EYFS Best Practice - All about…touch

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Touch is important for all of us, at every age, but our experience of touch in our earliest years has huge implications for our brain development, as well as our general health and well-being.

Human skin has evolved over millions of years into this profoundly complex organ (the largest in the body) that works in harmony with our central nervous system to not only protect what is inside us, but also to receive and transmit messages directly to the brain in response to the world around us.

Just as importantly, the brain and the nervous system need the stimulation that comes through our skin to actually be able to grow and develop. ‘Research has shown that touch is an important aspect of allowing as well as promoting normal growth and development in both animals and human infants’ (Greydanus and Merrick 2014).

SKIN-TO-SKIN CONTACT

Its vital significance in normal development has become recognised as an important feature of the first hours after birth, ideally with the baby lying naked (or just wearing a nappy) on the mother’s skin, ready to breastfeed. It is valuable for several reasons:

The mother’s skin helps the baby maintain a good body temperature, neither too hot nor too cold.

The autonomic system (ANS) of the baby and the mother co-ordinate during skin-to-skin contact. The ANS is the part of the nervous system that controls how our internal organs work, without us consciously directing them – for example, breathing, heartbeat and digestion. The baby’s system begins to self-regulate in co-ordination with the mother’s, helping to stabilise and set healthy metabolic levels for blood pressure, temperature, heart rate, etc.

Oxytocin is released in both the mother and the baby in response to skin-to-skin contact. This helps with breastfeeding but also has the effect on the mother of reducing the ‘fear’ centres in her brain, enabling her to become fearless in protecting her baby, and also to relax and enjoy ‘falling in love’ with her newborn.

‘The basic biological needs for warmth, nutrition and protection are thus provided from the very beginning. This early bonding fires security in the baby and instinctive protection behaviour in the mother, and sets the mother-baby pair on a course of healthy development and secure relationships’ (Bergman 2011).

What’s more, it isn’t just the baby and the mother who benefit from the profound benefits of touching skin-to-skin. Fathers, partners and other family members can experience the physical and emotional pleasure of connecting with a baby in this way, building strong secondary attachments and a nurturing relationship with the child. This becomes particularly important if, for whatever reason, there are limited opportunities for the mother to connect in this way.

KANGAROO CARE

An increased understanding of the importance of touch in the earliest weeks and months of a child’s life has led to a change in the way premature babies, in particular, are cared for in hospital. Originally these babies were touched as little as possible in their incubators aside from the essential medical procedures, as it was recognised that this kind of touch caused the babies stress and pain. But eventually it was also recognised that these babies (and their parents) were missing out on vital bonding and attachment experiences by not being held close and in skin contact.

‘Kangaroo care’ is now the norm in many neonatal units, where premature babies spend regular periods of time resting on parents’ chests or snuggled inside their clothes, with everyone benefiting from the physical and emotional connection.

Full-term babies can also derive just as much benefit from this kind of close proximity, and using slings to carry babies around (‘babywearing’) is becoming increasingly popular. (See the NCT guide to babywearing to be sure of using a sling safely). Local sling libraries can provide support and guidance in hiring or buying the safest type of sling or baby carrier.

LOVING TOUCH BUILDS…

attachment and self-regulation

Ideally, a baby will continue to receive warm, loving touch from familiar people throughout their childhood. Being picked up and held when distressed or while being fed provides reassuring experiences that reduce stress and invoke pleasurable feelings and a sense of safety.

Affectionate cuddles, strokes and squeezes should be part of regular care routines such as washing or changing. This reinforces a sense of being loved and cared about, as well as being cared for. Gentle strokes can soothe and promote sleep, while tickles, hugs and raspberries on the tummy provide physical and emotional stimulation, inviting the child to engage in playful connection.

All this tactile experience plays an important part in the attachment cycle. When a child has a need (for example, through hunger, tiredness, distress or anxiety) and familiar carers meet those needs with consistency and affection, the baby begins to trust they are safe and in good care.

As the child builds trust in others, they also build trust in themselves, knowing that they are safe and loved even if their carers aren’t available or able to respond immediately. From being regulated by their carers, they begin to learn how to regulate themselves, and in the process they may use touch to self-soothe – for example, sucking their thumb, or clutching a comfort blanket or soft toy.

attunement

The more a baby is affectionately and confidently held by their constant, familiar attachment figures, the greater the intimacy that develops between the baby and their carers. With this intimacy comes an increased ability on the part of the carers to be able to tune into the baby’s body language.

