CONTACT COMFORT OF CARETAKERS IN A
HOSPITAL SETTING
by
Judith Ann Grimes
A Thesis. Submitted to the Faculty of the
COLLEGE OF NURSING
In Partial Fulfillment of the Requirements
For the Degree of
MASTER OF SCIENCE
In the Graduate College
THE UNIVERSITY OF ARIZONA
1 9 7 4
STATEMENT BY AUTHOR
This thesis has been submitted in partial fulfill­
ment of requirements for an advanced degree at The
University of Arizona and is deposited in the University
Library to be made available to borrowers under rules of
the Library.
Brief quotations from this thesis are allowable
without special permission, provided that accurate acknowl­
edgment of source is made. Requests for permission for
extended quotation from or reproduction of this manuscript
in whole or in part may be granted by the head of the major
department or the Dean of the Graduate College when in his
judgment the proposed use of the material is in the inter­
ests of scholarship. In all other instances, however,
permission must be obtained from the author.
yf
'
/<ryA^m£^
APPROVAL BY THESIS DIRECTOR
This thesis has Been approved on the date shown below-;
AGNES M. AAMODT
Associate Professor of Nursing
Date
ACKNOWLEDGMENTS
The author wishes to thank the members of her thesis
committee. Dr. Agnes Aamodt, Chairman; Miss Cynthia Brown;
and Dr. Margarita Kay, for their guidance and advice during
this study.
Many members of the pediatric staff at the Arizona
Medical Center, The University of Arizona, deserve a special
thanks, including the physicians, nurses, and administrators
who permitted the study to be conducted.
The nursing per­
sonnel were exceptionally helpful and understanding
throughout the course of the study.
A very special thanks to Barbara Domurad, a fellow
classmate, for her drawings which contributed greatly to
this work.
Most of all, a special debt of gratitude is due to
my parents for their confidence and support.
iii
TABLE OF CONTENTS
Page
LIST OF TABLES . . . . . . . . . . . . . . . . . . . .
LIST OF ILLUSTRATIONS
vi
. . . . . . . . . . . . . . . .
vii
. . . . . . . . . . . .
viii
INTRODUCTION . . . . . . . . . . . . . . . . . .
1
ABSTRACT . . . . .
CHAPTER
1.
Development of the P r o b l e m ..........
Statement of the Problem . . . . . . .
Purpose of the study . . . . . . . . .
Conceptual Framework . . . . . . . . .
Assumptions
.............. . . . . .
Limitations
.............. . . . . .
Definition of Terms . . . . . . . . .
2.
.
.
.
.
.
.
.
.
.
.
.
.
3
3
4
4
6
6
7
.
.
.
.
.
.
REVIEW OF THE LITERATURE
8
Literature on Tactile Stimulation . . . . .
The Literature on Animal Studies . . . . . .
Literature on Maternal Activities
. ; . , .
Summary . . . . . . . . . . . . . . . . . .
3.
METHODOLOGY
. . . . . . . . . . . . . . . . . .
24
The Setting . . . . . . . . . . . . . . . .
The Sample . ,
,
Research Design . . . . . . . . . . . . . .
Data Collection
4.
PRESENTATION AND ANALYSIS OF THE FINDINGS
Characteristics of the Sample . . . . .
Categorization of the Data
The Findings . . . . . . . . . . . . . .
Caretaker Activities . . . . . . . .
Behaviors Accompanying Touch . . . . . .
Summary
8
14
18
22
24
24
25
26
...
28
. .
28
29
30
32
62
65.
. .
. .
. .
.
V
TABLE OF CONTENTS— Continued
Page
5.
INTERPRETATION OF THE FINDINGS
66
Generalizations
. . . . . . . . . . . . . . .
Conclusions . . . . . . . . . . . . . . . . .
Implications for Nursing . . . . . . . . . .
Recommendations for Further Studies . . . .
6.
SUMMARY
. . . . . , . . . .
. . . . , . . .
70
APPENDIX A.
THE FACE SHEET
APPENDIX B.
SCHEDULE OF CARETAKING ACTIVITIES . . . .
75.
APPENDIX C.
CONVERSATION ACCOMPANYING TOUCH . . . . .
78
REFERENCES CITED
................
66
67
67
68
. . . . . . . . . . . . .
74
81
LIST OF TABLES
Table
Page
1.
Characteristics of the S a m p l e ..........
31
2.
Frequencies of Contact According to
Infant Body Area . . . . . . . . . . . . . . .
