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The Newborn's Potential for Interaction
Volume 5, Number 6, NovemberlDecember 1976
JOGN Nursing Journal of The Nurses Association of The American College of Obstetricians and Gynecologists
The Newborn’s Potential for Interaction DYANNE AFFONSO, RN, BSN, M S N
The signijicance of the interaction process for both parent and child is set forth, and three behavioral components of the newborn’s potential for interaction are discussed: perceptual behaviors, effector behaviors, and signaling behaviors. In a practical section, the factors that can activate or inhibit the newborn’s interaction potential are outlined, and the significance of the findings for nursing practice are presented.
Human interaction is fundamental to human existence. The interaction process exerts a major influence on an individual’s successful adaptation in the world. Therefore, it is of value to explore a human being’s earliest interaction with the environment-that with his parents. For too long the emphasis in discussions on parent-infant interactions has been primarily on the parents, especially the mother. The infant has been largely ignored because he has been viewed as a passive recipient of maternal care, with limited capacity to exert any meaningful influence on the environment.’ However, interaction involves a two-way interchange of both intake and output. Thus, the importance of what the infant brings to the encounter can no longer be ignored or minimized. Modern research has brought new insight demonstrating that a newborn enters the world with the potential to actively interact with his environment and is not merely a recipient of stimuli. This potential for interaction needs only to b e activated by behavioral stimulations from the environment. The purpose of this paper is to explore selected features in a newborn’s November/Decernber 1976 JOCN Nursing
behavioral repertoire in order to demonstrate that the potential for interaction is readily present and waiting to be activated. Behavioral Components for Interaction The newborn’s interaction potential is rooted in three behavioral components. These are labeled by Bowlby’ as 1) perceptual behaviors, 2) effector behaviors, and 3 ) signaling behaviors. Perceptual behuviors refer to the sensory abilities by which the newborn can take in” or receive environmental stimuli. The newborn does this primarily through sensory experiences provided by sights, sounds, odors, touching, and tastes. Perceptual-sensory behaviors are important because they enable the infant to explore the environment by “taking in” stimuli through his own initiative. Exploratory behaviors are crucial in early life because they formulate the beginnings for parent-infant orientation. Parent-infant orientation is the process whereby both parent and child explore and familiarize themselves with each other toward the development of a relationship which will sustain “
9
them in their daily living. The perceptual-sensory capabilities in the newborn are remarkable! The newborn can see, hear, taste, and smell, and these abilities increase rapidly in efficiency within the first 2 weeks of life.”.“ The newborn not only is able to receive and respond to stimuli but also has a discriminating ability for various stimuli. This means the infant has a preference for selected stimuli. Thus, certain stimuli will b e more effective in arousing the newborn’s behavioral potential for interaction. Examples of the newborn’s discriminating abilities are as follows: -The newborn prefers visual stimuli containing contour, color, brightness, and movement as contrasted to dull, flat object^.^'^,^ Visual acuity is enhanced when objects are within 8-10 inches from the eyes4 -The newborn prefers auditory stimuli which are rhymical, soft, and human (especially that which is high-pitched, which is more typical of the maternal voice).‘” -The newborn is more likely to demonstrate “consoling behaviors” (indicative of contentment, peacefulness, feeling soothed) when tactile stimulations are warm, gentle, rocking, stroking, or rhythmical, as contrasted to cold, abrupt, jerky, touching acts.9,’ These discriminating abilities in the newborn are believed to be important for behavioral development. Their existence lends support to the belief that the newborn is not passive but can exert an influence on its environment. Discriminating abilities allow the infant to indicate what type of stimulus is desired. How is this possible? The infant’s behavioral responses to the stimuli (indicating perceived pleasure, dissatisfaction, or inattention) will affect the environment in terms of providing or not providing positive feedback (reinforcement) for the stimuli. For example, if a mother touches her infant and the infant provides behavioral clues which make the mother perceive that the infant does not enjoy her touching acts, it can be predicted that the mother may decrease her attempts to touch because she received no reinforcement for her actions. Thus, the newborn’s behavioral responses can influence whether a stimulus will continue, change, or be extinguished. An important concept is being demonstrated here. The newborn is exerting a degree of control over his subsequent behaviors because he now will be able to have some influence in forthcoming behavioral sequences in his daily interaction-primarily with his parents. Bowlby adds supports to this concept2: 10
Thus, owing to the selective sensitivity with which a baby is born, different sorts of behaviors are elicited by different sorts of stimuli and much more attention is paid to some parts of the environment than to other parts. . . some sorts of behavioral sequence are rapidly augmented (reinforced) whilst other sequences are rapidly diminished (habituated).
It is important to appreciate that the most potent stimuli for arousing a newborn’s perceptual behaviors for interaction are those involving human contact. Specifically, the newborn prefers stimuli from contact with the human face (especially eye-to-eye contact), sounds from a human voice, and the feel of a human touch. The rationale for the great arousal capacity of a human stimulus is described below”: If one analyzes the social object, the human being, . , one is struck by its extraordinarily high stimulating qualities. Visually the human face is bright, parts of it shine, it has contour and complexity. I t moves almost constantly, bringing stimulus change with every movement. I t produces sound. The human body offers tactile stimulation. Above all, the social object moves in response to the infant’s own movements. The human being is but another complex of stimuli, but because he is living, he is more interesting, and because he is human, he is more responsive.
