Resources for Parents

Articles on Parenting


Reviews of Parenting Books


Articles on Parenting

The Functions of Baby Skin

Written by Kim Walls, M.S., Founder & CEO of Episencial

Though your child’s skin will eventually perform all of the functions of your skin, her skin is quite different from yours in ways that are not immediately evident. The most important difference is that the functional development of baby skin is delayed. It is most vulnerable during the first year, and remains extremely delicate during the early years of life. Your skin can perform more effectively and easily. Your skin is also stronger and more resistant to environmental irritants and contaminants.

Your baby's skin:

  • is five times thinner than yours,
  • doesn’t produce as much oil,
  • is very reactive to environmental irritants,
  • has more surface area per pound of bodyweight,
  • is more sensitive to the sun,
  • and its immune boosting capacity is still developing.

Though the skin is your body’s largest organ, it is not always obvious just how many jobs and responsibilities the skin has. Here are the broad strokes about how your skin (and your child’s) keeps you healthy.

  • Skin creates a barrier between the internal body and the eternal environment, protecting the internal organs from bacteria, virus, fungi and a multitude of additional contaminants.
  • It maintains a healthy balance of surface microorganisms that both help and hinder in the skin’s functions.
  • Skin helps regulate the body’s temperature.
  • It identifies intruders and relays information about their biological composure to other immune system components, like T-Cells, for the body to mount an attack.
  • It produces oil to keep the skin from cracking due to environmental exposure.
  • It replaces itself with new, healthy cells quite frequently.
  • It produces melanin, a natural sunscreen, to protect the body’s DNA from destruction by ultra violet rays.
  • It produces vitamins.
  • The skin actively absorbs nutrients (and contaminants) from the outside and expels poisons and cellular byproducts from the inside.
  • It even influences emotions by accepting and transmitting sensations to the brain – from the sting of pain to the sweet touch of love.

Though your baby’s skin is not fully functional at birth, amazingly, it can still heal faster than yours because its cells can regenerate more quickly. Regardless of age and level of sensitivity, healthy skin is smooth, soft, moist, elastic, and it recovers quickly from bumps and scrapes. The color of healthy skin is even and it actively produces antibodies, melanin, collagen and elastin. The body’s immune system, basic protective mechanisms, and even emotional development are dependent upon healthy skin. As a parent, your selection of pure, natural and organic baby skin care products, as well as adherence to healthy skin care rituals, is critically important to your child’s future because radiant skin fully participates in keeping your baby’s body strong. With proper natural skin care, respect for the body can be instilled from birth and result in lasting health, grace, and confidence.


The Functions of Baby Skin Part II

Written by Kim Walls, M.S., Founder & CEO of Episencial

Though your child’s skin will eventually perform all of the functions of your skin, her skin is quite different from yours in ways that are not immediately evident. The most important difference is that the functional development of baby skin is delayed. It is most vulnerable during the first year, and remains extremely delicate during the early years of life. Your skin can perform more effectively and easily. Your skin is also stronger and more resistant to environmental irritants and contaminants.

Your baby’s skin:

  • is five times thinner than yours,
  • doesn’t produce as much oil,
  • is very reactive to environmental irritants,
  • has more surface area per pound of bodyweight,
  • is more sensitive to the sun,
  • and its immune boosting capacity is still developing.

Though the skin is your body’s largest organ, it is not always obvious just how many jobs and responsibilities the skin has. Here are the broad strokes about how your skin (and your child’s) keeps you healthy.

  • Skin creates a barrier between the internal body and the eternal environment, protecting the internal organs from bacteria, virus, fungi and a multitude of additional contaminants.
  • It maintains a healthy balance of surface microorganisms that both help and hinder in the skin’s functions.
  • Skin helps regulate the body’s temperature.
  • It identifies intruders and relays information about their biological composure to other immune system components, like T-Cells, for the body to mount an attack.
  • It produces oil to keep the skin from cracking due to environmental exposure.
  • It replaces itself with new, healthy cells quite frequently.
  • It produces melanin, a natural sunscreen, to protect the body’s DNA from destruction by ultra violet rays.
  • It produces vitamins.
  • The skin actively absorbs nutrients (and contaminants) from the outside and expels poisons and cellular byproducts from the inside.
  • It even influences emotions by accepting and transmitting sensations to the brain – from the sting of pain to the sweet touch of love.

Though your baby’s skin is not fully functional at birth, amazingly, it can still heal faster than yours because its cells can regenerate more quickly. Regardless of age and level of sensitivity, healthy skin is smooth, soft, moist, elastic, and it recovers quickly from bumps and scrapes. The color of healthy skin is even and it actively produces antibodies, melanin, collagen and elastin. The body’s immune system, basic protective mechanisms, and even emotional development are dependent upon healthy skin. As a parent, your selection of pure, natural and organic baby skin care products, as well as adherence to healthy skin care rituals, is critically important to your child’s future because radiant skin fully participates in keeping your baby’s body strong. With proper natural skin care, respect for the body can be instilled from birth and result in lasting health, grace, and confidence.


How to Care for Baby Skin – The Right Way

Written by Kim Walls, M.S., Founder & CEO of Episencial

Who doesn’t smile and even laugh out loud at the sight of a baby in the tub with a halo of bubbles? Bathing is a treat many adults overlook for their own sense of peace and joy. Grooming provides the opportunity for both you and your baby to be delighted by the ample stimulation available for your awakened senses of touch and smell. The hours you spend changing diapers, combing hair, brushing gums, bathing, and massaging your baby’s delicate skin are not only fun, they are necessary for her health and well-being. From this very early age you can institute joyful rituals and happy memories to create good grooming habits that will last a lifetime.

Cleanse

Typically, a sponge bath over your baby’s body with a little extra cleansing under the chin, under the arms, and in the diaper area is plenty. If warm, pure water cleanses sufficiently, there is no need to add a cleanser to your routine. The diaper area might be an exception. A build up of bacteria and fungi that aren’t thoroughly removed can cause diaper rash.

Many different kinds of products are available to aid in the task of cleansing. When water isn’t enough, try to select products that work safely, without the use of potentially risky ingredients. There are too many products on the market that can create unnecessary risks to your baby’s health, and yours. Many ingredients used in conventional toiletry products can disrupt the hormone, immune, and nervous systems and even damage your baby’s DNA. Also keep in mind that some clothing, diapers, food and water can also pose risks.

Natural cleansers provide a better choice to wash away the dirt, without stripping away natural oils in the process. Some common cleanser ingredients can be damaging to the skin and even your baby’s developing organs. You should also avoid antibacterial cleansers whenever possible. Antibacterial cleansers are unnecessary for every-day use and lead to increasingly stronger strains of bacteria that put everyone at risk for reduced health. There really is such a thing as too clean!

It seems all babies love a good bubble bath. Some babies love them so much that parents indulge daily. Babies really only need to be bathed once or twice per week. If more frequent baths are too much fun to pass up, try to keep them short. Your baby is ready for a bath when she can sit up by herself. If you see pruny little fingers and toes, the bath has probably gone on long enough. Because of your baby’s increased skin permeability, her fingers will wrinkle with water much more quickly than yours. Of course babies must never be left alone in a tub, not even for a second, but bath time can provide a wonderful break for you to relax, play and enjoy the beauty of your baby.

Hydrate

Moisturizing ingredients include a host of delightful options from pure aloe or noni gel to delicious plant oils like avocado or apricot kernel oil. Moisturizing is wonderful for baby skin, which is prone to dryness and it’s especially important for little ones who like to have frequent baths. Moisturizing also becomes more necessary when living in air-conditioned or heated homes or in windy, cold environments. A naturally humid environment is great for the skin. It may be less essential to moisturize regularly in a humid environment.

Also, be sure to take care of yourself! Maintain clean, soft hands when you cuddle and care for your baby. Hands should be free of dry or abrasive patches that might scratch your baby’s delicate skin. Because you wash, dry, and disinfect your hands before and after diaper changes and eating, your hands are at great risk of developing painful cracks and rough patches from extreme dehydration. Moisturizing hand cream may be your new best friend. Try to avoid any products containing alcohol in the base composition. Alcohol is very dehydrating and may be passed onto your baby’s skin. An excellent disinfectant is Thyme Oil. When your hands caress and love your baby, they should be worthy of her perfect little being.

Mineral Oil and Other Petroleum byproducts:

Though mineral oil is completely inert, it is a petroleum byproduct that can coat the skin like plastic, clogging the pores. It can interfere with the skin’s ability to eliminate toxins, promoting acne and other disorders. Mineral oil can slow down skin function and cellular development. Like petroleum based PEG compounds, mineral oil can be contaminated with cancer causing PAH’s (Polycyclic Aromatic Hydrocarbons) due to manufacturing impurities. Since September 2004 the European Union has banned the use of petroleum jelly due to the carcinogenic contamination found in products containing petrolatum. The ingredients for which these impurities are of concern include mineral oil, liquidum paraffinum, paraffin oil, paraffin wax and petrolatum.

Good lubricating oils including sunflower oil, avocado oil, sesame seed oil, plant sourced squalane, olive fruit oil, neem and jojoba oils, and other oils with a high polyphenol content. Many of these oils are powerful antioxidants. Historically oils have been used to promote soothing and healing, to soften skin and to prevent dryness and cracking. They lubricate without clogging pores, unlike petroleum based lubricants, and they help even skin texture, and soothe rashes. Therapeutic skin lubricants sooth and heal providing nourishment by increasing the oxygen and nutrient capacity of the skin.


