MamanKangourou

What is attachment?

Attachment is the lasting affective bond that exists between children and their caregiver. It is a very important bond, since babies absolutely need to bond with one or several significant people for their hearts and brains to develop properly. They need to be fed not only physically, but also to be touched, to be spoken to, to play. They need to count on at least one person in particular. It is known that babies raised in overcrowded orphanages may even die if they do not feel an emotional bond with someone or if they lose the only person with whom they shared a bond. Some stop eating and let themselves die.

What about normal babies? Attachment begins to form in the mother’s womb. Growing babies who already feel welcome and loved already share a positive bond with their mother and father and thus develop their self-esteem. After birth, parents care for them, talk to them, play with them and take their needs and reactions into account. And so, the attachment bond continues to develop.

On the other hand, babies do what they can to keep their caregiver nearby: they express sustained interest in human faces and voices, they smile, cry to call them close, reach a hand out as soon as they are able, and shows their interest in a thousand ways. They are “programmed” to seek proximity with adult caregivers.

Young babies do not seem to see the difference between the adults that care for them until the age of 6 to 9 months. It is at that age that children begin to better differentiate familiar people from strangers and no longer accept that someone unknown cares for them. We all now the tantrums children of that age can throw out of fear of losing mommy... since they don’t quite understand that mommy and daddy continue to exist even when they don’t see them.

From the age of one year, whether or not children have developed “secure” attachment can be more clearly observed. Secure attachment is seen when the presence of the familiar adult enables the child to relax and to know they are safe, allowing them to go out, openly and confidently, to discover the world around them. On the other hand, when the parent leaves the child in the presence of a stranger, children with secure attachment will show signs of worry. When the parent returns, the child will go to them for reassurance. If they have cried, parental presence and touch will be comforting. This is the case for the majority of children.

A minority of children, however, develop an “insecure” type of attachment. Some show little dependence on the parent, which is an abnormal situation for young children who obviously need adults. When the familiar adult leaves, they may continue to play quietly, seem barely aware that the parent has left and do not seek to be reassured upon their return. This attachment is said to be “evasive”. Other children manifest “ambivalent” attachment – they run to the returning parent, but do not appear reassured, and can become angry even while remaining with the parent.

Certain children worry us because they seem more often than not as comfortable with strangers as they are with their own parents. It seems as though they had not formed an attachment bond with anyone at all. This behaviour can sometimes be seen in children who were gravely neglected at a young age.

This attachment bond that forms during childhood is exceedingly important since it forever becomes our unconscious mental and emotional representation of what is an intimate relationship with someone. If I was loved, cared for, consoled and supported during my development, I know I can, in turn, love. It is not an intellectually-held concept; it is how I live my life even if I never put it into words. This knowledge has been imprinted in my brain since the very first years of my life. It most often defines how I behave with my spouse and how I raise my children. I tend to develop the same type of attachment with my children as I shared with my parents.

In a future article, we will examine the ways parents can help promote the development of secure attachment with their child.

Claudette Nantel,

Psychotherapist, pre- and perinatal psychology specialist

claudettenantel@sympatico.ca

This article is presented by Maman Kangourou (www.mamankangourou.com)

At birth, babies’ internal organs are fairly complete, but their brains continue to develop for several years. The average weight of a brain grows from approximately 400 g at birth to 1 000g at one year and 1 100g at age two (80% of the weight of an adult brain). The brain develops in phenomenal fashion starting in the third trimester of pregnancy until the end of the first year of life. But to develop its generic potential, babies’ brains absolutely require social and emotional contact.

As early as the fifties, John Bowlby, a British psychiatrist, asserted that an attachment-based relationship with at least one adult was as necessary to children’s emotional development as food is to their physical growth. Along with Mary Ainsworth, an American psychologist, he developed the theory of attachment. Babies will develop “secure” attachment if they receive daily care from a sensitive adult who can read their signals and meet their physical and emotional needs in a fairly consistent manner. If they are regularly in relation with an adult who is inconsistent in their care, or who manifests little affection, they will develop “insecure” attachment.

Since the nineties, research in developmental neurobiology has shown how this attachment develops in babies’ brains and confirms that attachment bonds are a biological necessity. The brain’s right hemisphere is the first to develop in children.  Dominant in fetuses and babies up to age 3, the right brain is, among other functions, the seat of non-verbal aspects of communication, intuition, empathy, creativity and sense of self, both emotionally and physically. The left brain, verbal and conceptual, starts to develop mainly from the age of 3. A majority of researchers claim that the social environment during the first two years of life, particularly the mother-child bond, enables the maturation of the right brain. That is where the bases of social adjustment, stress-coping mechanisms and emotional control develop. As Jeliu and Cousineau put it, the brain is literally sculpted by communication experiences and by emotions felt during early childhood (2003).

