Newborn Behavioral Observation

I am often asked what an NBO, or Newborn Behavioral Observation, is and why I do them. I was certified to practice the NBO in 2013 through the Brazelton Institute, and find it one of my most useful tools to use with new parents and their babies.

During the NBO I spend about 90 minutes with each family, though so many interesting topics come up we could easily spend more time if we had it. Usually Mom and/or Dad are present with the baby for the NBO, but any family member or caregiver can participate.

We start off by talking about what the family has already learned about the baby.  The NBO can be done at any time from birth to three months so the family may have had just those nine months before the baby was born to get to know him or her, or more time since birth.

The purpose of the NBO is to get to know what is unique about each baby. It is not an evaluation or a comparison to other babies or to what is “normal,” but a way to give each baby his or her own voice. Together we discover this baby’s preferences and vulnerabilities; this baby’s strengths and challenges. I explain what all infants experience when they leave the protected world of their mother’s body and emerge into a new world where they are bombarded with new stimuli and are learning every moment. With this general knowledge as a background, we look at how this baby has come into the world and how he or she is experiencing sensory stimuli.

There are eighteen structured observation items on the NBO for us to look at together. If we can start while the baby is asleep, we will look at his or her ability to protect sleep against visual and auditory stimuli. We’ll watch how the baby transitions from sleep to being awake, and at the baby’s own capacity and strategies for self-regulation. We’ll watch the baby’s body and facial expressions for clues about how he or she is handling things, and discuss how the baby’s parents or caregivers can support the baby where needed.

Throughout the NBO we’ll watch the baby’s skin color and movements for signs of stress, and together monitor the baby’s motor tone and activity level. We’ll talk about and listen to baby’s cry, what crying means, and what it feels like for both parent and baby. I will put on a glove and let the baby suck on my finger to see how the baby reacts to the new taste and feel, and also to see how strong the sucking response is. This often leads to conversations about how feeding is going and how the baby can be supported to have good breast- or bottle-feedings.

We also look at how the baby is prepared to interact in the social world. I will see if the baby is interested in tracking my red ball, and how she or he responds to my face and voice, and to the faces and voices of family members. We’ll see how baby responds when he or she hears a new sound nearby. Together, we’ll listen to what the baby has to tell us, sharing information with each other as we watch and interact.

In general, people seem to have an expectation that when babies are born they are all pretty similar.  I have found that nothing is further from the truth! From the moment of birth, every baby is his own special person, and it is so much fun to learn to watch for his individuality and help parents learn how to respond to best meet their baby’s needs. When parents start feeling as though they know and understand their babies, they feel more confident as parents, and the relationship is able to thrive. Learning to parent a new baby is a challenge, but the NBO provides tools to make the transition smoother for everyone.

Recently a couple called me for an NBO with their new baby. We had done an NBO with their first child two years ago.   When I asked what the biggest thing they took away the first time was, they said, “Confidence!” They described feeling like they understood their baby better and had more insight to what he needed. Their second baby was very different from the first, and the second NBO gave us a lot of opportunities to learn new strategies that supported the new baby, and gave us all insight into how he is different, not just from his brother, but from every other baby. That’s a special feeling indeed!