Baby Skin Stages

Written by Kim Walls, M.S., Founder & CEO of Episencial

Skin is a window into the body and mirrors the body’s environment.

Think about it. Skin is the first thing that is evaluated by healthcare providers (and has been for thousands of years all over the world). That’s because its appearance is a good indicator of how you are doing. Smooth, even-toned skin means the body is generally okay. Red, itchy, dry and bumpy skin means that something isn’t quite right.

Skin is more than skin deep!

Skin functions on three levels: to protect, nourish and purify the body. It is designed to block most of the things in life and the environment that can harm, and actively moves waste out of our bodies. At the same time, skin absorbs – like a sponge – healthy nutrients and moisture. Importantly, the skin is home to a variety of cells that are responsible for the body’s immunity. This is why choosing honest skin care products is so important. Keeping skin healthy works to keep your body healthy too!

What about baby skin?

Parents need to understand that the skin of young children is different, and requires special care. As little ones grow, their skin care needs change. This is why its so important to choose skin care that honestly protects and nourishes. Through our years of research, we’ve created a quick guide to how skin develops as your child grows. We call it Baby Skin Stages™:

Newborns & Preemies – The skin is very thin and, much like baby isn’t fully developed. Right now, baby is particularly vulnerable to the surroundings, such as environmental toxins from personal care products, food, clothing and cleaning supplies. Try to: limit contact with synthetic chemicals and use all-natural skin care products that help build skin strength and thickness.

Infants & Toddlers – The skin function develops and the surface thickens, however it’s not yet producing enough melanin, sweat or natural oils to maintain necessary moisture and act as the body’s first line of defense. Baby’s growing independence results in more exposure to the elements and germs. Try to: keep skin hydrated and protected with moisturizers and sunscreen and start teaching personal care habits like proper hand washing.

Children Five & Under – Now your child’s skin is beginning to take on its full duties. This is good because many children of this age spend time in group-care settings, increasing contact with bacteria and viruses. Bath-time becomes a “teachable moment” for kids to learn how to take care of some of their own grooming. Try to: Create personal care routines for children that include care for the environment – limiting the use of resources like water, paper and energy and using products that reduce exposure to chemicals.


Skin & Immunity

Written by Kim Walls, M.S., Founder & CEO of Episencial

Healthier Skin for a Stronger Immune System

Proper skin care for baby’s most formative early years is an essential component to health and a proactive approach to enhanced immunity. As the body’s first line of defense against harmful elements, and the producer of important immune chemicals like interleukin and interferon, healthy skin is integral to the strength of the immune system, and actively supports the body’s natural healing and protective abilities.

Not only does the skin support immunity, it contributes to, and communicates about, the body’s overall state of health. Nearly 30% of all unscheduled visits to the pediatrician’s office are prompted by a variety of skin conditions, such as rashes, dermatitis, eczema, psoriasis and sunburn (Baby Skin, Dr. Nelson Novick). Rashes, bumps and redness can be a telltale sign that your baby’s body is being exposed to more than it can handle.

Parents need to understand how baby skin is unique and know that it needs special care to help it stay healthy. A child’s skin has differing needs depending upon its stage of development and baby skin is more vulnerable to environmental irritants and contaminants. Below is the predominant framework to help parents understand the natural skin development during a child’s early years:

Baby Skin Stages™:

Newborns & Preemies – Baby skin is thin, permeable and, much like baby isn’t yet functioning at full capacity. The skin is therefore very vulnerable to its surroundings, especially environmental toxins from personal care products, food, clothing, and cleaning supplies. During this phase it is essential to limit contact with any synthetic chemicals and to support the skin’s barrier properties with pure natural and organic skin care products that help build baby skin strength and thickness.

Infants & Toddlers – The Baby’s natural skin functions develop and the surface thickens, however the skin is not producing enough melanin, sweat or natural oils to maintain necessary moisture and act as the body’s first line of defense. Baby’s growing independence results in exposure to the elements and environmental toxins, making hydrating, protective, and anti-inflammatory skin care an additional priority.

Preschool & Beyond – Skin function begins to mature and children learn to take over some of their personal grooming. Many children of this age spend time in group-care settings, increasing contact with bacteria and viruses. Establishing good natural skin care habits with organic skin care products that reduce exposure to harmful chemicals is essential to creating a lifetime of health and wellbeing.


Baby Skin Problems – Common Conditions

Written by Kim Walls, M.S., Founder & CEO of Episencial

As much as we wish it would, nothing remains perfect or forever unblemished. Because of environmental contaminants, and because your baby’s skin is not fully mature at birth, he will probably be affected by some kind of skin condition in his early years. Any number of natural catalysts such as allergies, hormones, genetics, bodily fluids, and even the weather can cause problems for the skin; but very often, something in the environment triggers an inevitable series of inflammations and irritations with which you and your baby will be forced to cope.

Not surprisingly, the number of newborns experiencing skin disorders is rising. Over 30% of unscheduled visits to the pediatrician’s office are caused by skin problems. Baby skin can be so permeable that it is easily dehydrated and infected. Because the skin is susceptible to all kinds of environmental toxins, from air pollution to chlorine in the water, we need to be especially careful not to put toxins directly on the skin through toiletry products.

A variety of minor skin conditions including pimples, rashes, scales, and bumps of other sorts, are well within the range of normal; but the associated discomfort still produces tantrums, crying, irritability, and whining that can simultaneously break your heart and send you into a panic. For the most part, there is no need for concern. These blemishes will usually go away quickly with a simple natural baby skin care treatment. There are plenty of creams, salves, and ointments to help reduce pain, sooth irritation and restore the skin to its natural state of perfect health. The products you choose should create a protective, nurturing environment without exposing your baby to unnecessary environmental contaminants like parabens and synthetic fragrances. Still, if you feel at all concerned, you should consult your doctor right away.

To prevent skin problems from recurring, you must engage in the tricky task of finding the source of the problem. While many common conditions, such as acne and eczema occur naturally, and are truly unavoidable, many more of your child’s skin conditions probably stem from the use of avoidable contaminants in impure toiletry products, non-organic foods, and contaminated water. For example, toiletry products that are formulated with irritants or bed linens that have been laundered with oily fabric softeners can aggravate baby skin. Many common skin conditions can be successfully treated and even prevented with non-pharmaceutical products under the care of a pediatrician who is predisposed to try a natural approach.

Just remember that skin is a window into the body’s internal condition and mirrors its external environment. Removing exposure to toxins, surprisingly prevalent in personal care products, reduces the workload of the body’s immune system and enhances overall health.


First Five Years – Creating Grooming Rituals

Written by Kim Walls, M.S., Founder & CEO of Episencial

As parents, we know the first five years of a child’s life are the foundation for developing knowledge, skills, behavior and emotions. One of the first ways babies experience the world is through touch – making their tender, delicate skin, and its care, so significant to their overall health and development. The grooming rituals created during this formative time translate into a healthy lifestyle for the future.

Those hours we spend changing diapers, combing hair, brushing gums, bathing, and massaging baby’s delicate skin are loving forms of bonding and serve a very necessary purpose for the continued health of our children. Through these nurturing experiences we become more aware of the impact our choices have on our health.

A key element in Episencial founder, Kim Wall’s approach to skincare is the understanding of a simple concept: Skin is a window into the body’s internal condition and mirrors its external environment. It is able to communicate stability and imbalance so well, it has been used for thousands of years as a primary diagnostic tool in nearly every form of medicine – Eastern and Western alike.

As loving and caring adults we can teach our children the significance of good grooming, with natural, green, and organic products, for their wellbeing. As they age, they will become more in touch with the concept of taking responsibility for one’s own good health. The 100% naturally luxurious Episencial baby skincare products, with their pure and gentle formulations, support a lifetime of closeness and good habits beginning with pregnancy and baby’s early years.


So What is Colic?

Written by Barry M. Lester, World Association for Infant Mental Health - Signal Newsletter, July-December 2006

Barry earned his doctoral degree with me in 1973. Two years prior to that he packed up and went off to Guatemala to work at the Institute for Nutrition for Central America and Panama, and of course, I just had to go there to observe his research lab and his dissertation work on habituation to auditory signals in very young infants. His interest in infant crying had its origins in this work and it launched what has become an extraordinary career in infancy, developmental psychology, psychophysiology, and developmental and behavioral pediatrics. Barry is Director of the Infant Development Center at Women and Infants’ Hospital in Providence, Rhode Island, and is Professor of Psychiatry and Human Behavior and Professor of Pediatrics at Brown Medical School. We have published 9 books together over the years and I am delighted that he agreed to provide this very appropriate response to Lisa’s essay. HEF

“So what is Colic?” and “How many different cries does a baby have?” are the two questions I am most frequently asked. What parents really want to know is: What causes colic, and how is colic defined and diagnosed. How can I make it go away? Underlying all the questions is the biggie: Is it my fault? The answers are more complicated than you might think.

We still don’t know what causes colic. There is no simple cure, no magic bullet, to make the baby stop crying. And despite many heroic attempts by pediatricians and researchers to downplay the condition, the suffering of colicky babies and their parents goes on daily. Colic makes professionals feel incompetent because they can’t treat something that upsets families so much.

