Pandemic 2020: Will the Kids Be All Right? Lessons on Parenting from 100 Years of Crises

April 16, 2020

Massive unemployment. Loss of life. Disrupted education. And an economy in free-fall. These are the ingredients for the kinds of tectonic social shifts that alter the arcs of human lives. And parents, as always, are at the fulcrum of the pressures, protecting their families while trying to hold together a semblance of normalcy for their children.

For 100 years, developmental scientists have studied how families and children respond to disasters, manmade and natural. From the Great Depression to Hurricane Katrina, from 9/11 to wars and historic migrations, we’ve learned a few things. Studies of resilience have shown us that certain conditions enable children to adapt well amidst adversity, and other conditions lead to unfavorable outcomes.

The most critical element, according to the research, is the presence of at least one stable, caring adult, someone who provides a secure psychological container and a scaffold for growth—and I’ll explain that more fully below. But there are other levers at play, too.

In times of societal crisis, the following qualities are important to a child’s psychological resilience. I share these with you in the hope that whatever your situation in caring for children during the pandemic, you can focus on what really matters to your family’s long-term psychological well-being and let go of the more minor concerns.

Dosage

Research on children’s resilience began with developmental psychologist Emmy Werner, who was a child during the horrors of World War II in Europe. Many of the 39 million civilians who died because of the war were children, and 20 million children were orphaned. Werner managed to survive with her cousins by “foraging in the ruins of bombed-out houses and in abandoned beet, potato, and turnip fields” when all of the adult males in her extended family perished on the battlefield or in prisoner camps.[1]

In order to explore how children survived, she studied the letters, diaries, and journals of 200 child eyewitnesses on all sides of the war across 12 countries. In addition, Werner conducted in-depth interviews with 12 adult survivors when they were in their 50s and 60s.

In her book, Through the Eyes of Children, Werner writes that many of the children who survived became adults with “an extraordinary affirmation of life.” However, children were affected differently depending on a number of variables. The most important was their level of direct exposure to violence, bombing, and combat. For example, in a study of 1200 British school children targeted in air raids, 18 percent had symptoms of post-traumatic stress disorder (PTSD), e.g., intrusive fears; nightmares; sleep disturbances; and heightened reactivity to loud noises, like sirens and explosions. These symptoms were present five years later at a rate comparable to those found in combat veterans of WWII and, later, the Vietnam War. When Werner interviewed her adult subjects more than 50 years later, they still reported frighteningly vivid memories of the sounds of air raid sirens, machine gun fire, and low-flying planes.

(Getty Images: Hulton Deutsch, Fred Ramage, Fox Photos)

Studies of children worldwide in other wars and conflicts, from South Central Asia to Rwanda to Ireland, corroborate that the dose is the poison. In other words, the degree or length of exposure to danger is strongly predictive of later disturbance.

This was true, too, for children who were alive at the time of the collapse of the Twin Towers in New York City on Sept 11, 2001. Representative studies of children and adolescents following the attacks showed that the greater the degree of direct or indirect exposure, the greater the symptoms of PTSD, anxiety, and separation anxiety, and of course children who experienced the loss of a family member suffered most. The proximity of children to the event when tragedy struck mattered. A study of 844 children showed that those who were below Canal Street when the towers collapsed, and witnessed the event or were out in the dust soon after, had more psychiatric and physical health disorders at ages 17-30. Those same children had four times the rates of both disorders co-occurring, compared to a control group of children who were across the bridge in Queens and only saw media coverage of the event.

But media coverage, too, is a kind of chronic exposure, albeit indirect. A study of middle school children who watched repeating loops of television coverage of the Oklahoma City bombings showed that they were more likely to have symptoms of PTSD seven weeks later (even though none of their families were harmed), compared to children who watched less television coverage.

Takeaway: Children with the most direct exposure to the pandemic—e.g., who lose a loved one or whose family is struggling with the disease, food shortages, or other deprivations—may be most at risk for psychological disturbances and should be prioritized for services and resources.
If possible, shield children, especially the youngest, from media exposure so that caregivers stay in control of the messages. Four- to six-year-olds can handle minimal, manageable facts about why their lives have changed. Teenagers can take in more information and are interested in understanding how the world works and their place in it. But even then, caution is warranted. It’s helpful to have a wise adult in the wings to talk about events and emotional responses, and extra care should be taken with sensitive or empathic teens, as they can become overwhelmed and anxious more easily. Staying constructive and action-oriented helps to mitigate the chances of depression and overwhelm.

Availability of loving caregivers

When uncertainty or danger strikes, children are “wired” to look to their caregivers to determine how safe they should feel. If their primary adult is calm, a child feels reassured. But if their adult is upset, the child feels unsafe, and their body and brain go into threat mode. And when the threat system is on too long without relief, physical and mental health problems can result.

The first documentation of the protective effect of a caring adult also came from observations of children during WWII. Anna Freud, daughter of Sigmund Freud, founded the Hampstead War Nurseries in England to care for children during the Blitz, the Nazi bombing campaign of the United Kingdom from 1940-41. Freud and her colleague Dorothy Burlingham documented their observations of children in their care in their book War and Children.

Though the children were not exposed to direct combat, they lived through repeated, unpredictable air raids throughout the day and night. Some children saw death up close, some were buried in debris, and many were injured. Freud and Burlingham found that, remarkably, when children were with their family members during these events, they rarely showed “traumatic shock.” They showed “little excitement and no undue disturbance. They slept and ate normally and played with whatever toys they had rescued.” The children seemed to equate their experience with just another childhood “accident,” like falling out of a tree or getting thrown off their bike. That the war “threatened their lives, disturbed their material comfort or cut their food rations” mattered little, according to Freud and Burlingham, as long as the children were with a trusted adult.[2]

But it became “a widely different matter” if a parent was killed or a child was separated from their parents. Children had a much harder time, for example, if they were evacuated for their safety to the countryside. Separation from parents was worse for children than enduring the bombings alongside their family, write Freud and Burlingham. This has been true in every war zone studied, from Rwanda to Bosnia and the West Bank to Syria. Studies show that if children lose the sense of safety anchored by a secure caregiver, the result is often an increase in PTSD, desensitization to violence, anxiety, depression, aggression, and/or antisocial behavior.

However, when the parent is present, their own emotional state matters. Freud and Burlingham write that most of the London population met the air raids with a “quiet manner,” so it was extremely rare to find children who were “shocked.” For example, they describe one Irish mother of eight whose windows were blown out in a bomb blast. When she showed up at the clinic, she said that they were “ever so lucky” because her husband was there and could fix the windows. Another mother brought her daughter in for a “cough and cold” but didn’t think to mention that they’d just escaped a bomb shelter destroyed in a fire. Due to the mother’s “lack of fear and excitement,” Freud and Burlingham write, the child “will not develop air-raid anxiety.” By contrast, they noticed that very anxious mothers had very anxious children. For example, one five year-old boy developed “extreme nervousness and bed wetting” when he had to get up in the night, get dressed, and hold his trembling mother’s hand.[3]

More recent research confirms that depression or anxiety in the primary caregiver is a significant risk factor for children’s psychological health. Anxious parents can overlook their children’s needs, and depressed parents usually under-respond to their children; either situation can lead to missed emotional cues and mental health problems in children.

Center on the Developing Child, Harvard University

On the other hand, when a supportive adult is present, the child can tolerate much more than if they were alone. Simply the presence of a calm adult can reduce the levels of cortisol, the stress hormone, in a child’s body. In fact, this supported exposure to manageable stress can even be “inoculating,” helping children to be more resilient, whereas complete avoidance of stress undermines the development of resilience.

The supportive adult figure doesn’t have to be a parent. Research shows that any non-parental figure in a caring capacity, including a neighbor, teacher, counselor coach, sibling, or cousin, etc., can be just as effective.

In addition to her study of children in WWII, Emmy Werner also conducted a 40-year longitudinal study on the Hawaiian island of Kauai to investigate the long-term effects of poverty and family dysfunction on children. She found that one of the strongest predictors of a child’s resilience was an emotional bond with an adult outside the immediate family.

This correlation was also found in a study of children in New Orleans who survived the flooding and aftermath of Hurricane Katrina. Children who fared the best seven years later were the ones who’d had the most supportive connections—family members, teachers, pastors, or shelter workers. By contrast, those who fared worst had lacked any constructive connections, and the ones who floundered marginally had had only one person as a solid anchor.

Werner also studied the records of pioneer families who travelled across deserts, mountains, and rivers in wagon parties. The Donner Party is perhaps the most tragic and well-known story of westward migration. A small band of 87 travelers took an ill-advised shortcut away from the Oregon Trail and onto a lesser known route around Salt Lake. The path eventually ended, and they had to cut through forests and brush to clear their way. The delay caused them to get trapped in the heavy Sierra snowfalls, unable to move for four months. As supplies dwindled, travelers resorted to eating their animal skin rugs and animals, and a few resorted to cannibalizing their deceased companions. Of the 41 children in the party, a third died, mostly infants and toddlers.

The ones who survived, according to Werner, had the strongest social supports from mothers, aunts, cousins, and a teacher who pooled what resources they had, maintaining whatever shreds of structure and normalcy they could muster. Werner details the particular significance of the sibling bond. Siblings shared food and drinks, nursed the sick and injured, and were confidants and supports to each other when the going got tough. The majority of children who survived went on to lead “long and productive lives,” becoming lawyers, ranchers, writers, prospectors, and heads of large families.[4]

Takeaway: Children are most resilient when they’re embedded in a network of social support: a parent, a caring parent figure, and/or siblings. Accounts like these suggest that the support that works for children doesn’t have to be overly-precious or hyper-conscious. Rather, practical, positive decency offered by ordinary people will suffice.
The message to parents who aren’t able to care for their own children because they’re essential workers—or are sick and quarantined away from their families—is that other committed adults can pinch-hit as caregivers just fine.
For stressed parents at home caring for children 24/7 and trying to work, too: Put on your oxygen mask first. Your self-care is essential. It’s a consuming challenge to bring your best self to this quarantine day after day, but your wellbeing is essential to you and your children. And rest assured, you don’t have to be perfect. Even in the healthiest relationships, parents are only “in-tune” with their children 30% of the time. What matters more is your flexibility to repair, to come back together, and perhaps to reunite at the end of a long day. Apologies, forgiveness, and self-compassion are key. Remember: the biggest lesson your children are learning from you is how to handle themselves in stressful situations.

Child characteristics

What about the characteristics of children? Do some kinds of children do better than others?

First, there is no “resiliency gene,” but difference in biological makeup does affect how children register and regulate stress. These foundations are created by genetic and epigenetic transmissions across generations and by childhood experiences, especially during sensitive periods. The physiology of the stress regulation system is established from the prenatal period, through the first three years of life, so the stress experienced during that time is very influential in shaping stress-sensitivity of a child’s system. However, research also shows that in puberty—a period of brain remodeling—a child’s stress physiology can be recalibrated for better or worse, depending on how much stress they’re experiencing.

About one in five children is more biologically “sensitive” to stress than others. Their “fight-or-flight” systems react more quickly, easily, and intensely to mild stressors. They can become more devastated in difficult conditions, even more susceptible to respiratory illnesses. But they bloom more brilliantly in favorable conditions—becoming the world’s artists, poets, inventors, and empaths.

The first wave of resiliency research presumed that children who were more easygoing and sociable (i.e., could enlist other people’s help), and “intelligent” did better. Newer research has refined those generalizations into more specific abilities.

Recent studies have pointed to certain kinds of cognitive and emotional skills related to resilience. Executive control involves the higher-order thought processes in the prefrontal cortex. These include self-management abilities like setting goals, devising a plan to accomplish the goal, problem-solving, flexibility, and monitoring progress along the way. Historical studies show that a family’s survival often depended on the contributions of children, and that the mastery and competence the children developed through these tasks served them well in their adult lives.

Emotion regulation is the process of monitoring feelings and using strategies to minimize unpleasant ones (down-regulation), increase pleasant ones (up-regulation), and maintain desirable ones in order to accomplish a goal. Positive strategies include reframing, acceptance, and finding a purpose. Drawing on children’s unique inner resources, like friendliness, musicality, humor, building, organizing, or creating can help keep their focus constructive. Unhelpful strategies include ruminating, numbing, escapism, venting, blaming, and disengaging; all of these lead to greater anxiety and poorer mental health outcomes in children.

Resiliency studies show that a combination of executive control and emotion regulation leads to the best outcomes and the lowest anxiety in children.

Takeaway: Some children may need a little more attention and support than others because of their age or their sensitivities. Pregnant women, infants, toddlers, preschoolers, and young teens need extra support and stress-buffering. It’s a good time to model, demonstrate, and teach executive control (e.g., through planning and completing projects) and emotional skills. Many professionals have suggested that during this time, traditional school lessons may be less important than social and emotional ones.

Prior vulnerability

Whatever the future effects of the pandemic on children and families, according to Jack Shonkoff, pediatrician and director of the Center for the Developing Child at Harvard, they will not be evenly distributed across families. Vulnerable families who already struggle with difficulties such as poverty, food insecurity, racism, immigration stress, and disabilities will experience more breakdowns like substance abuse, family violence, mental health problems, and later educational and employment challenges.

We’re already seeing news reports of faltering families. Divorce rates spiked in China following the peak of the pandemic, and early reports are signaling a similar trend in the U.S. The United Nations has reported a “horrifying” increase in domestic violence. As of this writing, calls to police and domestic violence hotlines are up 15-20% in New York; they’ve doubled in Lebanon and Malaysia, tripled in China, and increased 75% in Australia. Quarantined victims are trapped at home without access to teachers, counselors, or doctors who could support their emotional and physical safety. Part of the U.S. government relief package provides funding for shelters and hotlines. It seems that disasters that immediately threaten mortality like 9/11 or wars are less likely to spike family disturbance, but those that become chronic stressors like unemployment and the quarantine bring out the worst.

The disruption of education is a serious risk for vulnerable children. Educational consistency is a stabilizer for children in uncertain times, and teachers play critical roles in keeping disadvantaged children on track. Schools give structure and focus amidst disruption; many studies show that disasters interrupt children’s education, leading to unfulfilled lives, as well as a loss of human capital to society. UNESCO estimates that 91% of the world’s students are currently affected by school closures. While many schools are shifting to online education, the approaches are ad hoc and unstudied. Digital access is not available to everyone, though schools are struggling to provide students with internet hotspots. Some schools report that large numbers of students have “disappeared,” i.e., fewer than one half are engaging in online courses.

During the Great Depression, schools reduced their hours or closed. A million children lost access to school, and a quarter of a million children hit the road and rails, becoming “drifters” in search of work. For the first time, the federal government was spurred to take an interest in children’s well-being, because it was afraid that large numbers of disaffected youth could be susceptible to a rise of authoritarianism, similar to what was happening in Europe. The New Deal launched the first free school lunch program, free nursery schools, the first federally funded work-study programs, and the National Youth Administration and the Civilian Conservation Corps, which employed over seven million young people. The schools were funded to reopen, and Aid to Families with Dependent Children helped poor families. The government ended child labor and raised the mandatory school attendance age to 16 in order to eliminate having children compete with adults for jobs. The first safety net for children and families was cast, and the word “teenager” entered the vocabulary for the first time.

On the other end of the economic spectrum, affluent families that tend toward “overparenting” can be at risk for fostering anxiety, as they strive to perfectly recreate the school learning environment at home in order to keep up with standardized testing and the college admissions cycle. These families might benefit from broadening their definition of learning to focus on simply reading, problem-solving, communication, and social and emotional skills.

