MOTHERING

EARLY INFANT STIMULATION

by Mary Ann Ruffing

OOING at baby is not just a pleasurable pastime, it is part C of the infant’s education. In satisfying needs and cultivat- ing potential, the mother is a principal link between the infant and the outside world. She is the primary humanizing bridge of continuity between intrauterine and extrauterine existence. Mothering activities become a mode of communication be- tween mother and child, with the mother encouraging the in- fant to respond according to developmental potential. Hence, infant stimulation as well as those activities which encourage optimum responsiveness in areas of infant potential, must be regarded as vital aspects of mothering.

There is abundant evidence to support the timeliness and

NURSING FORUM 69

benefit of infant stimulation at critical periods during early development. The nurse who educates mothers about their im- portance in the developmental progress of young infants can help to enhance early mother-infant interaction.

Response, reinforcement, and encouragement of infant be- havior by the mother all serve to stimulate developmental prog- ress, state Yarrow and Goodwin (1965), noting that efforts to “buffer, enhance, and organize stimuli . . . [according to the infant’s] capacities and individual characteristics” provide a matrix for subsequent social and emotional development.

Once aware of the part she plays in promoting infant prog- ress and of the newborn’s potential, the mother can derive both pleasure and accomplishment from her activities. She can grow increasingly adept at recognizing signs of attentiveness and re- sponsiveness to the stimuli she provides. Moreover, she can aim to increase her influence through valid interpretation of infant behavior and through an effort to coordinate her inter- ventions with the appropriate infant activity.

Because maternal behavior has such an impact on infant responsiveness, early efforts to coordinate mothering activity with infant exploration should be a priority in the health main- tenance of developing families. The following guidelines for nursing practice can promote synchrony in mother-infant in- teractions as well as optimal infant stimulation.

1. Assist the mother in gaining early confidence in her ability to respond effectively to the infant’s crying signals during the first weeks of life.

When crying is the infant’s sole means of communication the sensitivity and promptness with which the mother responds, as

70 VOLUMEXVIII NO.l 1979

well as her ability to soothe the infant, form the foundation for socio-emotional development.

Since young infants experience rapid changes over relatively brief periods of time, mothers may find it challenging to dis- cover effective soothing measures. Rhythmic and monotonous forms of stimulation such as rocking, swaddling, and redundant sound, have all proven useful in reducing young infants’ levels of arousal and promoting relatively quiescent states, according to VandenDaele (1971) and Brackbill (1973).

Such experiences reinforce the infant’s evolving awareness of the close relationship with mother. In addition, Bell and Ainsworth ( 1972) point out, effective soothing frees the infant to respond to other stimuli in the environment, encouraging other modes of communication. Moreover, developmental milestones usually emerge when the infant exhibits an optimal- ly responsive state of alert inactivity, state Schaffer and Emer- son (1968).

2. Explain early infant learning as the discovery of connec- tions, relationships, and other contingencies between self and repeated occurrences.

The first three months of extrauterine life have been charac- terized by Watson and Ramey (1972) as a period of depriva- tion for the infant since “the combination of his short memory and the long recovery periods of his . . . motor . . . responses . . . prohibit his becoming aware of otherwise manageable con- tingencies in his world.” Accordingly, interaction between mother and infant becomes an ongoing medium for purposeful sensory stimulation and human mutuality.

Sights, sounds, smells, as well as bodily sensations of motion,

NURSING FORUM 71

position, temperature, and pressure all constitute important opportunities to learn for the infant, whose emotional, social, and cognitive potential develops through sensory experience. Even as newborns, normal infants show increasing proficiency at perceptual discrimination, responding to visual, auditory, and olfactory changes in the immediate environment. Green- berg and O’Donnell (1972) have found infants enjoy variety, preferring novel sources of stimulation as well as stimuli of an ever-increasing level of “intermediate” complexity.

The repetitive nature of much infant caretaking and mother- ing allows the infant’s perceptual awareness of the mother to become well ingrained. Infants whose perceptual consciousness of the mother has been duly reinforced during the first six months of life demonstrate high degrees of social responsive- ness, note Brody and Axelrad (1971). For the infant, the mother is a facilitator of early learning, as well as the consist- ent, unifying center of experience, serving to integrate sepa- rate systems of sensory experience about a single object, and advancing infant memory and other “synthetic processes of mental functioning,” according to Call ( 1968). Mothering provides an essentially human and non-mechanistic milieu for infant learning, because the mother not only shapes but partic- ipates in the infant’s world.

3 . Call attention to those behaviors which attest to the infant’s developmental responsiveness.

