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The Brazelton Scale: Gain a Better Understanding of Baby

Imagine knowing in the first few weeks of your baby’s life how she likes to be held, if she can tolerate loud noises, and whether she can distinguish human faces.

According to the research behind the Brazelton Scale, you can know all this and more about your newborn.

What Is the Brazelton Scale?

Dr. T. Berry Brazelton and Dr. Kevin Nugent, director of The Brazelton Institute, Children’s Hospital, Boston, Massachusetts, published The Brazelton Scale in 1973. The scale is designed to reveal an infant’s strengths and preferences, so that parents may have a better understanding of their newborn’s capabilities.

The scale contains 28 behavioral and 18 reflex items for parents and doctors to assess. It also reviews a baby’s capabilities in several different developmental areas: autonomic, motor, state regulation, and social-interactive systems. The result is not a score, but instead an understanding of how infants integrate these areas as they adapt to their new environment.

How It Works

The Brazelton Scale, also known as the Neonatal Behavioral Assessment Scale (NBAS), examines a wide range of behaviors in infants from birth to 2 months of age. The premise of the scale is that babies are born
ready to communicate. They may not use words, but their body movements, cries, and visual responses are their way of speaking. And the Brazelton Scale helps parents and caregivers understand just what it is their babies are saying.

“The scale gives us the chance to see what the baby’s behavior will tell us,” says Dr. Brazelton. “It gives us a window into what it will take to nurture the baby.”

For example, it gives parents information about the following:

  • If, and how, the baby likes to be handled
  • How the baby calms herself
  • If she is receptive to social interaction

The information garnered from the scale can help parents and doctors decide if a baby needs extra caregiving in certain areas.

In Ab Initio, a quarterly newsletter published by the Brazelton Institute, Mary Grimanis, RNC, MS, writes about 57 mothers and their healthy newborns who participated in a two-phase study of the effectiveness of the Brazelton Scale. The mothers said that the scale helped them as parents by giving them a greater awareness of their child’s behavior and development. One mother discovered that her newborn was sensitive to sound. She said the scale helped her “recognize the kind of things that made him upset … for example, the shaking of the rattle.”

Another mother said, “It helped me recognize the states she was in—to know when it is best to feed and play with her. It made me more observant of her.”

Look What Your Newborn Can Do

“A newborn already has nine months of experience when she is born,” says Dr. Brazelton. Even so, babies enter the world with what is akin to a survival checklist. They face four interrelated developmental tasks, each vital to the baby’s growth and development. The Brazelton Scale uses both behavioral and reflex measurements to assess a baby’s
capabilities across all four developmental areas.

These are the areas:

  • Breathing: This is a basic yet fundamental challenge. It is only after a baby’s breathing and body temperature are self-regulating that a baby can focus on additional areas of development. If an infant is “stuck” at this most basic level, excessive stimuli may be distracting and upsetting.
  • Motor control: Once breathing is mastered, infants move on to controlling their movements. If an infant is excessively active, parents can use swaddling and other techniques to control the activity level.
  • Response, or “state” regulation: The next level of development is an infant’s ability to process and respond to
    stimulation
    from the environment. A baby’s response to stimulation, as well as his ability to tune it out, provides key caregiving information. For example, infants who have difficulty blocking stimulation will need a quiet, darkened room for sleeping.
  • Social interaction: Once an infant’s breathing, motor, and “state” systems are balanced, she is ready to interact as a social being. Most babies are social from their very first moments of life. Bonding between parent and child is greatly enhanced when parents see how their newborn responds to their voices and focuses on their
    faces.

Once the trained examiner has measured the 28 behavioral and 18 reflex items across these four developmental areas, she can give the parents a detailed portrait of the baby’s specific needs and styles of behavior. Some babies like to be handled, others don’t. Some like social interaction, while others are happier without too much of it. These are key insights into the uniqueness of each baby. Parents and doctors alike benefit from knowing this information, and knowing it as soon as possible after a child is born.

Your Pediatrician and the Brazelton Scale

The chances are good that your doctor will know about the NBAS, but he or she may not be trained to administer it. For many years, the Brazelton Scale was used primarily as a research instrument. While it is beginning to catch on as a clinical tool for facilitating bonding and helping parents understand the capabilities of their infants, it is not yet used routinely.

That’s why Dr. Nugent developed a quicker-to-administer model of the scale that focuses on the key elements parents have found most helpful for understanding their babies’ behavior. This test, called the Newborn Behavioral Observations (NBO) system, can be administered in seven minutes. Best of all, Nugent’s new model has Mother and doctor working side by side performing the assessment. This way, they both learn about the child in the same way, at the same time. It is an invaluable process that not only has enormous implications for fostering the parent/child bonding process but also builds trust into the doctor/family relationship.

“This assessment has a huge impact on fostering relationship building,” says Dr. Nugent. “It really reveals who the baby is.” As a result, parents become better parents simply because they know so well just who they are parenting.

If you would like more information on the cost of administering the Brazelton Scale, as well as the location of the nearest certified NBAS
administrator in your area, contact the Brazelton Institute at 1295 Boylston Street, Suite 320, Boston, MA 02115 USA. Phone: 1-617-355-4959.

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