li$ector beCiaviors refer to those abilities which enable the infant to maintain contact with the environment through his available body actions. In the newborn period this is done primarily through the hands, feet, mouth, and head and is reflected in the various reflex patterns.’ Thus, effector behaviors have an interaction potential in the form of the >> newborn’s reflexes. Here are some examples: a. Rooting reflex-involves the infant turning his head when the cheek is stimulated by touch. What is happening is that the baby turns his head toward the stimulus to bring his face, especially his eyes, to better receive the stimulus through sight. The baby literally “enfaces” the stimulus.” b. Grasp reflex-allows the baby to maintain contact through touch by tightly grasping or clinging to the stimulus. c. Sucking reflex-stimuli to the mouth elicits sucking motions whereby the baby maintains contact with the stimulus of a nipple. The additional benefit is contact with the human who is bringing the nipple to the baby. Thus, behavioral responses relating to the sucking reflex are believed to have an orientation function. l2 The newborn can also use his effector behaviors to protect himself from environmental stimuli. There is increasing awareness that sensory overload “
Novernber/Decernber 1976JOGN Nursing
can lead to fatigue and decrease the infant’s learning potential. Examples of the newborn’s attempt to get away from” the environment and stimuli can be seen in the crossed extensor and withdrawal reflexes. Signaling behaviors refer to the gestures and vocalizations available to the infant in order to attract stimuli. In the neonatal period these behaviors are smiling, babbling, and crying. Studies have demonstrated that at as early as 1 and 2 weeks of life the newborn manifests grimaces which develop into full smiles at as early as 3 to 4 week^.^,^ During this time the infant is also capable of imitating vocalizations in response to vocal sounds heard. Crying also brings stimuli to the infant, primarily parental acts, to terminate the crying behaviors. In essence, these signals bring the infant into interaction with his environment, usually a human being. “
Impact of the Newborn’s Early Interaction Experiences What significance is there from early interaction experiences during the neonatal period of life? The behavioral effects which emerge from the newborn’s early life experiences provide the foundation by which the infant will begin to formulate a perception of the self and that of the world. Early interactional experiences help the newborn to differentiate himself as a separate entity from the environment. Through early scanning and exploration of the environment, the newborn learns to distinguish “me” from “not me.”13 Thus, the beginnings of ego formation are laid during the neonatal period. The newborn is engaging in a very significant life activity, i.e., creation of his own ,> lifespace. Lifespace refers to the unique impact left by an individual during the many interactional events which occur in daily life and is observable by the way the person responds, makes decisions, and adapts to whatever is encountered.l3 The opportunity for formulating one’s lifespace may be limited in early life by the type of stimuli input from the environment and the newborn’s limited ability to make choices and decisions. Nonetheless, early interactional patterns provide direction for the infant’s future behavioral development such as the formulation of “Who am I?” (self concept). Another significant outcome of early interactional experiences involves how the infant will perceive the world. This perception emerges from two significant phenomena. First, the types of stimuli that arouse an infant’s perceptual-sensory behaviors influence whether an infant will be activated to orient himself to the world. For example, the significance of touch, especially comforting maternal tactile “
November/December 1976 JOCN Nursing
contacts, is regarded as a major component in the infant’s initial orientation to the world and development of trust.13 The second phenomenon refers to that of “human imprinting.” Several researchers have proposed that there are sensitive periods in early life, beginning as early as 2 weeks, with general acceptance that the sensitive period is between 6 weeks to 6 months of life.“-16 One recalls that imprinting in animals involves the process whereby the animal learns to respond and adapt to the environment by following the mother’s behaviors. “Human imprinting” involves the belief that an infant learns to distinguish features of the environment from input provided by parental behaviors, primarily that of mother.17 That is described by Ambrose below14: . . . the infant is gradually piecing together and buiIding his picture of what a human being is like. He learns this from the first member of the human species he interacts with, namely his mother. When he learns the characteristics of the species via her, one of the things he learns is what the human face, and clothed body are like, also the voice, touch, smell, of the human being.
Therefore, we should not underestimate the significance of early life experiences which begin in the neonatal period. No matter how limited in quality or quantity early interaction experiences may seem, they have the cumulative effect of helping the infant begin to perceive himself and the world he is expected to live in. Factors Influencing the Interaction Potential There are certain influential factors which can activate or inhibit the newborn’s potential for interaction. Five of these factors will be discussed. Characteristics of the stimuli. It has already been observed that the newborn prefers certain visual, auditory, and tactile stimuli. Also, the value of the human stimuli cannot be over-emphasized. The evoking or arousal quality of a stimuli can raise an infant’s level of responsiveness, thus maximizing the infant’s capacity to receive stimuli and thereby interact with the e n ~ i r o n m e n t . ’It~ is important to appreciate that continuous, repetitious stimulation has no significant impact in arousing an infant’s interactive behaviors.” Thus, consideration must be given not only to the infant’s preference for a stimuli but its frequency and variety. lnfant state. The state of behavior determines the infant’s readiness to receive and respond to stimuli. For example, it is obvious that a sleepy, drowsy infant cannot visually fixate effectively on his mother’s face. Also a crying, fussy infant is not able 11
to receive stimuli adequately until quieted and consoled. Thus, the infant's behavioral state provides one guide to when stimuli should be given or when they should be withheld to protect the infant from sensory overload. Research findings have indicated that overs tim ulation can inhibit learning, Basic needs or drives. Basic biological needs, such as food and sleep, can evoke stimuli input because, in the process of fulfilling such needs, the infant usually comes in contact with a human being. For example, in the process of breastfeeding or bottle-feeding, more than hunger satisfaction occurs. The infant's interactive potential is aroused because he also receives such input as touch from mother, the sound of her voice, and the sight of her face. Therefore, it is important that a mother position herself during feeding so that the infant can see, hear. and feel the pleasurable stimuli of her humanness.
