Sydney pediatrician finds value in stillness
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Sydney pediatrician finds value in stillness

Zilibowitz stresses the importance of 'a basket of care' & 'watch, wait & wonder"

Michael Zilibowitz
Michael Zilibowitz

Michael Zilibowitz is a developmental and behavioral pediatrician with the Child & Family Health Services in Sydney, Australia. He recently attended the early childhood development Zero to Three annual conference in Ft. Lauderdale, Florida. Beforehand, the Jewish doctor visited the Jewish Healthcare Foundation.

While in Pittsburgh, Zilibowitz sat down with the Pittsburgh Jewish Chronicle to discuss his work and the Watch, Wait and Wonder program.

Tell me a little about your background and work.
I’m the clinical lead of a child and family health team. We look after an area of Sydney, it’s the northern beaches of Sydney, about 300,000 people. Our team provides services and early intervention, trying to identify problems as early as possible to support children and families in their development.

I’m part of a team that includes myself and another pediatrician, we have speech pathologists, occupational therapists and a large group of child and family health nurses who work in the community.

We provide a unique service, an early intervention program for vulnerable and at-risk children and families, that tries to provide a one-stop shop on our campus for children and their parents who often have intergenerational experiences of abuse and neglect. We provide both a home visiting program and an on-site therapeutic preschool. We take children from 1 year of age, but the home visits can start at birth. On-site we have early childhood teachers, psychologists, social workers, speech pathologists, play therapists and a parenting program.

Is there a reason you have these services grouped together?
We know that parents who come from these backgrounds have terrible experiences with authority. They are very mistrusting, and one has to develop and gain their trust. By providing all the services in one place, they aren’t going here and there. When that happens, they rarely make their appointments. When you have it all encapsulated, as I refer to it, a “basket of care,” the changes in the children are enormous. They’ve done some outcome studies, looking at speech, language and general development for the children. They are, I think, the best in the world, for this group of children.

In the last 15 years, there has been a tenfold increase of adolescents experiencing emergencies in Sydney that include suicide and self-harm. Social media and all those things play a part, as do the increasing problems of mental health in the community, but it undoubtedly starts at the beginning. If you’re going to provide support to these types of communities and provide it with the level of intensity and staff needed and feature a wide variety of different models of support, then you can make a real difference.

Is this an approach being adopted worldwide?
It isn’t and that’s maddening and crazy because this is an approach that’s so obvious. It’s so obvious that if you’re going to treat the most vulnerable people in our community, they need a basket of care. We’ve shown that economically the cost of our services are much, much cheaper than those of Family and Community Services, who have a whole range of other programs where they visit people in the home, send them to special preschools, provide programs for the parents. Our program is cheaper.

An American economist, James Heckman, has shown the economic benefit of these programs, that for every dollar you invest you save about $17 in terms of teen pregnancy and incarceration. People who go through these programs have higher grades, get better jobs, pay more taxes. You only see the rewards, though, way down the tracks. In many parts of the world, governments are starting to launch programs around the first thousand days, the first 2,000 days. I’m hopeful we’ll see these programs rolling out in a more comprehensive way.

I know that you use the Watch, Wait and Wonder program, which is a child-led psychotherapeutic approach based on an infant’s spontaneous activity in free play. What can parents learn from this program?
I have found the concept of Watch, Wait and Wonder a beautiful way to be with children. It recognizes that children innately know what they want out of a relationship. We, as adults, need to be still and present and allow them to use our attention to explore what they need from us. Very often, we’re so much about teaching, about doing, people are so busy, there’s such an emphasis on taking children here, there and everywhere, to enrich their skills, that we’re forgetting that stillness is at the core of what we all need.

Watch, Wait and Wonder helps parents be still and lets children lead them. It allows children to escape into their own inner world and communicate what they need from a relationship because play is a child’s work. It is akin to our dreams. Dreams are where we process challenges, difficulties, we celebrate achievements in dreams in symbolic ways. Children use play in the same way. Given a still parent available to them, they will use play and develop a greater capacity for play. Their imagination will grow and sometimes their development surges. Sometimes parents will say they see their children for their first time and fall in love with their children. It sets up a reciprocal relationship.

There’s a wonderful quote from Donald Winnicott, who said, “Children get to know who they are through the reflection they see in their parents’ eyes.” PJC

David Rullo can be reached at drullo@

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