You may never have heard of Jan Macvarish – I hadn’t until I came across an article of hers published on The Conversation titled “How ‘neuroparenting’ is sapping the joy out of family life’. The article does not paint a positive picture of neuroscience-informed policy and pokes fun at the use of “baby massage” as an intervention to support early childhood development.
As infant massage lies at the heart of our organisation’s activity – Baby in Mind delivers the only government accredited training in infant massage in Australia – my initial reaction to reading Jan’s article was to want to provide a counter-response in defense.
But then I remembered another article, also published on The Conversation, about the futility of trying to engage in debates based on facts about science (think climate change deniers). In this case, the article was discussing vaccination:
With [people] who are often fixed in their views, the discussion can descend into a game of scientific ping-pong, arguing back and forth about the evidence. These discussions are usually time consuming and are likely to further entrench [the other person] who, feeling cornered, will defensively rehearse and reinforce her arguments.”
Rather than citing scientific evidence, therefore, it may be more useful to first acknowledge that Jan’s article has some legitimate points. The thrust of the argument seems to be the science of neurodevelopment is being used as a form of social control because it is being used to dictate how children should be parented. The article suggests that neuroscience is being used to ‘interfere’ with the largely private task of parenting.
Of course, some people might be tempted to call Jan’s argument a bit uptight (we live in a culture that is uncomfortable with anything that sounds remotely post-modern). But it would be arrogant to deny this possibility. History is filled to the brim with the use of biology, medicine and ‘science’ to shape and control various aspects of people’s lives. We’ve seen it in relation to the subjugation of women, of people of colour, people with disabilities and various ethnic groups. Of course, this would mean the problem is not neurodevelopmental science as the article proposes, but with the ways in which all forms of science (and arguably, religion) have the potential to be wielded as instruments of power.
Although the article doesn’t provide any examples, one plausible scenario I often wonder about is whether our knowledge about the impact of poverty on brain development will one day be used to justify practices that exclude people who experienced childhood poverty on the basis that they have ‘improperly’ developed brains. This is perhaps an oversimplified example, but I suspect it is the sort of scenario that is possible if some of Jan’s arguments are correct. Removing children from families based on poverty because it is “scientifically justified” to protect their brains is not a far-fetched scenario either – particularly when we recall what happened to Aboriginal people in Australia based on chillingly similar arguments.
The article also observes that neurodevelopmental science seems to have resulted in a parenting movement which she terms ‘neuroparenting’. Neuroparenting, it is claimed, fixates on tasks which support neurodevelopment and distracts parents from having enjoyable and relaxed relationships with their baby. Again, I’m inclined to agree – but not because the article provides any evidence of this. Rather, for the past 15 years we (‘we’ being health care workers) have been battling the same problem with the confusion between Attachment Theory and Attachment Parenting.
Attachment Theory is a useful scientific theory used by academics to explore research questions, and by practitioners to formulate and evaluate our practice. Attachment Parenting, however, refers to a set of techniques which – usually proclaimed by an author with books to sell – that the performance of which will lead to ‘better’ children. The confusion between Attachment Theory and Attachment Parenting has presented a major challenge to health care workers for many years, ironically because we see so many risks to parent-infant relationships when parents feel they have “failed” at performing attachment-parenting techniques.
In reality, all children form an attachment relationship in one way or another, for better or worse. Attachment, in its true sense is to do with a relationship – not any particular technique. The quality of this relationship (healthy attachment) seems to be quite important in life-long mental and physical health outcomes which is why, those of us who provide services to parents pay attention to it. But a healthy attachment relationship can take many shapes and forms. Jan’s critique of ‘neuroparenting’ may be valid: there is no reason to think that any parenting dogma (whether spawned from science or religion) which emphasises technique over relationship would be anything other than problematic.
And it is here where Jan’s argument ressonates most strongly with me. Of course, she doesn’t mention that it is the neurodevelopmental research that has pointed to the importance of the relationship over the technique. But it is clear that it is the most simple of interactions – often imperceptable – between parents and babies which shape brain development. There is a sense of frustration and bewilderment in our office every time a new report or policy document is released proclaiming ‘touch is important!!’ as if it is a new discovery, and proposing complex policy solutions requiring expensive experts (often with no relevant knowledge) to ‘make it happen’.
