This week, a truly great person passed, just a few weeks shy of turning a sharp and incredibly healthy 100 years old.
His name was Dr. T. Berry Brazelton, and he is one of the few pediatricians whose work continues to define much of how we parent today.
Dr. Brazelton certainly had a tremendous impact on my life, even though our paths intersected only briefly. I met Dr. Brazelton during my time as an intern and resident at Boston Children’s Hospital. I didn’t know much when I met him, had little concept of how children develop, or the extraordinary impact this man had on how we think about how we all begin life and emerge.
Dr. Brazelton was born in Waco, Texas in April of 1918, about half a year before the end of World War I. He was a man of extraordinary charm, a true charismatic. At one point in his life, he had the option to pursue a career on the Broadway stage, even being cast in a Broadway show with Ethel Merman! But somehow medicine prevailed, and he became a doctor, and pediatrician.
After training, he and his family bought a home in Cambridge, Massachusetts where he opened a solo practice where he saw children and families for many decades.
Dr Brazelton’s singular observation
In the early 1960’s, Dr. Brazelton made an astounding observation, the one that I believe was the single most influential of his career.
At the time, parents in America were firmly attached to the authoritarian approach to parenting. Like us, like all parents, parents then were devoted to doing the best for their children, which then consisted of enforcing rules. American parents then has little knowledge, or interest in, what their child was thinking or feeling, or their developmental moment. Instead, the concern was that their child would grow up to be a good person, and learning rules was the #1 way to get there. A good example of this approach to parenting was seen in toilet training, where children were expected to poop and pee at very precise times, and faced physical punishment if they did not comply. Many families then demanded their toddler poop at 5PM or face spanking.
In his basement office, Berry Brazelton asked a simple question, what would happen if parents no longer demanded their child poop or pee? Would the toddler ever achieve continence? So, he advised a series of several hundred families to let their toddler figure it out, no guidance. Then he stepped back to see what happened. The results were published in 1962 in the official journal of the American Academy of Pediatrics (AAP): https://www.ncbi.nlm.nih.gov/pubmed/13872676. He also published his findings in various popular magazines.
What he found was that kids did very well on their own, thank you very much. The average age of complete toilet training observed was 18 months old!
This was an astounding observation, for it ushered in a sea change in how every parent thought about being a Mom and Dad. The observation had such a powerful impact that within a few years the approach to toilet training in America was turned upside down, and remains the way we train our children to this day. Instead of physically punitive imposition of authority, parents let go completely and let the child take the lead, and the children delivered! America was continent by age 1 1/2!
Not only did toilet training undergo a true revolution, but all parenting did. This observation from Dr. Brazelton was followed by over 50 years of talking to America about babies, toddlers, children, and parenting. It ushered in the transition from authoritarian parenting to nurturing parenting. From imposing rules, the American parent changed their charge to being experts on child development, filled with wonder at how their children develop, knowing their every need. The new deal was that if the parent could know their child’s thoughts and feelings, and responded at every moment to their needs, the child would develop to their best.
Over the ensuing 50+ years, the average age of toilet training constantly rose, now well over 3 years old. A course correction was clearly needed, and our own sense of what that should entail was summed up in one word, guidance. Yes to the end of authoritarian parenting, and bravo to the emergence of nurturing parenting, but let’s add a dash of guidance to the mix, and take one further step, turn the management of conflicts such as toilet training over to the child to manage. That is the story of our approach in Who’s the Boss, but that’s a story for another time.
But back in the 1960’s the success of Dr. Brazelton’s observation launched a life long career devoted to the observation of how babies live and act in this world. He published dozens of books, became a professor at Harvard, where a professorship on child development remains in his name. He taught dozens of generations of pediatricians.
How I met Dr. Brazelton
I am actually one of many thousands, if not millions, of people who met Dr. Brazelton, but for me it was a very special time that had enduring impact.
After medical school, I was honored to match to Boston Children’s for pediatric training, and in the first year, as an intern, our group was brought in to a weekly session on child development, taught by T. Berry Brazelton. I will never forget how he introduced us to understanding child development. He would hold a newborn in his palm, and engage. That was what happened mostly. He would turn his considerable charm on to the unsuspecting newborn, and the baby would, respond. He would then demonstrate all the wonderful things this baby could do, even at such a very young age- mostly a series of reciprocating grunts and movements.
But the point was that we are born all set to interact, to be in the world, endowed with a rich set of amazing skills, that only expand over time.
Then Dr. Brazelton would teach us the expected steps newborns took on their way to becoming toddlers, young children, school age children, and eventually adolescents and adults.
That was our first year, but he remained our teacher all three years of residency, and maintained a friendship with him from that point on.
When I neared the end of what seemed an endless time of training (I had agreed to pursue an extra three years of training, in neonatology), I had to decide whether to pursue my first love, the practice of pediatrics, or the career I had in front of me, research and academia. I went to Dr. Brazelton for help, and he had me over to his home, his home practice, and we chatted. That conversation was instrumental in my making my decision, I remain grateful to him to this day.
But I remain mostly grateful for the wildly charming and enthusiastic approach to connecting to young children he shared with us, imbuing each of us with a very deep sense of the humanity of people, even at their very beginning.
The Legacy of Dr. Brazelton
I will close with two thoughts on the impact of Dr. Brazelton.
The first is the truly unique impact he had on every parent in America, and around the world. As noted above, he played an outsize role in turning parenting from an exercise in punitively imposing rules, into an exploration of what a child’s mind is up to at any particular stage and how to connect with that mind. We see the impact of this revolution every time a parent today attempts to get their child to sleep through the night, toilet train, follow rules (still an important issue). The entire notion of attachment parenting owes its origins to Dr. Brazelton’s work.
The other impact I acknowledge with the greatest gratitude is the impact he had on my development as a pediatrician. I am so grateful our paths crossed when they did, allowing me to look at child development in an entirely different way that continues to define much of how I think and relate to it. Over time I would work with Ms. Susan Glaser to develop the approach to offering guidance in early childhood, but the foundation remains the nurturing model of parenting Dr. Brazelton brought to the world with such success.
Dr. Brazelton touched the lives of millions, I remain grateful I was one of them.
And, now, on the occasion of his passing, it is only right we all take a moment to give our thanks.
To your health,
Dr. Arthur Lavin