Educating the Experts – Lesson Three: Touch

By Tracy G. Cassels

[To read this article in Hebrew, please click here thanks to Idan Melamed!]
[To read this article in Portuguese, please click here thanks to Andreia Mortensen!]

“Touch is ten times stronger than verbal or emotional contact, and it affects damned near everything we do.  No other sense can arouse you like touch… We forget that touch is not only basic to our species, but the key to it.”

- Dr. Tiffany Field

Imagine your child playing happily on the floor when someone knocks over a book and it hits him in the head and he starts crying in pain.  What do you do?  Or imagine your child playing in the living room when you quickly leave the room to get something.  During your absence, a large crash comes from somewhere else, but is loud enough to scare your child and she starts crying.  Then what do you?  What do you do if your child is sitting in your lap getting his immunizations and cries as the needles enter his legs?  What do you do if, the day after getting immunizations, your child goes to the doctor again and becomes terrified upon seeing the room or the doctor?  The vast majority of people will respond that they would immediate pick up their child and hold them to calm and comfort them because that is the instinctual response.  You see, touch is our primary way of offering comfort, not only to those who are non-verbal, but to anyone.  And because touch is such a primal form of communication, we have evolved to expect touch, and lots of it.  Sadly we seem to have hit a point in society in which all touch is being labeled as potentially negatively, and thus avoided, because of the very real and awful effects of unwanted touch. But even those unwanted experiences serve to highlight the very real effect touch has on our emotional well-being.  While unwanted touch holds the power to maim an individual’s well-being, wanted (and needed) touch has the power to heal.

In Lesson Two, we talked about the social, psychological, and emotional needs of infants and how they were as important to an infant thriving as their physical needs.  And what makes these needs so important is touch; it’s the comfort we provide our children and babies and it isn’t cognitive, visual, or even vocal—though they can play roles—it’s tactile.  In this lesson, I hope to outline for you the myriad ways in which touch affects our lives and why any advice that promotes a reduction in touch isn’t serving to help our children at all.

Touch As Communication

Does anyone remember the song ‘More Than Words’ by Extreme from the 90s?  Here are the lyrics to jog your memory…

Saying I love you

Is not the words I want to hear from you

It’s not that I want you

Not to say, but if you only knew

How easy it would be to show me how you feel

More than words is all you have to do to make it real

Then you wouldn’t have to say that you love me

Cos I’d already know

What would you do if my heart was torn in two

More than words to show you feel

That your love for me is real

What would you say if I took those words away

Then you couldn’t make things new

Just by saying I love you

More than words

Now I’ve tried to talk to you and make you understand

All you have to do is close your eyes

And just reach out your hands and touch me

Hold me close don’t ever let me go

More than words is all I ever needed you to show

Then you wouldn’t have to say that you love me

Cos I’d already know

What would you do if my heart was torn in two

More than words to show you feel

That your love for me is real

What would you say if I took those words away

Then you couldn’t make things new

Just by saying I love you

More than words

When this song came out, I remember being rather disgusted by it actually.  It was such the clichéd theme of ‘don’t tell me you love me, show me’ that us girls were all warned about in school.  And yet, here I am, fifteen years later, realizing what a beautiful and accurate sentiment lays in this song (even if it wasn’t intentional).  I want to focus on two lines for a moment: All you have to do is close your eyes/And just reach out your hands and touch me.  In a very real sense, that is exactly what our children expect in order to show them love, and while we do it to a degree with children, when was the last time you consciously used touch as a means to communicate with an adult?  We tell people we love them, yet too often we don’t show them, though it’s through touch that we often truly feel loved as words are rarely enough.  With one touch we can communicate an array of emotions—love, anger, indifference, jealousy, fear—and because of the nature of the tactile sense, we are able to pick up nuances that words simply don’t speak.  We are so focused on words as the means to express ourselves that we’ve long forgotten that touch is not only the oldest form of communication (and first to develop in utero), but as humans, our largest[1][2].  Our skin covers our entire body, and every square inch has nerves that can pass information on to the brain, meaning that we can get more information than from any other sense.

Let’s now think of this from an infant perspective.  At birth an infant can barely see and doesn’t understand language, but he can smell and most certainly can feel.  Thus, telling an infant you love them doesn’t convey very much information to the infant; if you spent hours a day talking to your child, confessing your love, but withholding touch, your infant would grow up nearly as damaged as those you read about in Lesson Two.  Indeed, one prominent psychologist and ethologist, Konrad Lorenz, theorized that along with the physical features that make infants so cute, making us adults want to care for them and ensuring their survival, an infant’s skin is soft and silky in order to facilitate lots of touch[3].

