The Newborn Behavioral Observations (NBO) System
The NBO is a structured set of observations designed to help the clinician and parent
together, to observe the infant's behavioral capacities and identify the kind of support the
infant needs for his successful growth and development. The NBO system consists of a
set of 18 neurobehavioral observations, which describe the newborn's capacities and
behavioral adaptation from birth to the third month of life. While it describes the infant's
capacities, the NBO provides parents with individualized information about their infant's
behavior, so that they can appreciate their baby's unique competencies and vulnerabilities
and thereby understand and respond to their baby, in a way that meets her/his
developmental needs.
The 18 NBO items include observations of the infant's:
- capacity to habituate to external light and sound stimuli (sleep protection)
- the quality of motor tone and activity level
- capacity for self-regulation (including crying and consolability)
- response to stress (indices of the infant's threshold for stimulation)
- visual, auditory and social-interactive capacities (degree of alertness and response to
both human and non-human stimuli)
While the NBO attempts to reveal the full richness of the newborn's behavioral
repertoire, the clinical focus is on the infant's individuality, on the aspects of behavior
that make the baby unique and different. In other words, the NBO provides the baby with
a "voice", with a "signature". It gives the baby an opportunity to tell the caregiver who he
or she is, if you will, what her preferences are and what her vulnerabilities might be and
in what areas she may need support. By providing this behavioral profile of the infant's
strengths and challenges, the NBO can provide clinicians with the kind of individualized
guidance that can help parents meet their baby's needs. This, in turn, will help the parents
develop the kind of confidence they need to support their baby's development and enjoy
the experience of being a new parent.
While the NBO was developed to meet the needs of parents, it is designed in its ease of
use to be a helpful tool for pediatric professionals who work with parents during the
perinatal period. It is flexible and can easily be integrated into routine home visits. The
NBO was also designed to meet the needs of pediatric professionals who want a more
relational or family-centered model of care to replace the traditional pathology-seeking
biomedical model of care (Brazelton and Cramer, 1990; Stewart et. al. 1995). The NBO,
therefore, was designed as a relationship-building method that can be flexibly
administered and that offers individualized information to parents about their baby, with
a view to promoting a positive bond between parent and child and between themselves
and the parents and family.
For that reason, the NBO is best understood as a relationship building
tool. It is inherently interactive and family-centered, because parents are
involved as partners in the NBO session throughout.
So, while the NBO aims at fostering
positive parent-infant interaction, it also aims at promoting a positive relationship - a
partnership - between clinician and parents.
Background
The development of the NBO is based on over twenty-five years of research and clinical
practice with the Neonatal Behavioral Assessment Scale (NBAS) and was shaped by our
clinical work in a variety of clinical settings, working with infants and families. It was
also inspired by the formative influence of T. Berry Brazelton, whose teaching and
mentoring has informed our understanding and appreciation of newborn behavior, on the
one hand, and has molded our clinical stance towards parents and families, on the other.
His pioneering work with the NBAS on the nature of individual differences in newborn
behavior and his respectful non-judgmental clinical stance towards parents in his clinical
teaching, influenced both the content and clinical approach of the NBO.
With the growing recognition of the importance of the newborn period as a unique
opportunity for preventative intervention with families, Nugent developed a manual for
clinicians, with guidelines on how to utilize the NBAS as a teaching tool for use in
clinical settings (Nugent, 1985). The approach itself and the manual can be said to be the
precursor or the first iteration of the NBO system. A series of studies, summarized in
Brazelton and Nugent (1995) and Nugent and Brazelton (1989, 2000), have shown that
demonstrating the newborn infant's behavioral capacities to parents can serve as a
mechanism for helping parents learn about their new baby, thereby strengthening the
relationship between parent and child and supporting the family adjustment.
Specifically,
a number of studies have consistently reported positive effects of exposure to the
Neonatal Behavioral Assessment Scale on variables such as maternal confidence and
self-esteem, paternal attitudes toward and involvement in caretaking, parent-infant
interaction, and developmental outcome. Parker, Zahr, Cole et al. (1992), for example,
invited mothers to actively participate in the behavioral assessment of the infant in the
NICU setting, while Rauh et al. (1988) used the NBAS serially in the NICU as a teaching
tool with mothers of low birthweight infants. Studies by Widmayer and Field, 1981;
Worobey and Belsky,1982; Myers, 1982; Anderson and Sawin, 1983; Rauh et al. 1988;
Hawthorne-Amick, 1989; Beeghly et al., 1995, Gomes-Pedro et al., 1995; and the meta
analysis by Das Eisen and Reifman (1996), all report positive effects of the NBAS on
different outcomes.
The Newborn Behavioral Observations (NBO) system, initially known as the Clinical
Neonatal Behavioral Assessment Scale (CLNBAS), comes from this tradition and grew
from our desire to provide clinicians with a scale that retained the conceptual richness of
the NBAS but shifted the focus from assessment and diagnosis to observation and
relationship-building. The concepts underlying newborn behavior are, therefore,
complemented by theoretical principles describing the transition to parenthood and the
nature of the parent-infant relationship and by clinical principles describing the nature of
relationship-building in clinical practice.
Moreover, the NBO was designed to be flexible
and easy to use so that it could be easily integrated into the care of newborn families,
whether on hospital, clinic or home settings. We created the NBO to sensitize parents to
their baby's competencies, in order to foster positive parent-infant interactions between
parents and their new infant and thus contribute to the development of a positive parentinfant
relationship. It is conceived of as an interactive system, one in which parents play
an active role in both the observations of their baby's behavior and in the identification of
appropriate caregiving strategies.
Therefore, while the theoretical principles guiding the
use of the NBO and the accompanying training program, include many of the conceptual
themes that informed the NBAS, they are informed by theoretical and clinical principles
from the fields of child development, behavioral pediatrics, nursing, early intervention
and infant mental health.
|
