Bonding is the formation of a mutual emotional and psychological closeness between parents (or primary caregivers) and their newborn child. Babies usually bond with their parents in the minutes, hours, or days following birth.
Bonding is essential for survival. The biological capacity to bond and form attachments is genetically determined. The drive to survive is basic in all species. Infants are defenseless and must depend on a caring adult for survival. The baby's primary dependence and the maternal response to this dependence causes bonding to develop.
Bonding and attachment are terms that describe the affectional relationships between parents and the infants. An increased awareness of the importance of bonding has led to significant improvements in routine birthing procedures and postpartum parent-infant contact. Bonding begins rapidly, shortly after birth, and reflects the feelings of parents toward the newborn; attachment involves reciprocal feelings between parent and infant and develops gradually over the first year. The focus of this entry is bonding in the newborn period. Attachment develops over the larger period of infancy and is treated in a separate entry.
Many parents, mothers in particular, begin bonding with their child before birth. The physical dependency the fetus has with the mother creates a basis for emotional and psychological bonding after birth. This attachment provides the foundation that allows babies to thrive in the world. When the umbilical cord is cut at birth, physical attachment to the mother ceases, and emotional and psychological bonding begins. A firm bond between mother and child affects all later development, and it influences how well children will react to new experiences, situations, and stresses.
American pediatricians John Kennell and Marshall Klaus pioneered scientific research on bonding in the 1970s. Working with infants in a neonatal intensive care unit, they noted that infants were taken away from their mothers immediately after birth for emergency medical procedures. These babies remained in the nursery for several weeks before being allowed to go home with their families. Although the babies did well in the hospital, a troubling percentage of them seemed not to prosper at home and were even victims of battering and abuse. Kennell and Klaus also noted the mothers of these babies were often uncomfortable with them, sometimes not believing that their babies had survived birth. Even mothers who had successfully raised previous infants have special difficulties when their children had been in the intensive care nursery. Kennell and Klaus surmised the separation immediately after birth interrupted a fundamental relationship between the mother and the new baby. They experimented with giving mothers of both premature and healthy full-term babies extra contact with their infants immediately after birth and in the few days following birth. Mothers with more access to their babies in the hospital developed better rapport with their infants, held them more comfortably, and smiled at and talked to them more often.
Gradually bonding research brought about widespread changes in hospital obstetrical practice in the United States. Fathers and family members often remain with the mother during labor and delivery. Mothers hold their infants immediately after birth, and babies often remain with their mothers throughout their hospital stay. Bonding research has also led to increased awareness of the natural capabilities of the infant at birth, and so it has encouraged many others to deliver their babies without anesthesia (which depresses mother and infant responsiveness).
Emotionally and physically healthy mothers and fathers are attracted to their infant. They naturally feel a physical longing to smell, cuddle, and rock their infant. They look at their baby and communicate to the baby. In turn the infant responds with snuggling, babbling, smiling, sucking, and clinging. Usually, the parents' behaviors bring pleasure and nourishment to the infant, and the infant's behaviors bring pleasures and satisfaction to the parents. This reciprocal positive maternal and paternal-infant interaction initiates attachment.
One important part in the parents' ability to bond with the infant after birth is the healthy, drug-free newborn is in a "quiet alert" state for 45 to 60 minutes after birth. Immediately after birth the newborn can see, can hear, will turn his head toward a spoken voice, and will move in rhythm to his mother's voice. Mothers and fathers who have the opportunity to interact with their newborns within an hour after birth bond with their baby quickly. The act of holding, rocking, laughing, singing, feeding, gazing, kissing, and other nurturing behaviors involved in caring for infants (and young children) are bonding experiences. The most important ways to create attachment is positive physical contact such as hugging, holding, and rocking. It should be no surprise that nurturing behaviors cause specific neurochemical actions in the brain. These actions lead to organization of brain systems responsible for attachment.
Physical changes occur in the mother after birth, such as hormonal increases triggered by the infant licking or sucking her nipples and increased blood flow to her breasts when she hears the infant cry. Instinctive behaviors triggered in the mother in response to the infant immediately after birth promote her bonding with the infant and thus support the infant's survival.
Bonding experiences lead to healthy relations for children in the earliest years of life. During the first three years of life, the human brain develops to 90 percent of adult size. The brain puts in place most of the systems and structures that are responsible for future emotional, behavioral, social, and physiological functioning. Bonding experiences must be present at certain critical times for the brain parts responsible for attachment to develop normally. These critical periods appear in the first year of life and are related to the capacity of the infant and parent or caregiver to develop a positive interactive relation. Problems with bonding and attachment can lead to a fragile biological and emotional foundation for later experiences.
