Presentation Title: (Jan 26th, 2010)
Skin-to-Skin Contact as the Defining Developmental Environment :
A Model to Guide Practice Change
(NILS BERGMAN, MD MPH PHD)
nils@kangaroomothercare.com
“At the conclusion of this activity, the participant should be able to…” (Please list up to 3 learning
objectives)
1
Apply “evolutionary biology” concepts and principles to newborn care.
2
Identify and reduce “toxic stress” responses in preterms and newborns.
3
Use model to ensure parental presence in NICU is maximized.
________________________________________________________________________________
Mental model : “Explanation of someone’s thought process about how something works in the real
world …. Helps shape our behaviour and define our approach to solving problems”
HEIDELISE ALS - original model Synactive organization of behavioral development.(1;2)
Gibbins, HOATH - later model
The Universe of Developmental Care: A New Conceptual Model for Application
in the Neonatal Intensive Care Unit (3)
Jack SHONKOFF - Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy (4)
“mental models are deeply held images of thinking and acting … so basic to our understanding of the world that we
are hardly conscious of them” (5)
ASSUMPTIONS: ( “based on a small set of fundamental assumptions” )
Explicit statements
Conscious assessment
Testable, verifiable
!!
You Agree??
ASSUMPTIONS ON SAFE ENVIRONMENT:
References
1
“Habitat – niche”  place determine behaviors that ensure basic needs.
(6)
2
In the right habitat, developing organism behaves competently.
(6)
3
Maternal-infant skin-to-skin contact ( SSC ) is the right habitat.
(7)
4
SSC is the habitat (= place) where basic biological needs are provided.
(6;7)
5
Maternal-infant skin-to-skin contact is a SAFE ENVIRONMENT.
(8-10)
6
Many species: mother’s body is the ONLY SAFE environment.
(11;12)
1 2 3 4 5
ASSUMPTIONS ON UNSAFE ENVIRONMENT:
7
Maternal absence is perceived as an UNSAFE environment.
(13;14)
8
Maternal-infant separation is a severe form of stress.
(15-17)
9
Unsafe environment activates HPA axis (autonomic nervous system, ANS).
(18)
10 Early stress alters gene expression, with health impact across lifespan.
(18)
11 Epigenetic processes operate in the human fetus.
(19;20)
12 Epigenetic processes operate throughout development.
(21)
13 When RESILIENCE is exceeded, genome ADAPTATION follows.
(22-24)
14 With reference to ideal environment, the gene change is MALADAPTIVE.
(22-24)
15 The parasympathetic system also responds to threat and stress.
(8;25)
1
16 The ANS of a preterm or neonate differs from that of adults.
(25)
17 The primary defense of a preterm or neonate is immobilization
(25-27)
18 Threat response sequence: vigilance  freeze  dissociation
(25;28)
19 Children are not “small immature adults”
(25;28)
20 Newborns and infants are sensitive, and must still develop resilience.
(25;28)
21 Sympathetic and parasympathetic hyper-activation harms the brain.
(26;27)
22 Early toxic stress leads to neurological (mal)adaptation.
(29)
23 Early adverse experience profoundly impacts resilience and development.
(27;29)
24 Mother-Infant Interaction is the primary development determinant
(30)
PRELIMINARY CONCEPT: “PLACE MODEL”
ASSUMPTIONS ON THE SKIN-TO-SKIN CONTACT ENVIRONMENT
25 The basic behavior choice depends on “Am I Safe?” (neuroception)
(25;31)
26 SSC from birth STABILIZES, even low birth weight neonates.
(31)
27 SEPARATION at birth leads to DYS-REGULATION in preterms.
(31)
28 Skin-to-skin contact  amygdala  “frontal” PFOC  APPROACH .
(26;32;33)
29 SSC in neonates activates approach, separation leads to avoid orientation
(34-36)
30 Separated neonates experience disturbances of sleep cycling.
(37-40)
31 Separation causes ANS response patterns consistent with threat.
Bergman
ASSUMPTIONS ON DEVELOPMENTAL ENVIRONMENT
32 SSC promotes better sleep, brain maturation and neuro-protection.
(41;42)
33 Newborns have all their senses developed, open and receptive.
(Lind)
34 Maternal sensory environment “fires and wires” brain development.
(15;43-46)
35 Skin-to-skin contact activate “safe” maternal-infant ANS exchanges
(26;43;44)
36 Skin-to-skin is the foundation for physiological REGULATION.
(26;43;44)
37 Skin-to-skin contact signals “emotional safety”  brain develops.
(26)
38 SSC  SAFE  ANS exchanges  communication  ATTACHMENT.
(47;48)
39 Skin-to-skin contact INITIATES dual coding physical & mental health
(47)
40 Infants need the “buffering protection of adult support”.
(49)
41 “Relationships are the active ingredients of early experience.”
(49)
42 Critical “needed neural processes” are wired from birth & onwards.
(48;50-55)
43 SSC fired “needed neural processes” operate in the maternal brain also.
(48;5254;56;57)
(30)
44 Neurodevelopment requires the presence of mother (or parent).
DEVELOPMENTAL ENVIRONMENTS MODEL
IMPLICATIONS
(4)
Comment: references as above may not state the assumption formulated, but have been used to derive it.
2
“Approach to solving problems:
3. Uncompromising Mother’s (parental) presence is ABSOLUTE requirement.
4. Threatening Maternal-infant separation is primary cause of HARM.
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