was an interest in how individual infants Book review contributed to developing interactions between themselves and their parents. In the seventies, Brazelton thought that there By Zack Boukydis were cycles of attention and inattention which were influenced in sustained Recently the book Nurturing Children and have contributed centrally to connections interactions by both infants and parents. Families: Building on the Legacy of T. Berry between infant assessment and infant This perspective evolved into the mutual Brazelton (Barry M. Lester and Joshua D. mental health practice ;( J. Kevin Nugent; regulation model articulated by Edward Sparrow, Eds.) was published by Wiley- Kathryn Barnard; Heidi Als, Tiffany Field; Tronick and others and which contributed Blackwell (West Sussex, UK, 2010). The Rose Bigsby; Amy Salisbury); others who the still-face paradigm which allowed book is a collection of chapters written by have studied parent-infant interaction researchers and clinicians to observe the former students, colleagues and friends either developing Brazelton’s ideas infant’s efforts to regain (or repair) active, of the eminent American pediatrician (Edward Tronick; Tiffany Field) or reflecting mutual interaction with their parent. In T.Berry Brazelton following a tribute to on them (Daniel Stern). Also included is a the book, Daniel Stern provides a fresh Dr. Brazelton in Boston MA USA in 2008 chapter by Brazelton’s professional peer look at parent-infant interaction reflected marking his ninetieth birthday. the late Stanley Greenspan. in the perspective of infant arousal T. Berry Brazelton is known to millions of I highly recommend this book to anyone dynamics. Others such as Tiffany Field people worldwide as a clinician, scientist, - but especially to practitioners and used dimensions of infant neurobehavior advisor to parents; and major promoter of teachers of infant mental health. The work aseessed by the NBAS to study interactions policy to support children and families. of Dr. Brazelton on seeing, assessing and between infants and mothers struggling understanding infant development is with depression. When the copy of this book arrived at integrated into many chapters in this book. our flat in Budapest, my six year old (c.) Enabling practitioners to develop In developing training in infant mental more differentiated and complex models daughter saw the book and heard it was health, one can never ‘bring in’ enough about “Dr. T Berry” (as he is known in our of development as they learn to see experience and perspective on infant/child and support relationships with parents household). She left the room and arrived development and the effects of individual a few moments later with her copy of and infants. Joshua Sparrow’s chapter differences in infants on the developing describes the move in thinking about Going to the Doctor. We read this book a infant-parent relationship; including: number of times, before and after visits to development from one-way causality my daughter’s pediatrician. The book was (a.) Careful ‘differentiated’ observation of to systems theory. Also, with Brazelton’s also special for my daughter because Dr. infants. From Brazelton and colleagues’ emphasis on touchpoints in development, Brazelton and his grandson, Alfred (who contributions in the seventies and eighties there was a central emphasis on periods drew the pictures in the book) had signed onward, no longer were babies seen of development where there was it when I was at the tribute conference as passive recipients of environmental disorganization followed by reorganization for Dr. Brazelton in Boston. I told Alfred input but they were shown to have that included new abilities in the infant. (and his grandfather) that my daughter active, organized ways to seek out and The touchpoints perspective and the ‘got a great deal’ from the pictures in the respond to stimulation from parents emphasis on individual differences in book and Alfred wrote: “I am glad you and the environment. Brazelton and infant behavior provided a huge challenge like my pictures, Anna, keep on drawing.” colleagues were the first to develop an to existing models of development which My six year old daughter feels her own infant assessment (eventually called the needed to assume continuity from early connection to Dr. Brazelton (and his Neonatal Behavioral Assessment Scale infant behavior to later developmental grandson). (NBAS) that took into account not only attainment. Brazelton’s contributions reflex functioning and muscle tone; were aided by other developmental The book is an astounding collection of but ‘organized’ responses to sensory theorists and advanced methodologists, thirty-one chapters that reflect Brazelton’s input and ability to regulate or stabilize especially Sameroff (the transactional influence on many fields including internal states of arousal. Included in model) and others which have indicated child development, pediatrics, infant this perspective was an appreciation of that it is not ‘biological status’ alone, but mental health, nursing, psychology, child individual differences in newborn behavior complex interactions between infant and psychiatry, social work, physical and (first described in Brazelton’s book Infants environment, and infant and parent which occupational therapy, and policy. Each and Mothers) which brought the study help to predict later developmental status. chapter was written by a colleague who of temperament in child behavior into has been influenced by Brazelton over the As part of his opening chapter, Barry Lester the earlier period of infancy. Part of the provides perspective on how behavioral years and includes three generations of generativity of this perspective on infant students, collaborators and colleagues. epigenetics (interaction between fetus and neurobehavior includes the development prenatal biobehavioral environment) can The book begins with a thoughtful tribute of other systematized assessments of to Dr. Brazelton by Geoffrey Canada, contribute to an understanding of how different populations of infants and the infant ‘’arrives’ in the postnatal world President/CEO of Harlem Children’s Zone in ‘prenates’: (the Assessment of Preterm New York City, USA. with