Any problem with bonding experiences can interfere with attachment capacities. When the interactive, reciprocal "dance" between the parent and infant is disrupted or becomes difficult, bonding experiences are difficult to maintain. Disruptions can occur because of medical problems with the infant or the parent, the environment, or the fit between the infant and the parent.
The infant's personality or temperament influences bonding. If an infant is difficult to comfort, is irritable, or unresponsive, the baby may have more difficulty developing a secure bond. Moreover, the infant's ability to take part in the maternal-infant interaction may be compromised because of a medical condition, such as prematurity , birth defect, or illness.
The parent's or caregiver's behavior can also hinder bonding. Critical, rejecting, and interfering parents have children who may avoid emotional intimacy. Abusive parents have children who become uncomfortable with intimacy and withdraw. The child's mother may be unresponsive to the child because of maternal depression, substance abuse, or overwhelming personal problems that interfere with her ability to be consistent and nurturing for the child.
The environment is also a factor. A major impediment to healthy bonding is fear . If an infant is distressed because of pain , pervasive threat, or a chaotic environment, the baby may have a difficult time engaging in a sympathetic care-giving relationship. Infants or children living amid domestic violence, in refugee shelters, in areas besieged by community violence, or in war zones are at risk for developing attachment problems.
The fit between the infant's temperament and capabilities and those of the mother and father is important. Some parents can bond with a calm infant but are overwhelmed by an irritable infant. Understanding each other's nonverbal cues and responding appropriately is essential to preserving the bonding experiences that build healthy attachments. Sometimes a style of communication and response familiar to a mother from one of her other children may not fit her new infant. The mutual frustration of being "out of sync" can undermine bonding.
Since the first phase of bonding takes place in the womb, researchers believe difficult and unwanted pregnancies and planned adoptions interfere with mother and infant bonding. Teenagers and immature mothers often conceal and reject their pregnancies. This behavior and feeling may result in abandonment , neglect, and the absence of bonding at birth. Often there is also an emotional detachment from a fetus that causes emotional or physical pain to the mother during pregnancy. Mothers may have difficulty bonding with an infant if prenatal testing suggests the child will have a birth defect or is likely to be mentally retarded and malformed. And babies planned for adoption at birth may be "given up" emotionally by the birth mother during pregnancy. Any or all of these circumstances can interfere with the infant-parent bonding process.
The birth of a premature infant is documented to be a time of stress and crisis for parents and infants. Among these stressors are perceived losses and grief from the early abrupt termination of pregnancy, feelings of guilt and failure in inability to carry the infant to term, uncertainty regarding the infant's future health and developmental potential, and immediate and long-term separation of the infant from the family.
Parental involvement in the care of sick or premature newborns is a major concern of many pediatricians and nursery staff. Touching, stroking, and talking, and, later, massaging are encouraged during frequent parental visits to the nursery. It is hoped that the emotional bonding of parents with low birth-weight infants will increase the baby's chance of doing well despite prematurity.
Because premature infants are sometimes seem fragile, parents may handle them less. Skin to skin contact is important to the growing infant, premature or full term. Lack of this contact may predispose the child to psychological problems as well as diminish opportunities for learning.
The practice of "kangaroo care," first introduced by two South American neonatologists, is a method of skin-to-skin contact to promote parent and infant bonding especially for premature infants. This method involves holding infants dressed only in a diaper and a hat between the mother's bare breasts or against the father's chest, similar to a kangaroo carrying their young. Through contact with their parents' skin, the babies are kept warm and allowed close interaction with their parents. This decreases some of the stressors associated with premature births and helps infants needing neonatal intensive care.
Parents who have experienced kangaroo care have expressed excitement and joy with the practice and many have felt like parents for the first time since their infant's birth. Infants have been observed in a restful sleep state while in the kangaroo position. As well, kangaroo care has been found to promote parent and infant bonding, breastfeeding, and early discharge for premature infants.
Kangaroo care is offered to stable babies who are less than 1,500 grams and are breathing on their own. Babies needing oxygen or nasal continuous positive airway pressure (CPAP) may also be eligible. Cardiopulmonary monitoring and oximetry may be continued during kangaroo care. The nurse remains nearby to monitor the infant as necessary.
Attachment —A bond between an infant and a caregiver, usually its mother. Attachment is generally formed within the context of a family, providing the child with the necessary feelings of safety and nurturing at a time when the infant is growing and developing. This relationship between the infant and his caregiver serves as a model for all future relationships.
See also Attachment between infant and caregiver .
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Aliene S. Linwood, RN, DPA, FACHE