THE SCIENCE BEHIND THE NEW NEONATAL STANDARDS. - … · the science behind the new neonatal...

1

Dr Nils Bergman

MB ChB, DCH, MPH, MD

(USA equiv: MD, MPH ,PhD)

Cape Town, RSA

www.skintoskincontact.com

THE SCIENCE BEHIND THE NEW

NEONATAL STANDARDS.


NEONATAL STANDARDS.

NEURODEVELOPMENT

The DNA Behaviour

EVOLUTIONARY BIOLOGY

The Neuroscience of Birth & BreastfeedingThe Brain

EPIGENETICS

ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION

MICRO-RNA

HISTONE MODIFICATION

DNA METHYLATION

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


“Phenotype” – specimen resulting from

gene – environment interaction

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


2

”Neurons that fire together wire together while those which don’t,won’t”

Hebb/Carla Shatz REMNR1NR2NR3NR4

ACQUISITION CONSOLIDATION MEMORYFORMATION

poly-sensory input transfer information P wavesshort-term memory “SNR” strong signals returns infostored cortex amygdala / to neocortex:

hippocampus organizedAwake and REM NREM stage 4 REM

BRAIN WIRING

Stanley Graven 2006

modulates state organisationelicits emotional behaviours

activates pre-feeding actionsanticipatory digestive physiologyregulates pace of ingestive behaviour

SMELL

Schaal 2004 9

The secretion of Areolar(Montgomery’s) Glands

“In early ontogeny the sleeping brain may thusremain sentient of an organism’s odor environment.”

Doucet 2009 10

Joseph 2014 Arch Dis Child Fetal Neonatal Ed. 2014 Sep 22. pii: fetalneonatal-2014-306104.

doi: 10.1136/archdischild-2014-306104. [Epub ahead of print]

Getting rhythm: how do babies do it?

Birth ~ /~ 8w 9w 10w 11w

dates averaged “between 6 and 18 weeks”

CORTISOLday-nightrhythm

MELATONINday-night rhythm

TEMPERATUREday-nightrhythm

H3f3b genedetected

Infant:sleep cycles

begin to block on diurnalrhythms

Mother-infant synchrony

… at 12 weeks

(circadian)

START at 3 months

Can be “adult-like”

at 6 months.

Thomas 2014

3

In child:will appear on its own 3 – 12 m

ONE SIZE DOES NOT

FIT ALL:

Equally *normal*at 6 months

to sleep 2hoursas 6 hours

3 12 m

Infant sleep cycling critical for brain

development,BUT is also determined by brain requirements:

TEMPERAMENTPERSONALITYOREXIN METABOLISM“MORE SLEEP MORE WIRING”

In adult:sleep pertains

to memory

In child:neurodevelopment

(brain wiring)1st 1000 days

BRAIN WIRING

Peirano 2003

Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”

Sequence• Neural circuits that process basic information

are wired earlier than those that process more

complex information.

Slide by: Jack P. Shonkoff, M.D.

Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”

Sequence• Neural circuits that process basic information

are wired earlier than those that process more

complex information.

• Higher circuits build on lower circuits, and

skill development at higher levels is more

difficult if lower level circuits are not wired

properly.


4

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


AT BIRTH,

the brain has TWO CRITICAL SENSORY NEEDS:

SMELL & CONTACT

APPROACH RESPONSE … learned prenatally, reinforced both during the birth process and

repeatedly throughout the postnatal period,

… supported by a unique neural framework … a system that ensures rapid and robust maternal odor learning

SMELL vanilla / colostrum / water (control)

read NIRS activity FRONTAL LOBE

• This was confirmed by

demonstration of a statistically

significant negative correlation

between changes in [Hb O2] and

postnatal age (r 520.64, p 5 0.001

with 95% confidence interval) (Fig.

4). Those babies showing the

greatest increase in [Hb O2] were

between 6 and 24 h old at testing

• In the 14 babies older than 24 h

there was no significant difference

between the changes in [Hb O2]

during control and colostrum

exposure

APPROACH RESPONSE

In the 14 babies

older than 24 h

there was

no significant

difference

between the

changes in [Hb

O2] during control

and colostrum

exposure

Those babies

showing the

greatest

increase in

[Hb O2] were

between 6 and

24 h old at

testing

The first hours after birth are a

CRITICAL PERIOD

5

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


“For species such as primates, the mother IS the environment.”

Sarah Blaffer Hrdy, Mother Nature (1999)

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


Nothing an infant can or

cannot do makes sense,

except in light of mother’s body

raises its own temperature,has a higher blood glucose,metabolic adaptation faster.

