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Article 6 Keys to Quality Infant Care: Nurturing Every Baby's Life Journey

ALICE STERLING HONIG

Teachers of infants need a large bunch of key ideas and activities of all kinds to unlock in each child the treasures of loving kindness, thoughtful and eloquent use of language, intense active curiosity to learn, willingness to cooperate, and the deep desire to work hard to master new tasks. Here are some ideas that teachers can use during interactions with infants to optimize each child's development.

Get to Know Each Baby's Unique Personality

At 4 months, Luci holds her hands in front of her face and turns them back and forth so she can see the curious visual difference between the palms and backs. Jackson, an 8-month-old, bounces happily in accurate rhythm as his teacher bangs on a drum and chants, “Mary had a little lamb whose fleece was white as snow!” Outdoors, 1-year-old Jamie sits in an infant swing peering down at his feet sticking out of the leg holes. How interesting! Those are the same feet he has watched waving in the air while being diapered and has triumphantly brought to his mouth to chew on.

Teachers can tune in to each child's special personality—especially the child's temperament. There are three primary, mostly inborn, styles of temperament (Honig 1997 ). Some babies are more low-key; they tend to be slow to warm up to new caregivers, new foods, and new surroundings. They need reassuring hand-holding and more physical supports to try a new activity. Others are more feisty and sometimes irritable. They tend to be impetuous, intense in their emotional reactions, whether of anger or of joy. Easygoing babies are typically friendly, happy, accept new foods and caregivers without much fuss, and adapt fairly quickly and more flexibly after experiencing distress or sudden change. Try to find out whether each baby in your care tends to be shy and slow to warm up or mostly feisty and intense or easygoing. A caring adult's perceptive responses in tune with individual temperament will ease a child's ability to adapt and flourish in the group setting.

Physical Loving

Your body is a safe haven for an infant. Indeed, some babies will stay happy as a clam when draped over a shoulder, across your belly as you rock in a rocking chair, or, especially for a very young baby, snuggled in a sling or carrier for hours. As Montagu ( 1971 ) taught decades ago, babies need body loving: “To be tender, loving, and caring, human beings must be tenderly loved and cared for in their earliest years. … caressed, cuddled, and comforted” (p. 138).

As you carry them, some babies might pinch your neck, lick your salty arm, pull at your hair, tug at eyeglasses, or show you in other ways how powerfully important your body is as a sacred and special playground. Teach gentleness by calmly telling a baby you need your glasses on to read a story. Use the word gently over and over and over. Dance cheek-to-cheek with a young child in arms to slow waltz music—good for dreary days! Also carry the baby while you do a routine task such as walking to another room to get something.

Provide lap and touch times generously to nourish a child's sense of well-being. Slowly caress a baby's hair. Rub a tense shoulder soothingly. Kiss one finger and watch as a baby offers every other finger to kiss. Rock a child with your arms wrapped around him for secure comfort. Babies learn to become independent as we confirm and meet their dependency needs in infancy. A sense of well-being and somatic certainty flows from cherishing adults who generously hold, caress, and drape babies on shoulders and tummies.

Create Intimate Emotional Connections

Scan the environment so you can be close to every baby. Notice the quiet baby sitting alone, mouthing a toy piece and rocking back and forth with vacant eyes. Notice shy bids for attention, such as a brief smile with lowered lids. The child with an easy or cautious temperament needs your loving attention as much as the one who impulsively climbs all over you for attention.

A caring adult's perceptive responses in tune with individual temperament will ease a child's ability to adapt and flourish in the group setting.

Shine admiring eyes at the children, whether a baby is cooing as she lies in her crib, creeping purposefully toward a toy she desires, or feeding herself happily with messy fingers. Speak each child's name lovingly and frequently. Even if they are fussing, most babies will quiet when you chant and croon their names.

