Neonatal Behavioral Assessment Scale

The Neonatal Behavioral Assessment Scale (NBAS) can be regarded as the most detailed exam available focusing on prenatal behavior. It is increasingly used worldwide, both in research and clinical work.

Originally developed by Prof. Berry Brazelton and his colleagues in 1973, NBAS was designed to document the newborn's contribution to the parent-child system (which is extremely dynamic from an emotional and communicational viewpoint). In short, it wishes to understand the baby's language. Although babies do not speak during their first year of life, it is a fact that they are born ready to communicate through a vocabulary of body language, cries and visual responses. All these elements form the complex language of the baby's behavior.

Recurrent clinical usage of this assessment, and the different scientific studies that have been carried out in the past years - under different circumstances and by different technicians - have led to the conclusion that parents can be supported by what professionals share with them from the NBAS. This support will favor the baby's needs and provide the infant with a sensitive environment that helps promote its future organization, better suited to the baby's interaction with its surroundings.

This scale - used to assess newborns and babies up to two months old - admits a wide array of behaviors, and provides a behavioral 'portrait' of the child that - given certain stimuli - shows its strengths, adaptive responses and possible vulnerabilities.

This discovery is shared with the parents, so as to develop care strategies and pave way for a better baby-parent interrelationship. It therefore constitutes a practical guide of the utmost importance, which can help parents, health/education professionals and researchers understand the newborn's language, i.e. better understand the baby as a person.

With 28 items on behavioral repertoire and 18 reflex items focusing on the neurologic states, observations made using this scale do not provide a single result, but assess the baby's idiosyncrasies in a number of dimensions (autonomic stability; motor organization; state organization; and the quality of the infant's attention/interaction), whilst describing how the child incorporates them when interacting with the new environment.

The Newborn Behavioral Observations (NBO) system monitors the newborn behavior. It is based on over 30 years of NBAS research and clinical practice and is a simpler version of baby observation that focuses more on a kind of clinical intervention that is sensitive to the shared discovery of the baby's individuality and the construction of a therapeutic alliance with the parents.

The NBO system offers a significant opportunity to support parents in their transition to parenthood by helping them discover the baby's singularity, capacities, preferences and any areas that may require support. It's a baby focused and family centered observation helping parents to understand their child's behavior, promoting parent trust and positive interactions between parents and baby, thus contributing towards their attachment and to a sense of coherence and healthy development of the baby.

The NBO system can be used from birth until the baby is three months old, and in a variety of clinical contexts. It consists of 18 behavioral items that allow us to observe:
  • 1) Baby's capacity to adjust to sound and light stimuli;
  • 2) The quality of motor tone and activity level;
  • 3) The capacity for self-regulation;
  • 4) Baby's response to stress;
  • 5) Baby's visual, auditory and interactive capacities.