Feedback mechanism or behavioral responses. Feedback is essential in maintaining interaction because it is the necessary reinforcer for the stimuli-response sequence. This means parents will not continue to stimulate or explore the infant unless they feel their input is being received and is pleasurable. In the neonatal period the feedback given by the infant is so subtle that the behaviors are frequently not recognized, or they are misinterpreted. Therefore, parents need help in recognizing those behavioral responses that indicate that a stimuli has been received and the infant is ready for more. A newborn demonstrates reception of a stimuli by eliciting a change in behavioral state. Here are some examples indicating that a newborn is attending to a stimuli. The following are also known as attentive behaviors:
The mother smiles and vocalizes to the infant and moves her head rhythmically towards and away from his face. The infant first responds by rapt attention, with a widening of his eyes and a stilling of his body movements. Then his excitement increases, body movements begin again, he may vocalize and eventually a smile spreads over his face. At this point he turns away from his mother before beginning the whole cycle once again. Throughout this sequence the mother's actions are carefully phased with those of the infant. During the infant's attention phase the mother's behavior is restrained but as his excitement increases she vocalizes more rapidly and the pitch of her voice rises. At the point when he is about to smile her movements are suddenly reduced, as if she was allowing him time to reply. However, not all mothers behave in this way. Some subject their infants to a constant and unphased barrage of stimulation. The infant is given no pauses in which to reply and he seems to be totally overwhelmed by his mother. Instead of playing this game for long periods, he is quickly reduced to fussing and crying and shows sustained and prolonged turning away from the mother's face.
Nursing Implications Nurses are in a unique position to help parents appreciate and understand their newborns' behavioral potential for interaction. Nurses are the health professionals who are readily available to provide continuity of health care during the childbirth and childrearing experiences. There are numerous actions which have come to be considered as minimal for professional nursing care in the promotion of parent-child interactions. Examples of such nursing actions are:
-encouraging parents to see and touch their new babies immediately after birth and frequently -change in motor activity such as decreased movethereafter, ments in an active infant or increased movements -encouraging parents to express their feelings and in a quiet infant,lg concerns about their unborn and/or new infant -visual fixation such as glassy-eyed staring and and clarify misconceptions with factual informaeyes ~ i d e n i n g , ~ tion, -auditory attention demonstrated by head turn- -appreciating the impact of such concepts as anxiing, or eyes blinking or staring in response to ety and grief when discrepancies exist between sound,' parental expectations and reality of the new-decreased heart and respiratory rates." ._ born's appearance and behaviors, --being present during the initiation of infant care tasks (i.e.,bathing and feeding) to offer helpAppropriate parental responses. Parent-infant inful suggestions to increase parental confidence in teraction becomes meaningful when there is synthe care of the infant. chronization of responses between parent and infant. This means correct timing and appropriate responses to stimulations. This is beautifully illusIn addition to the above, the creative nurse can trated by Richards in a description of a mother add a new dimension to nursing care. In applying concepts enumerated in this paper, the nurse can trying to elicit smiling in her infant." 12
Novernber/December 1976JOGN Nursing
promote parent-infant interaction by implemen- penetrates not only the present situation but also ting actions to achieve the following: the individual’s and society’s future growth and development. Therefore, when nurses work to facil-Help parents become more aware that a newborn itate healthy parent-infant interaction, the effects has a potential for interaction. Parents need will influence the next generation, when infants knowledge that a newborn can see and hear and eventually become parents themselves. has a preference for stimuli-the human face, voice, and touch. Thus, parents need to appre- References ciate that the best stimulation they can offer their 1. Korner, A. : Mother-Child Interaction: One or Twonew infant is themselves. Way Street?” Social Work 10(3):47-51, 1965 -Help parents recognize when their infants are 2. Bowlby, J.: Attachment and Loss, Vol. I: Attachment. New York, Basic Books, 1969, p 268 best able and ready to receive stimulation. This 3. Lipsitt, L., T. Engen, and H . Kaye: “Developmental will prevent overload of stimuli which can cause Changes in the Olfactory Threshold of the Neofatigue and irritability leading to fussy behaviors. nate.” Child V e v 34:371-376, 1963 The devastating effect from this is not as crucial 4. Fantz, R. L.: “Pattern Discrimination and Selective to the infant as it is to the parents. Parents who Attention as Determinants of Perceptual Developfeel they cause their infants to fuss or cry will ment from Birth.” In Perceptual Development in decrease attempts to initiate interaction with the Children. Edited by A. J. Kidd and J. L. Rivoire. infant. New York, International Universities Press, 1966 -Help parents to appreciate the interaction po5. Watson, J. : “Perception of Object Orientation.” tential in the newborn’s basic needs and reflexes. Merrill-Palmer Quarterly 12:73-93, 1966 I t is especially important for parents to appreciate 6. Wolff, P.: “Observations of Early Development of Smiling.” In Determinants of Infant Behavior, Vol. that their infants need to see their faces, hear 11. Edited by B. M. Foss. London, Metheun and their voices, and feel their touch in such everyday Company; New York, John Wiley and Sons, 1963, pp tasks as feeding and bathing. Also, parents need 117-130 to understand that a reflex such as rooting is an 7. Wolff, P. : “Observations on Newborn Infants.” attempt to better enface” the stimuli, and as the Psych Med 21:110-118, 1959 infant turns his head, parents should allow vis8. Hetzer, H ., and B. Tudor-Hart: “Die fruhesten ualization of the stimuli by providing an unobreaktionen auf die menschliche stimme,” as interstructed view of themselves. preted by J. Bowlby, in Attachment and Loss, Vol. I : -Parents also need help in learning to coordinate Attachment. New York, Basic Books, 1969, p 270 their responses appropriately with their infants. 