36
Holding Patterns: Relationship of Infant
to Caretaker .
41
4.
Pick Up Patterns of Caretakers . . . . . . . . .
53
5.
Positions and Related Frequencies of the
Burp .
55
6.
The Diaper Change
. . . . . . . . . . . . . . .
56
7.
Summary of Content of Contact Behavior by
Individual Caretakers . . . . . . . . . . . .
58
Behavior of Caretakers which Accompanied
Touch .
64
3.
8.
vi
LIST OF ILLUSTRATIONS
Figure
Page
1. Functional Units of Caretaker Activities
. .
2. Nonfunctional Units of Caretaker Activities
3.
4.
5.
.
..
33
„
34
Description of Holding Patterns of
Caretakers , , . .
42
Description of Carrying Patterns of
C ar etaker s . . ® « ... . « . . . . . . « « .
Places Carried by Individual Caretakers
vii
....
.
47
51
ABSTRACT
The purpose of this study was to observe and
describe assigned caretaker activities rendered to newborns
through six months of age.
The investigator was concerned
only with the behavior of the caretaker and desired to learn
whether close body contact was being provided.
A supporting framework for this investigation was
taken from animal studies where contact comfort was a
variable of extreme importance in the development of
affectional responses in nonhuman primates.
Ten caretaker-infant units constituted the sample.
The investigator utilized direct observation with the con­
tinuous taking of notes to obtain the descriptive material.
Categorization of the data yielded four areas of
interest to nurses and those concerned with infant care.
These included:
content of caretaker activities, charac­
teristics of caretaker contact, holding and carrying
patterns, and behaviors accompanying touch.
Results indicated that nurses offer a wide variety
of contact and movement stimulation as a byproduct of
functional procedures.
viii
CHAPTER 1
INTRODUCTION
During the first year of life and with gradual
diminution thereafter, the human infant is totally depend-*
ent on the mother or the mother surrogate.
It is through
body contact with the mother or mother object that the
child makes its first contact with the world.
This bodily
contact provides the essential source of comfort, love,
security, warmth, and increasing aptitude for new expe­
riences.
Infants rely rather exclusively on touch as a
vehicle for communicating with other human beings.
Frank
(1957) , Casler (1965)., and Montagu (1971) believe that the
experience of being touched is a dominant factor in the
development of how one sees oneself as a physical person
and subsequently determines future learning and social
relationships.
During the first six months of life, body contact is
especially important as it is not until six months that the
average infant seems able to differentiate between its
mother and other human beings.
This critical period change
in responsiveness usually occurs in humans between the ages
i
of five and seven months.
Casler (1961:3-11) cites it is
reasonable and generally acceptable to set the age of six
1
months as the cutoff point for this critical change period.
Casler
also
notes that maternal separation and development
of ill effects in infants after the age of six months result
from the rupture of an already existing emotional bond with
the mother, therefore, maternal separation after six months
can provide no definitive information regarding the effects
of deprivation per se; rather it gives insight into the
effects of severing a learned affectional bond.
Conse­
quently, only those separations beginning before the estab­
lishment of this bond, or before six months of age, can
furnish data regarding the effects of intrinsic deprivation.
Skard (1965:33 9) notes that during the first six month
period one can separate mother and child if one takes care
that the child gets necessary mothering; that is, experiences
body warmth, rocking, patting, feeding, sucking, being
carried, and hearing voices.
It is not important who
stimulates the child in this manner as the child may be said
to be care oriented, not yet person oriented.
Frank (1957:223) notes it is well recognized that
the newborn mammal needs close body contact with its mother
for survival.
Harlow (1958) has demonstrated the signifi­
cance of physical contact between the monkey mother and her
infant for the subsequent healthy development of the latter.
Like all infant mammals who are licked, nuzzled, cuddled,
.and kept close to the mother, the human infant likewise has
a similar need for close bodily contacts, for tactual
soothing which calms and restores equilibrium when hurt,
frightened, or angry.
In nursing practice, the pediatric caretaker must be
cognizant of the fundamental importance of body contact in
the growth and development of the infant-child.
To be
tender, loving and caring, human beings must be tenderly
loved and cared for in their earliest years.
Development of the Problem
Initial interest in this study stemmed from the
researcher's past experience in caring for infants and
noticing how little close physical contact with infants was
made by caretakers while performing the many nursing duties
required in a day's work.
