Principle 6:
Provide Consistent,
Loving Care
Keeping Baby’s Attachment Secure
The notion that relationships are essential for regulating our behavior and moods and feelings as well as for intellectual development is one that needs greater emphasis as we think about
the kinds of settings and priorities we want for our children. The interactions that are necessary can take place in full measure only with a loving caregiver who has lots of time to devote to a child.
—T. Berry Brazelton, MD, and Stanley I. Greenspan, MD,
The Irreducible Needs of Children
Perhaps the most critical decision parents face in their parenting journey is who will be the primary caregiver of their cherished and vulnerable new baby. For most parents over the centuries, this has been the role of the biological mother, but, in the last fifty years, we have seen a huge cultural shift in the United States, with a larger percentage of mothers reentering the workforce with very young children. In 2011, 63.9 percent of mothers with children under the age of six were employed outside the home (compared to 11.9 percent in 1950).1
1 U.S. Department of Labor, Bureau of Labor Statistics, Employment Characteristics of Families Summary.
This chapter is about giving parents information about their baby’s need for consistent loving care, why this is so important to a baby’s development, and resources and creative solutions to help make this happen. We begin with the premise that all parents love their children and want what is best for their physical, emotional, and spiritual development, and when given the facts, parents can then make better decisions and come up with wonderfully resourceful ideas for their child’s care. An important note to this chapter: When studies refer to “nonmaternal care,” they are referring to care other than the baby’s primary attachment figure, which is not necessarily always the mother. A growing number of fathers are taking on the role of the primary caregiver for their young children. When we speak of the primary caregiver, it can refer to the mother, the father, or any person who is the primary person caring for the baby or child during waking hours and to whom the baby has the most secure attachment. This could also be a grandparent, an adult sibling, other extended family members, or a nanny.
Dr. Stanley Greenspan, clinical professor of psychiatry and pediatrics at George Washington University Medical School, and T. Berry Brazelton, clinical professor of pediatrics emeritus at Harvard Medical School, have written movingly about the critical necessity for a stable, loving caregiver in the early years of a child’s life. In their book The Irreducible Needs of Children, they advocate for parents to understand their essential roles in protecting the precious attachment process, which is the foundation of their child’s future psychological, intellectual, and moral well-being.
Dr. Greenspan, one of the world’s foremost authorities on infants and young children with developmental and emotional problems, conveys some of his ideas for child care in his book The Four-Thirds Solution. First, he gives parents insight about the critical emotional needs in a child’s first three years: “Our society doesn’t tell parents that the most important gift they can give their children is not a good education, elaborate educational toys, or summer camps, but time—regular, substantial chunks of it—spent together doing things that are emotionally and developmentally meaningful for the child.”2 The book describes how different families have adjusted their work schedules to make it possible for each parent to spend at least two-thirds of the day with the baby, not necessarily at the same time, giving a “four-thirds” solution for the child’s care. This is one of many ideas for parents to consider if one parent cannot be the primary caregiver in the early years.
2 Greenspan, The Four-Thirds Solution, 89–90.
Attachment theory has been described in Chapter 1 of this book, and reviewing this introductory chapter lays an excellent foundation for understanding the attachment needs of a baby and young child. Exciting research in the field of neurobiology (the mechanisms by which human relationships shape brain structure and function) is confirming what attachment theorists have been seeing for more than fifty years: a baby’s brain and even his DNA is shaped by relationships. This was a stunning discovery made possible only with the modern technology of brain imaging, the mapping of the genetic code, and the relatively new field of quantum physics. Ironically, mapping the genetic code only led to more questions, since the human body has far fewer genes than was theorized. Research in the field of cellular biology is showing us that the key to understanding our biology and psychology does lies not within our DNA but rather within the mechanisms of our cell membrane. Each cell membrane has receptors that pick up various environmental signals, and this mechanism controls the “reading” of the genes inside our cells. Our cells can choose to read or not read the genetic blueprint depending on the signals being received from the environment.