9. Wolff, P.: “The Natural History of Crying and Other Thus, parents need to be able to recognize when Vocalizations in Early Infants.” In Determinants of Humun Behaviors, Vol. 1V. Edited by B. M. Foss. an infant is attending to a stimulus so they do not London, Methuen and Company, 1969, pp 81-111 make it difficult for the infant to see, hear, or touch. Parents themselves can distract the in- 10. Rheingold, H.: “ T h e Effect of Environmental Stimulation Upon Social and Exploratory Behavior in Hufant’s ability to attend by overzealous attempts man Infant.” In Determinants of Human Behavior, to provide stimuli. I t is possible to achieve this Vol. I. Edited by B. M. Foss. London, Methuen and goal if nurses make deliberate plans to observe Company; New York, John Wiley and Sons, 1963, pp parent-infant interaction in some degree of 167-168 depth. 11. Blauvelt, H . , and J . McKenna: Mother-Neonate -Finally, nurses need to value the significance of Interaction: Capacity of the Human Newborn for feedback in the interaction process. Parents need Orientation.” In Determinants of Infant Behavior, feedback regarding their efforts to interact with Vol. I. Edited by B. M. Foss. London, Methuen and Company; New York, John Wiley and Sons, 1961, p p their babies. Nurses can manipulate the situation 4-5 to make the encounter between parent and infant as pleasurable as possible from the very begin- 12. Prechtl, H.: “The Directed Head Turning Response and Allied Movements of the Human Baby.” Behavnings. Parents need help in recognizing various 13:212-242, 1958 ior infant behaviors as reinforcers. And most impor13. Frank, L. : O n the Importance of Infancy. New York, tant, nurses should not hesitate to provide posiRandom House, 1966, p p 6, 99-103 tive feedback (praise, comments, pleasing ges- 14. Ambrose, J. A.: “Concept of Critical Period for the tures) to parents for their efforts in interacting Development of Social Responsiveness in Early Huand caring for the infant. man Infancy.” In Veterminants of Human Behavior, Vol. I. Edited by B. M. Foss. London, Methuen and Conclusion Company; New York, John Wiley and Sons, 1961, p When nursing care is truly significant, its impact 223 “
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13
15. Hinde, R. A.: “Nature of Imprinting.” In Determinants of Human Behavior, Vol. I. Edited by B. M. Foss, London, Methuen and Company; New York, John Wiley and Sons, 1961, pp 227-233 16. Gray, P. H. : “Theory and Evidence of Imprinting in Human Infants.” J Psych 46:155-166, 1958 17. Gewirtz, J . : “ A Learning Analysis of the Effects of Normal Stimulation, Privation, and Deprivation on the Acquisition of Social Motivation and Attachment.” In Determinants of Human Behavior, Vol. I. Edited by B. M. Foss. London, Methuen and Company; New York, John Wiley and Sons, 1961, pp 213-290 18. Lipsitt, L.: “Learning Processes of Human Newborns.” Merrill-Palmer Quarterly 12:45-71, 1966 19. Brown, Janet: “States in Newborn Infants.” MerrillPalmer Quarterly 10:313-327, 1964 20. Kagan, J. and M . Lewis: “Studies of Attention in the H u m a n Infant.” Merrill-Palmer Quarterly 11:95-127, 1965 21. Richards, M . : “Social Interaction in the First Weeks of Human Life.” Psychiatr Neurol Neurochir 74:38, 1971
Lewis, M., and L. Rosenblum: Origins of Behavior: Effect of the lnfant on Its Caregiver. New York, WileyInterscience, 1974 Richards, M.: “Social Interaction in the First Two Weeks of Human Life.” Psychiatr Neurol Neurochir 74:35-42, 1971 Rosenthal, M. : “The Study of Infant-Environment Interaction: Trends and Methodologies.” J Child Psychol Ps ychiutry 14:301-317, 1973 Address reprint requests to Ms. Dyanne Affonso, RN, Assistant Professor, College of Nursing, University of Arizona, Tucson, AZ 85721.
This article represents an extension of the work done by the author for the chapter, “Psychosocial Concepts Relevant to the in Neon ate, Childbearing: A Nursing Perspective, a muternalnewborn nursing text by Ms. Affonso and M s . Ann Clark ( F . A . Davis Company, 1976’). Dyanne Affonso is currently Assistant Professor at the College of Nursing at the University of Arizona in Tucson. She has taught previously at the University of Hawaii, where she took her R S N , and at the University of Mississippi. Ms. Afonso’s graduate degree is from the University of Washington. She has conducted several research projects und is an experienced nurselauthor. ”
Supplemental Bibliography Brazelton, T. B. : Neonatal Behavioral Assessment Scale. Philadelphia, J . B. Lippincott, 1973 Clark, A . , and D. Affonso: “Infant Behavior and Maternal Attachment: Two Sides to the Coin.” A m J MatChild Nurs, March-April, 1976, pp 94-99 Craig, M. : “Normal Neonatal Behavior Patterns: The First Week of Extrauterine Life.” Child and F a m 9(4):303-319, 1970 Korner, A. : “Individual Differences at Birth: Implications for Early Experience and Late Development.” A m J Orthopsychiatr 41(4):608-619, 1971 Korner, A., and E. Thomas: “The Relative Efficacy of Contact and Vestibular-Proprioceptive Stimulation in Soothing Neonates.” Child Dev 43:443-453, June, 1972
Childbirth Education The Council of Childbirth Education Specialists announces its Introductory Program schedule for 1977. March 1-4 March 22-25 August 8-1 1 November 1-4 November 7-10
New York, New York Atlanta, Georgia Boston, Massachusetts Kansas City, Missouri New York, New York
For further information, please write to Patricia Hassid, RN, Registrar, C/CES, 168 West 86th Street, New York, NY 10024.
