From the beginning of children's lives, fathers handle babies differently than mothers do. At first glance, one might think that men's and women's differing levels of experience with infants might explain differences in handling, but close observations document that even men who are very experienced with children handle them differently from women. Read this article to learn more.

Written by Kyle D. Pruett, M.D., Yale Child Study Center, New Haven, Connecticut. Edited from the Zero to Three Journal, August/September 1997 (Vol. 18:1)

There Is No Such Thing as a Fatherless Child

Children whose fathers are not in their daily lives start looking for their fathers as soon as it becomes clear to them that kids have moms and dads, even though their dad may not be immediately obvious. As a clinician and researcher observing the connections that young children seek from the adult world, I’ve seen the search countless times: Children who can’t find their fathers make one up or appropriate one to their liking, whether or not they call him “Daddy.” In a young child who has not felt some form of masculine nurture, the hunger for a paternal presence can be insatiable.

It is the presence of this hunger, beginning so early in children’s lives, that tips us off to the overall significance of men in the lives of developing children. As a well-known maxim about the early years reminds us, appetites tend to serve the survival and well-being of the infant. The child’s hunger for a father is no different.

The discussion that follows will review what we have come to understand about the unique contribution that men bring to the lives of young children, and how male presence works to promote development. We will also discuss how ongoing nurturing interaction with their own and other people’s children affects men—often profoundly.

Much of the literature of the past several decades that has focused on men and young children focuses on biological fathers specifically. But to the child, emotional paternity is what matters, and it is the child who eventually designates emotional paternity. Consequently, “father-effect” research is likely to be more meaningful if we assume that the literature addresses the psychological, or “life” father, rather than the “birth” or biological father. Fathers do not “mother” any more than mothers ever “father.” In their dealings with young children, men tend to resemble other men much more than they do women—whatever the biological relationships between the men and the children may be. From the beginning of children’s lives, fathers handle babies differently than mothers do. At first glance, one might think that men’s and women’s differing levels of experience with infants might explain differences in handling, but close observations document that even men who are very experienced with children handle them differently from women. Not better not worse, but differently. How does this happen? And what difference—if any does it make to the baby?

The Transition From "Male" to "Father"

Because it has been studied in some depth, the transition from “male” to “father” may be the best place to begin looking for answers to these questions. This transition is a very complex task, both psychologically and physically. Across many cultures, men are often profoundly involved in pregnancy and delivery. Their physiological involvement may range from weight gain to migrating aches and pains in the abdomen and mouth. Everyone knows about the food cravings of pregnant women, but their male partners have almost as many—especially for dairy products. In Mexico’s Yucatan peninsula, a woman’s pregnancy is considered confirmed when her spouse begins to crave carbohydrate-rich foods. Many expectant men experience increased —sometimes overwhelming—anxiety about being an adequate provider and protector, not to mention a competent nurturer. Dreams can change, indicating an important reorganization of the expectant father’s own inner world.

But in the transition from male to father, for sheer economy of effect nothing quite matches the value of being present at the birth of one’s own baby. (This is not to say that to miss it is to forever be left behind, as there are many opportunities to catch up.) The birthing experience gives a father, especially one who is new to the role, a leg up on becoming attached to his baby in a way that is unique to him and his own feelings about the child. This is something quite different from being just a mother’s helper. The power of being there as a witness to the birth holds whether the father has had the chance to prepare for the event or not. He may be more comfortable with the physical event of birthing if he has been prepared, but the attachment experience between father and newborn seems to be an intrinsically powerful one.

Greenberg’s classic study of the impact on fathers of witnessing their children’s birth found that those who were present at delivery more accurately described their babies’ moods and temperament and gave richer descriptions of their personalities at 3 and 6 months (1974). He used the term “engrossment” to describe the phenomenon of fathers who felt “so in love” with this being they had never met, wanting (often to their own amazement) to spend hours gazing at or touching their newborns.

But the period immediately after birth can find fathers vulnerable as well as engrossed. We are often so anxious to affirm a close and uninterrupted attachment between baby and mother that in the service of early “mother—infant bonding” we unwittingly disrupt the baby’s early connection to father. Fathers so often feel that they should - or are directly told to - back off from mother and newborn that some observers call the baby’s first three months of life the “fourth trimester” of pregnancy, as far as the father is concerned. Zaslow (1981) reports that two-thirds of first time fathers describe having some form of “the blues” during this time period. They feel less control over their own lives, inadequate to the task at hand, and marginalized in their relationship with their spouse. Interestingly, the best treatment for fathers’ depressed mood was more contact with the baby.