Despite what many well-meaning pediatricians tell their patients, colic is not a harmless condition. Our research–as well as plenty of others’– has shown that these babies are more likely to have difficult temperaments and to experience feeding and sleeping problems. Their cries and their heart rates are different. How the family functions can be impaired. Their parents perceive them as more vulnerable. They can go on to have behavior issues in preschool and problems later on in school with attention/hyperactivity, sensory integration, and emotional reactivity.

You don’t have to know what causes colic to be able to recognize, define, or diagnose it. There is a traditional definition of colic called the Rule of Three that is probably the one pediatricians use most. Developed in 1954 by pediatrician Morris Wessel, it was based on the patients that he was seeing in his practice in New Haven, Connecticut. I don’t like it much, but in all fairness, it has been around for a long time. Here it is: The Rule of Three says that colic exists when an otherwise normal, healthy baby cries for at least 3 hours a day for at least 3 days a week and has been doing this for at least 3 weeks.

One problem with this definition is that it equates colic with excessive crying, and it explains why the literature often uses phrases such as “colic or excessive crying.” Normally developing babies increase the amount they cry over the first 6 weeks. About 20 percent of babies cry for 3 hours a day or more–and that has been fairly well established. Babies who cry 3 hours a day may not have colic but may simply be normal babies with difficult temperaments.

There may indeed be babies who cry excessively because of colic–but there is more to colic than excessive crying. For many colicky babies there is a distinct colic episode. The baby has normal periods of crying during the day, but when he reaches a colicky phase, there is something different going on. Mothers say all the time: “This is not his normal crying, this is colic.”...

Many babies with colic have additional symptoms that occur especially during this distinct colic episode. At the Colic Clinic, we group these symptoms into four areas...

The main source for the symptoms, behaviors, and characteristics on the checklist come from the parents I’ve seen at the clinic and from countless interviews, magazine articles, and desperate calls and e-mails to friends and family. The second source was the scientific literature. What I learned from the research studies was that not all babies show all characteristics and not all babies show the same characteristics. But most show some. The four characteristics are sudden onset, cry quality, physical signs, and inconsolability.

Let’s take a closer look at the four characteristics: Sudden onset means that the colic episode seems to come out of the blue. One mother described it by saying, “It’s as if my baby is possessed.” Another term for this is paroxysmal onset, which suggests the sudden and episodic quality that sets it apart form regular crying. It is as if the baby is separated or insulated from the outside world. The episode takes on a life of its own. You get the feeling that this is something that is going to have to run its course. While you may be able to dampen it or ease it somewhat, you can’t really stop it. What you have to do is ride it out and make the baby–and yourself–as comfortable as possible.

The second characteristic is the cry quality. The cry changes–not in the same way for all babies, but for most babies there is a qualitative change in the cry during an episode. For many babies, the cry takes on the characteristics of pain cry. Mothers say that their babies sound as if they’re in pain.

What mothers mean by this, and what acoustic analysis confirms, is that the cry comes on suddenly and reaches its peak intensity very quickly. We hear that intensity as loudness, a higher pitch, and more noise. In fact, some mothers say it is more like a scream than a cry. One mother said, “He is screaming at the top of his lungs.”...

So what happens when your baby is screaming out of control? You want to help her. She is saying, “Mommy, Daddy, make it stop!” But you can’t. And that can make you feel helpless and inadequate as a parent.

The third attribute, physical signs, is actually a group of characteristics that describe changes in the baby’s body during a colic episode. The baby pulls his legs up into his chest. He gets doubled over, which is why mothers often say his stomach hurts and he looks and sounds as if he is in pain. His stomach gets hard and his leg and arm muscles get tight. (The technical term for this is hypertonia, which means increased tone, or tension, in the muscles.) His face gets red; there may be episodes of breath-holding. His fists clench–sometimes squeezed so tight that you can’t open them. It is almost as if the baby is holding on for dear life. The color in the wrists and fingers can get red or white. Sometimes the arms and legs stiffen and stick out straight.

The fourth characteristic is inconsolability. It may sound silly after all this to say that a baby in a colic episode is inconsolable. But the reason we included it is to underline what I said before: You really can’t stop this. You may be able to ease it somewhat, reduce some of the crying, perhaps reduce some of the intensity, and make the baby more comfortable. But you won’t really be able to stop it. Inconsolability happens when a baby is in an insulated cry state. This means there’s a wall between him and you so that you can’t really reach him the way you can when his cry state is normal. You need to know, though, that this thing is going to run its course. If you accept that, it will be easier and less frustrating for you–and for the baby.

You can see that by equating colic with excessive crying we run the risk of calling colic “normal” and missing a lot of other cry characteristics that colicky babies have. If it’s just about excessive crying, it’s easy to conclude that there’s nothing wrong with colicky babies. Babies can be excessive criers but be in a normal, not insulated, cry state. These babies do not show any of the true colic characteristics...

When does crying become a clinical concern? When is it a true syndrome? When is it colic? It has to do with how much the baby is crying, along with the additional symptoms–special episodes with sudden onset, changes in the cry, physical signs, and outright inconsolability. But there is still one critical ingredient missing, and it’s this: The crying has resulted in some problem either in the infant or in the family. In other words, colic is not just the crying. It’s the fact that the crying has caused a problem...

The way I define colic means thinking about it as a behavioral disorder. So if we regard colic as a behavior disorder, infants with excessive crying that causes clinically significant distress in the family or impairment in the infant would be said to have colic. On the other hand, a baby with excessive crying that causes no significant distress in the family or impairment in the infant would not be said to have colic.

Two criteria need to be met in order to diagnose colic: First, there is a significant complaint of a persistent pattern of crying that is more frequent and more severe than is typical for babies at this age. This can be a disturbance in the amount, frequency, or quality of crying. There may be excessive crying (Rule of Three) as well as symptoms such as sudden onset, high pitch, physical signs, and inconsolability. Second, there is clear evidence of impairment in other areas of function. This could mean that the behavior is affecting the baby’s development or other behaviors, the two most common being sleeping or feeding. Or the behavior could be causing stress in the parents, affecting family function and the marital relationship. It could be affecting the parent-infant relationship. There may be attachment or bonding problems. The parents may feel inadequate, suffer loss of self-esteem, and feel ineffective as parents. They may feel angry and disappointed that their baby is acting this way...

Colic is not just in the eye of the beholder. It is not just a mother having a problem with normal crying. Colic is an identifiable cry problem in the infant that is causing some impairment either in the infant or in relationships in the family. Something in the baby is causing a problem for the baby or outside the baby. That’s it. End of diagnosis. Beginning of treatment.

1. Excerpted with permission from:
Lester, B. M. & O’Neill G., C. (2005).
Why is my baby crying? New York, NY: HarperCollins Publishers.


Kangaroo Care Is Effective in Diminishing Pain Response in Preterm Neonates

C. Celeste Johnston, DEd, RN; Bonnie Stevens, PhD, RN; Janet Pinelli, DNS, RN; Sharyn Gibbins, PhD, RN; Francoise Filion, MS, RN; Anne Jack, MS, RN; Susan Steele, RN; Kristina Boyer, MSc(A), RN; Annie Veilleux, MD

Arch Pediatr Adolesc Med. 2003;157:1084-1088.

Click to read the original abstract

Objective To test the efficacy of maternal skin-to-skin contact, or kangaroo care (KC), on diminishing the pain response of preterm neonates to heel lancing.

Design A crossover design was used, in which the neonates served as their own controls.

Subjects Preterm neonates (n = 74), between 32 and 36 weeks’ postmenstrual age and within 10 days of birth, who were breathing without assistance and who were not receiving sedatives or analgesics in 3 level II to III neonatal intensive care units in Canada.

Interventions In the experimental condition, the neonate was held in KC for 30 minutes before the heel-lancing procedure and remained in KC for the duration of the procedure. In the control condition, the neonate was in the prone position in the isolette. The ordering of conditions was random.

Main Outcome Measures The primary outcome was the Premature Infant Pain Profile, which is composed of 3 facial actions, maximum heart rate, and minimum oxygen saturation changes from baseline in 30-second blocks. Videotapes, taken with the camera positioned on the neonate’s face so that an observer could not tell whether the neonate was being held or was in the isolette, were coded by research assistants who were naïve to the purpose of the study. Heart rate and oxygen levels were continuously monitored into a computer for later analysis. A repeated-measures analysis of covariance was used, with order of condition and site as factors and severity of illness as a covariate.

Results Premature Infant Pain Profile scores across the first 90 seconds from the heel-lancing procedure were significantly (.002<P<.04) lower by 2 points in the KC condition.

Conclusions For preterm neonates who are 32 weeks’ postmenstrual age or older, KC seems to effectively decrease pain from heel lancing. Further study is needed to determine if younger neonates or those requiring assistance in breathing, or older infants or toddlers, would benefit from KC, or if it would remain effective over several procedures. Given its effectiveness, and that parents of neonates in critical care units want to participate more in comforting their children, KC is a potentially beneficial strategy for promoting family health.

