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Reflections on Early Influences, Career Highlights, and Hopes for the Future
by Lee MacKinnon
Renowned pediatrician and scholar, T. Berry Brazelton, has touched the lives of children all over the world through his advocacy for families, research, writing, training of fellow pediatricians, and advice to parents. The Brazelton Neonatal Behavioral Scale (NBAS) is used in hospitals around the globe to assess newborn competencies, as well as their individual differences.
Recently, I had the honor of sitting down with Berry Brazelton to talk about his countless contributions over a long career. At age 94, he has a tremendous amount to share.
You have provided so much guidance over the years to families and practitioners working with them. How do the struggles of today’s families compare to those of the families you worked with in the early years?
I think there’s a lot more stress. It’s increasing at a logarithmic rate and the types of stress are increasing. Environmental stress is intensifying; for example, the destruction of our air. Another stress is that both parents often need to work and may need to leave their child much earlier than they want to. In impoverished families, particularly, this is a problem.
I also think we know so much now, and parents know that. If they look at the Internet, or parenting books and magazines, they think, “Everybody knows this but me, and I don’t know enough.” So they are constantly under stress, wondering, “Am I are doing the right thing? Whatever I do may be wrong.” And that is very stressful.
One thing we’ve learned in our Touchpoints Project is that telling parents ahead of time, “We’ll be there to support you when you get stressed. Turn to us,” is critical. Having somebody to turn to provides a major opportunity for them to relax. Also predicting when stress is going to hit is another way of reducing their anxiety.
What excites you in the research that is happening today? How does it relate to the work you have done.
The most important research that is going on right now is in the brain research. Seeing what we know now and our ability to look inside the brain and see what affects babies and fetuses and newborns is just such an exciting area to be able to develop.
It has really confirmed my emphasis on early preventative intervention from the very beginning. The most important thing we’ve learned from working with the Newborn Assessment Scale is that showing parents how to watch their baby for the cues that will help them understand what kind of baby they have and how to parent that baby is the most powerful thing you can give them as parents. After that they feel like they know everything when that baby does something new.
What in your life helped you realize that parents were such a vital part of this process?
Well, I had to get over a bias I had. I always felt that my mother paid more attention to my little brother than to me and I grew up sort of hating parents. When I finished my pediatric training I realized I didn’t like parents. In my psychiatric training, however, I realized that parents were the most important teachers their children would ever have, and nothing we could do was as important as what parents would do. That really changed me.
It sounds like your training in psychiatry had a great influence on you. How did you decide to go into that after your pediatric training?
Right after I finished my pediatric training at Children’s Hospital I realized that all I knew about was disease. I knew nothing about what a child was like, what their individual differences were, what it meant to their development, and nothing about parenting. And so I went to my professor, Charles Janeway, and said, “Charlie, I want to go into psychiatry and learn what a child is really like,” and he said, “Oh don’t do that. You’ll waste all this pediatric training.” (laughs) But I did. I spent five years at the Putnam Children’s Center in Roxbury.
How did you end up coming to Boston Children’s Hospital after that?
I was in private practice for 10 years after Putnam. At that time, the head of Children’s Hospital, Len Cronkhite, was a parent in my practice, and I said to him one day, “You know, Len. Nobody wants to go to Children’s unless they absolutely have to, because parents can’t be there with their children.” In those days, parents could only stay for 2 hours on Saturday afternoons. Children would start screaming on Thursday and scream right through the weekend, and everybody would say, “See. Parents are no good for children.” After hearing my views, Len said, “Well, come over and change it.” So I did. It took me about 5 years to change it, but by 1974 we had complete visiting all over the hospital. Siblings were allowed to visit. You could bring pets in. Everything.
In 1972 I started the Child Development Unit at Children’s Hospital, which was the first pediatric fellowship in typical development. I trained about 80 pediatricians who spread out all over the country as developmental pediatricians. Many have become professors of pediatrics.
What are your thoughts about the future of pediatrics?
Oh, I think it’s tough. I think now pediatrics requires much more paperwork, and pediatricians are trying to just go in and listen and spend 5 or 10 minutes with a patient and get out and keep going, trying to make enough money to pay their bills. Nurse practitioners are doing a lot of the work with pediatrics and families now. I think it’s a lot tougher than it was for me. I wish things would change and maybe with the new health care bill they will, but I’m afraid they may not.
What were some techniques that helped you as a practicing pediatrician?
I learned early in my practice that there are ways of saving time that pay off later on. If you spent an hour or an hour and a half with a patient in the beginning and learned all about them – what their dreams were and what their hopes for their child were, then every time you saw them after that, it would only take you 5 or 10 minutes. You didn’t waste any time. And if they had a problem I would have them come in without the child, and the parent, or both parents, and I could work on the problem together for an hour. It worked like a charm.
I had a regular question I used to ask dads to get them thinking. I tried to see the dads in pregnancy and at some point I’d turn to the dad and say, “If it’s a boy, do you plan to have him circumcised?” And he’d startle and throw out his arms and say, “We haven’t thought about it.” And his wife would lean forward and tell me what they had thought about. And since I knew that everybody in America has thought about circumcision, I’d say, “No. I want him to answer.” And he’d start telling me all about himself. He never mentioned the penis after that, but he’d tell me all about himself. It was a way of opening fathers up. Then they were always ready to answer anything after that.
Did your own role as a father inform your professional development?