Within the right hemisphere, it is mostly in the center of the brain, in the right limbic system, that the first socio-affective experiences are recorded in babies from age 0-2. During the first six months, there is an accelerated construction of cells and connections (called synapses) between neurons in the cerebral amygdala, located in the limbic system. At this age, babies are eager for social contact with all human beings. They have a deep interest in human faces. It is in the cerebral amygdala that reside the first associations they establish with many emotional states such as fear, joy, love – for example, “mommy, daddy, love me”, “when I am sad, mommy comforts me”, or “I can’t really count on anyone”. These experiences come through emotional contact with the mother and other loved ones, through visual cues, touch, caresses and sound, during daily care and play.

Then, around the age of 6 months, the amygdala matures and the more intense neurological development activity shifts to the callosal gyrus (first convolution above the corpus callosum) and nucleus septi. Babies now bond to known people who provide care and refuse contact with strangers. It is as though the neurological activity in the callosal gyrus and the nucleus septi inhibited the activity of the cerebral amygdala that eagerly sought out social contact with just anyone. Among people children trust, the mother is generally the favorite. The separation anxiety typical to the end of the first year appears.

From the second year of life, more intense activity can be observed in the orbitofrontal cortex (behind the eye socket). This cortex is the “higher management” of the socioemotional brain and plays an important role in emotional and behavioural self-control. Attachment quality, self-control and everything related (self-esteem, ability to empathize, etc.) continue to develop until adulthood, but the bases seem set by age 2 or 3.

If in the first six months babies are deprived of emotional contact, their amygdala remains functionally inert and “catatonic” behaviour similar to autism can be observed. Sadly, it has too often been observed in certain overpopulated orphanages. Deprivation of social stimulation after the age of 6 months may lead to children’s excessive familiarity with strangers, as though the callosal gyrus and nucleus septi, left unstimulated, could not inhibit amygdala activity. Jeliu and Cousineau (2003) explain that in some extreme cases of attachment system dysfunction, a kind of “social blindness” can be observed, an inability to identify and answer common social signals and great difficulty in remembering faces, people and places.

So the next time you feel you “haven’t gotten anything done today” other than caring for your baby, take heart in knowing that during this highly important day, you helped mold your baby’s brain with everything they will need throughout their entire life to relate to themselves and function in society.

Claudette Nantel,

Psychotherapist, pre- and perinatal psychology specialist

claudettenantel@sympatico.ca

This article is presented by Maman Kangourou (www.mamankangourou.com)

To know more:

- The limbic system:

           a) http://lyon-sud.univ-lyon1.fr/1197455438771/0/fiche___document/&RH=1196427363463 (click the second link, “Physiologie émotions couleur. Pdf”, and scroll to page 23)

           b) http://www.trauma-pages.com/a/schore-2001a.php Scroll to the top third of the article to see the diagram of the brain. The article is highly technical, but great if you read English. This article by Schore is a classic reference for the neurobiology of attachment.

- Jeliu, G. and Cousineau, D. Le cerveau et l’amour maternel. 2003. PRISME, no. 40, pp. 118-125 – Drs. Jeliu and Cousineau are pediatricians at Hôpital Ste-Justine in Montreal.

- Sunderland, Margot. La science au service des parents. 2007. Montreal: Ed. Hurtubise – A book that addresses childhood education in terms of what is known about brain and nervous system development.

- http://www.centrejeunessemonteregie.qc.ca/web/pdf/enjeu_Recherche2004.pdf - Rapport de recherche sur l’attachement, by Centre jeunesse de la Montérégie (2004) - Quebec experts discuss attachment, abandon, emotional deprivation and their effects on children. Particularly interesting for birth, adoptive or foster parents who are raising children having suffered difficult experiences in their first emotional relationships.

How can I promote secure attachment with my baby? In the first two articles in this series on attachment, we looked at what infant attachment is and how it develops in babies’ brains. We know that children who develop “secure” attachment have excellent chances of becoming socially well-adjusted teenagers and adults, able to experience healthy relationships with others.