The vulnerability of new fathers can be hard for new mothers to fathom. A new mothers is anxious to enjoy and practice her new maternal competence. Having her baby respond to her care of him or her is the best antidote to all her worry and concern about her inadequacy. Precisely the same is true for fathers. But since so many mothers have had practice in caregiving before having their own babies, and because they feel the enduring pressure of culture and society to demonstrate their competence, they feel particularly invested in practicing to “get it right.” When this is overdone, father can feel excluded and back off. In short order, the mother has the exclusivity she wants, but she has unwittingly lost her most important partner in care of the child.

Francis Grossman describes this very common phenomenon as “gatekeeping”: The mother “allows” the father into the child’s life to perform certain tasks she deems him adequate to accomplish, rather than supporting the father in developing his own unique and lasting attachment to the child, based on their mutual experience.

Does Paternal Care Matter to Babies?

If fathers have the capacity to nurture their children competently but differently from mothers, does this matter to the children? Apparently so, according to two decades of research. Eight-week-old infants can discriminate between their fathers and their mothers, and respond in a differential way to their approach. Yogman (I981) compared videotapes of comfortably seated infants’ response to their mothers’ approach and their fathers’. In anticipation of their mothers’ picking them up, babies settled in, slowed their heart and respiratory rates, and partially closed their eyes. When they expected their father to hold them, babies hunched up their shoulders, widened their eyes, and accelerated their heart and respiratory rates.

It is important to contemplate what this capacity is doing there in the “wiring” of the 6-to-8-week-old infant if we are to understand babies’ and fathers’ special responses to each other. These subtle face-to-face differences in play, modulation, verbal and physical contact are mutually appreciated by the child, the father, and the mother. They justify the father’s feeling that his relationship with his baby is irreplaceably special. A 17 year-old brand-new father was “blown-away” when his baby opened her eyes wide in response to his reaching down to pick her up. He asked his daughter, “I’m not your momma-and you still want me?” This tiny bit of encouragement from his baby touched him and kept him coming back for more.

Positive Effects of Male Involvement on Children's Development

Male involvement, supported by responses from babies and women, has measurable, positive effects on the development of children. Studying the effects of fathers’ participation in the daily care and physical maintenance of infants, Pedersen and his colleagues found that the more actively involved a 6-month-old baby had been with his or her father, the higher that baby scored on the Bayley Scales of Infant Development (Pedersen, et al, 1980). Examining 2-month-old infants from middle income, two-parent families, Parke and Sawin (1975) found that the more fathers participated in bathing, feeding, diapering, and other routines of physical care, the more socially responsive the babies were. Furthermore, a year later these babies seemed more resilient in the face of stressful situations.

Male involvement has positive effects on the development of vulnerable, as well as typical, infants and young children. In their studies of preterm infants, Gaiter (1984) and Yogman (1987) found that early paternal involvement had a significant mitigating effect on the long-term vulnerability of these at-risk infants. Both researchers found that fathers who visited their babies in the hospital frequently, touched them, and talked with the nurses about them, were significantly more involved with their infants up to a year after discharge from the hospital. Potentially as important were data suggesting that that the more present and involved the father, the more rapid the weight gain and earlier the discharge of the baby. (Pause for a moment and think about how easy it is for the fathers in your NICU—or those you have known—to find their babies, touch them, and talk to you or anyone about how they are doing.)

The very vulnerability of the preterm infant is an important factor in eliciting protective and providing impulses from men. These babies’ needs are so apparent that fathers, even though they are likely to be anxious and confused, can feel drawn to protect them even more than healthy newborns. This is fortunate, since mothers of preterm babies may also be anxious and even guilty about their babies’ troubles, and may themselves be ill after giving birth; consequently, fathers of preterm infants are compelled to pick up even more slack in early caretaking responsibilities.