Why would an infant need that?  One of the main reasons is that touching babies helps to regulate them physiologically.  That is, that touch can serve to control arousal states (including alertness, drowsiness, heart rate, temperature)[4][5] and can also serve to calm them down which includes the reduction of cortisol and β-endorphins, hormones associated with stress responses[6].  It is worth noting that while we typically combine touch with other senses to calm an infant, research has shown that touch with vestibular changes without any talking results in calming of infants while talk alone does not [7].  But the communicative functions of touch extend beyond the physiological.  In a review, Matthew Hertenstein of UC Berkeley explains that touch can communicate a plethora of emotional information, including valenced emotions, positive emotions, negative emotions, and discrete emotions[8].  And this is not just about extreme acts; for example, when testing infants’ reactions to negative emotions, the type of touch used was simply static, nothing harsh or cruel[9].  Furthermore, other research has shown that depressed mothers interact in different ways with their infants, passing on information about their negative state, resulting in the infants also experiencing the negative emotions[10].

In short, for adults and particularly for infants, touch remains (one of) the most important senses we have and allows for the communication of not only physical states, but emotional as well.  For infants who lack the means of advanced forms of communication, like talking, it is essential that we understand how our touch, or lack thereof, is passing on key information to them on a regular basis.

Touch Can Save and Cost Lives

While I feel we’ve already gone over the cost in lives in Lesson Two, I’ll briefly summarize it here as well.  Our primary understanding of the effects of lack of touch on human infants stems from observations (and then interventions) into the plight of children in orphanages and institutional care where, until recently, the basic physical needs were met, but the emotional and psychological needs (predominantly based in touch) were excluded.  The effects on infants were catastrophic, with an approximate 90% infant mortality rate and severe behavioural and social problems in those that managed to survive[11][12].  Even later in life, adults who had been raised in these institutions showed deleterious effects including chronic illness and psychosocial dysfunction[13].  However, when things are this bleak, there is usually a silver lining, and in this case it is the fact that the opposite holds true—providing touch to those at risk can drastically improve their outcomes.

Many of us know the stories of preterm babies who have been given no chance to survive and are then put in their mother’s arms only to live[14].  To those of us who understand the importance of touch, these cases highlight what we already believe, but to a critic they are simply anomalies or even miracles.  Luckily for those of us believers, researchers have managed to experimentally examine the effect of touch on preterm and low birth weight infants by randomly assigning infants to either the standard care in hospitals or skin-to-skin contact with a caregiver (also called Kangaroo Care).  What has been found is that infants who receive Kangaroo Care had lower rates of infection[15], decrease pain for certain procedures[16], better exclusive breastfeeding rates (which we all know has other health benefits)[17], better weight gain [17], a more mature neurobehavioural status[18], and a reduction in hospital stay[15][17].  Do I really need say anything more about the overarching and powerful healing effects of touch?

Touch Builds Bonds

Some of you experts at least talk about the importance of providing your child with hugs and kisses when they are not distressed.  While this isn’t a substitute for responsiveness to distress (which I will get to in a little bit), you at least realize the power of touch to build bonds and promote loving relationships.  But there are still those of you who promote such rigid schedules that I can only assume you fail to realize the overarching need for parents and infants to touch each other regularly and spontaneously if they want to build a healthy relationship.

As previously mentioned, at the basic physiological level, touch reduces stress responses in infants[6][19],  but it also affects the ways in which we behave ourselves and interact with one another.  For example, children whose parents demonstrated greater responsiveness to distress were more empathic[20] and were not as closed off from others[21].  Touch also governs our emotional well-being, with greater positive touch related to greater satisfaction, happiness, and overall well-being[2][22].  Experimental studies also suggest how influential touch is in our perceptions of others and our interactions with them, even the most benign interactions.  In one study, library cards were returned to participants with half receiving the briefest of touch (hand touching the other hand while returning the card) and the other half receiving no touch.  Participants who had been touched reported more favourable views of the library than those who received no touch, even though the participants who had been touched did not recollect the touch[23].  In another study, it was found that touch by a nurse on a patient the day before surgery decreased the patient’s stress, both measured physiologically via heart rate and blood pressure and subjectively by the patient[24].

In terms of building bonds and relationships, we know the effect of skin-to-skin contact releases oxytocin, the “love” hormone, which facilitates bonding and feelings of affection[25].  This is why newborns are placed on their mother’s chest right after birth (when possible) and why skin-to-skin contact is so effective at calming babies down.  In adult relationships, the same premise holds, with couples who report higher levels of touch—such as holding hands, kissing, cuddling—also reporting greater relationship satisfaction[26].  Of course, it’s possible that people in better relationships are just more apt to touch each other; however, research on the levels of oxytocin in ones system and frequency of touch suggests that there is a causal relationship.  For example, women who report having received more physical contact from their partners in the past also show higher levels of oxytocin and lower blood pressure (an indicator of stress) than women who report less physical contact[27].

