The Newborn Behavioral Observations (NBO) system is an interactive relationship-based tool that provides individualized information to parents about their baby's communication cues and overall development, with a goal to strengthen the parent-infant relationship. The NBO describes the infant's capacities in such a way that the parents can begin to understand and respond to their baby in a way that meets the baby's unique developmental needs. It consists of 18 neurobehavioral observations and is designed for use from birth through the third month of life. Inspired by the Neonatal Behavioral Assessment Scale, the NBO items are designed to show that newborns possess a wide range of visual, auditory, and perceptual abilities that allow them to explore the world around them and to engage in social communication. The NBO is above all, strength-based and is primarily guided by the principle that the quality of early experiences drives brain development and functional outcomes. The NBO is useful in a range of clinical and cultural settings and with families facing diverse challenges.
Over the first few months of life, newborns begin to build their ability to self-regulate as they attempt to adapt to their new extrauterine world, both the world of objects and the world of people. This does not mean an infant is able to regulate fully without a parent, however the infant does begin to gain some control of their response to the environment. This regulation occurs in four main categories and are summarized by the acronym AMOR, for Autonomic, Motor, Organization of State, and Responsiveness.
A - Autonomic/physiological stability: stabilization of breathing, temperature regulation, reducing tremors and startles, etc.
M - Motor regulation: development of good motor control and feeding skills; ability to maintain a controlled activity level
O - Organization of State: the ability to cope with stress; to be able to regulate state and develop predictable sleep-wake patterns
R - Responsiveness: development of a growing awareness of the environment and the capacity to process visual and social information and engage in social interaction
The goal of the NBO is to create a respectful and non-judgmental space for parents to “meet” their baby. The clinician elicits the baby's behaviors and brings the parents attention to their communication cues and unique personality. This allows the parents to respond to their infant with mindfulness, intention and above all, love. Parents feel more secure and confident in their parenting ability which decreases the risk of post-partum depression and improves parent-infant attachment.
Research
Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months (McManus et al. 2020). In several studies, the NBO was associated with enhanced mother–infant engagement (McManus and Nugent, 2012; Nugent et al. 2017) and was effective in helping parents be more responsive to their infant’s communication cues (Kristensen et al. 2020; Høifødt et al., 2020). Studies have also shown that mothers who participated in the NBO sessions demonstrated a reduction in postpartum depressive symptomatology (McManus et al. 2020; Nugent et al. 2014). Moreover, NBO practitioners demonstrated higher perceived confidence in working with low- and high-risk newborns and their families (McManus and Nugent, 2011).
In a series of non-randomized observational studies the NBO has been associated with enhanced mother–infant engagement, a greater understanding of the baby’s communication cues, increased levels of confidence among parents, positive parental perceptions of their interactions with their high-risk infants, increased levels of father involvement, and higher perceived confidence and enhanced practitioner mentalization among service providers in working with low- and high-risk newborns and their families (Simkin-Tran et al. 2020; Alvarez- Gomez, 2014; Appleton, Nickell & Nicolau, 2016; Cheetham & Hanssen, 2014; Holland & Watkins, 2015; Hawthorne & Nicolau, 2017; Kashiwibara, 2012; Nugent & Alhaffer, 2006; Sanders & Buckner, 2006; Savage-McGlynn & Hawthorne, 2014).
Hi, I'm a pediatric physical therapy and parent support clinician. I help families with children aged 0-5 years old by providing developmentally appropriate and skilled care. My
goal is to make sure each child has the best possible start in life and that each family feels supported. I work closely with parents to provide individualized care plans tailored to their child's needs, while also helping them gain skills and confidence as parents. I love working with families and young children and watching them grow and develop!
Source: Adapted from Nugent, Keefer, Minear, Johnson, & Blanchard (2007), Understanding newborn behavior and early relationships: The Newborn Behavioral Observations (NBD) system handbook. Baltimore, MD: Brookes.
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