W. Thomas Boyce MD - 15 Jan

This is an impressive and important booka collection of ideas and researchthat reveals the profound prenatal and perinatal factors that affect an infants and childs later development. Dr. Boyce identifies a special group of childrenorchidswho are outliers among groups of more typically developing children, or dandelions. Orchid children are uniquely fragile, needing special nurturing to achieve their best. Dandelions are more rugged and likely to overcome any difficulty, but are often average or ordinary in outcomes.

Dr. Boyce outlines an argument and backs it up with convincing research showing that children vary greatly in their development due to the unique interactions between their genes and environments. These interactions start in utero, for the fetus is already influenced by stressors, nutrition, and the mothers emotions before birth. The mother and unborn child strive to adapt to these influences, as if preparing to deal with the same conditions after birth. Thus a fetus whose mother is under stress, eating poorly, or depressed before birth can become a newborn with high levels of stress hormones, excessive vigilance, and a diminished ability to attend easily to learning. On the other hand, babies whose mothers are not stressed or depressed, are looking forward to delivery, and are eating and sleeping well are exceptionally ready to learn, engage in effective relationships, and optimally develop. These infants will be better able to learn self-regulation (by, for example, sucking on a thumb or fingers to calm themselves down from an upset). A mother who immediately starts nurturing, holding, stroking, cuddling, nursing, and talking softly to her baby will pass on the ultimate ingredients for healthy, positive development.

These events become reflected in the babys epigenome, leading, Boyce shows, to the eventual emergence of orchid or dandelion babies. All parents need to be given a chance to understand their babies temperaments and individual differences right from the start. To facilitate this understanding, a pediatrician, neonatologist, or nurse practitioner can translate the babys capacities and teach parents how a babys behavior can serve as a useful language, helping them to become responsive and optimal parents. Such an understanding of the child and his or her behavior can magnify the caring and sensitivity of all parents.

I have been concerned in my own practice of pediatrics in Cambridge, Massachusetts, about loving parents who attempt to protect their infants and children from all stress of any kind. It is important for infants and children to develop early their own ways of handling stress and difficulty. Such self-regulating mechanisms must be acquired and practiced throughout early childhood, by both orchid and dandelion children, so that they are ready to cope with the adversity all children must eventually face.

This is a book that I hope all parents and professionals (doctors, nurses, early childhood specialists, teachers, and others) will read in order to help them understand how different children, like orchids and dandelions, develop and grow. It will add to their understanding of how best to nurture each child, especially those who most challenge conventional approaches to treating, teaching, and caring for children.

T. Berry Brazelton, MD

Barnstable, Massachusetts

2017