Dr. Constance Helen “Connie” Keefer – the Compleat Pediatrician

By Kevin Nugent, PhD, Founder and Director of the Brazelton Institute

Brazelton Touchpoints Center faculty member Dr. Constance Keefer retired earlier this year after a half century of advocating for the health and well-being of young children and their families across the world. In this tribute, Dr. Kevin Nugent honors Connie’s passion, commitment, never-ending curiosity, and indomitable spirit. 

Dr. Connie Keefer with a young patient.

Dr. Constance Helen “Connie” Keefer has worked for 52 years in the field of pediatrics. She wanted to be a doctor from the age of four, impressed as she was by the power of the doctor who came to their house to heal and cure and bring solace to her and to her family. This sense of calling to help others was sustained by the moral values instilled in her by her parents so that after she graduated from Allegheny College, it was with a kind of inevitability that she went on to apply and was accepted at the University of Pittsburgh Medical School to study to become a doctor.

As a medical student, Connie was torn between a career in psychiatry and pediatrics.  Drawn initially to psychiatry, she made a decision to go to London to the Anna Freud Centre at the Hampstead Clinic to study psychoanalysis. Attending the weekly case study sessions led by Anna Freud, Connie was impressed by how Freud integrated direct observation with knowledge emerging from observations of the child in the consulting room. It was this emphasis on the importance of observation in understanding child development that led Connie back to the field of pediatrics. Returning to New York, she studied under pediatric neurologist Isabelle Rapin at the Albert Einstein College of Medicine. This was a transformative experience and confirmed for Connie the importance of observing children’s behavior in pediatric practice as the key to understanding the relationship between neurology and child development.

After graduating from medical school in 1969, Connie went on to Case Western Reserve University in Cleveland for an internship in pediatrics. She studied under two of the great pioneers in the field of pediatrics and neonatology, Marshall Klaus and John Kennell, whose research on mother-infant bonding was empowering mothers and was in turn changing the practice of newborn care across the world. This was another life-changing experience for Connie. as she was able to enter into the world of newborn babies and observed how these two giants in the field treated both babies and their families in the newborn nursery with such respect and compassion. This also gave her a new understanding of the parent-infant relationship and how that understanding could be integrated into her everyday care of newborns and their parents.

Encouraged by Klaus and Kennell to come to Boston to learn more about babies, Connie became Chief Resident at Massachusetts General Hospital from 1970–1972 and “almost accidentally, chanced upon Berry Brazelton” at Boston Children’s Hospital (BCH). Berry Brazelton had just founded the Child Development Unit and established a Fellowship program for pediatricians, designed to enable pediatricians to learn more about newborns and typical child development, something hitherto neglected in pediatric education. As she listened to Berry’s detailed descriptions of baby behavior, it must have resonated with the words written by her father, Fleming Orrin Keefer, in his observations of his own children, in one of his poems titled, “Sleeping Children”:

“Now is the time for reflection, standing in the darkened doorway,

Marvelling at the innocence of these inert forms,

Brushed with the patina of blessed childhood,

Damp-forheaded, partly lipped

Purity and serenity sculptured in living flesh.”

Connie knew immediately that this baby-centered, family-focused model of pediatric care was what she was searching for and she was accepted by Berry as one of the first Fellows at the Child Development Unit (CDU) in 1973. Berry’s teaching philosophy — inspired by Jerome Bruner at the Center for Cognitive Studies at Harvard University —focused on creating a space that allowed everyone to ask and answer questions while encouraging critical thought, a place that could be an “intellectual retreat.” In this setting, Connie was exposed to primary research, complemented by placement experiences interviewing pregnant mothers and observing newborn nurseries and community daycare centers, where she was able to refine her capacity of “empathic listening” and relationship building as a defining characteristic of her role as a pediatrician.

After her two-year fellowship at the CDU, she was invited by Berry to stay on as a faculty member. Her research on culture, parenting, child development, and newborn behavior was soon published in scholarly journals, and she contributed textbook chapters on development, cultural issues in behavior and development, on the shy child, and on the nursery care on the newborn. She went to Kenya to study the behavior of Gusii infants and this interest in cultural differences led her to China and many other countries where she taught pediatricians about newborn behavior and development and introduced the Neonatal Behavioral Assessment Scale to physicians across the world. She was also an inspirational mentor and it was the good fortune of many students — I was one of them in the 1978 — to have been guided by her into the world of the newborn infant — an invitation that was to irrevocably shape the future of my professional life and the lives of many others over the years.

