Coauthored with Beatrice Beebe, PhD*
Expectant mothers are barraged by information on websites, and from friendly advice and books helping to prepare them for the upcoming experience of motherhood, hoping to get it right the first time-around. Would you be surprised to learn that your future child’s development may be predicted from what happens in the first 4 months of life? Research on mother-infant interaction in the first months of life has opened up a discussion of several recommendations that impact your child’s nervous system health, cognition, and security of attachment.
Delay Clamping of the Umbilical Cord? The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping varies among institutions and settings, and such decisions in those circumstances are best made by the team caring for the mother-infant dyad. However it purports to increase hemoglobin levels at birth and improve iron stores for the first several months of life, imparting a favorable effect on developmental outcomes and possibly preventing infantile intra-ventricular hemorrhages.
Breastfeed Your Infant. Despite success in meeting the Healthy People 2010 goal for 75% of new mothers to initiate breastfeeding at birth, the duration and exclusivity of breastfeeding remains below national goals. Expert pediatricians note that breast milk has evolved to provide the best nutrition, immune protection, and regulation of growth, development, and metabolism for the human infant. Breast milk is critical in compensating for developmental delays in immune function in the neonate, and is responsible for reducing the permeability of the intestine to prepare it for extra-uterine life. The favorable gut microbiome, which appears to be a function of the interaction between human milk’s microbiota, is endowed with important antimicrobial activity. Healthy infant microbiome promotes integrity of the intestinal barrier and competitively inhibits pathogen binding, preventing inflammatory responses that can contribute to later illnesses such as asthma and gastrointestinal disorders. Breastfeeding may also reinforce the expression of genes that affect fat metabolism and deposition, conferring a protection against obesity.
Be Aware of Face-to-Face Communication with Your Infant. Infants begin life as social creatures. By three- to four months of age, the infant’s social capacity flowers and infants become extraordinarily communicative. They have a nonverbal “language” of looking and looking away, facial and vocal expressions from positive to negative, and head movements which move the infant into vis-à-vis orientation to the partner or into head aversions. This infant nonverbal language is met by the mother’s similar nonverbal language of looking, facial and vocal expressions, spatial orientation (such as upright or forward), and touch, all of which accompany her verbal language to her infant. Moreover, infants are capable of coordinating their behaviors with the partner, so that mothers and infants both adjust their behaviors to those of the other: each influences the other. Thus, it is not just the parent’s response that organizes the infant’s experience. Although the parent has the greater range and flexibility and capacity, both infant and parent co-create patterns of interaction.
By this age, patterns of face-to-face interaction are becoming organized and expectable. These patterns set a trajectory for the quality of relatedness and intimacy over the lifetime. Thus the organization of intimate relating is at stake in these early interactions. Research has shown that just a few minutes of filmed mother-infant face-to-face interaction at four months predict infant patterns of secure and insecure attachment at one year. Infant attachment patterns are predicted from both the mother’s response to the infant, and the infant’s response to the mother. Remarkably, an infant’s attachment pattern at one year predicts peer relations, school performance, adjustment problems in childhood and adolescence, and secure and insecure attachment patterns in young adulthood. Although most of this research is based on infants interacting with mothers, this work is just as relevant to fathers.
What does a secure pattern of communication look like during face-to-face interaction at four months? Let’s take the example of looking and looking away. Mutual gaze is a critical foundation of the mother-infant face-to-face encounter. But looking into the face of a partner can be very stimulating. Infants manage this arousing stimulation by periodically looking away, which down-regulates their arousal. Thus looking away is a critical infant coping capacity. Most mothers intuitively understand this, and they tend to try to engage the infant during moments of infant looking, and they tend to ‘back off” when the infant looks away. This is the secure pattern: it is the infant who determines the moment of looking and looking away, and the mother can wait, tolerate moments when her infant looks away, and trust that her infant will “come back.” But it can be hard for mothers to tolerate these moments. If the mother worries that her infant is not interested in her, for example, she may pursue, ”chase” her infant by moving her head and body in the direction in which the infant just moved away, or she may even pull the infant’s arm or try to move the infant’s head back in her direction. This is the insecure pattern. Maternal chase behavior is counter-productive: the infant requires even more time to regulate arousal down sufficiently to return to looking at the mother. Thus maternal confidence in her own ability to engage her infant, and her confidence in her infant’s attachment to her, are critical in her ability to tolerate moments when her infant looks away. What does a secure pattern of communication look like during face-to-face interaction at four months? Let’s take the example of looking and looking away. Mutual gaze is a critical foundation of the mother-infant face-to-face encounter. But looking into the face of a partner can be very stimulating. Infants manage this arousing stimulation by periodically looking away, which down-regulates their arousal. Thus looking away is a critical infant coping capacity.
The mother and infant are both reading the other’s nonverbal language and sensing the other’s state, from moment-to-moment. The underlying neuronal mechanisms for this facial-visual exchange in the mother-infant dyad have yet to be clarified. However, clues to sensing the state of the other at the neuronal level may rest upon so-called mirror neurons. A useful analogy is the story of a researcher who began to lick an ice-cream cone while a monkey with electrodes implanted in the brain was watching. Surprisingly, neurons activated in the monkey’s prefrontal cortex reacted in the same fashion whether the monkey reached for the cone or observed the actions of the researcher reaching for the cone.
Thus the observation and execution of human actions are tightly linked. Infants rely not only on their own individual discoveries or extrinsic reward, but accelerate and amplify their knowledge of people, things and the causal effects of human action by observing the actions of others, and using this as a basis for self-action. The mother-infant bond is just the beginning of something very special that lasts a lifetime.
*Clinical Professor of Medical Psychology, Columbia University Medical Center and the New York State Psychiatric Institute, New York, NY. She is lead author of the book, The Mother-Infant Interaction Picture Book. Origins of Attachment, shown below.