From the School of Nursing, McGill University (Dr Johnston, Mr Filion, and Ms Boyer), and the Department of Neonatology, Hopital Sainte Justine (Dr Veilleux), Montreal, Quebec; Faculty Nursing, University of Toronto (Dr Stevens and Ms Jack), the Department of Nursing, Hospital for Sick Children (Dr Stevens and Ms Boyer), and Sunnybrook and Women’s College Health Sciences Centre (Dr Gibbins), Toronto, Ontario; and Department of Neonatology, McMaster University, Hamilton, Ontario (Dr Pinelli and Ms Steele).


Sensory Deprivation and the Developing Brain

Written by Michael Mendizza

Brain growth and everything that implies is experience dependent. The last decade of research reveals a reciprocal dynamic between the brain and the environment. Change the environment and you change the brain. A sweeping statement, I know, but true.

For millions of years the natural environment triggered most brain growth as increasingly complex creatures adapted to that environment. In the last 50,000 years human adaptation has changed the environment. Today the melting of polar ice and mass extinction of species all over the planet demonstrate how changes in the human brain are affecting the environment. Environment and brain are not independent. They are two sides of a single coin.

This reciprocal dynamic develops as millions of sensors deep inside and covering the surface of the body contact the environment and abstract meaning form the sensory information gathered moment by moment. The structure of each major system of the brain is designed genetically. How each develops however, is shaped by adapting to sensory, emotional and later abstract symbolic experiences.

It is easy to appreciate how fresh, whole, organic foods nourish the cells of our body as sun, rich soil and rain nourish a plant. The same is true of all the senses, touch, movement, sight, hearing, taste, olfactory. The nature, quality, presence or absence of each sensation represent nutrients for the developing brain.

Our body was planted and evolved in a rich multi-sensory natural environment and expects to be fed rich multi-sensory experiences. Sensory deprivation, that is limiting, diminishing or removing all together the quality and/or quantity of one or more sensory experience very early in life, as the brain is establishing its foundation for life, may alter basic patterns that brain will use for a lifetime.

Dating back to the 1960s this reciprocal relationship between the brain and environment was studied in the laboratory by observing the impact of sensory deprivation on the developing brain. Harry Harlow?s famous mother-infant separation studies ushered in a cascade of research exploring how sensory experiences promote or retard brain growth and development.

Intimate body contact, breastfeeding, being held, movement and affectionate play provide naturally a constant source of multi-sensory experiences that feed development. From this point of view not breastfeeding, no skin to skin contact, not being held, not moving and playing affectionately are forms of sensory deprivation, which are as damaging as a steady diet of junk food would be or no sunlight to a very new and rapidly developing human being.

In many ways our modern life style and world are deficient in both touch and movement, both critical for healthy and whole development. One example, and there are many, the World Health Organizations recommends breastfeeding for two and a half yeas or longer, something virtually nonexistent in industrialized societies.

Yes, some women breastfeed but very few for twelve years or longer. What most fail to realize is that pleasure shared through intimate safe somatic stimulation is as or more important than vitamins and minerals, especially when considering early brain development.

Of course good nutrition is essential but so are intimate body contact, sight, smell, taste, touch, movement and affectionate play. These are the sensory nutrients that develop the regulatory capacities of the limbic (emotional-social-sexual) brain. An absence of these sensory-nutrients early in life retard the whole and integrated development of what has come to be called emotional intelligence lifelong.

Emotional intelligence is the natural expression of a neuro-integrative brain, one that embraces and weaves together life’s experiences and it is the limbic (emotional-social-sexual) brain that does the weaving. Depriving the brain of the sensory-nutrients it needs, again very early in life, has been shown to cause permanent alterations in brain development and function. If the sensitive window for optimum development of certain structures is passed, yes the damage is permanent.

No one knows this better than James W. Prescott, PhD, a pioneering researcher who followed with brain and behavior studies Harry Harlow’s mother-infant separation (sensory deprived) research. One of the most startling findings was that movement played a central role in the development of emotional-social-sexual intelligence. At ten months of age the mother-deprived infants who were raised with a moving surrogate (a cloth covered plastic bottle) expressed few of the pathologies that plagued mother-deprived infants raised with the same surrogates that were immobile. During the most sensitive period of brain growth and development conception to approximately eighteen months of age, movement is as critical as good nutrition.

Also see Pleasure Bonds by James W. Prescott, Joseph Chilton Pearce and Michael Mendizza


Bonding Matters

The Chemistry of Attachment, written by Linda F. Palmer, DC, author of Baby Matters

Human babies are born helpless, needing to be entirely cared for and protected. Luckily, they are born with all the necessary tools and “instructions” to attain such care for themselves, and to become a loved and loving part of their family and society. The ingrained neural and hormonal interactions provided for parent and child to assist them in this process are among the most powerful in nature. The hormonal cues are clear and compelling and our instincts can provide us with all the appropriate responses. Without taking great efforts to avoid and ignore such urges, parents will naturally follow the advice of their neurons and hormones, nurturing their babies and maintaining physical closeness with them.

Once born, baby’s hormonal control systems and brain synapses begin to permanently organize according to the human interactions she experiences. Unneeded brain receptors and neural pathways are disposed of, while those appropriate to the given environment are enhanced.

Oxytocin-a Bonding Hormone

Oxytocin is a chemical messenger released in the brain chiefly in response to social contact, but its release is especially pronounced with skin-to-skin contact. In addition to providing health benefits, this hormone-like substance promotes bonding patterns and creates desire for further contact with the individuals inciting its release.

When the process is uninterrupted, oxytocin is one of nature’s chief tools for creating a mother. Roused by the high levels of estrogen (“female hormone”) during pregnancy, the number of oxytocin receptors in the expecting mother’s brain multiplies dramatically near the end of her pregnancy. This makes the new mother highly responsive to the presence of oxytocin. These receptors increase in the part of her brain that promotes maternal behaviors.

Oxytocin’s first important surge is during labor. If a cesarean birth is necessary, allowing labor to occur first provides some of this bonding hormone surge (and helps ensure a final burst of antibodies for the baby through the placenta). Passage through the birth canal further heightens oxytocin levels in both mother and baby.

High oxytocin causes a mother to become familiar with the unique odor of her newborn infant, and once attracted to it, to prefer her own baby’s odor above all others’. Baby is similarly imprinted on mother, deriving feelings of calmness and pain reduction along with mom. When the infant is born, he is already imprinted on the odor of his amniotic fluid. This odor imprint helps him find mother’s nipple, which has a similar but slightly different odor. In the days following birth, the infant can be comforted by the odor of this fluid.

Gradually over the next days, baby starts to prefer the odor of his mother’s breast, but continued imprinting upon his mother is not food related. In fact, formula-fed infants are more attracted (in laboratory tests) to their mother’s breast odor than to that of their formula, even two weeks after birth.

By influencing maternal behavior and stimulating milk “let down” (allowing milk to flow) during nursing, oxytocin helps make the first attempts at breastfeeding feel natural. Attempts at nursing during the initial hour after birth cause oxytocin to surge to exceptional levels in both mother and baby. Mothers who postpone nursing lose part of the ultimate hormone high provided for immediately after birth. Powerful initial imprinting for mother and baby is intended to occur chiefly so that mother and baby will be able to find and recognize each other in the hours and days after birth.

Yet a lifetime opportunity for bonding and love is not lost if this initial window is missed. Beyond birth, mother continues to produce elevated levels of oxytocin as a consequence of nursing and holding her infant, and the levels are based on the amount of such contact. This hormonal condition provides a sense of calm and well being. Oxytocin levels are higher in mothers who exclusively breastfeed than in those who use supplementary bottles. Under the early influence of oxytocin, nerve junctions in certain areas of mother’s brain actually undergo reorganization, thereby making her maternal behaviors “hard-wired.”

As long as contact with the infant remains, oxytocin causes mother to be more caring, to be more eager to please others, to become more sensitive to other’s feelings, and to recognize nonverbal cues more readily. Continued nursing also enhances this effect. With high oxytocin, mother’s priorities become altered and her brain no longer signals her to groom and adorn herself in order to obtain a mate, and thus a pregnancy. Now that the child has already been created, mom’s grooming habits are directed toward baby. High oxytocin in the female has also been shown to promote preference for whatever male is present during its surges (one good reason for dad to hang around during and after the birth). Prolonged high oxytocin in mother, father, or baby also promotes lower blood pressure and reduced heart rate as well as certain kinds of artery repair, actually reducing lifelong risk of heart disease.

Although baby makes her own oxytocin in response to nursing, mother also transfers it to the infant in her milk. This provision serves to promote continuous relaxation and closeness for both mother and baby. A more variable release of oxytocin is seen in bottle-fed infants, but is definitely higher in an infant who is “bottle-nursed” in the parents’ arms rather than with a propped bottle.

Persistent regular body contact and other nurturing acts by parents produce a constant, elevated level of oxytocin in the infant, which in turn provides a valuable reduction in the infant’s stress-hormone responses. Multiple psychology studies have demonstrated that, depending on the practices of the parents, the resulting high or low level of oxytocin will control the permanent organization of the stress-handling portion of the baby’s brain — promoting lasting “securely attached” or “insecure” characteristics in the adolescent and adult. Such insecure characteristics include anti-social behavior, aggression, difficulty forming lasting bonds with a mate, mental illness, and poor handling of stress.

