The faculty of the 1998 Johnson & Johnson Pediatric Round
Table: New Perspectives in Early Emotional Development are
among the world's leaders in the field of infant development. Each
brought to the table years of experience from a variety of disciplines. The salient points of their discussions are summarized in the following
article.
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COMMUNICATION IS IMPORTANT |
Emotional development in infants and children has
lifelong effects, and everyone caring for them
pediatricians, child
health professionals, families, and caregivershas an important role in the growth and development of unique and healthy human individuals. A common theme to facilitate optimal infant development, advanced by
all participants in this Pediatric Round Table, is the need for
excellent communication and cooperation among all individuals who
influence young lives.
On one level, improved communication between researchers and clinicians
will get meaningful new information into practice where it can be used
effectively. This process will be even more effective if professionals
from both disciplines, in the interests of cross-fertilization,
exchange ideas and observations early and frequently. In many ways,
round table meetings such as this break new ground and establish the
foundation of productive alliances.
On another level, communication between professionals and parents,
grandparents, and day-to-day caregivers must have an appropriate tone
and content to actually deliver meaningful effective messages. It often
is important to step back from years of professional training to
think in parent terms. What do parents have to know to have the
greatest positive effect on their infant? What do I have to avoid
saying so that I don't add to their uncertainty, anxiety, or
frustration? One often-repeated example of the latter dealt with
explaining why the first years of life were important in the child's
later health and well-being. All too often this knowledge made parents
worry that even the tiniest mistake would destroy their infant's
opportunity for a happy, healthy, and productive life.
The answer to this dilemma is that there is no simple answer. Every
infant, every family, every environment is unique. Each is the
product of a diverse genetic, cultural, and religious heritage. The
pediatrician must embrace this complexity, yet communicate with
simplicity.
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MAJOR MESSAGES FOR PROFESSIONALS AND PARENTS |
But what is new, valid, and meaningful to professionals and
parents?
Emotional Development Is Important
A basic tenet is that early emotional development is as important
as early physical development. Talking about physical development is
always somewhat easier, because well-established milestones for growth
and physical skills have been known for years. Discussing emotional and
behavioral milestones is more complex because they are less
well-defined, and there may be a danger in proscribing clear-cut
"emotional milestones" because each infant is unique and develops
at his or her own pace.
Early Life Is a Crucial Time in a Person's Development
At a young age, the brain is growing, developing, and open in
special ways to visual, tactile, olfactory, and auditory stimulation. The combination of these stimuli, the way people interact with infants,
and the total environment in which infants live all influence long-term
behavior and intellectual development. For example, development of
emotional attachment between a mother and her new infant is important
within hours and days of birth. In cultures where mother and infant are
kept apart, the rates of infant abandonment and abuse are high; these
rates plummet when mother and infant are provided maximum contact with
each other. In this case, by allowing emotional development to occur
fully and naturally, a healthy mother-infant dyad is formed, a baby is
cared for by his mother, and society benefits on all fronts.
Discussing and Evaluating Emotional Development
Addressing emotional development requires professionals who are
sensitive and emotionally available. Helping parents and infants through emotional or behavioral problems is not the same as treating otitis media. Practitioners need to "be there" for their patients, not just physically, but emotionally. This involves using your own
emotions to appreciate the uniqueness and individuality of those you
care for. Your emotions help you understand your patients' feelings of
interest and surprise, struggle and suffering, or anxiety and
depression. Your emotions are a window into your patients' lives and
antennae for receiving their behavioral cues and concerns.
Considering this new dimension of clinical practice prompted a
discussion that focused on the role pediatricians and pediatric nurses
play in emotional and behavioral development. In the current environment of managed health care, what exactly are pediatric specialists and what should they do? A concern was that emotional issues, although important, are generally not considered billable items
within managed health systems. Therefore, there is little incentive to
devote time and resources to them. Bringing a developmental specialist
into a group practice has certain advantages, but the issue of funding
once again is a problem. But perhaps more important was the observation
that when parents come to a pediatrician, they want to see a
pediatrician. There are, for better or worse, expectations and
privileged relations that exist only between physicians and nurses and
their patients. Although other trained health professionals contribute
immensely, the pediatric specialists often are the first point of
contact and should take the lead in emotional assessment.