Apart from crying and contented gurgling, a young baby communicates many of their needs through bodily movement – for example, squirming and wriggling, kicking legs and feet, and reaching out with arms and hands.

Parents and carers who are frequently in close physical contact with their babies soon learn to read the subtle individual signs babies provide, to help them better understand what’s wrong and what they need. This physical attunement also enables the adults to know and appreciate not just the child’s emotional state, but also their level of physical and motor development.

This in turn helps them provide the appropriate level of risk and challenge for the developing infant – knowing when to help them with a task so as to avoid frustration or injury (for example, a baby reaching out for something; an older child climbing a tree) and when to step back and allow the child the opportunity to persevere and succeed (and sometimes fail) for themselves.

This level of physical attunement is particularly important in providing adults with the confidence to know when to allow children the opportunity to challenge themselves – essential in enabling children to ultimately self-manage risk efficiently.

a sense of self and bodily awareness

Research also shows loving or ‘affective’ touch is important in helping us develop our sense of self and bodily awareness (Crucianelli et al2013).

A child’s physical sense of themselves as a body that starts and finishes – and is separate from others – develops gradually through the experience of touch and movement. Research on adults has shown that slow and gentle touch can enhance feelings of body ownership and agency (being in control).

Although this sounds like common sense, it is an important precursor to future research exploring whether an absence of affective touch in early life might have links with later ‘abnormalities in the formation of a healthy body image and a healthy sense of self’ (Fotopoulou and Jenkinson 2014). Margot Sunderland suggests that, ‘From touch-starved childhoods, people can grow up with troubled bodies’ (Sunderland 2006).

PHYSICAL CONTACT

Rough and tumble

Also linked with a child’s developing sense of proprioception (internal ‘body maps’) is having the opportunity for lots of rough and tumble play. This is sometimes referred to as ‘cub’ play because of the way it resembles animal cubs play fighting as they develop their physical and social skills. It could equally perhaps be called ‘worm play’, as research has shown that worms need to wriggle and writhe together to grow healthily (Ardiel and Rankin 2010).

Baby massage

In addition to all the incidental positive tactile experiences of a young child’s day, we have also become more aware of the benefits of regular systematic massage for babies and children. Western society seemed to forget this over the years, whereas many other cultures have always routinely massaged their babies.

As well as providing the obvious benefit of promoting and reinforcing attachment, it can also reduce emotional distress and relieve symptoms of colic, etc (IAIM 2011).

LACK OF TOUCH

If affectionate, nurturing touch is important in supporting attachment, parental attunement, positive body image and self-regulation, then a lack of it is likely to have a detrimental effect on the development of all these important aspects of a healthy life.

At the extreme end of the spectrum, we know that children institutionalised in orphanages with little affectionate sensory stimulation showed impaired growth and cognitive development, as well as a high incidence of infection and attachment disorders (Ardiel and Rankin 2010). But research also suggests that a lack of loving touch in early childhood can be linked to both mild and serious social and emotional difficulties, as well as adult depression (Takeuchi et al 2010).

However, it is very important to remember that there may be many reasons why parents may not be able to provide the levels of affectionate touch required for healthy development. These include issues that affect the well-being of the parents themselves, such as:

• poor mental or physical health
• high stress levels
• post-natal depression
• anxiety
• lack of support
• their own lack of positive touchexperiences in early childhood.

It is important to note that these challenges can affect parents across all walks of life and socio-economic status – and even without the added challenges of disadvantage and poverty, anxious parents can easily become over-reliant on strict parenting routines and regimens that emphasise ‘training’ rather than responsive touch and attunement to the needs of the individual child.

Tactile issues

Adults who aren’t successfully ‘tuned into’ the infants in their care can find it difficult to regulate the amount of stimulation they provide. As a result, children can experience levels of touch that are over-stimulating, and may then have difficulty self-regulating their own physical interactions with others. They may play roughly with toys and things around them and not know how to be gentle.

Similarly, children with poorly developed proprioception may play or give affection roughly, finding it hard to judge their strength and moderate their physicality in relation to others. Other children may find light, gentle touch irritating or become easily distressed by tickling, especially if they don’t feel they have any control over the experience.