the individual differences in newborn Infant Behavior APIB; the NICU Network behavior seen and assessed by existing A partial list of contributors include people Neurobehavioral Scale (NNNS; for at-risk infant neurobehavioral assessments. surely known to readers of the Signal drug-exposed and preterm infants) and the Three sections of the book: Regression in a section of the book called “Infant Fetal Neurobehavioral Scale (FENS). and reorganization in relational models of mental health and the treatment of early (b.) Knowing how knowledge of infant development (chapters by Mikael Heimann trauma” [Charlie Zeanah & Paula Zeanah, development effects one’s understanding and Frans Plooj); Relational and contextual Alicia Lieberman & William Harris; Joy of the interactions between infants and developmental models (chapters by Osofsky & Howard Osofsky; and Dante parents. Included in Brazelton’s focus on Stanley Greenspan and Robert Levine) and Cichetti & Sheree Toth]; and many who individual differences in infant behavior Neuroscience perspectives on relational

18 THE SIGNAL JANUARY - MARCH 2011 and developmental models (chapters by throughout the second half of the 20th Zack Boukydis, PhD, Visiting Professor, Allan Schore and Jerome Kagan) provide century can do so in these chapters. Those Fullbright Fellow, Department of Pediatrics, advanced understanding of connections who want to engage in the transformations Semmelweiss University Medical School , between developing infants and their required in the 21st century, read, imagine, Budapest Hungary and University of Turku, developing relationships. and take action, know that Brazelton’s Turku, Finland. E-mail: zboukydis@gmail. footsteps, though wide and encompassing, com. (d.) Knowing how to build on solid move quickly.” models of development and parenting when building programs and services for The book is a valuable resource for training, families with young children. Brazelton for practice - and for reading and reflection. and colleagues influence on the translation When I was preparing to write this review, from infant development to models of care I tended to read one chapter and then evidenced in chapters by Kathryn Barnard spend some time afterward reflecting on on the Nursing Child assessment Satellite what I heard that was new; what confirmed Training (and Keys to Caregiving);Heidi my experience; what I disagreed with, Als and Rose Bigsby on care in the NICU and so on. Therefore, you could say I also for preterm infants and their parents; and recommended the book as a source of three chapters on nurse home visiting ‘daily’ reflection – and inspiration. programs (Kristie Brandt & J. Michael Murphy; David Olds; as well as Ann Post script. When I was a young Ph.D. Stadtler, Julie Novak & Joshua Sparrow). at Dr. Brazelton’s Child Development Unit, at Children’s Hospital, Boston, I was Joshua Sparrow as co-editor contributed astounded at his fellowship program. a chapter which provides a central It was developed for clinicians from perspective on Brazelton’s emphasis on pediatrics and other disciplines, at the forming relationships and collaborative fellowship level, to study and experience consultation. These ideas have grown what a colleague called ‘typical child through the evolution of the Touchpoints development and parenting.” Brazelton, program; evidenced in a chapter by I think, was concerned that pediatric Jayne Singer and John Hornstein on the residents (and others in allied disciplines) Touchpoints approach to early childhood had learned about diagnosing problems care. Separate chapters indicate Brazelton’s and treating known illnesses but this influence on infant mental health training learning was not often balanced by in early intervention and early head start learning about child development and (the late Libby Zimmerman); innovations the everyday concerns of parents. Early in behavioral/developmental pediatric on, I asked: “Why would people at this fellowship training (Constance Keefer); stage of their career return for two years child life (Myra Fox); early child care and of sitting on the floor in day care centers; education (Francine Jacobs, Mallary participating in the Early Childhood Service Swartz, Jessica Dym Bartlett & M. Ann and learning to join with colleagues in Easterbooks); and a thoughtful chapter many other disciplines in seeing and then, by Daniel Pederson and Jack Shonkoff supporting children and their parents?” on translating the science of early child One simple answer was that Brazelton development into policy and practice. The himself, and those around him; had created book concludes with a chapter by Sara what one fellow called “A hotbed of child Lawrence-Lightfoot called Respect and development.” The curriculum included Healing. how to learn from research and develop researchable questions in an applied (e.) The conduct of research in applied context. All of the fellows have moved on development, early intervention and to noteworthy careers as faculty, (often evaluation of infant mental health forming developmental/behavioral programs. Combining an emphasis on the pediatric and applied child development importance of individual differences with training programs); researchers (in first rate one on complex interactions between applied research protocols); clinicians and the infant and environment has placed a policy advisors. In a similar light, this book demand for new methods and new models is itself a “hotbed of child development of development. Barry Lester’s opening and issues central to infant mental health chapter and several others in the book practice.” detail how researchers have worked to translate Brazelton’s contributions into Two of the ‘Brazelton fellows’ have passed sound research protocols. on recently. This review is a tribute to Dr. Brazelton and is also dedicated to the To sum up the connection between memory of Stephen Parker, M.D. and Bob the new book and infant mental health Gatson, M.D . training and practice, I can but quote WAIMH’s own Hi Fitzgerald in his tribute on the back cover of the book: “Those who want to bask in and relive the exciting engagement with infants and families

19 WORLD ASSOCIATION FOR INFANT MENTAL HEALTH JANUARY - MARCH 2011