Some say that you mustn’t “spoil” a baby, that you should let them cry to “develop their lungs”, that they learn to comfort themselves and that they gain independence as quickly as possible. What are babies’ true needs? Experts in child psychology generally agree that “proximal nurturing” is what best meets their emotional needs, particularly the need to be close to their parents to feel safe. “Proximal”, from the Latin for “close”, as opposed to “distal”, which shares its roots with “distance”. It is the equivalent of the American term “attachment parenting” popularized in the eighties by Dr. William Sears. It is a child-rearing philosophy that takes for granted that the more sensitivity parents show in relation to their young child’s needs for dependence, the greater the true independence they will develop at a later age. Proximal nurturing is characterized by behaviours showing parental availability, rapid response and sensitivity to babies’ needs. These behaviours seem to promote babies’ basic security, and consequently, secure attachment.

Proximal nurturing begins if possible by skin-to-skin contact between mother and baby (and between father and baby) immediately after birth. This intimate tactile contact between baby and parents promotes the development of a deep emotional bond. Breastfeeding is then a logical choice for mothers who seek proximity with their baby. The innumerable benefits of breastfeeding for both babies and mothers are well-known.  Breastfeeding on request facilitates rapid response to babies’ needs. However, it is possible to practice proximal nurturing and to respond quickly to babies’ needs while bottle-feeding. What matters most to help babies develop secure attachment is parental availability. “Proximal” parents quickly respond to crying babies, even if they “only” need to be held by their parents. To them, babies’ emotional needs are just as important as physical ones.

Cosleeping or sleep sharing is when parents sleep in close proximity to their baby, generally in the same room. Bed sharing is a specific form of cosleeping: baby sleeps with at least one parent on the same surface. A practice as old as humanity itself, cosleeping is still widespread among two thirds of the population on the planet, in industrialized and non-industrialized countries across Asia, Africa, South and Central America. Here, after many years of babies sleeping alone in a room separate from their parents, cosleeping is making a comeback. How can we ensure it is practiced safely?

Sudden infant death syndrome (SIDS) and unexpected crib death (for example by suffocation) are the main cause of death in babies aged 1 month to 1 year. They were reduced by half in the nineties following an awareness campaign recommending that babies be laid down to sleep on their backs, on firm, flat surfaces, with no soft pillows or blankets, and for mothers not to smoke during pregnancy. When all these precautions are taken, the odds of SIDS decrease by another 50% among babies who sleep near their parents, when compared with those that sleep alone in their room. Since 2004, the Canadian Paediatric Society has recommended parent-baby cosleeping for the first six months of life (see http://www.cps.ca/english/statements/cp/cp04-02.htm) Cosleeping on separate surfaces is recommended, but not bed sharing, which involves certain risks that we must be aware of.

Cosleeping on separate surfaces satisfies many parents, since it allows them to check on baby’s breathing and meet their nightly needs without waking up too much themselves. It is extremely comforting for babies to hear their parents breathing, smell them, know that they are nearby if they need them. In general, this form of cosleeping is practiced with a bassinet or crib near or against the parents’ bed. There are also special little beds that hang on the edge of the parents’ bed or others that are set in bed, between mother and father.

While bassinets and cribs are generally built to established safety standards, adult beds are not. So when bed sharing, care must be taken to reproduce all baby safety conditions in the adult bed. First, ensure that baby cannot fall out of bed. The simplest solution is to get rid of the bed structure and to place the mattress on the ground, a good distance from the wall. This prevents the risk of serious falls. Most fatal accidents in parental beds occur when babies get caught between the mattress and the bed frame, headboard or footboard, or between the mattress and a wall or piece of furniture against which the bed was placed and which shifted slightly.

Always avoid sleeping with babies on a couch, padded armchair or waterbed, since it makes SIDS or accidental death by asphyxia is 25 times as likely. Not only is the surface too soft, but there are several areas on a couch or armchair for babies to get caught and asphyxiate: between cushions, or between a cushion and the back or armrest. 

In the parents’ bed, babies must also be kept away from blankets, bedspreads, soft pillows, etc. If parents use blankets, it is better to have several thin ones, made of porous material such as cotton, and to avoid thick blankets and duvets. Babies can sleep, always on their back, in a warm sleep sack or footed pajamas, with no blankets. Before the age of one year, babies should not sleep next to older children, or near pets. If an older child sleeps in the family bed, either place the baby in their crib near the family bed, or ensure that mother’s (or father’s) body serves as a barrier between the older child and the baby at all times.