How Stress Affects a Baby’s Brain
Cortisol is a stress hormone that is released by the adrenal glands when we are in a state of fear. Babies who are left to cry for long periods or who are afraid in a strange situation release massive amounts of cortisol, potentially creating a dangerous level in the brain. If released at toxic levels, it can damage key structures in the brain. Elevated cortisol levels are seen in the brains of depressed people and those with post-traumatic stress disorder: “Researchers at the National Institutes of Health have found a link between depression and traumas experienced in early childhood. Studies have shown that abused, neglected, or otherwise unnurtured infants and children are more likely to be depressed as adults, and now we have a way to understand the link between experience and the biology. It all relates to something called the hypothalamic-pituitary-adrenal axis.”3
3 Pert, Molecules of Emotion, 269.
In other words, a baby who is stressed produces hormones that make the synapses and neurons more vulnerable to an injury. The longer they remain elevated, the more likely it is that the functioning of many emotional and biological systems is affected. Even in very young babies, the amount of stress has a profound effect on what is called the baby’s “intrinsic memory.” We cannot consciously recall events stored in our intrinsic memory; these memories are deeply encoded, creating generalizations from experience. The processing of these memories and emotional reactions takes place in the amygdala, which is an almond-shaped group of neurons located deep within the medial temporal lobes of the brain. This exciting research is where attachment theory and biology intersect. Dr. Daniel Siegel describes it this way:
An infant who has a healthy, secure attachment has had the repeated experience of nurturing, perceptive, sensitive, and predictable caregiving responses, . . . which have been encoded implicitly in her brain. She has developed a generalized representation of that relationship—a mental model of attachment—which helps her know what to expect. . . . Given that these repeated experiences have been predictable, and that when there have been disruptions in mother-infant communication, the mother has been relatively quick and effective at repairing the ruptures, this fortunate infant has been able to develop a secure, organized model of their emotional relationship.4
4 Siegel, The Developing Mind, 32.
Now more than ever before, we understand the vital role the parent-child relationship plays in shaping the template of the baby’s emotional, intellectual, and biological life. It is critical that parents do everything they can to ensure that the primary caregiver in their baby’s life be nurturing, predictable, and responsive.
Studies done on the long-term effects of nonmaternal care of infants and young children have been controversial and confusing, with mixed conclusions. However, emerging data clearly sound warnings to parents. Some research indicates that babies under the age of one year who spend more than thirty hours in day care (some studies say twenty hours) may develop behavioral problems as they get older, such as excessively aggressive behavior. Boys seem to be particularly vulnerable to long hours in day care.5
5 Belsky and Rovine, “Non-maternal care in the first year of life.”
Center care, in and of itself, adversely increased the likelihood of infants developing insecure attachment to their mothers, compared with infants who were in maternal care, individual non-parental care with a relative, individual non-parental care with a paid caregiver, or family day care. The results suggest that it is the poor quality of center care and the high infant-caregiver ratio that accounted for this increased level of attachment insecurity among center-care infants.6
6 Sagi et al., “Shedding further light on the effects of various types and quality of early childcare.”
Another key factor that emerges from this research is the importance of continuity of care in the early months and years of a child’s life. Until the child is old enough to verbalize his needs to his caregiver, it is critical for the caregiver to be in attunement with the baby so that his needs are met consistently and sensitively. Try to imagine what it must be like for a baby who is crying to be fed or picked up when the caregiver is overwhelmed with several babies needing the same thing. A mother of triplets, or especially quadruplets, is given tremendous sympathy and often offered help in caring for her babies, yet in the best day-care situation, a four-to-one ratio is considered a manageable standard. Adding to this the low salaries day-care providers typically earn, is it any wonder that day-care employees have one of the highest turnover rates of any occupation? Dr. Isabelle Fox, in her book, Being There: The Benefits of a Stay-at-Home Parent, coined the phrase “caregiver roulette” to describe the high turnover rate of care providers in American day-care facilities. When a baby adjusts to the smells and voice of one care provider and then a new person comes in, she has no frame of reference and no comprehension of this new person, the new smells, or the new voice. When an infant experiences the frequent loss of caregivers, especially in the preverbal years, it can be emotionally devastating, and as a result she may become insecurely attached or learn not to attach to anyone.
The stress of caring for several babies all day long takes a tremendous toll, especially when the caregiver is not emotionally invested in the babies. Dr. Greenspan has found that even the most dedicated child-care providers often “hold back” emotionally because separating from their tiny charges would otherwise be “too emotionally wrenching.”7 He warns that even in the best centers, the ratio of infants to caregiver is four to one, and the toddler ratios can rise as high as ten to one.8 “We are expecting [the day-care system] to operate the way very well-functioning families do. . . . As a result, children aren’t getting the consistent one-on-one nurturing with the same caregiver
. . . that almost all of us who study and work with children agree they need. Furthermore, many highly motivated caregivers don’t receive the training, support, and pay they need to work with children on a sustained basis.”9
