Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Thursday, August 12, 2010

Comment on MA Enforcement of 8 Week Maternity Leave

It is not until about eight weeks of age that an infant has a fully developed capacity for mutual gaze. Then a baby looks directly into his mother’s eyes, while she, in turn, reflects back this loving gaze, cooing softly in response to her baby’s earliest communication. When a mother looks at a baby in a way that communicates with him, not with words but with feelings, “I understand you,” he begins to recognize himself, both physically and psychologically. He begins to be able to regulate his feelings. This mutual gaze, literally and figuratively being “seen,” actually facilitates the development of the baby’s brain.

The Massachusetts Supreme Judicial Court now has proposed to interrupt this newly emerging dance of co-regulation by ruling this week that woman workers are entitled to only eight weeks of maternity leave. This ruling applies only to women whose maternity falls under state law, and differs from the wiser federal Family and Medical Leave Act of 1993 which provides up to 12 weeks of unpaid leave and job protection.

Research at the interface of neuroscience and infant development is offering great insight into how mutual gaze actually grows the brain. Our knowledge about early brain development is derived from a combination of detailed video observations of mother-infant interaction and studies of the brain known as functional MRI. These imaging studies can actually see which parts of the brain are responsible for what behaviors. This research has shown that healthy wiring of the brain is contingent on attuned responses of caregivers. This attunement is not only in gaze but in touch, sound of voice and facial expressiveness.

When baby is born, the amygdala, the lower center of the brain that responds to fear and stress, is fully formed. The amygdala connects directly to the hypothalamus, which in turn connects directly with the parts of the body, like the adrenals, responsible for the release of hormones that lead us to experience the physical sensations of stress.

At about 2 months of age, another part of the brain known as the medial prefrontal cortex(MPC) begins to develop. It serves to regulate and control the smoke alarm. When a mother engages in this dance of co-regulation with her baby, she is wiring his brain, helping the fibers of the MPC to grow. The MPC continues to develop well into a person’s twenties. An infant’s brain, however, doubles in weight in the first year of life. A lot of wiring goes on in the third month.

When these connections are not well developed, intense emotions are not regulated. In the face of difficult feelings a person may be flooded with stress hormones. He may become overwhelmed by feelings of rage, anxiety or sadness.

Interesting research by Dr. Hilary Blumberg at Yale offers food for thought. Using MRI, she has found that adolescents with bipolar disorder have structural abnormalities in the amygdala and underdeveloped prefrontal cortex. She points to hopeful research using medication to rewire the brain to treat the emotional dysregulation characteristic of the disorder.

This is not to say that stressed early relationships inevitably lead to psychopathology. But doesn’t it make sense to do all that we can to insure that brains are wired well in the first place?

Important changes happen not only in an infant’s brain but also in a mother’s brain in her baby’s third month of life. When a mother sees her loving gaze reflected back at her from her baby, she develops a sense of competence. This trust in herself is critical in helping her face the many challenges ahead in her role as parent.

Certainly a mother who works full time is well able to facilitate her child’s healthy development if she is receiving appropriate support. But even under the best of circumstances, returning to work means that a mother will be stressed. Offering her the option for a full three months of what D.W. Winnicott, pediatrician turned psychoanalyst, referred to as “primary maternal preoccupation” seems an important and wise investment in the next generation.

1 comment:

  1. This is a beautiful explanation of brain development, Dr. Gold.

    I can't help but wonder if brain development fostered by interaction with a parent at 12 weeks of age is any less important than that which occurs at 9 weeks - ?

    Extrapolating that thought - is there ever a good time for a primary caregiving parent to pull-out of full-time child care?

    I propose that the Family and Medical Leave Act does not 'support' full-time employed parents best no matter the time period allowed. Seems to me the regulation of employment is far removed from the role of parenting in the physiology of brain development.

    However, the more parents understand about the importance of their role in their developing children, perhaps they can be influenced. Instead, parents seem to be 'taught' that employment is necessary and expected (for a certain expected lifestyle), SAHM-lifestyle is looked down upon, and courts are adequate decision-makers for social issues.

    There is no substitute for capable parents.
    Barbara

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