Be it through the role of oxytocin or some other mechanism, positive touch affects us positively.  Babies are no different; arguably the effects of touch are even more salient for them.  In fact, infants seek out touch in building relationships.  Dr. Tiffany Field, one of the leading researchers on touch, found that infants who were reinforced with touch (as opposed to just mom’s face and voice) showed more smiling and vocalization and less crying[28].  Additionally, touch in infancy has long-reaching effects with infants who receive little touch often have problems accepting touch as adults and engaging in meaningful relationships[1].  Touch helps us form loving and lasting relationships, but even the smallest amount can leave us calmer and happier.

Aggression and Touch

In Lesson Two we learned about Harry Harlow’s monkeys.  What wasn’t fully covered was that these monkeys, being very touch deprived even with the preference for the cloth mom, were incredibly aggressive and antisocial.  In some cases, caring for a younger monkey was able to calm them and socialize them to a degree, but by and large, they had to remain outcasts[29].  While it’s clear that this level of deprivation is not normal in our society nor is it condoned by anyone, the research suggests that there is a linear relationship between aggression and frequency of positive touch.  In a series of cross-cultural studies, Dr. Field examined the amount of touch and aggression in both preschoolers and adolescents in the United States and France.  In all cases, she found greater positive touch in France for all ages and the associated decrease in aggression and violent tendencies[30][31][32].  Interestingly, she also found that adolescents who experience less touch use more self-stimulating behaviours—drinking, drugs—which she hypothesized to be a response to the lack of touch.  How would this work?  Well, touch stimulates the self and increases oxytocin, a natural drug if you will, and so the lack thereof results in individuals attempting to find that same feeling of well-being that touch induces.  Like all forms of self-medication, it is rarely as effective and usually more damaging.

Even without the research, we can look back at history to see that the effects of touch on aggression.  An anthropological examination of 49 societies in the 1970s, separating them into those that offered lots of touch and those that offered minimal touch, demonstrated very disparate adult behaviours[33].  For those societies in which infants were lavished with touch and affection, common adult behaviours included: low invidious displays of wealth, low theft, low religious activity, and negligible killing/torturing/mutilation.  For those in societies in which pain or indifference is the normal state for infants we see: slavery, polygamy, inferior status for women, and aggressive religious gods.  This is on top of the already differential levels of aggression and violence in the society.  Going further back, it seems that societies were at least implicitly aware of the effects of touch on aggression.  As early as the Spartan years (and possibly earlier), war-heavy societies would remove the children at a young age (in Sparta it was 7 years of age) from the parental home in order to train them to be warriors.  Notably, the training was not the type to include hugs and cuddles, but was harsh and brutal[34].  Even today we see similar behaviours in warring regions in the development of child soldiers.  Children removed from their homes to a base with no caring and little touch in order to create cold-hearted killers (e.g., the myriad stories of child soldiers in areas of Africa like the Congo).  While there are many factors that affect the presence and degree of antisocial and aggressive behaviour in children and adults, there is little doubt that a lack of touch has an important role.

(It is worth adding here that there is also a relationship between negative forms of touching and behavioural problems, as we would expect.  In one study, it was found that harsh touch in infancy was associated with both behavioural and emotional problems later in life[35].  This is important to remember because touch that does not comfort or offer kindness can do lasting harm.  A mother who grabs her infant is not helping her and in no way should the aforementioned research on touch be construed to include this negative type of touching.)

How Does This Fit Into the ‘Expert’ Advice?

As I mentioned at the beginning, some of you seem to realize the importance of touch and promote play touch during the day.  Others, not so much.  Here is where I hope to make it clear that both views are actually doing children a disservice.  One, there is the logical reason that young infants simply do not understand the boundaries of day and night.  When you sleep 18-20 hours a day (as most newborns do), sleep is sleep; furthermore, if you’re telling parents not to cuddle when their child is distressed at sleep time, that actually is more of the time than awake time.  That means you’re ignoring your child’s needs more than half the time.  So let’s be honest about this – touch isn’t discriminatory and kids need it at all hours of the day.  To extend this point, let me ask you a question… How often is enough to be touched?  How much does a mother or father need to touch their infant during the day to “make up” for the lack of touch at night or during sleep?  Because in Western societies, our youngest infants are touched by humans approximately 12-20% of the time and our oldest infants (still under a year), less than 10% of the time[36].  Do you really think that’s enough?  It seems to me that we’re teetering into the extreme zone covered in Lesson Two, and I wouldn’t be surprised to find out that it was one of the factors leading to the ever-increasing rates of childhood aggression and psychological disorders[44].