When parents smoke (please, never in the baby’s room), cosleeping on separate surfaces is recommended. Mothers who smoked during pregnancy should not sleep with their babies, even if they breastfeed. The combination of maternal smoking during pregnancy and bed sharing is a risk factor for SIDS, while cosleeping on separate surfaces is protective.

It is also recommended that obese parents not share their bed with babies. The weight of their body on the mattress could create a gap in which babies could get caught, creating a risk of crushing.

It is very important to place babies in their crib rather than the parents’ bed if either parent is under the influence of alcohol or any other substance that can affect alertness. The same goes for extremely tired or sick parents. Quite often in cases of infant death by crushing or accidental asphyxia, the parent involved was in no condition to care for a baby.

Despite all these warnings that may lead you to believe bed sharing is dangerous for young babies, this isn’t the case when parents take basic precautions. Certain experts even hypothesize that a non-smoking mother who breastfeeds and shares her bed with her baby actually represents a protective factor against SIDS. Scientific literature contains no known cases of such mothers who had crushed their baby during bed sharing unless other factors were involved: alcohol, drugs (including certain cold or allergy medications that cause drowsiness), or excessive fatigue. Ligue La Leche encourages mothers to breastfeed while lying in bed, even if they sometimes fall asleep with their baby held against them. This nocturnal mother-baby proximity is known to promote the establishment and duration of breastfeeding. It now also appears to be shown that breastfeeding is a protective factor against SIDS.

It should be added that cosleeping must be a family decision. It is only a good choice if the entire family sleeps better and if everyone’s emotional and physical needs are met. Certain parents have valid reasons for choosing to have babies sleep in their own room. In this case, rapid response to nocturnal cries and close cuddling during the day will help meet babies’ need for contact.  

Claudette Nantel,

Psychotherapist, pre- and perinatal psychology specialist

claudettenantel@sympatico.ca

This article is presented by Maman Kangourou (www.mamankangourou.com)

Additional resources

In French:

http://cododo.free.fr/ A francophone site on cosleeping, written by Nathalie Roques, and full of information, suggestions, and accounts of the author’s personal experience. A must read.

http://www.aspq.org/view_bulletins.php?id=53&article=265 An article by Association pour la santé publique du Québec in favour of cosleeping.

http://www.babyfriendly.org.uk/pdfs/french/sharingbedleaflet_french.pdf “Partager un lit avec votre bébé : un guide pour les mères qui allaitent.” Also available in English at http://www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf “Sharing a bed with your baby: A guide for breastfeeding mothers” UNICEF (United Kingdom) leaflet that summarizes precautions you should take to share a bed safely with a baby.

http://www.votre-enfant.com/wiki/La_mort_subite_du_nourrisson_%28MSN%29 A 2006 article published in Le Figaro that describes the issues with cosleeping and sharing a bed, the risks of SIDS, etc.

In English:

http://www.nd.edu/~jmckenn1/lab/index.html An anglophone site on cosleeping, by Dr. James McKenna, American anthropologist and world authority on cosleeping.  A highly interesting article by Dr. McKenna, “Why We Never Ask ‘Is it Safe for Infants to Sleep Alone?’: Historical Origins of Scientific Bias In the Bed-sharing SIDS ‘Debate’", can also be found at http://www.naturalchild.org/james_mckenna/why_we_never_ask.html

McKenna, James J. Sleeping with your baby: a parent’s guide to cosleeping.  Whether you do it occasionally or every night, do it safely. 2007. Washington, DC: Platypus Media, LLC.  An excellent little book, written by the eminent American specialist on cosleeping, to inform parents on the elements of risk they need to be aware of to make the most of their cosleeping experience with baby. Available online (under $20) or on www.chapters.indigo.ca or www.amazon.ca

In 2003, the excellent American magazine Nurturing (often found in Quebec in natural food stores) published a special issue on cosleeping. Its articles are still relevant today and available in a booklet entitled “Sleeping with your baby: the world’s top scientists speak out” at www.nurturing.com/shop or 1-888.810.4150.

From the same source, the January-February 2009 issue of Nurturing is available. It contains a great overview and update on the most recent scientific data on cosleeping, in “The science of sharing sleep”, by L. Gettler and J. McKenna.