Some children may avoid physical interactions altogether and evade or actively resist cuddles and hugs. Touch sensitivity can also present as a resistance to tactile experiences – for example, sand and water, finger-painting or other ‘messy’ activities. This is also sometimes referred to as ‘tactile defensiveness’ and can be associated with dyspraxia, autistic spectrum and sensory integration disorders. It is very important to note that not all tactile issues stem from a lack of caring touch in early childhood, and practitioners should always seek advice and guidance if they are concerned.

HEALTH AND SAFETY

It would be impossible to talk about touch in the early years and not make reference to ‘health and safety’. There are very sound reasons why safeguarding children should involve a professional understanding of the ways in which touch should be used appropriately in care and education settings. However, heightened anxiety and fear of litigation has led to individuals and organisations becoming so overly anxious about safeguarding themselves as well as children that we are now in serious danger of creating a touch-deprived society. This cannot be allowed to happen in early years and school environments.

If we believe that affectionate touch is essential to healthy growth and development, then we must also be clear that ‘Withholding appropriate physical touch and comforting would be as abusive as imposing inappropriate touch’ (Elfer, Goldschmied and Selleck 2012).

This is important for all children, but for those for whom caring touch is lacking at home (for whatever reason), it becomes doubly important that we continue to be clear about how and why sharing affectionate touch is essential in both our schools and settings.

IMPLICATIONS FOR PRACTICE

Pick me up!

Sometimes, babies and young children just need physical contact to soothe them in the way that nothing else will do. The body-to-body contact can release stress-relieving hormones that reduce feelings of anxiety or perceived threat. Remember, little things can seem intolerable to babies and young children, because they can’t rationalise their fear or self-regulate their anxiety. They need us to ‘co-regulate’ with them, time after time, until they are eventually able to do it for themselves, and warm, affectionate physical contact is the quickest way to soothe anxious little bodies.

There’s always time for cuddles

At any age, the benefits of a bear hug, an arm squeeze or a quick cuddle cannot be denied – for both the hugger and the hugged. The physical contact of a cuddle triggers ‘feel-good’ chemicals (opiods and oxytocin) to flood the brain and make you feel good, and help to relieve stress or discomfort.

The more a child is used to having hugs and cuddles, the more likely they are to continue to give and want to receive them long after babyhood. Though things may shift for a while during adolescence, a young adult who has grown up comfortable with physical contact is more likely to have a positive sense of their body.

Keep calm and get in touch

Sometimes just the close physical presence of a calm, understanding adult can make a world of difference to a stressed-out child. Words aren’t always needed, but sitting side by side, on a lap or snuggled together on a sofa, can induce a state of calm and allow the feel-good chemicals back into the brain.

Sometimes children will stay by their key person, needing the close proximity to feel safe, but as they grow in confidence they will head off to explore further, just returning back every once in a while to touch base. Often this might involve just leaning next to you while you do something else until they are ready to go off again. Remember, this kind of physical connection reinforces relationships and attachment and is hugely important for a child’s well-being – and their readiness to learn and flourish.

MORE INFORMATION

Bergman J (2011) ‘Skin-to-Skin Contact’, http://breastfeedingtoday-llli.org/skin-to-skin-contact

Greydanus DE and Merrick J (2014) ‘Newborn Care: What We Can Learn from the Kangaroo Mother’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4109615

Ardiel E and Rankin CH (2010) ‘The Importance of Touch in Development’, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865952

Babywearing: A Guide by NCT, http://bit.ly/2fUBnBV

Fotopoulou AK and Jenkinson P (2014) ‘Affective Touch by Others Determines how we Perceive our Own Body’, www.bodyinmind.org/touch-and-how-we-perceive-our-body

Crucianelli L et al (2013) ‘Bodily pleasure matters: velocity of touch modulates body ownership during the rubber hand illusion.’ Frontiers in Psychology, 4 (703)

IAIM (2011)’The benefits of baby massage’, www.iaimbabymassage.co.uk/baby-massage-benefits.html

Takeuchi MS et al(2010) ‘The Effect of Interpersonal Touch During Childhood on Adult Attachment and Depression: A Neglected Area of Family and Developmental Psychology?’ Journal of Child and Family Studies, 19 (1)

Elfer P, Goldschmied E and Selleck DY (2012) Key Persons in the Early Years. Routledge

Sunderland M (2006) The Science of Parenting. Dorling Kindersley

O’Connor A and Daly A (2016) Understanding Physical Development in the Early Years: Linking bodies and minds. Routledge

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