Although babies do not understand the meanings of the words, they do understand tonal nuances and love when your voice sounds admiring, enchanted with them, and happy to be talking with them. While diapering, tell the baby he is so delicious and you love his plump tummy and the few wispy hairs on that little head. Watch him thrust out his legs in delight on the diapering table. Your tone of voice entrances him into a deep sense of pleasure with his own body (Honig 2002 ).

Harmonizing Tempos

Tempo is important in human activities and is reflected in how abruptly or smoothly adults carry out daily routines. Because adults have so many tasks to do, sometimes we use impatient, too-quick motions, for example, while dressing a baby to play outdoors. When dressing or feeding, more leisurely actions are calming. They signal to children that we have time for them. Rub backs slowly and croon babies into soothing sleep.

A baby busily crawling across the rug sees a toy, grasps it, then plops himself into a sitting position to examine and try to pull it apart. He slowly looks back and forth at the toy as he leisurely passes it from hand to hand. He has no awareness that a teacher is about to interrupt because she is in a hurry to get him dressed because his daddy is coming to pick him up. Young children need time and cheerful supports to finish up an activity in which they are absorbed. If they are hurried, they may get frustrated and even have a tantrum.

Enhance Courage and Cooperation

Your presence can reassure a worried baby. Stay near and talk gently to help a child overcome his fear of the small infant slide. Pascal sits at the top, looking uncertain. Then he checks your face for a go-ahead signal, for reassurance that he can bravely try to slide down this slide that looks so long to him. Kneeling at the bottom of the slide, smile and tell him that you will be there to catch him when he is ready to slide down.

Be available as a “refueling station”—Margaret Mahler's felicitous term (Kaplan 1978 ). Sometimes a baby's independent learning adventure comes crashing down—literally. Your body and your lap provide the emotional support from which a baby regains courage to tackle the learning adventure again.

Create loving rituals during daily routines of dressing, bath times, nap times, feeding times. Babies like to know what will happen and when and where and how. Babies have been known to refuse lunch when their familiar, comfortable routines were changed. At cleanup times, older babies can be more flexible and helpful if you change some chores into games. Through the use of sing-song chants, putting toys away becomes an adventure in finding the big fat blocks that need to be placed together on a shelf and then the skinny blocks that go together in a different place.

Young children need time and cheerful supports to finish up an activity in which they are absorbed. If they are hurried, they may get frustrated and even have a tantrum.

Address Stress

Attachment research shows that babies who develop secure emotional relationships with a teacher have had their distress signals noticed, interpreted correctly, and responded to promptly and appropriately (Honig 2002 ). At morning arrival times, watch for separation anxiety. Sometimes holding and wordlessly commiserating with a baby's sad feelings can help more than a frenzied attempt to distract her (Klein, Kraft, & Shohet 2010 ). As you become more expert at interpreting a baby's body signals of distress and discomfort, you will become more sensitively attuned in your responses (Honig 2010 ).

Learn Developmental Milestones

Learning developmental norms helps teachers figure out when to wonder, when to worry, and when to relish and feel overjoyed about a child's milestone accomplishments. Day and night toilet learning can be completed anywhere from 18 months to 5 years. This is a wide time window for development. In contrast, learning to pick up a piece of cereal from a high chair tray with just thumb and forefinger in a fine pincer grasp is usually completed during a narrow time window well before 13 months. By 11 months, most babies become expert at using just the first two fingers.

Hone Your Detective Skills

If a baby is screaming and jerking knees up to his belly, you might suspect a painful gas bubble. Pick up the baby and jiggle and thump his back until you get that burp up. What a relief, for you as well as baby. Maybe an irritable, yowling baby just needs to be tucked in quietly and smoothly for a nap after an expert diaper change. Suppose baby is crying and thrashing about, and yet he has been burped and diapered. Use all your detective skills to determine the cause. Is it a hot day? He might be thirsty. A drink of water can help him calm down.