However, despite having some reasonable premises, the article misses some of the most critical issues and descends into an argument that is confusing and contradictory.
The first point of confusion is that while there is in fact a very clear distinction between neurodevelopmental science and ‘neuroparenting’ (as there is a difference between attachment theory and attachment parenting) the author does not seem to clearly define this distinction, and in some cases seems to use the terms interchangably. Therefore, it is difficult to separate whether the article’s main concern is with neurodevelopmental science specifically, or the tendency for any science to be misrepresented to achieve power motives.
To illustrate the problem with neurodevelopmental science (or neuroparenting techniques) the author states:
So cuddling and touching a baby becomes formalised in “brain-nurturing” baby massage classes. Mothers must ask the baby’s permission before initiating touch and specific movements are prescribed by an instructor. Meanwhile, midwives and health visitors tell new parents that they must engage in specific interactions with their babies, to build the child’s language skills through talking and singing.
However, this description of Baby Massage is – well – completely inaccurate. In our protocols, at least, mothers [or fathers, because men are parents and attend our infant massage classes too] don’t have to ask permission before initiating ‘any form of touch’. Nor are movements ‘prescribed’ by an educator but are highly fluid and responsive to each individual parent and child. In other words, having criticised midwives and health educators for confusing technique and relationships, the author seems to face the same difficulty she is criticising in others.
The article’s description of ‘Baby Massage’ is also difficult to take seriously because – aside from being inaccurate – there is an absence of any effort to distinguish between high quality infant massage, and lower-quality approaches. This is a bit like saying “all vaccinations are bad [or good]” – when clearly there are vast differences between medical and homeopathic vaccinations. Research over the past five years has begun to make emerging – but compelling – distinctions between different approaches to infant massage education. Ironically a focus on technique versus a focus on relationships is one of the key differences between low and high quality infant massage respectively.
The article doesn’t stop at Baby Massage and midwives. It takes a broader swing at the terminology used in many infant development practice communities. This includes the words: ‘cues’, ‘behavioural states’ and ‘attunement’. Infant development professionals commonly use these terms to describe the facts that babies:
- communicate (using cues),
- have needs (related to behavioural state); and
- need adults to be able to take notice of, and interpret of these needs (attunement).
Here’s what she says exactly:
This is because under neuroparenting we are in an alien, joy-sapping territory – not a loving family home. Caring for a child becomes a matter of “attunement” – a “neurobiologised” version of the mother-child relationship where the mother must be constantly attentive to behavioural “cues”, which are said to express the baby’s needs.
It is not clear what the author’s issue is with these concepts because, rather than providing a critique, discussion or research to extrapolate these concerns, the article simply uses “double quotation marks” around these words in a sort of passive-aggressive wink to the reader with no further explanation. Is it that she takes issue with the use of these particular words as jargon? Or with the concepts themselves? And it is not clear from this if the author is even familiar with the neurodevelopmental research which has driven our understanding that parents do not need to be ‘constantly available’.
The author then goes on to cite parental concern and fixation on academic achievement as an example of the negative impact of neurodevelopmental research. We may well need to be concerned about the over-emphasis on academic achievement in any context. But I am confused why this is used as an example to illustrate the ‘problem’ with neurodevelopmental science because, if anything, this body of research tends to indicate that preoccupation with academic achievement is detrimental to brain development.
Overall, this article completely misses an important opportunity to engage in professional and respectful dialogue about what should be crucial issues for practitioners who work with families to grapple with. Issues of power and discourse arguably have as significant impacts on child and family well-being as a child’s relationships. This is an issue that personally I think we have yet to fully debate across our professional communities, and should be something we discuss with vigour. It behoves those of us in policy, health care or in any position of power to ensure there are significant and effective safeguards in place to monitor the use of power with, and surveillance of, families. And, perhaps more importantly, to highlight that we can never truly be free from the power imbalance we have in our work. As other researchers have proposed, a genuine relational ethic establishes a foundation of a ‘wise authority’ (McAllister et al, 2004, p. 578) and workers who are ‘mindful of the power they held…[who] neither flaunted nor denied such power, but carried it softly and exercised it judiciously’ (deBoer & Coady, 2007, p. 36) seem to be those most likely to enable long-term positive outcomes for children.
