The tactile context of a mother’s caregiving: Implicationsfor attachment of low birth weight infants<Sandra J. Weissa,*, Peggy Wilsonb, Matthew J. Hertensteinc,Rosemary CamposdaProfessor, Department of Community Health Systems, University of California, San Francisco, Box 0608,San Francisco, California 94143, USA bClinical Nurse Specialist, San Francisco General Hospital, San Francisco, CA, USA cPhD Candidate, Department of Psychology, University of California, Berkeley, CA, USA dAssistant Research Specialist, Institute for Human Development, University of California, Berkeley, CA, USAReceived 8 March 2000; received in revised form 8 September 2000; accepted 8 September 2000AbstractThis study examined the degree to which specific properties of maternal touch may be associatedwith a low birth weight infant’s security of attachment at one year of age, considering the potentialmodifying effects of maternal sensitivity and history of touch as well as infant gender and biologicalvulnerability. One hundred and thirty one socioculturally diverse infants and their mothers wereevaluated for medical complications during the neonatal period. Videotapes were made of theinfant-mother dyads during an infant feeding at three months of age. Each videotape was analyzed fora mother’s properties of touch and her sensitivity as well as for infant responsiveness. When the infantwas six months old, each mother completed a questionnaire to determine felt security regarding herown history of touch as a child. Researchers completed the Attachment Q-Set for each infant at oneyear of age.Analysis of covariance indicated that sheer frequency of touch had no relationship to infantattachment but use of nurturing touch by mothers was associated with security of attachment.However, the degree of infant vulnerability (i.e., perinatal complications, birthweight, and responsiveness)moderated the effects of nurturing touch. Nurturing touch was associated with more secureattachment for robust infants but with less secure attachment for highly vulnerable babies. Neithermaternal sensitivity nor gender appeared to moderate the relationship of touch to attachment or to haveany direct relationship to attachment outcomes. Infant vulnerability decreased the likelihood of a* Corresponding author. Tel.: 11-415-476-1504; fax: 11-415-476-6042.E-mail address: sweiss@itsa.ucsf.edu (S.J. Weiss).Infant Behavior & Development 23 (2000) 91–1110163-6383/00/$ – see front matter © 2000 Elsevier Science Inc. All rights reserved.PII: S0163-6383(00)00030-8secure attachment while a mother’s felt security regarding her own tactile experience as a childincreased her infant’s chances of having a secure attachment. © 2000 Elsevier Science Inc. All rightsreserved.Keywords: Parenting; Touch; Attachment; Low birth weight1. IntroductionAttachment theorists have long regarded the quality of parent-infant physical contact as acentral feature of the responsive and available caregiving environment that is necessary infostering an infant’s sense of security (Ainsworth et al., 1978; Bowlby, 1973). In fact, Main(1990) argues that physical contact with an attachment figure is “the ultimate signal” to theinfant that s/he is safe and secure, noting that Bowlby (1969) placed physical contact as acentral requirement of proximity and felt security. The thesis that ‘contact comfort’ createsan experience of refuge or safety for a child was originally proposed by Harlow (1962;Harlow & Zimmermann, 1959) whose research with rhesus monkeys provided evidence ofthe importance of bodily contact between infant and mother as the basis of reassurance andfelt security for an infant. Subsequent human research also indicates that close bodily contactwith the mother may be superior to other modalities in helping an infant cope with distressor discomfort (Grossman et al., 1985; Hunziker & Barr, 1986). Although much of the focuson physical contact has been on its role in situations of stress or uncertainty, Ainsworth andcolleagues’ (1978) seminal work demonstrated that it was the quality of touch in day- to- dayinteractions, not simply separations, which influenced the infant’s attachment expectations.While the link between physical contact and attachment may be salient for all infants, ithas special importance for low birth weight (LBW) babies. Because of their fragile orunderdeveloped nervous systems, LBW infants have diminished ability to regulate theirresponses to their tactile environments during the first few months of life. Numerous studieshave demonstrated potentially detrimental effects of touch on high risk infants’ neurobehavioralstatus and emotional distress (e.g., Als, 1986; Gunnar et al., 1987; Harrison et al.,1990). Because of these findings, many hospitals have adopted ‘minimal handling’ policiesthat require nurses and parents to touch babies infrequently, and primarily for essentialmedical procedures or cleaning