After this long intensive period in her career as a researcher, teacher, and faculty member, Connie decided to review and reevaluate her life choices and she made the momentous decision to take a “leave of absence” from the academic world to consider other possibilities. The most dramatic change was when she married Habib Tayarani, which led her on yearly visits to Iran to meet Habib’s family. During this time, she also returned to her great interest in music and literature, reading and writing, resumed playing the flute, and joined an ensemble. By now, Connie was ready to move into the world of community pediatric practice and for the next 11 years, she practiced pediatrics in Cambridge, working face-to-face with infants and families. So many parents, including my wife Una and I and our children Aoife and David, who had only just arrived in the United States, were fortunate to become her “patients” and were privileged to be listened to and enveloped in the caring, affirmative, and respectful care that characterized her approach, such that she is an integral part of our own family story and undoubtedly is embedded in the family stories of thousands of families to this day.

In the 1990s, Connie served as Director of the Newborn Nurseries at Brigham and Women’s Hospital (BWH) and directed the Healthy Connections Program at Boston Children’s Hospital, a perinatal intervention program. She also became Assistant Professor of Pediatrics at Harvard Medical School. Knowing how Connie understood how residents and medical students needed to learn more about newborns and the care of newborns as part of their training, Dr. Judith Palfrey, Chief of the Division of General Pediatrics at Boston Children’s Hospital, invited Connie to develop a curriculum for pediatric residents. As part of the new curriculum, Connie developed the PEBE, an innovative examination for pediatric practitioners, which combines the usual “head to toe” sequence of the physical examination with the observations about the baby’s behavior that reflect developmental capacity and the baby’s individual style. In 2001, Connie mentored fellow pediatrician Lise Johnson as successor in the role of Director of Well Newborn Care at BWH, ensuring the continuation of the same infant-focused, family-centered approach begun by Connie, which served as a “best practice” example of continuity of care and exemplified the same kind of passionate relationship-based care in Newborn Units around the world.

At around the same time, Connie was invited by Berry Brazelton and Josh Sparrow to join the Brazelton Touchpoints Center at BCH as Senior Faculty. She brought her extensive experience in pediatric practice, clinical teaching, and cross-cultural research to her Touchpoints faculty role. She saw how the Touchpoints approach could inform pediatric residency training in developmental and behavioral pediatrics. Asa  teacher and mentor, Dr. Keefer’s lucid, engaging, insightful approach reached trainees across the world and confirmed the importance of relationship-building in their work with families by keeping the focus on the baby and on the relationship.

Connie has been as an integral part of the  Brazelton Institute since its inception. Along with Sue Minear, Lise Johnson, Yvette Blanchard and myself, Connie played a critical role in testing and developing the Newborn Behavioral Observations (NBO) system to become the evidence-based tool it has become today. The focus of the NBO is frankly on relationship-building and is now used in settings around the world to help parents understand and appreciate their newborn infant and, at the same time, is designed to help the pediatric practitioner develop a partnership with the parents around the baby’s behavior. Connie is an author on the NBO Handbook, Understanding Newborn Behavior and Early Relationships, and had a central role in developing the training curriculum and has been engaged in training, teaching, and mentoring right up to the present moment.

Throughout her career, Connie has been an evidence-based optimist, animated by a moral, even utopian, purpose. She imagines a more just and equitable society and believes that without better health care services for parents and infants from the very beginning, it is impossible for people to claim other fundamental human rights. If one might find a hidden emotional spine to all her work, it is that policies that support families are critical, as the strength and quality of the relationship between caregivers and their children are fundamental to the effective development of children’s brain functions and capacity. In terms of her academic leadership throughout the time, Connie has always been a public intellectual to her bones. In this, she is a champion of those who experience the brunt of inequality, poverty, and discrimination and is committed to supporting the development of policies, resources, and optimal environments for children. Moreover, she believes that preventive intervention in the first years will result in much higher economic returns later.

In his book, To Be a Doctor, Felix Marti-Ibanez, writes, “To be a doctor, then, means much more than to dispense pills or to patch up or repair torn flesh and shattered minds. To be a doctor is to be an intermediary between man and GOD.” I feel  exceptionally privileged to have been Connie Keefer’s colleague and friend for almost half a century. Indeed, my colleagues and I at the Brazelton Institute describe Connie as simultaneously wise, empathic, open-minded, honest, kind, non-judgmental, culturally humble, enthusiastic, optimistic, and validating. She inspires total confidence in parents, and daily renews the magical relationship that by itself constitutes good treatment for any kind of ailment and the best starting point for confronting all causes of pain and suffering. Although so many virtues are difficult to find in a single human being, such combinations can be found in Connie Keefer across her 52-year practice. Indeed, I can end this account of the career of Dr. Connie Keefer, our colleague and friend, by echoing the words of her poet father, Fleming Orrin Keefer, in one of his earlier poems:

“Our gratitude wells up in us,

No full heart e’er spoke neatly,

And though our tongues prove traitorous,

Our hearts pay tribute to thee.”

Dr. Connie Keefer — the compleat Pediatrician!

Ad multos annos!