Babies need extreme comfort to overcome the damaging effects of stress

Affection and attention are crucial for infants — they help the brain develop chemicals that protect against stress

Published April 16, 2017 5:00PM (EDT)


Excerpted from “Born Anxious: The Lifelong Impact of Early Life Adversity and How to Break the Cycle.” by Daniel Keating (St. Martin’s Press 2017). Reprinted with permission from St. Martin's Press. 

When a baby signals that something is amiss, it matters if the need is met fairly promptly, at least most of the time. This doesn’t mean being at the infant’s beck and call at every moment of the day or night, but it does mean that distress should lead to soothing in a reasonably predictable way for the baby. Why is it significant that a baby’s needs be met when he lets you know he’s unhappy? After all, if feeding, changing, and soothing are happening—regardless of whether this is happening at just the moment the baby is demanding it—shouldn’t that be nurturing enough?

No, actually. Think of it this way: Something doesn’t feel quite right to the baby, and so the stress system kicks in to signal that something is wrong. “I’m hungry,” “I’m wet,” “I’m lonely,” or some other discomfort. Getting that need met in a timely fashion tells the baby that the world—or, at least, the baby’s world—is predictable, reliable, and worth feeling good about. As that sense of faithfully being cared for—let’s call it trust—starts to become internalized, the tolerance for delay increases gradually: “Mom or Dad will be here soon.” This is not yet a self-aware process, of course, but it does establish the early neural links from stress to solution—and, over time, to self-soothing. More specifically, it turns off the stress signal, helping to establish the feedback loop that will be needed for later self-regulation—and to keep the stress response system in check.

Let’s consider what happens when these signs of predictable nurturance are not present. Simulating circumstances in which a baby’s needs are not met in scientific experiments are limited for ethical reasons, thankfully, but one technique that is often used in research focuses on the absence of social warmth with “the still-face paradigm.” With this, the parent looks at a baby for a short period of time with no emotional expression at all. (When this is too difficult or upsetting for the parent, an experimenter presents a blank expression.) At first, most babies are a bit puzzled, but soon they begin to present their best, most adorable bids for emotional connection—smiling, laughing, gazing expectantly— all to no avail. Pretty soon, they become quite flummoxed, often launching into a full-bore cry. And what else happens? Their HPA axis kicks in, sharply raising their cortisol levels. Experiencing this pattern repeatedly can then lead to the methylation of the stress gene. It is the repetition of affectionate responsiveness—or its absence—that matters, rather than one-off events. If, at times, a mother or father or other caretaker simply can’t respond right away, it’s unlikely this will lead to methylation and its later problems. It is the constancy of this kind of behavior that is meaningful, the steady drip of everyday life.

And yet there are a number of understandable reasons for an absence of emotional warmth and responsiveness from parents. If the parent is suffering from serious depression—whether postpartum or chronic—the baby will sense that his caretaker is unavailable, and the stress system will be alerted. Well- intentioned interventions, like sleep training (“cry it out”) have been shown to have, for young infants, the unintended consequence of increased cortisol release, with potential long-term effects. (One of the leading proponents, Richard Ferber, has subsequently clarified that this is not a recommended method for young infants.) If Mom and Dad can only be present intermittently, with alternate caregivers who are not emotionally available, the baby will sense that something is amiss. This is why, under these kinds of circumstances, it is extremely valuable to seek out a person or a small group of people who can consistently provide a reliably warm and responsive setting and look after the infant if the parents or primary caregivers are emotionally or physically unavailable.

Affection and attentiveness are so crucial because they help to create the basis for the development of brain chemicals that are a major buffer against stress. The first of these is oxytocin, known less formally as the “love hormone” or the “trust hormone.” Few of us can resist a sentimental response when we see a picture of a mother with her baby in the crook of her arm, the two of them gazing into each other’s eyes. But what they are experiencing at that moment is even more extraordinary. There is a surge of oxytocin for both parent and child that will reach one of the all-time peak levels in a lifetime. An even higher level occurs for both mother and child during breast-feeding. The ability to invoke these potent emotions—and attendant physiology—during moments of bonding creates a strong protection against “stress-dysregulation” (SDR). It not only soothes and provides contentment but, amazingly, the oxytocin itself can mop up any cortisol that may be in the baby’s system. In essence, oxytocin can absorb—and dispel—excess amounts of the stress hormone that may still be coursing through the body.

Serotonin, another neurochemical that is central to positive social connections, can mitigate both anxiety and consequent acting-out behaviors. A well-functioning serotonergic system, as with oxytocin, counteracts SDR, limiting the triggers of cortisol activation from mild stressors. A child who is neglected by a parent in infancy—or who doesn’t feel attended to by a caregiver—is set on a course toward anxiety, depression, and mood disorders. Serotonin is a powerful antidote for these dis- orders, which is why medical treatment targets the serotonergic system. The widely used selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine), and others, for example, are designed to make more of an individual’s serotonin available to the key receptors in the brain, elevating mood and preventing a slide toward depression. But when offered enough affection and attention in the first year of life, a child’s natural production of serotonin is heightened—this, along with the release of oxytocin, makes for a strong defense against stress from the very start.

* * *

If the baby has developed SDR in utero, this can cause a considerable strain on the parent-child bond from the get-go. If you have cared for a baby like this, you know just how hard things can get. These infants’ needs will be greater because they are much more sensitive to any discomfort: they are just a little bit more out of sorts, more tired, more startled. As a result, the parent-on-call button gets pushed more often. To make things even harder, because these babies are born with their stress system already biologically embedded in the on position, they are more difficult to soothe. It’s natural that a parent with a child like this may get more than a little frustrated and pull away. No matter how hard they try, they end up feeling like ineffectual parents, because their baby doesn’t respond to their efforts at soothing. It’s hard to develop a sense of mastery when efforts to calm an infant don’t work.

For these parents, walking, rocking, feeding, swaddling, and holding close—nothing is guaranteed to settle the baby. And, even after settling or falling asleep, it doesn’t take much to get the baby going again. As I described earlier, warmth and closeness—and the oxytocin-serotonin cascade this can set off—offer a special kind of joy for both parent and baby. This is a natural evolutionary response; it is an essential reason why caring for a demanding newborn seems worth it. But what if that feeling is rare because the baby is so difficult to comfort, in large part because he’s just not comfortable in his own skin? Then it becomes more challenging to maintain the commitment to monitoring and responding in a timely way.

Parents of these children are dealing with hard-to-soothe kids, their own fragile emotional state, and feelings of failure that result from this. So it’s just the icing on the cake when they don’t get the support they need. Efforts to express their feelings of frustration and sadness are sometimes met with judgment: “Well, you signed up for this, so if it’s not as peachy as you thought it would be, tough—it’s still your job.” One of the things I hope will come out of understanding why these children are so hard to soothe is that parents will blame themselves less, seeking and hopefully receiving support rather than judgment. They will also be freed from the inclination to make harsh attributions about why their baby is acting this way.

Despite all of these challenges, despite feelings of irritation or incompetence, many parents simply refuse to take no for an answer from their babies, swaddling and bouncing and holding them close—defiantly whispering “shhh, shhh, shhh”—in a relentless effort to calm them down. This is the essence of supernurturing. And this is exactly the right instinct, even as it’s sometimes very hard. If this extreme comfort is provided early and consistently enough, it is just what these infants need to overcome their SDR.

By Daniel Keating

Daniel Keating is a professor of psychology at the University of Michigan. His research focuses on neurodevelopment, stress, and risk behavior. His most recent book is "Born Anxious: The Lifelong Impact of Early Life Adversity — and How to Break the Cycle."

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