The effectiveness of various soothing techniques on human neonates

In Touch with the Heartbeat: Newborns' Cardiac Sensitivity to Affective and Non-Affective Touch

The sense of touch is the first manner of contact with the external world, providing a foundation for the development of sensorimotor skills and socio-affective behaviors. In particular, affective touch is at the core of early interpersonal interactions and the developing bodily self, promoting the balance between internal physiological state and responsiveness to external environment. The aim of the present study is to investigate whether newborns are able to discriminate between affective touch and non-affective somatosensory stimulations and whether affective touch promotes a positive physiological state. We recorded full-term newborns' (N = 30) heart rate variability (HRV)-which reflects oscillations of heart rate associated with autonomic cardio-respiratory regulation-while newborns were presented with two minutes of affective (stroking) and non-affective (tapping) touch alternated with two minutes of resting in a within-subject design. The results revealed that non-affective touch elicits a decrease in HRV, whereas affective touch does not result in a change of HRV possibly indicating maintenance of calm physiological state. Thus, newborns showed cardiac sensitivity to different types of touch, suggesting that early somatosensory stimulation represents scaffolding for development of autonomic self-regulation with important implications on infant's ability to adaptively respond to the surrounding social and physical environment.

Does touch matter? The impact of stroking versus non-stroking maternal touch on cardio-respiratory processes in mothers and infants

The beneficial effects of touch in development were already observed in different types of skin-to-skin care. In the current study, we aimed at studying potential underlying mechanisms of these effects in terms of parasympatho-inhibitory regulation. We examined the specific impact of affective maternal stroking versus non-stroking touch on the cardio-respiration of both mothers and infants in terms of respiratory sinus arrhythmia (RSA). We compared a 3-min TOUCH PERIOD (stroking or non-stroking touch) with a baseline before (PRE-TOUCH) and after (POST-TOUCH) in 45 dyads (24 stroking/21 non-stroking touch) with infants aged 4-16 weeks. We registered mother-infant ECG, respiration and made video-recordings. We calculated RR-interval (RRI), respiration rate (fR) and (respiratory corrected) RSA and analyzed stroking mean velocity rate (MVR) of the mothers. ANOVA-tests showed a significant different impact on infants' respiratory corrected RSA of stroking touch (increase) versus non-stroking touch (decrease). Further, during and after stroking touch, RRI significantly increased whereas fR significantly decreased. Non-stroking touch had no significant impact on infants' RRI and fR. In the mothers, RRI significantly decreased and fR significantly increased during the TOUCH PERIOD. The mothers' MVR occurred within the range of 1-10 cm/s matching with the optimal afferent stimulation range of a particular class of cutaneous unmyelinated, low-threshold mechano-sensitive nerves, named c-tactile (CT) afferents. We suggest CT afferents to be the a potential missing link between the processing of affective touch and the development of physiological and emotional self-regulation. The results are discussed with regard to the potential role of CT afferents within the building of early self-regulation as part of a multisensory intuitive parenting system and the importance to respect this ecological context of an infant in research and clinical applications.

fNIRS detects temporal lobe response to affective touch

Touch plays a crucial role in social-emotional development. Slow, gentle touch applied to hairy skin is processed by C-tactile (CT) nerve fibers. Furthermore, 'social brain' regions, such as the posterior superior temporal sulcus (pSTS) have been shown to process CT-targeted touch. Research on the development of these neural mechanisms is scant, yet such knowledge may inform our understanding of the critical role of touch in development and its dysfunction in disorders involving sensory issues, such as autism. The aim of this study was to validate the ability of functional near-infrared spectroscopy (fNIRS), an imaging technique well-suited for use with infants, to measure temporal lobe responses to CT-targeted touch. Healthy adults received brushing to the right forearm (CT) and palm (non-CT) separately, in a block design procedure. We found significant activation in right pSTS and dorsolateral prefrontal cortex to arm > palm touch. In addition, individual differences in autistic traits were related to the magnitude of peak activation within pSTS. These findings demonstrate that fNIRS can detect brain responses to CT-targeted touch and lay the foundation for future work with infant populations that will characterize the development of brain mechanisms for processing CT-targeted touch in typical and atypical populations.

Natural Parenting — Back to Basics in Infant Care

This review examines an age-old approach to parenting recently rediscovered in Western industrialized societies and known by names such as natural parenting, attachment parenting, and instinctive parenting. Its leading principle is utmost sensitivity to the child's innate emotional and physical needs, resulting in extended breastfeeding on demand, extensive infant carrying on the caregiver's body, and cosleeping of infant and parents. The described practices prevailed during the evolutionary history of the human species and reflect the natural, innate rearing style of the human species to which the human infant has biologically adapted over the course of evolution. An overview of research from diverse areas regarding psychological as well as physiological aspects of early care provides evidence for the beneficial effects of natural parenting. Cross-cultural and historical data is cited to reveal the widespread use of the investigated parenting style. It is concluded that the described approach to parenting provides the human infant with an ideal environment for optimal growth both psychologically and physiologically. It is yet to be determined how much departure from this prototype of optimal human parenting is possible without compromising infant and parental wellbeing. The review also invites a critical reevaluation of current Western childrearing practices.

