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Background: Phototherapy has been the standard of care for the treatment of hyperbilirubinemia in neonates. It is generally safe procedure, although behavioral and neurological side-effects can occur. Aim of Study: To assess behavioral and neurological responses of neonates with jaundice undergoing phototherapy. Subjects and Methods: A descriptive exploratory research design was utilized on a convenient sample of sixty neonates with jaundice, total serum bilirubin level ranged from seven to twenty mg/dl and undergoing phototherapy at the NICU of El-Monera Pediatric Hospital, Cairo University. A neonatal characteristics assessment sheet, and Neonatal Behavioral Assessment Scale (NBAS) were used to collect data from September 2018 to February 2019. After written consent from parents, neonatal characteristics were recorded from the medical sheet and every neonate was assessed individually using (NBAS) two times, before starting and after stopping phototherapy. Results: The current study revealed that all neonates were full term and their mean weight was 2.86±0.53. Behavioral and neurological responses of neonates with jaundice were differed significantly after than before starting phototherapy on the NBAS. Conclusion: There were behavioral differences of studied neonates after phototherapy related to their habituation, social interactive, motor response, state organization, state regulation and reflexes. Recommendation: NBAS must be used as a tool in the routine care for neonates with jaundice undergoing photother-apy and establishment of health educational instruction for all working nurses in NICUs about appropriate nursing care to minimize the potential side effects and complications of phototherapy.

Background: The neonatal behavioral assessment scale (NBAS) was primarily developed to aid in the assessment of full-term neonates. The aim of this study was to detect if the NBAS was also valuable in the assessment of preterm neonates. Materials and Methods: We assessed 112 infants at a neonatal unit using the NBAS, 4th edition. The inclusion criteria included an oxygen saturation level between 88–95% and a heartrate of 100–205 beats per minute. Infant neurobehavior was assessed using the NBAS. Results: For full-term and preterm neonates, we observed that the NBAS enabled us to assess both groups of infants and gave relevant information pertaining to them. We found a significant correlation between the average week of gestation and response to touch, sensory input, peak of excitement, cost of attention, hand-to-mouth, and quality of alertness. Conclusions: The NBAS is a valuable scale for evaluating the neurobehavior of preterm neonates. The week of gestation at birth affects certain aspects of neurobehavior, such as response to sensory input, putting hand to mouth, peak of excitement, and cost of attention. The NBAS as an individually structured assessment may help in planning for early rehabilitation and intervention for this vulnerable population.

Introduction The concept of the ‘Butterfly Effect’ was first proposed by Lorenz (1972), an American mathematician and meteorologist who observed that within unstable dynamic environments a small initial event can amplify and result in greater outcomes. Retrospective studies show that exposure to Adverse Childhood Experiences (ACE) can indeed negatively affect lifespan development, but few studies have prospectively sought to capture the Butterfly Effect from pre-birth. Aims This doctoral research study aimed: 1. To explore the neurodevelopmental trajectories of babies exposed to multiple adversities between conception and four months postpartum; 2. To explore the attachment trajectories of dyads exposed to multiple adversities during this time; 3. To explore whether the type, timing and intensity of the adversities experienced leads to differing neurodevelopmental and attachment trajectories observed. Methods A prospective mixed-methods case series analysis approach was adopted within a psychoanalytically informed constant comparison grounded theory framework. Multi-modal methods gathered neurodevelopmental, attachment and adversity data from five high-risk mother-baby dyads between conception and four months postpartum. Measures included: Neonatal Behavioral Assessment Scale examinations, Bayley-III assessments, Infant CARE-Index video footage, maternal interviews and questionnaires. Infant growth measurements were also recorded. Results Through triangulated multi-modal data analyses a grounded theoretical model emerged: The Butterfly Model. Findings demonstrate the Butterfly Effect observed across the neurodevelopmental and attachment trajectories of babies exposed to multiple adversities between conception and four months postpartum. Protective factors were also observed in some cases. The results suggest that the type, timing and intensity of adversities is more important than multiplicity alone, with some adversities showing a greater impact on developmental trajectories than others. Conclusions This research is one of the first case studies to prospectively capture the developmental trajectories of babies exposed to multiple adversities from conception to early infanthood. Closer observations are discussed alongside the limitations of this study and recommendations for future research and clinical practice proposed.