“When children are involved in things they’re really interested in, a project or an exploration, they will be learning. Everything around them is a learning experience. Parents should think about how to take advantage of that,” advises Linda Darling-Hammond, professor at Stanford University Graduate School of Education and CEO of the Learning Policy Institute.

Takeaway: Vulnerable and disadvantaged families, especially with multiple stressors, should have access to and seek help from mental health and legal services. Local schools and each states’ Department of Education list educational guidance and resources for students and families. Staying connected to education is especially critical for children with any kind of disadvantage, while families who tend toward overparenting may benefit from dialing down excessive traditional educational demands.

A higher calling

Many studies of resilience find that survivors who do well have philosophies or spiritual traditions through which they interpret events and derive hope and optimism. Ann Masten, professor at the Institute for Child Development at the University of Minnesota, is a noted theoretician in the study of children’s resilience. In her book, Ordinary Magic: Resilience in Development, she writes that many faith traditions—including Buddhism, Hinduism, Judaism, Christianity, and Islam—naturally incorporate all of the ingredients for resilience. They offer parenting guidance; identify moral conduct; provide role models, mentors, and community support; teach and practice self-regulation; and value the greater good. A connection to some definition of the divine and a philosophical framework help survivors make meaning of their experience and in the process, help them keep calm. Studies show that some homeless families in shelters persevere because of their faith. African American communities find connection, spiritual guidance and a coherent vision through their churches; and orphans in war-torn Sri Lanka find acceptance and peace through Buddhist and Christian practices of meditating, storytelling, and reading scripture.

Sometimes, cultural practices offer meaningful support. A study of 1000 Afghani adolescents showed that in prolonged periods of armed conflict, Afghani cultural values of faith, family unity, service, effort, morals, and honor shored up resilience. Werner’s longitudinal research in Kauai showed that many adults who eventually created happy lives drew from their cultural heritage, becoming involved in Hawaiian conservation efforts, going to the ocean in times of trouble, or caring for their elders.

Recent psychological work suggests that having a sense of purpose may be enough to get you through. Surviving, ensuring your child’s well-being, volunteering, keeping your job, or finding awe in the moment may just be enough for now.

Takeaway: A connection to something greater than ourselves—whether it’s a spiritual practice, cultural beliefs, or a sense of purpose—can help families and children orient their thoughts, feelings, and actions. Participating in a larger flow can feel supportive and calming. Children, even very young ones, enjoy and benefit from these kinds of feelings and experiences.

* * * * *

Children are neither inherently resilient nor vulnerable. Instead, their well-being arises out of who they are as individuals together with the cascades of experiences they have. Some children may luck into a combination of resources that set them on a good path early on. But even for children who don’t do well initially, studies of the life course show that many can still find happiness later in life from a new opportunity, education, a good relationship, or a fulfilling career.[5]

For now, the world is in a difficult state of uncertainty. We don’t know how long we’ll be sheltering in place, the course of the virus, or what kind of “normal” life we will return to. But the enduring lessons for our children will surely be the emotional ones. These are the lessons they will remember as adults when they inevitably experience upheaval again—only then, it may be without us. So let’s stay focused on, and grateful for, what really matters.

Dads Want to Co-Parent — And It Matters

June 15, 2018

When co-parents tend to their relationship first, everyone benefits.

Note: This blog post is primarily about fathers (in honor of Father's Day) and particularly fathers who are partnered with women. This is just one of the many types of family structures that exist and I'm interested in all types of family structures. However, much of the detailed research on co-parenting involves heterosexual relationships. The good news is that many of the findings here that apply to fathers in heterosexual relationships also apply to co-parents of all kinds.

Arms heavy with meals I had prepared, I crossed the sunlit porch, slipped off my shoes, and walked through the front door. I found my friends, new parents, standing quietly side by side in their darkened kitchen. Shaye, their tiny newborn, had just awakened from his nap and was resting on his mama’s shoulder. A hushed atmosphere of disheveled slumber lingered.

Jed, Shaye’s father, turned to investigate the food I’d brought, lifting lids from the containers and filling his plate with chicken. “Do you want some?” he asked Emily, his wife.

“Later,” she said, sitting down on the couch to talk. Little Shaye lay quietly on her lap, attentive to sights and sounds, while Jed ate beside us.

Soon it was time to breastfeed, and Jed stood to bring Emily a pillow and a glass of water. When feeding was finished, Jed brought Emily her lunch, took Shaye from her arms, and burped him; then they disappeared for a walk in the afternoon sunlight while Emily turned to talk with me. After a while, Jed came back in, changed Shaye’s diaper, and, standing, started to rock the baby back to sleep. When Shaye fussed, his parents passed him back and forth until he settled.

I was in awe of this ballet, of Jed and Emily’s seamless choreography. Each shift in task was preceded by a considerate, “Do you want…?” “Could you please…” Or a “How are you doing?” This was true partnership in action.

Co-parent collaboration is good for the entire family

Carolyn Pape Cowan and Phil Cowan, psychologists emeriti at the University of California at Berkeley, have studied families for over 40 years. Parenting is hard, they acknowledge, and the transition to parenthood is an especially vulnerable time. More than 50 studies worldwide show that, as joyous and welcome as a new child might be, trouble usually starts to brew in the parents’ relationship after a birth. There’s too much to do, sleep is short, and freedom is seriously curtailed—a recipe for conflict and dissatisfaction that can place everyone at risk.

But when parents tend to their relationship and learn to collaborate constructively, everyone is much more likely to stay on track and thrive. Through several major studies involving more than 1,000 couples in very diverse walks of life, the Cowans found that when parents nurture their own bond, it maintains relationship satisfaction across the challenge of parenting—for years. It also improves the parents’ relationships with their children. In turn, the children are happier, and more sociable, and secure. Notably, tending to the co-parents’ relationship creates more benefits for the family than even parenting classes, men’s groups, or moms’ groups that tend to overlook couples’ issues.

Why is nurturing the couple relationship so powerful, even for the children?

“The relationship between the parent figures creates the atmosphere in which children are growing,” replied Carolyn. “If parents have unresolved high conflict, it makes children nervous and preoccupied with their parents; they end up not doing as well socially or academically. But if parents are warm and respectful, and treat each other kindly and gently, the children feel secure and therefore, free to explore life. They also have a positive model for their own lives as to how relationships should work.”

Phil added, “There are ‘spillover’ effects. That is, if a partner is unhappy, it’s very difficult to turn around and be a nurturing, supportive parent to the child. And our research shows that when a couple functions effectively as a team, it helps them ward off stresses and strains from outside the family, like job stress, poverty, or difficult life events.”

A healthy relationship invites dads in

One of the benefits of this early collaboration, the Cowans report, is that fathers feel more welcomed into the emotional labor and rewards of parenting.

“We know from our own and others’ research that one of the best predictors of father involvement is the relationship with the mom,” says Phil. “And that’s true regardless of the family structure, whether they are biological parents, adoptive parents, stepparents, divorced, cohabitating, or married. If you improve the relationship between the co-parents, partners are happier, and it draws dads in, not only to the relationship but into the family.”

And dads matter.

They want to be involved in parenting. A recent survey on parents of 2200 Millennials and Generation Xers revealed that 90% of the fathers said being a parent was their greatest joy, and 73% said their lives began when they became a father.

“Most of the fathers we’ve worked with want to be more involved with their babies and young children than their fathers were with them,” said Carolyn. “Some of them say, ‘I want my son or daughter not to be afraid of me and be able to talk about anything with me.’ Regardless of ethnicity—African-American, Mexican-American, European-American—all the fathers we’ve worked with either want to emulate some aspect of their own father, or they’re really eager to do it differently.”

Parenting has benefits for fathers, too. Research shows that fathers who are more involved in their children’s lives have better physical and mental health, are more stable, and live longer. Kyle Pruett, a psychiatrist at Yale University who with Marsha Kline Pruett collaborated with the Cowans for the past 15 years, quipped that health insurance providers should lower premiums for men when they become fathers.

When fathers are involved, moms also benefit. Women are still spending an average of twice as much time than men providing care for young children, even though dads have increased their involvement over the last 30 years by 65%. More support from fathers is welcome.

Dads are just as capable as moms

For a couple of decades, research has shown that mothers and fathers are equally capable of parenting well. Both mothers and fathers:

Are warm and responsive to their babies’ smiles and happiness;
Provide comfort when their babies cry;
Encourage exploration;
Engage in developmentally sensitive teaching;
Encourage their children’s autonomy.

Research shows that, as a general rule, mothers and fathers are equally sensitive and attuned to their children’s feelings.

Natasha Cabrera, psychologist at the University of Maryland, has been studying fathers, especially poor fathers, for 20 years. Many dads she sees are very hands-on. “They know how much their child weighs or what makes their baby cranky,” she says. “In a study we have going on right now, almost half of the children are soothed better by the dads than the moms.”

According to Cabrera, sometimes people assume that dads are incapable, and sometimes dads hide their capability so the mothers don’t “look bad.” “But often dads can be more understanding of their children because they have less of an agenda. They’re more laid back, less stressed, so they see the child more clearly,” Cabrera explains.

Dads and moms make different contributions to development

Language development: Cabrera has found that mothers and fathers talk to their children in different ways. One at a time, she gave moms and dads the prompt to “just talk to your child.” Then she recorded how many words were said, and which types of words were used. She found that fathers talked to their children in longer and more complex sentences and included more diverse kinds of words than mothers.

“The quality of their language was higher,” Cabrera said. “As a result, the two-year-olds knew more words, and more diverse kinds of words. So fathers are making important contributions to their children’s language development.”

Emotion regulation and risk-taking: Worldwide, dads seem to take on the role of exciting their babies. They’re more likely than mothers to engage in rough-and-tumble play, sweep the baby high into the air, or go for hysterical giggles, while still paying attention to what the baby can tolerate. Scientists think that this experience of excitement and energetic feelings—within the safety of the father’s watchful care—contributes to a baby’s emotion regulation and healthy willingness to take risks.

Fathers tend to hold babies differently—facing out, like a hood ornament, Kyle Pruett says—as if they’re “getting their child ready for the world.”

Less aggressive problem-solving: Ruth Feldman, psychologist at Bar-Ilan University in Ramat Gan, Israel, found that fathers who were sensitive and attuned to their children’s feelings and behavior benefitted their child’s social development. When these children, especially the sons, first encountered peer groups in preschool, their social problem-solving was more constructive and less aggressive or passive. These benefits continued into the early teens and were more attributable to fathers’ than mothers’ contributions. In other words, good fathering was critical to these children’s interpersonal problem-solving. They learned how to stand up for themselves respectfully, neither shying from conflict nor resorting to aggression.

Parents can relax and appreciate the diversity that each one brings to their parenting role, Cabrera points out. “There are similarities, and differences, and they complement each other to contribute to a child’s development and resilience.”

There’s an early, sensitive period for fathers’ involvement

Nature seems to draw fathers into parenting from the start.

Several studies examine the hormonal and neurological changes that occur in expectant and new fathers. For example, in a study of 34 couples, the hormones prolactin and cortisol—related to bonding behaviors in animals and humans—increased in women and men as childbirth approached. While the women’s cycle was driven by pregnancy, the men’s changes were related to their partner’s changes; that is, closer involvement with partners correlated more closely with men’s hormonal changes. And the greater the hormonal increases in men, the more “couvade” they experienced—i.e., the behavioral changes in weight, appetite, emotions, or energy some men experience during their partner’s pregnancy.

After the birth, men’s testosterone dropped to low levels, perhaps in preparation for their first interaction with their babies. And men who had higher prolactin before birth and lower testosterone after birth were more responsive to infants, looking, smelling, holding, and responding to their cries more. Other studies confirm that lower testosterone in fathers is related to a more sensitive “attunement,” or synchrony, with their babies in the first six months of life. While the caregiving system is “plastic”—e.g., adoptive parents bond just as closely as biological parents—nature seems to have provided this easy on-ramp to parenting.

Interestingly, men and women fall in love with their babies in different ways.

Women’s brains are primed by pregnancy, birth, and breastfeeding to get drawn into caring for their baby. Changes in the subcortical, “bottom-up” limbic regions of the brain connected to vigilance, mirroring, and emotional connections can even be identified in brain scans post-delivery.

By contrast, men’s brains are remodeled by their participation in caregiving. The more fathers engage in activities like soothing, changing diapers, and feeding, the more oxytocin (the bonding hormone) they produce, and the stronger the activation they show in the “mentalizing” regions of the brain. These are the more “top-down” processes from cortical regions that help a father to imagine and figure out what another person needs. And there doesn’t have to be a biological connection. Adoptive gay dads showed neurological changes similar to bio-moms and bio-dads.

The takeaways from the brain science are twofold. One, the caregiving system is “plastic,” and human brains are wired to change in ways that make room in a person's consciousness for caregiving, whether they're biologically related to a child or not. And two, dads shouldn’t wait until their children can talk to get involved in parenting.

“If you’re not involved in this sensitive period, it’s going to pass you by,” says Pruett.

About half of fathers—and mothers too—underestimate the importance of the earliest weeks and months of a child’s life. The hormonal and neurological changes that occur in fathers when they're involved with their pregnant partner, and later when they help with the physical acts of caregiving, actually pave the way for them to become more connected with their baby in ways that can have long-lasting effects.

What stands in the way?

Unfortunately there are a lot of barriers to full father participation in America. Structural barriers like lack of paid parental leave force both parents to choose between their paycheck and caring for their baby. Even if fathers have paid leave from work, many fear taking advantage of it, lest they be punished or ostracized by employers.

The Cowans and Cabrera react when I ask them about barriers to father involvement.

“There’s a pervasive cultural bias against fathers,” says Phil Cowan. “Often, in social service agencies, men are the ‘bad guys,’ especially to providers who are used to seeing family violence. But most men are not violent and would like to be caring, involved fathers if we would just make space for them. Outreach programs tend to focus exclusively on moms, like the Maternal and Child Health Bureau. And in our own experience we’ve found that sometimes dads’ names are not even listed on a family’s file.”

Cabrera agrees saying that research findings have important implications for decisions society makes about fathers, including custody arrangements, mental health interventions for fathers, and incarceration.

“Fathers, especially poor men, are often considered optional except for the financial support they can provide, and often visitation is denied or strictly limited,” Cabrera says. “Or we’re more concerned about mothers’ mental health and depression than the mental health of fathers. In most cases fathers love their children, and now research shows they are important for children in ways besides financial. I think we’ve done a lot of injustices to many men who would be very capable.”

“And the bias is not just in family service agencies, it’s in psychology, too,” says Phil. “Ninety percent of the parenting research is on moms.”

Cabrera agrees: “By using the maternal template for research, we miss things fathers do that might be interesting and required in kids’ development. Dads are not just babysitters, backups, or paychecks. They’re important for development.”

Mothers sometimes stand in the way. In a 2015 representative survey of parents, 40% of dads (versus 17% of moms) said they’d like to be more involved in parenting but their co-parent didn’t let them. And 43% of dads (versus 16% of moms) said their co-parent was too controlling.

What’s important about couple collaboration?

