Reading the body language of infants

Heidelise Als forced a paradigm shift in treating premature babies based on their body language. (Evan Richman/Globe Staff)

Heidelise Als is big on the idea of listening to body language, which is fitting because Als is easy to read. Her arm movements tell you a lot. With two simple gestures, she's almost capable of telling you her life's story.

The first one is the cradle, where Als mimes the act of a mother holding an infant close to her chest. Her arms are both tense and soothing during this gesture - which she does quite often when talking about her work - because she's making it clear that this is perhaps the most important and delicate thing a human will ever hold, so hold on tight.

The second gesture, the one that neatly jumps her career ahead through the decades, is the universal symbol for "Why?" Arms are out to the side, shoulders shrugged. As she tells her story, she makes this gesture a lot, too.

It's been said that Heidelise Als revolutionized the field of neonatology, forcing a paradigm shift in the entire idea of how we care for premature infants. And she did so not as a physician but as a psychologist who constantly asked why we weren't reading the body language of the infants who "will tell you what works for them in no uncertain terms."

Als, who at 67 is the director of neurobehavioral infant and children's studies at Children's Hospital Boston, actually began her career as a teacher in her native Germany. Teaching was satisfying and paid the bills, she said, but her real passion was observing children.

"I've always been fascinated by the differences between children," Als said recently sitting in the neurobehavioral studies room at Children's, where researchers will observe children's behavior from behind one-way mirrors. "How did they get there? Why is life a challenge for some people while other people thrive?"

To answer this "why?" she left Germany for graduate school at the University of Pennsylvania, where she studied everything from the differences in twins to how primate mothers teach their young by "show and tell." But there were two things that drastically changed how she thought about childhood development.

The first was her thesis research, where she observed every second of the interactions between 50 new mothers and their babies from birth until the time they left the hospital a few days later. And the second was when she gave birth to her son, Christopher, who suffered significant birth trauma and brain damage. (Now 42, Christopher lives at Camphill Village, an acclaimed group home for the developmentally disabled in upstate New York).

Though each baby was different, she found that they were all telling their mothers what they needed through their body language, eliciting the parental behavior that would allow them to find their unique pleasurable balance. "What this told me was that we don't fit the child to the environment," she said. "We fit the environment to the child."

After coming to Children's Hospital in 1973, she began to observe those signals in neonatal intensive care units, and was shocked by what she saw. Infants were often strapped down, unable to move, with tubes down their throat and IVs in their arms, under 24-hour fluorescent lights with loud monitors and staff shouting to be heard over the monitors, and the parents were usually not allowed to touch their children. Als wondered how the brain development was affected by this disregard for the infant's "pleasure."

"It was clear that they didn't like what people were doing to them," she said. "They'd curl up, fight, swipe at the hands of the doctor. I was stunned by their behavioral messages of discomfort, but the medical community said it didn't matter, that they didn't have enough brain development to feel pain. The lung was all that mattered."

It was then that Als launched the next generation of the NICU, according to Dr. Bob White, a neonatologist at Memorial Hospital in Indiana who is chairman of an international committee that writes the standards for NICU design. "She led the charge out of the 'lung' phase, away from 'Let's just keep babies alive' to 'Let's also take care of this wonderful fragile brain we have in our care.' It was a paradigm shift that revolutionized the field."

Als set out to show that it wasn't dangerous to allow the baby to turn onto its side to get comfortable, to cover it in a blanket, to dim the lights, to make the environment calm and quiet. Not only was it not dangerous, her research found, but it was better for the babies, who came off ventilators and feeding tubes faster and did much better behaviorally.

Working with her husband, Children's neurologist Frank Duffy, she demonstrated, through EEG readings, that these measures had a positive impact on brain development.

Similar research, with similar findings, would lead Als to create the Newborn Individualized Developmental Care and Assessment Program. The program, which has 10 domestic and seven international centers, trains caregivers on how to observe and interpret infant behavioral cues, and to structure their care and environment to best support the infant's self regulation.

Als is proud of her achievements, but she's not the sort to get serious and reflective when asked to assess her place in history. She's more the giggly type, exhibiting a constant display of an almost goofy infectious warmth.

But it's clear she's taking the question seriously because, as she ponders her answer, she reclines in her chair and begins to cradle her arms.

"I guess you could say that I've helped change the lives of infants and families in the NICU. That's what it boils down to." Then she blushes and smiles again.

"It's a tiny piece in the larger view of the world, but it's a piece. And it's a piece I wouldn't do without."

Hometown: Krumbach, Germany; lives in Brighton.

Education: Studied pedagogy at the University of Eichstätt, graduating in 1963; at the University of Pennsylvania, she earned a master's degree in education in 1968, and a PhD in developmental psychology in 1975.

Hobbies: Als says her hobby is their home in Tunbridge, Vt. "We built it ourselves, and I have a garden with flowers and dogs and cats and sheep and horses."