I was privileged to have worked with Berry Brazelton (Fig) for over 40 years. In 1978, as a new graduate student from Ireland, I first looked over his shoulder in the company of his pediatric fellows, as he used the scale he had just developed—the Neonatal Behavioral Assessment Scale (NBAS)—to examine a less than 1-day-old female newborn in the old Boston Lying-In Hospital. Even as he examined the baby’s reflexes, I was immediately struck by his—what could only be called gentleness, even tenderness—in the way he both held and spoke to the baby. He called her by her first name. “You are so alert, Sarah. Your mother must be very proud of you.” When he took a red ball out of his kit and moved it slowly from 1 side to the other, the baby began to track the ball and locked on to it, as if she did not want to release it from her gaze. “She can see,” blurted her mother, shaking her head in disbelief. When he began to talk to her in lilting, melodic phrases, Sarah’s face relaxed and her eyes widened and brightened. They were now interacting with each other—in a give-and-take, back-and-forth cyclical rhythm that had all the hallmarks of true conversation. Figure. Berry Brazelton (courtesy of Insieme photo by Fulvia Farassino). That babies could see and hear and had a wide repertoire of behavioral endowments at birth was a revelation to me, but Berry Brazelton had just demonstrated that this less than 1-day-old baby also had her own well-defined personalized behavioral style and was already shaping and leaving her mark on the world. She and Berry Brazelton left their mark on me and on all the pediatric fellows who were present on that August day, many years ago. In this clinical newborn encounter, we …

BACKGROUND AND PURPOSE: Fetuses with isolated nonsevere ventriculomegaly (INSVM) are at risk of presenting neurodevelopmental delay. However, the currently used clinical parameters are insufficient to select cases with high risk and determine whether subtle changes in brain development are present and might be a risk factor. The aim of this study was to perform a comprehensive evaluation of cortical development in INSVM by magnetic resonance (MR) imaging and assess its association with neonatal neurobehavior. MATERIALS AND METHODS: Thirty-two INSVM fetuses and 29 healthy controls between 26-28 weeks of gestation were evaluated using MR imaging. We compared sulci and fissure depth, cortical maturation grading of specific areas and sulci and volumes of different brain regions obtained from 3D brain reconstruction of cases and controls. Neonatal outcome was assessed by using the Neonatal Behavioral Assessment Scale at a mean of 4 ± 2 weeks after birth. RESULTS: Fetuses with INSVM showed less profound and underdeveloped sulcation, including the Sylvian fissure (mean depth: controls 16.8 ± 1.9 mm, versus INSVM 16.0 ± 1.6 mm; P = .01), and reduced global cortical grading (mean score: controls 42.9 ± 10.2 mm, versus INSVM: 37.8 ± 9.9 mm; P = .01). Fetuses with isolated nonsevere ventriculomegaly showed a mean global increase of gray matter volume (controls, 276.8 ± 46.0 ×10 mm3, versus INSVM 277.5 ± 49.3 ×10 mm3, P = .01), but decreased mean cortical volume in the frontal lobe (left: controls, 53.2 ± 8.8 ×10 mm3, versus INSVM 52.4 ± 5.4 ×10 mm3; P = < .01). Sulcal depth and brain volumes were significantly associated with the Neonatal Behavioral Assessment Scale severity (P = .005, Nagelkerke R2 = 0.732). CONCLUSIONS: INSVM fetuses showed differences in cortical development, including regions far from the lateral ventricles, that are associated with neonatal neurobehavior. These results suggest the possible use of these parameters to identify cases at higher risk of altered neurodevelopment. ispartof: AMERICAN JOURNAL OF NEURORADIOLOGY vol:40 issue:9 pages:1567-1574 ispartof: location:United States status: published

