the early years really matter in the larger scheme of lifelong development, our conclusion is unequivocal: What happens during the first months and years of life matters a lot, not because this period of development provides an indelible blueprint for adult well-being, but because it sets either a sturdy or fragile stage for what follows.”2
Readers will appreciate the distinction. Adhering to the best that science has to recommend during the fourth trimester does not present an “indelible blueprint,” since infants, babies, and children can and do overcome poor beginnings. But why start them out by giving them a lot to overcome? Rather, let's do our best to set the stage for “sturdy” development by treating the first three months of life as the biological continuation of fetal development that it is.
New research has begun to change thinking, establishing the fourth trimester as an especially vital time for laying down the very foundations of development. Yet this excellent science is not without controversy, as currently interpreted by the popular media and various advocacy groups. Two particularly inflamed hot-button issues are breast feeding versus formula feeding and cosleeping versus sleeping alone. Acknowledging a variety of opinions on these issues, the text sticks to the research while recognizing that science is a leading factor, but not the only factor, in parents’ decisions on feeding and sleeping arrangements. In this objective way, the book stands apart in providing a comprehensive survey of a newborn's developmental needs while remaining intimate, personal, and nonjudgmental. It can help new parents—biological or adoptive, as well as others who provide consistent love and attention to infants—make their own personal decisions within the parameters of best practices.
The need for loving attention is a constant theme of this book. Each chapter also draws on personal interviews with prominent researchers, practitioners, and parents. These resources are documented in the text in sufficient detail for a curious reader to pursue specific questions in the relevant literature.
The first three months of an infant's life need not be a mystery to bumble through. It's a common joke that infants don't come with an operating manual. This compilation of recent medical, biological, neurological, behavioral, developmental, and social science research from the past two decades provides the basis for just such an operating manual. New parents can comprehend much of what throughout human history has been inexplicable and, in the process, get their babies off to the best possible start.
The book begins millions of years ago with the chapter “Evolution and the Primitive Brain of a Newborn.” It is the natural starting point in helping parents and caretakers understand that the reason human infants arrive so unfinished is deeply rooted in our common evolution—beginning with the moment our hominid ancestors first stood and walked on two legs. Readers will understand why forty weeks of gestation is both a biological imperative and insufficient for greater brain development in the uterus. They will begin to see that all newborns need another three months, a fourth trimester, of uncompromisingly close connection to their mothers or an equally loving and attentive caretaker.
The remainder of the book is organized by first addressing how such an immature brain influences infants’ most basic needs: crying, sleeping, and eating. These behaviors deserve three distinct chapters since they are the source of every parent's most urgent worries. These three concerns are linked to each other just as communication is linked to need. Every newborn cry of life reminds us that this human being isn't ready to be separated from the uterus. Food, warmth, soothing movement, and comfort once flowed to her without effort. Now, she must signal hunger, discomfort, and fear with a cry, at first her only tool of communication. Now, as she makes her transition from the womb to the world, each adult response to her wailing demands is helping to complete the neurological wiring vital for living. The comforting closeness so recently experienced by the fetus continues as chemicals released by physical contact or close proximity to a mother, father, or caring adult help the newborn regulate sleep and arousal.3 Food, passively received in the womb, now requires effort.
The best nutritional transition to the real world during the fourth trimester, as evolution and biology make clear, is breast milk. A clear understanding that breast feeding is the most natural extension of pregnancy is an important starting point for every birth mother as she makes her own decision. I balance that truth with the reality that some women cannot breast-feed or don't want to. Adoptive parents, foster parents, grandparents, and all manner of attentive caretakers cannot breast-feed. For them, formula is a perfectly adequate second-best choice as they, too, help their newborn with the transition to life in the world by holding the infant closely, making eye contact, and touching him. What he has received without asking for during nine months in the uterus—food, soothing comfort, sleeping on his own timetable—must continue during the time of transition via attentive response to his cries.
Even as the basic needs for soothing, sleep, and food are met, the senses are proving to be nature's first teachers. After addressing parents’ most urgent concerns, the book's next chapters delve deeply into sensory development—sound, sight, and touch. (Taste and smell, scientifically studied in far less depth in newborns and tightly linked to feeding, are discussed in the feeding chapter.) Nothing in infant development happens in isolation, and these three senses are intimately connected to soothing, sleeping, and eating. But these senses each deserve a closer look. Babies recognize their mothers’ voices at the moment of birth because they've heard them in the uterus. Hearing these voices again during the fourth trimester is an important part of the transition, and newborns turn to their mothers’ voices more readily than to any others. (Though, in the case of adoptive parents or alternative caretakers, babies will soon recognize a consistent new voice and will turn to the voice they've come to know.) From the moment of birth, infants are busy soaking up the acoustics of their surroundings.
Vision is less developed than hearing at birth, but newborns can already see shadows of eyes, edges of faces, and areas of high contrast. Newborns see better than once thought, but the concept of “seeing” is complex, since vision consists of multiple components—focus, contrast, three-dimensionality, color—all developing at varying rates. Furthermore, the areas of the brain that interpret what's coming through the eyes are not yet set up to register what's seen in the way adults understand vision. Yet astonishingly, the very act of seeing is exactly what babies need in order to sort it all out. Each flicker of vision is setting up neural connections that will eventually let babies see the full world around them. The relatively slowly developing sense of vision carries infants forward from a place of darkness in the womb into a world of light.
The sense of touch, influenced for forty weeks by the warmth of amniotic fluid and the secure confines of the uterus, continues during this time of transition through swaddling, cuddling, and stroking. The last fifteen years have seen a sea change in understanding touch, both painful and pleasurable types. Simple, human touch—comforting pats in response to tears, smiles in response to contented moments—releases brain chemicals that calm the infant. On the other hand, trauma and stress (abuse, neglect, pain) release a flood of neurochemicals, including cortisol, that can set a child up for future trouble.
There are coexisting truths about the development of the senses: infants come into the world highly immature and yet extremely capable of learning and communicating. Each sense, at its own stage of readiness at birth, interacts with all the others to mold a brain that is forming the likes, dislikes, and very personality of a new human being.
As the senses are developing brand-new connections in the brain, the body is growing stronger. Neurological and physical developments are linked—these are similar to the mind-body connections science now recognizes in adults. Just as every interaction with the senses is building better abilities to see, hear, and feel, every kick is building muscles that will soon enable the baby to crawl, walk, and run. Biological mothers know that these early flailings begin during gestation, and many fathers have felt their force as they've laid