Notice Stress Signs

Scan a child's body for stress signs. Dull eyes can signal the need for more intimate loving interactions. Tense shoulders and a grave look often mean that a child is afraid or worried (Honig 2010 ). Compulsive rocking can mean a baby feels forlorn. Watch for lonesomeness and wilting.

Some babies melt down toward day's end. They need to be held and snuggled. Murmur sweet reassurances and provide a small snack of strained applesauce to soothe baby's taste buds and worries. Check his body from top to bottom for signs of stresses or tensions, such as eyes avoiding contact, teeth 2425grinding, fingernail chewing, frequently clenched fists, so that you can develop an effective plan for soothing. Be alert, and tend to children's worrisome bodily signs; these will tell you what you need to know long before children have enough language to share what was stressful (Honig 2009 ).

Play Learning Games

Parents and teachers are a baby's preferred playmates. While playing learning games with infants, pay attention to their actions. Ask yourself if the game has become so familiar and easy that it is time to “dance up the developmental ladder” (Honig 1982 ) and increase the game's challenge. Or perhaps the game is still too baffling and you need to “dance down” and simplify the activity so that the child can succeed.

Provide safe mirrors at floor level and behind the diapering table so children can watch and learn about their own bodies. Hold babies in arms up to a mirror to reach out and pat the face in the mirror. Lying on the floor in front of a securely attached safety mirror, a young child twists and squirms to get an idea of where his body begins and ends.

Your body can serve as a comforting support for some early learning activities. Sit an infant on your lap and watch as he coordinates vision and grasp to reach and hold a toy you are dangling. Babies love “Peek-a-boo! I see you!” These games nurture the development of object permanence—the understanding that objects still exist even when they are out of sight. Peek-a-boo games also symbolically teach that even when a special adult is not seen, that dear person will reappear.

Provide Physical Play Experiences

Play pat-a-cake with babies starting even before 6 months. As you gently hold a baby's hands and bring them out and then back together, chant slowly and joyously, “Pat-a-cake, pat-a-cake, baker's man; bake me a cake just as fast as you can. Pat it, and roll it, and mark it with a B, and put it in the oven for [baby's name] and me.” Smile with joy as you guide the baby's hands rhythmically and slowly through the game, and use a high-pitched voice as you emphasize her name in the sing-song chant. Over the next months, as soon as you begin chanting the words, the baby will begin to bring hands to the midline and do the hand motions that belong with this game. Babies who are 9 to 11 months old will even start copying the hand-rolling motions that belong with this game.

To encourage learning, try to arrange games with more physical actions. Sit on the floor with your toes touching the baby's toes, then model how to roll a ball back and forth.

Introduce Sensory Experiences

Safe sensory and tactile experiences are ideal for this age group. As he shifts a toy from hand to hand, turns it over, pokes, tastes, bangs, and even chews on it, a baby uses his senses to learn about the toy's physical properties. Teachers can blow bubbles so babies can reach for and crawl after them. Provide play-dough made with plenty of salt to discourage children from putting it in their mouths. Older babies enjoy exploring finger paints or nontoxic tempera paint and fat brushes.

Play Sociable Games

Give something appealing to a seated baby. Put out your hand, smile, and say “Give it to me, please.” The baby may chew on the “gift,” such as a safe wooden block or chunky plastic cylinder peg. After the baby passes it to you, say thank you, then give the object back with a smile. Give-and-take games with you are a sociable pleasure for babies and teach them turn-taking skills that are crucial for friendly social interchanges years later.

Seated on a chair, play a bouncing game, with the baby's back resting snuggly against your tummy. After you stop bouncing and chanting “Giddyup, horsie,” a baby often bounces on his or her tush as if to remind you to start this game over and over. An older baby vigorously demands “More horsie!” to get you to restart this game. Babies enjoy kinesthetic stimulation too, such as when you swing them gently in a baby swing. A baby will grin with glee as you pull or push him in a wagon around the room or playground.

