What Every Child Must Have to Grow, Learn, and Flourish

By T. Berry Brazelton, M.D. Stanley I. Greenspan, M.D.
Edited by Marco Pavia

A Merloyd Lawrence Book

Copyright © 2000 T. Berry Brazelton, M.D., and Stanley I. Greenspan, M.D. All rights reserved.
ISBN: 0-7382-0325-4

Chapter One

The Need for Ongoing
Nurturing Relationships

Although consistent nurturing relationships with one or a few caregivers are taken for granted by most of us as a necessity for babies and young children, often we do not put this commonly held belief into practice. The importance of such care has been demonstrated for some time. The films of René Spitz and the studies of Spitz and John Bowlby revealed to the world the importance of nurturing care for the physical, emotional, social, and intellectual health of children and the dire consequences of institutional care. Other pioneers, such as Erik Erikson, Anna Freud, and Dorothy Burlingham, revealed that to pass successfully through the stages of early childhood children require more than a lack of deprivation; they require sensitive, nurturing care to build capacities for trust, empathy, and compassion.

    More recent studies have found that family patterns that undermine nurturing care may lead to significant compromise in both cognitive and emotional capacities. Supportive, warm, nurturing emotional interactions with infants and young children on the other hand, help the central nervous system grow appropriately. Listening to the human voice, for example, helps babies learn to distinguish sounds and develop language. Interactive experiences can result in brain cells being recruited for particular purposes—extra ones for hearing rather than seeing, for instance. Exchanging emotional gestures helps babies learn to perceive and respond to emotional cues and form a sense of self. Brain scans of older individuals show that experiences that are appropriately emotionally motivating and interesting harness the learning centers of the brain differently from experiences that are either over- or understimulating.

    Deprivation or alteration of needed experiences can produce a range of deficits. When there is early interference with vision, for example, difficulties have been observed ranging from functional blindness to problems with depth perception and spatial comprehension. Emotional stress is also associated with changes in brain physiology.

    In general, there is a sensitive interaction between genetic proclivities and environmental experience. Experience appears to adapt the infant's biology to his or her environment. In this process, however, not all experiences are the same. Nurturing emotional relationships are the most crucial primary foundation for both intellectual and social growth.

    At the most basic level, relationships foster warmth, intimacy, and pleasure; furnish security, physical safety, and protection from illness and injury; and supply basic needs for nutrition and housing. The "regulatory" aspects of relationships (for example, protection of children from over- or understimulation) help children stay calm and alert for new learning.

    Research with newborns by one of us (T. B. B.) shows that a newborn baby will attempt to keep himself under control in order to look and listen to cues around him. He will put together four midbrain reflexes—tonic neck, Babkin hand to mouth, rooting, and sucking—in order to stay alert. If he cannot succeed, and loses control, he will use the human voice or touch to reinforce his effort to regulate his "state" toward alertness.

    By eight weeks of age, this same research shows, he will be able to distinguish and respond differentially to his mother's versus his father's versus a stranger's voice and face. He is quietly alert to his mother, ready for a playful interaction with his father. Each of these important people will have learned his rhythms and cues and he will have created an expectancy to react appropriately with them. These are the ingredients for a strong sense of self-esteem in the future, and for the motivation for learning later on. In addition, this learning is fueling his ability to maintain impulse control for the future. The most important learning in the early years is provided by human interaction. Objects and learning devices do not compare.

    One of us (S.I.G.) has shown that relationships and emotional interactions also teach communication and thinking. Initially, the infant's communication system is nonverbal. It involves gestures and emotional cueing (smiles, assertive glances, frowns, pointing, taking and giving back, negotiating and the like). From these, there emerges a complex system of problem-solving and regulating interactions that continue throughout the life of the individual. Even though this nonverbal system eventually works in conjunction with symbols and words, it remains more fundamental. (For example, we tend to trust someone's nonverbal nod or look of approval more than words of praise, which are sometimes misleading; and we shy away from a person with a hostile look even if the person says, "You can trust me.")

    When there are secure, empathetic, nurturing relationships, children learn to be intimate and empathetic and eventually to communicate about their feelings, reflect on their own wishes, and develop their own relationships with peers and adults.

