Excerpt: 'Touchpoints: Birth to Three' Read an excerpt from Touchpoints: Birth to Three by T. Berry Brazelton.

Excerpt: 'Touchpoints: Birth to Three'

'Touchpoints: Birth to Three'

In the first edition of Touchpoints, I laid out a map of infancy developed from four decades of pediatric practice in Cambridge, Massachusetts, and research at Children's Hospital, Boston. Since its publication in 1992, much more has been learned about young children's development, and our world has become an even more complex and challenging one in which to raise them. In the years that followed, I have worked with child psychiatrist Joshua Sparrow (whom I have asked to help me revise this book) and others at the Brazelton Touchpoints Center in Boston to bring my approach in working with young families to healthcare and childcare professionals around the country, from Harlem to Puget Sound. Now, many hospitals, clinics, childcare centers, preschools, and other institutions serving families with young children have been using my preventive, strengths-based model and have joined a national network of more than seventy Touchpoints Collaboratives. This work has introduced us to families of every kind, in just about every state in our nation. They have taught us much about the pressures on families today and the strengths they rely on to face them.

Back in the 1990s, the human side of medicine was being dismantled by the managed care experiment that we now all know failed to contain healthcare costs. But since then, our field has begun to rediscover the therapeutic importance of relationships, and more and more pediatric healthcare providers are taking up the touchpoints approach to families to rehumanize their work, and to make it more fun!

For years, families have struggled with the demands of dual careers or single parenthood. More recently, certain technological advances have made it easier for some parents to work at home — often a mixed blessing. Some workplaces have introduced more family-friendly policies, such as quiet, private places to pump breast milk and flexible hours to attend family events. (Many more still must do so.) An upswing in downsizing and outsourcing has forced increasing numbers of parents, though, to work without benefits like these (or even healthcare coverage for their children), while the shortage of affordable, high-quality child care persists.

Though we still aren't investing adequately in early childhood education, great strides have been made in understanding how very young children learn and how their brains develop. With our new knowledge comes new pressure (much of it from marketers) on parents to stimulate their infants — in just the "right" ways — earlier and earlier. But children learn more from the full complexity of their spontaneous interactions with parents than from any prepackaged program.

Meanwhile, progress in pediatrics has proceeded apace, and specialists are saving ever smaller premature infants and other desperately imperiled young lives. Modern-day ultrasounds offer unprecedented windows into our unborn children's worlds, and fetal surgery can sometimes even repair defects that they reveal. Yet we continue to miss out on many other opportunities for prevention, and we now face new challenges in the current epidemics of asthma, autism, and obesity. Though we still have no cures for these, there is progress. However, the resources have not been dedicated to making new treatments available to every child who needs them.

Since the first edition of this book, it has become harder for parents, even in so-called developed nations, to promise their children a safe world. Manmade disasters, added to the natural ones, and new forms of terrorism have forced parents — and children — to find new strategies for coping, and new strengths. Still, we can promise our children that we will be truthful with them about the challenges of our world, and that we will each do what we can do to protect them. As my own children grew older, I began to realize — as do many parents (who eventually join the PTO or coach after-school sports) — that to protect their futures I would need to turn my attention to whatever small part I could do for other people's children too. In these uncertain times, we can give our children hope by modeling — with our own small acts of generosity — the ways that they, too, can do what they can to help. Such gestures reassure them that they belong to a community that cares. We can also approach their development as a series of opportunities to instill in them the self-control, self-respect, and sensitivity to others that they will need in order to be resilient and to make their own contribution one day to bettering our strained world.

In the face of these new threats and ever-greater technological prowess, a new trend seems to be gathering steam. As demands on families' time together threaten to pull them apart, many are reaffirming traditional forms of family intimacy. For instance, we've now recognized that the alleged nutritional equivalence and convenience of formula do not make up for all the natural advantages of breast milk. Breast-feeding is not simply a better way of nourishing a baby, it is one of nature's most potent means of cementing the mother-infant bond as they interact with each other in the pauses between bursts of sucking. Also, co-sleeping, long a traditional practice, has begun to gain popularity. More recently, another return to more intimate parent-infant rituals has surfaced in the area of early toilet training. "Elimination communication" is a new term for the traditional practice of carrying a baby close throughout much of the day, which allows parents to respond to babies' physical cues when they need to urinate or move their bowels. Family mealtimes are now also finally being reclaimed as we rediscover the importance of family relationships for healthy nurturance (including the prevention of childhood obesity). These and other "new" trends, it seems to me, affirm a heightened sense of urgency for families to restore intimacy in the face of uncertain times, and to defend it from childrearing techniques imposed by commercial culture and the demands of the workplace.

The map of behavioral and emotional development that I have called "Touchpoints" has been refined over years of research at Children's Hospital in Boston and at other sites around the world. It is designed to reassure parents that they can navigate the predictable spurts in development, and the equally predictable issues that they raise, with the resources that they can find within themselves, their communities, and their cultures. Unlike yardsticks of physical development (the heights, for instance, that parents take such pride in marking off on door-frames), this map has many dimensions. Emotional, behavioral, motor, and language development all occur at their own pace but also affect each other. A child's advances in any one of these areas are preceded by temporary backslides, or regressions, in the same area, or another. The cost of each new achievement can temporarily disrupt the child's progress — and the whole family's stability. Yet each of these disruptions also offers parents a chance to reflect, consider a change in direction, and grow along with the child.

The concept of "touchpoints" is a theory of the forces for change that drive a child's development. Though they may be expressed differently in different cultures, touchpoints are universal. This is because they are for the most part driven by the predictable sequences of early brain development, especially in the first three years of life, the focus of this book. Since the first edition of Touchpoints, scientific advances in our understanding of this process have begun to confirm the connections between the behavioral developments (and underlying brain development) and the regressions that I observed for so many years in my practice.

Just before a surge of rapid growth in any line of development, for a short time, the child's behavior seems to fall apart. Parents can no longer rely on past accomplishments. The child often regresses in several areas and becomes difficult to understand. Parents lose their own balance and become alarmed. Over the years, I have found that these predictable periods of regression can become opportunities for me to help parents understand their child and solidify my relationship with them. The touchpoints become a window through which parents can view the great energy that fuels the child's learning. Each step accomplished leads to a new sense of readiness for the next. When seen as natural and predictable, these periods of regressive behavior are opportunities to understand the child more deeply and to support his or her growth, rather than to become locked into a struggle. A child's particular strengths and vulnerabilities, as well as temperament and coping style, all come to the surface at such a time. What a chance to get to know a small child as an individual!

From Touchpoints: Birth to Three, Second Edition by T. Berry Brazelton, M.D., Revised with Joshua D. Sparrow, M.D. (Da Capo Press, 2006).