INTRODUCTION: The first hours of life are still a window of opportunity to identify at-risk newborns, but there are few studies focusing on early neonatal behavior.OBJECTIVE: Describe in a cross section the behavior of newborns born in conditions of low perinatal risk under 48 hours of extrauterine life and compare it with historical referents.METHOD: We studied 47 newborns with low perinatal risk, whose behavior was assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Scores were obtained by item and area, and then were compared with 7 historical referents.RESULTS: Low scores were found, both by item and by areas in up to 25% of the population. NBAS scores were related primarily with age of newborn, weight, and height. Significant differences were found in relation to referents for which higher scores were reported in the majority of cases.CONCLUSIONS: A pattern was found of behavior, in which the same areas or items caused greater or lesser difficulty in achieving higher scores or those which required a certain level of adaptation to the environment, which would lead us to believe that our newborns should attain the scores seen in other populations as they advance in age.

Background/aim: The aim of the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is to gather a comprehensive profile of neonatal functioning by describing the full range of neonatal behavior, including competencies and strengths, as well as difficulties or deviations. This instrument has proved to be of great clinical value by detecting infants at risk for later developmental problems. This work was conducted methodologically with the aim of a Turkish validity and reliability study of the BNBAS. Materials and methods: The study was conducted in a large tertiary hospital in Turkey. After establishing content and language validity, the BNBAS was applied to 380 newborns aged 1–3 days and test–retest analysis was performed for 60 newborns 52–55 days later in the first phase. The validity and reliability study of the BNBAS included behavior and support subscales, while reflex items were not included. Results: In the study, 5 items were excluded from the original BNBAS after the factor analysis. Cronbach alpha was found as 0.974 (30 items). The behavior subscale consisted of 23 items and the support subscale consisted of 7 items. Newborns showed good overall tone and activity level and low amounts of irritable behavior. Conclusion: It may be recommended to use the BNBAS as a valid and reliable measurement tool in neonatal behavioral evaluation by physicians and nurses.

BACKGROUND: The first three years of a child's life are a key period of physical, physiological, cognitive and social development, and the caregiver‐infant relationship in early infancy plays an important role in influencing these aspects of development. Specifically, caregiver attunement facilitates the move from coregulation to self‐regulation; a parent's ability to understand their infant's behaviour as communication is a key part of this process. Early, brief interventions such as the Neonatal Behavioral Assessment Scale (NBAS) or Neonatal Behavioral Observation (NBO) system are potential methods of improving outcomes for both infant and caregiver. OBJECTIVES: To assess the effects of the NBAS and NBO system for improving caregiver‐infant interaction and related outcomes in caregivers and newborn babies. Secondary objectives were to determine whether the NBAS and NBO are more effective for particular groups of infants or parents, and to identify the factors associated with increased effectiveness (e.g. timing, duration, etc.). SEARCH METHODS: In September 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and four trials registers. We also handsearched reference lists of included studies and relevant systematic reviews, and we contacted the Brazelton Institute and searched its websites to identify any ongoing and unpublished studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi‐RCTs that had used at least one standardised measure to assess the effects of the NBAS or NBO versus inactive control for improving outcomes for caregivers and their infants. DATA COLLECTION AND ANALYSIS: Two reviewer authors independently assessed the records retrieved from the search. One reviewer extracted data, and a second checked them for accuracy. We presented the results for each outcome in each study as standardised mean differences (SMDs) or as risk ratios (RR) with 95% confidence intervals (CIs). When appropriate, we combined the results in a meta‐analysis using standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the overall quality of the body of evidence for each outcome. MAIN RESULTS: We identified and included 16 RCTs in this review: 13 assessing the NBAS and 3 the NBO for improving outcomes in 851 randomised participants, including parents and their premature or newborn (aged 4 to 12 weeks) infants. All studies took place in the USA, and we judged all of them to be at high risk of bias. Seven studies involving 304 participants contributed data to one meta‐analysis of the impact of the NBAS or NBO for caregiver‐infant interaction, and the results suggest a significant, medium‐sized difference between intervention and control groups (SMD −0.53, 95% CI −0.90 to −0.17; very low‐quality evidence), with moderate heterogeneity (I(2) = 51%). Subgroup analysis comparing the two types of programmes (i.e. NBAS and NBO) found a medium but non‐significant effect for the NBAS (−0.49, 95% CI −0.99 to 0.00, 5 studies), with high levels of heterogeneity (I(2) = 61%), compared with a significant, large effect size for the NBO (−0.69, 95% CI −1.18 to −0.20, 2 studies), with no heterogeneity (I(2) = 0.0%). A test for subgroup differences between the two models, however, was not significant. One study found a significant impact on the secondary outcome of caregiver knowledge (SMD −1.30, 95% CI −2.16 to −0.44; very low‐quality evidence). There was no evidence of an impact on maternal depression. We did not identify any adverse effects. AUTHORS' CONCLUSIONS: There is currently only very low‐quality evidence for the effectiveness of the NBAS and NBO in terms of improving parent‐infant interaction for mostly low‐risk, first‐time caregivers and their infants. Further research is underway regarding the effectiveness of the NBO and is necessary to corroborate these results.

