Ab Initio International | NBO and the Home Visit

by Tanya Swezey Stabinsky, Edgewood House School LLC

While one of the primary goals of the NBO is to foster parent-infant connection, this vignette describes how the Newborn Behavioral Observations (NBO) System can be used in early care and education settings to strengthen rapport between providers, parents, and children. Additionally, this example illustrates an opportunity to foster family-infant connections inclusive of older siblings.

Early care and education (ECE) programs and teachers frequently provide the educational and caregiving base for children over a number of years, particularly for families with multiple children. ECE programs are often child-focused programs that adopt a relationship-based, family-centered approach, and often become the hub for children and parents during the early years of family life. The practitioner in this vignette, Tanya, is an early care and education teacher with additional experience as an Infant-Family & Early Childhood Transdisciplinary Practitioner. She is visiting the home of a current student, Jules, 4 years old, and soon-to-be-enrolled Noah, 2.5 years old. Mom and Dad are both pediatric medical practitioners and have invited Tanya to visit their home and administer the NBO with their one-week-old son, Wyatt. Mom, Dad, and Jules are present for the encounter. While brother, Noah, is also present, his focus is on Tanya’s keys and cell phone, and as age appropriate, exhibits less interest in Wyatt. What transpired during the 1.5 hour visit was a multi-faceted relationship-building process between all.

When Tanya arrived, the family was engaged in their typical afternoon activities in a relaxed manner. The atmosphere set a comfortable tone for engaging in casual dialogue about life with Wyatt. In an unplanned but lovely way each family member received both individual time to share about Wyatt, and time all together in shared focus. Young Jules and Tanya had already talked at school about what might happen during the visit, and with support from Tanya, Jules was ready to take charge of the “purple” bag of “toys.”

Wyatt slept for the first hour of the visit. This provided an opportunity to watch his easy habituation to noise and light, directing the family to Wyatt’s barely noticeable stress reactions. A diaper change allowed time to reflect on diapering choices, and to discuss Wyatt’s only real inconsolable distress - being undressed for diaper changes. Mom was able to reflect on temperament, sensory issues, diapers being used, etc. A bit of fussiness before the feeding allowed Tanya to see how easily the family was able to soothe Wyatt with their repertoire, and, with permission, Tanya held and provided regulatory support for Wyatt as she went through the NBO steps. Wyatt’s return to sleep state allowed Tanya to focus on Jules and follow her invitation to her room, and to see the garden Jules was planting. Jules enjoyed the magical opportunity to show her teacher what her own space looked like. All the while, typical family noise and movement showed the natural habituation Wyatt had developed in his first week of life.

Exploring various neonatal topics with Mom and Dad came naturally for both parents and practitioner. Wyatt’s sex was a surprise until delivery, which was a great opening for Mom and Tanya to reflect upon the imagined baby and the real baby Wyatt. At school, Jules and her classmates had made a “guesstimate” poster so Jules had also had the opportunity to explore the imagined baby. Wyatt had surprised almost everyone by being a boy, and Mom said, although expecting a girl, she couldn’t imagine him any differently now.

The family shared conversation with Tanya about temperament, sleep protection and the sharing of infant care tasks, and Dad shared how different being a Pediatrician had become since having his own children. Both parents spoke of their various personal choices surrounding infant care and how this had opened up their sensitivity to their own clients and their child rearing choices. This provided a natural opening to approach sleep safety and to discuss Wyatt’s sleeping and eating patterns and, had it been needed or requested, an opportunity for Tanya to provide guidance.

As the home visit continued, Tanya admired how Jules showed herself to be a competent older sister, eagerly participating in shared moments of marveling with Mom and Dad. Tanya and parents spoke about how different having a third child is, giving Tanya an opportunity to honor parental (as well as sibling) mastery by pointing out how very relaxed the parents were with the children’s interactions with Wyatt. This led to a rich discussion on temperamental differences between all three siblings and a shared exploration of how blending ages and stages was working for family life.

During the time with the family, Tanya noted a bit of ambivalence in Jules’ behavior. As Tanya engaged with the family she tried to reflect in action about the meaning of Jules’ behaviors. The first time ambivalence was noted was when Tanya asked Mom and Dad if Wyatt could be undressed for a bit of wakeful observation. As Tanya unsnapped his sleeper, Jules snapped it right back up. Then again a bit later, Jules challenged Tanya and tried to keep Wyatt away from her, while at the same time demanding Tanya stay on the couch near her. The momentary power struggle brought the progress of the NBO to a standstill. Tanya had to hold the tension of the mixed message she was getting from Jules. Do four-year-old “big sisters” have their own kind of “gatekeeping”? Was it just too much for Jules to share both her new sibling and her teacher? Tanya encouraged Jules to help hold the pillow on her lap and sit next to her in such a way that they could both be front and center with each other and with Wyatt. Tanya put her arm around Jules and verbalized how different it was to share her teacher with Wyatt, and at the same time share Wyatt with her teacher. Within moments Jules relaxed, she giggled and laughed with her teacher, and the two had a moment of shared marveling. Perhaps preschoolers also need the opportunity to be the expert on their new baby.

Clinical Note: Tanya was struck by the idea of using the NBO as a relational tool with the entire family. Could including new siblings, by allowing them to join in the love affair with the new baby, provide a special connection that could assist with the transition of welcoming a new sibling? After the home visit, Jules continued to connect with her brother’s development, most notably how he was “rooting for her finger” or “Look. He recognizes my voice and turns to find me.” As a follow up, Jules and her teacher charted on a poster board the first 3 months of developmental behavior, including when Wyatt might go through his fussiest stage with increased crying, and when he might begin to smile and more fully notice the world around him at 8-10 weeks. Tanya felt an increase in an already strong relationship with both Jules and her parents. Though less of a focus during the visit, Tanya also was able to observe soon-to-be-student, Noah, in the midst of his home environment. The parents noted how the whole family shared on-going conversations about Wyatt’s behavior based on the NBO, most notably his continued ability to habituate to noise when they were out and about. Parents and Tanya both noted what a special feeling it was to know that when Wyatt reaches his preschool years, his teacher will have been a part of his life from the beginning. The NBO succeeded as a way to build relational history for all of them.