rituals. As a result, some parents learn to withhold their touchto protect their baby and thus develop ingrained patterns of infrequent interaction whichcontinue over time. Other parents who are less sensitized to their babies’ vulnerabilities mayoverstimulate their infants without recognizing their regulatory difficulties. LBW infantsmay also be especially vulnerable to touch because of their history of invasive and painfulmedical procedures which can distort their somatosensory perception and increase thepotential for touch to be aversive (DeMaio-Feldman, 1994).In addition, there is evidence that certain types of neurobehavioral limitations (many ofwhich are experienced by LBW infants) may affect the attachment relationship adversely(Belsky & Rovine, 1987; Crockenberg, 1981; Miyake, Chen & Campos, 1985; Vaughn &Bost, 1999; Van den Boon, 1994). These limitations (e.g., difficulty orienting, weaker muscletone, irritability, tremors, lack of responsiveness) are associated with diminished CNS92 S.J. Weiss et al. / Infant Behavior & Development 23 (2000) 91–111integrity at birth, resulting from underdeveloped or medically compromised nervous systems.In contrast to full term, robust infants who have every sensory system functioning on theirbehalf at birth or soon after, many LBW babies are at risk because of such neurobehavioralproblems. They are less capable of dampening their own distress, depending substantially ona caregiver during their first few months to regulate their neurobehavioral response to bothinternal and external stimuli (Als, 1986). As a result, they are especially susceptible to theeffects of parental behavior. In addition, the infant’s ability to engage the mother via eyecontact, vocalization or facial expression predicts greater security of attachment (Grossman,Grossman & Schwan, 1986), placing minimally responsive LBW babies at even greater riskfor attachment problems (van Beek, Hopkins & Hoeksma, 1994).2. The impact of touch on attachmentAttachment theory emphasizes the role of touch in the context of maternal sensitivity andresponsiveness to distress. The literature highlights two major characteristics of touch: itsoverall availability to the infant and the degree to which it is affectionate and tender versusrejecting or abusive.
2.1. Availability or frequency of touch
The amount of touch provided to the child is often defined as an index of maternal
availability. Ainsworth and colleagues (1978) originally noted that mothers of secure infants
used touch more extensively than mothers of insecure-anxious infants. Significant correlations
between the attachment of infants and a number of maternal qualities of touch have also
been described in a review and synthesis article written by several scientists with related
programs of research (Waters, Kondo-Ikemura, Posada and Richters, 1990). These authors
detail the relationships of monkey infant attachment to a mother’s a) close holding of her
infant for extended periods, b) carrying of the infant when moving from place to place, and
c) tolerance of the infant’s touching of her body during play. They also present data
indicating that human infants classified as secure enjoy more playful physical contact with
their mothers than babies classified as insecure.
In one of the few experimental studies manipulating the amount of physical contact
between mothers and their infants, Anisfeld and colleagues (1990) compared attachment
outcomes for infants who were carried ventrally in soft baby carriers with those transported
in infant seats. They concluded that increased maternal contact from early carrying enhanced
the likelihood of secure attachments for the infants.
In contrast, other studies indicate that mothers of insecure-avoidant infants may have some
aversion to touch, appearing to dislike close physical contact with their infants (Egeland &
Farber, 1984; Main, 1981; Main & Stadtman, 1981). Some scholars speculate that this
discomfort with touch is transmitted from mother to infant because the babies of mothers
who have insecure attachments begin to show some aversion to and/or lack of enjoyment of
physical contact as they develop (Main, 1990; Pederson & Moran, 1995; Posada et al., 1995).
While results cited above imply that more extensive touch enhances attachment outcomes,
S.J. Weiss et al. / Infant Behavior & Development 23 (2000) 91–111 93
other findings suggest that too much touch can have a negative impact on attachment.
Ainsworth et al. (1978) noted that mothers of insecure-resistant infants used touch that was
interfering and at times inappropriate to the infant’s needs. Other investigators have found
that insecure-avoidant attachments are related to intrusive, excessively stimulating caregiving
approaches (Lewis & Fiering, 1989; Smith & Pederson, 1988; Vondra et al., 1995). On
the other hand, ‘moderate stimulation’
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