14
November/December 1976JOGN Nursing
JOGN Nursing Journal of The Nurses Association of The American College of Obstetricians and Gynecologists
The Newborn’s Potential for Interaction DYANNE AFFONSO, RN, BSN, M S N
The signijicance of the interaction process for both parent and child is set forth, and three behavioral components of the newborn’s potential for interaction are discussed: perceptual behaviors, effector behaviors, and signaling behaviors. In a practical section, the factors that can activate or inhibit the newborn’s interaction potential are outlined, and the significance of the findings for nursing practice are presented.
Human interaction is fundamental to human existence. The interaction process exerts a major influence on an individual’s successful adaptation in the world. Therefore, it is of value to explore a human being’s earliest interaction with the environment-that with his parents. For too long the emphasis in discussions on parent-infant interactions has been primarily on the parents, especially the mother. The infant has been largely ignored because he has been viewed as a passive recipient of maternal care, with limited capacity to exert any meaningful influence on the environment.’ However, interaction involves a two-way interchange of both intake and output. Thus, the importance of what the infant brings to the encounter can no longer be ignored or minimized. Modern research has brought new insight demonstrating that a newborn enters the world with the potential to actively interact with his environment and is not merely a recipient of stimuli. This potential for interaction needs only to b e activated by behavioral stimulations from the environment. The purpose of this paper is to explore selected features in a newborn’s November/Decernber 1976 JOCN Nursing
behavioral repertoire in order to demonstrate that the potential for interaction is readily present and waiting to be activated. Behavioral Components for Interaction The newborn’s interaction potential is rooted in three behavioral components. These are labeled by Bowlby’ as 1) perceptual behaviors, 2) effector behaviors, and 3 ) signaling behaviors. Perceptual behuviors refer to the sensory abilities by which the newborn can take in” or receive environmental stimuli. The newborn does this primarily through sensory experiences provided by sights, sounds, odors, touching, and tastes. Perceptual-sensory behaviors are important because they enable the infant to explore the environment by “taking in” stimuli through his own initiative. Exploratory behaviors are crucial in early life because they formulate the beginnings for parent-infant orientation. Parent-infant orientation is the process whereby both parent and child explore and familiarize themselves with each other toward the development of a relationship which will sustain “
9
them in their daily living. The perceptual-sensory capabilities in the newborn are remarkable! The newborn can see, hear, taste, and smell, and these abilities increase rapidly in efficiency within the first 2 weeks of life.”.“ The newborn not only is able to receive and respond to stimuli but also has a discriminating ability for various stimuli. This means the infant has a preference for selected stimuli. Thus, certain stimuli will b e more effective in arousing the newborn’s behavioral potential for interaction. Examples of the newborn’s discriminating abilities are as follows: -The newborn prefers visual stimuli containing contour, color, brightness, and movement as contrasted to dull, flat object^.^'^,^ Visual acuity is enhanced when objects are within 8-10 inches from the eyes4 -The newborn prefers auditory stimuli which are rhymical, soft, and human (especially that which is high-pitched, which is more typical of the maternal voice).‘” -The newborn is more likely to demonstrate “consoling behaviors” (indicative of contentment, peacefulness, feeling soothed) when tactile stimulations are warm, gentle, rocking, stroking, or rhythmical, as contrasted to cold, abrupt, jerky, touching acts.9,’ These discriminating abilities in the newborn are believed to be important for behavioral development. Their existence lends support to the belief that the newborn is not passive but can exert an influence on its environment. Discriminating abilities allow the infant to indicate what type of stimulus is desired. How is this possible? The infant’s behavioral responses to the stimuli (indicating perceived pleasure, dissatisfaction, or inattention) will affect the environment in terms of providing or not providing positive feedback (reinforcement) for the stimuli. For example, if a mother touches her infant and the infant provides behavioral clues which make the mother perceive that the infant does not enjoy her touching acts, it can be predicted that the mother may decrease her attempts to touch because she received no reinforcement for her actions. Thus, the newborn’s behavioral responses can influence whether a stimulus will continue, change, or be extinguished. An important concept is being demonstrated here. The newborn is exerting a degree of control over his subsequent behaviors because he now will be able to have some influence in forthcoming behavioral sequences in his daily interaction-primarily with his parents. Bowlby adds supports to this concept2: 10
Thus, owing to the selective sensitivity with which a baby is born, different sorts of behaviors are elicited by different sorts of stimuli and much more attention is paid to some parts of the environment than to other parts. . . some sorts of behavioral sequence are rapidly augmented (reinforced) whilst other sequences are rapidly diminished (habituated).
It is important to appreciate that the most potent stimuli for arousing a newborn’s perceptual behaviors for interaction are those involving human contact. Specifically, the newborn prefers stimuli from contact with the human face (especially eye-to-eye contact), sounds from a human voice, and the feel of a human touch. The rationale for the great arousal capacity of a human stimulus is described below”: If one analyzes the social object, the human being, . , one is struck by its extraordinarily high stimulating qualities. Visually the human face is bright, parts of it shine, it has contour and complexity. I t moves almost constantly, bringing stimulus change with every movement. I t produces sound. The human body offers tactile stimulation. Above all, the social object moves in response to the infant’s own movements. The human being is but another complex of stimuli, but because he is living, he is more interesting, and because he is human, he is more responsive.