The Cowans described the five aspects of collaboration they focus on in their work with parents of young children:

Individual well-being of each parent: Are they anxious or depressed? What do they worry about? Do they feel effective, or not? How is each partner feeling?
The couple relationship: What are some helpful strategies for problem-solving in the relationship? How can couples approach solutions and maintain their sense of calm?
Parenting and co-parenting strategies: What is the authoritative parenting style and which specific strategies reflect that style? They encourage couples to make incremental changes and to plan time to reflect together on how things are going.
Three-generational reflection: How have parents’ own childhoods, especially the relationship between their own parents, affected them? What approaches would they like to carry over from their childhood experiences, and what would they like to do differently?
Stressors: Are there other stressors pressuring the family that should be addressed and where might they find support to lower their stress?

Six months after my first visit, I followed up with Emily, Jed, and little Shaye—and I experienced them as a solid, well-coordinated unit who were really enjoying each other. They were navigating the challenges of new parenting with thoughtfulness and care.

They recently helped their baby to sleep through the night. How? “We spent hours and hours arguing over strategies, and had months of conversations," Jed said. "Finally I said, ‘Emily, you need sleep. Something needs to happen here.’”

Now they’ve established a pattern where Jed manages much of the nighttime so Emily can sleep. He thaws and warms the breast milk, feeds Shaye, and then puts him down for sleep. If Shaye wakes up, Jed briefly comforts him, and then rolls back to bed.

“It can be challenging,” says Jed. “But the whole process is sweet and I love the interaction with him. It feels important to me that I can be that nurturing and effective.”

Juggling two work schedules and baby care without outside help is hard, and Jed is candid about that: “The most stressful part is when you’ve got 400 things on your mind and you’re racing against a deadline, and there’s nothing else you can do but be with your child. I’m more tired than I’ve ever been, and drink more caffeine now than in my entire life. I’ve hit my edges a few times, but it’s grown my capacity.”

"There’s not a lot of social support for new fathers," he continues. "Now I'm more interested in other dads. But it's not like we give a lot of advice to each other, it’s more like, ‘hey, what’s it like to be you right now?’”

How has fatherhood changed him?

“I feel more joyful and playful and fulfilled,” he says.

* * * * *

Additional resources

An Interview with Dr. Kyle Pruett, 2014

Conversation with Dr. Ruth Feldman and Dr. Kyle Pruett, 2014

More video talks by experts on the importance of fathers: Simms/Mann Institute

When Partners Become Parents: The Big Life Change for Couples, by Carolyn Pape Cowan and Philip Cowan

Do Fathers Matter? What Science is Telling Us about the Parent We’ve Overlooked (2014), by Paul Raeburn.

All In: How Our Work-First Culture Fails Dads, Families, and Businesses—and How We Can Fix It Together (2015), by Josh Levs

And for fun

Home Game: An Accidental Guide to Fatherhood (2009), by Michael Lewis

Pops: Fatherhood in Pieces (2018), by Michael Chabon

What is a Secure Attachment? And Why Doesn’t "Attachment Parenting" Get You There?

April 3, 2017

A few months ago, a young friend of mine had a baby. She began a home birth with a midwife, but after several hours of labor, the baby turned to the side and became stuck. The midwife understood that the labor wouldn’t proceed, so she hustled the laboring Amelie into the car and drove the half-mile to the emergency room while Amelie’s husband followed. The birth ended safely, and beautiful, tiny Sylvie emerged with a full head of black hair. The little family of three went home.

When the baby was six weeks old, Amelie developed a severe breast infection. She struggled to continue breastfeeding and pumping, but it was extremely painful, and she was taking antibiotics.[1] Finally she gave in to feeding her baby formula, but she felt distraught and guilty. “Make sure you find some other way to bond with your baby,” her pediatrician said, adding to her distress.

“Piglet sidled up to Pooh from behind. “Pooh!” he whispered.
”Yes, Piglet?”
”Nothing,” said Piglet, taking Pooh’s paw. “I just wanted to be sure of you.”

— A. A. Milne

Fortunately, sleep came easily to Sylvie; she slumbered comfortably in a little crib next to Amelie’s side of the bed. Still, at four months, Amelie worried that the bond with her baby wasn’t forming properly and she wanted to remedy the problem by pulling the baby into bed. Baby Sylvie wasn’t having it. When she was next to her mother, she fussed; when Amelie placed her back in the crib, she settled. Again, Amelie worried about their relationship.

“Amelie” is an amalgam of actual friends and clients I have seen in the last month, but all of the experiences are real. And as a developmental psychologist, I feel distressed by this suffering. Because while each of the practices—home birth, breastfeeding, and co-sleeping—has its benefits, none of them is related to a baby’s secure attachment with her caregiver, nor are they predictive of a baby’s mental health and development.

“Attachment is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.”

— Alan Sroufe

“Attachment is not a set of tricks,” says Alan Sroufe, a developmental psychologist at the Institute for Child Development at the University of Minnesota. He should know. He and his colleagues have studied the attachment relationship for over 40 years.

Why the confusion about a secure attachment?

Over the last 80 years, developmental scientists have come to understand that some micro-dynamics that take place between a baby and an adult in a caring relationship have a lifelong effect, in very specific ways, on the person that baby will become.

“Attachment,” Sroufe explains, “is a relationship in the service of a baby’s emotion regulation and exploration. It is the deep, abiding confidence a baby has in the availability and responsiveness of the caregiver.”

A secure attachment has at least three functions:

Provides a sense of safety and security
Regulates emotions, by soothing distress, creating joy, and supporting calm
Offers a secure base from which to explore

In spite of the long scientific history of attachment, psychologists have done a rather poor job of communicating what a secure attachment is and how to create one. In the meantime, the word “attachment” has been co-opted by a well-meaning pediatrician and his wife, William and Martha Sears, along with some of their children and an entire parenting movement. The “attachment parenting” philosophy promotes a lifestyle and a specific set of practices that are not proven to be related to a secure attachment. As a result, the movement has sown confusion (and guilt and stress) around the meaning of the word “attachment.”

The attachment parenting philosophy inspired by the Searses and promoted by an organization called Attachment Parenting International is centered on eight principle concepts, especially breastfeeding, co-sleeping, constant contact like baby-wearing, and emotional responsiveness. The approach is a well-intentioned reaction to earlier, harsher parenting advice, and the tone of the guidance tends to be baby-centered, supportive, and loving. Some of the practices are beneficial for reasons other than attachment. But the advice is often taken literally and to the extreme, as in the case of my “Amelie,” whose labor required hospital intervention and who suffered unduly in the belief that breastfeeding and co-sleeping are necessary for a secure attachment.

Attachment parenting has also been roundly critiqued for promoting a conservative Christian, patriarchal family structure that keeps women at home and tied tightly to their baby’s desires. Additionally, the philosophy seems to have morphed in the public consciousness into a lifestyle that also includes organic food, cloth diapers, rejection of vaccinations, and homeschooling. The Searses have sold millions of books, and they profit from endorsements of products that serve their advice.

“These [attachment parenting principles] are all fine things,” observes Sroufe “but they’re not the essential things. There is no evidence that they are predictive of a secure attachment.”

Sroufe unpacks feeding as an example: A mother could breastfeed, but do it in a mechanical and insensitive way, potentially contributing to an insecure attachment. On the other hand, she could bottle-feed in a sensitive manner, taking cues from the baby and using the interaction as an opportunity to look, talk, and play gently, according to the baby’s communication—all behaviors that are likely to create secure attachment. In other words, it is the quality of the interaction that matters. Now, one might choose breastfeeding for its digestibility or nutrition (though the long-term benefits are still debated), but to imply, as Amelie’s pediatrician did, that bottle-feeding could damage her bond with her baby is simply uninformed.

There is also confusion about what “constant contact” means. Early on, the Searses were influenced by the continuum concept, a “natural” approach to parenting inspired by indigenous practices of wearing or carrying babies much of the time. This, too, might have been taken up in reaction to the advice of the day, which was to treat children in a more businesslike manner. There is no arguing that skin-to-skin contact, close physical contact, holding, and carrying are all good for babies in the first few months of life, as their physiological systems settle and organize. Research also shows that the practice can reduce crying in the first few months. But again, what matters for attachment is the caregiver’s orientation and attunement: Is the caregiver stressed or calm, checked out or engaged, and are they reading a baby’s signals? Some parents misinterpret the prescription for closeness as a demand for constant physical closeness (which in the extreme can stress any parent), even though the Searses do advise parents to strive for a balanced life.

“There’s a difference between a ‘tight’ connection and a secure attachment,” Sroufe explains. “A tight attachment—together all the time—might actually be an anxious attachment.”

And what of emotional responsivity? This, too, has a kernel of truth, yet can be taken too far. It is safe to say that all developmental scientists encourage emotional responsiveness on the part of caregivers: The back-and-forth, or serve-and-return, is crucial to brain development, cognitive and emotional development, the stress regulation system, and just authentic human connection. But in my observation, well-meaning parents can become overly-responsive—or permissive—in the belief that they need to meet every request of the child. While that is appropriate for babies in the first half to one-year year of life (you can’t spoil a baby), toddlers and older children benefit from age-appropriate limits in combination with warmth and love. On the other hand, some parents feel stressed that they cannot give their child enough in the midst of their other responsibilities. Those parents can take some comfort in the finding that even within a secure attachment, parents are only attuned to the baby about 30% of the time. What is important, researchers say, is that the baby develops a generalized trust that their caregiver will respond and meet their needs, or that when mismatches occur, the caregiver will repair them (and babies, themselves, will go a long way toward soliciting that repair). As long as the caregiver returns to the interaction much of the time and rights the baby’s boat, this flow of attunements, mismatches, and repairs offers the optimal amount of connection and stress for a baby to develop both confidence and coping, in balance.

What is the scientific view of attachment?

The scientific notion of attachment has its roots in the work of an English psychiatrist named John Bowlby who, in the 1930s, began working with children with emotional problems. Most professionals of the day held the Freudian belief that children were mainly motivated by internal drives like hunger, aggression, and sexuality, and not by their environment. However, Bowlby noticed that most of the troubled children in his care were “affectionless” and had experienced disrupted or even absent caregiving. Though his supervisor forbade him from even talking to a mother of a child (!), he insisted that family experiences were important, and in 1944 he wrote his first account of his observations based on 44 boys in his care. (Around the same time in America, psychologist Harry Harlow was coming to the same conclusion in his fascinating and heart-rending studies of baby monkeys, where he observed that babies sought comfort, and not just food, from their mothers.)

Bowlby went on to study and treat other children who were separated from their parents: those who were hospitalized or homeless. He came to believe that the primary caregiver (he focused mainly on mothers) served as a kind of “psychic organizer” to the child, and that a child needs this influence, especially at certain times, in order to develop successfully. To grow up mentally healthy, then, “the infant and young child should experience a warm, intimate, and continuous relationship with this mother (or permanent mother substitute) in which both find satisfaction and enjoyment.”

But the attachment figure doesn’t have to be the mother or even a parent. According to Bowlby, babies form a “small hierarchy of attachments.” This makes sense from an evolutionary view: The number has to be small since attachment organizes emotions and behavior in the baby, and to have too many attachments would be confusing; yet having multiples provides the safety of backups. And it’s a hierarchy because when the baby is in need of safety, he or she doesn’t have time to analyze the pros or cons of a particular person and must automatically turn to the person already determined to be a reliable comfort. Research shows that children who have a secure attachment with at least one adult experience benefits. Babies can form attachments with older siblings, fathers, grandparents, other relatives, a special adult outside the family, and even babysitters and daycare providers. However, there will still be a hierarchy, and under normal circumstances, a parent is usually at the top.

photo credit: K. Merchant

photo credit: D. Divecha

In the 1950s, Mary Ainsworth joined Bowlby in England, and a decade later back in the U.S. began to diagnose different kinds of relationship patterns between children and their mothers in the second year of life.[2] She did this by watching how babies reacted in a sequence of situations: when the baby and mother were together, when they were separated, when the baby was with a stranger, and when baby was reunited with the caregiver after the separation. Ainsworth and colleagues identified the first three of the following patterns, and Mary Main and colleagues identified the fourth:

When babies have a secure attachment, they play and explore freely from the “secure base” of their mother’s presence. When the mother leaves, the baby can become distressed, especially when a stranger is around. When the mother returns, the baby expresses her joy, sometimes from a distance and sometimes reaching to be picked up and held (babies vary, depending on their personality and temperament, even within a secure attachment). Then the baby settles quickly and returns to playing.

The mothers who fall into this pattern are responsive, warm, loving, and emotionally available, and as a result their babies grow to be confident in their mothers’ ability to handle feelings. The babies feel free to express their positive and negative feelings openly and don’t develop defenses against the unpleasant ones.

Babies in insecure-avoidant attachments seem indifferent to the mother, act unstressed when she leaves, and exhibit the same behaviors with a stranger. When the mother returns after a separation, the baby might avoid her, or might “fail to cling” when picked up.

The mothers in insecure-avoidant attachments often seem angry in general and angry, specifically, at their babies. They can be intolerant, sometimes punishing, of distress, and often attribute wrong motivations to the baby, e.g., “He’s just crying to spite me.” One study showed that the insecurely-attached babies are just as physiologically upset (increased heart rates, etc.) as securely attached babies when parents leave but have learned to suppress their emotions in order to stay close to the parent without risking rejection. In other words, the babies “deactivate” their normal attachment system and stop looking to their mothers for help.

As toddlers, insecure-avoidant children don’t pay much attention to their mothers or their own feelings, and their explorations of the physical world are rigid and self-reliant. By preschool, these children tend to be more hostile, aggressive, and have more negative interactions overall. Avoidance and emotional distance become a way of dealing with the world, and instead of problem-solving, they are more likely to sulk or withdraw.

Babies with an insecure-ambivalent/resistant attachment are clingy with their mother and don’t explore or play in her presence. They are distressed when the mother leaves, and when she returns, they vacillate between clinging and angry resistance. For example, they may struggle, hit, or push back when the mother picks them up.

These babies are not easily comforted. They seem to want the close relationship, but the mother’s inconsistency and insensitivity undermine the baby’s confidence in her responses. This pattern also undermines the child’s autonomy, because the baby stays focused on the mother’s behavior and changing moods to the exclusion of nearly everything else. In insecure-ambivalent babies, separation anxiety tends to last long after secure babies have mastered it. Longitudinal studies show that these children often become inhibited, withdrawn, and unassertive, and they have poor interpersonal skills.

The last pattern of insecure attachment—which is the most disturbing and destructive—is disorganized attachment, and it was described by Ainsworth’s doctoral student, Mary Main. This pattern can occur in families where there is abuse or maltreatment; the mother, who is supposed to be a source of support, is also the person who frightens the child. Such mothers may be directly maltreating the child, or they might have their own histories of unresolved trauma. Main and her colleague write, “[T]he infant is presented with an irresolvable paradox wherein the haven of safety is at once the source of alarm.”

This pattern can also result when the mother has a mental illness, substance addiction, or multiple risk factors like poverty, substance abuse and a history of being mistreated. Babies of mothers like this can be flooded with anxiety; alternatively, they can be “checked out” or dissociated, showing a flat, expressionless affect or odd, frozen postures, even when held by the mother. Later these children tend to become controlling and aggressive, and dissociation remains a preferred defense mechanism.[3]

“The emotional quality of our earliest attachment experience is perhaps the single most important influence on human development.”

— Alan Sroufe and Dan Siegel

How important is attachment?

“Nothing is more important than the attachment relationship,” says Alan Sroufe, who, together with colleagues, performed a series of landmark studies to discover the long-term impact of a secure attachment. Over a 35-year period, the Minnesota Longitudinal Study of Risk and Adaption (MLSRA) revealed that the quality of the early attachment reverberated well into later childhood, adolescence, and adulthood, even when temperament and social class were accounted for.

