T. Berry Brazelton - The Irreducible Needs Of Children: What Every Child Must Have To Grow, Learn, And Flourish

What Every Child Must Have
to Grow, Learn, and Flourish

T. Berry Brazelton, M.D.
Stanley I. Greenspan, M.D.

As a pediatrician and a child psychiatrist caring for the families in our practices and engaging in studies of child development on a broader scale, we have become deeply concerned about the unmet needs of children in this country and abroad. Although there have been admirable initiatives in public health, education, pediatrics, and the law to improve the lot of children, few have tried to identify the fundamental requirements of a healthy childhood. In this book, we have set out to identify the very most basic needs, the kinds of care without which children cannot grow, learn, and thrive. Once these are recognized, plans to ensure that these requirements will be met can be more easily designed and evaluated.

We have also become aware of certain stresses on young families that have increased significantly in our lifetime. Under these stresses, mothers and fathers find it hard to meet the needs of their children. Few families can face these stresses and the tensions they create without outside support. We have allowed these tensions and conditions to multiply without the cultural supports that could be mustered. In investigations (1989-1991) by the National Commission for Children, it became apparent that our country lags behind a number of other cultures in supporting strong families. We risk paying a terrible price in our childrens later behaviordrugs and antisocial and violent acts. As one CEO asked, Will it cost our country much to create the necessary supports to meet the irreducible needs of infants and children? Compared to what? We can no longer afford to ignore what our neglect of these needs means to our childrens ultimate development. Our grandchildren will live together in a society with the offspring of neglected families. So will yours.

In our work as physicians and advocates for children, both of us have seen signs of great hope; new awareness and new programs that make the best interests of the child a top priority are developing nationwide. We hope our effort to clarify the basic needs can help point to further remedies, remedies that will demand the response of national and state governments, of communities, of business, and of individuals. No one layer of our society can face them alone.

Early childhood is both the most critical and the most vulnerable time in any childs development. Our research, and that of others, demonstrates that in the first few years, the ingredients for intellectual, emotional, and moral growth are laid down. If they are not, it is true that a developing child can still acquire them, but the price rises and the chances of success decrease with each subsequent year. We cannot fail children in these early years.

The irreducible needs we will lay out are experiences and types of nurturing to which every child has a right. In a society as affluent as ours, no one of us has a right to ignore them. Yet once we define these needs, it becomes clear that our society is failing many of its families and small children at present.

As physicians deeply committed to the well-being of children, we can no longer stand by with the complacency that silence implies.

At the White House Conference on Infant and Child Development a few years ago, there was a consensus that appropriate early experiences were vital for intellectual and emotional growth. When this consensus emerged, the president asked an essential question: What specific types of experiences are most important and how much each of them is necessary? No one attempted an answer. Child development professionals have never clearly articulated an answer. Fathers and mothers are asking the same question. They want to know the specifics of how to raise happy, confident, creative, intelligent, emotionally healthy children. They want their children to grow into adults who can nurture their own children and be reflective enough to lead a diverse, complex world into the future.

In the chapters that follow we will try to answer the question asked by the president and so many parents. Avoiding vague generalities, we will identify seven irreducible needs of infants and children.

Addressing these seven irreducible needs will take us all on a journey into our attitudes and policies towards children and families. It will lead us to re-evaluate our convictions and our daily practices in child care and family functioning, education, health care, social services, and our legal system. In order to illustrate just how thorny these questions are, we have included a sample of our own dialogue as we tried to identify each need. This dialogue is drawn from actual transcripts of discussion we had over a period of time. They give the flavor of our collaboration as well as suggest how we developed the recommendations.

As will be seen, the dialogues and recommendations are based on a synthesis of our clinical and research experience rather than a review, other than very selective, of the studies on the topics discussed. Due to the limited number of studies in some areas many of the most important questions (such as how much nurturing care a baby requires each day) must be addressed by integrating clinical experience with the available research. This at least creates a frame of reference for setting current standards as well as for future studies and discussion. The chapter-by-chapter notes at the end of the book offer some reviews of the literature and also some of our related research.