Local Doctor Helps Parents Understand Their Babies

Seated in his office at Children’s Hospital in Boston, Kevin Nugent’s eyes light up as he clicks on a photo on his laptop and begins to tell the story of the mother and baby before him on the screen. In a soft, soothing Irish lilt, Nugent tells how this “beautiful” little boy was born with Down syndrome. His mother was still coming to terms with a life she had not envisioned for her son or herself as they prepared to leave the neonatal intensive care unit of a Boston hospital. On the day this photograph was taken, Nugent had stopped in to examine the infant before his discharge and, in doing so, he asked the mother to call out her son’s name.


“He turned his head to his mother’s voice and, all of a sudden, it was like this veil had been lifted. The mother kissed the baby’s hand and said, ‘He knows me. He knows me,’” explains Nugent. “Suddenly, a person appeared to her. It was not just a diagnosis. There was a little boy she could get to know and a future opened up for them.”


Some 30 years after he first went on rounds with world-renowned Boston pediatrician T. Berry Brazelton, M.D., Kevin Nugent, Ph.D., is still in awe of a newborn’s ability to make his or her needs known to the world and the deep desire of parents to fulfill them.


A pediatric psychologist and director of the Brazelton Institute at Children’s Hospital in Boston, Nugent has spent his professional life learning how to interpret the language of babies and has become an international expert in this field. While people once considered babies as passive beings with a single-minded focus on eating and sleeping, decades of research by Nugent, Brazelton and others has proven that newborns have a wide range of complex communication strategies. A cry, a yawn, a smile, a furrowed brow – even a tightened leg muscle – are all part of a rich language repertoire that, when decoded, can help parents better understand their child’s preferences and, in many ways, says Nugent, the person that child is destined to become.


In his latest book, Your Baby Is Speaking to You (Houghton Mifflin Harcourt, 2011; $18.95), Nugent teams up with photographer Abelardo Morell to provide parents with a visual guidebook for deciphering baby behavior. The text and beautiful black-and-white photos can help parents understand the distinction between a baby’s light sleep and deep sleep, how to recognize signs of overstimulation, and why some babies simply don’t like to be cuddled.


The babies photographed were patients at Brigham and Women’s Hospital in Boston, and many of the images were captured in the mothers’ hospital rooms with parents nearby. There are babies smiling, breastfeeding, crying, grasping at rings, following a red ball with their eyes, and putting a fist into their mouths.


“This is a book that has been in my mind for years,” says Nugent, 68. “It is not a how-to book. There are plenty of child-rearing experts for that. This is a book about your baby. These expressions that we have captured hopefully give you another entry into your baby’s heart and mind and soul.”


Echo from the Past

The fact that babies transform lives is something more than academic to Nugent. He experienced the phenomenon firsthand as a boy growing up in Ireland – a boy whose mother died suddenly when he was only 10.


“I felt like the ground had opened up,” he says. “I was lost.”


But as the oldest of five children, he had to assume greater responsibility for looking after his baby brother. He changed his diapers, prepared his bottle and wheeled his pram along the streets of their small town west of Dublin.


“It gave me a whole reason for living,” says Nugent. “In getting to know him, I rediscovered myself. It gave me hope.”


On rounds with Brazelton many years later as a graduate student at Boston College, Nugent recognized himself in a new mother the two men met. She was overcome with emotion as her baby’s eyes locked onto her own for the first time. Witnessing the power of this tiny being to change a life stirred up memories of Nugent’s past and sealed the direction of his future.


What also changed Nugent was Brazelton himself, and the way the pediatrician made it possible to see that a 1-day-old baby was already a complete person with her own likes and dislikes.


New Thinking About Babies

In the early 1970s, Brazelton pioneered the development of the Neonatal Behavioral Assessment Scale, a screen used in hospitals around the world to evaluate, among other things, an infant’s reflexes, tone, and tolerance to sound and light, and how a baby responds to the sight of a red ball, a voice and a face. The information gleaned helps caregivers and parents better respond to the temperament of the infant.


Inspired by the success of the scale, Nugent and his colleagues developed the Neontatal Behavioral  Observation System (NBO), a series of 18 maneuvers to help clinicians and parents observe a baby’s behavior together. The NBO takes less time than the original scale and is viewed as more of a tool to teach parents about their babies than as a formal method of evaluation. Nugent’s new book is seeing the NBO in action.


“What this does is give the babies a voice,” he says of the NBO test. “What does he want us to know about him? What does she find helpful and what does she find frustrating? It can also help parents grow into their own skins as parents.”


In the book, his first directed exclusively to parents, Nugent explains how to differentiate between a cry of pain (a single shriek, followed by short silence and then loud crying) and a cry of hunger (which begins softly and becomes loud and rhythmic). He explains how a yawn can be a baby’s signal that he’s had enough face time, or that the common crossing of feet isn’t incidental, but rather a way to control random leg movements as the baby learns to soothe himself.


The nice thing about newborns is that they’re very forgivable, as their parents are bound to misread as many cues as they get right, says Nugent. He encourages parents to “befriend the cry,” which is one of a baby’s key means of communication, and to understand that “every solution is unique to every parent and baby.”


Many parents are hungry for books to tell them how to raise a newborn the right way, but Nugent likes to say the baby is its own how-to manual, with a wealth of information if parents are open to learning their language.


“There is no blueprint. The baby is the only one who has the blueprint,” he says. “The guidebook is in the baby, and if we give him half a chance, he’ll tell you what he wants.”


Susan Flynn is associate editor of the Boston Parents Paper.

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26 May 2011

By Susan Flynn