    Relationships also teach children which behaviors are appropriate and which are not. As children's behavior becomes more complex in the second year of life, they learn from their caregivers' facial expressions, tone of voice, gestures, and words what kinds of behavior lead to approval or disapproval. Patterns are built up through the give-and-take between children and caregivers. Importantly, along with behavior, however, emotions, wishes, and self-image are also coming into being. The emotional tone and subtle interactions in relationships are vital to who we are and what we learn.

    Relationships enable a child to learn to think. In his interactions, the child goes from desiring Mom and grabbing her to saying "Mom" and looking lovingly. He goes from "acting out" or behaving his desires or wishes to picturing them in his mind and labeling them with a word. This transformation heralds the beginning of using symbols for thinking.

    Pretend or imaginative play involving emotional human dramas (e.g., the dolls hugging or fighting) helps the child learn to connect an image or picture to a wish and then use this image to think, "If I'm nice to Mom, she will let me stay up late." Figuring out the motives of a character in a story as well as the difference between 10 cookies and 3 cookies will depend on this capacity.

    The ability to create mental pictures of relationships and, later, other things leads to more advanced thinking. For instance, a key element essential for future learning and coping is the child's ability for self-observation. This ability is essential for self-monitoring of activities as simple as coloring inside or outside the lines or matching pictures with words or numbers. Self-observation also helps a person label rather than act out feelings. It helps him to empathize with others and meet expectations. The ability for self-observation comes from the ability to observe oneself and another in a relationship.

    We have thus come to understand that emotional interactions are the foundation not only of cognition but of most of a child's intellectual abilities, including his creativity and abstract thinking skills.

    This recognition of the role of early emotional interactions in intellectual functioning is not the same as Howard Gardner's important idea of separate, multiple intelligences, or Antonio Damasio's research on the brain which suggests that emotions are important for judgment but somehow separate from academic capacities or overall intelligence. We do not see these as separate. Jean Piaget, the pioneering cognitive psychologist considered the child as a causal thinker once he can learn that pulling a string brings the sound of the ringing bell. However, this is not the child's first opportunity to learn about causality. A baby's first lesson in causality occurs many months earlier, when he learns that a smile brings a responsive smile of delight to his parent's face. The child then generalizes this emotional lesson to the physical world. We have been able to identify how affective or emotional interactions lead the way at each stage.

    Emotions are actually the internal architects, conductors, or organizers of our minds. They tell us how and what to think, what to say and when to say it, and what to do. We "know" things through our emotional interactions and then apply that knowledge to the cognitive world.

    For instance, when a toddler is learning whom to say "hello" to, he doesn't do this by memorizing lists of appropriate people. Experience leads him to connect the greeting with a warm friendly feeling in his gut that leads him to reach out to other people's welcoming faces with a verbalized "Hi!" If he looks at them and has a different feeling inside, perhaps wariness, he's more likely to turn his head or hide behind your legs. We encourage this kind of "discrimination" because we don't want our children to say "Hi!" to strangers. We want them to say hello to nice people like Grandpa. If a child learns to greet those people in this way, he will quickly say "Hi!" to a friendly teacher or to a new playmate. He carries his emotions inside him, helping him to generalize from known situations to new ones, as well as to discriminate or decide when and what to say.

    Even something as purely academic and cognitive as a concept of quantity is based on early emotional experiences. "A lot" to a three-year-old is more than he wants; "a little" is less than he expects. Later on, numbers can systematize this feel for quantity. Similarly, concepts of time and space are learned by the emotional experience of waiting for Mom, or of looking for her and finding her in another room.

    Words also derive their meaning from emotional interactions. A word like justice acquires content and meaning with each new emotional experience of fairness and unfairness. Even our use of grammar, which the noted linguist Noam Chomsky and others believe is largely innate and needs only some very general types of social stimulation to get going, is based in part on very specific early emotional interactions. For example, we found that autistic children who did not use proper grammar and repeated only nouns, like door, table, and milk, could learn correct grammatical forms if we helped them first become emotionally engaged and intentional. At the point where they learned to experience and express their desire or wish (for example, when they pulled us to a door to open it), they began properly aligning nouns and verbs ("Open the door!"). Infants and toddlers without significant challenges engage in these purposeful emotional interactions routinely; perhaps because they are so routine their importance for grammar and language has been missed.