The Neonatal Behavioral Assessment Scale (NBAS) is a widely used in the neurobehavioral assessment of neonates in clinical practice and research. Lester's data reduction system for the NBAS items is the most often used in research, but the few factor analytic studies carried out with it leave gaps in its validation. The current study aimed to test and compare (a) the factorial structure of the Lester's data reduction system for the NBAS and (b) an alternative data reduction system, slightly modified from Lester's system. The NBAS was administered to 196 healthy Portuguese full-term infants (51% male) in the first 72 h of life (M = 43.63 h). Construct validity of the data reduction systems was tested through confirmatory factor analysis (CFA). Lester's original system was compared to three alternative models, two of which included a revision of the scoring rules for three items and the exclusion of five items. The CFA generally supported the six-factor structure. However, fit indices for Lester's original model were only fair. An alternative, revised model with a second-order factor – Self-Organizing System – demonstrated a better fit. The results provide evidence to support a modified form of Lester's six behavioral clusters as a data reduction model for the NBAS items.

During infancy, cardiac vagal modulation has been associated with attentional and social engagement behaviors. While studies have shown that infants display a behavioral repertoire that enables them to interact with others by being able to regulate themselves in order to attend to and to discriminate emotional and social cues, vagal modulation to sensory stimuli and its association with behavioral outcomes at early ages remains to be addressed. In this study, we analyzed the cardiac vagal response of 1-month-old infants to two auditory stimuli intensities and whether vagal response was associated with social interactive and self-regulatory abilities. Therefore, we recorded cardiac and respiratory physiological responses in 28 infants using a Biopac System. Neurobehavioral assessment was performed using the Neonatal Behavioral Assessment Scale. We observed increased respiratory sinus arrhythmia (RSA) amplitude to both auditory stimuli intensities when compared to baseline. No intensity effect was found for the RSA response. Additionally, we observed that higher RSA amplitude to both auditory stimuli was positively correlated with adjusted self-regulatory behaviors, suggesting a convergence between multiple measures assessing infants’ state regulation. Results are discussed in light of 1-month-old infants’ auditory stimuli processing and its implications for regulatory behaviors and the emergent social-like behaviors., Foremost, we thank all the families and infants who participated in this study. We would like to thank Pedro Hispano Hospital, particularly to Dr. J. Lopes dos Santos, for all the kindness throughout the time that we were there for the data collection process. We thank Maria de Gois-Eanes for all the help and knowledge and Santiago Galdo-Alvarez for the contributions to this study. Furthermore, we thank Associaç ~ao Viver a Ciencia for the Sim- ^ biontes prize in 2013. This work was supported by Fundaç~ao Bial (grant number 42/08) and financed by Fundaç~ao para a Ciencia e Tecnologia (FCT) under a PhD grand (reference SFRH/BD/68263/2010)., info:eu-repo/semantics/publishedVersion

