Ab Initio International | Using the NBO in a Dutch Paediatric Setting

By Louise Spanjerberg, paediatrician, IMH-specialist, NBO-specialist
Amstelland Hospital, Amstelveen, The Netherlands
IMH-Centre Amsterdam The Netherlands

I work as a paediatrician in a small hospital near Amsterdam where I take care of children from zero to 18 years old, and their parents. I mainly focus on infants. For a long time I had been wondering why we had practically nothing to offer to parents and little babies with problems such as crying, fussing, sleeping-and feeding-difficulties. As paediatricians we have studied gastroesophageal reflux, allergy to cow’s milk, and colic, so when a parent comes to us with problems like crying or feeding difficulties, we can take a blood sample, X-rays, or a sonogram of the skull, but often the results of these medical tests do not give a clue to what is causing these problems. Even a change in nutrition usually doesn’t work, and referring to a psychologist is not an option because they have no knowledge about infants. Most of the time it is simply not possible to understand what is going on or to find any kind of remedy. Eventually we tell the parents their baby is healthy, even though the problem persists. I always felt sorry in this situation and felt like I was failing in my role as a paediatrician, because I knew something was still wrong.

In 2005 I learned about Infant Mental Health and in 2006 and 2007 I was trained as an Infant Mental Health specialist (Amsterdam RINO Noord-Holland). Weekly observation of a baby girl and her mother and family taught me a lot. Most importantly, I learned that babies are able to speak to us! Background theories, especially “the interaction between mother and baby” and “the Motherhood Constellation” provided me with a whole set of tools to work properly with babies and their parents. Fortunately as an Infant Mental Health-specialist and as a paediatrician I also got a job in the first Infant Mental Health Centre in the Netherlands, which was an excellent way to develop my skills.

In the Infant Mental Health (IMH) Centre parents tell us about problems they had during pregnancy and giving birth, how hard it is to see their preterm and small-for-gestational-age baby in the incubator, and how they feel that their baby still belongs in the hospital. In these situations, most of the parents are not able to read their babies’ signals.. Of course there are also parents and babies doing well in these conditions, but in general you never know which parents will be able to face this. Many parents visiting the IMH Centre are still not convinced that their baby has no medical problems: “It looks like the baby is in pain when crying.” Soma and Psyche are difficult to separate.

My question was, "How can we help babies and parents in the hospital to either prevent these problems or refer them to the IMH centre in time?"  I was particularly concerned with higher risk cases, when babies were born premature or small for gestational age or when a newborn needed hospital care

In 2011 I learned about the NBO. I thought this could give me tools to help me look at the baby in a different way. Talking with the parents about the baby as an individual and about their actual questions could help me be a paediatrician who is not only performing a physical examination, looking at the weight, and. asking questions about feeding, urination and defecation,

In May 2011 I did the NBO training in London with trainers, Joanna Hawthorne and Betty Hutchon. Back home I started to practise and here is an example of what I observed in using the NBO with a preterm infants and his family.

A little boy called Jim was born in our hospital. Hi gestational age was 34 3/7 weeks, APGAR scores were 8 and 9, and  birth weight was 1880 grams. He had to be treated in the incubator. After twelve days we were able to take him out, but he was still not able to drink properly, so he was treated in a crib. In another week he was dismissed from the hospital when he was 37 weeks and his weight was 2065 grams. After two weeks, I saw Jim and his mother at the outpatient clinic. I explained the 6 states to his mother and she told me that the baby never reached the quiet alert state, only the active alert state. During the NBO he had a very strong reaction to the rattle. He could not habituate to light and he was very anxious. He was not able to respond to face and voice and was difficult to soothe. During our conversation his mother was wondering if it might be better to let him sleep in a separate room, so there would be less noise from his little sister and the television. I supported her idea, which gave her the confidence to make it happen. One month later we repeated the NBO. This time the baby was in a quiet alert state and the NBO went much better. The mother greatly enjoyed the NBO sessions She turned out to be a psychologist herself and told me it had been very helpful to learn more about her baby.

More NBO sessions followed with other families. The parents like it a lot when you observe their babies so carefully, and they ask me important questions parents have never asked me before. The NBO is a very helpful tool to use when you are a paediatrician.