Oh, absolutely. I learned so much from my children. My first child was this very quiet, withdrawn, unavailable little girl. If I talked to her too loud, she’d startle and she wouldn’t look me in the face. And I thought, “This is as hard as having a hyperactive child. “ And that ‘s what led me to write Infants and Mothers, because I could see that having a very quiet child was as difficult as having a very active child. As a parent, everything that happened taught me more. Once she had a temper tantrum on the 4th floor of Jordan Marsh, and some of my parent patients had just passed by, and I knew they were there. She lay down and started screaming her silly head off. Everybody in the whole department store seemed to gather around, looking at me. “What did you do to this beautiful little child?” I was so upset, I wrapped her in my overcoat and ran down four flights of stairs and out on to the street. When I unwrapped her, she was blue and I thought, “Oh my God, I’ve killed this child over a temper tantrum. “ (laughs) And I realized how passionate parents could get and they could do things they didn’t mean to do. Everything like that taught me about parenting, and, in fact, I’ve always wondered if every pediatrician shouldn’t have children.
When did you become interested in babies?
I knew by the time I was 8 years old just what I wanted to do. I had to take care of 8 cousins every Sunday while my parents were inside, and I had to learn how to get inside these children’s brains in order to handle 8 small children for about 4 hours. So I learned very early how to do it and learned how exciting it was. My grandmother would come out and say, ”Oh Berry. You’re wonderful with children,” and it was very exciting to get that kind of praise. I knew I wanted to grow up and be a doctor, a pediatrician.
Following that, my meeting with Sally Provence was a big moment in my understanding of babies. She was the first person I met who believed, like I did, that babies weren’t just lumps of clay. And if you worked with them, often they would interact with you and you could get them to do almost anything. We learned together that the reason that everyone treated babies as if they couldn’t see or hear was that they were barraging them with so many sights and sounds that they were shut out. So we learned very early that reducing sights and sounds and just interacting with the baby and getting the baby to come up with you and interact with you was a powerful way to get the baby to respond to you.
When I went down to Yale to work with her for the first time, she got this baby to interact with her by doing a sort of pas de deux. They would dance and dance. And she would get the baby to follow her and she would sing to it, talk to it. And I said, “Sally. It looks to me like you get inside of that baby’s brain. And she said, “Of course. Isn’t there a baby’s brain inside of each of us?” (laughs) And I said, “Yes.”
As you look back over your career what do you consider the highlights?
Well, I think that one was studying child psychiatry but the main one was being able to change the face of pediatrics around the country. This began with the Newborn Behavior Assessment Scale, because up until that time everybody thought that babies couldn’t see or hear and they treated them like lumps of clay. They were doing things, that we still are doing, such as surgical procedures on babies without anesthesia. Then there was the ability to train pediatricians who spread out around the country and the world, sharing these ideas. And after that came the Touchpoints work that we’re doing now, which is becoming so successful. And finally the work with Kevin (Nugent), with our Newborn Behavioral Observation system, is just spreading itself all over the world. We are really changing how people handle babies and the way parents can look at babies.
You became such an icon on television and through your books. Was that a surprise to you? And what was that like for you?
Absolutely amazing! (laughs) I couldn’t believe it. I still can’t. It’s wonderful when parents stop me on the airplane or something and say, “You saved my life.” It’s very exciting. I’ve been very lucky. The popularity of Infants and Mothers surprised me, but I knew they needed it. It has sold over one million copies, and it is translated into 20 languages.
You traveled to so many places and had a huge impact on many countries. Kevin Nugent describes walking with you down a main street in Nagasaki, trying to find your way somewhere, and when you looked down a side street and saw a mother and baby, you went straight down. Even when you couldn’t speak the language, you were right there playing with the mother and the baby.
(laughs) We had a lot of fun that way. Whenever I went to a place I had never been, I always sat down next to a mother with a small child and if I didn’t know the language, it didn’t matter. Pretty soon the child and I would start making contact with each other, and the mother would start trying to pull the child away. I’d pull out a toy and the child would reach for it and the mother would start smiling at me. Then we’d set up a conversation and from then on she’d take me anywhere, show me anything. It worked like magic.
You’ve done so much all over the world and I’m sure there were times that you were exhausted and overwhelmed. What sustained you in your work?
I’ve always had fun. And I’ve always had fun with the people I work with. Whenever I’d get depressed I’d just go pick up a baby and play with it. Babies just revive you. Once in Bosnia, I was in a camp for children whose parents had been killed in front of their eyes - their fathers strung up outside of their houses and left there for weeks on end, and their mothers raped and tortured and then killed in front of them. All these kids were either there with grandparents, if they had survived, or with nobody. It was a very depressing place. A young woman, who was a psychologist, recognized me and came up to me and said, “Dr. Brazelton, I can’t stand to work here any longer because it is too depressing. What do you do when you burn out?” I said, “You know what? I go find a newborn.” And she said, “Really? There’s a newborn here. Do you want to go and see it?” So we went and started playing with this newborn and as soon as we did, this woman began to open up and became alive again. She said, “This is like a miracle.” She learned from me, if you need to be picked up, a baby will do it.
That’s a lovely story. Do you have any words of wisdom for pediatricians and other professionals working with parents and children today?
Well, I wish they all could pay attention to the fact that we’re not the ones raising the children - that the parents are. And that children’s individual differences matter a great deal. Paying attention to the child’s behavior is the best way to understand what the child is trying to say to you. No matter what he says verbally, it’s more important to watch what he’s doing at the time. And I wish every pediatrician could be trained on how to understand a baby and see what the developmental processes are and to understand how parents support their children’s development. Then I think they’d pay more attention to relationships and how to work with parents to give them what they need.
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