BABY ACES: When we consider the traumas that qualify as ACEs, babies need their own list.

Babies are obviously very different from older children developmentally, including their ability to understand and process trauma.  Indeed, a baby may be completely unaware of an actual ACE— say, the incarceration of their father— which a middle schooler would be painfully aware of.  Yet at the same time, the baby could be much-more-acutely impacted by the secondary effect of this same ACE: a sad, stressed, and distracted mother.   Similarly, if a parent dies in a car accident when a child is in middle school: that child will experience the pain and trauma of the loss, but will also have the developmental maturity to know they have not been deliberately abandoned, as well the support of a larger network of attachments, to bolster and comfort them.  A baby does not have these buffering factors, and will experience the death of their mother as utter abandonment. 
 
We already know that even the temporary ‘loss' of a mother can have devastating consequences for a toddler.  The film  “A Two Year Old Goes To The Hospital,” by Dr. John Bowlby (link below), perfectly illustrates how even a fairly quotidian event that few would classify as “trauma”— in this case, a toddler spending a week in the hospital— is very traumatic indeed.   Though the little girl has language, and though she receives compassionate care from hospital staff (and even visits from her mother!), the whole experience is far beyond her developmental capacities, and hence is it very traumatic.  
 
Further, the impact of an ACE received in babyhood can be much more damaging over the lifespan, due to the fact that the growth of the human brain and the formation of neural networks are very rapid at this time.  By three, a baby’s brain has reached 90% of its adult size.  And during these first three years, brain development is heavily skewed toward the right (unconscious) brain.  (This makes sense, as babies do not have language, logic, or other left-brain capacities at birth).   Right brains, however, perceive the whole-- and through these perceptions, draw inferences.  Babies can do this.  And they learn a great deal about “reality” through their somatic states of pleasure or distress, and how responsive their caregiver is to these states.    
 
Given babies’ exquisite neurological vulnerability, it is particularly chilling that toddlerhood is the most likely time for a child to be abused.  
 
Right-brain learning is not like the ‘learning' most of us think of.  It is not overt or instruction-based, but rather implicit and relational, unfolding within the primary relationship with the mother, or mother-substitute.  From being swiftly and reliably comforted by an empathic, aware mother, from being cuddled and played with, the baby learns “I feel good/life is good/I am good,” and this notion gradually embeds itself in the childs right brain as part of ‘reality.'  A baby who is often yelled at, hurt, or ignored learns “I feel bad/life is bad/I am bad,” a very different ‘reality.'   Such ‘certainties’ about ’the way things are’ are largely formed in our first three years, through the implicit learning inherent in daily experiences.  
 
Just like we need nutritious food to grow properly, the developing brain also requires certain nutritive daily experiences to develop optimally.  The lack of any developmental requisite is a Baby ACE. 
 
Consider the example of the Romanian orphans:  though cared-for physically, these babies' lack of emotional connection and mental stimulation— normally provided by bonded relational experiences— caused profound, irreversible brain damage: a heartbreakingly stark example of how not meeting a baby's developmental psychosocial needs may be the most serious ACE of all, because of damage to the structure and function of the very organ we use to navigate life.  
 
With mental illnesses like anxiety disorders and depression steeply rising— and also hitting much earlier, now widespread in primary school-- we need to shine a light on all heretofore ‘invisible’ ACEs that deeply affect babies and toddlers.  We need to begin with a clear picture of the developmental requisites of our species, and notice how modern society fails to meet them.  Modern life has stripped away experiences that our species evolved to get, resulting in developmental injury or trauma.   
 
One invisible loss is our modern-day lack of carrying.  As strollers, car seats, cribs, and bouncy chairs have replaced human arms, modern babies get much less carrying and much less body contact than would be expected in our "primal nest."  In the 1970’s, the NIH’s Dr James W Prescott did a study to determine what childrearing practices correlated with the calmest and happiest adults and the most stable societies.  He looked at dozens of native peoples and their practices and found that when a society carried it’s small babies around, it had a 90% liklihood of being a peaceable society.
 
Carrying is more than just being cozy and warm — it is also essential to a baby’s developing brain.  The area of the brain that is most robust at birth is the vestibular system, which perceives body motion and location in space (proprioception).  This system is perceiving and developing in utero as the baby rolls and bobs, and is thus primed and ready for input at birth.  The familiar jouncy movement of being carried by a walking mother provides the newborn both familiar comfort and mental stimulation.  The vestibular system is heavily connected to both the prefrontal cortex (self control) and the limbic system (emotion).  Motion turns out to be a key need for babies' brains, as anyone who has ever rocked, bounced or jiggled a baby to sleep can attest.  We also see this need in other primates, like Dr Harry Harlow’s rhesus monkeys.  Neglected babies who do not get enough movement will often rock or head-bang to provide it for themselves.
 