Stereotypes, Expectations, Roles and Variations in Male Nurturing

The stereotype of the male as his child’s protector and provider has powerfully shaped the expectations of fathers’ (and others’) expectations of their roles. In traditional families, fathers have had an important and acknowledged additional role as the most significant “other-than-mother” in the baby’s life. We have learned that infants can develop deep emotional attachments to their fathers which do not depend on the security they derive from their different attachment to their mothers. As we have noted earlier, even very young infants experience men as different from mothers in smell, size, style, feel, sound, and overall presence. Babies soon become aware that fathers simply aren’t around as much as mothers; they seem to pop up here and there at odd times. When the father is there, he matters, but in ways that are different from mother. Through these experiences, babies start to learn from their fathers about comings and goings, transitions, separations, and loving, but non-maternal, nurturing. The father is thus a perfect resource for help in differentiating one’s own self from one’s own mother’s self. That is why so many toddlers turn so decisively to fathers in the second year, as they practice their own autonomy and differentiation from their primary caretakers, mothers.

The father’s role in helping his offspring develop a sense of their sexual identity has been recognized for some time. More than 20 years ago, Maccoby and Jacklin (1974) examined the ways that fathers and men in general differentiate or shape children’s sexual identity to conform with societal norms regarding gender-role expectations. They describe men’s language, vocabulary, and physical handling styles that together serve to render sons “masculine” and daughters “feminine.” Differences in nurturing that have to do with role and differences that are related to gender are extremely difficult, if not impossible, to tease apart.

A darker concern regarding male interest in children’s sexuality arises here, knowing as we do the rates of sexual exploitation of young children by men, many of whom are also fathers. But here, too, research concerning the effect of male care on both man and child is encouraging. Hilda and Seymour Parker at the University of Utah studied several hundred families with histories of child sexual abuse and compared the predisposition’s of stepfathers and biological fathers to abuse children. They found that men who participate in the physical care of a biological child or stepchild younger than three are significantly less likely than less-involved men to sexually abuse their own or anyone else’s children later in life (Parker & Parker, 1987). The relationship of man and infant that develops in the context of physical care appears to prevent adults’ exploitation of that intimacy as the child matures.

Of course the variability and range of male nurturing are as broad as in female nurturing. Most findings about distinctive patterns of male nurturing are merely trends; we all know fathers who resemble traditional mothers and mothers who resemble traditional fathers. But much of the research does seem to suggest that in their interactions with nurturing men, young children seem to be responding to more than just the “otherness” of the father. Men’s distinctive styles of playing with and teaching very young children (which will evolve later into different styles of discipline) all serve to effect this particular pairing between father and baby—a relationship that does not seem to be the same as that between a baby and other “important-but-not-mother” nurturing adults.

Fathers as Primary Caregivers

What does paternal care look like when it is not simply supplemental or episodic? What does male nurturing look like, and how does it affect the growth and development of children, when it is subjected to the daily expectation of serving as the primary emotional and physical resource for one’s children? For 12 years now, I have been conducting a small, longitudinal hypothesis-generating study of the developmental impact on young children of having a father as primary caregiver early in life (Pruett, 1985, 1987, 1992). My sample consists of 18 two-parent Hispanic, Caucasian, and African-American families from across the socioeconomic spectrum. Some of these parents had planned before having a child that the father would serve as primary caregiver; some had reached this decision through a process of compromise; and some felt forced into this arrangement by economic circumstances. None of them considered this arrangement as anything other than temporary.

Effects on children’s development

At several intervals, beginning when the study children were from 2 to 22 months old, we assessed their development using the Yale Provence-Gesell Developmental Schedules. We last interviewed the children at the 10 year follow-up. After the first year, some interesting trends began to emerge:

l. These children raised primarily by men were active, vigorous, robust and thriving infants. They were also competent. The majority of infants functioned above expected norms on several categories, particularly adaptive-problem-solving and social adaptation.

Apart from the quantitatively scored aspects of these babies’ performances, curious qualitative and stylistic characteristics emerged frequently. Most noticeably, these infants seemed especially comfortable with, and attracted to, stimulation from the external environment. They could quiet and regulate themselves, but their appetite for engaging the outer world and bringing it into their own was especially sharp. Although this finding was harder to quantify, many of the babies seemed to expect that their curiosity, stick-to-it-iveness and challenging behavior would be tolerated (possibly even appreciated) by adults in their environment, be they parents, child care providers, or examiners. These babies seemed to expect that play would be rich, exciting, and reciprocated, and that block designs and puzzles would eventually yield to persistence and determination. Twenty-two-month-old Amy was typical of this group, as, with a robust whack, she sent her carefully and proudly constructed 10-cube block tower sprawling across the room, sat forward on the edge of her chair, and fixed her eyes on the examiner’s eyes as if to say, “Am I great or what?!”