It was the caretakers' inatten­
tion to this significant but non-prescribed nursing activity
that focused this researcher toward investigating the area
of contact comfort.
Statement of the Problem
There is need in nursing for a better understanding
of the role caretakers play in giving contact comfort to
young hospitalized infants.
This inquiry was addressed to
gaining insight into answers to the following questions.
1.
How much bodily contact is provided a hospitalized
infant by the caretakers?
2.
What is the character of that contact?
Purpose of, the Study
This study was conducted in order to observe and
describe the nature of an assigned caretaker's contact with
a hospitalized infant.
It will provide data which may later
be utilized to address important questions related to the
need for contact comfort of one human being by another.
Conceptual Framework
Man's closest phylogenetic relatives are the monkeys
and apes.
Harlow and Zimmerman (1959), working at the
primate laboratory at the University of Wisconsin, have been
trying to determine variables which make up the affectional
system of Rhesus Macaque monkeys.
They sought to understand
more about the need for intimate physical contact in humans
through controlled experimental studies of nonhuman primates.
They believe the overwhelming importance of the contact
variable has been clearly demonstrated in experiments with
monkeys and see contact comfort as a variable of extreme
importance in the development of affectional responses.
Harlow (1961) and Harlow and Harlow (1965) have
listed five relatively separable affectional systems;
infant-mother,
(2) infant-infant, (3) heterosexual,
mother-infant, and (5) adult male-infant.
(1)
(4)
The variable of
contact comfort, as they call it, is a factor in all these
systems and is essential in the first, third, and fourth
systems.
In the primate, the primary tie of the infant for
the mother is achieved through the operation of two
dominant systems:
a system associated with breast and the
act of nursing and a system developed around contact.
Tests
with wire and cloth surrogate mothers by Harlow and
Zimmerman (1959) suggest that the primary function of ■
nursing may be that of insuring frequent and intimate con­
tact between mother and infant, thus facilitating the
localization of the source of contact comfort.
The experimental analysis of the development of the
infant monkey's .attachment to an inanimate mother surrogate
demonstrates the overwhelming importance of the variable
of warm soft body contact.
The results also indicate that
without the factor of contact comfort only a weak attach­
ment is formed and feeding, in contrast to contact comfort,
is neither necessary nor sufficient for affectional develop­
ment,
Close bodily contact appears to be an important
stimulus to elicit maternal affectional response.
This study was focused around Harlow's (1961)
mother-infant, infant-mother affectional systems in the
form of caretaker-infant, infant-caretaker.
In Harlow's
studies, infant monkeys who had not experienced contact
comfort would invariably exhibit deep distress character­
ized by crying rigid immobility, or peculiar type of con­
vulsive, rocking, jerking motions which mirrored the
6
rocking behavior frequently observed in neglected or de­
fective human children.
Assumptions
Assumptions that were made for this study consisted
of the following:
1.
2.
Human infants are dependent.
Infants rely on touch and body contact as signifi­
cant vehicles for communicating with other human
beings.
3.
The infant's bodily contact to the torso of the
caretaker is a commonly used comforting type of
contact comfort among human beings.
Limitations
This study was confined by the following factors:
1.
The sample
of selected children was small.
2.
The sample
of observations was confined to those
caretaker activities given to newborns through six
months of age with various medical problems.
3.
The sample
of observations was confined to a period •
of time in which feeding took place.
4.
The observations were made by only one observer for
a limited period of time„
5.
The observer was unable to select and describe many
significant aspects of the total activities.
The cultural taboos of individual caretakers' touch
and professional behavior were not considered.
The study was carried out in only one inpatient,
community health care setting.
Definition of Terms
Caretaker.
The person specifically assigned to care
for the subject.
Contact comfort.
a.
The holding of the infant upright so that the
body of the infant was in close physical contact
with the torso or placed on the shoulder of the
caretaker.
b.
The holding of the infant horizontal to the
torso of the caretaker and cradled in the arms,
as in the "nursing" position.
Behavior episode.
An easily discriminated part of
the stream of activities associated with caretaking
behaviors.
CHAPTER 2
REVIEW OF THE LITERATURE
This review of the literature focused on the
following areas:
tactile stimulation, animal studies, and
maternal activities.
Literature on Tactile Stimulation
The tactile modality among the human species has not
been fully explored due to difficulties in attempting to
experiment with tactile stimulation and measure either the
stimulus or the response.