Carrying further connotes presence, and thus it also boosts attachment.  In one study, simply providing a soft carrier to at-risk new moms and telling them to use it daily *doubled* the rate of secure attachment in their kids.   When a mother carries a baby with her most of the day, she is also likely to be breastfeeding him.  In a state of nature, human beings were breastfed for several years, whereas now, the typical US baby gets about 4-6 months, if breastfed at all.  Co-sleeping would have once been routine, whereas it is very rare today.  Dr James McKenna explains the benefits of co-sleeping for co-regulation.  
 
External co-regulation is the very portal to emotional self-regulation and self-efficacy, two key skills of human thriving.  External co-regulation describes how a mother notices a baby’s emotional state, mirrors it, and (if necessary) modulates it.  If a baby is crying, she croons and calms him.  If a baby is bored, she offers him stimulation or play.   If  baby is overtired, she helps him fall asleep.  Through many repetitions, the baby internalizes the ability to recognize their own feeling-states, as well as the skill to modulate them.  Dr Allan Schore describes this as a kind of download: “the right brain of the mother becomes the right brain of the child.”  Lack of Emotional Self Regulation, normally learned 0-3, underlies virtually all mental illness. 
 
Now let’s consider the electronic distractions of modern life: like computers and iPhones.  If you are constantly pulled away from noticing your baby by a pinging, addictive iPhone, it is harder to be a good mirror-er or co-regulator.   Dr. Beatrice Beebe’s work explains this intuitive and intricate mirroring process as it unfolds microsecond by microsecond in an attached dyad.  The lack of attunement and mirroring is a clear Baby ACE.
 
In a state of nature, as Dr. Bruce Perry explains, human beings lived in small tribes.  These bands of hunter-gatherers would have about 40 people, and a ratio of about 6 adults for every child under six (as extended breastfeeding delays the return of fertility).  A cave baby would intimately know a small number of people, and be exposed all day long to multiple familiar adolescents and adults—  thus receiving a lot of modeling, and very little competition for adult attention.  Further, no baby would be left to cry, or its wails might draw predators to the cave.  In Evolutionary terms,“Cry It Out” is an ACE.
 
Today, a typical daycare has a ratio of 1:6—only 1/36 the amount of adult modeling of primal man— and yet many revolving-door caregivers.  Babies fret and cry and are left in cribs or carriers with propped bottles.  Daycare provides dramatically less modeling, less adult attention, and the not-found-in-nature experience of having to vie for limited attention with five other babies. If the baby manages to attach to the caregiver, then later attachment-loss is built in, when they graduate to the next-age room.  This too is the complete inverse of what humans evolved to have.   Though daycare has become typical, it is far from normal in evolutionary terms.
 
Some 30% of American infants now grow up in group care from their earliest weeks of life, and thus receive much less carrying, fewer attachment experiences, slower response times, less or no breastfeeding, serial lost attachments, and far less intimate presence or mirroring.  This explains why early daycare only seems to benefit babies with substandard home environments.   Certainly no cave baby would have to wait 12 hours for his primary caregiver to reappear.  This wait is extremely stressful on infants, as the altered salivary cortisol patterns of daycare babies attests.  Clearly, babies who grow up in group care are missing out on a great deal of what every cave baby got.  There is simply no way one daycare worker can be empathic and attuned to 5 babies all day long, as anyone contemplating babysitting quintuplets immediately realizes.  No wonder American rates of secure attachment are so poor.  And secure attachment is precisely what buffers that hypothetical middle-schooler who experiences an ACE like violence or parental loss.  Baby ACEs magnify later ACEs.  
 
In order to prevent the invisible ACEs of modern babyhood, our mental model must begin with the hunter-gatherer “evolutionary nest” that launched our species and tuned our survival organ: the human brain.  This model is a web of intimate connections, a mom with her baby strapped to her back, offering the breast upon demand, and co-sleeping.   Basically, anything that puts a wedge between the mother-baby dyad, whether physical, emotional, or temporal, is a potential developmental ACE.  To prevent ACEs, public policy must carve out protections for the dyad in early life.
 
