Assessment of behavioral dimensions of newborns.: Reactive, creative , reflexive and ,may be, passive behaviour

1. Definition of Newborn
A newborn infant, or neonate, is a child under 28 days of age. During these first 28 days of life,
the child is at highest risk of dying. It is thus crucial that appropriate feeding and care are
provided during this period, both to improve the child’s chances of survival and to lay the
foundations for a healthy life.
Behavior:
It may be defined as the way in which one acts or conducts oneself, especially towards others.
It is the way in which an animal or person behaves in response to a particular situation or
stimulus. And in case of a newborn behavior may be defined the way it functions and attains
different stages of growth and development.
Importance of Newborn Behavioral Assessment:
Newborn, or neonatal, deaths account for 45% of all deaths among children under 5. The
majority of all neonatal deaths (75%) occur during the first week of life, and between 25% to
45% occur within the first 24 hours.The main causes of newborn deaths are prematurity and
low-birth-weight, infections, asphyxia (lack of oxygen at birth) and birth trauma. These causes
account for nearly 80% of deaths in this age group.Up to two thirds of newborn deaths could
be prevented if skilled health workers perform effective health measures at birth and during the
first week of life.
Thus assessment of the newborn is very vital. While babies may not speak their first word for
a year, they are born ready to communicate with a rich vocabulary of body movements, cries
and visual responses: all part of the complex language of infant behaviour.All newborn babies
are routinely examined by a pediatrician within the first 24 hours of life and again prior to
discharge to home. A general appraisal of the baby's color, overall appearance, muscular
activity and response to handling are made throughout the examination. A professional
examination will certainly include sensing the sensing capacities of the newborn. Thus, special
senses and behavioral patterns are assessed and evaluated in order to establish normality of the
baby. If there are variances from the normal patterns, it’s assessed accordingly a response is
devised and designed to address it.
What and how newborn Behavior is assessed:
A professional assessment scheme must reveal the individuality of then newborn. By the end
of the assessment, the examiner must have a behavioural "portrait" of the infant, describing the
baby's strengths, adaptive responses and possible vulnerabilities. The examiner shares this
portrait with parents (and other stake holders) to develop appropriate caregiving strategies
aimed at enhancing the earliest relationship between babies and parents and other stakeholders.
Though newborns seem vulnerable, yet they are highly capable when they are born. "A
newborn already has nine months of experience when she is born," Dr. T. Berry Brazelton, the
developer of the Neonatal Behavioural Assessment Scale (NBAS) proclaims. The newborn is

2. capable of controlling his/her behaviour in order to respond to her new environment.
Babies "communicate" through their behaviour, which, although it may not always seem like
it, is a rational language. Not only do infants respond to cues around them, like their parents'
faces, but they also take steps to control their environment, such as crying to get a response
from their caregivers. Newborns are social organisms, individuals with their own unique
qualities, ready to shape as well as be shaped by the caregiving environment.
Thus professionals have developed standard procedures (e.g., scales) to assess the newborns:
they need to be assessed physically and neurologically to portrait a picture of the potentialities
(or the absence of them) of the baby. The examiners are trained to get the best performance
from the child by doing everything possible to support the infant in "succeeding." For example,
one part of the exam looks at an infant's ability to self-console when she is upset. Some infants
console themselves easily, while others have a more difficult time. If the infant cannot console
herself, the examiner takes measured steps to help her. Not only do we learn how much support
the infant may need at home, but also how far along the child is at completing her
developmental agenda.
By the end of the exam, the examiner has developed a vibrant portrait of the newborn, which
can be used to tailor caregiving to the baby's specific physical needs and behavioural style.
Does the baby like to be handled? Is the baby receptive to social interaction? Does the baby
easily calm herself? These standard scales must give a peep into the possible and, may be, a
designer future of the newborn. A professional may study and assess the baby through
(A) Special Senses and,
(B) Reflexes
as explained below:
(A) Special Senses and Behavior Patterns
Vision
The structures necessary for vision are present and functional at birth although immature. The
baby is sensitive to bright lights, which cause him/her to frown or blink. The body demonstrates
a preference for black and white patterns and the shape of human face. The newborn’s focusing
distance is about 15-20 cm which, allows him/her to see the mother's face when being nursed.
He/She can track a moving object briefly within the first five days.
Hearing
The baby turns the eyes towards sound, comforted by low-pitched sounds. High-pitched sounds
make him uncomfortable. A sudden sound elicits a startle or blink reflex. He/She prefers the
sound of the human voice to other sounds. The baby can discriminate between voices and
prefers the mother's. This too, promotes mother-baby interaction (De Casper and Fifer, 1987).