When an infant does not receive regular oxytocin-producing responsive care, the resultant stress responses cause elevated levels of the stress hormone cortisol. Chronic cortisol elevations in infants and the hormonal and functional adjustments that go along with it are shown in biochemical studies to be associated with permanent brain changes that lead to elevated responses to stress throughout life, such as higher blood pressure and heart rate. Mothers can also benefit from the stress-reducing effects of oxytocin-women who breastfeed produce significantly less stress hormone than those who bottle-feed.

Nor are fathers left out of the oxytocin equation. It has been shown that a live-in father’s oxytocin levels rise toward the end of his mate’s pregnancy. When the father spends significant amounts of time in contact with his infant, oxytocin encourages him to become more involved in the ongoing care in a self-perpetuating cycle. Oxytocin in the father also in-creases his interest in physical (not necessarily sexual) contact with the mother. Nature now provides a way for father to become more interested in being a devoted and satisfied part of the family picture through his involvement with the baby.

With all of its powers, oxytocin is but one of a list of many chemicals that nature uses to ensure that baby finds the love and care he needs.

Vasopressin & Protection

Although present and active during bonding in the mother and infant, vasopressin plays a much bigger role in the father. This hormone promotes brain reorganization toward paternal behaviors when the male is cohabitating with the pregnant mother. The father becomes more dedicated to his mate and expresses behaviors of protection.

Released in response to nearness and touch, vasopressin promotes bonding between the father and the mother, helps the father recognize and bond to his baby, and makes him want to be part of the family, rather than alone. It has gained a reputation as the “monogamy hormone.” Dr. Theresa Crenshaw, author of The Alchemy of Love and Lust, says, “Testosterone wants to prowl, vasopressin wants to stay home.” She also describes vasopressin as tempering the man’s sexual drive.

Vasopressin reinforces the father’s testosterone-promoted protective inclination regarding his mate and child, but tempers his aggression, making him more reasonable and less extreme. By promoting more rational and less capricious thinking, this hormone induces a sensible paternal role, providing stability as well as vigilance.

Prolactin & Behavior

Prolactin is released in all healthy people during sleep, helping to maintain reproductive organs and immune function. In the mother, prolactin is released in response to suckling, promoting milk production as well as maternal behaviors. Prolactin relaxes mother, and in the early months, creates a bit of fatigue during a nursing session so she has no strong desire to hop up and do other things.

Prolactin promotes caregiving behaviors and, over time, directs brain reorganization to favor these behaviors. Father’s prolactin levels begin to elevate during mother’s pregnancy, but most of the rise in the male occurs after many days of cohabitation with the infant.

As a result of hormonally orchestrated brain reorganization during parenthood, prolactin release patterns are altered. It has been shown that fathers release prolactin in response to intruder threats, whereas childless males do not. On the other hand, nursing mothers do not release prolactin in response to loud noise, whereas childless females do. In children and non-parents, prolactin surges are related to stress levels, so it is generally considered a stress hormone. In parents, it serves as a parenting hormone.

Elevated prolactin levels in both the nursing mother and the involved father cause some reduction in their testosterone levels, which in turn reduces their libidos (but not their sexual functioning). Their fertility can be reduced for a time as well. This reduction in sexual activity and fertility is entirely by design for the benefit of the infant, allowing for ample parental attention and energy. When the father is intimately involved with the infant along with the mother, there should be some accord between the desires of the two, and oxytocin and other chemicals provide for heightened bonding and non-sexual interest in each other, which serves to retain a second devoted caretaker for the infant.

Opioids & Rewards

Opioids (pleasure hormones) are natural morphine-like chemicals created in our bodies. They reduce pain awareness and create feelings of elation. Social contacts, particularly touch-especially between parent and child- induce opioid release, creating good feelings that will enhance bonding. Odor, taste, activity, and even place preferences can develop as the result of opioid release during pleasant contacts, and eventually the sight of a loved one’s face stimulates surges. Opioid released in a child’s brain as a conditioned response to a parent’s warm hugs and kisses can be effective for helping reduce the pain from a tumble or a disappointment.

Parents “learn” to enjoy beneficial activities such as breastfeeding and holding, and infants “learn” to enjoy contact such as being held, carried, and rocked, all as a response to opioid release. Babies need milk, and opioids are nature’s reward to them for obtaining it, especially during the initial attempts. The first few episodes of sucking organize nerve pathways in the newborn’s brain, conditioning her to continue this activity. This is the reason that breastfed babies sometimes have trouble if they are given bottles in the newborn nursery-early exposure to bottles creates a confusing association of pleasure with both bottle nipples and the mother’s breast. In fact, any incidental sensations experienced during rocking, touching, and eating that aren’t noxious can become part of a child’s attachment and will provide comfort. It could be the warmth of mother’s body, father’s furry chest, grandma’s gentle lullaby, a blanket, or the wood-slatted side of a crib.

Prolonged elevation of prolactin in the attached parent stimulates the opioid system, heightening the rewards for intimate, loving family relationships, possibly above all else. Just as with codeine and morphine, tolerance to natural opioids can occur, which will reduce the reward level for various activities over time. But this is not a problem for attached infants and parents, because higher levels of oxytocin, especially when created through frequent or prolonged body contact, actually inhibit opioid tolerance , protecting the rewards for maintaining close family relationships. On the other hand, consuming artificial opioid drugs replaces the brain’s need for maintaining family contacts.

Once a strong opioid bonding has occurred, separation can become emotionally upsetting, and in the infant possibly even physically uncomfortable when opioid levels decrease in the brain, much like the withdrawal symptoms from cocaine or heroin. When opioid levels become low, one might feel like going home to hold the baby or like crying for a parent’s warm embrace, depending on your point of view. Sometimes alternate behaviors are helpful. For instance, thumb-sucking can provide some relief from partial or total withdrawal from a human or rubber nipple and can even provide opioid-produced reminiscences for a time.

Norepinephrine & Learning

Breastfeeding also causes dopamine and its product, norepinephrine (adrenaline), to be produced, which help maintain some of the effects of the early bonding. They enhance energy and alertness along with some of the pleasure of attachment.

Norepinephrine helps organize the infant’s stress control system, as well as other important hormonal controls in accordance with the nature of the early rearing experiences. It promotes learning about the environment-especially learning by memorization that is carried out by oxytocin, opioids, and other chemical influences.

Pheromones & Basic Instincts

How does the man’s body know to initiate hormonal changes when he is living with a pregnant female? How can an infant accurately interpret mother’s “odors” that adults often can barely detect? The answer is pheromones. Among other things, pheromones are steroid hormones that are made in our skin. Our bodies are instinctually programmed to react accordingly when we detect these pheromones around us.

Newborns are much more sensitive to pheromones than adults. Unable to respond to verbal or many other cues, they apparently depend on this primitive sense that controls much of the behavior of lower animals. Most likely the initial imprinting of baby to odors and pheromones is not just a matter of preferring the parents’ odors, but is a way nature controls brain organization and hormonal releases to best adapt baby to its environment. Baby’s earliest, most primitive experiences are then linked to higher abilities such as facial and emotional recognition. Through these, baby most likely learns how to perceive the level of stress in the caretakers around her, such as when mother is experiencing fear or joy. Part of an infant’s distress over separation may be caused by the lost parental cues about the safety of her environment. Of course the other basic sensation an infant responds to well is touch, and coincidentally, body odors and pheromones can only be sensed when people are physically very near each other.

What the World Needs Now...

Infants universally cry when laid down alone. If we allow ourselves to listen, our neurons and hormones encourage us in the proper response. Babies are designed to be frequently fed in a fashion that requires skin-to-skin contact, holding, and available facial cues. Beneficial, permanent brain changes result in both parent and infant from just such actions. Contented maternal behaviors grow when cues are followed. The enhancement of fatherhood is strongly provided for as well. A father’s participation encourages his further involvement and creates accord between father and mother. Frequent proximity and touch between baby and parents can create powerful family bonding-with many long-term benefits.

Sadly, over the last century parents have been encouraged by industry-educated “experts” to ignore their every instinct to respond to baby’s powerful parenting lessons. Psychologists, neurologists, and biochemists have now confirmed what many of us have instinctually suspected: that many of the rewards of parenthood have been missed along the way, and that generations of children may have missed out on important lifelong advantages.

Endnotes

1. T.R. Insel, “Oxytocin – a neuropeptide for affiliation: evidence from behavioral, receptor autoradiographic, and comparative studies,” Psychoneuroendocrinology 17, no. 1 (1992): 3-35.
2. H. Varendi et al., “Soothing effect of amniotic fluid smell in newborn infants,” Early Hum Dev (Estonia) 51, no. 1 (Apr 1998): 47-55.
3. R.H. Porter et al., “An assessment of the salient olfactory environment of formula-fed infants,” Physiol Behav 50, no. 5 (Nov 1991): 907-11.
4. S.S. Knox and K. Uvnas-Moberg, “Social isolation and cardiovascular disease: an atherosclerotic pathway?” Psychoneuroendocrinology 23, no. 8 (Nov 1998): 877-90.
5. M. Altemus et al., “Suppression of hypothalamic-pituitary-adrenal axis responses to stress in lactating women,” J Clin Endocrinol Metab 80, no. 10 (Oct 1995): 2965-9
6. R.S. Bridges, “The role of lactogenic hormones in maternal behavior in female rats,” Acta Paediatr Suppl 397 (Jun 1994): 33-9.
7. G.L. Kovacs et al., “Oxytocin and addiction: a review,” Psychoneuroendocrinology (Hungary) 23, no. 8 (Nov 1998): 945-62.
8. G.W. Kraemer et al., “A longitudinal study of the effect of different social rearing conditions on cerebrospinal fluid norepinephrine and biogenic amine metabolites in rhesus monkeys,” Neuropsychopharmacology 2, no. 3 (Sep 1989): 175-89


Massage for Infants and Children on the Autism Spectrum

Written by Mary Gengler Fuhr, OTR/L, RYT, CEIM with Jackie Kalina Hattori, COTA/L, LMP and Carrie Sheppard, MEd., LMHC

It is estimated that 1 in 110 children in the US are considered to have an Autism Spectrum Disorder (ASD)

...which includes autism, Asperger’s syndrome, and pervasive developmental disorder – not otherwise specified (PDD-NOS). This means that most people know someone whose family is affected by ASD and most Certified Educators of Infant Massage (CEIMs) will work with a baby or child who will be diagnosed with ASD.