For this reason, any program of Universal Childcare must differentiate between a “child" and a baby, whose needs are so unique.  Subsidies for maternal care of pre-verbal babies would be much more developmentally appropriate, would help launch more functional families, and (along with mentoring if needed) ought to be part of any national plan.  What may be fun and stimulating for a 3 or 4 year old can be a severe psychosocial stress on a tiny non-verbal baby, who still needs a dyad to interpret and contain him.
 
We have to have the courage to advocate for tiny children in the face of the hurt feelings of adults who may have to use daycare for their kids, the frustration of women who wish to advance in their careers without penalty, or the resentment that so little hands-on parenting is expected of men.  The problems of equality for adults must never take precedence over the evolutionary, atavistic needs of our children. 
 
Babies need what babies need, and not giving it to them is an ACE.  
 
 
 
Laura Haynes Collector is a Court Appointed Special Advocate in Santa Barbara CA.  She is also retired La Leche League Leader and mother of three.
 
 
 
links: 
 
 
A Two Year Old Goes to The Hospital    https://www.youtube.com/watch?v=s14Q-_Bxc_U
 
 
 
 
 
Dr James McKenna  https://cosleeping.nd.edu/
 
 
 
 
 
 
 
 

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Sara L Johnson posted:

This is great!  I am an obstetrician working in a low resources setting--will share this with colleagues, it would be a great basis for curriculum in group prenatal care.  thanks!

Sara, 
I would really like to see some concerned doctors try to find a way to get this knowledge into Pediatrics / Family Practice / Obstetrics / Psychiatry / Neurology education where it is so essential.  How can we do that? 

https://m.youtube.com/watch?v=63fBJPFPCbs

http://www.violence.de/tv/rockabye.html

Robert Olcott posted:

Kate White's article on Pre- and Peri-Natal Care, in Somatic Psychotherapy Today journal, presents an interesting example of a hospitalized toddler, captioned: "The Unibomber". Ted Kaszinski was hospitalized as an infant, and only allowed one hour per day contact with his mother. ....

Here is that link: https://secureservercdn.net/19...e-Shadow-revised.pdf

Hello!

I am so glad to see more about the baby's experience. I have been tracking the baby's experience of birth and the prenatal time for 20 years. We started an online program through birthpsychology.com for educators. I have created a training for practitioners who work on the frontline especially (see ppncenter.com under trainings. It is Integrated Prenatal and Perinatal Dynamics). I teach this training with Lois Trezise, a midwife of 40 years.

Here are a few more links. Prenatal and Perinatal Psychologist Marti Glenn and I created Adverse Early Experiences. You can see more at: https://katercst.typeform.com/to/zgRCiI. I have also attached the document. We have combined it with ACES.

You can also see the work of Veronique Meade: https://chronicillnesstraumast....com/author/vermead/

You can read more about this early paradigm on kindredmedia.org. Lisa Reagan is supporting many perspectives there as a journalist and parenting expert.

Helping babies and families, supporting education for practitioners and educators has been my passion for many years. I offer education and support. You can see my website, ppncenter.com or belvederearts.com, or my patreon channel, https://www.patreon.com/amorebeautifullife or my online school https://prenatal-and-perinatal...rning.teachable.com/.

Kate

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Carey,

Thanks for your comment!

I think the Nurse Family Partnership is a very good ACE prevention model... it provides mentoring/ 'mothering' for the young Mom at risk, starting in month 5 of pregnancy, and then continuing w/ weekly support till the baby is 2.  That program costs about $10,000 to provide -- 2.5 years of weekly home visits.  And it pays for itself before the baby is in kindergarten via higher BF rates, better outcomes, fewer emergency room visits, etc.  Advantages persist into teen years.  VERY effective.

There is another great program for adolescents in Baltimore called "Thread"  -- I could imagine their model (a team of 10 volunteers who support one at risk youth) could be duplicated for young Moms... a corps of volunteer 'Grandmothers' who can provide drop-ins, babysitting, mentoring, help.  I have been doing this for 2 years for a friend who is a SAHM with a 2 and 4 year old.  I thought, "be the change you want to see" and volunteered to come by once a week to help w/ the kids, allowing them to get familiar with me so in case she were to have an emergency, I would be able to pinch hit or help.  I have grown so fond of these kids!!  It has been a complete joy.  I got breast cancer midway through 2018, when I had been doing these visits for 5 months or so.  I decided to continue visiting them during my treatment (part of me thought, in case I don't get to be a grandmother, I could at least have the experience with these babies)...  and it was such a good decision.  Highlight of each week!  They LITERALLY jump up and down when I arrive.  What could be a sweeter feeling?

