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.

Can a Pregnant Woman’s Experience Influence Her Baby’s Temperament?

October 8, 2018

Thirty years ago, when my Indian mother-in-law first learned that I was pregnant, she had some advice: Eat a lot of ghee (clarified butter), think pleasant thoughts, and gaze upon beauty.

Charming, I thought. I had a full time job with a two-hour commute. Where was there any time for meditative reflection? Still, she planted a thought in my mind, and I began to wonder. Was there a connection between my internal state and the development of the baby growing within me?

Folk wisdom and cultural beliefs throughout history have maintained that a woman’s emotions affect the fetus. Animal studies have shown that maternal stress, especially, can affect offspring—but it’s not been clear exactly how relevant those findings are for humans. In the last 15 years, though, research on human mothers and babies has caught up to show that my mother-in-law was at least partly correct: A pregnant woman’s emotional state—especially her stress, anxiety, and depression—can change her child’s development with long-lasting consequences.

Yerkes and Dodson, 1908, in Diamond, DM et al. (2007).

Some stress is good.

When it comes to stress, psychologists often affirm the Goldilocks approach: too little is not good, as it makes us passive. And too much is not good because it can overwhelm us and contribute to emotional upheaval and physical disease. Along the spectrum, there’s a “just-right” amount of stress that helps us to function optimally in most situations.

The Goldilocks principle (called the Yerkes-Dodson law, in psychology) seems to be true in pregnancy, too. “The human brain requires sufficient, but not overwhelming, stress to promote optimal neural development both before and after birth,” writes researcher Janet DiPietro of Johns Hopkins University.

Pietro and colleagues studied pregnant women who were mentally healthy, well-educated, and had low-risk pregnancies. Midway through the pregnancies, Pietro measured the level of the mothers’ psychological distress (stress, anxiety, or depression). After the babies were born, she tested their development at six weeks and then again at the two-year point. She found that babies whose mothers had mild-to-moderate distress were more advanced in their physical and mental development. Another study showed that the babies’ brain development benefitted from a little prenatal stress, maturing a bit faster, with quicker connectivity among neurons.

Does that mean that women should welcome stress in order to boost their fetus’ development?

Absolutely not. According to DiPietro, the normal stresses of modern life are enough already. “The last thing a new mom needs is to head into newborn baby care stressed and exhausted.” In other words, healthy women leading reasonably normal lives can “stop worrying about worrying.”

But too much stress can be harmful.

On the other hand, when women experience severe stress during pregnancy, their babies can be at risk for serious problems. What kinds of stresses are harmful?

In studies on pregnant women, intense stress has been defined to include the following: the loss of a loved one; war; a major catastrophe like an earthquake, flood, fire, or terrorist attack; and interpersonal violence. These stresses have been linked to subsequent miscarriage, prematurity, or low birth weight in infants.[1] Stress that is chronic—like poverty, homelessness, racism, and discrimination—can also lead to low birth weight, as well as later physical and psychological problems. Babies whose mothers experienced these kinds of toxic levels of stress while pregnant are statistically more likely to have respiratory and digestive problems, irritability, or sleep problems in the first three years of life. They are also more apt to experience developmental problems, with cognitive, behavioral, social-emotional, and health issues that suggest neurodevelopmental changes that ripple into adolescence and adulthood. Many of the studies were careful to rule out other potentially confounding environmental factors in order to isolate the effects to the prenatal environment.

A woman who experiences depression is also cause for concern. Newborns of mothers who were depressed during pregnancy are four times more likely to have a low birth weight than babies born to mothers who are not depressed. When women are depressed during pregnancy, there’s also a greater likelihood that they’ll suffer postpartum depression, which can become a major challenge for the whole family. Not only does the mother suffer, but research shows that depression in the primary caregiver is one of the strongest predictors of poor developmental outcomes in children. These children simply do not receive the normal interpersonal attunement and feedback they need in order to grow in emotionally healthy ways.

Even anxiety about being pregnant can be cause for concern. Research shows that “pregnancy-related fears”—worrying about an unplanned pregnancy, a specific medical risk, the fetus’ health, labor and delivery, or your ability to be a good parent—can be problematic in high doses. Excessive levels of anxiety (as opposed to what you worry about) are correlated with a greater likelihood of having a preterm birth. Also, pregnant women’s high levels of anxiety are correlated with later problems in children, including a difficult temperament, behavioral and emotional problems, anxiety, problems with attention regulation, impulsivity and hyperactivity, immune functioning and autoimmune disease, cognitive problems, and stress regulation.

Fetal stress and infant temperament

Psychologists have long known that babies enter the world with different temperaments. Some babies seem easy and sociable; others are more reactive, difficult to soothe, and are more sensitive to their environment. Until recently, scientists thought babies were “just born that way,” with temperaments that were “constitutional,” part of their makeup, or “inherited” from parents.