3. Smell and Taste
Babies prefer the smell of milk to that of other substances and show a preference for human
milk. Within a few days, the baby can differentiate the smell of his/her mother's milk. The baby
turns away from unpleasant smells. His/Her preference for sweet taste is demonstrated by
vigorous and strong sucking and a grimacing response to bitter, salty or sour substances
(Blackburn and Loper, 1992).
Touch
Infants are acutely sensitive to touch, enjoy skin-to-skin contact, immersion in water, stroking,
cuddling and rocking movements
(Blackburn and Loper, 1992). A puff of air on the baby's face induces an inspiration or gasp
reflex. His curving response to touch and the gasp reflexes enhance his/her relationship with
the mother. The baby withdraws from painful stimuli, bulges his brow and nasolabial furrow
and may cry vigorously (Rushforth and Levene, 1994).
Sleeping and Waking
Following the initiation of respiration at birth, the baby remains alert and reactive for a period
of approximately 1 hour after which the baby relaxes and sleeps. The length of this first sleep
varies from a few minutes to several hours. Subsequent sleeping and waking rhythms show
marked variations and the baby takes some time to settle into his/her individual pattern.
Initially, waking periods are related to hunger, but within a few weeks, the waking periods last
longer and meet the need for social interaction.
Two sleep states are identifiable:
Deepsleepin which the baby's eyes are closed, respirations are regular, no eye movements are
present, response to stimuli is delayed and is quickly suppressed. Jerky movements may occur
at intervals.
Light sleep in which eye movements could be observed through the closed eyelids.
Respirations are irregular and sucking movements occur intermittently. Response to stimuli
occurs more readily and may result in alteration of sleep state. Random movements are noted.
Awakening states
A wider range of awakening states is observed, ranging from drowsiness to crying.
Drowsy state: The baby's eyes may be open or closed with some fluttering of the eyelids.
Smiling may occur. Limb movements are generally smooth, but are interspersed by startle
responses.
Quiet alert state: Motor activity is minimal, the baby is alert to visual and auditory stimuli.
Active alert state: The baby is generally active and reactive to the environment.
Active crying state: The baby cries vigorously and may be difficult to console. Muscular
activity is considerable.
Remarks

4. The amount of time that the baby spends in which state varies and influences the way in which
he responds to stimuli, whether visual, auditory or tactile (Brazelton, 1984).
Crying
Crying is the way in which the baby communicates discomfort and summons assistance.With
experience, it is possible to differentiate the cry and identify the need, which may be hunger,
thirst, pain, general discomfort
[for example, wanting a change of position or feeling too cold or too warm), boredom,
loneliness or a desire for physical or social contact. The mother needs to learn how to comfort
her baby. Rocking induces sleep, and swaddling and upright position appear to be soothing
(Downey and Bidder, 1990).
Growth and Development
Because of physical limitations, the baby is dependent on the mother (or other care
Giver) for his/her continued growth, development and survival. These will progress
satisfactorily only if the baby is in a safe environment, the nutritional needs are met and the
psychological development is promoted by appropriate stimulation and loving care.
Abnormality of the baby's body systems
Inadequate nutrition or emotional deprivation will compromise the baby's ability to grow and
develop to his/her full potential.
His relatively immature organ functions and vulnerability to infections and hypothermia
demand that care must be designed to meet the needs and capabilities.
(B) Reflexes:
The baby's reflex responses are elicited in order to establish normality of the nervous system.
These are
Rooting Reflex: It is a primitive reflex. If the cheek is rubbed, the infant will turn his head into
that direction of the stimulus.
Sucking reflex — it develops at 32-36 weeks of gestation. If sucking reflex is poor it indicates
the baby is premature or there may be some difficulty in swallowing.
Moro's reflex/startle reflex — it can be assessed in two ways:
(I) The baby should be held supine over the right hand and arm. The flexed head is
suddenly allowed to drop by about 30°. A Positive response consists of rapid
abduction and extension of upper limbs and opening of hands followed by slower
addiction and flexion or embrace equivalent
(II) Place newborn on a firm surface and make a loud sound by banging the
examination table. The limbs will extend and then flex.
This reflex is useful to evaluate the alertness, muscle tone and hearing of the baby. This reflex
should be assessed last, as the infant will start crying.

5. Stepping/dancing Reflex- Place the child in standing position near the table, the feet will touch
the table and flex alternately by both legs giving an appearance as if the baby is dancing. It
disappears by 1-2 months.
Doll’s eye Reflex — Turn the head of the infant. The eyes move in the opposite direction. It
disappears once the Child is able to focus. .
Tonic neck reflex — When infant’s; head is quickly turned to one side, the extremities on that
side extend and those on opposite side will flex.
Grasping reflex —put your finger near the child's palm; the child closes its finger around it.
If finger is placed near the toe, they curl around the finger.'
Babinski reflex —when a stimulus is given to the plantar surface. Stroke the sole of the foot
beginning at the heel. Stroke upward along lateral aspect of the sole then move finger across
ball of foot. There is dorsiflexion of the large with fanning of other, toes.