One of the most important—and, to some ways of thinking, paradoxical—findings was that a secure attachment early in life led to greater independence later, whereas an insecure attachment led to a child being more dependent later in life. This conclusion runs counter to the conventional wisdom held by some people I’ve observed who are especially eager to make the baby as independent and self-sufficient as possible right from the start. But there is no pushing independence, Sroufe found. It blooms naturally out of a secure attachment.

photo credit: K. Merchant

In school, securely attached children were more well-liked and treated better, by both their peers and their teachers. In one study, teachers who had no knowledge of a child’s attachment history were shown to treat securely attached children with more warmth and respect, set more age-appropriate standards, and have higher expectations. In contrast, teachers were more controlling, had lower expectations, got angry more often, and showed less nurturing toward the children with difficult attachments—and who, sadly, had a greater need than the securely attached kids for kindness from adults.

The MSLRA studies showed that children with a secure attachment history were more likely to develop:[4]

A greater sense of self-agency
Better emotional regulation
Higher self-esteem
Better coping under stress
More positive engagement in the preschool peer group
Closer friendships in middle childhood
Better coordination of friendships and social groups in adolescence
More trusting, non-hostile romantic relationships in adulthood
Greater social competence
More leadership qualities
Happier and better relationships with parents and siblings
Greater trust in life

A large body of additional research suggests that a child’s early attachment affects the quality of their adult relationships, and a recent longitudinal study of 81 men showed that those who grew up in warm, secure families were more likely to have secure attachments with romantic partners well into their 70s and 80s. A parent’s history of childhood attachment can also affect their ability to parent their own child, creating a cross-generational transmission of attachment styles.

But early childhood attachment with a parent is not destiny: It depends on what else comes along. For example, a secure preschool child can shift to having an insecure attachment later if there is a severe disruption in the caregiving system—a divorce or death of a parent, for example. But the effect is mediated by how stressed and available the primary attachment figure is. In other words, it’s not what happens, but how it happens that matters. Children who were previously secure, though, have a tendency to rebound more easily.

Sroufe writes in several articles that an insecure attachment is not fate, either; it can be repaired in a subsequent relationship. For example, good-quality childcare that offers emotional support and stress reduction can mitigate a rocky start at home. A later healthy romantic relationship can offset the effects of a difficult childhood. And good therapy can help, too, since some of the therapeutic process mimics the attachment process. Bowlby viewed development as a series of pathways, constrained by paths previously taken but where change is always possible.

Without conscious intervention, though, attachment styles do tend to get passed through the generations, and Bowlby observed that becoming a parent particularly activates a parent’s childhood attachment style. One study looked at attachment styles over three generations and found that the mother’s attachment style when she was pregnant predicted her baby’s attachment style at one year of age for about 70% of cases.

What about parents who might not have gotten a good start in life and want to change their attachment style? There’s good news. Research on adult attachment shows that it is not the actual childhood experiences with attachment that matter but rather how well the adult understands what happened to them, whether they’ve learned some new ways of relating, and how well they’ve integrated their experience into the present. In other words, do they have a coherent and realistic story (including both good and bad) of where they’ve been and where they are now?

Support matters, too. In one of Sroufe’s studies, half the mothers were teenagers, which is usually a stressful situation. Sroufe found that the teenagers with good social support were able to form secure attachments with their babies, but if they didn’t have support, they were unlikely to form a secure attachment.

How to parent for a secure attachment and how to know if it’s working.

“The baby needs to know that they’re massively important,” says Sroufe. “A caregiver should be involved, attentive, sensitive, and responsive.”

“The baby will tell you what to do,” Sroufe explains. “They have a limited way of expressing their needs, so they’re not that difficult to read: If they’re fussing, they need something. If their arms are out, they want to be picked up. And if you misread them, they will keep on signaling until you get it right.” He gives the example of bottle-feeding a baby: “The baby might want a break, and she looks around. What does the baby want? To look around! If the parent misreads and forces the bottle back, the baby will insist, maybe snap her head away, or pull away harder.”

“How can I know if my baby is securely attached?” a client asked me about her six-month old. Clearly observable attachment doesn’t emerge until around nine months, but here are some clues that a secure attachment is underway:

0-3 months:

The baby’s physiology is just settling as the baby cycles quickly among feeding, sleeping, and alert wakefulness. Meeting the baby’s needs at different points in the cycle helps establish stability.
At this point, the baby has no clear preference for one person over another.
In her quiet, alert state, the baby is interested in the faces and voices around her.

4-8 months:

Attempts to soothe the baby are usually effective at calming her down. (Caveat: An inability to soothe might not be predictive of insecurity but rather point to one of a host of other possible issues.)
The primary caregiver has positive interactions with the baby where the back-and-forth is pleasant.
The baby has calm periods where she is interested in the world around her, and she explores and experiments to the extent she is physically able to—looking, grasping, reaching, babbling, beginning crawling, exploring objects with her mouth, hands, etc.
Infants begin to discriminate between people and start to show preferences. They direct most of their emotions (smiles, cries) toward the caregiver but are still interested in strangers.
They are very interested in the people they see often, especially siblings.

9 months:

The baby shows a clear preference for a primary caregiver.
The baby shows wariness toward strangers, though the degree varies with temperament.
The baby is easily upset when separated from her primary caregiver, though that, too, varies with temperament.
The baby is easily soothed after a separation and can resume her exploration or play.

9 months – 3 years:

The child shows a clear emotional bond with a primary person.
The child stays in close proximity to that person but forms close relationships with other people who are around a lot, too, e.g., babysitter, siblings.

Beyond this age, the attachment relationship becomes more elaborated. With language and memory, the rhythms of attachment and separation become more negotiated, talked about, and planned, and there is more of a back-and-forth between parent and child. By toddlerhood and beyond, an authoritative parenting style deftly blends secure attachment with age-appropriate limits and supports. A sensitive parent allows the changing attachment to grow and stretch with a child’s growing skills, yet continues to be emotionally attuned to the child and to protect their safety.

One of the best resources for how to parent for a secure attachment in the first few years of life is the new book Raising A Secure Child by Kent Hoffman, Glen Cooper, and Bert Powell, all therapists who have worked with many different kinds of families for decades. Their work is based squarely on the science of attachment, and they call their approach the Circle of Security. The circle represents the seamless ebb and flow of how babies and young children need their caregivers, at times coming close for care and comfort, and at other times following their inspiration to explore the world around them. The caregivers’ role is to tune into where on the circle their child is at the moment and act accordingly. Parenting for a secure attachment, the authors say, is not a prescriptive set of behaviors but more a state of mind, a way of “being with” the baby, a sensitivity to what they are feeling. The authors also help parents see the ways that their own attachment history shows up in their parenting and help them to make the necessary adjustments.

The neurobiology of attachment

“Attachment theory is essentially a theory of regulation,” explains Allan Schore, a developmental neuroscientist in the Department of Psychiatry at the UCLA David Geffen School of Medicine. A clinician-scientist, he has elaborated modern attachment theory over the last three decades by explaining how the attachment relationship is important to the child’s developing brain and body.

Early brain development, Schore explains, is not driven just by genetics. The brain needs social experiences to take shape. “Mother Nature and Mother Nurture combine to shape Human Nature,” he writes.

Infants grow new synapses, or neural connections, at a rate of 40,000 new synapses a second, and the brain more than doubles in volume across the first year. Genetic factors drive this early overproduction of neurons, Schore explains, but the brain awaits direction from the social environment, or epigenetic processes, to determine which synapses or connections are to be pruned, which should be maintained, and which genes are turned on or off.

One of the first areas of the brain that begins to grow and differentiate is the right brain, the hemisphere that processes emotional and social information. The right brain begins to differentiate in the last trimester in utero, whereas the left-brain development picks up in the second year of life. Some of the regions that process emotion are already present in infants’ brains at birth—the amygdala, hypothalamus, insula, cingulate cortex, and orbitofrontal cortex. But the connections among these areas develop in specific patterns over the first years of life. That’s where input from the primary relationship becomes crucial—organizing the hierarchical circuitry that will eventually process, communicate, and regulate social and emotional information.[5]

“What the primary caregiver is doing, in being with the baby,” explains Schore, “is allowing the child to feel and to identify in his own body these different emotional states. By having a caregiver simply ‘be with’ him while he feels emotions and has experiences, the baby learns how to be,” Schore says.

The part of the brain that the primary caregiver uses for intuition, feeling, and empathy to attune to the infant is also the caregiver’s right brain. So it is through “right-brain-to-right brain” reading of each other, that the parent and child synchronize their energy, emotions, and communication. And the behaviors that parents are inclined to do naturally—like eye contact and face-to-face interaction, speaking in “motherese” (higher-pitched and slower than normal speech), and holding—are just the ones shown to grow the right-brain regions in the baby that influence emotional life and especially emotion regulation.

The evidence for epigenetic effects on emotion regulation is quite solid: Early caregiving experiences can affect the expression of the genes that regulate a baby’s stress and they can shape how the endocrine system will mobilize to stress. Caregiving behaviors like responsiveness affect the development of the baby’s vagal tone (the calming system) and the hypothalamic-pituitary axis (the system that activates the body to respond to perceived danger). High quality caregiving, then, modulates how the brain and body respond to and manage stress.

Schore points out that the ventromedial prefrontal cortex, a brain region in the right hemisphere, both has the most complex emotion and stress-regulating systems of any part in the brain and is also the center of Bowlby’s attachment control system. Neurobiological research confirms that this region is “specifically influenced by the social environment.” [6]

Stress management is not the only important part of emotion regulation. In the past, Schore explains, there was an overemphasis in the field of emotion regulation on singularly lowering the baby’s distress. But now, he says, we understand that supporting positive emotional states is equally important to creating [what he quotes a colleague as calling] a “background state of well-being.” In other words, enjoy your baby. It’s protective.

A baby’s emotion regulation begins with the caregiver, and the Goldilocks principle applies: If the caregiver’s emotions are too high, the stimulation could be intrusive to the baby, Schore explains. Too low, and the baby’s “background state” settles at a low or possibly depressive emotional baseline. Just right, from the baby’s point of view is best.

And babies are surprisingly perceptive at registering their feeling environment. Hoffman, Cooper and Powell write:

The youngest babies can sense ease versus impatience, delight versus resentment or irritation, comfort versus restlessness, genuine versus pretending, or other positive versus negative responses in a parent when these reactions aren’t evident to a casual observer. Little babies may pick up on the smallest sigh, the subtlest shift in tone of voice, a certain glance, or some type of body language and know the parent is genuinely comfortable or definitely not pleased.

Schore explains that in a secure attachment, the baby learns to self-regulate in two ways: One he calls “autoregulation” which is self-soothing, or using his own mind and body to manage feelings. The second is “interactive regulation” which is going to other people to help up- or down-regulate feelings. This twin thread of self-reliance and reliance on others, then, begins in the earliest months, becomes very important in the first two years of life, and continues in more subtle ways throughout the life span.

This all might sound daunting for a new parent, who could still be tempted to overdo the focus on the infant and how the connection is going—potentially leading to the same kinds of stress and guilt that the attachment parenting movement creates.

But fortunately, the caregiver doesn’t have to be 100% attuned to the baby and ongoing repairs are an important part of the process:

“The idea that a mother should never stress a baby is problematic,” Schore says. “Insecure attachments aren’t created just by a caregiver’s inattention or missteps. It also comes from a failure to repair ruptures. What is essential is the repair. Maybe the caregiver is coming in too fast and needs to back off, or maybe the caregiver has not responded, and needs to show the baby that she’s there. Either way, repair is possible, and it works. Stress is a part of life, and what we’re trying to do here is to set up a system by which the baby can learn how to cope with stress.” Optimal stress, he explains, is important for stimulating the stress-regulating system.

Still, both Sroufe and Schore acknowledge the emotional labor of parenting. And they are vehement that parents need to be supported in order to have the space and freedom to care for babies.

“It takes time for parents to learn to read their baby’s signals,” Sroufe said.

Schore calls America’s failure to provide paid family leave—and we’re the only country in the world that doesn’t—the “shame of America.”

“We are putting the next generation at risk,” he explains, pointing to rising rates of insecure attachments and plummeting mental health among American youth. Parents should have at least six months of paid leave and job protection for the primary caregiver, and at least two months of the same for the secondary one, according to Schore, and Sroufe goes further, advocating for one full year of paid leave and job protection. And a recent study showed that it takes mothers a year to recover from pregnancy and delivery.

Intellectual and cognitive development have been privileged in our society, but it is our emotion regulation that organizes us, our existence, and how we experience life, Schore says. A study from the London School of Economics draws the conclusion that “The most important childhood predictor of adult life-satisfaction is the child’s emotional health…. The least powerful predictor is the child’s intellectual development.”[7]

So where does this leave my friend Amelie? The hard part will be navigating the distracting advice and creating the workarounds she needs for the lack of cultural support. But she enjoys her baby immensely, and I’m confident that she’ll form a secure attachment with Sylvie, as she trusts her own “right-brain” flow of empathy, feeling, and being, and tunes in to Sylvie’s own unique ways of communicating.

And Sylvie will do her part to draw her parents close. Because regardless of babies’ individual personalities—and whether they cry a lot or sleep very little, whether they’re breastfed or bottle-fed—they draw you in with their wide-open gaze, their milky scent, and their tiny fingers that curl around your big ones. Before you know it, they light you up with their full-body smile that’s specially for you, and they draw you near with their plump little arms clasped around your neck.

And the sweet elixir of the attachment relationship is underway.

References:

[1] While many medications are considered safe to take while breastfeeding, complete side effects may not be fully understood. For example, recent research suggests antibiotics may change the test baby’s microbiome (the implications of which are unclear), and some antibiotics are thought to discolor developing teeth.

[2] This section refers to primary caregivers as mothers since this research focused just on mothers.

[3] This section was adapted from the chapter on Attachment, in D. Davies’ Child Development: A Practitioner’s Guide, Guilford, 2011.

[4] Sroufe, A. & Siegel, D. “The verdict is in: The case for attachment theory.”

[5] From Schore, A. (2017). Modern attachment theory, in APA’s Handbook of Trauma Psychology, p. 6.

[6] Schore, A. (2017). “Modern attachment theory.” In APA Handbook of Trauma Psychology: Vol 1 (publication pending).

[7] http://onlinelibrary.wiley.com/doi/10.1111/ecoj.12170/full p. F720, in Layard,R., Clark, A.E., Cornaglia, F., Powdthavee, N. & Vernoit, J. (2014) What predicts a successful life? A life-course model of well-being. The Economic Journal, 124, p. F720-F738.

How To Soothe a Crying Baby

February 29, 2016

My most exhausting parenting memories have to do with being unable to soothe a crying baby. My husband and I had two children three years apart, on our own, thousands of miles away from our families. We were both in the startup phases of our careers, and so we took turns: We swaddled the babies, walked the hallway, put them on the dryer, swayed to music, drove in the car, used pacifiers, sat in a steamy bathroom, and rocked in the rocking chair. For a couple of years, I was so tired, I could hardly string complex sentences together at work.

New parents know this drill. And there are two big questions that arise pretty quickly: “How do you get it to stop?” and “When can we start letting the baby ‘cry it out’?”

My own childhood was not a great guide. I grew up in a time and place where the attitude toward crying even among normal parents could be summed up by the dictum, “Quit your crying,” and “I’ll give you something to cry about.” I wanted to take a different path.