7 Greenspan, The Four-Thirds Solution, 43.
8 Ibid., 5–6
9 Ibid.
Academic Warns Child Care Can Lead to Aggression
Professor Jay Belsky, director of the Institute for the Study of Children, Families, and Social Issues at Birkbeck University of London, revealed that U.S. research showed children who spent long periods in day care were more likely to have poor behavior. Researchers found that 17 percent of the children who were in care for more than thirty hours a week were regarded by teachers, mothers, and caregivers as being aggressive toward other children. That compared with 6 percent for the group of children in child care for less than ten hours a week.10
10 Associated Press, “Study: Child aggression linked to hours in day care.”
Working and Alternate Caregivers
Mothers who plan to return to work shortly after the birth of their baby sometimes tell their doctors or friends that they are afraid to get “too attached” to their babies. They are worried that this will make separation too painful when they must return to work. However, it is detrimental for parents to distance themselves emotionally from their babies, because it can permanently affect their growing relationships with their children. Instead, parents should treasure those early weeks of bonding with the baby and get to know her personality, feeding patterns, and what makes her unique. This will help a mother make better decisions about her baby’s care and create better communication with the caregiver.
Pediatrician and author T. Berry Brazelton made this observation more than twenty years ago at a public talk in Denver, Colorado:
I’ve had young [pregnant] women sitting in my office and they . . . don’t want to get into the subject (of their babies) in depth anymore. I began to realize that what they were saying to me, when they were not willing to share the deeper emotional feelings about the turmoil of pregnancy or not wanting to talk about nursing, was that they had to return to work too soon. They were already guarding themselves, in pregnancy, from too deep an attachment. Now, that scares the hell out of me. . . . These young women are grieving for what they might have had at a time when they ought to be investing themselves so emotionally and passionately that, of course, it is going to hurt to leave. . . . If you can guard yourself like that, then what kind of a nurturing person are you going to be?11
11 Magid and McKelvey, High Risk, 17.
Dr. Brazelton is one of many professionals who continually challenge parents to take very seriously their children’s needs for consistent care. Parents must face the reality of the challenges of the child-care situation, and, if both parents must work (or in the case of a single parent), creative strategies can be used. If you live in a country that offers paid maternity leave, then consider yourself very fortunate. If not, find out if your employer offers a family leave of absence; a parent may be able to return to work after a year or two without sacrificing his or her career path. Parents can explore a variety of economic and work-arrangement options that permit their children to be cared for by one or both parents at all times. For example, parents can consider ideas for cutting expenses, or they may be able to use financial assets they already have so that one parent can be home. Today’s workplace is increasingly flexible and family-friendly, providing employees with the opportunity to explore different work situations that best fit their families’ needs. Some places of employment are getting creative and helping new parents with on-site day care, or even allowing the baby to stay with Mom or Dad at the workstation. Recently, an article in USA Today reported that an advertising firm in Austin, Texas, allows its employees to bring their babies to work until they are old enough to crawl. The article said that the Parenting in the Workplace Institute in Framingham, Massachusetts, reports that the number of companies allowing children at work on an occasional basis climbed to 29 percent last year, up from 22 percent in 2006, according to the Society for Human Resource Management. Some of these progressive companies include Marriott International, Microsoft, and J.C. Penney.12
12 Armour, “Day care’s new frontier.”
Poor-quality care can result in:
A four-state survey of one hundred randomly chosen child-care centers found that the vast majority of children who spent their days in child-care centers were receiving less than adequate care.14
Infants exposed to twenty or more hours a week of day care were more likely to be classified as insecurely attached than those in maternal or paternal care. Boys in particular showed vulnerability in attachment to both parents when in day care more than thirty-five hours a week.15
13 Phillips, Testimony before the U.S. Senate Committee.
14 Greenspan, The Four-Thirds Solution, 27–29 and 36–37.
15 Belsky and Rovine, “Non-maternal care in the first year of life.”
The Parenting in the Workplace Institute (www.parentingatwork.org) promotes baby-friendly workplace programs, and it has identified more than eighty organizations (and it says this number is probably very low) in which employees can bring their babies to work every day. They have found that babies at work tend to be overwhelmingly content, primarily because their needs are met quickly and they are held much of the time by parents and coworkers. Mothers who take their babies to work are more likely to continue breastfeeding, and nursing on cue also keeps the babies happy and healthy. The institute is devoted to expanding the adoption of these baby programs as well as explaining and promoting the attachment care principles that lead to success for businesses and for babies.