But the new research on fetal development changes that notion, and our understanding has progressed toward an interplay between biology and environmental influences—even before birth.

Catherine Monk, Professor of Medical Psychology in Psychiatry and Obstetrics and Gynecology at Columbia University Irving Medical Center, and her colleagues study the long reach of prenatal influences, especially among women who suffer from depression, stress, and anxiety. They found that some fetuses register mothers’ stress, and that fetal reactivity correlates with infant temperament at four months.

Monk and her colleagues brought 50 pregnant women into the lab and monitored the fetal heart rate while the women completed the Stroop Test, a mildly stressful mental task. Fetuses of women who were clinically depressed or anxious showed they registered the performance stress of their mothers, by the changes in their heart rates during the task. Later, when the babies were four months old, researchers assessed their temperaments by watching how reactive they were to a range of new stimuli (sounds, sights, smells), and some important patterns emerged. In particular, fetuses who had greater heart rate changes during their mothers’ task were more likely to be highly reactive at four months of age.

Subsequent studies have shown while the heart’s reaction to stress is important, the recovery from the stressor—how soon the heart returns to baseline—is also predictive. A quicker heart-rate recovery in the fetal period predicts an easier temperament and even more prosocial behavior later in childhood.

The fetus’ response to stress and the ability to return to baseline, may be the earliest sign of a fetus’ emerging stress regulation system, which in turn is the foundation of temperament (reactivity and regulation). The stress regulation system involves complex processes throughout the brain and body, and its effects cascade through complicated pathways into all the other areas of development. In infancy, the stress regulation system affects babies’ ability to form an attachment with others, to explore and learn about their world, and to receive feedback from others that helps them grow. It also affects their health and immune systems. Even for adults, scientists find that over the entire lifespan, the ability to manage the ups and downs of our interior worlds—stress, emotions, energetic “arousal,” and positivity—affects our physical and mental health, relationship quality, decision-making, and even creativity. Some studies assert that stress regulation has consequences for education, employment, and overall life satisfaction.

But a baby isn’t born with a thermostat set to some ideal of normal. In utero, the fetus is programmed to listen for cues about their future environment and start adapting accordingly.

“Theoretically, it’s an elegant evolutionary adaptation,” Monk told me in a recent interview. “The pregnant female communicates to her offspring cues about what the postnatal world is like, and the adaptation starts in utero.” But problems arise when the fit between the stone-age brain and the modern world is misaligned. “It could be advantageous to be reactive and vigilant if you’re in a dangerous postnatal environment,” Monk explains. “But we’re not facing bears in the woods now, so maybe the system for prenatal adaptations made to anticipate adverse environments (the environments that are eliciting stress and anxiety in pregnant women) aren’t adaptive for our modern world.”

The stress regulation system operates much like a thermostat that sets the room temperature, increasing the heat or turning it down to achieve a desired range. When we perceive a threat, the sympathetic nervous system activates a fight-flight-or-freeze response throughout the body and brain. When we judge that the threat has subsided, the parasympathetic system turns on to try to bring the whole system back to a resting state.

Because the biological “hardware” is just forming during the fetal period and early infancy, these are crucial times for setting the stress baseline in each fetus and young baby.

How do mother’s feelings get through to the fetus?

Scientists are curious about how stress reaches a developing fetus. This research is just in its early stages, and much more needs to be learned. But so far, scientists are focusing on a few mechanisms which may operate together or independently:

One is cortisol, a stress hormone that’s a downstream product of the body’s stress response. Women with anxiety and depression have higher levels of cortisol. And there is some evidence that when the placenta registers higher levels of cortisol from the mother, it creates an epigenetic change—a molecular modification to the gene that changes how it functions—that allows more cortisol through to the growing fetus, which in turn affects the stress regulation system.

“The placenta is highly susceptible to maternal distress and a target of epigenetic dysregulation,” Monk and colleagues write.

Inflammation is another focus of investigation. The pro-inflammatory cytokines—proteins that impact the behavior of cells and resulting immunity—may play a role, but the research on the exact pathways involved is still in the early stages.
Scientists are also looking at the role of infection and the microbiome, but there is no conclusive evidence at this time.

There are other complications, too. For example, one gestational period doesn’t seem more sensitive than another, but the impact of stress might vary depending on which areas of the brain are developing when the stress occurs. And while both sexes are affected, there are hints that male and female fetuses might react differently. For example, some research shows that female fetuses are more reactive to stress in utero, but other studies suggest males and females react similarly, but that males recover more quickly.

How much control do pregnant women have?

It should be obvious that almost every source of major stress—war, the loss of a loved one, violence, poverty, homelessness, a demanding workload, etc.—is outside the control of the woman experiencing it. But given that we live in a culture that frequently blames mothers for whatever happens to their children, I was concerned that this new research might be wielded against women.