Observe Babies' Ways of Exploring and Learning

Observe a baby to learn what and how she is learning, then adapt the activity to offer greater challenge. Observation provides information that lets teachers determine when and how to arrange for the next step in a child's learning experience. Watch quietly as a baby tries with determination to put the round wood top piece for a ring stack set on the pole. His eyes widen in startled amazement as he gradually realizes that when the hole does not go through the middle, then that piece will not go down over the pole—a frustrating but important lesson. Calmly, a teacher can demonstrate how to place the piece on top of the pole while using simple words to describe how this piece is different. She can also gently guide the baby's hands so he feels successful at placing the piece on top.

Enhance Language and Literacy in Everyday Routines

Talk back and forth with babies; respond to their coos and babbles with positive talk. When the baby vocalizes, tell her, “What a terrific talker you are. Tell me some more.”

The diapering table is a fine site for language games. With young babies, practice “parentese”—a high-pitched voice, drawn-out vowels, and slow and simple talk. This kind of talk fires up the brain neurons that carry messages to help a baby learn (Doidge 2007 ). Cascades of chemicals and electrical signals course down the baby's neural pathways. A baby responds when you are an attentive and delighted talking partner. Pause so the baby gets a turn to talk too, and bring the game to a graceful close when baby fatigue sets in.

Talk about body parts on dolls, stuffed animals, yourself, and the babies in the room. Talk about what the baby sees as you lift her onto your lap and then onto your shoulders. Talk at mealtimes. Use every daily routine as an opportunity to enhance oral language (Honig 2007 ).

Daily reading is an intimate one-on-one activity that young babies deeply enjoy in varied spaces and at varied times of the day (Honig 2004 ). Hook your babies on books as early as possible. Frequent shared picture-book experiences are priceless gifts. Early pleasurable reading experiences empower success in learning to read years later in grade school (Jalongo 2007 ).

Cuddle with one or several children as you read and share books together every day. Use dramatic tones along with loving and polite words. You are the master of the story as you read aloud. Feel free to add to or to shorten picture-book text according to a particular child's needs. Group reading times can be pleasurable when infants lean against you as you sit on the rug and share a picture book. Teachers often prefer the intimacy of individual reading times with babies (Honig & Shin 2001 ). Individual reading can help a tense or fussy baby relax in your lap as he becomes deeply absorbed in sharing the picture-book experience.

Encourage Mastery Experiences

Children master many linguistic, physical, and social skills in the first years of life. Watch the joy of mastery and self-appreciation as a baby succeeds at a task, such as successfully placing Montessori cylinders into their respective sockets. Babies enjoy clapping for their own efforts. Mastery experiences arranged in thoughtful doses bring much pleasure, such an eagerness to keep on exploring, trying, and learning. Watch the baby's joy as he proudly takes a long link chain out of a coffee can and then stuffs it slowly back in the can. He straightens his shoulders with such pride as he succeeds at this game of finding a way to put a long skinny chain into a round container with a small diameter opening.

Mastery experiences arranged in thoughtful doses bring much pleasure, such an eagerness to keep on exploring, trying, and learning.

Vygotsky taught that the zone of proximal development is crucial for adult-child coordination in learning activities. You the teacher are so important in helping a child to succeed when a task may be slightly too difficult for the child to solve alone. Hold the baby's elbow steady when she feels frustrated while trying to stack one block on top of another. For a difficult puppy puzzle, a teacher taped down a few of the pieces so a baby could succeed in getting the puppy's tail and head pieces in the right spaces. If a baby has been struggling with a slippery nesting cup for a while, just steady the stack of cups so he can successfully insert a smaller cup into the next largest one.