    Not only thinking grows out of early emotional interactions, but so does a moral sense of right and wrong. The ability to understand another person's feelings and to care about how he or she feels can arise only from the experience of nurturing interaction. We can feel empathy only if someone has been empathetic and caring with us. Children can learn altruistic behaviors, to do "the right thing," but truly caring for another human being comes only through experiencing that feeling of compassion oneself in an ongoing relationship. We can't experience emotions that we never had, and we can't experience the consistency and intimacy of ongoing love unless we've had that experience with someone in our lives. For some it may be a grandmother or an aunt, or it may even be a neighbor, but it must be there. There are no shortcuts.

    An ongoing, emotional, nurturing relationship with a baby and toddler enables us to engage in interactions in which we read and respond to the baby's signals. This basic feature of caring relationships between a baby and a caregiver who really knows her over the long haul is responsible for a surprisingly large number of vital mental capacities. These "reciprocal interactions" teach babies how to take initiative. As pointed out earlier, they do something and it makes something happen. This is also the beginning of learning to think purposefully or causally. A sense of self, will, purpose, assertiveness, and the beginning of causal logical thinking all occur through these wonderful reciprocal interactions.

    By 2-3 months, a baby and her parent will have been through 3 levels of learning about each other. In stage 1, the parent learns how to help the newborn infant maintain an alert state (1-3 weeks). In stage 2 (3-8 weeks), in the alert state she will produce smiles and vocalizations which are responded to by the adult. In stage 3 (8-16 weeks) these signals are reproduced in "games" (Stern) in which vocalizations and/or smiles are reproduced in bursts of 4 or more, imitated by the adult, in a series of reciprocal bursts or "games." Rhythm and reciprocity are learned in these games.

    By 4 months, the baby will have learned to take control of the game, and to lead the parent in them (Margaret Mahler called this "hatching"). Thus, autonomy comes to the surface within these games.

    Something else is also occurring. Through these reciprocal interactions the child is learning to control or modulate his behavior and his feelings. We all want children who are well regulated or well modulated, that is, who can be active and explorative some of the time, concentrate and be thoughtful and cautious other times, and joyful yet other times. We want children who can regulate both their emotions and their behavior in a way that is appropriate to the situation. We admire adults who are able to do this.

    The difference between children who can regulate their mood, emotions, and behaviors and children who can't—for whom the slightest frustration feels catastrophic, whose anger is enormous and explosive—lies in the degree to which the child masters the capacity for rapid exchange of emotions and gestures. When a child is capable of rapid interactions with his parents or another important caregiver, he is able to negotiate, in a sense, how he feels. If he is annoyed, he can make an annoying look or sound or hand gesture. His father may come back with a gesture indicating "I understand" or "OK, I'll get the food more quickly," or "Can't you wait just one more minute?" Whatever the response is, if it is responsive to his signal he is getting some immediate feedback that can modulate his own response. He gets a sense that he can regulate his emotions through regulating the responses he gets from various environments. We now have a fine-tuned system rather than a global or extreme one. The child doesn't have to have a tantrum to register his annoyance; he can do it with just a little glance and a little annoyed look. Even if his mother or father doesn't agree with him or can't bring that food right away, they are signaling something back that gives the child something to chew on while he is deciding whether to escalate to an even more annoyed response. Even if he does escalate to a real tantrum, this extended sequence is preferable to going from 0 to 10 in one second. All the different feelings, from joy and happiness to sadness to anger to assertiveness, become a part of these fine-tuned regulated interactions, in a pattern of subtle nuances rather than an all-or-nothing pattern.

    If a child is not learning to engage in this fine-tuned interaction, he doesn't expect his emotions to lead to a response from his environment. The emotions consequently exist somewhat in isolation and simply get bigger. The child is driven to use more global responses of anger or rage or fear or avoidance or withdrawal or self-absorption. Very young babies are prone to these more extreme reactions in the early months of life. When they cry, they cry very hard and loud because they are frustrated until we help settle them down. This has certain similarities with what has been described as the flight/fight reaction, which is a more global reaction of the human brain. But children are not limited to flight-or-fight reactions. They can have a variety of global reactions: global rage, avoidance, withdrawal, self-absorption, fear, or impulsive action.

