At the outset of a Zoom visit with 7-week-old son James in my behavioral pediatrics practice, his mother Sondra explained to me that he is “stiff because of my medication.” While feeding him a bottle she told me she was unable to breastfeed due to the effects of MAT (medicated assisted treatment, now called medication for opioid use disorder, or MOUD.) It was not concern about her current use of methadone, which is widely considered to be safe for breastfeeding, but rather the in-utero exposure. Yet when I asked about the pregnancy and delivery, I learned that James had not had any withdrawal symptoms, had not required any treatment, and had gone home from the hospital in 2 days. I wondered about the certainty of her conviction that what she called “stiffness” was related to her medication. But at this point in the visit, I didn’t know. Certainly, it was possible. I decided to take a bit of a risk. What might we discover if we observed his movements together?
I suggested she lay him down on a blanket where we could watch him. She unwrapped him and carefully placed him on the floor. We both immediately noticed how with his extremities free, he straightened out his arms and legs as Sondra talked to him. I wondered if his movements might reflect a communication with her. As she continued to speak in a soft, lilting voice James moved his arms as if to reach for her. In what I call a “Trevarthan moment” he offered evidence for infant researcher Colwin Trevarthan‘s discovery of purposeful movements in newborn infants. As if in response to his gesture, she spontaneously picked him up. He again extended his arms and legs as he turned to her voice before folding himself up in her arms. “Look how he likes to curl up. He knows how to comfort himself.” she remarked with delight, “He’s such a little person already!” She now saw his movements not as her failure but as his strength.
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