This study analyzed the mediating role of fetal heart rate variability (FHR) on prenatal depression and neonatal neurobehavioral maturity. A sample of 104 pregnant women was recruited and divided into two groups according to their Edinburgh Postnatal Depression Scale (EPDS) scores (depressed/non-depressed). FHR variability in response to speech stimuli was assessed at term (between 37 and 39 weeks gestation). The neonates were then assessed on the Neonatal Behavioral Assessment Scale (NBAS) during the first 5days after birth. The fetuses of non-depressed pregnant women showed higher HR variability than the fetuses of depressed pregnant women in response to speech stimuli, and later as neonates they performed more optimally on the NBAS (on autonomic stability and total scores). FHR variability mediated the relationship between the mother's prenatal depression and the neonatés NBAS performance. Prenatal depression effects on neonatal behavior may be partially explained by its adverse effects on fetal neurobehavioral maturity., This study was financed by “FCT – Fundação para a Ciência e Tecnologia” (SFRH/BD/21956/2005 and SFRH/BSAB/14445/2014 grants). Ministry of Science, Technology and Higher Education in the scope of POCI 2010. Advanced training for science – measure IV.3. Reimbursed by the European Social Fund – Operational Human Potential Program (POPH) – and by national funds of MCTES. This research was also supported by FEDER Funds through the Programa Operacional Factores de Competitividade – COMPETE and by National Funds through FCT – Fundação para a Ciência e a Tecnologia under the project: PTDC/SAU/SAP/116738/2010. This study was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Education and Science through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER‐007653)., info:eu-repo/semantics/publishedVersion

Birth of an ill or premature infant and early separation from the mother on behalf of admission to a neonatal intensive care unit was found to be one of the most important predictors of postpartum depression. The goals of the study were to examine the postpartum depression symptoms frequency in the group of mothers of infants in the neonatal intensive care unit (NICU) at Pediatric Clinic of Ljubljana, and to examine the clinical use of the Neonatal Behavioral Assessment Scale (NBAS) to support the mother-infant bonding and to promote parental competencies. 63 mothers of infants in NICU participated in the study about postpartum depression symptoms frequency and 26 infants and their parents participated in the assessment of the neonatal behavior (12 mothers participated in both parts of the study). The results showed that early hospitalization of the newborn increases the risk of postnatal depression in mothers. The percent of mothers who scored 10 or more points on the Edinburgh Postnatal Depression Scale (EPDS) was higher than the incidence of postpartum depression in Slovenia. Results support the need of a postpartum depression screening tool for mothers of infants at NICU and show that the use of NBAS is a potentially useful tool to promote parent-infant interaction.

This article celebrates Berry Brazelton's extraordinary contribution to our understanding of child development by focusing on two representative themes. The first is that newborns are competent and organized from the very beginning and that the neonate is in a dynamic rather than passive relationship with the environment. The second is the recognition that the newborn period is an extremely sensitive stage in the transition to parenthood and as such may be the intervention "touchpoint" par excellence for professionals who are dedicated to giving children and families the best possible start in life.

This study aims to (a) identify and profile groups of infants according to their behavioral and physiological characteristics, considering their neurobehavioral organization, social withdrawal behavior, and endocrine reactivity to stress, and to (b) analyze group differences in the quality of mother–infant interaction. Ninety-seven 8-week-old infants were examined using the Neonatal Behavioral Assessment Scale and the Alarm Distress Baby Scale. Cortisol levels were measured both before and after routine inoculation between 8 and 12 weeks. At 12 to 16 weeks mother–infant interaction was assessed using the Global Rating Scales of Mother–Infant Interaction. Three groups of infants were identified: (a) “withdrawn”; (b) “extroverted”; (c) “underaroused.” Differences between them were found regarding both infant and mother behaviors in the interaction and the overall quality of mother–infant interaction. The identification of behavioral and physiological profiles in infants is an important step in the study of developmental pathways.

The purpose of the present study was to examine newborns’ behavioral and physiological reactions to the cry of another infant (labeled a reactive cry). 101 newborns of depressed ( N = 40) and non-depressed ( N = 61) mothers were assessed on the Brazelton Neonatal Behavioral Assessment Scale (NBAS, Brazelton and Nugent, 1995 ) and 89 of those infants also participated in an auditory task. Cardiovascular activity (heart period, parasympathetic tone, and recovery to basal activity) was obtained from a sub-sample of these infants ( n = 37). Vocal distress and regulatory behaviors were examined when newborns listened to another infant's cry and to a simulated sound (the control condition). ANOVAs indicated that newborns of depressed mothers showed lower basal parasympathetic tone. In addition, newborns of depressed mothers responded with less vocal distress to the cry sounds of another infant, and were delayed in physiological regulation following this sound. These findings suggest that newborns of depressed mothers show altered, possibly dysregulated, behavioral and physiological patterns during socio-emotional situations in comparison to newborns of non-depressed mothers.