The Diagnostic and Statistical Manual of Mental Disorders IV describes the criterion for ASD to include: differences in thinking, communication, social relatedness, sensory processing, symbolic play, and restricted, repetitive patterns of behavior and interests. Therapists also note that confusion and anxiety affect children and their parents. Sleep disturbances are also prevalent. Children with autism tend to have multiple disabilities such as ADHD, learning disabilities, anxiety, seizure disorder, and speech differences which complicate diagnosis and treatment.

Most children are not diagnosed with ASD until age 2 and many not until elementary school.

However, The Science Daily reported on Jan. 26, 2012 that research conducted at the Centre for Brain and Cognitive Development at the University of London, “shows that in their first year of life, babies who will go on to develop autism already show different brain responses when someone looks at them or away.” In addition, “The human brain shows characteristic patterns of activity in response to eye contact with another person, and that response is a critical foundation for face-to-face social interactions. Older children diagnosed with autism show unusual patterns of eye contact and of brain responses to social interactions that involve eye contact.”

While it was at one time thought that children with ASD did not want to be touched, it is actually a matter of finding the right kind of touch or sensory- motor experience that is calming or regulating for the individual child.

Each child and each parent’s sensory system, touch history, and social- emotional makeup is unique. Some children on the spectrum may seek out touch while others may be more sensitive or avoidant. But, with patience and practice in reading the child’s cues and adapting the touch, a satisfying touch/tactile interaction can be experienced.

As Certified Educators of Infant Massage (CEIMs), we have the opportunity to help parents explore what works best for their childand best enhances their relationship with their child with ASD.

As we know, infant and pediatric massage offers a multi-sensory approach. Massage provides the opportunity for eye to eye contact, skin to skin contact, exchange of smell, communication, turn taking, and relaxation. These all promote bonding and attachment and are critical for the child on the Autism Spectrum.

Research has shown benefits of infant/pediatric massage with children with autism in the areas of increased eye contact, less stereotypic behavior, more on task behavior, increased social relatedness and improved sleep. (Escalona, et al. 2001, and Field et al. 1997)

Each infant and child is unique and so we will present 3 different approaches to massage, based on our personal experiences.

Mary Fuhr, a pediatric Occupational Therapist writes:

With preschoolers and older children, we have found that a firm, but gentle pressure/ touch is often preferred over stroking. Temple Grandin (a world renowned animal scientist and person with ASD) has described her need for deep pressure which ultimately led to the development of her “squeeze machine” to help achieve a calm state.

Prior to beginning massage, parents let their children know that this is “calm body time.”

They also explain to their child, that he or she can tell their parent to “stop; go harder or softer; faster or slower.” Communication and building trust are essential components of the massage experience.

The type of touch we have found to most consistently be regulating for our clients with ASD is a cross between the gentle hold technique Vimala Schneider McClure shared early on in her work, and Thai yoga massage.

We have found that a firm rhythmic pressure/touch and release has been very well accepted by children on the autism spectrum. In addition, we will often encourage parents to roll a small, soft, weighted (dependent on the size of the child) ball over their child’s legs, back and arms. This is somewhat similar to the Indian technique of rolling a ball of dough over a baby’s body.

Another strategy to help with calming is to have the parent wrap the child snuggly in a favorite blanket and then apply the pressure touch through the blanket. Using puppets is often helpful for children who are especially sensitive to skin to skin contact. Puppets can add an additional element of play and creativity.

We have found that combining this pressure/ touch with children’s relaxation stories and music is very beneficial.

Favorites include “A Boy and a Bear,” “A Boy and a Turtle,” and “Angry Octopus” by Lori Lite (www.stressfreekids.com). Parents and children can practice deep breathing together in “Boy and a Bear,” while sharing positive touch. “Boy and a Turtle” introduces progressive relaxation and visualization. Parents can give pressure/ touch to each body part, synchronizing their movements to the body part being mentioned in the story. For example, in the story, the boy and the turtle first dip their feet in the water. Parents can massage or give pressure/touch to their child’s feet. Next the boy and turtle dip their legs in the pond. Parents provide the touch to their child’s legs, and so on. In the book, each body part becomes a color of the rainbow after it is dipped in the pond. This engages the child’s imagination while the visualization also helps produce relaxation.

When listening to and reading the story about the “Angry Octopus,” parents help their children learn about squeeze/ release techniques as the octopus learns to let go of his anger. Parents can again provide a pressure/ touch to their child’s body following the story. With practice and their parents’ guidance and support, the child learns to be able to use touch techniques, music, deep breathing, visualization, and other strategies for their own self- regulation.

Jackie Hattori, a Certified Occupational Therapy Assistant and Licensed Massage Practitioner adds:

“Being a massage therapist and the mother of a child with ASD, I have a unique perspective on massage and autism. There is a saying that children with ASD are like snowflakes, no two are alike. This is especially true when we look at how children on the spectrum react to touch. My son was a very easy baby. It wasn’t until he was around 3 that I realized he might be on the spectrum. Through my journey to find his diagnosis, I realized that I had been soothing his sensory system unknowingly. I gave him massages after his baths using soft touch and lots of reciprocal eye contact to encourage bonding.

I also carried him in a carrier most of the time to meet the needs of his vestibular system, but truly the most helpful thing looking back was tapotement. Tapotement is the rhythmic, soft tapping or percussion of your hands. When my son would get off kilter or need to calm down, this technique helped immensely. Massage is not a cure for sensory issues but it is an important tool that needs to be further studied.”

Carrie Sheppard, a Licensed Mental Health Counselor, and parent of a college-aged child with ASD reports:

“I have many examples where touch in general has transformed a parent-child bond, empowered a parent to solve a regulation or soothing-related problem, or improved a sleep problem.”

Carrie discussed how using massage would calm her son quickly when he was younger and having a meltdown. She used a gentle, but firm, squeezing motion massage at his joints. For example, she would start at the shoulders, and then move to both elbows, then both wrists, etc., all the way down his body. This was a highly effective technique to help her child become more regulated.

Parents with children with ASD can greatly benefit from the pediatric massage experience and the calming time together.

A child with ASD may have behavior that varies widely and can be unpredictable, causing stress and anxiety for parents. They may feel like they are walking on eggshells, never knowing when one will break. Research by Tiffany Field (1994) has shown that the massage giver reaps multiple benefits of relaxation from providing the massage. Parents we have worked with confirm this.

As CEIMs, one of the greatest gifts we can offer parents is to listen without judgment.

Many parents report that their healthcare providers or school personnel don’t listen or don’t understand the full magnitude of their child’s condition and behavior. Similarly, through massage, parents focus on taking time to listen to and “read” their child’s communication cues. They then modify the experience based on how their child responds to their touch. The importance of helping parents and children with ASD feel relaxed, connected, and engaged in a relationship through touch cannot be underestimated. It is life-changing.

NOTES

Escalona, A., Field, T., Singer-Strunk, R., Cullen, C., & Hartshorn, K. (2001). Brief report: Improvements in the behavior of children with autism following massage therapy. Journal of Autism and Developmental Disorders, 31, 513-516.

Field, T. (1994). Infant Massage. The Journal of Perinatal Education, 3, 7-14.

Field, T., Lasko, D., Mundy, P. & Henteleff, T., Kabot, S., Talpins, S. & Dowling, M. (1997). Brief report: Autistic children’s attentiveness and responsivity improved after touch therapy. Journal of Autism & Developmental Disorders, 27, 333-338.

Pediatric Massage for the Child with Special Needs by Kathy Fleming Drehobl and Mary Gengler Fuhr has been updated and is now available as an ebook though iTunes, Barnes and Noble, smashwords, and other locations. More information can be found at www.pediatricmassage.com, under the "infant and pediatric massage" tab.


Reviews of Parenting Books


The Baby Book

Written by William Sears, M.D., and Martha Sears, RN.
Published by Little, Brown and Company 2003 Revised Edition
Review by CEIM Anne Greetham, now based in Singapore.

The part of the infant’s development which I found particularly interesting was all about the infant’s brain and the enormous amount of development it undergoes during the first few years of life. Indeed it develops so much that unlike any other of our organs it has achieved approximately 60% of its adult size in the first 12 months of life.

One can note that a baby’s head appears very large compared to the rest of its body at birth, this is because most of the brain is already there and so it does appear to be disproportionate. This brain matter however needs a great deal of work doing to it to ensure that all the neurons are connecting and the right information is being processed by the baby.