Researchers in child development'
for more than a century have been seeking to learn the
effects of the different forms and amounts of contact which
a child at different developmental levels receives from the
mother.
In the search for enlightenment into the different
factors involved in mother-child relationships and the
effects of each of them, some investigators have sought to
understand whether it is accurate to speak about "maternal"
deprivation.
The deprivation may be something which has
nothing to do with the personal mother, but rather involves
rocking, talking, or body contact per se.
Darwin (1965:213) was one of the first to deal with
the theory of emotion and emotional expression.
In the
Showing of love, "a strong desire to touch the beloved
person is commonly felt; and love is expressed by this means
more plainly than by any other.
Hence we long to clasp in
our arms those whom we tenderly love."
Late in the nineteenth century Bain (1899:126-127)
asserted that ". . . touch is the fundamental and generic
sense . . . the combined power of soft contact and warmth
amounts to a considerable pitch of passive pleasure . . . x
our love pleasures begin and end in sensual contact."
Frank (1957:221-223) emphasized the importance of
tactilism and noted that communication begins much earlier
\
than speech; tactile experiences are the first and most
elementary mode of communication.
It has influence upon
whatever forms of communication that follow.
Frank (1957:
226) posited that ". . . the child's reception of verbal
messages is predicated in large measure upon his prior
tactile experiences so that facial expressions and gestures
become signs and symbols for certain kinds of tactile
communications and interpersonal relations."
Frank (1966) asserted that the human infant has need
for tactile contacts and the soothing comforting and re­
assurance that comes from gentle tactile stimulation,
especially rhythmic patting.
Casler (1961:36) noted that the variable of bodily
support had not received much attention from modern psy­
chologists.
He observed that most bodily support given an
10
infant involved some combination of vestibular and tactile
factors.
Casler (1965) studied the effects of extra-tactile
stimulation on a group of institutionalized infants, pre­
dicting that twenty minutes per day of added tactile stimula­
tion administered impersonally for a certain period, would
result in improved functioning as measured by the Gesell
Developmental Schedule„
hypothesis.
His experiment did i support the
The implications here were for institutional
caretakers to provide opportunities for extra handling and
rescheduling of nurses' assignments.
He found the source of
tactile stimulation was irrelevant.
Any source, an imper­
sonal caretaker or even a machine would be satisfactory if
the dosage of stimulation was approximately correct? that
what was needed was tactile stimulation in proper dosages.
Clay (1966:1-3) discussed the importance of the
human need for intimacy and noted that one of the primary
ways of meeting this need is through tactile communication.
She pointed out that tactile messages are the first modality
in communication for human beings.
Until the infant can
understand through words, touch is his main avenue for
communicating with other people and with the world of
material things.
In Clay's (1966:5) study the human
organism was thought of as "an active participant in his
surroundings who seeks and in fact requires stimulation in
order to become and to remain human."
11
Hallstrom (1968) investigated positioning an infant
during immunization injections using "contact comfort" which
she abstracted from nonhuman primate studies conducted by
Harlow.
The study substantiated the hypothesis that
infants who were supported in their mothers1 arms during the
injection showed less stress.
This was evidenced by a
decrease in the intensity and duration of crying.
Recent neurobiological and neurobehavioral findings
help explain why perceptual stimulation is so important for
normal development.
Prescott (1972) reported that sensory
stimulation is like a nutrient and just as malnutrition
adversely affects the developing brain so does sensory
deprivation.
He listed a number of studies which have
clearly documented that sensory deprivation during the
formative periods of development can result in the failure
of the deprived sensory system to develop and function
normally.
Conversely, enriched sensory stimulation during
these same periods can result in increased growth charac­
teristics of the sensory system.
Prescott (1971: 357) also suggested that movement
disorders such as rocking, head banging, and whirling,
commonly reported as a consequence of maternal-social
deprivation or sensory deprivation, reflect impaired neuro­
physio logical functioning.
"...
varied emotional be­
havioral disorders that are commonly reported as a con­
sequence of maternal-social deprivation are uniquely
12
attributable to deprivation of the somatosensory system and
not to deprivation of the other sensory systems, particu­
larly the visual and auditory systems."
Prescott (1971:358)
states it has been well established that the sensory systems
require sensory input for their normal growth and develop­
ment.
He goes on to note that if such sensory input is
deficient during the formative periods of development, loss
of sensory capacity and function as measured behaviorally
and heurophysiologically can ,be demonstrated.