Promote Socioemotional Skills

Babies learn empathy and friendliness from those who nurture them. Empathy involves recognizing and feeling the distress of another and trying to help in some way. A young baby who sees another baby crying may look worried and suck his thumb to comfort himself. Fifteen-month-old Michael tussles over a toy with Paul, who starts to cry. Michael looks worried and lets go of the toy so Paul has it. As Paul keeps crying, Michael gives him his own teddy bear. But Paul continues crying. Michael pauses, then runs to the next room and gets Paul's security blanket for him. And Paul stops crying (Blum 1987 ).

When teachers showed deeply respectful caregiving, then they observed that babies did develop early empathy and internalize the friendly interactions they had experienced.

Conclusion

Later in life, a baby will not remember your specific innumerable kindly caring actions in the earliest years. However, a child's feelings of being lovable and cherished will remain a body-memory for life. These feelings of having been loved will permeate positive emotional and social relationships decades later.

Keep your own joy pipes open. How brief are the years of babyhood. All too soon young children grow into the mysterious world of teenagers who prefer hanging out with peers to snuggling on an adult lap. Reflect with deep personal satisfaction on your confidence and delight in caring for tiny ones—hearing the first words, seeing the joy at a new accomplishment, watching the entranced look of an upturned face as you tell a story, feeling the trust as a baby sleepily settles onto your lap for refreshment of spirit, for a breath of the loving comfort that emanates from your body.

Life has grown more complicated in our technological, economically difficult, and more and more urbanized world. But you, the teacher, remain each baby's priceless tour guide into the world of “growing up!” You gently take each little person 2627by the hand—literally and figuratively—and lure each and every baby into feeling the wonder and the somatic certainty of being loved, lovable, and cherished so that each baby can fully participate in the adventure of growing, loving, and learning.

Your nurturing strengthens a baby's determination to keep on learning, keep on cooperating, keep on being friendly, and keep on growing into a loving person—first in the world of the nursery and later in the wider world. You can give no greater gift to a child than to be the best guide possible as each child begins his or her unique life journey.

Article 7 Vaccination Nation

CHRIS MOONEY

The decadelong controversy surrounding the safety of vaccines is over—or is it? A fierce debate continues over what really puts our children at risk.

Vaccines do not cause autism. That was the ruling in each of three critical test cases handed down on February 12 by the U.S. Court of Federal Claims in Washington, D.C. After a decade of speculation, argument, and analysis—often filled with vitriol on both sides—the court specifically denied any link between the combination of the MMR vaccine and vaccines with thimerosal (a mercury-based preservative) and the spectrum of disorders associated with autism. But these rulings, though seemingly definitive, have done little to quell the angry debate, which has severe implications for American public health.

The idea that there is something wrong with our vaccines—that they have poisoned a generation of kids, driving an “epidemic” of autism—continues to be everywhere: on cable news, in celebrity magazines, on blogs, and in health news stories. It has had a particularly strong life on the Internet, including the heavily trafficked Huffington Post, and in pop culture, where it is supported by actors including Charlie Sheen and Jim Carrey, former Playboy playmate Jenny McCarthy, and numerous others. Despite repeated rejection by the scientific community, it has spawned a movement, led to thousands of legal claims, and even triggered occasional harassment and threats against scientists whose research appears to discredit it.

You can see where the emotion and sentiment come from. Autism can be a terrible condition, devastating to families. It can leave parents not only aggrieved but desperate to find any cure, any salvation. Medical services and behavioral therapy for severely autistic children can cost more than $100,000 a year, and these children often exhibit extremely difficult behavior. Moreover, the incidence of autism is apparently rising rapidly. Today one in every 150 children has been diagnosed on the autism spectrum; 20 years ago that statistic was one in 10,000. “Put yourself in the shoes of these parents,” says journalist David Kirby, whose best-selling 2005 book, Evidence of Harm, dramatized the vaccine-autism movement. “They have perfectly normal kids who are walking and happy and everything—and then they regress.” The irony is that vaccine skepticism—not the vaccines themselves—is now looking like the true public-health threat.