Some companies allow parents to telecommute (work from home); this can allow both parents to interact with the baby during the day. Some employers allow parents to bring the baby to the workplace for breastfeeding or checking in. Working part-time, working as a consultant, working on limited projects, or participating in a job share can all allow parents more access to their infant during the critical first year of life and beyond.
Parents who attend API support groups often share their solutions for how they found ways for one parent to be the primary caregiver. Here is one family’s story:
When I had my first baby, my husband was a struggling musician playing five nights a week at a nightclub, and I was teaching school. We decided to try to make it on one salary but soon realized that we could not pay our bills and were faced with me going back to teaching and putting the baby in day care. When we started looking at the costs, it almost didn’t seem worth going back, so we got creative. We got a loan from the Teacher’s Union to help us when money got short each month. I learned how to get very frugal with money, like clipping coupons and going to yard sales. In fact, my friends and I made a game of bargain hunting, and we helped each other when we saw a good sale or found a new recipe. We got by with one car, and I learned I was able to qualify for supplemental food through the WIC program in our community. When I look back on those years, I have no regrets about the sacrifices we made as a family—it was so worth it to be with my baby and not have the worry of whether he was crying and needing to be picked up or was taking his first step and one of us was not there for him. I went back to teaching school when he was a toddler, and my husband and his mother were able to share child-care duties for him during the day, so it was amazing what a little creativity and determination did to help us find a plan that worked for us.
Parents whose work situation does not lend itself to this type of flexibility have even more reason to practice attachment parenting. Being sensitive and responsive to the child’s needs and feelings, holding, and cuddling can help parents and babies reconnect after being apart. For instance, parents that share sleep with their baby can have the extra touch time that they missed out on during the day. Infant massage is another way to reconnect in the evenings, and breastfeeding mothers find that pumping their milk while separated keeps up their supply so they can continue the nursing relationship when they are together in the evenings and on weekends.
It is also important to realize that the caregiver will be an incredibly important attachment figure in the child’s life, and the parents may experience some jealousy. Keeping the lines of communication open is critical, and finding ways to keep the connection strong with your child while sharing this attachment with another caregiver is important to the health of your child and the success of this arrangement.
Here are some helpful tips when a parent is returning to work:
The books listed in Appendix C go into much more detail about the pros and cons of substitute care, how to find and interview a potential caregiver, and how parents can find creative solutions to staying home, working part-time, or splitting care with parents and caregivers.
Some parents may see any criticism about child care as an attack on their particular decisions. . . . The assumption is that critics of day care are really advocating a return to an era when women stayed at home and cared for children instead of pursuing careers. These agendas . . . are preventing us from having a coherent discussion about the actual quality of day care today. . . . If we clear away the smoke . . . this is what we see: Much of the child care available for infants and toddlers in this country simply isn’t good for them.
—Stanley Greenspan, MD,
The Four-Thirds Solution: Solving the Child-Care Crisis in America Today
Separations Because of Shared Custody
Some families find themselves in a difficult situation because of work schedules, divorce, or shared custody. In their book, The Unexpected Legacy of Divorce: A 25-Year Landmark Study, Judith Wallerstein, Julia Lewis, and Sandra Blakeslee give guidance to parents, attorneys, and judges in considering the attachment needs of babies and very young children:
When a baby doesn’t see her primary caregiver for several days, the child suffers a lot because she is likely to assume that the caregiver has disappeared and that she’s been abandoned. But our knowledge about how much absence the infant can tolerate without severe suffering is still insufficient to build regular disappearances of a parent into the child’s schedule. Putting the child’s best interests forward and honoring what is best for the child is extremely hard to do. . . . It requires parents to stand apart from their raw, hurt, jealous, competitive feelings and take an objective, compassionate look at what life will be like for their child. . . . Surely the job of the court is to give priority to the helpless child over the demands of the parent.16
16 Wallerstein et al., The Unexpected Legacy of Divorce, 216–17.
The data from several studies suggest that repeated overnight separations present a greater challenge to the development of organized primary attachments than do daytime separations. Furthermore, it is known that especially in high-conflict separations, frequent transitions can exacerbate interparental conflict.17
17 Amato and Rezac, “Contact with non-residential parents”; Emery, “Interparental conflict and the children of divorce and discord”; Hess and Camera, “Post-divorce family relationships”; Johnston et al., “Ongoing postdivorce conflict.”