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

“The newbornmay appear

helpless, but

TRANSITION

Warming, feeding and

protection behaviours areintricately, inseparablylinked to the right place.

(Alberts 1994)

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BABY

BONDINGThe BOND is made up of the

sensory inputs from the parent to the infant

REGULATION

Bowlby 1969, 1973, 1980

6

Through “hidden maternal regulators” ...

warmth activity levelmilk heart rate

“ physiological set points “internal working modelsscripts – templates

a mother precisely controls everyelement of her infant’s physiology,

from its heart rate to its release of hormones

from its appetite to the intensity of its activity

(Gallagher 1992)

Through “hidden maternal regulators” ...

The BOND is made up of the

sensory inputs from the parent to the infant

REGULATION

Bowlby 1969, 1973, 1980

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BABY

BONDING

AT BIRTH,

the brain has TWO CRITICAL SENSORY NEEDS:

SMELL & CONTACTconnect direct to the amygdala

AMYGDALA:EmotionalProcessingUnit CPU

Prefrontal cortexExecutive function

SOCIAL and EMOTIONAL

INTELLIGENCE

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BABY

BONDING

Morphing emotion AMYGDALA FUSIFORMGYRUS

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BABY

BONDING

Smell

Skin contact

Simulation theory:EMPATHY is generated

by inner imitationof actions of others

In humans, oxytocin increases gaze to the

eye region of human faces and enhances

interpersonal trust and the ability to infer

the emotions of others from facial cues.

7

Smell

Skin contact

A primary visual areas,

B somatosensory motor cortex

C primary auditorycortex

D parietal cortex & cerebellum

E m l anterior pre-frontal cortex

Fransson 2007

Smell

Skin contact

EMOTIONCONTROL CENTRE

FACE RECOGNITIONCENTRE

OXYTOCIN

E prefrontal

A primary visual

B somatosensory

C primary auditory

D parietal& cerebellum

28 days old, 30 w PMA

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONBABY

BONDING Toxic stress

Garner 2011

8

The basic

science of

pediatrics.

Shonkoff J P et al.

Pediatrics 2012;

129:e232-e246

©2012 by American Academy of Pediatrics

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

Positive Stress

• Moderate, short-lived stress responses, such

as brief increases in heart rate or mild changes

in stress hormone levels.


Bad

Good

• An important and necessary

aspect of healthy development

that occurs in the context of

stable and supportive relationships.

High

StressLow

Stress

Tolerable Stress

• Stress responses that could disrupt brain

architecture, but are buffered by supportive

relationships that facilitate adaptive coping.

• Generally occurs within a time-limited period,

which gives the brain an opportunity to recover

from potentially damaging effects.


NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONBABY


• Strong and prolonged activation of the body’s

stress management systems in the

absence of the buffering

protection of adult support.

9

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONBABY


•Disrupts brain architecture and leads to stress management systems that

respond at relatively lower thresholds, thereby

increasing the risk of stress-

related physical and mental illness.

SEPARATION DYSREGULATES

CORTISOL

CORTISOL

MICHAEL MEANEY epigenetics

CORTISOL

Unsafe environment activates HPAaxis (autonomic nervous system, ANS).

Psychobiology

and molecular

genetics of

resilience

Adriana Feder*, Eric

J. Nestler‡, and

Dennis S. Charney‡ Nat Rev Neurosci. 2009 June ; 10(6): 446–457. doi:10.1038/nrn2649

HG BABY HG BABYLOW Grooming care

HG - High Grooming Low Grooming LG

HG BABY LG BABY

MOTHER MOTHER

Healthy UNHEALTHYadult adult

HG – High Grooming Low Grooming - LG

Makes MOTHER Makes MOTHER

UNHEALTHYadult

LOW Grooming LG

Makes MOTHER

CORTISOL

10

HG - High Grooming Low Grooming LG

HG BABY LG BABY

MOTHER MOTHER

Healthy UNHEALTHYadult adult



Early stress alters gene expression,with health impact across lifespan.



HEALTHYadult

HIGH Grooming HG

Makes MOTHER

Earliest care at birth matters

Same gene switched

LG BABY LG BABYHIGH grooming care

OXYTOCIN

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONBABY


OXYTOCIN CORTISOL

Primate separation studies

Maternal Separation Paradigm0w 1w 2w 3w 4w 5w 6w 12w

n 4 Mat MNSgroup reared no mothern 4 Mat MNS group as aboven 4 Mat (control)

Gene specific for the AMYGDALA( GUYC1A3)

Separated at 1 week:

LOW gene expression

Increased self soothing Anxiety

Decreased sociality Depression

Repeated shortseparations:

LOW gene expression

Correlate to human adult depression

11

2ND

KNOCK

Adults with depression, suicides:LOW gene expression

smalller hippocampal volumereduced expression frontal lobe

DOHAD

Developmental Origins of

Health and Adult Disease

… very early, once off, and forever.

