Building Blocks for Healthy Kids - Nutrition Education Curriculum
The Building Blocks of Healthy Attachment Building Blocks of Healthy Attachment + ... Saves the...
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11/19/2011 1 + Frank Belmonte, D.O., MPH Debbie Lindgren, M.A. Advocate Lutheran General Children’s Hospital The Building Blocks of Healthy Attachment + Objectives Define Attachment Review the structure and function of the infant brain in terms of attachment Explain the importance of the parent infant dyad to the biology of attachment Review the “milestones” of infant attachment Review strategies to promote healthy parent infant attachment
Transcript of The Building Blocks of Healthy Attachment Building Blocks of Healthy Attachment + ... Saves the...
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Frank Belmonte, D.O., MPHDebbie Lindgren, M.A.Advocate Lutheran General Children’s Hospital
The BuildingBlocks ofHealthy
Attachment
+Objectives
Define Attachment
Review the structure and function of the infant brain in termsof attachment
Explain the importance of the parent infant dyad to thebiology of attachment
Review the “milestones” of infant attachment
Review strategies to promote healthy parent infantattachment
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+Disclaimer
We have no relevant financial disclosures
However….
We do not claim to be experts in attachment, but would liketo share with you some of our experiences with families
+What is Attachment?
Attachment is a special, secureemotional relationship or bond
between an infant and hiscaregiver that involves an
exchange of comfort, care andpleasure
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Neurobiology ofAttachment
Neurobiology ofAttachment
Milestones of AttachmentMilestones of Attachment
Assisting in AttachmentAssisting in Attachment
+Structure and Function: TheNeurobiologic Elements ofAttachment
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+A Two Year Journey
Multiple neurobiologists have theorized that from birth to twoyears, the infant brain is right side dominant
Alan Schore, PhD. describes “right to right braincommunication” between a mother and her infant
The brain volume doubles in size from the last trimester tothe end of the second year
After this, a period of synaptic pruning occurs in whichconnections that are not utilized are discarded
“Cells that fire together, wire together. Cells that do not, dietogether” – A.Schore
+Synaptic Pruning
BIRTH 7 YEARS 15 YEARS
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+Right and Left Brain Attributes
+Evolving Cerebral Architecture
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+Brain Development in the First Year
Right Side Brain Structure Developmental Trajectory
Amygdala – part of the limbicsystem – center of emotion
“Online” at birth – the right amygdalaprocesses olofactory stimuli – mediatingthe recognition of maternal and baby scent
Anterior Cingulate Critical development at 8 weeks – regulateslaughing and crying, play and separation,face recognition and autonomic activity
Right Insula Develops over the first year – in thetemporal lobe. Regulates the subjectiveawareness of inner body feelings andemotionality
Right Parietal Cortex Representation of the physical self and theability to distinguish self from others
+Orbital-Frontal Cortex
Between 9-12 months the orbital-frontal cortex undergoes acritical period of growth that continues through the secondyear of life
This area of the brain acts as the highest level of control ofbehavior, especially in relation to emotion
Functional MRI studies done by Nitschke and colleaguesshow that mothers viewing photographs of their babies havemaximal brain activation in their right orbital-frontal cortex
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+Hypothalamic-Pituitary AdrenalAxis
The right cerebral hemisphere is critically involved inregulating the HPA Axis and the infants physiologic stressresponse
This regulation originates from the right pre-frontal cortex.There is research to suggest that the volume of this area isactually larger in adults who experienced secure attachmentas infants
Essentially, the mother’s own endorphins and opiatesstimulate the baby’s endogenous production of thesesubstances thus fostering the milieu for brain growth anddevelopment
+Summing it up…
Attachment is a neurobiologicphenomenon
Mother and Infant are bothright brain predominantfollowing delivery
This right brain predominanceis so powerful that mothers aremore likely to hold theirbabies in the left cradlingposition!
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+Milestones in Attachment
+Parent Infant Dyad
INFANTATTACHMENT
PARENTBONDING
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+Parent Bonding
There is an exaggerated greeting response
Imitation of facial expression
Parents are wired to respond to their infants distressed cry
Bonding begins in utero
+The parents are primed torespond…
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+Infant Attachment
The infant has built in capacity to “hook” the parents
They are soothed by their hold and comforted by theirtouching and swaying
They will turn to their voice preferentially
They are attracted to the human face
+Birth
The “golden hour” after birth
Baby is awake and interactive
Prefers the parents voice andface
Establishing their new role
Adrenalin Rush
Anticipation is over – meetnew family member
Learning the baby’s cry – agreat opportunity to forgetrust
Infant Parent
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+One Month
Infant uses their sense ofsmell, taste, and touch tointeract with their socialenvironment
Baby is learning that parentwill always be there, needswill be met
Learning how to respond tothe baby’s needs and how toconsole
You cannot spoil the infant
The parent develops routinesto establish connections withthe infant
Infant Parent
+Two Months
Mutual gaze encouragesintense face to face interactionwith the parent
Facial, vocal and gesturalcommunications occur
“Affect Synchrony” occurs- theparent synchronizes theiraffect with that of the newborn
Post-partum Depression canimpair the synchrony
Infant Parent
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+Four Months
Increase in reciprocalcommunication
Baby is social and interactive
Screams to get attention
Parents “fall in love” with thebaby
More comfortable with care
Find comfort in “knowing theirbaby”
Infant Parent
+Six to Nine Months
Stranger Anxiety – memorydevelopment
Saves the biggest laughs andsmiles for parents
Looks to parent for safety andcomfort
Parent becomes the “securebase” – Bowlby
Parents know their child’sneeds
Infant Parent
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+
Infant
With added mobility, need asecure base
Knows where to getcomforted, when hurt or afraid
Looks to parent for praise
Joint attention
Parent
Provide secure base
Respond with comfort andpraise (clapping)
Shares activities
Nine to Twelve Months
+Babies are primed to connect!!