Developmental science, though, was a good guide:

Crying in the first three months of life

In 1972, Johns Hopkins University researchers Sylvia Bell and Mary Ainsworth conducted a groundbreaking—and now classic— study on infant crying. For two-to-four hours at regular intervals across the first year of life, they went into the homes of 26 mother-infant pairs and took continuous notes on baby-mother interactions. What they found was important news: Babies whose mothers responded consistently and promptly to their babies’ cries in the first three months of life cried less often and for shorter duration in the subsequent months.

These responded-to babies also transitioned more quickly to other, non-crying modes of communication, like facial expressions, gestures, and vocalizations, later in the first year. (A more recent review of studies of infant crying linked less crying to better language skills.)

What about the babies whose mothers didn’t respond to their cries? Some mothers believed that if they responded, their babies would be encouraged to cry more, becoming more dependent and demanding—in a word, “spoiled.” This view is rooted in advice from the 1920s-‘40s from behaviorists like John B. Watson and promoted by the U.S. Children’s Bureau of Infant Care. Their opinion was that parents should have an emotionally detached, businesslike relationship with their children. An entity as powerful as the federal government advised that parents should not pick up their children between feedings, lest the baby become a “spoiled, fussy, and household tyrant” who makes a “slave of the mother.”(1) This advice was not based on scientific evidence, but extrapolated from operant conditioning and what was understood about the power of positive reinforcement. Today, nearly 100 years later, that advice has been hard to eradicate.

A predictable pattern

Babies’ cries are important signals, their only communication device in the beginning. The cries are part of a stone-age “operating system” that are designed to draw the caregiver close for protection and survival and to help manage the body, brain, and feelings at the time of greatest helplessness. Just how the caregiver responds to those signals is important for wiring up a nervous system that will be as calm, organized, and integrated as possible; in other words, it’s foundational for later growth and development.

Cries run the continuum from gentle fussing that might start quietly and build up toward discomfort, hunger, or boredom, to loud, high-pitched cries that may be followed by breath-holding that signals alarm, danger, or pain. And there is everything in between.

Babies' cries are both similar and unique. Digital acoustical cry analyses captures qualities like frequency, energy, and signal-to-noise ratio and show that a pain cry has a different pattern from other cries (it’s high-pitched, loud, and sudden, with some breath-holding). Each individual baby’s cry also has a unique “cryprint.” That cryprint is something many caregivers recognize; that is, they know their own baby’s cries from that of other babies.

Though every baby is a little different, “normal” crying in the first three months of life follows a fairly predictable pattern:

Crying tends to start up at around two weeks after birth, peak at around six weeks, and gradually decline and stabilize at around three-to-four months. The six-week peak is seen in many cultures (and even in chimpanzee babies):

Each line represents a separate study of crying. Reprinted with permission from Barr, R.G., (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

Most young babies have a fussy period. In newborns it’s often around midnight, whereas in older babies, it’s more often in the late afternoon or early evening. Extra holding, cuddling, or swaddling can help.
According to the American Academy of Pediatrics, two-to-three hours of crying a day is normal for babies in the first three months of life.

Why do young babies cry?

Babies under three months cry for many reasons: They’re hungry, they’re uncomfortable, they’re in pain, they’re too warm or too chilly, they want more or less stimulation, they’re wet, they’re transitioning from being asleep to being awake, they don’t like a hard surface or a scratchy fabric, and the list goes on.

For an exhaustive list of possible reasons for crying, and corresponding soothing techniques, see this list at reflux.org.

In addition, some babies just cry more than others, according to pediatric psychiatrist Barry Lester of Brown University, who has seen thousands of babies in his Colic Clinic at the Brown University Center for the Study of Children at Risk. Each baby has a distinct personality and a unique temperament that, in the beginning, have little to do with parenting. Some babies are reactive and easily upset, he says, and once they get wound up it’s hard to help them calm down. On the other hand, some reactive babies are easy to soothe and may even self-quiet after their parents back off for a bit. Some babies are not particularly reactive but are still hard to soothe; so for those babies, it takes longer to trigger crying, but once they start, they’re hard to bring down.(2) And some lucky parents have babies who are just “easy”; they don’t cry much, and they’re easy to soothe when they do start.

Sometimes there is a mismatch between the baby’s needs and the parent’s ability to respond. Less experienced, first-time caregivers as well as those with less support, can easily overreact. Or caregivers may have personalities, feelings, or beliefs that get in the way of reading their baby’s signals, intentionally or unintentionally. For example, studies show that caregivers with restrictive attitudes, insufficient empathy, or a high stress response respond less well to their babies. On the other hand, too much empathy, e.g., taking on the baby’s cries as evidence of unbearable suffering, can lead to “empathic distress” in the caregiver, and in an attempt to control their own strong feelings, they might withdraw, or become overly-intrusive. Fortunate parents who’ve had positive childhood experiences—or who’ve come to terms with difficult ones—tend to find it easier to respond more sensitively to their babies’ cries.

Depressed caregivers have the hardest time responding to their babies, putting babies at greatest risk for poor outcomes. Pediatric psychiatrist Barry Lester writes that babies are highly attuned to their caregivers’ feelings, and as a result may even cry more in an unhappy environment.(3) Depression can appear in many forms, from the mild depression arising from parenting pressures and lack of sleep to full-blown, biochemical, post-partum depression. We also know that being unable to soothe a crying baby can itself trigger feelings of helplessness and depression. Sooner or later, almost every parent will break down in tears because no matter what she does, she can’t stop her baby’s crying. I remember being trapped in an airplane seat for four hours with hot tears leaking down my cheeks when I couldn’t soothe the baby in my arms. (I later learned that she had an ear infection, but there was nothing I could do in the moment except rock her gently in my arms and whisper calmly in her ear.) It is a humbling, exasperating feeling—and it’s important that parents not blame themselves, Lester urges.

Some babies cry in the first three months for no reason that professionals can understand. Psychologists and pediatricians refer to this as “endogenous” crying, meaning simply that the source is internal. Endogenous crying is uniquely human, according to Debra Zeifman, psychologist at Vassar, in her review of research studies on crying. Even our close relatives the chimpanzees stop crying when their needs are met or they’re picked up; only humans seem to have the kind of crying that can perpetuate itself regardless of the trigger.

Endogenous crying seems to resolve at around three months, when it becomes more “exogenous,” or linked reliably to external triggers. This shift from internal to external coincides with other developmental shifts, suggesting that there is a maturation of an underlying system—a “forebrain inhibitory mechanism,” or some aspect of the central nervous system—at around three months. For example, also at around the three-month mark, endogenous smiling is replaced by more social smiling, stimulated by a familiar face; newborn reflexes disappear and are replaced by more voluntary behaviors; the sleep-wake cycle settles down into a more predictable rhythm, and there are changes in EEG patterns.

And finally, in rare cases, some babies’ distinct cries (often very high-pitched or poorly phonated) may reflect underlying neurological disturbances. Scientists are working to develop acoustical cry analyses that can predict later developmental disorders such as autism.

But one important reason babies cry, Zeifman says in a vast review of studies of infant crying, may be that they have been left alone.

Holding, carrying, feeding: What’s the evidence?

Babies in Western cultures, says Zeifman, spend an exceptionally large amount of time alone compared to babies in less developed cultures. Western parents for the most part are discouraged from physical closeness and frequent feedings, and they’re often encouraged to ignore their baby’s crying. Western babies are carried an average of about 30% of their waking hours, compared to 80-90% of waking hours for babies in non-Western cultures.

Anthropologists think that continuous holding may have been a strategy to reduce infant mortality, the risk of which has been lowered dramatically in the West. Yet, practices that distance caregivers from their infants, many anthropologists and psychologists say, may contribute to more crying. In Why Is My Baby Crying?, Barry Lester points to a survey of over 180 societies that found that babies cried less when they were carried.(4)

In a randomized control study (the gold standard of studies) of supplemental holding, 99 Canadian mothers were randomly assigned to either hold their babies a minimum of three hours throughout the day (whether they were crying or not), or to a control group (where babies spent extra time in front of a mobile or abstract shape). At six weeks of age, when crying normally peaks, the extra holding had the greatest impact—reducing overall crying by 43% and nighttime crying by 51%. Extra holding made a smaller but still positive difference later, at four, eight, and twelve weeks as well.

Supplemental holding reduced crying compared to a control group. Reprinted with permission, from Hunziker, U.A. & Barr, R. G. (1986). "Increased carrying reduces infant crying: A randomized controlled trial." Pediatrics, 77 (5), 641-648. — Supplemental holding reduced crying compared to a control group. Reprinted with permission, from Hunziker, U.A. & Barr, R. G. (1986). "Increased carrying reduces infant crying: A randomized controlled trial." *Pediatrics*, 77 (5), 641-648.

When babies are carried, held, or worn, mothers can sense early on when something is wrong, and attend or soothe before a cry even erupts. There is no known downside full-time carrying to babies, either to their health or their psychological outcomes. Carrying and holding is, however, a lifestyle challenge in Western cultures—it is not easy for babysitters, daycare providers, or working parents to provide that extra holding to individual babies. However the benefits of it should just be more proof that we need better policies to support parents since it is unlikely that we’re going to change the way babies’ nervous systems and brains develop!

Feeding intervals also reduce crying in young babies. For example, a correlational study of two American subgroups—one from La Leche League and one control group—found that frequent feedings reduced crying in babies who were two months old but did not make a difference for four-month-old babies.

Given that more holding and more frequent feedings help the youngest babies cry less and be more comfortable, it may be possible that the amount of crying in young babies may be more flexible than we think, more amenable to care practices. If we place infants in playpens and cribs and don’t co-sleep, we may miss the early cues that babies are in distress. In Why Is My Baby Crying?, Lester goes so far as to say that Western caregiving practices actually train babies to cry. When we leave babies physically apart from caregivers until they cry, babies get the message “If you want me, call me.”(5)

Crying it out?

Some babies do defy the norm and stop crying when left to “cry it out.” In fact, a follow-up study to Bell and Ainworth’s classic 1972 work found that a few mothers who ignored their babies had babies who cried less. However, most researchers critique those findings on either methodological grounds or as a sign of “giving up” on the baby’s part—a despair and withdrawal that could ultimately lead to detachment. Modern baby gurus like pediatrician and author William Sears and psychologist Penelope Leach agree. Sears says that when caregivers let babies “cry it out,” babies can lose trust in the “signal value of the cry” and maybe even in the caregiver relationship. Leach says that leaving a baby to cry it out can activate such high levels of the stress hormone cortisol and can deplete levels of oxygen that it can be toxic to a baby’s brain. “Crying it out” also undermines the important “serve and return” interaction that is the earliest basis of cognitive development.

A 2002 report summarizes the physiological changes that can happen when babies are left to cry hard:

Heart rate rises; there can be tachycardia, i.e., racing heart. Blood pressure increases by 135%.
Oxygen levels go down.
Blood pressure in the brain becomes elevated.
Stress response is activated, with elevated levels of cortisol. If uninterrupted, this creates a cascade of effects that can eventually damage the developing brain, affect the genes that regulate stress, damage the hippocampus, and result in later problems with learning, memory, attention, and emotion regulation.
Prolonged crying can lead to aerophagia, or air-swallowing, causing pain and problems with digestion.
Energy reserves are depleted due to rapid motor movements.
White blood cell count increases with vigorous crying, suggesting the body is preparing a survival response.

What about colic or crying that won’t stop?

Estimates of colic vary, from 10% to about 20-40% of babies in Western societies. Most pediatricians diagnose colic on the Rule of Threes: crying for more than three hours a day, for more than three days a week, for more than three weeks, in a baby that is otherwise healthy. But pediatricians don’t have any solutions; they simply encourage parents to persevere until the colic runs its course, usually by around three months of age. The real risk of colic, they agree, is the stress it exacts on caregivers, placing those babies at high risk for abuse (and even shaken baby syndrome) when parents “lose it.”

As the Founder of the Colic Clinic, Barry Lester is the nation’s leading expert on colic, and he takes a strong stance. “Crying is normal,” he writes. “Colic is not. People who say that colic is normal not only are wrong; they also are doing a huge disservice to families who have colicky babies.”(6) In Why Is My Baby Crying, he defines colic as “an identifiable cry problem in the infant that is causing some impairment either in the infant or in relationships in the family.”(7)

His colic symptom checklist includes:

A sudden onset of crying—the episode seems to come out of the blue
A change in the quality of the cry (more towards pain
A change in the physical body—pulling legs up, doubling over, tightening of muscles;
The baby is inconsolable

The full checklist along with a cry “diary” can help caregivers and pediatricians problem-solve the excessive crying. Though the cause of colic is unknown, Lester has in some cases identified gastroesophageal reflux disease (GERD), pain, food allergies, and other sensitivities. But there is no predictable common theme, and most often, no cause can be identified. Yet families still need help, since colic can pose some developmental risk and family relationship problems due to the stress it creates.

Colicky babies are more likely to have difficult temperaments and feeding and sleeping problems, all of which can interfere with the settling of the nervous system in the first three months. Their cries and heart rates are different from those of normal babies. They are at risk for behavior problems in preschool as well as attention deficit, hyperactivity, sensory integration, and emotional reactivity.(8)

Colic can take away the joy of parenting and make caregivers feel helpless and incompetent, despairing, and even angry and hateful toward the baby. It’s helpful if caregivers can know the amount of crying they can handle (their “safe cry zone,”) and what strategies they can use when their coping starts to fail—deep breathing, soft music, walking, rocking—so that they can continue to respond calmly. But when the stress rises, it’s imperative that someone else be recruited to hold the baby and give the parent some relief. This is not always possible, of course, especially for single parents, but it’s important that caregivers find some way to care for themselves as well as their babies’ crying, Lester says.

Crying in later infancy.

Crying in the first three months of life is about regulating bodily needs, wiring up the nervous system, and feeling close to and safe with a caregiver.

Crying later in infancy becomes more complex, as it’s also related to a baby’s growing cognitive and emotional capacities. The graph below shows crying data from several studies over the first two years of life.

Reprinted with permission from Barr, R.G. (1990). The normal crying curve: What do we really know? Developmental Medicine and Child Neurology, 32 (4), 356-362.

At around six to nine months, crying due to stranger wariness emerges. This is a normal, healthy sign that a baby understands who her “person” is, though again, different babies have different temperaments and will express more or less concern. Anthropologists think that stranger wariness served an ancient but important safety purpose of removing a baby from an incompetent or unsafe caregiver and reuniting the baby with her safe person. Very often the chosen caregiver that the baby attaches to is one specific person, even when multiple adults have cared for the baby. The baby might look at, reach for, or cry for her person when others are present, and then quiet as she is enfolded into safe arms.. But again, babies vary, and some attach just fine to multiple caregivers.
At around nine to twelve months, fear of strangers and fear of separation from a caregiver can peak crying again. This reflects a healthy cognitive growth; the baby can now anticipate the feeling of being alone, and she knows that crying is a kind of tether to the caregiver. This might especially coincide with dropping off at daycare, and skilled providers should be able to offer age-appropriate soothing.
Walking at 12-18 months can precipitate another burst of crying. As toddlers’ mobility carries them farther away from the caregiver, perhaps into a different room, they may suddenly realize that they are at sea.
Crying has another burst at around two years of age, when a baby’s growing sense of self and control over their own body meets thwarted goals and frustration. This coincides with the cognitive ability to plan action, to have deliberate wishes and intentions. As many developmental scientists say, this crying is not about the parents; it’s about the baby’s healthy growth.