“Could this research be used as a new form of mother-blaming?” I asked Monk.

“I think about this a lot,” she replied. “I don’t want my research to be adding stress to a woman’s life.”

Monk pointed out several caveats to the findings:

First, she cautioned that the research is just beginning, and we have to consider that these are correlations, not cause-and-effect. The associations have been shown repeatedly by different researchers, but it is not possible to complete a scientifically controlled study of intense stress on humans that would sort that out.

Second, Monk explained that a pregnant woman’s stress is just one of many “exposures.” There are numerous biological and environmental influences on development: The air a woman breathes, the water she drinks, the nutrition she ingests, and whether she exercises, gets sick, or is exposed to toxins. There are genetics. The father’s sperm quality matters, too, and is affected by his age, health and risk factors, and even frequency of physical exercise. Support from partners, families, and friends is important in mitigating stress.

Third, we should care for pregnant women more preventatively. “If we want to have a healthy population, a healthy workforce, then society is responsible,” Monk says. “So let’s take care of women and families early on with policies and programs that support them.”

Fourth, some stress is modifiable. “I see homeless women living in shelters, and I see busy medical doctors juggling family life with their practices,” says Monk. “One person can’t move the level of poverty in the country, but we can do something to help people cope with it. We really do know how to de-stress people and help them with depression and anxiety.”

And finally, stress hardware isn’t completely formed by birth. Once born, the quality of early caregiving continues to alter the epigenome that regulates stress, emotions, and behavior, dialing up or down the expression of genes that set the baseline for stress regulation. In many cases, good caregiving after birth can offset a rocky prenatal start.

How much stress is too much?

“How can women know if their stress levels are harmful or normal?” I asked Monk. “Are some kinds of stress worse than others?”

She replied, “Science is not at a place yet of saying that one kind of stress is worse than another. In our clinic, we see women in extreme stress, and what matters is how much, and what inner and outer resources they can bring to the experience.”

Monk listed some indicators of harmful stress:

When stressful feelings are chronic (symptoms might include an inability to get up in the morning, a continual low mood, not eating or sleeping)
When there’s prior exposure to trauma or abuse (which the anticipation of parenting might reactivate)
When a person’s life foundation is weakened by repetitive daily stresses (e.g., “Will I lose my job?” “Where’s my next meal coming from?” “Are we getting a divorce?”)
Or continual feelings of being overwhelmed

In addition, Monk and her colleagues use the Perceived Stress Scale to measure stress in their research subjects. They found that women in poorer mental health (comprising about 20% of their samples) score around a 26 or less on the scale. Items such as “I feel like I don’t have control,” “I often feel overwhelmed,” and “I feel like I can’t get things done,” are indicative.

Monk adds, though, that fewer psychologists are trying to measure a person’s amount of stress, and instead are looking at how they function across different areas of their lives. For example, a person might ask, “How am I functioning now compared to six months ago?” Or, “How am I functioning cognitively, physically, interpersonally, or emotionally?” This approach offers more useful information, Monk notes, allowing the person to leverage what is going well and to shore up what is not.

What helps?

Every person has unique vulnerabilities and strengths, and every situation is different. But research confirms that although we might not be able to control what happens to us, we have some control over how we react. And that matters. We can change our responses to stress through self-care (nutrition, sleep, and moderate physical activity); increasing our repertoire of emotion strategies for coping; having positive experiences; and seeking support from others. A strong support network of engaged partners, helpful family members, and good friends can buffer the ill effects of stress. Techniques like meditation and mindfulness have been shown to reduce stress and create better pregnancy outcomes and physical health.

As an example, Monk and her colleague Elizabeth Werner developed a four-session intervention that reduces the risk of depression in pregnant women by half. The PREPP program (Practical Resources for Effective Postpartum Parenting) reaches out to women through OB-GYN offices, and offers them education on three topics:

Parenting skills (e.g., How to help babies sort out day-night cues; encouragement for carrying the baby when he’s not crying, etc.)
Psychoeducation (e.g., What to expect about babies’ crying); and
Mindfulness and self-reflection (e.g., Examining how you were parented)

This intervention reduced depression and anxiety in mothers, and their babies became better self-regulated as well.

“By learning more about handling their baby, a mother may literally be facilitating their baby’s regulation along with their own. Mothers and babies get onto a bidirectional, more positive cycle,” Monk says.