Babies cry because they are hungry, they need contact (as important as physical hunger), they hurt, they are uncomfortable, or they are tired. It also happens often that babies cry without us really knowing why. Sometimes we will realize the next day that they were coming down with a cold or were teething… Some babies are hypersensitive or more “difficult” than others. Some psychologists see it as existential unease relating to a difficult birth or prenatal experiences. Others suffer from what is called “infantile colic”, inconsolable crying, often for hours on end later in the day, every day, and whose origins are difficult to pinpoint. What we now know is that crying babies really need the presence of a compassionate adult, because they cannot console themselves.

What can parents do to help babies cry less? First of all, prevent. We know that babies in cultures where proximal nurturing is practiced (baby wearing, cosleeping, parental proximity) cry much less than North American and European babies. Research done in Montreal in the eighties revealed that young babies held for at least 3 hours a day in their parents’ arms or in a baby carrier cried 40 to 50% less than others who were only held for feeding and other necessities. Other studies reveal that babies who are breastfed more often and those who are not left to cry without consolation cry less. Basically, crying is babies’ last resort. By being attentive, you can pick up on clues to babies’ needs well before they begin to cry. It is easier to anticipate the needs of the baby you carry for a good part of the day. You learn to better understand signs of distress and satisfaction.

There are a number of “tricks” to console and calm babies: taking them in your arms, or offering a feeding, for example. Each trick works for some, but not for others. Each baby has tricks that work often, but not always. And when babies remain inconsolable despite all your efforts? Or when they wake up for the fourth time since being set down to sleep? I can’t take any more, even if I know they’re probably teething! At that point, the “CALMS” method may come in handy. This method focuses on caring for yourself first before taking care of the baby.

Step 1: Before going to the crying baby, I take a moment to be present and to identify my feelings: do I feel anxious, angry, guilty, desperate, exhausted, incompetent, like a bad mother, etc.? I take the time to feel where these feelings reside in my body. I show myself compassion, as though I were with a good friend who was going through the same thing.

Step 2: I take a few deep breaths, with my feet firmly planted on the ground.

If necessary, I drink a glass of water, or I look out the window. I wait to be calmer, more centered. Sometimes it takes a few minutes…

Step 3: Then I listen closely to my baby’s cries. “What are you trying to tell me, little one? What do I hear in your cries?” Panic, pain, frustration, anger, sadness…?

Step 4: Once I have listened to baby’s feelings, I can speak to the baby. I can take the baby and set them face to me. “I feel you are frustrated, afraid, angry... (according to what I felt). I hear you darling, I am here with you. I want to help you.” Never say “Hush now, it’s over, no need to cry.” If baby still cries in my arms once I am rooted and centered, then baby still has something to express. At this point, we can also share what we feel. “I’m tired too. I’m frustrated that I don’t understand what you need. I’m trying to calm myself to best help you.” It is possible that baby may cry even harder at this point. I let baby know that I hear them, that I understand that they are not well. Even if baby continues to howl, the message that you are there with them, that you really care, will sink in.

Step 5: We can now do what we feel is necessary to calm baby down. Take baby in your arms, offer a feeding, etc. You will realize that they will now truly be able to calm down. Often, they will fall fast asleep, much calmer that if you had picked them up while you were still filled with frustration, anger or impatience.

This method doesn’t solve everything, but it promotes a respectful, trusting relationship between baby and parents. When baby cries a lot, it is necessary to see a professional to determine the cause and to act. It is also very important not to stay for too long alone with a baby that cries a lot. Even if consoling baby doesn’t come easily to Dad, trust him. Tell him about the 5 steps. They can be learned. Contact with other mothers and those who usually support you will allow you to “recharge your batteries” and may sometimes offer you a break. Babies need a presence when they cry, but often another adult than mom or dad will do the trick just as well.

Claudette Nantel,

Psychotherapist, pre- and perinatal psychology specialist

claudettenantel@sympatico.ca

This article is presented by Maman Kangourou (www.mamankangourou.com)

Ref.:

- CALMS. A guide to soothing your baby. By Carrie Contey and Debby Takikawa 2007. Available in the US (approximately $12 USD) on www.amazon.com   Wonderful little book that discusses the needs of babies and provides examples of applying the CALMS method.

- “7 choses que les parents doivent savoir à propos des pleurs des bébés”, by Dr. William Sears: http://autourdelanaissance.over-blog.org/categorie-10212134.html  

- Ne pleure plus bébé! By Claude-Suzanne Didierjean-Jouveau. 2008. Ed. Jouvence. Available in bookstores or online (approx. $9) http://www.mamanautrement.com/index.php/fr/boutique/lecture/lecture-education/12/ne-pleure-plus-bebe/43/