The Preview: Early Childhood

Strengthen parents' skills by increasing understanding of their child's development


	Help parents see things through their child's eyes in this sample activity on Speaking from the Child's Perspective

Children thrive when parents have a good understanding of their developmental needs and know how to respond appropriately. The new book Your Guide to Nurturing Parent–Child Relationships: Positive Parenting Activities for Home Visitors provides a framework for professionals to help parents build a healthy relationship with their children. Underlying the guidance and activities in Your Guide is the Positive Parenting approach:

A positive parent is a loving, understanding, reasonable, and protective teacher and model. Such parents listen and respond sensitively to each child's needs and show empathy with and respect for their child. They are able to build on the strengths of their child's nature yet be flexible as time and circumstances dictate. They are reasonable by being consistent and predictable. A parent following the Positive Parenting approach is actively involved with his or her child and provides not only a physically safe environment but also an emotionally safe atmosphere in which the child can experiment with emotions, relationships, and ideas.

Your Guide contains activities designed to strengthen the knowledge, skills, and confidence of those who touch the lives of children from birth to age 5 for professionals to share with parents that promote the Positive Parenting approach, which is backed by the science of parenting and child development.

The activities to strengthen parenting skills in Your Guide are categorized into four areas:

• empathy and caring
• coping and resilience
• problem solving
• social competence

They do not have to be presented sequentially, and all activities may not be appropriate for all families. The activities have been designed to maximize family engagement through discussion, reflection, game playing, and concrete action. This is in recognition that families respond differently to different approaches.

Wherever possible, variations or alternatives have been suggested for activities that require a higher literacy level. If English is a second language for a family, the parents can be encouraged to fill out goals, priorities, preferences, and actions in their language of origin.

To see a sample activity, be sure to download Speaking from the Child's Perspective, from the Empathy and Caring section, in the box above.

Adapted from Your Guide to Nurturing Parent–Child Relationships: Positive Parenting Activities for Home Visitors by Nadia Hall, Chaya Kulkarni, and Shauna Seneca.

Promote relationship-building in the first 8 weeks of life

To help parents understand their child's development from the very beginning, Dr. Kevin Nugent, director of The Brazelton Institute of Children's Hospital Boston, and colleagues developed the Newborn Behavioral Observations (NBO) system. The NBO, which consists of 18 neurobehavioral observations, enables practitioners to sensitize parents to their child's behavior by describing the infant's capacities from birth to 3 months. It provides individualized information about the infant's unique competencies and vulnerabilities so parents can understand and respond in a way that meets the child's developmental needs.

The NBO was developed on the basis of more than 30 years of research and clinical practice with the Neonatal Behavioral Assessment Scale (NBAS). It can be used while the family is still at the hospital, at office visits, or during a home visit. The following is an example of how to use the NBO to address one mother's concerns.

The Lopes twins, born at 38 weeks and 7 pounds each, have been thriving in their first days and are ready to be discharged. Their mother is recovering well from her cesarean and has multiple family members supporting her. Nurses have found her to be coping well with her infants, though a bit nervous.

Upon entering the room, Dr. Zhu sees that Ms. Lopes is anxious about taking her newborn twins home. Dr. Zhu puts aside her discharge teaching "agenda" to explore Ms. Lopes's anxieties. Ms. Lopes exresses her concern that maybe her twins are not ready to go home. Dr. Zhu is perplexed because, looking at the medical record, the infants are healthy, term infants who have transitioned well, and are medically stable for hospital discharge after 4 days of life. Rather than explain the medical reasons for why the infants are ready to go home, Dr. Zhu listens. She proposes to Ms. Lopes that they unwrap the infants and look at them together.

Immediately, Dr. Zhu senses Ms. Lopes's anxiety decrease as she perceives that her concerns are being heard. Dr. Zhu goes through the NBO to share with Ms. Lopes the aspects of the babies' examinations that are healthy and typical. They also look at important areas that will require extra care, such as attention to head control and careful bundling of small newborns.

At the end of this shared observation, Ms. Lopes is visibly more open to Dr. Zhu's opinion regarding safety for discharge. Recognizing Dr. Zhu's genuine interest in her and her infants, Ms. Lopes volunteers her fear: She describes a friend whose infant died at home. Dr. Zhu acknowledges the mother's fear and does not meet it with superficial assurances that these infants are typical. Instead, she proposes another option: a visiting nurse to check on mother and infants after discharge.

Now reassured, Ms. Lopes is mentally available to take in important guidance. Having been shown aspects of her own infants' health, she is less likely to be anxious at home and to convey that anxiety to her babies. Moreover, in the brief minutes that Dr. Zhu spent during this encounter, her relationship with this mother has been strengthened and a key trust established.

For a more detailed example of how to use the NBO to strengthen parenting skills, download this vignette of a postpartum visit by a public health nurse.

Adapted from Understanding Newborn Behavior & Early Relationships: The Newborn Behavioral Observations (NBO) System Handbook by J. Kevin Nugent, Constance H. Keefer, Susan Minear, Lise C. Johnson, and Yvette Blanchard.