As for me, since this knowledge wasn’t around to confirm my mother-in-law’s advice during my pregnancies, I hedged my bets. I knew I carried high levels of stress from a turbulent childhood, so I took some extra care. I exercised, was thoughtful about my food, and took a prenatal yoga and meditation course. But by the second pregnancy, I was frequently overwhelmed with panic attacks at the prospect of managing work and two children. Already my energy was low, and I filled in with chocolate milkshakes when I should have rested. Fortunately, both daughters did fine in the long run and are well-adjusted adults. But many women face graver challenges, and as a society, it’s our responsibility to protect and support them. Many countries have made children a collective investment, but in America, tragically, we haven’t. It’s a big problem—and a big topic, which I’ll save for a future blog entry.

More Resources

How pregnant women’s emotions affect prenatal and child development:

Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, by Annie Murphy Paul.
Catherine Monk’s videos on prenatal stress here.
Newsletter from Janet DiPietro’s lab.

Stress reduction in pregnancy:

Newman, K. M. (2016, August 17). “Four Reasons to Practice Mindfulness During Pregnancy,” Greater Good Magazine. Retrieved from https://greatergood.berkeley.edu/article/item/four_reasons_to_practice_mindfulness_during_pregnancy.
Bardacke, N. (2012). Mindful Birthing: Training the Mind, Body, and Heart for Childbirth and Beyond. New York, NY: HarperOne.
Mindful Birthing Network: Mindful birthing. (n.d.). Retrieved from http://www.mindfulbirthing.org/.
Hardwiring happiness: Zimmer, E. (2015, June 24). 082: Dr. Rick Hanson. The one you feed. Retrieved from http://www.oneyoufeed.net/rick-hanson/.
Introduction to mindfulness-based stress reduction:
- Palouse Mindfulness. (2015, August 28). Mindfulness-Based Stress Reduction (UMass Medical School, Center for Mindfulness). Retrieved from https://www.youtube.com/watch?v=0TA7P-iCCcY.
- Sega, A. (2016, August 22). Jon Kabat Zinn: Practical Stress Reduction. Retrieved from https://www.youtube.com/watch?v=3fjNPbErciU.
- Kabat-Zinn, J. (2016). Mindfulness for Beginners: Reclaiming the Present Moment and Your Life. Boulder, CO: Sound True.
This is one of my favorite resources for self-development:
- Hanson, R. (n.d.). Rick Hanson. Retrieved from http://www.rickhanson.net/rick-hanson/

How to find out about, and advocate for paid leave from work:

Find out if your state has paid family and medical leave protection here:
- National Partnership for Women and Families. (n.d.). Paid leave means a stronger nation. Retrieved from http://www.nationalpartnership.org/issues/work-family/paid-leave-means-map.html.
Quick economic statistics re: the costs to both employers and employees of NOT having paid leave: https://drive.google.com/file/d/1geQNdDBd2MDBvzvOMJg_YKdfVqSsduWZ/view.
Companies that offer paid leave, and their rationales for doing it:
- National Partnership for Women and Families (2018, January). Companies with new or expanded paid leave policies (2015-2018). Retrieved from http://www.nationalpartnership.org/research-library/work-family/paid-leave/new-and-expanded-employer-paid-family-leave-policies.pdf
An article on how businesses can adopt paid leave:
- Williams, J. C., & Massinger, K. (2015, November 23). “Need a Good Parental Leave Policy? Here It Is.” Harvard Business Review. https://hbr.org/2015/11/need-a-good-parental-leave-policy-here-it-is.
How to negotiate a leave, from the Harvard Business Review:
- Gallo, A. (2012, October 25). “How to Negotiate Your Parental Leave,” Harvard Business Review. Retrieved from https://hbr.org/2012/10/how-to-negotiate-your-parental-leave.html.
The effects of paid leave on child health and employee retention:
- National Partnership for Women and Families. (n.d.). Studies on the Effects of Paid Leave. Retrieved from http://go.nationalpartnership.org/site/PageServer?pagename=issues_work_library_paidleave_research#effect

Reference

Yerkes and Dodson, 1908, in Diamond, D.M., Campbell, A.M., Park, C.R., Halonen, J., & Zoladz, P.R. (2007). The temporal dynamics model of emotional memory processing: A synthesis on the Neurobiological basis of stress-induced amnesia, flashbulb and traumatic memories, and the Yerkes-Dodson law. Neural Plasticity, article ID 60803, 33pgs. doi:10.1155/2007/60803

Footnote

[1] Low birth weight, sometimes referred to as “small for gestational age,” occurs when the weight at birth is lower than expected for the length of the pregnancy. It is a risk factor for subsequent development. The U.S. has the one of the highest rates of babies born with low birth weight—about 1 in 13. Babies who are born very small for their gestational age are more likely to go on to develop problems, but most low-birth-weight babies who receive good nutrition and sensitive, affectionate care and stimulation, catch up and do just fine.

Additional Photo Credits

Top panel, left to right: MaxRiesgo, RapidEye, vm, DragonImages

Middle panel, left to right: FatCamera, photominus, Dean Mitchell, martinedoucet

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.

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

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.

“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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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.