Effects on fathers

So, the babies were doing well. How about the fathers? We were interested in how fathers felt about their babies, how they felt about themselves as parents, and how they (and their spouses) felt about the fathers in other adult roles.

Fathers developed an intense attachment to their babies and a sense of themselves as primary caregivers in stages. They achieved a critical reciprocal nurturing relationship with their babies at different rates, usually depending on how much time they had to get themselves ready for this role in their family. Most of the families had a 3 to 8-week period after the baby’s birth in which the mother served as primary, or at least co-equal, caretaker of the infant, but some families had no time to prepare for the transition when mother returned to school, job, or career. This transition was critical for both parents and babies.

Once they assumed primary caregiving, the men reported a consistent sequence of realizations. When first confronted with everyday troubles, such as a baby’s inconsolable crying, the father, not surprisingly, would think to himself, “What would my wife do?” The surprise came in the next stage. Anywhere from 10 days to a few months later, these men had completely abandoned their mental portrait of themselves as being a stand-in for mom, or even of being a “Mr. Mom” (a term they universally despise). Unique caregiving styles emerged as the men gradually began to think of themselves as parents in their own right. Most of the men, however, kept this new sense of themselves to themselves - perhaps from fear that it would go away, or perhaps because “they shouldn’t even have it.” Later on, many fathers reflected that their reticence had been wise; they thought that articulating their own emerging parental self-confidence at the time would have hurt their wives’ feelings.

Fathers were amazed at the depth and rapidity with which they became attached to their babies. They found it perhaps even harder to believe that the babies saw them as so immensely significant. One father was baffled when his 4-month-old daughter stopped eating for two days and developed a week-long sleep disturbance after he shaved off his beard. She became irritable and inconsolable and avoided her father’s gaze when he attempted to comfort her. She would accept her mother’s solace, but even then only briefly. Only after a neighbor failed to recognize him at the elevator did this father think that his daughter might be having the same problem, and be missing the bearded daddy she knew and loved. This phenomenon of intense attachment becomes understandable when we look at the power of the daily, sometimes tedious tasks of caring for a 3- to 4 month-old baby to evoke in a father a profound commitment to the baby’s well-being.

Both fathers and their spouses reported that the experience of primary caretaking had vastly changed fathers’ behavior, concerns, and self-image as adults. Not all the changes were positive. Fathers said, for example, that although they loved their babies, they suffered a loss of esteem as “productive” members of society. They worried about becoming dull and overweight, losing their intellectual edge or physical prowess, and suddenly enjoying soap operas. Loneliness was a problem for most of the fathers, who found few if any peers with whom to discuss their babies and their world.

On the other hand, these fathers felt more aware of the emotive world, spending large amounts of time simply watching their children sleep or eat. They also felt as though they were learning to “not sweat the small stuff” (What parent of an infant has time for this?). The fathers felt guilty for feeling angry at their kids after the fourth sleepless night in a row, or when they felt that they had lost patience with a cranky inconsolable baby. As I listened to their stories, I heard again how hard this job is regardless of the primary caregiver’s gender, and how comforting it would be for many young mothers to listen to the fathers’ list of joys and worries. So much of it comes from the job itself!

Wives of primary caregiver fathers were more positive than the fathers themselves in characterizing the changes that occurred in these men. Wives found their husbands more patient not only with their children but with them (unless the father felt his wife was not pitching in enough), and more emotionally available, even though more physically exhausted. However, mothers struggled with envy as they watched the relationship deepen between their child and their spouse. They found this feeling hard to express, however, since most mothers also were grateful that the father was looking after their child, and not “some stranger.”

Later findings

Interesting though these early findings may be, observations made during a relatively brief period in the life of a young child can tell us very little. Anna Freud, Sally Provence, Albert Solnit, and Alan Sroufe, among others, have taught us that longitudinal studies are the best way to stay humble as researchers. Time and time again, we learn that we are rarely clever enough to ask the right questions the first time we interact with a study population. So I went back to the group of fathers and children at age 2 and again at age 5, again using play interviews and the Yale Provence-Gesell Developmental Schedules with the children.