Prescott has proposed that the somatosensory system
has two major divisions: somesthesis (non-movement senses)
and kinesthesis (movement senses).
The somesthetic division
consists of the cutaneous and visceral afferences and the
kinesthetic division consists of proprioceptive (muscles,
tendons, joints) and vestibular-cerebellar afferences.
From
this behavioral point of view, the motor system may be con­
sidered as a sensory-feedback system so that movement
restraint may be interpreted as a form of sensory depriva­
tion.
Prescott sees somatosensory deprivation as the
primary etiological factor in the development of socialemotional disorders, particularly pathologic violent be­
haviors.
He believes that the cerebellum becomes super­
sensitive and hyperexcitable in function due to insufficient
somatosensory stimulation during early development.
Prescott and McKay Cl97 2; 15). state;
13
the somatosensory deprivation theory of human
development which originated from animal depriva­
tion studies has found supportive evidence from
national statistical studies and cross-cultural
studies which have related early deprivation
phenomena to a variety of asocial, drug abuse,
and violent-aggressive behaviors.
Korner and Thoman (1972) experimented with six
interventions which replicated common maternal soothing
techniques.
These interventions entailed contact along with
the forms of stimulation which attend contact and the expe­
rience of being moved.
The latter invariably provides
vestibular stimulation as well as the concomitant activation
of the proprioceptive receptors.
These receptors, particu­
larly those which are located in the neck muscles, become
activated whenever the head is moved.
Two of these inter­
ventions are strikingly similar to my definition of contact
comfort which includes vestibular-proprioceptive movement
combined with contact.
The results suggest that the soothing effects
usually attributed to contact comfort may be largely a
function of the vestibular proprioceptive stimulation which
attends most contacts between mother and child.
These
authors write that contact comfort has been described by
Bowlby (1958), Harlow (1958), and Ribble (1943) but point
out that several different forms of stimulation are in­
volved in contact comfort, including tactile, cutaneous,
olfactory, thermal, kinesthetic, and vestibular
14
proprioceptive stimulation as well.
Korner and Thoman
(1972:450) state that
while continuous vestibular-proprioceptive stimula­
tion (as provided during rocking) has long been
known to calm infants, the soothing effect of
brief vestibular-proprioceptive stimulation
provided by changes in body position has not
been sufficiently stressed in the literature.
Their study showed that body contact without move­
ment had a significant effect in calming infants but this
effect was not as potent as that of body contact and move­
ment combined.
The Literature on Animal Studies
To facilitate a more focused approach to the problem
of experimenting with different factors involved in motherchild relationships and the effects of each of them, animals
of different kinds have been used.
During the last sixty
years birds such as hens, ducks, and geese and mammals such
as monkeys and apes have provided increased insight into
mother-child relationships in these animals.
Since similar
factors operate in human infants, studies of animals and
their behavior can be helpful in understanding human tactile
communication.
There are certain areas of animal research
which particularly apply to this study.
The effect of touch
on infra-human behavior was demonstrated by Hammett (1922),
Harlow (1958), Melzack and Thompson (1956), and Melzack and
Scott (1957).
The imprinting process of animals was
heralded by Lorenz (1956).
Mason (1968) documented that
15
movement as a source of stimulation was indispensable for
proper animal development.
Hammett (1922) discovered that albino rats which had
been petted and gentled were less timid, less apprehensive,
and less high strung than those which had received only
incidental and infrequent handling.
In 193 5 Konrad Lorenz published a pioneered paper on
a phenomenon he called imprinting.
Lorenz (1956) reported
experiments with different kinds of birds and the process
of imprinting.
a
According to Skard (1965:335) "imprinting is
process whereby some impressions of early life have' a
lasting effect on the individual marking the whole of his
total social development."
Lorenz
pointed out that im­
printing must happen at a critical period, at a certain
developmental stage in each kind of animal.
The question
arises whether there are such critical periods for imprint­
ing in all animal species where there are parent-young
relationships including the human child.
Also there are
times when children are particularly approachable and
sensitive to human ties which enable them to develop love
for an adult.
Gray (1958) placed the critical period for
human imprinting to the human species in general from about
six weeks to six months.
Harlow (1958, 1961)
noticing the young monkey will
hang onto its mother's fur until it gets hold of the nipples
to suck and receive milk, thought there must be two
16
different characteristics in the mother that the young
would seek, the fur and the milk.
important?
But, which was more
Were the infants tied to and grew to love the
mother because she gave them food or because she had fur to
snuggle into?