Signs of perceptual attentiveness should be observed and encouraged long before significant marks of motor progress emerge, such as rolling over and sitting up alone. One such sign is the orienting response (comparable to a “taking-in” mech-

72 VOLUMEXVll l NO.1 1979

anism) developed during the first months of life. Common orienting behaviors include visual fixation, suppressed limb activity, and pupil dilatation. (Rewey, 1973) Pupil dilatation can also be viewed as an index of the affective value of the visual stimulus, becoming larger from the age of four weeks in the presence of a human object, and providing evidence of the infant’s early ability to discriminate social forms of stimuli. (Fitzgerald, 1968) After sucking, the visual system is the earli- est motor system over which the infant gains substantial vol- untary control, Stern (1971) notes. While all gazing activity is notable during the first months, from the first weeks of life infants pay more attention to and prefer human faces to other visual images. Accordingly, a cardinal sign of early develop- mental progress is the infant’s gazing at mother and other objects.

4. Differentiate contact stimulation and representative be- haviors in terms of intrauterine origins.

All modes of sensory stimulation can be classified as either contact or social stimulation. Differentiation can be based on sensory experiences available during prenatal life. Pressure and touch sensitivity, for example, are present several months be- fore birth, Spears and Hohle (1967: l l 3 ) contend. In view of the capacity for prenatal association of the fetus, extrauterine adaptation might be eased by affording the infant continuity of experience through those sensory mechanisms which pro- vide prenatal stimulation, Montague (1971 :57) suggests.

According to Call ( 1968), rooting and hand-mouth activity, for example, are two highly-organized newborn behaviors with intrauterine origins. Rooting behavior, incorporating head-

NURSING FORUM 73

orienting movements with the sucking reflex, is readily trig- gered by tactile stimulation near the mouth. Its obvious sur- vival value is as a prerequisite to adequate nipple attachment during feeding. Hand-mouth activity is a neurophysiologic re- sponse occurring whenever the newborn is placed in a feeding position. Through additional early experiences, the infant learns to put its hand to the mouth in anticipation of feeding. Similarly, all objects are grasped and then brought to the mouth for appraisal.

Contact stimulation triggers both rooting and hand-mouth behavior in the newborn. Touching and other contact afforded by the mother during feeding, bathing, and grooming activities have physiologic and psychologic benefits as well as affording a variety of stimulation: vestibular, skin contact, support, ther- mal, and kinesthetic. Moreover, holding provides the infant with opportunities to initiate and reciprocate head and other body movements with the mother. Furthermore, stimulation of the rooting response promotes the infant’s ability to synchro- nize with the mother’s insertion of the feeding nipple, Call adds.

5 . Emphasize the skills necessary to develop social stimulation during the first two months of life.

In contrast to the proximity and intrauterine origin of con- tact modes of stimulation, vision and hearing are concerned with relatively remote events in the external environment. The first six weeks of life mark a critical socialization period during which elementary forms of social approach and withdrawal are learned through the use of visual and auditory skills.

Visual attentiveness to objects grows rapidly, hastening the development of visual coordination and object discrimination.

74 VOLUMEXVIII N0.I I979

Shortly after learning to fixate and follow objects, the infant is able to make sustained eye contact with the mother. The infant also acquires the ability to terminate eye contact successfully through gaze aversion, a subtle yet vital skill in human rela- tions. As early as the second week of life, the infant is known to practice gaze aversion, or the turning of the head away from an object, Stern (1971) reports.

6. Encourage mutual eye contact between mother and infant.

Over the first three months of life, as the amount of eye-to- eye contact increases, more complex social responses such as smiling and vocalization emerge from the infant within the context of mutual regard, as reported in Moss and Robson (1968), and Robson (1967). Significantly, both smiling and gaze fixation have been shown to occur most when infant and mother are in an en face configuration/orientation to one an- other, that is, with their eyes meeting fully and in the same vertical plane of rotation at a 0 degree angle, Robson notes.

7. Reinforce all infant efforts to vocalize.

At six weeks, eye-to-eye contact and the facing position are the chief evidence of attachment between mother and infant. Soon to emerge, along with infant smiling, are infant vocaliza- tion efforts. As with visual behavior, infants appear to prefer and respond innately to human auditory stimulation. The new- born auditory system is geared to the lower frequencies of bio- logically meaningful sound such as language and the human voice, Lenard (1969) reports.

As well as localizing sound sources and preferring human vocalization, infants are capable of structuring acoustic in-

NURSING FORUM 75

formation into linguistically-relevant patterns. Human infants exhibit an early ability to discriminate language intonations and speech segments such as consonants and vowels (Morse, 1972), an ability reminiscent of early visual fixation behavior. As a result, speech and the human voice are highly desirable and effective forms of auditory stimulation to facilitate the development of language skills throughout the first year of life.

8. Encourage regular periods of affectionate play at times when the infant is optimally alert and responsive.

The need for early maternal-infant interaction that is exclu- sively social in nature warrants special emphasis. Most care- taking situations occur with mother and infant at a forty-five degree angle of facial orientation. The en face orientation/ configuration, the prerequisite of eye-to-eye contact and other reciprocal mother-infant activities, has been shown to be unique to mutual action of an essentially affectionate, non- caretaking, and playful nature, Robson states. Accordingly, there is a compelling need for mothers to initiate physical con- tact with their infants in situations other than those of a simple caretaking nature.