    By the time a child is talking at age 2 and 2 1/2 he should already have the capacity to be involved in long chains of interaction (reciprocal interactions) involving his different emotions, feelings, and behaviors. These are built on the earlier patterns laid down at 2-4 months. Children without this capacity operate in a catastrophic or extreme manner, having extreme meltdowns or tantrums or getting carried away with their excitement and joy, or anger or sadness, or even depression. Often, these extreme reactions are out of proportion to the events of the moment. They suggest that some parts of the child's feelings, mood, and behavior didn't have a chance to become regulated through reciprocal interactions. Families have different capacities to get involved in negotiations around certain behaviors and feelings. Some interact well with one another around assertiveness and anger, but not as well around sadness or sense of loss. Others are just the reverse.

    The earliest patterns of parent/infant communication lay the groundwork for the later patterns. As children learn to regulate their behavior and feelings they can then go to the next level and problem-solve with the feelings and actually try to change what's happening in their environment. If something feels unpleasant, they can do things to change the situation and the feeling. If it is a pleasant feeling, they can change their environment to bring on more of those feelings. So by 18-20 months children already have lots of experience in trying to lessen those conditions that make them feel sad or angry and to increase those conditions that make them feel happy. Then, as they progress further up to age 2 or 2 1/2, they can form images in their minds—what we call symbols or ideas—and actually label the feelings that have come under fine regulation. We see this in the pretend play of children when they create scenes where there is anger, happiness, or sadness. Children who are well regulated have more details in their dramas. There is more subtlety to their feelings. Children who are more extreme in their reactions, in contrast, have more global patterns in their pretend play. At yet at a further level, they can begin reasoning about their feelings, figuring out why they are happy or sad or joyful. This occurs between ages three and four. As they get older, they can reflect on these feelings and understand them in the larger context of their peer relationships. They can recognize the gray area of feelings. As they become older this capacity for reflective thinking about feelings gets stronger and stronger.

    Interactive emotional relationships, therefore, are important for many of our essential, intellectual, and social skills. This type of interaction is also central when we are trying to help children with special needs. Often, creating opportunities for long, empathetic, nurturing interactions around the child's different feelings can go a long way to helping a child learn "regulation" even when it isn't there in the first place.

    The notion that relationships are essential for regulating our behavior and moods and feelings as well as for intellectual development is one that needs greater emphasis as we think about the kinds of settings and priorities we want for our children. The interactions that are necessary can take place in full measure only with a loving caregiver who has lots of time to devote to a child. A busy day-care provider with four babies or six or eight toddlers usually won't have the time for these long sequences of interaction. Similarly, a depressed mom or dad or an overwhelmed caregiver with five children or parents too exhausted at the end of the day may not have the energy for these long patterns of interaction and negotiation.


Early Relationships

TBB: We first learned the power and importance of interactive relationships while using our neonatal assessment. When we started, nobody thought we should interact with the baby. In the past, we just let the baby lie there and observed him. That allowed us to believe that "babies don't see or hear"—crazy notions. As soon as we began interacting with the baby, holding him to alert him, cuddling him to soothe him, we saw that you could reinforce the baby for doing fantastic things. We saw "Here is an interaction that the baby stores." Then along come the mother and the father, each treating the baby differently, and he stores those differences and reflects them back by six to eight weeks with different responses. These emotional responses grow from ongoing interactions with consistent caregivers and are the key to future development.

SIG: We can now make a case that it's this early reciprocal dialogue with emotional cueing, rather than any cognitive stimulation like flash cards, that leads to the growth of the mind and the brain and the capacities to reason and think. Both emotional and intellectual development depend on rich, deep, nurturing relationships early in life, and now continuing neuroscience research is confirming this process.


Excerpted from THE IRREDUCIBLE NEEDS OF CHILDREN by T. Berry Brazelton, M.D. Stanley I. Greenspan, M.D.. Copyright © 2000 by T. Berry Brazelton, M.D., and Stanley I. Greenspan, M.D. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.