li$ector beCiaviors refer to those abilities which enable the infant to maintain contact with the environment through his available body actions. In the newborn period this is done primarily through the hands, feet, mouth, and head and is reflected in the various reflex patterns.’ Thus, effector behaviors have an interaction potential in the form of the >> newborn’s reflexes. Here are some examples: a. Rooting reflex-involves the infant turning his head when the cheek is stimulated by touch. What is happening is that the baby turns his head toward the stimulus to bring his face, especially his eyes, to better receive the stimulus through sight. The baby literally “enfaces” the stimulus.” b. Grasp reflex-allows the baby to maintain contact through touch by tightly grasping or clinging to the stimulus. c. Sucking reflex-stimuli to the mouth elicits sucking motions whereby the baby maintains contact with the stimulus of a nipple. The additional benefit is contact with the human who is bringing the nipple to the baby. Thus, behavioral responses relating to the sucking reflex are believed to have an orientation function. l2 The newborn can also use his effector behaviors to protect himself from environmental stimuli. There is increasing awareness that sensory overload “
Novernber/Decernber 1976JOGN Nursing
can lead to fatigue and decrease the infant’s learning potential. Examples of the newborn’s attempt to get away from” the environment and stimuli can be seen in the crossed extensor and withdrawal reflexes. Signaling behaviors refer to the gestures and vocalizations available to the infant in order to attract stimuli. In the neonatal period these behaviors are smiling, babbling, and crying. Studies have demonstrated that at as early as 1 and 2 weeks of life the newborn manifests grimaces which develop into full smiles at as early as 3 to 4 week^.^,^ During this time the infant is also capable of imitating vocalizations in response to vocal sounds heard. Crying also brings stimuli to the infant, primarily parental acts, to terminate the crying behaviors. In essence, these signals bring the infant into interaction with his environment, usually a human being. “
Impact of the Newborn’s Early Interaction Experiences What significance is there from early interaction experiences during the neonatal period of life? The behavioral effects which emerge from the newborn’s early life experiences provide the foundation by which the infant will begin to formulate a perception of the self and that of the world. Early interactional experiences help the newborn to differentiate himself as a separate entity from the environment. Through early scanning and exploration of the environment, the newborn learns to distinguish “me” from “not me.”13 Thus, the beginnings of ego formation are laid during the neonatal period. The newborn is engaging in a very significant life activity, i.e., creation of his own ,> lifespace. Lifespace refers to the unique impact left by an individual during the many interactional events which occur in daily life and is observable by the way the person responds, makes decisions, and adapts to whatever is encountered.l3 The opportunity for formulating one’s lifespace may be limited in early life by the type of stimuli input from the environment and the newborn’s limited ability to make choices and decisions. Nonetheless, early interactional patterns provide direction for the infant’s future behavioral development such as the formulation of “Who am I?” (self concept). Another significant outcome of early interactional experiences involves how the infant will perceive the world. This perception emerges from two significant phenomena. First, the types of stimuli that arouse an infant’s perceptual-sensory behaviors influence whether an infant will be activated to orient himself to the world. For example, the significance of touch, especially comforting maternal tactile “
November/December 1976 JOCN Nursing
contacts, is regarded as a major component in the infant’s initial orientation to the world and development of trust.13 The second phenomenon refers to that of “human imprinting.” Several researchers have proposed that there are sensitive periods in early life, beginning as early as 2 weeks, with general acceptance that the sensitive period is between 6 weeks to 6 months of life.“-16 One recalls that imprinting in animals involves the process whereby the animal learns to respond and adapt to the environment by following the mother’s behaviors. “Human imprinting” involves the belief that an infant learns to distinguish features of the environment from input provided by parental behaviors, primarily that of mother.17 That is described by Ambrose below14: . . . the infant is gradually piecing together and buiIding his picture of what a human being is like. He learns this from the first member of the human species he interacts with, namely his mother. When he learns the characteristics of the species via her, one of the things he learns is what the human face, and clothed body are like, also the voice, touch, smell, of the human being.
Therefore, we should not underestimate the significance of early life experiences which begin in the neonatal period. No matter how limited in quality or quantity early interaction experiences may seem, they have the cumulative effect of helping the infant begin to perceive himself and the world he is expected to live in. Factors Influencing the Interaction Potential There are certain influential factors which can activate or inhibit the newborn’s potential for interaction. Five of these factors will be discussed. Characteristics of the stimuli. It has already been observed that the newborn prefers certain visual, auditory, and tactile stimuli. Also, the value of the human stimuli cannot be over-emphasized. The evoking or arousal quality of a stimuli can raise an infant’s level of responsiveness, thus maximizing the infant’s capacity to receive stimuli and thereby interact with the e n ~ i r o n m e n t . ’It~ is important to appreciate that continuous, repetitious stimulation has no significant impact in arousing an infant’s interactive behaviors.” Thus, consideration must be given not only to the infant’s preference for a stimuli but its frequency and variety. lnfant state. The state of behavior determines the infant’s readiness to receive and respond to stimuli. For example, it is obvious that a sleepy, drowsy infant cannot visually fixate effectively on his mother’s face. Also a crying, fussy infant is not able 11
to receive stimuli adequately until quieted and consoled. Thus, the infant's behavioral state provides one guide to when stimuli should be given or when they should be withheld to protect the infant from sensory overload. Research findings have indicated that overs tim ulation can inhibit learning, Basic needs or drives. Basic biological needs, such as food and sleep, can evoke stimuli input because, in the process of fulfilling such needs, the infant usually comes in contact with a human being. For example, in the process of breastfeeding or bottle-feeding, more than hunger satisfaction occurs. The infant's interactive potential is aroused because he also receives such input as touch from mother, the sound of her voice, and the sight of her face. Therefore, it is important that a mother position herself during feeding so that the infant can see, hear. and feel the pleasurable stimuli of her humanness.
