Newborn Behavioural Observations System (NBO)

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Introduction

Much of the literature surrounding the theory of attachment and infant development agree that the relationship between caregiver and infant is an essential component in the development of confidence, self-regulation, adaption to stress and forming future positive relationships. Furthermore, research has highlighted the importance of an attuned caregiver in aiding the positive development of a child's brain and physiology in the first year of life.

Dr T Berry Brazelton first developed the Neonatal Behavioral Assessment Scale (NBAS) in 1978 as a way of assessing 1. neurological functioning in the newborn and 2. their ability to actively participate in interactions. The Newborn Behavioral Observations (NBO) system is the shorter clinical variation of the NBAS and was first published in 2007.

The NBO is a strengths-based and infant-led form of assessment, with the outcome being an individualised description of an infant's neurobehavioral capabilities. It is currently used as an "interactive relationship-building tool to strengthen the relationship between infants and parents".

Objective

The objective of the NBO is to encourage parent education and active care-giving. It is a tool used to direct a caregiver's attention to an infant's behaviour and develop an understanding of meaningful communication through an infant's behaviour. It allows for the development of handling and caregiving techniques that caregivers can use in the home environment to respond to infant behavioral cues.

The NBO is also used within the research setting to:

1. Explore the associations between observed infant behaviours and other variables
2. Establish the effectiveness of the tool in influencing infant and caregiver outcomes.

Intended Population

The NBO can be performed with healthy newborns (gestational age of 36 weeks) to 3 months "post-term". Preterm or medically fragile infants can also have the NBO administered, but need to be stable enough to be close to discharge or who are already at home, post-discharge. infants (newborns to 3 months of age) together with their caregivers.

Both low-vulnerability and high-vulnerability families have been considered when designing the NBO system. In addition, caregiver's are not limited to mothers or fathers, but include all those who take on a care giving role of the infant.

Administration

Environment/Setting

The NBO is a flexible tool that can be used in the clinical setting, at home, at the hospital or even a children's centre.

Duration of assessment

The duration of the assessment is usually 20-30 minutes.

Frequency of administration

The NBO can be administered once, however, depending on the goals set for intervention and needs of the family, it can be administered weekly, fortnightly or monthly. Being able to perform more than one administration allows for a more holistic picture of the infant and their development. It also allows caregivers and clinicians to discuss appropriate reciprocations to the baby's responses for such things as feeding and sleeping.

Content

The NBO consists of 18 neurobehavioral observations.

1. Habituation to light.
2. Habituation to sound.
3. Muscle tone in legs and arms.
4. Rooting.
5. Sucking.
6. Hand grasp.
7. Shoulder and neck tone.
8. Crawling response.
9. Visual tracking.
10. Visual response to face.
11. visual response to face and voice.
12. Orientation to sound.
13. Orientation to voice.
14. Crying.
15. Soothability.
16. State regulation.
17. Response to stress.
18. Activity level.

Evidence

In a Cochrane review evaluating the effectiveness of both the NBAS and NBO, it was concluded that current studies (1981-2015) were of low-quality evidence.

Links

The Newborn Behavioral International site has links to research dealing with the NBO.