Because this is often not the case, there is a need to motivate,
influence, and educate medical professionals in the skills of emotional
and behavioral assessment. Quite naturally, these skills need to be
applied in clinical practice. Once again, communication among peers is
important in making others aware of early emotional development.
Continuing Medical Education programs, journal articles, symposia,
conferences, and just talking to colleagues are all valid methods to
increase awareness of development. For medical students and pediatric
residents, more training should be available in infant development and
behavior.
The Role of Family and Environment
Infants exist in complex settings involving parents,
relatives, caregivers, religious beliefs, and ethnic practices, as well as the physical environment. These create a tapestry within which the
infant's life is woven; each thread leads to and from the infant in
ways that professionals should understand. With that understanding,
opportunities are created to form therapeutic alliances for the
benefit of the infant.
The infant's overall environment was cited as crucialthe number of
risk factors correlates inversely with later success. Infants with
multiple risk factors are more likely to be developmentally and
intellectually compromised compared with those with few or no risk
factors. The pervading role of the environment complicates interventions or research that address only one or two variables when
many risk factors may be present. Therefore, it may be beneficial for
professionals to take a step back and examine the entire picture before
diagnosing or intervening in developmental problems.
Yet within this tapestry, the birth of an infant provides an
entry point for positively affecting with development in a familial context. Because birth is a time of reorganization and redefinition for
the mother and family, professionals have an unmatched opportunity to
become involved. At or around birth, there is an openness that enables
you to learn about parental expectations, ghosts, or potential problems
in the caregiving environment. Learning of these situations makes it
possible to reassure parents and, when needed, to embark on more
extensive interventions.
It also is important to remember that mothers are not the only
caregivers involved intimately with newborns and children. Fathers make
important, tangible contributions to infant development. Professionals
are encouraged to include the role of fathers in their own context of
infant development and, consequently, encourage fathers themselves to
participate actively in their infants' lives.
Similarly, nonparental caregivers can have considerable impact on
infant development. An emerging concern for this group is how to
provide them with appropriate developmental information. In light of
the focus first on mothers, then on fathers, caregivers (who may be
with the infant as much or more than the parents) could certainly
benefit from additional consideration. In the absence of more concrete
plans, communication once again is importantprofessionals need to
talk with parents, and parents with caregivers, to ensure that infants
are getting all they need to develop optimally.
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THE NEED FOR MORE RESEARCH |
Early emotional development is a field rich in opportunities
to advance the understanding of fundamental processes that shape the
lives of infants and families. At the biological level, much still can
be learned about the chemical, physiologic, and structural relations
between the developing human brain and behavior. This exploration
should include expanded study of normal baseline behavior, as well
as examples of abnormal development, pathology, and trauma.
In examining behavior itself, better descriptions are needed for
a variety of clinical syndromes and emotions; any such description then
would be subject to empiric verification. Also worth studying is the
possible identification of hierarchical emotional milestones in
development; on the other hand, such milestones may be absent, and
research will reveal the importance of individual variability in
emotional development.
The richest areas for research will flow from the collaboration
of professionals with different, yet complementary, skills and
experience. Cooperation among neurologists, psychologists, developmental biologists, pediatricians, and nurses can lead to improved study design and more definitive data for virtually all issues
in early development. Working together will help everyone appreciate
the complexity and contextualized nature of emotions and help create
new tools to capture and understand that complexity.
And, finally, research is needed to discover the best ways to deliver
information about early emotional and behavioral development to parents
and caregivers. Although it can be anticipated that optimal
communication will involve a variety of techniques and approaches,
helping parents understand their infants and themselves is at the heart
of many intervention strategies. By sharing our new perspectives in
early emotional development in the most effective ways, we can make a
lasting positive impact on the healthy development of infants and their
families throughout the world.
