The tactile context of a mother’s caregiving: implications for attachment of low birth weight infants☆

Abstract

This study examined the degree to which specific properties of maternal touch may be associated with a low birth weight infant’s security of attachment at one year of age, considering the potential modifying effects of maternal sensitivity and history of touch as well as infant gender and biological vulnerability. One hundred and thirty one socioculturally diverse infants and their mothers were evaluated for medical complications during the neonatal period. Videotapes were made of the infant-mother dyads during an infant feeding at three months of age. Each videotape was analyzed for a mother’s properties of touch and her sensitivity as well as for infant responsiveness. When the infant was six months old, each mother completed a questionnaire to determine felt security regarding her own history of touch as a child. Researchers completed the Attachment Q-Set for each infant at one year of age.

Analysis of covariance indicated that sheer frequency of touch had no relationship to infant attachment but use of nurturing touch by mothers was associated with security of attachment. However, the degree of infant vulnerability (i.e., perinatal complications, birthweight, and responsiveness) moderated the effects of nurturing touch. Nurturing touch was associated with more secure attachment for robust infants but with less secure attachment for highly vulnerable babies. Neither maternal sensitivity nor gender appeared to moderate the relationship of touch to attachment or to have any direct relationship to attachment outcomes. Infant vulnerability decreased the likelihood of a secure attachment while a mother’s felt security regarding her own tactile experience as a child increased her infant’s chances of having a secure attachment.

Introduction

Attachment theorists have long regarded the quality of parent-infant physical contact as a central feature of the responsive and available caregiving environment that is necessary in fostering an infant’s sense of security Ainsworth et al 1978, Bowlby 1973. In fact, Main (1990) argues that physical contact with an attachment figure is “the ultimate signal” to the infant that s/he is safe and secure, noting that Bowlby (1969) placed physical contact as a central requirement of proximity and felt security. The thesis that ‘contact comfort’ creates an experience of refuge or safety for a child was originally proposed by Harlow 1962, Harlow and Zimmermann 1959) whose research with rhesus monkeys provided evidence of the importance of bodily contact between infant and mother as the basis of reassurance and felt security for an infant. Subsequent human research also indicates that close bodily contact with the mother may be superior to other modalities in helping an infant cope with distress or discomfort Grossman et al 1985, Hunziker and Barr 1986. Although much of the focus on physical contact has been on its role in situations of stress or uncertainty, Ainsworth and colleagues’ (1978) seminal work demonstrated that it was the quality of touch in day- to- day interactions, not simply separations, which influenced the infant’s attachment expectations.

While the link between physical contact and attachment may be salient for all infants, it has special importance for low birth weight (LBW) babies. Because of their fragile or underdeveloped nervous systems, LBW infants have diminished ability to regulate their responses to their tactile environments during the first few months of life. Numerous studies have demonstrated potentially detrimental effects of touch on high risk infants’ neurobehavioral status and emotional distress (e.g., Als 1986, Gunnar et al 1987, Harrison et al 1990). Because of these findings, many hospitals have adopted ‘minimal handling’ policies that require nurses and parents to touch babies infrequently, and primarily for essential medical procedures or cleaning rituals. As a result, some parents learn to withhold their touch to protect their baby and thus develop ingrained patterns of infrequent interaction which continue over time. Other parents who are less sensitized to their babies’ vulnerabilities may overstimulate their infants without recognizing their regulatory difficulties. LBW infants may also be especially vulnerable to touch because of their history of invasive and painful medical procedures which can distort their somatosensory perception and increase the potential for touch to be aversive (DeMaio-Feldman, 1994).

In addition, there is evidence that certain types of neurobehavioral limitations (many of which are experienced by LBW infants) may affect the attachment relationship adversely Belsky and Rovine 1987, Crockenberg 1981, Miyake et al 1985, Vaughn and Bost 1999, Van der Kolk and Fisler 1994. These limitations (e.g., difficulty orienting, weaker muscle tone, irritability, tremors, lack of responsiveness) are associated with diminished CNS integrity at birth, resulting from underdeveloped or medically compromised nervous systems. In contrast to full term, robust infants who have every sensory system functioning on their behalf at birth or soon after, many LBW babies are at risk because of such neurobehavioral problems. They are less capable of dampening their own distress, depending substantially on a caregiver during their first few months to regulate their neurobehavioral response to both internal and external stimuli (Als, 1986). As a result, they are especially susceptible to the effects of parental behavior. In addition, the infant’s ability to engage the mother via eye contact, vocalization or facial expression predicts greater security of attachment (Grossman, Grossman & Schwan, 1986), placing minimally responsive LBW babies at even greater risk for attachment problems (van Beek, Hopkins & Hoeksma, 1994).