Everyday Rituals

Everyday experiences in a baby’s life can develop and stimulate his or her senses and provide parents an opportunity to nurture their baby’s ability to learn, think, and grow. A simple ritual of bathing and skin-to-skin massage creates an ideal opportunity for parents to create multisensorial experiences through what a baby feels, sees, hears, and smells.

 A bath time ritual offers an opportunity for skin-to-skin contact.  What a baby feels…  

Touch is one of the most well-developed senses when a baby is born⁹ and the World Health Organization recommends providing skin-to-skin contact starting at birth.² Skin-to-skin contact (tactical stimulation) has a positive impact on many areas of baby development. Skin-to-skin contact through bath time and massage has been shown to reduce cortisol, a biomarker of stress, in parents and babies,^5,10 facilitate weight gain with enhanced food digestion through increased vagal tone in preterm infants;¹¹ and reduce maternal depressed mood and anxiety scores.¹²

Maternal depression and anxiety are a particular concern in mothers who experience postpartum depression. Mothers (n=40) whose preterm infants were about to be discharged from the neonatal intermediate care nursery were randomly assigned to 2 groups: the first group of mothers conducted touch stimulation through massage and the second group only observed their preterm infants receiving touch stimulation through massage. The 8-minute massage session consisted of 2 identical, standardized, 4-minute segments without removing the infant from the bassinet. While both groups of mothers had lower depressed mood scores following the session, mothers of preterm infants who actually performed the touch stimulation through massage on their infant also had lower anxiety levels.¹²

Stress is also commonly seen in preterm infants and can contribute to dysregulation of glucose metabolism, thus hindering weight gain and healthy development.13 In addition to stress reduction, preterm infants gain weight through increased vagal activity and gastric motility following skin-to-skin contact (touch stimulation) through massage.¹¹ Vagal activity is an important component in the regulation of the autonomic nervous system. Vagal activity and gastric motility are essential for healthy growth and development of babies, particularly preterm infants. Medically stable preterm infants (n=80) in the neonatal intensive care unit were randomly assigned to a skin-to-skin contact through massage group or to a standard care control group to assess vagal activity and gastric motility responses. The group of infants receiving skin-to-skin contact through massage exhibited consistent short-term increases in vagal activity and gastric motility as well as weight gain during the 5-day study.¹¹

Through the gentle touch of a parent’s hands, bath time is a simple ritual that provides an ideal opportunity for increased skin-to-skin contact.

 Bath time is an opportunity for visual stimulation.  What baby sees…  

Making eye contact is the most powerful mode of establishing a communicative link.¹⁴

Bath time is also an opportunity for parents to engage in direct eye-contact with their baby. Visual stimulation is essential while a baby’s vision is developing from birth until about the age of three.¹⁵ From the moment they are born, babies prefer visual stimulation with wide open eyes and a direct gaze. Babies use direct eye contact as a form of communication and even demonstrate enhanced neural processing when a parent looks at him/her with direct eye contact.¹⁴

Healthy, 2-to-5-day-old infants (n=17) looked longer at a direct gaze compared to an averted gaze and four-month-old babies’ (n=20) brain electric activity showed enhanced neural processing from a direct gaze.¹⁴ The exceptionally early sensitivity to mutual gaze demonstrated in this study shows early foundation for the later development of social skills. Babies quickly learn how to communicate through eye contact and how to convey important expressive information, such as a meaningful smile, by observing the behaviors of the people around them.¹⁴ The World Health Organization recommends that parents engage in direct eye contact with their baby from the moment he/she is born² for healthy baby development.

 Bath time is an opportunity for auditory stimulation.  What a baby hears…  

Another sense important in communication and emotion is hearing (auditory stimulation). Our sense of hearing enables us to experience the world around us through sounds. Bath time is an ideal opportunity for auditory stimulation through the introduction of new sounds, such as water splashing at a baby’s feet, and for the parents to talk or sing to their baby.

Sounds not only create memory in the auditory and language areas of the brain cortex, but also generate neurological connections to the limbic system in babies.¹⁶ Babies can recognize a parent’s voice as demonstrated by enhanced brain activity in the left, posterior temporal region of the brain.¹⁷ This is the region in which linguistic processing occurs, suggesting a role in communication and language development.¹⁷ Furthermore, when a preterm baby is sung to or spoken to in a soft, soothing voice, such as that used in a lullaby, heart rate improves, bonding between the infant and parent is enhanced, and the stress parents associate with preterm infant care decreases.¹⁸

A randomized clinical multisite trial of preterm infants (n=272) at 32 weeks gestation with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) showed that when infants are sung to with a soothing voice, their heart rate function improves with time. During the auditory stimulation, the heart rate of the infants was reduced and became more rhythmic. Moreover, auditory stimulation provides an additional time for parent-baby bonding while reducing stress in parents.¹⁸

 Bath time is an opportunity for olfactory stimulation.  What a baby smells…  

The sense of smell is unique in that scent is directly processed in the brain. Stimulation of a baby’s sense of smell (olfactory stimulation) provides many healthy developmental benefits including emotional, social and memory,^4,19 with greater benefits in learning ability shown when olfactory stimulation is combined with touch stimulation.⁴ A pleasant scent during bath time has been shown to promote relaxation in both baby and parents.¹⁰

The ability of young babies to remember a scent early in life is also shown through the soothing and relaxing effects of a scent that is familiar to them. A familiar scent can aid in calming an infant during times of pain or stress²⁰ and has been shown to soothe a crying baby.21 Full-term, breast fed, healthy babies (n=42) were randomly assigned to 1 of 4 groups: (1) naturally familiarized with their mother’s milk odor, (2) familiarized with a vanilla scent, (3) unfamiliar scent, and (4) no scent. Babies who smelled their mother’s milk or vanilla, cried significantly less after a routine heel stick compared to infants who smelled an unfamiliar odor or no odor at all. The quicker recovery from pain suggests that babies are able to remember scents and that smelling a familiar odor reduces agitation.²⁰ Reduced agitation or an overall calm feeling is also shown when parents give their babies a bath with a gentle scent.¹⁰

When multiple senses are combined, such as olfactory and tactile stimulation, babies exhibit improved cognitive response. A study investigating olfactory conditioning and associative learning of 1-day old newborns (n=66), found that babies responded more by turning their head toward a familiar scent when it was combined with touch than scent or touch alone. Babies were randomly assigned to 4 groups: exposure to scent and touch concurrently, touch followed by scent, scent alone, and touch alone. One day following initial exposure to the scent, only the babies who received scent and touch together turned their heads toward the scent, demonstrating a learned response.

These results suggest that complex associative olfactory learning can occur in babies within the first 48 hours of life and the stimulation of multiple senses may be more powerful than individual sense stimulation.⁴ Bath time provides a simple opportunity for parents to provide olfactory and touch stimulation. Parents who gave their baby a scented bath provide more tactile stimulation through increased skin-to-skin contact with their baby than those who did not use scents during bath time¹⁰ creating an enhanced multisensorial experience.

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