The need for loving attention is a constant theme of this book. Each chapter also draws on personal interviews with prominent researchers, practitioners, and parents. These resources are documented in the text in sufficient detail for a curious reader to pursue specific questions in the relevant literature.
The first three months of an infant's life need not be a mystery to bumble through. It's a common joke that infants don't come with an operating manual. This compilation of recent medical, biological, neurological, behavioral, developmental, and social science research from the past two decades provides the basis for just such an operating manual. New parents can comprehend much of what throughout human history has been inexplicable and, in the process, get their babies off to the best possible start.
The book begins millions of years ago with the chapter “Evolution and the Primitive Brain of a Newborn.” It is the natural starting point in helping parents and caretakers understand that the reason human infants arrive so unfinished is deeply rooted in our common evolution—beginning with the moment our hominid ancestors first stood and walked on two legs. Readers will understand why forty weeks of gestation is both a biological imperative and insufficient for greater brain development in the uterus. They will begin to see that all newborns need another three months, a fourth trimester, of uncompromisingly close connection to their mothers or an equally loving and attentive caretaker.
The remainder of the book is organized by first addressing how such an immature brain influences infants’ most basic needs: crying, sleeping, and eating. These behaviors deserve three distinct chapters since they are the source of every parent's most urgent worries. These three concerns are linked to each other just as communication is linked to need. Every newborn cry of life reminds us that this human being isn't ready to be separated from the uterus. Food, warmth, soothing movement, and comfort once flowed to her without effort. Now, she must signal hunger, discomfort, and fear with a cry, at first her only tool of communication. Now, as she makes her transition from the womb to the world, each adult response to her wailing demands is helping to complete the neurological wiring vital for living. The comforting closeness so recently experienced by the fetus continues as chemicals released by physical contact or close proximity to a mother, father, or caring adult help the newborn regulate sleep and arousal.3 Food, passively received in the womb, now requires effort.
The best nutritional transition to the real world during the fourth trimester, as evolution and biology make clear, is breast milk. A clear understanding that breast feeding is the most natural extension of pregnancy is an important starting point for every birth mother as she makes her own decision. I balance that truth with the reality that some women cannot breast-feed or don't want to. Adoptive parents, foster parents, grandparents, and all manner of attentive caretakers cannot breast-feed. For them, formula is a perfectly adequate second-best choice as they, too, help their newborn with the transition to life in the world by holding the infant closely, making eye contact, and touching him. What he has received without asking for during nine months in the uterus—food, soothing comfort, sleeping on his own timetable—must continue during the time of transition via attentive response to his cries.
Even as the basic needs for soothing, sleep, and food are met, the senses are proving to be nature's first teachers. After addressing parents’ most urgent concerns, the book's next chapters delve deeply into sensory development—sound, sight, and touch. (Taste and smell, scientifically studied in far less depth in newborns and tightly linked to feeding, are discussed in the feeding chapter.) Nothing in infant development happens in isolation, and these three senses are intimately connected to soothing, sleeping, and eating. But these senses each deserve a closer look. Babies recognize their mothers’ voices at the moment of birth because they've heard them in the uterus. Hearing these voices again during the fourth trimester is an important part of the transition, and newborns turn to their mothers’ voices more readily than to any others. (Though, in the case of adoptive parents or alternative caretakers, babies will soon recognize a consistent new voice and will turn to the voice they've come to know.) From the moment of birth, infants are busy soaking up the acoustics of their surroundings.
Vision is less developed than hearing at birth, but newborns can already see shadows of eyes, edges of faces, and areas of high contrast. Newborns see better than once thought, but the concept of “seeing” is complex, since vision consists of multiple components—focus, contrast, three-dimensionality, color—all developing at varying rates. Furthermore, the areas of the brain that interpret what's coming through the eyes are not yet set up to register what's seen in the way adults understand vision. Yet astonishingly, the very act of seeing is exactly what babies need in order to sort it all out. Each flicker of vision is setting up neural connections that will eventually let babies see the full world around them. The relatively slowly developing sense of vision carries infants forward from a place of darkness in the womb into a world of light.
The sense of touch, influenced for forty weeks by the warmth of amniotic fluid and the secure confines of the uterus, continues during this time of transition through swaddling, cuddling, and stroking. The last fifteen years have seen a sea change in understanding touch, both painful and pleasurable types. Simple, human touch—comforting pats in response to tears, smiles in response to contented moments—releases brain chemicals that calm the infant. On the other hand, trauma and stress (abuse, neglect, pain) release a flood of neurochemicals, including cortisol, that can set a child up for future trouble.
There are coexisting truths about the development of the senses: infants come into the world highly immature and yet extremely capable of learning and communicating. Each sense, at its own stage of readiness at birth, interacts with all the others to mold a brain that is forming the likes, dislikes, and very personality of a new human being.
As the senses are developing brand-new connections in the brain, the body is growing stronger. Neurological and physical developments are linked—these are similar to the mind-body connections science now recognizes in adults. Just as every interaction with the senses is building better abilities to see, hear, and feel, every kick is building muscles that will soon enable the baby to crawl, walk, and run. Biological mothers know that these early flailings begin during gestation, and many fathers have felt their force as they've laid a hand on a pregnant belly. An important chapter on physical development shows why the “exercise” begun in the womb must continue, with caretakers encouraging infants to vary their positions during awake time. Holding infants in various positions not only strengthens muscles, but it also gives infants a view of the world from more than one perspective, each view affecting the synapses being formed.
Almost universally, parents, regardless of their circumstances or limitations, want to do the best for their children. But with conflicting advice from the media, and with an array of books and toys promising smart and happy infants, parents can be confused about what course to follow. To put their minds at ease, a chapter on stimulation summarizes appropriate sensory stimulation. Loving attention to cries, along with soothing voices, comforting touches, eye contact, and closeness to the mother's body (or an equally loving caretaker's body) are the kinds of stimulation an infant needs. A view of a mother's face, a father's profile, the sound of live voices, the touch of skin or flannel or tweed, the smells of healthy foods cooking, and the taste of milk are preparing infants for the inimitable world that envelops them. For millions of years, trees, grass, voices, music, cuddling, constant proximity to mothers, and loving human interaction have provided all the stimulation infants need.
Finally, the book steps away from the newborn to delve into research on parents. Physical and psychological studies examining the postpartum months as experienced by mothers are extensive, and there are exciting new indications that, just as human interaction is sculpting infant brains, those same interactions are reshaping maternal brains. Research into fathers’ health is fledgling, but science now knows that men, too, are susceptible to postpartum depression and that welcoming a child into a family can be stressful for both parents.
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