The U.S. court system obviously has an enormous need to receive education on the attachment needs of children whose parents are going through a separation or divorce. Of particular importance are custody decisions that are based on the developmental needs of the child. Usually a schedule based on a baby’s gradual abilities to tolerate longer separations from his primary caregiver is the ideal. Information on providing consistent and loving care during these difficult situations is available through resources listed on the API website, www. attachmentparenting.org.
The first few weeks and months of parenting, your newborn will quickly teach you what flexibility and “going with the flow” truly mean. Instead of trying to fit a new baby into the existing prebaby schedule, parents can come up with creative ways to design new routines that include the baby. This may mean taking a sleeping newborn out on date night, getting exercise by taking walks with the baby in a sling, or working with employers to customize a schedule that maximizes parents’ time with their children. Parents can take a trusted caregiver with them if they go out for a long evening or special event; many babies are happy to stroll around a restaurant or other interesting environment with a caregiver, allowing parents some time to be alone. This technique also works well for family vacations or business trips.
Being together as a family in the first months of a baby’s life allows parents to solidify parenting views and ensure that the baby is receiving consistent care. A baby thrives when she knows what to expect and when her needs are met in a responsive and loving manner by caregivers (remember that babies love predictability). In the early months, a baby’s natural attachment-promoting behaviors, along with a parent’s instinctual drive for caregiving, work together to develop a strong bond. Families can support the breastfeeding relationship of mother and baby by helping them to stay close during infancy, thus making breastfeeding success more likely.
Practical Tips for Short Separations
Although having one or both parents or loving family members to provide consistent, loving care at all times is certainly the ideal, it is not always possible. If parents need to be separated from an infant or a young child for a short time, the following tips may help minimize stress and fear:
A Mother’s Story: An Unexpected Evening
Out with Our Five-Year-Old
You never know when a precious family memory will start out as a seeming disaster! Many years ago, my husband and I had been planning a special evening out with his boss. I bought a new dress and carefully arranged child care with a trusted family friend. The plan was that I would drop off our boys (ages seven, five, and two), come home, and have a leisurely bath, so we’d have plenty of time to get ready. For some reason, our five-year-old son did not want to be left that night—he worried about it all day, but I kept reassuring him that he’d have so much fun, we’d only be gone a few hours, and that Mommy and Daddy would spend some special time with him the next day. I finally got them all in the car, but as I was pulling away from the curb, I looked back to see that he was still very distressed, and he begged me to let him stay home. Impulsively, he ran back into the house and I followed, asking my husband to talk to him, since I had no choice but to take the other boys to the sitter. I dreaded the scene when I returned home, thinking that they would both be upset and my husband would be stressed about what to do. We were going to a very exclusive restaurant that did not cater to children, so I wondered if we’d have to cancel.
I will never forget the joy on my son’s face when I came back in the house. My husband had dressed him in his Sunday best suit, and they were both looking so handsome. They had talked through the problem and decided that if it was this traumatic to be left, and if he was willing to go to a grown-up event and sit quietly in the restaurant, we would let him go with us. Of course, he was an angel that night and all the guests couldn’t get over his maturity and sweetness. I remember how it felt so right to listen to him and find a positive solution that kept all of our dignity intact. And I will always be grateful to my husband for trusting that our son’s needs came above a dinner out with the boss!
—Barbara N.
Parents must avoid using shame, fear, threats, or intimidation to force the separation or to attempt to prevent children from crying about it. This can prolong and exacerbate a child’s fears of separation. Be especially aware of the preverbal child’s reaction and behavior both when the parent leaves and when parent and child are reunited. The child may cry, be extremely clingy, or may suddenly revert to a less mature behavior. Parents must take into account their child’s personality and developmental stage in assessing whether the separation or child-care situation is causing anxiety or stress.
Some children seem to accept separations that are not their choice, only to later display negative behavior or sadness caused by the stress they have experienced. Therefore, it is important to be aware of the child’s reactions and sensitive to his feelings. Parents may acknowledge a child’s feelings by articulating what he must be feeling: “You feel sad because Mommy left, don’t you?” Long separations can cause a baby to go through feelings of grief and loss and can affect his attachment to his parents. Therefore, it is critically important that parents who are separated from their children spend focused and intentional time reconnecting with their child after separation.
Children are ready for separation at different ages, and sensitive parents will know what their child’s tolerance levels are, depending on who the caregiver is and the length of time they will be away. Being in attunement with your child will give you the knowledge and insight of what is best for keeping strong the security of attachment you have nurtured.