How to soothe a crying baby in the first few months of life

The scientific evidence is clear: Responding to a baby’s cries in the early part of life is important to the baby’s well-being, establishment of a healthy nervous system, and subsequent growth. The hard part is to figure out how! Once a baby's obvious needs are ruled out, extra holding, frequent feedings, and the skin-to-skin contact of kangaroo care go a long way toward reducing crying. Putting on your own oxygen mask first—activating your own calm response—is crucial, and so is recruiting the support of other caring adults. Ideally parenting is not a solo activity, and we are all invested in the outcome!

Here are my favorite resources for techniques on how to soothe a baby:

For a long list of options, see Coping With a Crying Infant by Jeanne Clarey Bruening.
Harvey Karp’s book, The Happiest Baby on the Block, summarizes five steps for effective soothing: swaddling, holding, making a shushing sound, gentle jiggling while supporting the head, and sucking. For a shortcut, here’s a video.
Here’s how to swaddle a baby. As I write this, a new study has linked swaddling to sudden infant death syndrome (SIDS). However, it’s difficult to interpret the limited results. Deaths occurred most often when babies were on their stomach, less on their sides, and least on their back, all of which is true of SIDS when babies aren’t swaddled. Caution should be taken to swaddle correctly. Follow guidelines for back sleeping, and consider other options for infants older than six months (when the risk of SIDS doubled).
Pinky McKay’s book, 100 Ways to Calm the Crying, is a compassionate, respectful collection of ideas. It will soothe just in the reading!
Barry M. Lester’s book, Why Is My Baby Crying? The Parent’s Survival Guide for Coping with Crying Problems and Colic, written with Catherine O’Neill Grace, is a reassuring read for caregivers struggling with colic. He validates that parents who have babies with crying problems deserve and need support, and he has good diagnostics and suggestions. His Colic Clinic is in Providence, RI.
Here are twelve basic reasons babies cry, and how to soothe them, from The Baby Center.
Here is a Temperament Tip Sheet to consider the range of preferences for babies of different temperaments.

Conclusion

A final thought: Babies are born in a very immature physical state, with nervous systems and brains and bodies that have a long way to go—25 years, really—until they reach maturity. Parents and caregivers have to be flexible and adaptive in supporting the child’s current developmental needs. Different kinds of responses are important at different ages. For young babies, consistent affectionate responding is about meeting their physical and psychological needs, calming and integrating the nervous system, and creating a loving and trusting foundation to the relationship.

As babies grow—one to two years old and beyond—it may not be appropriate or even possible to soothe every cry. In fact, small bits of manageable stress in the presence of a caring adult help to “inoculate” a toddler for some of life’s vicissitudes and realities. But this is a gradual on-ramp, with a supportive adult. Later, new factors become important for parents to consider, like the development of language and cognition, the neurological ability to inhibit oneself, and the scaffolding of emotional skills.

Whatever the age, a good cry can always go a long way toward letting off steam, communicating, and healing.

Notes

(1) U. S. Children's Bureau of Infant Care. Care of Children Series No. 2. Bureau Publication No. 8 (Revised), 1924. As cited by Bell, S. & Ainsworth, M. (1972). Infant crying and maternal responsiveness. Child Development, 43 (4), 1171-1190.

(2) Lester, B. with Grace, C.O. (2005). Why Is My Baby Crying? The Parent's Survival Guide for Coping with Crying Problems and Colic. NY, NY: Harper Collins, p 89.

(3) Lester, p. 73

(4) Lester, p. 88

(5) Lester, p. 92

(6) Lester, p. 1

(7) Lester, p. 69

(8) Lester, p. 58

What Newborns Need for a Healthy Psychological Start

January 30, 2016

When I was a new mom, there were plenty of books about how to physically care for a newborn: how to swaddle, how to change a diaper, and how to treat skin conditions. But there was next to nothing on how to care for a newborn’s psychological well-being. What’s important for infant mental health? Erik Erikson, the famed psychoanalyst of the sixties, recommended eye contact for the foundation of newborn trust—so I spent a lot of time looking at my newborn baby girl.

That’s a start.

Since then, developmental scientists have learned a lot about what gets babies off to a good psychological beginning. And it’s deceptively simple: It’s about breath and heart; rhythm and timing; paying attention.

States

For nine months of pregnancy, the mother’s body provides everything a baby’s body needs: nutrition, oxygen, temperature control, and waste management. When the two bodies separate, the baby’s body has to learn to regulate all of these processes itself…amid myriad new sensations like sights, sounds, tastes, temperature fluctuations, restrictions, movements, and more. The simple coordination of the first breath with the heartbeat is itself a wonder of biological engineering.

As the baby’s body takes over its own bio-rhythms, it rapidly cycles through different states. In the space of one-and-a-half to two hours, the baby turns a tight schedule that keeps parents on their toes and is completely at odds with an adult sense of time. But how parents respond to these changing states forms a foundation for the baby’s later psychological and social development.

Generally speaking, there are six states, with transitions in between:

Deep sleep: The baby sleeps quietly without moving, and breathing is regular
Light sleep: The baby might move, may have irregular breathing and even startle at noises, or may experience eye movements in the dreamy sleep of REM sleep (rapid eye movement). Babies can cycle between deep and light sleep, even within an hour. Sometimes, in the first few months of life, babies wake between the deep and light sleep cycles and have difficulty returning to sleep. (Newborns sleep about 16 hours a day, and about half of that is in REM sleep.
Drowsiness: In the transition between waking and sleeping (e.g., waking up, or conversely, going to sleep), the baby’s eyes may open and close, or even roll back. The baby might stretch, yawn, or doze.
Quiet alert: The baby’s face is bright, eyes are open wide, and the body remains quiet. This is time when the baby takes in her environment on her own terms. She might be looking, or staring, or simply quietly focusing on what she sees, hears, or senses. This is a good time to give babies their space, to let them get used to feeling comfortable settling alone.
Active alert: The eyes are open and scanning and alert, and both the facial expressions and body are medium-active. Babies are especially open to social interaction in this state, so this is a good time to gently engage with the baby, talking quietly, singing, touching.
Crying/fussy: A baby cries, screams perhaps, and the whole body and soul can become quite stressed and disorganized. Babies are born nearly helpless, so crying is the best signaling system to recruit outside help to regulate a need. With experience, parents soon anticipate the various needs—to eat, to be comforted, to be changed, to warm up or cool down, for more or less stimulation, to be eased into sleep.

The underlying biology: oscillators and pacemakers.

Scientists have so far pointed to two biological mechanisms that underlie infant states and that have implications for later psychological development:

The oscillator controls the sleep-wake cycle. It develops in a fetus at about 30 weeks in utero, in a region called the suprachiasmatic nucleus, which is in the hypothalamus just above the brainstem. Even in utero, a fetus begins a tiny sleep-wake cycle: researchers and mothers alike notice that in the last trimester, the fetus is more active at some times and in quiet sleep at other times. The cycle is short (called an ultradian rhythm), but after birth it begins the long march toward a circadian rhythm—one that harmonizes with the light and dark cycles of a 24-hour period. Before birth, the sleep-wake oscillator is sensitive to conditions in the fetal environment, like the maternal hormone melatonin as well as the intrauterine environment such as mother’s diet and exposure to light and dark. After birth, postnatal practices like the skin-to-skin contact called kangaroo care are related to longer periods of alertness and more organized sleep-wake cycles.
The cardiac pacemaker regulates the pace of the heartbeat and coordinates the heartbeat with the breath to alternately activate (in-breath) and calm (out-breath) the heartbeat. This is part of the autonomic nervous system (ANS) that originates in the brain stem and connects many organs in the body—the heart, lungs, eyes, glands and digestive tract. The ANS is roughly divided into the sympathetic nervous system (SNS), which goes on metabolic alert when the baby is in need or distress, and the parasympathetic nervous system (PNS), which calms and soothes and restores the system once again.

Developmental scientists have become especially interested in the calming system arising from the vagal tone. The vagus nerve is the 10th cranial nerve, a complex web of connections from the brainstem and reaching throughout the body that control and put the brakes on stress, shifting bodily resources away from fight or flight and back to “restore and grow.” Like the oscillator, vagal tone is also perceptible in the third trimester, around 33-35 weeks gestational age. After birth, it, too, is enhanced through the skin-to-skin contact of kangaroo care and even infant massage. Not surprisingly, sensitive care encourages a strong vagal tone.

Synchrony: the dance between caregiver and newborn.

A new parent’s first challenge is to figure out how to react to a baby’s changing states. Granted, there is physical care involved—changing diapers, dressing, bathing, feeding, and more. But it is the process of joining a baby’s rhythm—not just physically, but psychologically, in harmony—that is most important for creating a strong psychological foundation. Psychologists have given this process many names: responsive care, attunement, and co-regulation.

Ruth Feldman, a psychologist at Bar-Ilan University in Israel and at the Yale School of Medicine, calls this coordinated interaction between caregiver and infant, “synchrony.” At first, she says, the relationship is biological: Pregnancy produces surges in the bonding hormone oxytocin in the mother, which primes her to attend to her baby (nonbiological parents generate oxytocin through interactions). In research studies, mothers with more oxytocin reported having more pleasurable feelings with their babies than mothers with lower levels of oxytocin. They were also observed to react in more sensitive ways, more often, to their babies’ behaviors.

In turn, as the baby is touched, or has skin-to-skin contact, or is breastfed, her nervous system is calmed, the biological clock organizes, and the vagal tone develops. Responsive, loving, warm care in the first weeks and months of life can even turn on or off the genes that regulate a baby’s stress.

Caring for a newborn changes parents' brains. As parents gaze at their newborn; talk gently; use soft, higher-pitched voices; and are positive, warm, and encouraging, their brain’s gray matter, or cell bodies, actually grow in the emotion and thought regions that support parenting behaviors.

Timing is important. In one of Feldman’s studies, when mothers appropriately chose the babies’ alert state to talk and touch their babies, the babies remained alert for longer periods of time.

[photo credits Kelly and Sahil Merchant, Mia Divecha]

The physiologies of caregiver and baby harmonize in the process. In one study, Feldman observed the heart rates of mothers and babies as they played with each other face-to-face. When the interactions were synchronized in an easy back-and-forth, the rise and fall of mother and baby’s heartbeats actually tracked each other, with a one-second lag. In other words, the mother—or any sensitive caregiver—helps to regulate a baby’s very heartbeat through loving, synchronous interactions. Feldman postulated that this is likely internalized by the baby as an “emotional sense of security that accompanies the child throughout life.” Other studies show that oxytocin levels, and even brain alpha waves, track between mother and baby in synchronous interactions as well.

Quick timing is also essential for soothing a distressed baby. In a now-classic study on crying, researchers Sylvia Bell and Mary Ainsworth at Johns Hopkins found that babies whose caregivers consistently responded quickly to their cries, cried less often and for shorter periods of time by the end of their first year.

Some parents need help synchronizing.

Many new parents intuit their babies’ needs—and/or learn to identify needs through observation—but others can benefit from some explicit coaching. Jenny Goyne is a postpartum doula who helps new parents through the stresses of the postpartum period and is especially dedicated to helping parents identify and work with their baby’s rhythms.

“I often encourage parents to just observe and watch their babies,” she says. For example, when the baby is quiet and content, she points out to the parent just how the baby is taking in her people and the world around her, and Goyne encourages parents to give the baby space to do just that. “Many parents feel they need to ‘do something,’” she says, “like sing a song, or entertain the baby, or exercise or stimulate them. There’s a lot of entertaining going on.”

“I remind them—this is all new to a baby. They’re just becoming aware of what’s around them and trying to make sense of all of it all. Babies, especially in the early weeks, also tire easily, and parents may not realize that when the baby looks away, or yawns, or begins to fuss or even cry, that they’ve had enough.”

Even breastfeeding can require some patience and self-restraint at first. It can take some time for the baby to find her way into it. In some cases, new mothers feel like they have to do something to make breastfeeding happen, which tends to stress the baby, and then the baby picks up on the stress and doesn’t want to eat. Many older mothers who are professionals and used to having answers just want to know what to do to make it work. “I often simply help them relax,” Goyne says. In other cases, mothers and babies benefit from coaching: some babies need coaxing to latch on, and there are strategies for making breastfeeding more comfortable for both mother and baby. In some circumstances, breastfeeding is not even possible, so helping a mother come to terms with this may be important. “Conversations about what this means to a mother are important. There’s often a grieving process that needs to take place,” Goyne adds.

She also teaches parents to read the smaller nuances they might otherwise miss.

“Most people can tell the difference between smiling, crying, and sleeping, but we’re not so good at the subtleties of what babies are doing,” she says. For example, she points parents to the signs that a baby is about to transition between states, like the agitated movements or jerky motions or even hiccupping that can precede crying. Or the looking away that says she’s had enough. Anticipating babies’ needs can help keep their nervous systems organized for longer periods of time.

And then: Every baby is different.

“Babies don’t go by a book,” Goyne quips. “They have different temperaments. Some babies’ eyes are wide open. They’re taking in the world and are eager to interact. Others may be shy, or even a bit withdrawn. These babies need more space and perhaps less contact. The shy ones, especially, can make new parents feel insecure, sometimes causing them to work hard to get their baby’s attention, which can be quite overwhelming to a baby.”

“New parents might not realize that babies often enjoy having some time to themselves, to observe and experience the world without the parental filter,” says Goyne.

It doesn’t help that each practitioner tells a new parent something different. “The advice is not standardized,” she says. “You have to figure out on your own what works for your particular baby.” She supports parents in doing that by observing the baby and describing to the parent what she sees in terms of behavior and temperament, so that parents understand their own baby’s unique cues.

Some parents want to put the baby on a schedule to hasten the transition to “adult time,” but Goyne discourages that: “Babies don’t go by our clocks,” she says. “Many parents don’t realize that and think something’s wrong. They don’t know how to make sense of ‘baby time.’” Jenny’s job is done when parents gain confidence reading their baby’s signals—a few weeks for some, and up to three months for families with twins.

By three months, patterns of reciprocal interaction are well-established. By this time the baby starts to become skilled, herself, at initiating and sustaining interactions. She offers a social smile that makes the mom happy and the mom talks to her in return; the baby looks at an object in the distance and the father points and names the object; with a little encouragement from the baby, the grandpa excites her to screeching with silly play but quiets down when the baby crosses the threshold to being disorganized or upset. The adult is the baby's outsourced regulatory system.

Just how important this social connection is to a baby is demonstrated through the still-face experiment. Baby and mother face each other, cooing, talking, and touching, until the mother makes her own face stone-still and expressionless. The baby tries heroically to reengage the mother, even yelling and reaching for her, and when the efforts are futile, she falls apart in distress, sensing the connection is completely ruptured. When the mother reengages, though, the baby’s nervous system becomes calm, she smiles and re-engages, and the connection is restored.

The Goldilocks effect: Not too much, not too little, but good enough is best.

A cautionary note is in order for the overly-conscientious parent: Good enough is best. Within a normal range of interactions, babies, especially older ones, benefit from some variations in timings and styles. Babies get the gestalt of it. In normal human dialogue, mismatches and repairs are common. Infants get sensitized early to rhythm of these miscoordinations and interactive repairs, says psychologist Ruth Feldman at Bar-Ilan and Yale Universities.

