Neonatal Behavioral Observation System Supports Parents With Newborns

Madison, Wisconsin - Noah just turned 18 days old, but he's already communicating with his parents and the outside world.

He is capable of eye-to-eye contact and has good muscle tone - both good signs for someone not even three weeks old.

Noah's parents agreed to have him participate in the Neonatal Behavioral Observation System (NBO), which was demonstrated recently before participants in the Wisconsin Infant, Early Childhood, and Family Mental Health Certificate Program.

This post-graduate course is offered through the Department of Psychiatry at the University of Wisconsin School of Medicine and Public Health and the Division of Continuing Studies. 

The Neonatal Behavioral Observation System was developed at the Brazelton Institute at Children's Hospital, Boston by Drs. Kevin Nugent, Constance Helen Keefer, Susan Minear, Lise Johnson, and Yvette Blanchard under the guidance of Dr. T. Berry Brazelton, noted pediatrician and author of 24 books on child development.

The procedure includes a series of observations and maneuvers that describe infant behaviors, interpreted by the clinician to determine the newborn's strengths and needs for support. The goal is to help parents understand the infant as they become attached to their newborn. 

Infants are observed on their sensitivity to light and sound, muscle tone, response to speech and facial expressions, visual tracking and other behaviors.

Nugent, who is also the founder and director of the Brazelton Institute, held Noah in his arms while the child's parents, Jenni and Brian, looked on. He tested Noah's orientation to sound using a rattle and his visual tracking by using a red ball.

Nugent said Noah's ability to make eye-to-eye contact with him was definitely a positive.

"We believe babies are born to seek out the people and things that are going to be important in their lives," he says. "They seem to be drawn to human faces more than anything else.  When I looked at Noah and he looked back, there was almost this sense of 'I'm OK and the world is going to be OK because these people look at me with love.' It's the beginning of trust."

Nugent said lack of eye-to-eye contact may be present in premature or low birth-weight babies, leaving parents with challenges in helping the newborn adjust to normal life. However, that is not an impossible task.

"There are too many other issues in these babies' lives, and they're still not able to become engaged with others," he says. "Parents have to be patient in waiting for the moment when they can make eye-to-eye contact, take it easy, and not overstress the baby."

Nugent was also impressed by Noah's muscle tone at such an early age. 

"He was good, firm and strong," said Nugent. "Keep in mind it takes some babies longer to acquire this. We observe the kind of tone the child has with the view of helping the parents provide support if the baby needs support."

Nugent stresses that the Neonatal Behavioral Observation System is simply used to help parents through the infant's early stages of life, and is not meant to predict the child's physical and mental development, or how the baby will progress into adulthood. 

"The first two or three years are crucial in the child's development," he says. "We are just at the first few yards of this journey, and trying to give the family a good start at understanding the baby and creating this sense of trust.  Parents are hungry for information, the baby is desperately trying to get on track, and using the NBO can facilitate this process."

"The NBO is not a predictor and it's not saying if Noah will be good, bad or indifferent in the future," adds Nugent. "My goal was to support the parents, to sensitize them to what Noah was saying, and enhance their relationship as best I could.  I wanted to give Noah a voice and develop supportive relationships around the baby."

The Wisconsin Infant, Early Childhood, and Family Mental Health Certificate Program, which includes health care professionals, day care operators, and others who work with children, features a series of lectures that focus on how to detect and respond to mental health problems in children.