Two, some of you will argue that you promote being in the room with your infant while they cry in order to reassure them, but do not allow for contact.  I hope this entire post has made it clear that that is far from ideal from your infant’s perspective.  Furthermore, as discussed in Lesson Two when I reviewed data from the Still-Face paradigm, infants seeing their parent but not getting a response from them elicited increases in stress levels.  So this notion of soothing by merely being present is rather ludicrous and contrary to what we know about infants’ responses to such situations.

Three, research has shown that attachment is built upon consistency.  So consistency of touch and consistency of responding to an infant’s needs are critical to building a secure attachment with your baby[37].  A failure to provide support, primarily in the form of touch, during the stressful nighttime for baby simply adds confusion.  Mom is there sometimes and not others, what should I do?  As intelligent as babies are, you’re asking them to try and understand something they are simply not capable of doing.  In line with this, some of the worst psychological outcomes for abused children come from cases where the abuse was inconsistent—not knowing what to expect led the child to have to function on high alert all the time which is damaging on many levels[38].  Additionally, there is other research suggesting that infants have a flesh memory for touch with their caregivers and thus the gaps at night are truly realized and remembered long-term[39][40][41].

Finally, there is emerging research to suggest that the hugs and kisses we provide during the day have little effect on how our children perceive their security, or our ability to make them feel safe and secure.  While there is no doubt that certain practices have global effects on our children (like abuse), one factor that has always befuddled researchers is how hard it has been to show global effects for most practices.  After all, we think of parenting as a unitary construct and any part of the practice should have widespread effects.  What researchers Joan Grusec and Maayan Davidov have proposed, however, is that we are making a mistake in thinking of parenting as a unitary construct[42].  Upon reviewing a plethora of research on parenting, it looks as though the socialization of our children really is made up of domains and so problems in one domain affect the outcomes associated with that particular domain, but not others.  With the case of touch, play and cuddles during the day would be part of the ‘reciprocity’ domain in which parent and child interact as equals in a pleasant, positive manner which is distinct from the ‘protection’ domain whereby our children expect us to care for them and respond to them when they are distressed.  Some evidence for this particular distinction comes from research showing that responsiveness to distress at six months predicted fewer behavioural problems and greater social well-being later on, but sensitivity and warmth to non-distress (i.e., playing and cuddling with your child when he or she is not distressed) had no such predictive powers[43].  So while your promotion of lack of tactile comfort during sleep times may not result in widespread problems in children, it most certainly has an effect on some very important areas of social and emotional functioning.

In sum, touch is unbelievably powerful and can be used to heal or harm.  But equally important is to understand that the various types of touch that affect our children, even positive touch, are not simply interchangeable.  The hug that comes from calming a distressed child is qualitatively different than the hug that comes when you’re playing with your child during the day.  Our children need all those different kinds of touch in spades if we want them to thrive.  And I know, you’re going to tell me that if we do it too much, they’ll never learn to calm and help themselves… well, guess what Lesson Four is on?  That’s right – self-soothing.

 

More from Educating the Experts

Lesson One: Crying

Lesson Two: Needs

Lesson Four: Self-Soothing

Lesson Five: Schedules



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Comments

  1. Jespren says

    Good post but I’m half asleep from my cosleeping little one waking up to nurse (and therefore touch ;) )me every hour all night, so I’ll comment in depth once my mind can get on track.

  2. Donna says

    Good post, thanks for sharing :) For someone who has heard “you’re making a rod for your own back” for the last week and is feeling sleep deprived over her non-sleeping baby, this is at least reassuring that I’m coming from a good place at least. In fact, it’s making me think that it’s a good thing I’ve got a Close Carrier on the way so I can do some baby wearing during the day when I really need to get things done, rather than always putting him in a bouncer or waiting until he is asleep!

  3. Nicole says

    This has been a great series, I just have a quick question. You posted that research says that touching and responding to a distressed child has a much greater effect than touch during calm times or play.

    Would that mean that a child who is more often distressed, but quickly responded to would have a better outcome than one that is not distressed often, and is touched during calm times?

    • says

      That’s kind of like comparing apples and oranges :) If a child is not distressed, but happy, there would be no reason to image negative outcomes. Our outcomes have more to do with how we are responded to during distressing periods rather than calm periods though. However, touch during calm times is still immensely important and has very practical and real effects! I don’t want anyone going away thinking that touch when not distressed is useless – far from it!

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