Background: The Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982). Objective: Examine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants. Method: The NBAS was performed in the first week of infant life (3 days±2) and in the seventh week of life (52 days±5). Results: Principal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants. Conclusion: Changes in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale., Financed by the Operational Program Science and Innovation 2010 (POCI 2010) of the III Community Support and co-financed by the European Community Found FEDER (POCI/SAU-ESP/56397/2004; Anxiety and depression in women and men in the transition to parenthood: Effects on fetal and neonatal development and behaviour) and under a FCT PhD Grant (SFRH/BD/18249/2004).

El aumento de los recién nacidos prematuros en los últimos años hace que se incremente el interés por estudiar las consecuencias de este factor de riesgo. En este trabajo se evalúan 30 prematuros (a las 40 semanas de edad gestacional) con la Escala para la Evaluación del Comportamiento Neonatal de Brazelton y se comparan sus resultados con los de un grupo control formado por 28 neonatos a término. Así mismo se comparan dentro del grupo de prematuros el efecto del peso, el sexo y la gravedad de la prematuridad. Los controles muestran superioridad en 9 de los 28 ítems comportamentales de la Escala y en dos de las 5 categorías. Los prematuros muestran superioridad en Habituación. Las niñas muestran mejor ejecución en la categoría Social-Interactiva. Los prematuros se ven afectados por la abrupta interrupción de su maduración intrauterina. Aunque podría haber un efecto de aprendizaje debido a la exposición extrauterina. The increasing number of preterm babies in recent years has raised interest in studying the consequences of prematurity as a risk factor. In the present paper, 30 preterm babies (at 40 weeks of gestational age) were assessed using the Neonatal Behavioral Assessment Scale and the results were compared with those of a control group of 28 full term babies. Moreover, the influence of weight, sex and gestational age was analyzed considering the Brazelton results in the preterm group. The preterm group showed significantly lower scores than the control group for 9 of the 28 behavioral items in the Scale and for 2 of the 5 clusters. However, preterm babies performed better in habituation to disturbing stimuli (light and noise) during sleep. In relation to the influence of sex, premature girls performed better in the Social-Interactive cluster. The preterm group has lower neurobehavioral conditions than the full term group, probably due to the abrupt interruption of their intrauterine maturation. In contrast, they showed a better ability of habituation, maybe as a consequence of a learning effect due to earlier additional extrauterine exposition.

The increasing number of preterm babies in recent years has raised interest in studying the consequences of prematurity as a risk factor. In the present paper, 30 preterm babies (at 40 weeks of gestational age (GA)) were assessed using the Neonatal Behavioral Assessment Scale and the results were compared with those of a control group of 28 full term babies. Moreover, the influence of weight, sex and GA was analyzed considering the Brazelton results in the preterm group.The preterm group showed significantly lower scores than the control group for 9 of the 28 behavioral items in the Scale and for 2 of the 5 clusters. However, preterm babies performed better in habituation to disturbing stimuli (light and sound) during sleep. In relation to the influence of sex, premature girls performed better in the Social-Interactive cluster.The preterm group has lower neurobehavioral conditions than the full term group, probably due to the abrupt interruption of their intrauterine maturation. In contrast, they showed a better ability of habituation, maybe as a consequence of a learning effect due to earlier additional extrauterine exposition.

NICU nurses and developmental specialists have a unique opportunity to facilitate the beginning of a meaningful parent/infant relationship in the NICU setting. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is one tool that can be utilized to support this process. When parents observe this assessment, they learn to recognize and understand infant cues and gain confidence for everyday routines such as diapering, feeding, general caregiving, and even taking that first trip with the baby to the grocery store. Parents become empowered when they discover not only their baby’s amazing competencies, but also their own. In addition, the BNBAS provides a framework through which parents can effectively communicate and advocate for their baby.