Different adults have different kinds of rhythms, especially with older babies. For example, in research, fathers and mothers showed different kinds of interactive styles and different modes of co-regulation. With their five-month-olds, mothers typically played face-to-face and coordinated tiny, little interactions at a low-to-medium level of emotional arousal. They looked at things together, pointed, verbalized, and used gentle, affectionate touch. Fathers, on the other hand, were more exuberant: They laughed together and played physical games or games using objects. Their play was bigger, more open, and more exciting. They were just as synchronous, though, calibrating the back-and-forth between themselves and their babies; they were simply more emotionally intense and had different content. And mothers tended to be more synchronous with their daughters, and fathers with their sons, rather than the other way around. It's likely, though, that these kinds of patterns are not fixed but are flexible. The point is that babies can do fine with different styles of interacting.

It’s when the overall pattern is off that there is need for concern. Jenny Goyne described intrusive, anxious parents who feel the need to entertain a baby even when the baby is quiet and content. One study showed that these kinds of parents have higher activation in the amygdala, or fear regions of the brain in contrast to parents who are in synchrony with their infants and the reward regions (the nucleus accumbens) of the brain are activated. Psychiatrist Margaret Mahler has video footage of intrusive mother-infant pairs where the mother ignores the baby's signals that she wants to crawl or play her own way. When seen a year later, that baby is wrapped around the mother’s legs in anxiety, uninterested in exploring her world. Anxious mothers tend to miss the signals that their babies need space. In the process, they not only stress their babies; they also deprive them of the ripe opportunity to be content on their own, or to explore the environment on their own terms.

On the other end of the spectrum, when mothers are aloof or depressed, they hardly engage at all in the normal back-and-forth that settles a baby’s nervous system. Maternal depression is predictive of some of the worst outcomes for babies.

Important for future development.

Synchrony between caregivers and babies has lasting beneficial effects into toddlerhood and well beyond into adolescence, in almost every area that matters:

Emotion regulation, self-control, stress management: Feldman and her colleagues found that babies whose mother could follow their lead in infancy (3 months and again at 9 months), had better self-control at two years old than babies who did not have a synchronous relationship. This was especially true for babies with more difficult temperaments. Young children who’d experienced early synchrony were both more willing to pick up toys and put them away and more able to resist touching objects they wanted. Long-term studies show that early synchrony predicts lowered stress and better emotion regulation well into the teen years.
Social relationships: Babies who experience attunement with their caregivers become kindergartners who have more reciprocal, give-and-take relationships with their peers and they are better at resolving conflicts. As teenagers, they enjoy social relationships more and are more skilled at sustaining them.
Cognition: Two aspects of synchrony are particularly important to set the stage for optimal learning. One is the calm emotional state that is required for attention, learning and memory to happen. The second is the “serve-and-return” nature of the interaction, where babies learn cause-and-effect in their world, that the world is ordered, has governing laws, and is not chaotic. They become motivated only when they can make sense of the world and feel that they have some small bit of control and self-efficacy. Studies show that babies who experience synchronous relationships have higher IQs at two and four years old; their symbolic expressions—in language and play—are richer and more sophisticated; and their language refers more often to their own and others’ internal states, e.g., “I feel” and “You think.”
Attachment: Greater synchrony with caregiver in infancy is correlated with better attachment at one year, and fewer behavior problems at two years old.
Empathy: One study that followed babies from 3 months to 13 years old found that teenagers who had experienced synchrony with their caregivers as babies had greater empathy, suggesting that, as Feldman says, “synchrony sensitizes infants to the emotional resonance that underlies human relationships across the lifespan.”

You can’t spoil a baby.

New parents often wonder how soon their babies should become independent. The importance of the biological connection between sensitive caregivers and their babies should dispel those notions of independence. A baby cannot be spoiled, in fact the opposite is true. A baby needs a loving caregiver who gives her what she needs, on her terms, in order to wire up the major biological systems that create a foundation for later psychological and cognitive well-being. This synchrony is critical in the first month of life to organize and settle the nervous system, and it continues to remain very important in the sensitive period across the first year.

* * *

Additional Resources

What do doctors screen newborns for?

What are newborn reflexes?

Developmental milestones in the first month

Tips for grandparents of newborns

How to find a postpartum doula

Books on physical care of newborns and infants:

Mayo Clinic’s Guide to Your Baby’s First Year

Your Baby & Child, by Penelope Leach

The Essential First Year by Penelope Leach

Caring for Your Baby and Young Child: Birth to Age 5, by the American Academy of Pediatrics

The Baby Book, by William Sears

The Wonder Weeks, by Frans Plooij and Hetty van de Rijt

The Transition to Parenthood: What Happened to Me?

November 30, 2015

"Tell me about the joys of being a new parent," I prompted my niece, whose little baby is five months old. She is 34, works full-time, and is married to my nephew.

The transition to parenthood is profound, as many parents already know. Developmental scientists consider it to be one of the most massive reorganizations in the lifespan, changing the brains, endocrine systems, behaviors, identities, relationships, and more, of everyone involved.

Kelly's answers had a quiet and whimsical grace.

"There is nothing more beautiful in this world than his smile," she said. "Or watching him discover something new. Last night he found the upper register of his voice, so he spent five minutes shrieking at a high pitch, playing around with the newfound note."

Kelly is a beautiful person, so I wasn't surprised to hear her speak appreciatively about her young son. And, in recent and evolving research, scientists are charting a "global parental caregiving network" that gets shaped in a new parent's brain to bring about some of the very thoughts, feelings, and behaviors that Kelly and other new parents experience.

In 2014, Ruth Feldman, a researcher in Israel and at the Yale School of Medicine, conducted an experiment with her colleagues. They went into the homes of 89 new parents, collected samples of oxytocin (the bonding hormone), and videotaped the parents interacting with their newborns. Later, the researchers put the parents in a functional-MRI machine and replayed their videos back to them, observing which parts of parents' brains "lit up" when they saw their own infants (versus videos of unrelated babies) .

The researchers found two main regions of the brain particularly active in new parents. The first is the "emotion-processing network." This is located centrally and developed earlier in evolution than the neocortex (see below). It involves the limbic, or feeling, circuitry and includes:

The amygdala, which makes us vigilant and highly focused on survival
The oxytocin-producing hypothalamus, which bonds us to our newborns
The dopamine system, which rewards us with a squirt of the feel-good hormone to make us motivated and enjoy parenting

All together, this network creates a heightened emotionality in parents in response to their babies. In fact, according to researchers Laura Glynn and Curt Sandman, the volume of gray matter (or number of neural cell bodies) increases in the above regions in new mothers and is associated with their positive feelings toward their infants. (See Glynn and Sandman's review article on brain changes in pregnant mothers.)

The second region is the "mentalizing network" that involves the higher cortex, or the more thinking regions of the brain. This area, along with additional superhighways that develop between the emotion and mentalizing systems, focuses attention and grounds in the present moment: Who couldn't stare at a new baby forever? It also facilitates the ability to "feel into" what a baby needs: Areas of the brain that involve cognitive empathy and the internal imaging of, or resonance with, a baby, light up. These regions help a parent read nonverbal signals, infer what a baby might be feeling and what he/she might need, and even plan for what might be needed later in the future (long-term goals). These regions are also associated with multitasking and better emotion regulation. In other words, parents' brains are remodeled to protect, attune with, and plan for their infants.

Other research has found that hormonal changes in pregnant women dampen their physical and psychological stress response, as if to make more space to tune in to their babies' needs.

But along with all these changes, there seems to be a collateral cognitive hit: In a meta-analysis of 17 studies, 80% of women reported impaired aspects of memory (recall and executive function) that began in pregnancy and persisted into the postpartum period.

Mothers aren't the only ones whose brains are remodeled. The brains of fathers, too, light up in ways that nonparents' brains don't. Feldman and her colleagues found that while the emotion processing network is most active in the biological mothers she studied, it is the mentalizing networks that are more active in the brains of fathers who are co-parenting alongside moms. The more fathers engage in caregiving tasks, the more oxytocin they produce, and the stronger the activation in the mentalizing areas of the brain.

Interestingly, in gay dads who are primary caregivers (half of Feldman's subjects), both emotion and mentalizing systems were highly activated by engaging in parenting. (For more on how parenting changes fathers' brains, I recommend the fun read, Do Fathers Matter? What Science is Telling Us about the Parent We've Overlooked, by Paul Raeburn.)

In other words, parenting is a very plastic and flexible process. While pregnancy prepares a mother's brain for parenting, the act of caregiving can produce upticks in oxytocin (the bonding hormone) and create neurological changes that support parenting in many adults--dads, adoptive parents, and other alloparents (any caregiving adults).

Kelly's husband Sahil is open about the new feelings he's having as a dad. "Winnie [short for Winter] is a curious, cheerful little person, and watching him develop and experience the world for the first time brings me endless amusement and joy. With Winnie, I've found new depths of love--it feels like a very biologically driven emotion."

While he is drinking in the sweet elixir of his baby, Sahil is also running his feelings through the thought circuitries. "Besides being afraid of the regular things--injury, illness, and such--I am also sad that his innocence will inevitably be eroded over time, and that he will inevitably experience all the various pains involved in growing into an adult."

Kelly admires her husband's changes and says that one of her greatest joys is "watching my husband develop into an incredibly loving, nurturing, and giving father."

Parents, naturally, continue to develop as individuals, and the arrival of a baby stimulates self-reflection. Observing Winnie moved Kelly to reflect on what must also have been the miracle of her own beginnings. "I'm fascinated by the fact that I, too, floated in a sack of amniotic fluid; that I, too, saw my hand for the first time and probably stared at it for 30 minutes straight, waving it in the air. Or that I, too, might have been startled by my own sneeze, or gas, or yawn."

Sahil says, "Having a child has given my life more meaning. For example, rather than working to earn money just for myself, to purchase various objects and experiences, I now have a great reason to do so. I'm more careful now, too. I have a child who depends on me, so I feel like I need to take better care of myself, so that I can be my best possible self to take care of Winnie."

Challenges

The joys of parenting are often felt more deeply than almost any other feeling humans are capable of having. But the challenges are great, too. "Every mom I knew was surprised by the impact of becoming a parent and wished she knew more about coping with it," writes Jan Hanson in Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships. Hanson is a nutritionist who co-authored the book with her husband, the neuropsychologist Rick Hanson, as well as OB/GYN Ricki Pollycove.

There are challenges to parents' physical health: recovery from pregnancy and delivery, the adjustment to breastfeeding, disturbed nutrition, fatigue, and insufficient sleep. As you would expect, Kelly reports that trying to stay rational, keep conflicts down, and drive safely are difficult on three hours' sleep and/or when she's been up, exhausted, since 4 A.M. She is experiencing what researchers know: That proper sleep is critical to health and well-being, including mood, decision-making, performance, and safety.

There are psychological adjustments to the new parenting role, too. Some parents need time to recover from a difficult or complicated birth process. For some, parenting demands can trigger strong unresolved feelings from childhood, especially if it was traumatic or troubled. Hormonal changes, along with sleeplessness and the constant demands of a new baby, can create surprising new feelings, too: anger, sadness, feeling trapped or isolated--even guilt, fear, and inadequacy. Some parents have to wrestle with having lost a previous child, or perhaps they are parenting a difficult or differently abled child. Kathleen Kendall-Tackett writes about these psychological challenges, and more, in The Hidden Feelings of Motherhood: Coping with Stress, Depression, and Burnout.

Having a new child introduces new challenges to the parents as a couple. Conflicts often increase in a relationship after the birth of a child, in part due to the "roommate hassles" of who will do what in the household as well as disagreements about parenting styles. Sometimes the sense of intimacy, closeness, and sexuality in a relationship can get derailed with the arrival of a little one. Couples are challenged to re-synchronize their relationship and develop a new sense of teamwork.

The couples who are most at risk for serious problems after the birth of a child, write parenting scholars Carolyn Pape Cowan and Philip Cowan in their book When Partners Become Parents, are those who were on the rocks before the child came along. Becoming a parent amplifies any pre-existing fissures in the relationship. Especially problematic are poor communication patterns--where one stonewalls, digs in, and/or refuses to budge, while the other escalates. In contrast, couples who have productive ways of working out new difficulties and challenges do the best adjusting.

After the arrival of a child, there are new logistics to deal with: new strains in managing a household, financial and legal concerns, when and how to go back to work, and figuring out childcare. Like many contemporary mothers, Kelly experiences the challenges as coming from both sides: the struggle to feel okay going back to work after three months versus the struggle to feel okay staying home without being criticized as a poor worker or an anti-feminist.

New parents also undergo a rearrangement of their social life, including how they interact with extended family and friends. Some friendship networks get reconfigured (not all childless people want to hang out with new parents). Kelly noticed that other people changed in their relationship to her as she became a parent. Many people offered unsolicited opinions, especially on the topics of sleep and clothing: "At times it felt that anyone who had once been a mother felt the need to say that my baby should put on more clothing. Even in 90-degree weather when he was sweating! And I was quite happy to be co-sleeping with Winter, but I was made to feel guilty about this on many occasions. Sleep is such a touchy topic, and many people tried to convince us to get Winter into a crib if we wanted what was best for him." Kelly found support from her sister who encouraged her to be firm about her internal compass in the face of many differing opinions: "Your only option is to learn to listen to yourself and know that you know your situation, and what works for your family, better than anyone else." Kelly adds that the most helpful exchanges are ones where she is encouraged to share how things are going, and in return hear a similar story and outcome. "Not only does it feel good to know I'm not alone in this, it educates me about what works much better than direct advice."

Rick and Jan Hanson and Ricki Polycove have seen so many thoroughly exhausted mothers in their practices that they identified a "depeleted mother syndrome," a condition where the mother's "outpouring, stresses, vulnerabilities, and low resources" are so overwhelming as to "drain and dysregulate her body."

The solution they recommend is threefold, focusing on lowering parenting demands, increasing supportive resources, and building resilience. Rick Hanson is a thorough, compassionate, skilled, and practical therapist, and Mother Nurture is therapy in a book: From one-minute soothers, to resolving childhood issues, there is much help in the way of cognitive, neurological, and commonsense approaches. Among other things, he provides suggestions for :

taking care of your body
small daily practices to improve outlook
reframing circumstances
concrete problem solving approaches
transforming painful emotions from the past
problem-solving sleep
vitamins to help with the nervous system
assessing neurotransmitters
staying connected to your partner with empathy
sharing the load
maintaining intimacy
healing hurt feelings

Kelly noticed that just as her identity started changing as a parent, there was a tendency for people to converse with her exclusively about motherhood. She was naturally thrilled that her loved ones were excited about Winnie, yet she longed for relationships that also nurtured her individual identity as a painter, a counselor, yoga enthusiast, and traveller.

As an American, Kelly is not alone in this experience. Kathleen Kendall-Tackett writes that in many non-industrialized countries, the postpartum period is a special time of "mothering the mother." New mothers are considered especially vulnerable so their activities are limited, they're relieved of normal work, and they stay relatively secluded with their babies while other relatives take care of them. Along with that extra care, there are special rituals and gifts that mark this as an important period. American mothers, in contrast, are quickly released from the hospital and are often even expected to entertain guests who come to visit the new baby. That difference in support, Kendall-Tackett says, is why in industrialized countries about 50-80% of new mothers experience the "baby blues," and another 15-25% have full-blown postpartum depression. In more traditional cultures where new mothers are exclusively nurtured, postpartum depression is "virtually non-existent."

Kelly agrees: "A mother needs to be nurtured and cared for because she is doing nothing for herself at this point. Everything is being given to the baby and I find little time to do things like even wash my hair or take a bath. Or connect with a friend. Even getting a hug from my husband can be hard in those times when a baby is especially demanding. When I do get that hug, I need it more than ever before."

