smell tells a baby that you are there. These can all help that infant fight harder to get and stay well.
 

Babies Guide Us

Even the most premature or fragile baby is capable of guiding us to care for them. It is up to us as adults to fine-tune our receptors to hear and see what they are telling us. Babies tell us when they are ready for interaction. This is what is generally referred to as "an alert state". They will also tell us if they are having fun or when they need a rest. Their eyes, color, cries, movements are all signals to us. It might take some experimentation but one can soon learn to read a baby's signals and then to provide attention and interaction based on the cues from the baby herself.

When we take time to observe our infants and young children, we become amazed at their range of communication. And in our caregiving suggestions, it is important and possible to build the self-confidence of each and every caregiver to understand their baby. Simple, non-threatening messages might go something like:

 "Look at your baby looking at you. She is telling you that she is awake and likes the way you look into her eyes. This is one of the best times for you to begin to play with her. Now, see how your baby is looking away and closing her eyes. Perhaps she is telling you that she needs a rest. Maybe if you just hold her for a while, she will relax and rest. See how your baby knows and feels your love and care".

Or,

 "Your baby is weak and fragile. She is sick and getting medical care. You are sleeping next to her and you also spend all day watching and worrying. If you gently place your hand on her, or put your finger in her finger, she will know you are there. You can put your shawl near her too - she can smell that you are near and that will give her security. Maybe the lights are too bright during the day. You can block out the light with your hand or shawl. If your baby seems nervous and her arms and legs seem to move all around, you can swaddle her if it is not too hot. Or, you can guide her to suck her thumb or place her hands together in the middle of her stomach. And one of the best things you can do is put your baby on your own skin and let her snuggle next to you".
 

The Key is Balance

Our goal as programmers and caregivers is to ensure that each infant receives the best care and attention. We must also ensure that her body and brain are ready and able to accept and receive. The baby and caregiver are partners. This attachment and relationship is absolutely necessary for later cognitive, physical, social and emotional development.  The more understanding a caregiver has about what her infant needs, wants and is capable of doing - the better suited the environment and interaction will be for each child.

Infants and young children, as well as adults, need balance. Each needs rest and activity, comfort and stimulation. Therefore, the best ECD will not be about the number of brain connections that can be made, or the daily games that are played, or even the number of new things a very young child sees, hears, tastes, touches or smells. It will be how caregivers understand that their infant is both capable and vulnerable and, that each blossoms in her own time. It will be how throughout a caregiver's busy day, precious moments are spent building a relationship with their child based on a balance between love, comfort, play, and learning. A balanced approach will more likely promote the growth and development of balanced, capable children and adults.