Instead of inviting us to consider this issue, the article takes a different approach. On the one hand the author upholds the importance of organic and individualised relationships between parents and infants and then, on the other hand, ridicules the very frameworks that practitioners are turning to support these types of relationships in highly individualised contexts. And does so in a way that does not indicate an understanding of the basic principles guiding our practice or our own relationships with families. This kind of misinformation and ridicule is counterproductive to supporting any progressive or constructive debate or dialogue.
This reminds me of a comment made to me by one of our members, a Maternal-Child Health Nurse of 25+ years experience, when we spoke recently about an emerging trend of beauty spas offering a baby weigh service. She said:
I get this response sometimes myself from people in the community “Oh, you must have a lovely job, weighing, holding and cuddling babies”. But even something as simple as weighing someone else’s baby needs to be attended by someone who understands and respects the relationship the baby has with the parent. In our team, we haven’t had open sessions for weighing babies for several years now. Because, what appeared to be a simple task, was fraught with challenges. How do you make sure the mother can raise concerns? What if the baby is underweight? How do you then observe or determine the potential factors influencing this? How do you explore with the mother other challenges that can be associated with failure to gain weight – such as postnatal depression or stress in the family such as domestic violence? And you need to answer these questions in a way that upholds the dignity of the parent, the safety of the baby, and the integrity of the relationship between them both.
It is the easy option and a cheap shot to make light of the task of weighing babies, without seeing the reality of how the nurse is being in and managing her relationship with a parent. It is tempting to dismiss the knowledge she brings to this task when you don’t have this knowledge yourself, let alone to acknowledge the skill she is using to maintain an openness to ‘not knowing’ sufficient to the extent that the parent’s knowledge and expertise has scope to emerge.
In the same way, it is easy to poke fun at and belittle a what a Baby Massage class might look like on the surface, without having to learn about or acknowledge the complexity of the individual interactions and strategies taking place.
And this is, for me the greatest flaw with Jan’s article. It gives us almost no direction of where to go and no opportunity to gain insight into how we can improve our practice to benefit families.
Some of the ideas suggested are important, but if academics are to be useful to broader society (beyond a fun meme on Facebook), they must give us something useable – either to help further debate or to guide practice. It is not clear if the article is arguing that government and health workers should have no role whatsoever in parenting? This seems impracticable – as a society we accept some level of government (and science and religious) intrusion into our parenting as a trade-off for greater public health (vaccinations, laws about using child restraints, and child protection services are three obvious examples). So where is the cut-off? Should we only interfere when there is a risk to child or parent safety? Disruptions to early parent-infant relationships are dire risk factors for mental health and child abuse – amongst other things. Does this qualify as a reason for engaging parents and health workers? Is the article suggesting that health workers should ignore the relationship between parents and babies as one of the crucial determinants of maternal-child well-being during the first year (on the back of data that suicide is the major cause of maternal deaths)? Does the author refute the science on brain development all together? If she objects to the use of strategies which support healthy relationships and interactions between parents and babies, what alternatives does she propose? What is her analysis of some of the radical practice models – such as Nurse-Family Partnerships, Signs of Safety, Key-Person Policy, and, yes, Cue-Based Infant Massage – which focus almost exclusively on indvidualising the context of practitioner relationships with families?
And I can’t help but wonder, where the child’s voice is in this article. What might we imagine the baby’s perspective could be about all of this?
These are the questions that we deal with every day, in the context of real people’s lives. Answering them is not straightforward and can be fraught with difficulties and dilemmas – often in situations that can escalate into life-or-death outcomes for both children and families if we do not provide the right support, to the right person at the right time. Managing ethical flaws in practice (or research) is always going to be an ongoing process – but it is never an abstract argument. These discussions are something that parents, children and practitioners deserve to have taken seriously – beginning with a basic understanding of the diverse work that infant development professionals actually do before commenting on it.
The feature image for this article is credited to Bruce Perry from the Child Trauma Academy.