The transition to parenthood is a huge transformation. And America, with no comprehensive child-family policy and no federal paid family leave policy--is a particularly unsupportive place to have a child. But the accumulating research is pointing to just how sensitive and important this period is for families. With a little knowledge and some foresight, parents-to-be, and their loved ones, can better plan for the transition. The rise in popularity of the postpartum doula (a person, usually a woman, who is trained to help new families in the home) is a step in the right direction.

Rick Hanson encourages new mothers--and fathers--to insist that others take their needs seriously. "Treat yourself like you matter," he says.

* * * * *

Further reading (some of these are oldies but still goodies):

On coping with the challenging feelings of becoming a new parent:

The Hidden Feelings of Motherhood: Coping with Stress, Depression, and Burnout (2001) by Kathleen Kendall-Tackett
*Mother Nurture: A Mother’s Guide to Health in Body, Mind, and Intimate Relationships (2002) by Rick Hanson, Jan Hanson, and Ricki Pollycove
When Partners Become Parents: The Big Life Change for Couples (1992) by Carolyn Pape Cowan and Philip Cowan
The Gentle Art of Newborn Family Care: A Guide for Postpartum Doulas and Caregivers (2012) by Salle Webber

On becoming a father:

Do Fathers Matter? What Science is Telling Us about the Parent We’ve Overlooked (2014) By Paul Raeburn
All In: How Our Work-First Culture Fails Dads, Families, and Businesses—and How We Can Fix It Together (2015) by Josh Levs
Home Game: An Accidental Guide to Fatherhood (2009) by Michael Lewis

Safe Cosleeping is Better for Babies' Development than Sleep Training

March 31, 2015

Over twenty years ago, when our children were born, my husband Arjun and I had the sleep debate that many American parents still have today: Where should we put the baby to sleep at night?

Arjun grew up in India, and though he'd slept apart from his parents, his ayah (nanny) had always slept close by. I, on the other hand, grew up in small-town Minnesota and had slept alone in a crib at the end of a hall. When it came to our own kids, we each argued that the other's experience must have been better. He believed in the superiority of modern, Western ideas, and I was sure that the ancient practice of sleeping together was the natural state of parenthood.

"We'll roll over on her," he worried.

"We'll sleep better," I countered, thinking breastfeeding in bed sounded pretty good.

Last week, a New York Times blog post reignited the discussion for another generation of new parents. "Sleep Training at Eight Weeks: Do You Have The Guts?" it asked. Sleep training is the process of getting a baby to sleep through the night through a variety of behavioral techniques, and in the extreme by letting a baby "cry it out" in a room without a parent's responsive soothing or feeding. After a couple of days, the logic goes, the baby "gets used to it," and "learns" to sleep alone through the night.

This school of sleep training, based on operant conditioning, runs counter to the current science of infant development. Here are a few examples:

Crying in babies is not a misbehavior to be modified; it is a physiological signal that something is wrong. Babies who are picked up when they cry learn that their needs will be met and they cry less over the long run. On the other hand, if a baby's crying is consistently ignored, she can learn that her signaling system is ineffective, undermining the developing sense of self-efficacy. Her natural demands, then, can escalate into more anxious ones. The general rule of parenting infants is that you cannot spoil a baby.
Though many Americans want their children to learn to be independent as early as possible, forcing a baby to manage herself alone is not the way to foster independence. Rather, independence arises naturally out of a secure relationship that builds up after many episodes of having her needs adequately met. For a summary of studies on the relationship between cosleeping and later child outcomes, see here.
To a helpless baby (and all babies are), crying and being ignored is inherently stressful. Though mild stress can "inoculate" a little one and help her learn to self-regulate her inner states, overwhelming stress--especially in infancy--can be toxic. Toxic stress can interfere with the expression of genes that set a baby's stress regulation levels in the developing brain.
Each baby is different, with a unique temperament, yet sleep training is a one-size-fits-all approach. Just because one baby sleeps through the night doesn't mean that all babies can and should. A vital part of parenting involves learning your baby's unique needs.
And finally, a systematic review of sleep training programs for babies under six months, published recently in the Journal of Developmental and Behavioral Pediatrics concluded that the strategies have "not been shown to decrease infant crying, prevent sleep and behavioral problems in later childhood, or protect against postnatal depression." In fact, sleep training in the first weeks and months of a baby's life, "risk[s] unintended outcomes, including increased amounts of problem crying, premature cessation of breastfeeding, worsened maternal anxiety, and, if the infant is required to sleep either day or night in a room separate from the caregiver, an increased risk of SIDS."

Cosleeping, not sleep training, is what is "biologically appropriate," says James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. McKenna has studied infant-parent cosleeping for most of his career.

Technically, cosleeping is defined as any situation where the infant and parent are within sensory range of each other. It has often meant sharing the same bed, but that has some risks as Arjun pointed out. Nowadays, McKenna, and many others in the United States, recommends separate-surface cosleeping, for example, placing the baby in a bassinet within reach or in a small crib next to the bed.

"There are as many ways to cosleep with your baby as there are cultures doing it," McKenna says.

Here's why keeping babies close is important:

Following birth, babies and caregivers remain physiologically connected to each other in complex ways, and when this bond is supported, babies do better. Breastfeeding, for example, is ideal for brain growth and future health. Babies who are breastfed have lower rates of sudden infant death syndrome (SIDS), diabetes, and other serious health conditions, while breastfeeding mothers have lower rates of postpartum depression, cardiovascular disease, diabetes, and hypertension. Breast milk is low in calories (but easy on digestion) so babies feed every hour and a half to two hours. When babies sleep close to their caregivers, they sleep more lightly, and wake two to three times more often than babies who are further away. The close proximity offers easy access with minimal disturbance.

Individual babies vary in how often they wake, from two to 13-15 times a night. But feeding isn't the only thing that happens more in the frequent wakings. When babies rouse, oxygen levels and heart rates rise, which is good for brain growth and development and immune functioning. The light sleep and frequent stirring also interrupt and stop episodes of apnea, or pauses in breathing, that can be deadly when prolonged.

And babies aren't the only ones responsible for the wakings. When McKenna observes mother-baby pairs sleeping in his lab, he finds that mothers wake babies about 40% of the time, and babies wake mothers about 60% of the time. The nighttime cameras show that mothers are often simply reassuring the babies emotionally: They "touch, hug, inspect, whisper"--loving gestures that also in turn raise baby's heart rate and oxygen levels.

"Remarkable to observe," McKenna says. And, not surprisingly, his cameras show that babies spend almost 100% of their sleep facing their mother.

Staying close to the adult's body helps the baby remain at a more stable body temperature. Physical contact, in close cosleeping, helps babies to "breathe more regularly, use energy more efficiently, grow faster, and experience less stress," says McKenna. Babies, too, who are not necessarily breastfed, as in the case of adoption, will also naturally reap the many other benefits of such close contact.

When babies are artificially put into deeper sleep through formula-feeding and the sensory isolation of a separate room, McKenna says, they not only are deprived of this close interaction and its attendant physical and emotional benefits, but the risk of SIDS rises. By contrast, in cultures where co-sleeping is the norm, incidents of SIDS are far lower or even unheard of.

Not all cosleeping arrangements are safe, though. Parental smoking, drinking, and drug use make parents insensitive to their babies and can be dangerous. The presence of other children and/or heavy duvets that can smother, are also are dangerous. So are places where a baby can get trapped, like gaps between beds or in couches or recliners. (A list of recommended guidelines can be found here.)

Despite the benefits of cosleeping, pediatricians still frequently recommend sleep training to exhausted parents of infants. This is unfortunate, especially for young infants under six months old. Rather than working to harmonize the mother and baby's biological systems, sleep training begins an adversarial emotional relationship between parents and their children. As McKenna points out, it sets us early onto the course of trying to make our children who we want them to be rather than respecting who they biologically are. And ironically, parents' sleep efficiency is not related to the number of times they're woken, but to their overall stress; e.g., mothers who exclusively breastfeed wake more often but have better quality and duration of sleep. McKenna recommends that pediatricians provide information on all sides of the issue so that parents can make informed decisions.

In our case, with a little practice and encouragement, Arjun got used to babies in the bed. And he'll be first to admit how addictive a baby's scent is.

Our girls had different timelines for transitioning to separate beds. By the time they were preschoolers, they began the night in their own beds, often ending in ours. But by this time, a family's values and preferences can be safely in play, and closeness happened to be just fine with us.

Time is always on your side, in parenting. Children won't be twenty and still sleeping with you.

Though in the deepest corners of our hearts, we sometimes miss it.

What Happens to Children When Parents Fight

April 30, 2014

When I was a child, my parents’ fights could suck the oxygen out of a room. My mother verbally lashed my father, broke jam jars, and made outlandish threats. Her outbursts froze me in my tracks. When my father fled to work, the garage, or the woods, I felt unprotected. Years later, when my husband and I decided to have children, I resolved never to fight in front of them.

“Children are like emotional Geiger counters,” says E. Mark Cummings, psychologist at Notre Dame University, who, along with colleagues, has published hundreds of papers over twenty years on the subject. Kids pay close attention to their parents’ emotions for information about how safe they are in the family, Cummings says. When parents are destructive, the collateral damage to kids can last a lifetime.

As a developmental psychologist I knew that marital quarreling was inevitable but I also knew that there had to be a better way to handle it. Cummings confirms: “Conflict is a normal part of everyday experience, so it’s not whether parents fight that is important. It’s how the conflict is expressed and resolved, and especially how it makes children feel that has important consequences for children.” Watching some kinds of conflicts can even be good for kids—when children see their parents resolve difficult problems, Cummings says, they can grow up better off.

How to Raise Your Child's Intelligence before Kindergarten

April 18, 2013

We parents spend a lot of time, energy, and money to advance our children's intelligence. Researchers have just made that job a lot easier by identifying the four most effective things we can do before kindergarten to give our children the best start on their intellectual development.

Full disclosure, I'm not a fan of the focus on "intelligence." It is too narrow a concept--the tests for it are culturally biased in favor of White middle class kids, there are many ways to be intelligent and successful that the tests don't measure, it is not predictive of life success, and social and emotional skills are just as important as intellectual ability. That said, in the right hands an intelligence test can be a useful diagnostic tool, and the term intelligence offers one way to talk about intellectual, or I prefer the broader term "cognitive," skills. But I admit, I couldn't help but peek at this research if even to compare it against how I nurtured these qualities in my own children. A common theme jumped out at me, which I'll get to.

New York University researchers John Protzko, Joshua Aronson, and Clancy Blair looked at 74 interventions that were designed to raise children's intelligence from the prenatal period to kindergarten with the goal of uncovering the most effective ones. They included only studies that met the gold standard of research design--the randomized control study--and they published their findings in the January issue of of Perspectives on Psychological Science.

What did they discover? Four significant building blocks of intelligence in early childhood:

1. Long-chain polyunsaturated fatty acids (LC-PUFA) supplements for pregnant mothers and newborns - IQ gains of more than three and a half points.

Pregnant mothers are encouraged to take many kinds of supplements but only LC-PUFA--found in foods rich in Omega-3s--raised young children't IQs, either when pregnant mothers were given the supplement or it was added to infant formula. The fatty acids are thought to be essential building blocks for nerve cells in the prefrontal cortex--and the body can't produce them on its own. One study showed that very young children who received the supplements for 8 weeks showed more activation in the prefrontal cortex than those who did not.

Is Empathy Learned--or Are We Born with It?

December 2, 2012

Twenty-three years ago, my husband and I were strolling with our toddler on the steamy streets of Yogyakarta, Indonesia, where we were taking a time-out before diving into our careers. At eighteen months, Zai was toddling ahead of us, and I watched as an elderly woman approached her, cupped hands outstretched, in the universal request for food or money. I held my breath as Zai offered the woman her most precious possession: her stuffed kitty. I did not want to interfere with Zai’s gesture of compassion—but the kitty was her security object. Empathy—a concern for others—is present in children from the beginning but not much has been known about how it unfolds early in life. Studies of newborn babies show that they cry more to the sounds of other babies’ cries of distress than they do to equally loud sounds of other types or even to recordings of their own crying. Psychologists believed that while this reaction foreshadows later empathy and suggests a hard-wired orienting to other people’s feelings, empathic distress throughout the first year of life was a more contagious, reactive, egocentric kind of response. Upset in others simply triggered, or got merged with, a baby’s own feelings of anxiety or fear.

Empathy in Children: The New Research

Until recently, researchers believed that true empathy doesn’t emerge in children until the second year of life, after 12 months of age, when a more separate sense of self begins to be consolidated. Psychologists believed that to accurately appraise how another person feels required greater cognitive complexity. Children needed to be able to separate what others might be feeling from their own internal experience. But three researchers were interested to see whether true empathy might actually be evident earlier, in the first year of life: Israelis Ronit Roth-Hanania at The Academic College of Tel Aviv-Yaffo and Maayan Davidov at The Hebrew University, and Carolyn Zahn-Waxler at the University of Wisconsin, Madison.

Roth-Hanania, Davidov, and Zahn-Waxler went into the homes of 37 mostly white, middle- and upper-middle class infants from eight to 16 months and set up three distressing situations:

The mother pretended to hit her finger with a toy hammer and be upset for one minute (and she avoided eye contact with her child in this minute so as to not bias the child’s response).
The mother walked toward the baby and pretended to bump her knee, again showing distress for one minute (and again without making eye contact).
The baby was shown a video of another baby crying for one minute.

All of the infants showed genuine empathy in emotional and cognitive ways. The younger babies’ feelings of concern for their mothers’ pain registered on their faces, from a fleetingly furrowed brow to sustained looks of sadness. Many cooed or made other sympathetic sounds. As the babies tried to figure out what had happened, their glances bounced from the hurt body part up to the mother’s face and back. Some made questioning sounds, or they looked to the face of another adult for interpretation.

“The family is the most effective and economical structure for nurturing and sustaining the capacity of human beings to function effectively in all domains of human activity—intellectual, social, emotional, and physiological.”

— Urie Bronfenbrenner

Check out “Real Talk,” an online or in-person group for teen girls to learn how to have honest conversations, meaningful connections, and good fun.

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“Adolescents appear to do best when they grow up in a family atmosphere that permits the development of individuality against a backdrop of close family ties.”

— Laurence Steinberg

I got the chance to interview legendary Bay Area child and family therapist, Sheri Glucoft Wong for a three-hour conversation about what matters most in the small, everyday moments of life with children.

No one understands kids like Sheri, and she

This past weekend we saw images of American teenagers fleeing ordinary high school football games because of gun violence and images of Iranian teenagers protesting their lethal oppression by the state. Here in the U.S., we are experiencing continual

What helps to support teens’ emotional wellbeing? Permission to explore their identity, witnesses in their lives who clearly “see” and support them, and participation in “competing joys” that offset stress, are just a fe

Burning Man is a different experience for everyone. To me, a developmental psychologist, it feels like a mirror on childhood, full of magic and playfulness and spontaneity. But it is better than many childhoods, with its intentional culture of care,

“If we can only make it clear that feelings are mentionable and manageable, we will have done a great service for mental health.”

— Mr. Rogers

Yale Center for Emotional Intelligence

The Yale Center for Emotional Intelligence uses the power of emotions to create a more effective and compassionate society. The Center conducts research and teaches people of all ages how to develop their emotional intelligence. Learn more here.