La Leche League is great for pregnant/ BF moms.  Free mother-to-mother support & information re breastfeeding -- which has a large crossover with attachment parenting.        1-800 LA LECHE.  Great resource to pass out to new Moms. 

I would love to see child development taught in middle school.  It's the one science most people will actually use!   Plus, this is around the time kids start to babysit as well.  It could plant accurate ideas about babies, how they think, how they learn, and what they need. 

Babies are innocent, never 'bad'-- and it's impossible to spoil them with kind treatment.  Babies are also totally somatic.  Most people know how to pet/rough house with a puppy or kitten, but don't realize petting, cuddling, holding, tickling, rocking, humming, blowing raspberries, roughhousing and other "touch" or "rhythm" modes of communication work great for babies.  Use your body, noises, tickles, etc-- non verbal somatic communications. 

The two I play with like nothing better than roughhousing: being dangled  upside down and  then flung onto the couch.  They go insane!  

Public Service Announcements could remind us of the primal needs of babies, aka attachment parenting, and that you CANNOT spoil a baby through love, cuddling, and gentle care; indeed all that is nutritious Brain FOOD.  I can imagine a PSA where a kid melts down and a mom handles it well.  It is surprising how quickly a tantrum can be diffused if you have skill. 

We really have to bust the whole lie of "quality day care."  Most daycare in the USA is nowhere near "quality" and NONE of it is quality for infants.   Only nanny-care is close to dyadic care, but nannies *leave*.  There is no high quality  "group" solution for babies.   The dyad = quality.  Nothing else comes close.  

My SAHM friend is in a cultural desert, in terms of other stay-home Moms.  All her friends w similar age kids are working and the kids are in care.  It's really hard to feel like one is not "wasting time" being home with babies in the current culture.   It helps Moms when the culture says "you are doing important work" not "hustle back to paid employment, pronto."  The false equivalence of being a "great mom" whether you are present or not has created this lie.  Mother is a VERB.  

I will say that among the older kids I know  (peers of my kids, whose parents are my friends) the ones who went to daycare as infants are the ones with the anxiety issues.  Their parents love them and are good/safe parents but the kids have the issue.  I think that backwards cortisol patterning is very damaging.  Also, the one young person I know with a serious mental illness... his bonded, caring nanny stole something and was fired when he was 2 and a half.  I think it destroyed him mentally-- an abandonment/death for a baby.  It did not "show up" as severe depression until adolescence.  He is 30 now and still struggling.

You have to encourage a baby and draw them out to engage with you.   You have to show him you are paying attention.  Humor is a great way to delight/amuse/interest  a baby.  They totally get humor even when non verbal...  Silly noises, silly actions.  Once when the littler one (at about 15 months) was refusing lunch and being a bit of a pill, I offered him a bite of a a sock.  He looked at me warily, but with a sly grin-- he knew it was wrong/silly.  Then I pretended to take a taste of the sock -- and I spat it out with a "yuck!!" --he CRACKED UP.   2 weeks later, he came over to me with a sock and offered it to me to take a bite, to repeat the joke.

 The hardest thing for a formerly abused person to do is trust.  But babies require a HUGE amount of trust.  You have to trust they are doing their best.  That a night wakeup is not designed to torture you.  That they WILL "get it" with enough reinforcement/repetition.  That crying must always be addressed with calm compassion.  You have to maintain trust for 2-3 years till they get big enough to show you it is working, they get it, and they are a good kid.  If you are your baby's advocate and ally, they will turn out well.

Thank you for writing this brilliant and beautiful piece. It is powerful and needs wide circulation. 

I would love to know I more about how you envision things changing to help people learn that when they become parents, they need to provide the level of connection you’re talking about. 

Childhood development taught in middle school? Maternal leave? 

A change from people living in single-family housing to group homes?  

In a perfect world, what would life look like today for an expectant mom with limited resources? 

Thank you again!

Carey

Thank you for this beautiful summary. The first time I read about ACEs I immediately thought of newborns and the routine separation from their mothers in hospital nurseries and then the really prolonged separation of weeks or months in an NICU. If we saw the separation as a problem we could modify our policies 

Last edited by Elizabeth Allemann
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