During the infants development the brain multiplies its neuron connections, the more of these it does the brighter the child, it also covers the neurons in myelin and it is this covering which enables the messages to pass quickly between neurons and furthermore it also insulates the nerves.

An enormous amount of this development has taken place in utero but there are numerous things that can help the development immediately post birth and it is these which will support our work as infant massage instructors.

How we talk to our infant has a profound affect on their development, therefore as instructors we possess a tremendous opportunity to emphasis this when taking our courses. We can show the carer that the baby starts to respond when we take time to talk and indeed to listen to the young one. This respectful contact not only enhances the baby’s ability to learn, it also helps them to feel nurtured. This sensitive communication helps the infant to trust and develop emotionally. Too often infant carers are extremely busy and unaware of the value to take the time to actually talk and listen to their child. As a CEIM we can show them that this time spent talking and listening to the baby whilst massaging will benefit the infant’s brain also.

The infant’s brain will also develop faster through the art of touch. It has been shown that a baby will respond better if carried and shown its environment rather than being left to fuss in a boring cot. In the same way we can stimulate the infant’s body by touch making them aware of the different parts of their bodies. We can also help the baby to better reach the quiet alert state which enables the greatest amount of learning to take place and hence promote their brains development.

Studies have also shown that touch promotes the growth of myelin and so enables the infant to pass nerve impulses faster. The massaged infant may therefore develop neurologically faster than the infant touch deprived.


Pre-Parenting Nurturing Your Child from Conception

Written by Thomas R.Verny, M.D., and Pamela Weintraub
Review by Irene Brophy

This book points out that for a baby’s secure emotional development it is essential for the infant to have a secure relationship with one or two primary caretakers which then leads to rapid learning of emotional and cognitive skills. These interactions have permanent advantages because they are “evolutions number one tool for constructing the brain”. Dr Verny states that “we are unable to point to Darwin’s law of evolution as proof that humans are mindless automations driven by their genes to mercilessly propagate the spices and survive, the nature of brain building means this can’t be so”.

When looking at children’s development we can’t just look at exposure to poverty and crime, that we must also look at how the child was reared, the bond formed with his mother and father not only from birth even before that – life in the womb. Because when baby is born it already has memory, it has a sense of self, its emotions are already established i.e. whether she will be prone to depression, joy, anxiety or calm.

The brain, a living organism is capable of growing, multiplying and dying. “The brain is bathed in a biochemical soup of hormones, neurotransmitters and polypeptides which allows it to establish two-way communication with far flung regions of the body”. This is how a pregnant woman communicates intimately with her unborn child and it is these same molecules that form the baby’s personality.

Dr. Verny talks about the evidence he and other scientist have gathered over the last 10 years, that pregnant women and their unborn children can sense each others thoughts and feelings. It does make a difference to the development of the child’s personality and mind if baby was conceived in love, haste or hate. Another important factor is whether the women did want to be pregnant and whether she lives in a calm, stable environment free of addiction. Support from family and friends, also has an impact on baby’s personality, as does prenatal and early natal experiences of bonding and attachment between mother and baby.

Dr. Verny has had ample evidence over the last 30 years whilst exploring the frontiers of prenatal psychology that the initial layers of memory start as early as conception.

Bruce H. Lipton, a cellular biologist said “cells read their environment, assess the information and then select appropriate responses to maintain their survival.” A good example of cellular memory is our immune system, defenses operate through recognizing and remembering infectious invaders, vaccines work because the immune responds.

Thus, neuroscience suggests that “true intelligence and memory—the very essence of self—are located not just in the brain but throughout the body.” And “They constitute a single, interactive network. They are one.”

What this means is that a fully developed central nervous system is not necessary or the brains to receive, store and process information, that, in fact, the mother passes on information, whether it be stress related cortisol or feel-good endorphins into the baby’s blood system which affect receptors all the way through the babies development, no matter how early in life. Therefore, first memories are being gathered within the cells of the baby’s bodies before even the brain develops.

At birth the infant’s body “is primed with hormones for socializing and empathy and her brain, literally programmed with the capacity to love. Throughout the early years of life research shows, that the baby’s brain is continuously tuned by his caregiver’s brain to produce the correct neurotransmitters and hormones in the appropriate sequence;” This programming determines the brains architecture that the baby will have throughout his life. Therefore, if baby is traumatized or abused and if the trauma is powerful enough, that is, if the process is inappropriate or incomplete, damage will result and cause permanent psychological problems.

Environment, bonding and healthy stimulation and not genetics are what are essential for the long term health, ability, passion, mood and character of babies.


Born for Love: why empathy is essential – and endangered

Written by Maia Szalavitz and Bruce D. Perry, MD, PhD
Published by Wm Morrow, 2010
Review by Lisa Galatio, Program Manager at Healthy Families Steuben in Hornell, NY

I believe this book would be of great interest to anyone involved in infant massage. Born for Love explains how individuals develop, or in some cases do not develop, a sense of empathy at a very early age. It is how we are nurtured as infants that can determine how well we are able to empathize with others as we grow older.

A great deal of brain development takes place during the first year, and how successful that development is hinges on the care we receive. I have attended lectures and read books by Dr. Bruce Perry in the past and have been fascinated by his work on the impact of trauma during childhood on brain development. This book narrows his work down even more to talk about how one’s sense of empathy is developed. Many of the concepts in the book reinforce the reasoning behind infant massage.

One of my favorite quotes from the book is that “love grows brains”. A concept that was newer to me is that our brains contain “mirror neurons” that entrench certain behaviors in our own minds by copying what we see. Simply, we learn to care for others by copying how we are cared for. The more we are loved and cared for as infants, the more we are capable of caring for and loving others. This seems like common sense, but the book explains how being cared for physiologically makes us more empathetic. There are many stories about how individual children suffered by having a less than nurturing early childhood.

There are also many illustrative stories in the book about how the human race actually survives better by being empathetic, and the consequences society could suffer at the loss of empathy. It is amazing to think of how important the relationship between a parent and a child can have on the larger world. Vimala has a wonderful quote that captures the main idea of this book:

“The chalice of this infant’s heart is filled to overflowing, and as she grows she will seek opportunities to share her love with others. And how will she do this? By following the model she has been given. She will be there for others in the way her caregivers have been there for her. What a lovely, healthy cycle!”

This book is an excellent argument for our work in infant massage. Infant massage is a beautiful way for parents to express their love for their infants and one of the earliest ways our babies can experience what love feels like. The book also reinforced my general work with parents and reminded me of why it is so important.

The book specifically talks about how an isolated mother is a distressed mother and how crucial it is for pregnant women and new mothers to be nurtured, supported, and educated on infant care. The information I gleaned from the book has definitely rejuvenated my commitment to parent education, as well as my role as an infant massage instructor.


SuperBaby: 12 Ways to Give Your Child a Head Start in the First 3 Years

Written by Dr. Jenn Berman
Review by Jacqueline Storm Godwin

When I became unexpectedly pregnant in 2009, I read every book I could on pregnancy, labor, and raising a child because I felt unprepared and was terrified my ineptitude would scar my child for life. I found that many of the books I read on childrearing repeated information, gave advice that seemed obvious (even to me), or didn’t seem to fit with my lifestyle. I found plenty of books on how to get my child to sleep and how to make my own baby food, but what I really wanted to know was “How do I give my son the best possible start?” My goal was not to raise the next Einstein; I just wanted him to feel secure, enjoy learning, and above all, be healthy and happy.

When my mom gave me Superbaby: 12 Ways to Give Your Child a Head Start in the First 3 Years by Dr. Jenn Berman, I snatched it out of her hands and devoured it in days. The book gave me the tips I was looking for to give Henry the best start. Dr. Berman organizes the book in 12 chapters focusing on ways to enhance your child’s development. Not only does she provide her own experience as a mom and therapist to provide advice, but also she supports her tips with research and evidence from experts in the field. The chapters include tips on respectful communication, responding to cues, creating security and predictability, the importance of touch, promoting language development, sign language, foreign language, reading, the importance of play, TV time, reducing exposure to toxic chemicals, and eating and nutrition. In addition, there is advice and information on childcare, preschool, baby routines, and reducing the risk of SIDS in separate appendixes.

Each chapter is informative and contains useful information, but one of the chapters I found most helpful is the chapter “Let Your Fingers Do the Walking”. This chapter stresses the importance of touch and its benefits to babies claiming that touch helps infants become smarter children, have healthier digestion, sleep better, improve their weight gain, develop better sensory awareness, enhance muscle tone and coordination, and better handle stress. Berman also points out the emotional advantages of touch claiming that physical contact creates self-esteem, helps infants bond with caretakers, teaches self-soothing, helps your baby learn to trust, and makes for better mothering.

While all touch is beneficial to children, Dr. Berman considers two forms of touch to be “super-touch” in that the benefits are huge to the child. The first form is kangaroo care. She begins the chapter citing Catherine Real, who, as a newborn, was having respiratory distress and was close to death. After a nurse encouraged Catherine’s parents to hold Catherine skin-to-skin, she was able to make a full recovery. Dr. Berman attests to the power of Kangaroo Care with her own twin daughters who weighed less than five pounds at birth, but she also acknowledges the benefits aren’t just for sick babies. Healthy babies and their mothers gain from kangaroo care, or K-care also. Babies whose parents practiced kangaroo care were reported as experiencing earlier bonding, having less colic, interacting with their parents more, improving and increasing their sleep, and having significantly shorter crying spells, to name a few benefits. The mothers had an easier time breastfeeding, felt more bonded with their babies, and were more affectionate with their babies.