Early stress alters gene expression,with health impact across lifespan.

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONBABY


SKIN-TO-SKIN CONTACT

SEPARATION

BREAST- VAGALMOTHER FEEDING (PSNS) GROWTH

OTHER PROTEST- STRESS SURVIVAL orDESPAIR (SNS)

THE PLACE MODEL

12

Reference

RCT of skin-to-skin contact from birth versus conventional incubator care for physiological stabilisation in 1200- and 2199-gram newborns.

Bergman NJ, Linley LL, Fawcus SR.

Acta Paediatrica 2004 Vol 93(6); 779-785

“100% SCRIP STABILIY”

S S C C M C

1200g to

2200 g1 - 6h 56% 11%

@ 6h 100% 46%

1200g to

1800g1 - 6h 44% 0%

@ 6h 100% 25%

Stabilisation first 6 hours, average hourly SCRIP score

5.1

5.2

5.3

5.4

5.5

5.6

5.7

5.8

5.9

6

6.1

2nd 3rd 4th 5th 6th

KMC all

KMC <1800

CMC all

CMC <1800

Hourly average of SCRIP score, 2nd to 6th hour

Stabilization 1200g – 1800g

Skin-to-skin

Incubator

INCUBATORS DE-STABILISE

NEWBORNSStabilisation first 6 hours, average hourly SCRIP score

5.1

5.2

5.3

5.4

5.5

5.6

5.7

5.8

5.9

6

6.1

2nd 3rd 4th 5th 6th

KMC all

KMC <1800

CMC all

CMC <1800

Premature babies are not in incubators because they are unstable.

Premature babies are unstable because they are in incubators.

REGULATION vs STIMULATION

Expected vs UnexpectedEcologic salience vs Potential threatResource growth vs threat readiness

OXYTOCIN vs CORTISOL HOMEORHESIS vs HOMEOSTASIS

MOTHER vs OTHER

13

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

MOTHERBABY

BONDING Sensitization

SEPARATION

Toxic stress

Critical period concept :

“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”

a mother’s brain …

SENSITIZATION

Milk making NUTRITION

HypothalamusPituitary:PROLACTIN

Maternal ferocityPROTECTION

OXYTOCIN Gaze increase: BONDING

OXYTOCINCingulate Suppressed

REGULATION

Amygdala:CHOLECYSTOKININ Emotion / satiety

HypothalamusPituitary:

Cingulate

Amygdala

SENSITIZATION

0

5

10

15

20

25

-0.2 0 0.2 0.4 0.6 0.8 1

Maternal Behavior Q-Sort

Ho

urs

of

SS

C i

n I

nfa

nts

' F

irs

t 2

4 H

ou

rs

SENSITIZATION

Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security

0

5

10

15

20

25

-0.2 0 0.2 0.4 0.6 0.8 1

Maternal Behavior Q-Sort

Ho

urs

of

SS

C i

n I

nfa

nts

' Fir

st

24

Ho

urs

Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security

SENSITIZATION

0

5

10

15

20

25

25 27 29 31 33 35 37 39 41 43 45

Maternal Behavior Subscale of the NCATS

Ho

urs

of

SS

C i

n I

nfa

nts

' F

irs

t 2

4 H

ou

rs

Dose of SCC first 24 hours correlatesNCATS ( Nursing Child Assessment Teaching Scale )

Predicts cognitive outcome

14

Conclusion: Mother/infant SSC benefits mothers by reducing their depressive symptoms and physiological stress in the postpartum period.

JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x

EPDS (depression) score DECREASED significantly for first two visits.

JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x

Control

SSC

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

SEPARATIONMOTHERBABY

BONDING Sensitization Toxic stress

Insensitiveparenting

… anxious parenting … mediated by stress-related mechanisms

and greater neural disorganization.

SEPARATION

Toxic stress


Well-adapted parenting … reward-related motivational mechanisms, temporal organization, and affiliation hormones

OXYTOCIN

may contribute to mental health risks & RESILIENCY in the mother–infant dyad.

Brain differences between VD & CSD mothers …

C/S

NVD

NVD

15

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




There is a critical period for maternal neuroplasticity at birth.