For many infants, the time of optimal alertness and respon- siveness may follow a daytime feeding session. During these periods, reciprocal eye contact between infant and mother is the key interaction around which the mother may incorporate other kinds of stimulation. For example, she might pick up and closely hold the infant, encourage visual following and smiling, and talk to the infant or repeat any sounds made. The goal is to establish a dynamic pattern of mutuality. In addition to pro- viding rhythm, repetition, and reinforcement, the mother

76 VOLUMEXVIII NO.1 1979

should evaluate whether progressive, new day-to-day experi- ences keep pace with the infant’s development.

9. Promote awareness of infant ability by others.

Young infants operate at much higher levels of alertness, responsiveness, and acquisitiveness than is generally realized. Evidence of the newborn’s active engagement with surround- ings, including attentiveness to humans, can be a persuasive means of prolonging and deepening the involvement of others. Since the infant learns, develops memory, and cultivates per- sonality through experiencing bodily sensation, there is virtual- ly no event which does not have an impact. Moreover, deliber- ate and purposeful stimulation is valuable to the infant during the first three months of life as a preventive against deprivation.

Although the cumulative effects of early stimulation have yet to be firmly established, experiments continue to demon- strate the infant’s considerable range of responsiveness and discrimination. The mother-infant relationship affords the best opportunity for infant stimulation during the first months of life. Use of the guidelines presented here will help nurses in maternal-child, family, and community practices to inte- grate infant stimulation into the context of early mother-infant interaction.

REFERENCES

Bell, S. M. and Ainsworth, M.D., “Infant Crying and Maternal Responsiveness,” Child Development, XLIII ( 1972) pp. 1171- 1 190.

Brackbill, Y . , “Continuous Stimulation Reduces Arousal Level: Stability of Effect Over Time,” Child Development, XLIV (1973) pp. 43-46. -

NURSING FORUM 77

Brody, S. and Axelrad, S., “Maternal Stimulation and Social Re- sponsiveness of Infants,” The Origins of Human Social Rela- tions, (ed. by H. R. Schaffer) New York: Academic Press,

Call, J. D., “Lap and Finger Play in Infancy, Implications for Ego Development,” International Journal of Psychoanalysis, XLIX

Fitzgerald, H. E., “Autonomic Pupillary Reflex Activity During Early Infancy and Its Relation to Social and Nonsocial Visual Stimuli,” Journal of Experimental Child Psychology, VI (1968)

Greenberg, D. J. and O’Donnell, W. J., “Infancy and the Optimal Level of Stimulation,” Child Development, XLIII (1972) pp.

Lenard, H. G., et al., “Acoustic Evoked Responses in Newborn In- fants: The Influence of Pitch and Complexity of the Stimulus,” Electroencephalography and Clinical Neurophysiology, XXVII

Montague, A., Touching, New York: Harper and Row Publishers, 1971, p. 57.

Morse, P. A., “The Discrimination of Speech and Nonspeech Stimuli in Early Infancy,” Journal of Experimental Child Psy-

Moss, H. A. and Robson, K. S., “Maternal Influences in Early Social Visual Behavior,” Child Development, XXXIX ( 1968)

1971, pp. 195-215.

(1968) pp. 375-378.

pp. 470-482.

639-645.

(1969) pp. 121-127.

chology, XIV (1972) pp. 477-492.

pp. 401-408.

78 VOLUMEXVll l NO.1 1979

Rewey, H. H., “Developmental Change in Infant Heart Rate Re- sponse During Sleeping and Waking States,” Developmental

Robson, K. S., “The Role of Eye-to-Eye Contact in Maternal-In- fant Attachment,” Journal of Child Psychology and Psychiatry and Allied Disciplines, VIII ( 1967) pp. 13-25.

Schaffer, H. R. and Emerson, P. E., “The Effects of Experimental- ly Administered Stimulation on Developmental Quotients of Patients,” British Journal of Social and Clinical Psychology,

Spears, W. C. and Hohle, R. H., “Sensory and Perceptual Processes in Infants,” Infancy and Early Childhood (ed. by Yvonne Brackbill) New York: The Free Press, 1967, p. 113.

Stern, D. N., “A Micro-Analysis of Mother-Infant Interaction: Behavior Regulating Social Contact Between a Mother and Her 3% Month-Old Twins,” Journal of the American Acad- emy of Child Psychiatry, X (1971) pp. 501-517.

VandenDaele, L. D., “Infant Reactivity of Redundant Propriocep- tive and Auditory Stimulation: A Twin Study,” Journal of

Watson, J. S. and Ramey, C. T., “Reactions to Response-Contin- gent Stimulation in Early Infancy,” Merrill-Palmer Quarterly,

Yarrow, L. J . and Goodwin, M. S., “Some Conceptual Issues in the Study of Mother-Infant Interaction,” American Journal of Orthopsychiatry, XXV (1965) pp. 473-481.

Psychology, VIII (1973) PP. 35-41.

VII (1968) pp. 61-67.

Psychology, LXXVIII (1 97 1 ) pp. 269-276.

XVIII ( 1972) pp. 2 19-227.

NURSING FORUM 79