by Lauren Porter

Be faithful in small things because it is in them that your strength lies. ~Mother Teresa

People often argue that the little stuff doesn’t matter. The details of how you respond to your baby’s cries, hunger, sleep, happiness or distress are often replaced by schedules, schemes and strategies aimed at getting life under control and back to ‘normal.’ Instead of listening to our babies and following their cues, we panic and look outward for advice. Despite popular belief, babies do indeed come with instruction manuals. They’re encoded with them. The question is: can you read the one you’ve been given? All parents, regardless of how in tune and aware, sometimes need the outside assistance of family, friends or professionals. But it’s the little stuff that’s actually most important and is sadly often overlooked.

All difficult things have their origin in that which is easy, and great things in that which is small. ~Lao Tzu

Amazing new research with premature babies in Boston, Massachusetts, USA now offers us big reasons to rethink the value of those supposedly little things. Premature infants are at risk for multiple developmental, cognitive and physical difficulties as they grow and age. In the past, this risk was attributed solely to their premature status and viewed as intractable. However, these babies in Boston are disproving this belief and showing us how early experience can alter the very structure of a brain.

Do not think that love, in order to be genuine, has to be extraordinary. What we need is to love without getting tired. ~Mother Teresa

For any new baby, leaving the rich, nurturing and perfectly attuned environment of the womb is stressful. For premature babies whose under-developed nervous system already leaves them with fewer resources for managing life in the outside world, birth is made even more traumatic by invasive procedures, bright lights, loud noises, cold sterile environments and separations from mother. Dr. Heidelise Als, Associate Professor of Psychology at Harvard Medical School, works at Children’s Hospital in Boston and developed an intervention called Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

NIDCAP is changing the culture of newborn care and enriching the health and development of babies along the way. Developmental specialists work with hospital staff and parents to help them recognize, understand and react to the signals of their babies. Nurses and parents alike are taught to see babies as active participants in their own care, responding to their cues just as with other kinds of communication or language. In other words, they are learning to read their instruction manuals. Parents are not restricted to particular visiting hours and are encouraged to hold their babies with as much skin-to-skin contact as possible, especially during stressful procedures. Big comfortable reclining chairs are provided so parents can be with their babies at all time, even in sleep. Parents are also assisted to create a personalized, private, calm environment in their child’s incubator area to create a soothing oasis in the middle of the noisy hospital.

Great things are done by a series of small things brought together. ~Vincent Van Gogh

So what’s the amazing part? The findings show notable and dramatic differences in brain structure and development. The premature babies who participated in the NIDCAP program were identical to the control group. They ranged from 28 to 33 weeks gestational age and had similar levels of health and family health status. The only difference is that the NIDCAP group received the intervention until the age of 2 weeks (adjusted for prematurity).

At 2 weeks and then again at 9 months of age, all babies underwent neurobehavioral, electrophysiological and magnetic resonance imaging (MRI) testing to assess brain development and neurological structure. At both measurement points, babies in the NIDCAP group had substantially better results, evidencing healthier levels of emotional regulation, motor quality, and cognitive functioning. The babies were more relaxed and responsive than their control group counterparts and their brains were better organized and contained more white matter, the material needed for learning, thinking and decision-making. They also showed better connections in areas that control senses like vision. By nine months of age, these babies showed remarkable differences in their abilities to hold crayons, grab and manipulate objects and crawl, all predictors of future cognitive functioning.

Miracles are a retelling in small letters of the very same story which is written across the whole world in letters too large for some of us to see. ~ C. S. Lewis

Dr. Als’ research is continuing. She is now doing more long-term studies and looking at the impact of the NIDCAP program on these babies as they age. Thus far the trend continues through age 1 and preliminary data from the 8 year olds indicates the same results. By old standards, her results are nothing short of miraculous. Many people still resist her thinking, despite ample evidence that the quality and philosophy of care for babies makes such a huge difference. Nonetheless, research like this helps highlight the force of early experience and the influence of seemingly small details. After all, it is not just premature babies who are vulnerable to stress or who have critical periods of brain development. Most everyone now acknowledges the crucial importance of the first years of life. Dr. Als’ data helps to spell it out in ways we can both understand and implement.

Anyone who doesn't take truth seriously in small matters cannot be trusted in large ones either. ~Albert Einstein

This research emphasizes the significance of early relationships and how the nuanced and almost imperceptible differences in response can mean the difference between health and handicap. All these babies had equal and excellent medical care. The differences in their brains – and ultimately their emotions, thoughts and abilities – arose from interactions and relationships. To many in the world, whether a baby is held, how a baby is fed or where a baby sleeps is believed to have little impact on future wellbeing. Things that can’t be counted or measured, like how well a baby is nurtured, are often dismissed. What NIDCAP has done is measure the immeasurable, linking the warmth and responsiveness of early experience to quantifiable outcomes. Instead of an event to be managed or a problem to be solved, these fortunate babies were treated as people to be acknowledged, known and engaged with. They needed nurturing and connection. In meeting their needs, which are the needs all babies share, they flourished in a way that was previously unheard of. This work has direct implications for the choices and challenges of home, hospital and society at large. When we follow the wisdom and compassion offered by this science, we work toward the true potential of our children. In small things we place our faith. From small things greatness can grow.