By the fifth year of the study, I was surprised to find that in seven of the 16 original families with whom I still had contact fathers were still serving as primary caregivers to the target children and some additional siblings. Among the remaining 9 families, the mother served as primary caregiver in six; there were second children in five of these families. Three families used supplemental child care, nursery school, or baby-sitting arrangements; fathers and mothers described themselves as sharing care of their children “roughly equally.” Here is what we found about the children, now age 5 years:

There were no signs of trouble, either intellectual or emotional, in this group of children. Some differences were emerging in the level and range of the children’s emotional maturity, the quality of their human relationships, and their ability to handle the stress and strain of everyday life. No gross markers separated them from their more traditionally mother-reared age peers. They felt a zest for life, were both assertive and comfortably dependent, showed a vigorous drive for mastery, and expressed the usual childhood worries for boys and girls. This group of children showed a robust emotional flexibility, including rudimentary evidence that they might be developing greater than usual ease in moving back and forth between roles and expectations traditionally thought of as feminine and masculine. If there was anything unique about their internal images of themselves as revealed in their play, it was the prevalence of the father as a nurturing force. Children who have a father as a primary nurturer seem to be more curious about and interested in father as procreator than more traditionally reared children. Father makes human beings along with mother, who also gives birth to them.

Ultimately, the major findings from the 10-year follow-up (children’s ages, 10 to 12) can be summarized as follows;

l. Significant benefit to the child of having a father as primary caregiver in infancy and the pre-school years arose from the presence of two parents who interacted well with each other and with the child, and not necessarily from special cognitive or emotional stimulation from the father alone.

The fathers joined early in the transactional and reciprocal nurturing activities that stimulate the emotional attachment so vital in the development of personality in the early years. The style and choice of a father’s caretaking behaviors are rooted deeply within the father’s normal, self involved wish to be nurtured and to nurture. This mechanism is important in mothers as well, although mothers’ caretaking behaviors can be affected powerfully by the physically intimate experiences of pregnancy, childbirth, and breastfeeding. The father’s caregiving style reflects selected imitation of and identification with important care givers in his life. In other words, men’s nurturing capacities do not appear to be wholly determined by either genetic endowment or gender identity. Instead, the cultural and social rewards and reinforcements of competent nurturing interact in a man’s mind with the internal pleasure of being a particular kind of father. The process yields a paternal competence that is unique to that man and that child.

Implications of Research Findings

As with all research, we must be cautious about overinterpreting the implications of fresh insights about the importance of fathers in the lives of young children. For example, on the basis of some of these data, some would have us rush to force fathers to stay in the lives of their children and supply support, both financial and emotional, regardless of the reasons for the fathers’ absence. Yet with so much to learn about male nurture (including the possible role of biological mediators, such as oxytocin and pheromones) and few observational, longitudinal studies even underway, it is not at all clear what would be accomplished by external efforts to mandate a father’s presence in a family that has been unable to preserve that presence on its own or with supports it has sought voluntarily. Longitudinal studies that take full account of context must be our standard when we are trying to understand complex phenomena, or to use research findings to guide programmatic and policy decisions.

Varieties of Fathering

Like motherhood, fatherhood—especially “emotional fatherhood"—can be expressed at various levels of intensity and competence. A single child may have a biological father, one or more stepfathers, grandfathers, uncles, and other important males present in his or her life. Distinctions among these "significant others” may be simply academic from the perspective of the young child who has chosen, among all the possibilities, who emotionally fathers him or her. Consequently, it is with caution that I discuss research that has focused on masculine nurturance of young children in a variety of special circumstances.

Single custodial fathers, whose numbers have quadrupled since the 1980 census, do a decent job with their children. DeFrain and Eirick (1981) describe them as a reasonably successful group, educated, usually in managerial positions, earning incomes equal to or above the national average, and open-minded, flexible in their fathering, and responsive to their children’s needs. Given the impact of poverty on children’s development in this country, judges find it difficult to ignore the likely economic benefits of placing children with fathers when assigning custody in controversial divorce cases in which both parties seem equally competent (or equally incompetent). Still, as Kline Pruett and Santangelo (in press) have shown, the process of divorce itself can be a tremendous threat to the paternal presence in the life of children and needs substantial reform before it can become a less toxic contaminant in the child’s life. Stepfathering, which is as prone to negative stereotypes as stepmothering, is increasingly common in this country and increasingly complex, given the layering and mixture of biological and non-biological children across generations in some blended families. Research suggests that stepfathers may be more attentive to the needs of their stepchildren and less arbitrary in their parenting style than are many fathers who are living with the mothers of their biological children.