Harlow started his experiments by isolating
the maternal characteristics in artificial mothers with
which monkeys could grow up from birth.
His studies with
rhesus monkeys have established that body contact in mammals
is necessary for species survival as well as development of
an affectional system.
The studies of Harlow (1958, 1971)
have amply documented the self clutching, rocking behaviors,
thumb, toe, and penis sucking in monkeys isolation-reared.
Prescott
(1972)
interpreted these behaviors as a conse^
quence of somatosensory deprivation where somesthetic and
vestibular mechanisms are rendered dysfunctional
Melzack and Thompson (1956) and Melzack and Scott
(1957) have documented the hyperexcitability behavior of
dogs reared in isolation where body contact, touching, and
movement stimulation from other animals and humans were
non-existent.
Schaller (1963) studied gorilla behavior and noted
the comfort and security which the infant derives from
close contact with the female even after she has ceased to
provide food.
He concluded it is probably essential to its
bodily and mental well-being as well as the infant's later
successful integration into the group as a whole,
Schaller
17
came to the same conclusion observationally as Harlow did
experimentally.
Rheingold (1963a;5) noted that in mammals, the first
or neonatal stage of maternal attachment is primarily a
stage of very close mother-infant contact.
When comparing
mammalian neonates with human babies she noted that the
competence of the infrahuman mammalian infant is remarkable
in its persistent effort at getting close to and sucking the
mother.
The human neonate is much less able to move itself
into contact with the mother and to cling to her than other
mammal young.
The anthropologist Montagu (1971) has reviewed the
importance of tactile experience and the kind of skin
stimulation necessary for healthy physical and behavioral
development of the human and infrahuman organism.
His
interest in touch and the significance of the skin reflects
a concern for this underappreciated aspect of communication.
Mason (1968) documented that movement and rocking
stereotypes in particular are a consequence of somatosensoryvestibular deprivation.
He reared isolated infant rhesus
monkeys on a moving surrogate mother and demonstrated that
these animals did not develop rocking behaviors, as did
monkeys reared under identical conditions except that the
surrogate mother did not move.
More succinctly, monkeys
reared on the mobile surrogate mother did not manifest the
typical maternal-social deprivation syndrome; in particular,
18
the rocking and movement stereotypes were prevented.
The
rhesus monkeys reared on the stationary surrogate mother
developed the classical symptoms associated with the
■maternal-social deprivation syndrome.
This work indicates
that stimulation other than tactile is also indispensable
for proper development.
Literature on Maternal Activities
Ribble (1943). was the first pediatrician to state
that the physiological needs of an infant include not only ;
the need for food and sucking but being held, carried about,
and fondled by the mother.
The first systematic observa­
tions in the field of mother-infant interactions were
carried out by Brody (1956).
She recorded the frequency of
touch in her observations of patterns of mothering and
stressed that physical handling was the infant's first
pleasurable response and the best single index of a mother's
total relationship to the infant,
Bowlby (1958) stressed
the innate need for prolonged physical contact and clinging
which are important in producing a strong mother-infant tie.
Fromm-Reichmann (1959) talked about the need for physical
contact which is innate and consistent from birth.
She
attributed physical and emotional disturbances to con­
sistent lack of physical contact,
Rheingold (1960) studied ten infants, five at home
and five in an institution.
She found that significant
19
maternal differences tended to be differences in amount, not
in kind, of caretaking activities.
Rheingold (1963b)
investigated effects of environmental stimulation upon
responsiveness to persons and objects among three month
infants (1) in an institution and (2) others reared in their
own homes of high economic status.
She found the institu­
tionalized infants to be more attentive and responsive.
Her
explanation was that they received stimulation by more care­
takers in more varied ways and learned more ways to hold
the attention of an observer.
This implied that the
quantity and variety of institutional care might be regarded
as providing an adequate alternative to home care by the
mother at least up to the age of three months.
These
findings are surprising only if one simply takes for granted
mothers' care at home is generally superior to that of
institutionalized caretakers.
Research described by Brody and Axelrad (1970) was
planned to replicate the early investigation (Brody 1956)
with a larger sample, longitudinally rather than crosssectionally and in an urban setting.
She studied maternal
stimulation and responsiveness of the infant spanning the
whole first year.
These studies showed that there was a
significant relationship between high and low degrees of
social stimulation by the mother and corresponding high and
low degrees of social responsiveness of the infant at six
months.