BIDIRECTIONAL !!

Affect regulation

“Human brains are RELATIONAL”

… co-creating touch… signature unique to caregiver

PRATHIBA REEBYE


Secure attachment

Attuned parenting

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BEYOND BREASTFEEDING Feed Sleep Cycling

MOTHERBABY


Secure attachment

Attuned parenting

EMOTIONAL INTELLIGENCE

SOCIAL INTELLIGENCE

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH

BEYOND BREASTFEEDINGFeed Sleep Cycling

BABY

BONDING

Secure attachment

SEES

Mum’s eyes

Hand TOUCH

Mum’s skin

Skin-to-skin

CONTACT

SENSATIONS THAT WIRE BRAIN

Back FEELS

Mum’s arm

holding

TASTES

Mum’s milk

Ear HEARS

Mum’s voice

SMELLS

Mum’s milk

WARMED on

Mum’s front

MOVES

with Mum

Slide from JILL BERGMAN

a kind of invisible hothouse

BREAST - FEEDING=

BRAIN - WIRING

16

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


BABY

BONDING

Secure attachment

John Bowlbysecure attachment

“a safe base from which to explore the world”.

Safe HavenSecure baseProximity

maintenanceSeparation

distress

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting

Disordered attachment

Toxic stress


DISEASEHEALTH

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE

SOCIALCONTROL CENTRE

OXYTOCINDOPAMINE

CORTISOL

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


17

PR - Peer Reared

MR – Mother Reared

Plasma CORTISOL response to STRESS (2y)

RESILIENCE:“capacity to maintain

healthy emotional functioning in the after-

math of stressful experiences”

DISEASEHEALTH MR PR

OXYTOCIN DURING LABOUR

CHANGES MOTHER’S BRAIN !!

Same brain circuits …as RESILIENCE,

“highly conservedneuro-endocrine behavior”

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


DISEASEHEALTH

RESILIENCE VULNERABILITY


CHANGES MOTHER’S BRAIN !!

This brain responds tobaby’s cry differently :

Amygdala –The emotional brain - to love her baby –relationship - to focus on care for baby

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL



Orbitofrontal cortex –activates approach

Nucleus accumbens –Reward and pleasure motivation- (dopamine)

Fusiform gyrus –(face coding unit of brain)

seeks her baby’s face


Cingulate - (inhibition)switched off - makes ferocity for defence

Thalamus -activity coordinating centre of brain - to focus on care for baby

Hypothalamus –activates arousal response to respond

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


… there is considerable overlap in the brain structures associated with these neural mechanisms … functional interactions among the circuits.

18

FEARCONTROL

CENTRE

REWARDCONTROL

CENTRE


OXYTOCINDOPAMINE

CORTISOL


An overly responsive fear circuit … may negatively influence functioning of the reward system.

… a properly functioning reward circuit may be necessary for …positive social behaviors.

Resilience Vulnerability

DISEASEHEALTH

RESILIENCE(= STRESS RESISTANCE)

“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”


DISEASEHEALTH

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress


OXYTOCIN

SEPARATION CORTISOL

SKIN-TO-SKINCONTACT

OPPOSITES

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress


OXYTOCIN

CORTISOL

OXYTOCIN

OXYTOCIN

OXYTOCIN OXYTOCIN

OXYTOCIN

CORTISOL

CORTISOL

CORTISOL

OXYTOCIN

OXYTOCIN

CORTISOL

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress

InsensitiveparentingPROLACTIN

CCK

VASOPRESSSINDOPAMINE

Prog / Estr

DHEA

19

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

intricately, inseparablylinked to the right place.

(Alberts 1994)

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

intricately, inseparablylinked to the right place.

(Alberts 1994)

MOTHER

is the key toneurodevelopment …… because she is the

RIGHT PLACE !!


- birth hormone- breastfeeding hormone- LOVE hormone- FRIENDSHIP hormone

OXYTOCIN

Protect my OXYTOCIN!

birthdoulasofpittsburgh.com

The DNA Behaviour


BIRTHCOMPANION

FATHERAT BIRTH

ZEROSEPARATION

Best midwife + doula + father

cortisol oxytocin dopamine

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


“except in the light

of mother’s body.”

20

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


“needed neural

processes”

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


buffering protection

of adult support”

“Absence of the

buffering protection

of adult support”

“Absence of the

The Neuroscience of Birth & Breastfeeding

Do not measure how much skin-to-skin contact you are doing.Measure minutes of separation Your dose of TOXIC STRESS

“Non-pharmacological reduction of

hypercortisolaemia in preterm infants”(Modi & Glover 1998, Mooncey et al 1997)

Preterm infants experience prolonged severe stresswith tenfold increases in stress hormones.