The decadelong vaccine-autism saga began in 1998, when British gastroenterologist Andrew Wakefield and his colleagues published evidence in The Lancet suggesting they had tracked down a shocking cause of autism. Examining the digestive tracts of 12 children with behavioral disorders, nine of them autistic, the researchers found intestinal inflammation, which they pinned on the MMR (measles, mumps, and rubella) vaccine. Wakefield had a specific theory of how the MMR shot could trigger autism: The upset intestines, he conjectured, let toxins loose in the bloodstream, which then traveled to the brain. The vaccine was, in this view, effectively a poison. In a dramatic press conference, Wakefield announced the findings and sparked an instant media frenzy. For the British public, a retreat from the use of the MMR vaccine—and a rise in the incidence of measles—began.

In the United States, meanwhile, fears would soon arise concerning another means by which vaccines might induce autism. Many vaccines at the time contained thimerosal, a preservative introduced in the 1930s to make vaccines safer by preventing bacterial contamination. But thimerosal is 50 percent mercury by weight, and mercury is known to be a potent neurotoxin, at least in large doses. In 1999 new federal safety guidelines for mercury in fish stirred concerns about vaccines as well.

The U.S. government responded by ordering that thimerosal be removed from all vaccines administered to children under age 6, or reduced to trace amounts. (Some inactivated influenza vaccines were exempted.) The step was described as a “precautionary” measure. There was no proof of harm, government researchers said, just reason to worry that there might be. Meanwhile, scientists launched numerous studies to determine whether thimerosal had actually caused an autism epidemic, while some parents and their lawyers started pointing fingers and developing legal cases.

Within weeks of this year's federal court decisions—which examined and vindicated both the MMR vaccine and thimerosal environmental lawyer Robert F. Kennedy Jr. wrote a column in The Huffington Post in which he continued to press his case that the government has peddled unsafe vaccines to an unsuspecting public. It is a cause he has championed since 2005, when he published “Deadly Immunity” in Rolling Stone and Salon magazines. The article was a no-holds-barred denunciation of the U.S. public-health establishment, purporting to tell the story of how “government health agencies colluded with Big Pharma to hide the risks of thimerosal from the public … a chilling case study of institutional arrogance, power, and greed.” Half a decade after the original thimerosal concerns were first raised, Kennedy claimed to have found the smoking gun: the transcript of a “secret” 2000 meeting of government, pharmaceutical, and independent researchers with expertise in vaccines. Kennedy's conclusion: The generational catastrophe was real; our kids had been poisoned. If true, it would be perhaps the greatest biomedical catastrophe in modern history.

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But for Kennedy to be right, a growing consensus in the medical establishment had to be wrong. Indeed, Kennedy blasted a leading organ of science that had just vindicated both the MMR vaccine and thimerosal, the Institute of Medicine (IOM). “The CDC [Centers for Disease Control and Prevention] paid the Institute of Medicine to conduct a new study to whitewash the risks of thimerosal,” Kennedy wrote, “ordering researchers to ‘rule out’ the chemical's link to autism.” In reality, the IOM—a branch of the National Academy of Sciences (NAS), the government's top independent scientific adviser—carefully creates firewalls between the funding it receives to conduct scientific assessments and the results it ultimately produces. “Funders don't control the composition of the committee, and they don't meet with the committee,” says Harvard public-health researcher Marie McCormick, who chaired the IOM vaccine-safety committee in question. “And on no NAS or IOM committee are the members paid; they all work pro bono. There's no reason for them not to look at the data.”

The same year Kennedy's article came out, journalist David Kirby published Evidence of Harm—Mercury in Vaccines and the Autism Epidemic: A Medical Controversy. He followed a group of parents from the Coalition for SafeMinds, an autism activist organization. They had grown convinced that vaccines and other environmental factors had caused their children's conditions. Kirby's chronicle of the parents' efforts to publicize the dangers of vaccines became a best seller and greatly advanced SafeMinds' cause.