20 -
Montagu (1971:110) viewed the mothering activity of
touch as an act of feeling something with the body, the
operative word being feeling.
He noted that "although
touch is not itself an emotion, its sensory elements induce
those neural, glandular, muscular, and mental changes which
in combination we call emotion.
Hence, touch is not
experienced as a simply physical modality, as sensation,
but affectively as emotion."
He discussed throughout his
book the mothering activities provided by close contact.
Among them are patting, stroking, caressing, and rhythmic
motions of the mother's body.
Montagu believed that by
being stroked, caressed, carried, cuddled, and cooed to,
the infant develops a feeling of being loved and thus
learns to stroke, caress, cuddle, coo to, and love others.
Evidence that may be interpreted as supporting the
singular importance of somatosensory deprivation in con­
tributing to developmental deficits is the study of
Ainsworth (1967) who reported precocious motor development
in African infants when contrasted to Caucasian infants.
Close physical contact with the mother during infancy was
considered an important social factor for this precocity.
In a recent study on African precocity Liederman et al.
(1973) found that Kikuya infants surpassed United States
test performance on thirty-eight mental test items and
twenty motor test items.
The Kikuya lagged behind on seven
mental test items and two motor items.
Liederman suggested
21
that the reason for this difference involved more physical
contact given the Kikuya infants during the first six months
of life by the maternal caretakers.
Pedersen, Yarrow, and Rubenstein (197 2) studied
mother-inf ant sensory interactions and related these inter­
actions to scores of mental and psychomotor development
obtained from the Bayley Scales of Infant Development plus
four additional measures derived from Bayley, namely, social
responsiveness, goal orientation, secondary circular reac­
tions (perseverative play), and object permanence.
The
results indicated that kinesthetic stimulation was the most
important sensory modality variable.
Thus as Prescott
(1972:14) stated: '
. . » vestibular stimulation (physical holding and
carrying) were significantly related to the
infants1 mental and psychomotor developmental
states as well as to the specific social and
cognitive-motivational variables. Particularly
interesting was the finding that passive and
active somesthetic (tactile) stimulation were
significantly related to only two of the dependent
variables, viz„, goal orientation and secondary
circular reaction. . . . v.isual and auditory
stimulation were related to only one dependent
variable, viz., social responsiveness.
Prescott believed that the study of Pedersen et al,
(.1972) clearly supported the greater potency of somatosensory
stimulation, particularly vestibular stimulation in infant
development.
The findings of easier (1965), Korner and
Thoman '(.1972), and Ainsworth (1967) are consistent with this
point of view.
Summary
The literature of touch and physical contact was
briefly reviewed.
The survey of tactile stimulation in
animals and humans revealed that physical contact does have
positive effects on the young infant.
noted
Prescott (1972:4)
that isolation-reared monkeys and institutionalized
^
children are in social-environmental conditions where
neither infant monkeys nor children receive sufficient body
contact and movement by being picked up, handled, and
carried.
Thus, both somesthetic (touch) and vestibular
(movement) sensory receptors and their projections to other
brain structures do not receive sufficient sensory stimula­
tion for normal development and function.
Emotional, physical, and intellectual malfunctioning
is known to occur among children in many institutions„
Some authors, Bowlby (1958) among the foremost, have alleged
that this malfunctioning is attributable to the deprivation
of maternal love.
It is more likely however, the depriva­
tion of maternal love can have ill effects only after
specific affective responsiveness has been achieved by the
child, usually at about six months of age.
Ill effects
found in children maternally deprived before this age
probably have some other cause.
Evidence is accumulating
both on the human and animal level that this other cause is
perceptual deprivation, that is, vestibular and other forms
of stimulation.
Recent neuro-physiological findings as
reviewed by Prescott (1971) from animal deprivation studies
explain why perceptual stimulation in the form of contact
and movement is so important for normal development.
It is
therefore important to discover if adequate contact and
movement forms are actually given to infants by caretakers.
This was the thrust of this study.
CHAPTER 3
METHODOLOGY
The research design is presented in this chapter.
The Setting'
The infants in this study were hospitalized patients
on a pediatric ward at a local medical center.
The care­
takers were employees in the hospital's pediatric unit.
The hospital is located in a southwestern city of approxi­
mately 415,000 population.
The center is a resource for
a variety of students in the health professions.
The Sample
Ten children were selected.
The following criteria
were used in sample selection:
1.
That the child was between newborn and six months
of age.
2.
