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"It's being integrated into nursing practice pretty widespread," said Ann Stadtler, MSN, CPNP, director of the nonprofit Brazelton Touchpoints Center at Children's Hospital in Boston. "In 1995, this was a pilot program for nurse practitioners. Since then, we've found [all] nurses have really taken to this approach."

The namesake of the program, Brazelton, is an author and professor emeritus at Harvard Medical School. Thirty years ago, he helped establish the pediatric training and research center at Children's Hospital in Boston.

Brazelton, who some credit as the country's most influential pediatrician since Benjamin Spock, MD, is best known in research circles for his development of the Brazelton Neonatal Behavioral Assessment Scale in the 1970s. The "Brazelton" is used worldwide to test physical, neurological and emotional responses in newborns.

Baby highlights

Brazelton's Touchpoints model theorizes a series of milestones that describe the development process of children from newborn to age 3, before language skills develop. Touchpoints also focuses on changes in parents.

For instance, the "newborn touchpoint" is a stage when new babies begin their initial attachment to parents, while the emotions of the mother and father simultaneously depart from the "idealized children of their imaginations" as they grasp the child's gender, size and temperament, according to Brazelton.

At the three-week Touchpoint interval, babies are establishing how they react to parents' caregiving. At the six- to eight-week period, parental self-confidence grows as infant feeding and sleeping habits are stabilizing and the baby begins to engage with its environment.

Touchpoints follows the child through the third year, when talking begins to dominate the child's mode of expression. Instructing parents in Touchpoints ideas provides them with a basis of understanding the fits and spurts of changes they'll experience with their child's early development, according to the program.

Brazelton's reputation is what attracted Smith to the Touchpoints program. She went to Boston for the individual training session offered by the Touchpoints Center, and later returned to be trained as a Touchpoints instructor herself.

Harris Methodist's Education Center formally implemented the Touchpoints model in its mother/baby nursing unit, training 17 nurses in the program. The hospital eventually plans to train all 450 nurses who work in its center for obstetrical, perinatal and neonatal care.

Smith held a training session for nurses and child care professionals in June, teaching not only nurses from Harris, but also nurses from Cook Children's Health Care System of Fort Worth. For two days at a church recreation building in nearby Arlington, Smith walked her class of 30 to 40 students through the 13 Touchpoint milestones designated in Brazelton's course. In addition to videos, lectures and question-and-answer sessions, the attendees also enjoyed personal visits from parents and their children for live demonstrations.

Twenty-month-old Julian arrived apprehensively in the play area of the center, overwhelmed by the sight of so many strangers around him. They watched Julian interact with his father and a Touchpoints program coordinator before slowly enthralling himself with books, balls and stuffed animals. The students noted his diminishing shyness, though still needing to stay within a zone of comfort near his father.

"We point out the little things the child is doing, and why," Smith said. "And we not only look at the development of the child, but the development of the parent."

Improving the relationship between parents and children is the base goal of Touchpoints, but the first step in achieving that goal is improving the relationship between the nurse or doctor and the parents. Nurses said Touchpoints teaches them how to defer to parents, who sometimes feel excluded or powerless in deciding the direction of care for their child.

"It makes really good sense in building relationships with people you're caring for," Smith said. "These people are going to come back for more appointments, be more satisfied with their care [and] they're going to tune in to their babies more."

Kathleen Stuckly, RN, a neonatal nurse for Harris Methodist trained in Touchpoints, said parents are understandably reticent to interfere with a health care provider's treatment of their children, but sometimes that caution ushers in a guarded, psychological barrier especially evident with premature and sick babies.