Stress hormones at such levels are neurotoxic.

RCT on methods to reduce of stress (at one hour):

Cortisol EndorphinMassage slightly lower no change

Soft music no change no change

Skin-to-skin 66% lower 74% lower

CORTISOL

SEPARATION

NEURODEVELOPMENT

The DNA Behaviour



EPIGENETICS


ZERO

SEPARATION

BIRTH

BREASTFEEDINGFeed Sleep Cycling

MOTHERBABY



NEONATAL STANDARDS.

21

… more like POETRY thanNeuroscience ??

close and loving relationship

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress


… more like POETRY thanNeuroscience ??


NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress


… a definition of currentNeuroscience !!!


• “NINO approach to Birth”

• 1st 1000 seconds – Start skin-to-

skin contact on mum (later dad)

• 1st 1000 minutes first day/ night

• 1st 1000 hours- first 6 weeks

• 1st 1000 days – (started at

conception … to end of year 2.)

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




There is a critical period for maternal neuroplasticity at birth.

ZERO SEPARATIONfor first 1000 minutes

Support parents to have

22

ZERO SEPARATIONfor first 1000 minutes

Enable babies


NEONATAL STANDARDS.

Does it apply MORE or LESS to PRETERMS ??

This science applies to FULLTERM BABIES

ZERO

SEPARATION

This science applies to PRETERM BABIES … immunity, microbiota,

enteromammary cycle …

Enable babies to receive

… developmentally ready ?? no longer preterm !(Evidence of harm !)

Promote cup-feeding !

23


NEONATAL STANDARDS.

… actually, YOU are theirpartners in care …

The first hours after birth are a

CRITICAL PERIOD

mutual psycho-neuro-physiological

caregivers GC Anderson

“Human brains are RELATIONAL”

… co-creating touch… signature unique to caregiver


Secure attachment

Attuned parenting

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

MOTHERBABY

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


MOTHERBABY


Secure attachment

Attuned parenting


NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH


MOTHERBABY


Secure attachment

Attuned parenting


SOCIAL INTELLIGENCE

24

Proposed areas of INNOVATION!

Skin-to-skin by parents … others ?Role of father in continued BRF

Furniture to decrease separation dose Garments to decrease separation dose

Feeding frequency for best output?Synchronizing feeding and sleeping.

BIRTH BONDING Sensitization Toxic stress

IT MATTERS

HOW WE ARE BORN


SEPARATION

Vulnerability

DISEASE


Toxic stress


SEPARATION

VIOLATESthe innate agendaof mother and baby


BIRTH


MOTHERBABY


Secure attachment

Attuned parenting

Resilience

HEALTH

A mother and baby

DYADare asingle

psychoneurobiologicalorganism

NEURODEVELOPMENT

The DNA Behaviour




EPIGENETICS

BIRTH




Secure attachment

Attuned parenting


DISEASEHEALTH


Toxic stress


25

Nelson Mandela

… in describing themeasure of a nation,

he has argued that:

“There can be no keener revelation of a society’s soul than the way in which it treats its children.”

http://www.google.co.za/url?sa=i&rct=j&q=Mandela+children+no+keener+measure&source=images&cd=&cad=rja&docid=28ZeDnl7FonrOM&tbnid=Lis73rdl0IBzEM:&ved=0CAUQjRw&url=http://www.eddysvision.com/2011_10_01_archive.html&ei=KjhjUbS7Fq2l0wXn54HYDQ&bvm=bv.44770516,d.ZG4&psig=AFQjCNFMsFQRVjw5-SZT6XPglGuoh9jo0Q&ust=1365543072105327

http://www.google.co.za/url?sa=i&rct=j&q=Mandela+children+no+keener+measure&source=images&cd=&cad=rja&docid=28ZeDnl7FonrOM&tbnid=Lis73rdl0IBzEM:&ved=0CAUQjRw&url=http://www.eddysvision.com/2011_10_01_archive.html&ei=KjhjUbS7Fq2l0wXn54HYDQ&bvm=bv.44770516,d.ZG4&psig=AFQjCNFMsFQRVjw5-SZT6XPglGuoh9jo0Q&ust=1365543072105327

THE SCIENCE BEHIND THE NEW NEONATAL STANDARDS. - … · the science behind the new neonatal...

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Transcript of THE SCIENCE BEHIND THE NEW NEONATAL STANDARDS. - … · the science behind the new neonatal...