Connected Caregiving

Carol Gray Describes Connected CaregivingThis is part five of the Tribute to Magda Gerber series.

It is important for babies to explore their worlds with some degree of independence. However, they are still babies and we must do certain things for them. Many of these activities fall into the category of caregiving. These are things like diapering, pottying, dressing, grooming, bathing and feeding.

Magda got her infant/child development mentoring with Emmi Pikler, pediatrician and director of Loczy, now known as the Pikler Institute in Budapest Hungary. Loczy was founded in 1946 as an orphanage for children whose parents had died in World War II. Today it mostly serves social orphans – some are abandoned. Others are children whose parents can’t take care of them due to things like poverty, drug abuse or mental illness.

One of the challenging things about orphanages is that there are more babies than caregivers. At Loczy they worked hard to develop caregiving routines that maximized interaction, focused attention on the child and fostered cooperation. At Loczy they  found that when the children got the individual attention they needed from one special adult they were better able to form secure attachments, develop relationship skills and prepare for a transition to family life.

Way back when – Magda taught me her method of cooperative, language-rich diapering. It took me longer than usual, but when I understood the benefits I was on my way to becoming a reformed speed-diaperer.

Here’s how it works: The caregiver tells the child that it’s time to change the diaper and waits for a response. In fact, every step of the way the caregiver tells the child what is going to happen next.  She asks for cooperation and waits for a response, “Please hold your legs up. I’m going to wipe you off.”

The diapering table is set up so that the baby and caregiver are face-to-face with the baby’s feet against the caregiver’s belly. This is distinctly different from the sideways set-up of most American changing tables.

The baby and caregiver participate in a mutual exchange. The baby is offered appropriate choices, “Do you want to wear the pink or the blue diaper wrap?” The baby gets focused attention. When the diapering is over the baby is free to return to another activity. Because his attention needs have been met, the baby will have less need for adult participation during the next activity (usually what we call free play).

In an institutional setting this works great because the caregiver probably has a few babies to look after. One at a time they can get their diapers changed and then go on to something else without any further adult intervention.

But why bother trying this at home?

I think it makes sense to give concentrated attention during caregiving activities that have to be done anyway. We might as well, right? Asking for cooperation and expecting the baby to participate, even at a very young age, fosters increasing cooperation over time. Babies who are tended in this way avoid those diapering (or other care-giving) power struggles later on.  Last, it helps give babies the confidence to be more independent at other times – like when they are working on motor skill acquisition.

Of course, this model can be applied to any caregiving activity, “Are you hungry? Do you want to nurse? OK wait just a moment while I get ready. Now open your mouth wide. Thank you.”

A silent, swift, efficient caregiving moment is a lost opportunity.

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