Feedback mechanism or behavioral responses. Feedback is essential in maintaining interaction because it is the necessary reinforcer for the stimuli-response sequence. This means parents will not continue to stimulate or explore the infant unless they feel their input is being received and is pleasurable. In the neonatal period the feedback given by the infant is so subtle that the behaviors are frequently not recognized, or they are misinterpreted. Therefore, parents need help in recognizing those behavioral responses that indicate that a stimuli has been received and the infant is ready for more. A newborn demonstrates reception of a stimuli by eliciting a change in behavioral state. Here are some examples indicating that a newborn is attending to a stimuli. The following are also known as attentive behaviors:
The mother smiles and vocalizes to the infant and moves her head rhythmically towards and away from his face. The infant first responds by rapt attention, with a widening of his eyes and a stilling of his body movements. Then his excitement increases, body movements begin again, he may vocalize and eventually a smile spreads over his face. At this point he turns away from his mother before beginning the whole cycle once again. Throughout this sequence the mother's actions are carefully phased with those of the infant. During the infant's attention phase the mother's behavior is restrained but as his excitement increases she vocalizes more rapidly and the pitch of her voice rises. At the point when he is about to smile her movements are suddenly reduced, as if she was allowing him time to reply. However, not all mothers behave in this way. Some subject their infants to a constant and unphased barrage of stimulation. The infant is given no pauses in which to reply and he seems to be totally overwhelmed by his mother. Instead of playing this game for long periods, he is quickly reduced to fussing and crying and shows sustained and prolonged turning away from the mother's face.
Nursing Implications Nurses are in a unique position to help parents appreciate and understand their newborns' behavioral potential for interaction. Nurses are the health professionals who are readily available to provide continuity of health care during the childbirth and childrearing experiences. There are numerous actions which have come to be considered as minimal for professional nursing care in the promotion of parent-child interactions. Examples of such nursing actions are:
-encouraging parents to see and touch their new babies immediately after birth and frequently -change in motor activity such as decreased movethereafter, ments in an active infant or increased movements -encouraging parents to express their feelings and in a quiet infant,lg concerns about their unborn and/or new infant -visual fixation such as glassy-eyed staring and and clarify misconceptions with factual informaeyes ~ i d e n i n g , ~ tion, -auditory attention demonstrated by head turn- -appreciating the impact of such concepts as anxiing, or eyes blinking or staring in response to ety and grief when discrepancies exist between sound,' parental expectations and reality of the new-decreased heart and respiratory rates." ._ born's appearance and behaviors, --being present during the initiation of infant care tasks (i.e.,bathing and feeding) to offer helpAppropriate parental responses. Parent-infant inful suggestions to increase parental confidence in teraction becomes meaningful when there is synthe care of the infant. chronization of responses between parent and infant. This means correct timing and appropriate responses to stimulations. This is beautifully illusIn addition to the above, the creative nurse can trated by Richards in a description of a mother add a new dimension to nursing care. In applying concepts enumerated in this paper, the nurse can trying to elicit smiling in her infant." 12
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promote parent-infant interaction by implemen- penetrates not only the present situation but also ting actions to achieve the following: the individual’s and society’s future growth and development. Therefore, when nurses work to facil-Help parents become more aware that a newborn itate healthy parent-infant interaction, the effects has a potential for interaction. Parents need will influence the next generation, when infants knowledge that a newborn can see and hear and eventually become parents themselves. has a preference for stimuli-the human face, voice, and touch. Thus, parents need to appre- References ciate that the best stimulation they can offer their 1. Korner, A. : Mother-Child Interaction: One or Twonew infant is themselves. Way Street?” Social Work 10(3):47-51, 1965 -Help parents recognize when their infants are 2. Bowlby, J.: Attachment and Loss, Vol. I: Attachment. New York, Basic Books, 1969, p 268 best able and ready to receive stimulation. This 3. Lipsitt, L., T. Engen, and H . Kaye: “Developmental will prevent overload of stimuli which can cause Changes in the Olfactory Threshold of the Neofatigue and irritability leading to fussy behaviors. nate.” Child V e v 34:371-376, 1963 The devastating effect from this is not as crucial 4. Fantz, R. L.: “Pattern Discrimination and Selective to the infant as it is to the parents. Parents who Attention as Determinants of Perceptual Developfeel they cause their infants to fuss or cry will ment from Birth.” In Perceptual Development in decrease attempts to initiate interaction with the Children. Edited by A. J. Kidd and J. L. Rivoire. infant. New York, International Universities Press, 1966 -Help parents to appreciate the interaction po5. Watson, J. : “Perception of Object Orientation.” tential in the newborn’s basic needs and reflexes. Merrill-Palmer Quarterly 12:73-93, 1966 I t is especially important for parents to appreciate 6. Wolff, P.: “Observations of Early Development of Smiling.” In Determinants of Infant Behavior, Vol. that their infants need to see their faces, hear 11. Edited by B. M. Foss. London, Metheun and their voices, and feel their touch in such everyday Company; New York, John Wiley and Sons, 1963, pp tasks as feeding and bathing. Also, parents need 117-130 to understand that a reflex such as rooting is an 7. Wolff, P. : “Observations on Newborn Infants.” attempt to better enface” the stimuli, and as the Psych Med 21:110-118, 1959 infant turns his head, parents should allow vis8. Hetzer, H ., and B. Tudor-Hart: “Die fruhesten ualization of the stimuli by providing an unobreaktionen auf die menschliche stimme,” as interstructed view of themselves. preted by J. Bowlby, in Attachment and Loss, Vol. I : -Parents also need help in learning to coordinate Attachment. New York, Basic Books, 1969, p 270 their responses appropriately with their infants. 