Crying patterns of Korean infants in institutions

This study investigates whether the crying pattern of infants reared in institutions is different from those reared at home in the same cultural backgrounds. Ninety-five institutional infants and 143 home infants, aged 2-18 weeks were studied through diaries, recorded by children's care-givers or mothers. Results showed that the crying duration of the infants in institutions was almost double that of infants at home (86 vs 45 min/day) and contact period with the care-givers was half that of home infants (136 vs 279 min/day). In addition, the duration of periods when the babies were alone was much longer in the institution group (1089 vs 1002 min/day). There was a tendency for both groups of institution and home infants to cry more during the evening (from 18.00 to 24.00 h) but there was no definite peak of crying at any age except the slight increase of crying after 12 weeks for the institution group. When compared with research on Western infants, the daily crying durations of both institution and home infants fall short of those of their Western counterparts. The effect of care-giving style on the crying pattern, including physical proximity, is discussed.

Mothers' reports of infant crying and soothing in a multicultural population

OBJECTIVES

To investigate the prevalence of infant crying and maternal soothing techniques in relation to ethnic origin and other sociodemographic variables.

DESIGN

A questionnaire survey among mothers of 2-3 month old infants registered at six child health clinics in Amsterdam, the Netherlands.

SUBJECTS

A questionnaire on sociodemographic characteristics and crying behaviour was completed for 1826 of 2180 (84%) infants invited with their parents to visit the child health clinics. A questionnaire on soothing techniques was also filled out at home for 1142 (63%) of these infants.

RESULTS

Overall prevalences of "crying for three or more hours/24 hour day" "crying a lot", and "difficult to comfort" were 7.6%, 14.0%, and 10.3%, respectively. Problematic infant crying was reported by 20.3% of the mothers. Of these infants, only 14% met all three inclusion criteria. Problematic crying occurred less frequently among girls, second and later born children, Surinamese infants, and breast fed infants. Many mothers used soothing techniques that could affect their infant's health negatively. Shaking, slapping, and putting the baby to sleep in a prone position were more common among non-Dutch (especially Turkish) mothers than among Dutch mothers. Poorly educated mothers slapped their baby more often than highly educated mothers.

CONCLUSIONS

Mothers' reports of infant crying and soothing varied sociodemographically. Much harm may be prevented by counselling parents (especially immigrants) on how and how not to respond to infant crying. Health education should start before the child's birth, because certain soothing techniques could be fatal, even when practised for the first time.

Pain and pain management in newborn infants: a survey of physicians and nurses

BACKGROUND

Despite an increased awareness among clinicians regarding pain and pain management for infants undergoing surgery, pain associated with procedures performed outside the operating room may not be adequately managed.

PURPOSE

To examine the beliefs and self-described behavior of physicians and nurses regarding the management of procedural pain in newborn infants.

METHODS

A survey was distributed to 467 clinicians (nurses and physicians) working in 11 level II and 4 level III nurseries in a large metropolitan area. Respondents were asked to rate the painfulness of 12 common bedside nursery procedures and how often pharmacologic and nonpharmacologic (comfort) measures are currently used and should be used for those procedures. Demographic data were also collected.

RESULTS

Surveys were completed by 374 clinicians (80% response rate). Physicians and nurses believe infants feel as much pain as adults and that 9 of the 12 listed procedures are moderately to very painful. Neither pharmacologic nor comfort measures are believed to be used frequently, even for the most painful procedures. Physicians and nurses believe both pharmacologic and comfort measures should be used more frequently, but nurses believe comfort measures should be used more frequently than do physicians. Beliefs about infant pain and procedural pain were related to pain management preferences. Physicians' but not nurses' ratings were associated with significant personal pain.

CONCLUSIONS

Despite their beliefs that infants experience significant procedure-related pain, clinicians believe pain management for infants remains below optimal levels. Barriers to more consistent and effective pain management need to be identified and surmounted.

What it means to "spoil" a baby: parents' perception

Discussion concerning spoiling a baby frequently takes place in pediatric-care settings and may occur without a clear understanding of how parents define the word "spoil" when baby care is discussed. This study presents data from 531 parents asked to respond to a questionnaire on spoiling babies. The majority of mothers and fathers believe a baby can be spoiled, but considerable variation exists in perceptions of how this takes place, what a spoiled baby is like, and the present and future effects of spoiling. The younger and less educated parents have more rigid and negative views about the effects of spoiling babies.

Assessment of individual differences among healthy newborns on the Brazelton scale

Inter-individual differences and behavioral stability assessed with the Brazelton scale were examined in twenty 3-8-day-old full-term newborns at a German newborn nursery. The extent of variability measurable with Brazelton scores was determined by the relative mean information value "Hrel" in each variable, which indicates the discriminating power of each scale. The value "Hrel" was high in irritability, consolability, cuddliness and alertness. Inter-individual differences, illustrated by individual mean scores, were lowest in orientating behaviors. Differences in alertness correlated with several other reaction patterns. No significant correlations were found between the NBAS variables and neonatal sex, birth weight, birth duration, and maternal age. However, the relative weight gain between day 1 and day 8 was correlated with alertness, orientation to face and to rattle, irritability, rapidity of build-up and state lability. Individual behavioral stability over time was generally low in most variables. The low degree of behavioral stability and the low relative mean information in several variables reduce the applicability of the scale for the originally suggested purposes.

The response of neonates to intra-uterine sounds

Playing prerecorded intra-uterine sounds to newborns reportedly soothes the babies. This study investigates this claim, particularly because of its promise for identifying neonates with severe hearing losses. 60 babies, up to eight days old, were observed individually under two conditions. In one, activity was rated on the Brazelton scale before and during presentation of intra-uterine sounds. In another, similar ratings were made but no sounds presented. The results indicate that intra-uterine sounds calm 90 per cent of babies who are fussy or crying but have no evident effect on babies who are awake but merely alert or who are slightly drowsy. These findings are discussed and improvements in procedure are suggested for use of intra-uterine sounds in routine screening for severe neonatal hearing loss.