2/6/23

The Brazelton Institute

Boston Children's Hospital

Newborn Behavior
Observations (NBO)
System

The Parent and the

Practitioner AMOR
Module 4

Objectives
In this module you will learn to describe:
• The Parent AMOR: A loose hierarchy of psychic regulatory tasks
parents face to promote healthy reciprocity
in their developing relationship with the baby

• The Practitioner AMOR: the parallel tasks and qualities that support
the Infant AMOR and the Parent AMOR

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Parent AMOR

The NBO is a practical tool to support three critical

transitions in the first 100 days of life
I. For the Infant - a major bio-behavioral shift in infant behavior and state
regulation during a time of rapid brain development

II. For the Parents - a formative stage in the transition to parenthood and a
sensitive stage in the development of the parent-infant relationship and family
functioning

III. For practitioners - a pivotal stage in the practitioner’s relationship with the
family: the “intervention moment par excellence”

The NBO Parent AMOR Framework

The parent’s task of psychic
regulation and responsiveness

Every parent is in a state of

potential disequilibrium and
reorganization through the
transition to parenthood with the
attendant possibility of crisis and
opportunity for development.

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The Transition to Parenthood

The new parents are engaged in:
• Reworking their own relationship with their own mothers and
fathers and family

• Reworking their internal view of themselves as parents

• Sorting out their feelings about the new baby

• Establishing the bases of their parental functioning

Parent AMOR
A loose hierarchy of psychic regulatory tasks Affect Regulation
parents face to promote healthy reciprocity
in their developing relationship with the baby M entalization

O penness to the “real baby”

Responsiveness

Parental Affect Regulation

The ability of the parent to

modulate their emotional state
and to focus on experience and
feelings in oneself and others

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Parental Affect Regulation

What do you see in the
expression and posture of this
mother and baby?

How do we take into account

cultural differences that may be
at play?

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Mentalization
• To reflect on how the baby might be
feeling in a particular situation
• To wonder about child’s mental states
underlying the expressed behaviors
• To see the baby as an individual,
separate from the parent
• To be curious about what is in the
baby’s mind (Arietta Slade)

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Mentalization
Examples of Parent Mentalization • Parents appropriately adjusting their position
in response to behavioral cues
or touch to better support their baby
• Wondering aloud about their baby’s feelings
• “I wonder what my son is thinking, he seems
so thoughtful”
• “He does that to annoy me”
• “She really finds her hands soothing”.

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Openness to the “real baby”

The parent’s ability to see and

respond to the real baby,
resolving the imagined baby
they have feared or dreamt of

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”Ghosts in the Nursery”

Parent’s negative or idealized
representations of the baby based on their
own childhood and childhood parenting
experiences (Selma Fraiberg)

These ghosts make it difficult to see “the

real baby”

Ignored or misunderstood infant

communication cues may increase the risk
for child neglect and abuse Credit: “Ghosts in the Nursery” by Doris Rubinic

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Parental Responsiveness
• Reciprocation of infant affection,
communication and mutual engagement.

• Empathic response to the baby’ cues

• Sensitive reading of and response to

baby’s cues so baby feels safe and
validated.

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Moments of Meeting
Maya

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Practitioner AMOR

The tasks and qualities

that support the
Infant AMOR and the
Parent AMOR

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Practitioner AMOR
A Affect Regulation
Attention
Architecture
Awareness of culture

M Mentalization
Model
Moments of Meeting

O Openness
Observation
Optimal support

R Responsiveness
Repetition
Reframing
Respect
Rejoice
Reflective practice

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Practitioner AMOR:
Supporting Affect Regulation
• Adjust your affect to meet the family
where they are

• Use your own emotion regulation and

awareness to be attuned to the family

• Create a safe, non-threatening, non-

judgmental, non-didactic setting

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Practitioner AMOR:
Other As to keep in mind
• Architecture: Notice the conditions in
the room, location of everyone

• Attention: Stay present in the session

• Awareness: of your biases

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Practitioner AMOR:
Supporting Mentalization
• Be curious to what is in the baby’s mind/what is in
the parent’s mind

• Allow babies– through their behavior - to reveal

themselves as having intentions, goals, preferences
– allowing babies to tell their own story

• Gain understanding into the parent’s concerns,

feelings, and distress, to be open and curious about
them and their story

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Practitioner AMOR:
Other Ms to keep in mind

• Model, don’t lecture

• Foster Moments of Meeting

through shared attention and
observation

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Practitioner AMOR:
Supporting Openness
• “Angels in the Nursery” (Alicia Lieberman)

• An “angelic” protective factor against a

cycle of mistrust, interactional mismatch,
and potential maltreatment

• Help parents understand and accept “the

real baby” and to promote the bond
between parent and infant – as he or she is

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Practitioner AMOR:
Other Os to keep in mind
• Observation (not assessment)
“Say what you see”

• Optimal support

• Provide facilitation to support the

mother and baby

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Practitioner AMOR:
Supporting Responsiveness
• Responsiveness to the baby’s cues in your handling

• Repeating (of what the parent says to create

emphasis and the feeling of being heard)

• Reframing (misattributions that the parent may

make)

• Respect for the parent’s knowledge of her baby and

for their social and cultural context.

• Rejoice with the parent in the miracle of their baby

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Practitioner AMOR:
Other Rs to keep in mind
• Other ”R”s to keep in mind

• Reflective practice for deepening your practice,

supporting and being supported by your peers

• Refuel How do you care for yourself to avoid

burnout?

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Summary
During an NBO, the infant is engaged in the tasks of
self-regulation and requires support from the parent and the
practitioner

The Parent AMOR captures some of the parent’s psychic regulatory

tasks

The Practitioner AMOR captures some of the practitioner’s own

regulatory tasks and support strategies

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