The other form of “super-touch” that Dr. Berman cites is infant massage. Massage, according to Dr. Berman, has medical benefits in addition to all the benefits basic touch has. Massage can ease constipation, colic, eczema, asthma, congestion, gas, cradle cap, teething, and dry skin. Most important, though, she writes, “the real purpose of massage is to help you tune into your child and get to know him better” (84). While she does not delve into too much depth into specific strokes or technique, she does offer a list of tips to help parents get started, urging them to use soothing music, pay attention to Baby’s cues, and use a non-nut or petroleum based oil. She advises to start small since it may take babies time to develop a tolerance and offers a list of cues to look for in case Baby becomes over-stimulated.

Dr. Berman’s book is a resource every new mother should have on her bookshelf. Even though not all of her advice can be put into practice right away, Dr. Berman acknowledges that progress rather than perfection is the goal. Her chapter on chemicals was extremely alarming to me, but I appreciate her advice on slowly incorporating more earth-friendly products into my home rather than needing to completely ransack my house of all toxins. Likewise, her chapter on nutrition was helpful, and though I am not in a position to buy only organic food, I am able to avoid ‘the dirty dozen’ types of produce that contain the most pesticides and buy their organic alternatives instead.

I know that no book can replace experience when it comes to being a parent, but with every word my son speaks, every sign he flashes at me (usually more) and every compliment I receive from strangers at how happy Henry seems, I feel like Superbaby has given me answers I would have otherwise still been searching for. Little did my mom know that when she gave me Superbaby, she would be making it possible for me to give my son the gifts of health, happiness, confidence, security, and a love of learning. I now give Superbaby by Dr. Jenn Berman at every baby shower I attend because those gifts are the ones that really count.


Beginning to Play

Written by Ruth Forbes
Published by McGraw-Hill Education, 2004
Review by Natsumi Shinohara

In this book, the author discusses how parents or early childhood care practitioners need to facilitate babies or young children’s play experience by paying attention to the babies’ developmental aspects and the importance of interaction between babies and adults.

One of the descriptions I found interesting was about how the sensory experiences, especially in playful manners, contribute to the babies’ development with delight and pleasure. It was explained that babies use all of their senses to explore their environment: touching, tasting, smelling, looking, and hearing. These senses allow babies to advance their understanding about their world and assimilate information they obtain from the sensory play experiences. It is also said that babies need rich play experiences coordinated with the sensory stimulations and involved the emotions of the adults who are interacting with the babies. These play experiences, when repeated over a period of time actually help the baby’s brain to build the neural connections, which boosts the brain function.

The fact that any kind of sensory experiences helps babies explore and learn their world supports the basic approach of the infant massage. Infant massage mainly aims to promote the bonding process between the baby and his/her parents, stimulate the baby’s cognitive development, and enhance the baby’s physical and emotional relaxation. The knowledge of the power of babies’ sensory experiences including touch, sounds, smell, taste, and vision brings about further understanding of how to involve all of these senses in the infant massage period.

For example, I would suggest the parents talk to their baby during massage and tell him/her the body part where they are giving massage, as this will help the baby learn what his/her body is like by being touched and talked by someone he/she trusts. It is my responsibility as an infant massage instructor/educator to teach the parents that the infant massage program is not just a physical intervention, but a holistic approach which enhances well-being of both babies and their parents by utilizing the baby’s every sensory experience. Babies are able to actively participate in the massage feeling the touch, listening to their parent’s voice, looking at their parent’s face, and realizing their parent’s smell. As a result, the massage goes far beyond just a physical activity, to a reciprocal interactive experience, which brings various benefits to both babies and their parents. When parents know this, they will be able to fully understand how to approach their babies in or out of the massage time.


Gentle Birth, Gentle Mothering

Written by Sarah J. Buckley, MD
Published by Celestial Arts, 2009
Review by Kerrie Hurst, Certified Educator of Infant Massage

In Gentle Birth, Gentle Mothering, Australian family physician Dr. Buckley offers a fresh lens on choices related to prenatal, intrapartum, and postpartum care as well as how gentle early parenting choices can promote lifelong well-being for babies. She does this through her personal experience and wisdom that comes from being a doctor and mother of four as well as through extensive current research that challenges old thinking and even current trends in obstetrics and parenting worlds.

In relationship to infant development, I found Dr. Sarah Buckley’s chapter on “Love, Attachment, and Your Baby’s Brain” particularly interesting and pertaining to infant massage. She blends the neuroscience of infant development with practical information for parents, providing suggestions for attachment-style parenting that will benefit babies through their whole lives.

Babies are born with about 200 million brain cells (neurons), but with very few connections, known as synapses, between those neurons. Early social experiences form synapses that Dr. Sarah Buckley likes to call the “firing and wiring” of brain development. In the womb, the firing and wiring of baby’s brain begins with sensations such as warmth, being rocked, different tastes from mom’s diet via amniotic fluid, and hearing mom and dad’s voice. Babies are calmed and settled when mom is calmed and settled. Increased maternal stress during pregnancy can even fire and wire a baby’s brain for dysfunction in learning and cause over-reactivity to stress.

After birth, different experiences primarily concerned with physical interaction create synapses in baby’s brain. Since newborns only have a focusing distance of 10-12 inches, newborns can see their parents while in their arms or at the breast. Neurons are activated and electrically fire to areas in the brain concerned with vision and facial recognition. With repeated gazes, repeated firing causes synapses that connect vision with facial recognition. Physical interactions between parents and baby offer the baby warmth, the touch and smell of skin, support and movement from being held, and sensations and hormones from breastfeeding. When baby hears the mother’s heartbeat, the sound is already connected to pleasurable feelings from living inside the womb. These early experiences with the social environment are critical to the maturation of brain tissue and form vital brain connections.

These physical interactions also contribute to physiological stability for mom and baby. Through a process called mutual regulation, mom and baby exchange information and influence each others’ body processes for well-being and optimal development. For example, during skin-to-skin contact, mom’s temperature immediately increases to warm baby. Skin-to-skin contact also regulates a sense of well-being as it reduces stress hormones. Lower levels of stress and stress hormones reduce baby’s energy requirement, improve blood sugar levels, stabilize temperature, and activate the parasympathetic nervous system. This offers enhanced digestion, healing, growth, and imprints calm and connection through the hormone oxytocin. For the mom, physical contact with baby enhances the production of oxytocin and prolactin, helping her to regulate her maternal instinct, behaviors, and fertility. Dr. Sarah Buckley highlights that in many ways, mom and baby are like one physiologic organism, “motherbaby” which demonstrates the importance of the mother’s ongoing loving presence and touch to optimize baby’s physical and emotional well-being and development (Buckley 220).

Dr. Sarah Buckley highlights the need to provide an ideal environment for infancy including frequent access to mother’s breast, security at night through co-sleeping, protection from painful and traumatic events such as circumcision, social interaction, and lots of touch/body contact (ideally skin-to-skin) with loving adults. Positive early social experiences trigger emotional and social learning and wire the baby’s brain for ease and pleasure with future social interactions.

The right side of a child’s brain is dominant over the left side for the first three years of life. The right brain is involved with bonding and attachment and is connected with the limbic system known as the emotional brain. It undergoes a growth spurt in the first two years of life. An attachment bond between mother and baby builds a healthy right brain and limbic system and is a major developmental task for the first two to three years. This secure bond is built through the baby’s repeated positive and attuned interactions with mother and later with others. These interactions include episode of mutual gazing and smiles, laughter and joy, and temporary disengagements like pulling away when the input is too intense for baby.

Babies learn to mirror their mothers and actually download the mother’s brain patterns and behaviors and incorporate them into their own brain structures and future behaviors. Babies need help with adjusting their emotions and emotional reactions when experiences are new or stressful. When a parent responds calmly, the modeling produces a brain program that the baby will download and integrate as a template for future stressful situations. Therefore, a parent’s ongoing presence and availability helps baby to learn emotional self-regulation.

In addition to reducing stress in and after pregnancy for mother and baby, Dr. Sarah Buckley recommends skin to skin mother-baby contact, continuous holding and carrying, breastfeeding, ample opportunities for positive social interactions with attuned caregivers, ongoing availability of a primary care-giver, co-sleeping, remaining calm and physically close to baby during episodes of unavoidable stress to help ensure soothing, prioritizing secure attachment, and building community support for these choices. I would like to add that infant massage is an excellent modality to further encourage love, attachment, and brain development. The five senses of touch, sound, sight, smell, and even taste are deeply engaged through infant massage which can only help to activate and develop the brain by building synapses between neurons. It also encourages an amazing avenue for attachment and bonding. Dr. Sarah Buckley says herself that “liberal maternal-infant body contact will imprint calm and connection (through oxytocin) and minimize stress (through arginine vasopressin) during interaction, giving a good start to the pre-attachment phase” (Buckley 226). The physiological, emotional, and social benefits of infant massage to both caregiver and baby are countless and further validated through the knowledge made available through this book.