Teenage fathers, unless they receive support and guidance from family, community mentors or professionals, are as uninformed about the needs of their children as are teenage mothers. Surprisingly, however, most teen fathers feel close to their partners and to their babies. Many wish to be included in the rearing of their children (Greenberg, l995).

Grandfatherhood may offer many men the perfect opportunity for flagrant expression of unambivalent male nurturing. As my own father observed, “By this point in my life, I have either made it or not made it, and my grandchildren couldn’t care less. They love me without judgment, and I return the favor without a second thought.” The special release from splitting one’s life and heart between providing for and being with one’s own children that characterizes non-custodial grandparenthood catalyzes an unselfconscious affection that many men were unable to show their own children, but feel perfectly comfortable sharing with their grandchildren.

Children whose own fathers have been unavailable during their nurturing years can pull very hard for male nurturance from a grandfather, and it is a wise mother and grandmother who support this connection. As one single mother said at a ZERO TO THREE National Training Institute, “I can tell my son to be a man, but I can’t show him.” Do not overlook granddad. Often, he is just waiting to be asked. Many of the more successful intervention programs for at-risk children that have worked to increase their male presence have benefited especially from the grandfather dynamic. What a grandfather (or grandfather figure) may have lost in speed and strength, he has usually compensated for in patience, wisdom, grace, and even humor. Grandparenting can go so well that the middle generation can feel envy over the absence of such closeness in their own growing up.

Non-paternal males can play critical roles in the lives of children who do not have access to their own fathers on a regular basis. Mothers may not find it especially easy to recruit a masculine presence, especially if the absence of the child’s father has to do with negative experiences in her own life with men. But we know that children whose fathers are absent tend to be children who have few if any male models of nurturing or care anywhere in their life. These children can be at increased risk for constricted dependency on their often exhausted, lonely mothers, knowing no “significant other” to help them feel secure as they search for autonomy from her.

Men in the community—coaches, teachers, neighbors, husbands of friends, men from the family ’s religious community, Big Brothers, friends’ dads and grandfathers, uncles—can all bring the male presence into the lives of even very young children who are hungry to discover what the masculine presence has to offer them. Nurturing men can be quiet, loud, strong, ascetic, thoughtful, or action-oriented. They can represent the usual variety, of human experience. What is important is that they want to be in the lives of young children. It is we who have to think of the roles they can play and facilitate their involvement. Program is our problem, not theirs. Since we are still working to define what it is that young children seek from men, why it matters to be held in their arms and minds, our net must be cast wide and often.

Lessons From the Nursery

In closing, it seems wise to return to where we shall always learn most about early development—the nursery. There we will see that the human drive to nurture and care is so powerful that it is equally present in boys and girls as toddlers. The 30-month-old boy is just as devoted to bathing, feeding, dressing, changing, napping, and burping his baby doll as is his female pal. It is so important to get this behavior right that the little boy’s joy in practice seems endless. Yet once the societal implications of being either male or female enter the picture in the next couple of years, many little boys begin to drift inexorably into the block corner, never to return. But if you observe carefully, you will see a longing look over a young boy’s shoulder from time to time, as if he still wishes that he could hang out where the real action is without being called, or feeling like, “a baby.”

As norms evolve and we see more and more men and fathers valuing and sustaining their own nurturing capacities into adulthood, it will be easier for our male and female children to hang on the power of nurturing competence across gender roles and expectations, taking it with them into the block corner. Because men are increasing their contact with their kids, the male and paternal presence is likely to become even more influential. Pleck has found that fathers have increased their accessibility to their children by 50 percent since the 1970s and early 1980s (Pleck, 1997). Nurturing competence starts out so strong, and for such excellent reasons—given a little support, it never really needs to disappear. And a little support can help a lot, precisely because the fathering research has shown that fathering is influenced even more than mothering by contextual forces in the family and community (Doherty, Koumeski, & Erickson, 1996).

The connections made in the intimacy of the nurturing domain have enduring effects on the man and baby who connect there. Our programs, our research, our interventions, and our policies need to foster these connections. Missed opportunities also have enduring effects.