9. Wolff, P.: “The Natural History of Crying and Other Thus, parents need to be able to recognize when Vocalizations in Early Infants.” In Determinants of Humun Behaviors, Vol. 1V. Edited by B. M. Foss. an infant is attending to a stimulus so they do not London, Methuen and Company, 1969, pp 81-111 make it difficult for the infant to see, hear, or touch. Parents themselves can distract the in- 10. Rheingold, H.: “ T h e Effect of Environmental Stimulation Upon Social and Exploratory Behavior in Hufant’s ability to attend by overzealous attempts man Infant.” In Determinants of Human Behavior, to provide stimuli. I t is possible to achieve this Vol. I. Edited by B. M. Foss. London, Methuen and goal if nurses make deliberate plans to observe Company; New York, John Wiley and Sons, 1963, pp parent-infant interaction in some degree of 167-168 depth. 11. Blauvelt, H . , and J . McKenna: Mother-Neonate -Finally, nurses need to value the significance of Interaction: Capacity of the Human Newborn for feedback in the interaction process. Parents need Orientation.” In Determinants of Infant Behavior, feedback regarding their efforts to interact with Vol. I. Edited by B. M. Foss. London, Methuen and Company; New York, John Wiley and Sons, 1961, p p their babies. Nurses can manipulate the situation 4-5 to make the encounter between parent and infant as pleasurable as possible from the very begin- 12. Prechtl, H.: “The Directed Head Turning Response and Allied Movements of the Human Baby.” Behavnings. Parents need help in recognizing various 13:212-242, 1958 ior infant behaviors as reinforcers. And most impor13. Frank, L. : O n the Importance of Infancy. New York, tant, nurses should not hesitate to provide posiRandom House, 1966, p p 6, 99-103 tive feedback (praise, comments, pleasing ges- 14. Ambrose, J. A.: “Concept of Critical Period for the tures) to parents for their efforts in interacting Development of Social Responsiveness in Early Huand caring for the infant. man Infancy.” In Veterminants of Human Behavior, Vol. I. Edited by B. M. Foss. London, Methuen and Conclusion Company; New York, John Wiley and Sons, 1961, p When nursing care is truly significant, its impact 223 “
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15. Hinde, R. A.: “Nature of Imprinting.” In Determinants of Human Behavior, Vol. I. Edited by B. M. Foss, London, Methuen and Company; New York, John Wiley and Sons, 1961, pp 227-233 16. Gray, P. H. : “Theory and Evidence of Imprinting in Human Infants.” J Psych 46:155-166, 1958 17. Gewirtz, J . : “ A Learning Analysis of the Effects of Normal Stimulation, Privation, and Deprivation on the Acquisition of Social Motivation and Attachment.” In Determinants of Human Behavior, Vol. I. Edited by B. M. Foss. London, Methuen and Company; New York, John Wiley and Sons, 1961, pp 213-290 18. Lipsitt, L.: “Learning Processes of Human Newborns.” Merrill-Palmer Quarterly 12:45-71, 1966 19. Brown, Janet: “States in Newborn Infants.” MerrillPalmer Quarterly 10:313-327, 1964 20. Kagan, J. and M . Lewis: “Studies of Attention in the H u m a n Infant.” Merrill-Palmer Quarterly 11:95-127, 1965 21. Richards, M . : “Social Interaction in the First Weeks of Human Life.” Psychiatr Neurol Neurochir 74:38, 1971
Lewis, M., and L. Rosenblum: Origins of Behavior: Effect of the lnfant on Its Caregiver. New York, WileyInterscience, 1974 Richards, M.: “Social Interaction in the First Two Weeks of Human Life.” Psychiatr Neurol Neurochir 74:35-42, 1971 Rosenthal, M. : “The Study of Infant-Environment Interaction: Trends and Methodologies.” J Child Psychol Ps ychiutry 14:301-317, 1973 Address reprint requests to Ms. Dyanne Affonso, RN, Assistant Professor, College of Nursing, University of Arizona, Tucson, AZ 85721.
This article represents an extension of the work done by the author for the chapter, “Psychosocial Concepts Relevant to the in Neon ate, Childbearing: A Nursing Perspective, a muternalnewborn nursing text by Ms. Affonso and M s . Ann Clark ( F . A . Davis Company, 1976’). Dyanne Affonso is currently Assistant Professor at the College of Nursing at the University of Arizona in Tucson. She has taught previously at the University of Hawaii, where she took her R S N , and at the University of Mississippi. Ms. Afonso’s graduate degree is from the University of Washington. She has conducted several research projects und is an experienced nurselauthor. ”
Supplemental Bibliography Brazelton, T. B. : Neonatal Behavioral Assessment Scale. Philadelphia, J . B. Lippincott, 1973 Clark, A . , and D. Affonso: “Infant Behavior and Maternal Attachment: Two Sides to the Coin.” A m J MatChild Nurs, March-April, 1976, pp 94-99 Craig, M. : “Normal Neonatal Behavior Patterns: The First Week of Extrauterine Life.” Child and F a m 9(4):303-319, 1970 Korner, A. : “Individual Differences at Birth: Implications for Early Experience and Late Development.” A m J Orthopsychiatr 41(4):608-619, 1971 Korner, A., and E. Thomas: “The Relative Efficacy of Contact and Vestibular-Proprioceptive Stimulation in Soothing Neonates.” Child Dev 43:443-453, June, 1972
Childbirth Education The Council of Childbirth Education Specialists announces its Introductory Program schedule for 1977. March 1-4 March 22-25 August 8-1 1 November 1-4 November 7-10
New York, New York Atlanta, Georgia Boston, Massachusetts Kansas City, Missouri New York, New York
For further information, please write to Patricia Hassid, RN, Registrar, C/CES, 168 West 86th Street, New York, NY 10024.
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November/December 1976JOGN Nursing