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+Clinical Interventions inAssisting Healthy Attachment
+A crucial time
For the rest of the life span, the right hemisphere is imprintedwith the template for future relationships and attachment
Right brain neuropsychology represents the substrate ofthree critical human interactions: trust, empathy and moraldevelopment
We have a front row seat during this critical time in humandevelopment….. What are issues that derail this naturalprocess? What can we do to help get things back on track?
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+Situations which may impairnormal attachment
Unexpected C-Section
Maternal or infant illness after delivery
Postpartum Depression
NICU stay
Ghosts in the Nursery - Selma Fraiberg
Colic
Infant Temperament
Environment
+
Our goal is simple…
To assist parents in seeing theirnewborn as a unique individual,
who knows them best and ishardwired to attach
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+Attachment Rounds
We take time once per week toaddress these issues at normalnewborn nursery rounds
Resident physicians arechallenged to understand themilieu in each family unit
They are asked to identifytemperament and newbornstate
+How do we begin?
What is your baby’s name?
How did you choose that name?
Who does she remind you of?
Does she have a personality yet? What is she like?
What have you noticed about him so far?
How is he different from your other children?
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+Brazelton’s Neonatal BehavioralObservation Scale (NBOS)
An observational scale designed to assist clinicians andparents in understanding their newborns uniquetemperament and strengths
It provides the infant with “a voice”
We teach residents in pediatrics and family medicine how tointegrate elements of this tool into their routine newbornexam
+Six States of the Newborn
Recognizing newborn state can reveal to parents that infantshave a non-verbal way of communicating with their parents
Deep Sleep
Light Sleep
Drowsy
Quiet Alert
Active Alert
Crying
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+Educating Families on theStrengths of their newborn
Infants can see clearly at 12 inches and can visually track
Hear and locate sounds
Habituate
Recognize mom’s voice
Discriminate mom’s face
Recognize emotional expression
+“She is so strong! Look at her headcontrol.”
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+“Look at her go dad!”
Check meout Dad!
Check meout Dad!
+“Wow, she really seems to like thisposition”
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+“Look at how alert she is!”
+“She really knows who her momis!”
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+Promoting Attachment in the FirstYear
Screening for postpartum depression and domestic violenceand getting mother help
Talking for the baby during the exam
Acknowledging stranger anxiety
Asking about the babies temperament
Reframing the behaviors in a positive light
+
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+Conclusions
Babies are hardwired to attach
Attachment is a dynamic process that can be impacted by theparent/infant relationship
Families bring their own story to the table, and severalelement of this unique story may impact the attachmentprocess
Health care providers can assist families in identifying theseelements and provide means to overcome them
We can directly impact the future psyche of the infant.
+Thank You!
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+References
Fraiberg, Selma; Adelson, Edna; Shapiro, Vivian - Ghosts in the Nursery: A Psychoanalytic Approach to theProblems of Impaired Infant-Mother Relationships
Schore Ph.D., Allan; Attachment, Affect Regulation, and the Developing Right Brain: Lining DevelopmentalNeuroscience to Pediatrics; Pediatrics In Rev.iew, Vol26 No.6, June 2005. 204-217
Epstein, HT. An outline of the role of brain in human cognitive development. Brain Cognition. 2001;45:44-51
Stuss DT. Alexander MP. Affectively Burnt in: one role of the right frontal lobe?. Memory, Consciousness andthe Brain: The Talin Conference. Philadelphia, Pa: Psychology Press 1999:215-227
Brazelton, TB. Nugent, JK. Neonatal Behavioral Assessment Scale. Clinics in Developmental Medicine No.137. Cambridge University Press, 1995
Maldonado-Duran, JM. Infant and Toddler Mental Health: Models of Clinical Intervention with Infants andTheir Families. American Psychiatric Publishing Company, 2002
Insel, Thomas. A Neurobiological Basis of Social Attachment. American Journal of Psychiatry.154: June 1997:726-735
Grienenberger, J. Kelly, K. Slade, A. Maternal reflective functioning, mother-infant affectivecommunication, and infant attachment: Exploring the link between mental states and observedcaregiving behavior in the intergenerational transmission of attachment. Attachment and HumanDevelopment. September 2005; 7(3):299-311
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