That the child be free of serious medical problems
which required intensive care status or use of
numerous pieces of equipment.
3.
That the child be on oral feedings.
Permission for the study was granted by the Director
and the Assistant Director of the pediatric unit.
24
25
The chart and nursing care plan were utilized to
obtain background information.
Samples were selected after
personal observation of each child and review of records.
Research Design
This study involved direct observation.
collected in February, 1974.
Data were
Individual caretakers,
assigned by routine hospital procedure, were observed caring
for infants.
This method was chosen because it allows
recording while the behavior is taking place.
The focus of
the observation was on the behavior of the caretaker and the
quantity and quality of contact made with the infant.
This
researcher wished to observe and describe only the behavior
of the caretaker and learn, how much close bodily contact is
provided a small infant and the character of that contact.
A subject was selected and the researcher then
viewed the assignment sheet to learn the infant's caretaker.
The caretaker was approached by the researcher.
The in­
vestigator introduced herself and the purpose and plan of
the study were explained to insure uninterrupted observa­
tions.
if a mother was present in the room, similar ex­
planation was given before the session began.
The explana­
tion stated the project was to observe and describe the
variety of activities provided a small infant during
hospitalization.
26
The observer remained as unobtrusive as possible by
placing herself in a corner of the. room with visual access
to the child and caretaker.
Continuous notes were taken
beginning when the caretaker entered the room and ending
when she left the room without the infant.
If the caretaker
carried the infant out of the room the researcher followed.
The period of observation chosen was approximately two
hours.
The hours were at times when feeding would be
included in the activity of the caretaker.
The time was
recorded at the beginning of each session; the time the
caretaker entered and left the room; the beginning and end
of each behavior episode; and the end of each session.
This
was done so that the hours could be divided into natural
units of behavior for later study.
Data Collection
Information gathered about the caretaker included:
the nursing status, ethnic identity, and sex.
Nursing
status referred to Registered Nurse, Licensed Practical
Nurse, and Nursing Assistant.
Ethnic categories were
Caucasian, Mexican-American, Black, Indian, and Oriental.
Infant information included only birthdate and sex
(Appendix A).
A schedule for caretaker activities was adapted from
Chamorro et al.
(1973).
These touching behavior categories
were used to facilitate observation of common caretaker
27
behavior and to facilitate notations regarding what occurred
during behavior episodes (Appendix B).
CHAPTER 4
PRESENTATION AND ANALYSIS OF THE FINDINGS
This chapter presents the characteristics of the
sample, categorization of the data, and analysis and dis­
cussion of the findings as related to the statement of the
problem.
Characteristics of the Sample
The sample population was composed of ten infantcaretaker units (the infant-caretaker combination).
The
infants ranged in age from three weeks to six months.
of the infants were female and six were male.
Four
Two had
intravenous feedings and a third had a recent cleft lip
repair with a Logan bow across the mouth.
Seven infants
were free of equipment.
A total of seven different caretaker-persons were
observed.
All were female.
Mexican-American.
Six were Caucasian and one
There were two licensed practical nurses
and five registered nurses.
Whether the registered nurses
were from diploma, associate, or baccalaureate degree
programs was not ascertained as it was not considered an
important aspect of the study.
Three of the ten caretakers
were observed twice; one LPN and two RN's.
28
29
Categorization of the Data
The raw data included thirty-six pages of copious
notes with some drawings showing position alignment.
Times
were noted to divide session length, caretaker entrance and
exit from the room, and behavior episodes.
Accurate timing
of some behavior episodes was not accomplished as the
researcher was kept so occupied describing position and
activities there was failure to look at the watch.
Those
times that were noted are listed in the tables.
The schedule of caretaking activities (Appendix B)
was used in ordering the data into functional and non­
functional units and categories related to the quantity and
quality of contact.
the data:
The following categories emerged from
content of caretaker activities, characteristics
of caretaker contact, area and frequency of infant body
contact, distinguishing features of holding and carrying
patterns, places carried by individual caretakers, pick up
patterns of caretakers, positions and related frequencies
of the burp, diaper change, summary of the content of con­
tact behavior by individual caretakers and behavior which
accompanied touch.
The information in these categories
focused on the caretaker.
The nature of the contact was not analyzed for
cultural differences, as the sample of ethnic identities
was small.
Individual differences were noted but whether
these were cultural was not the concern of the present
30
study.
Contact differences between female-male infants and
whether caretaker personnel status had any bearing on the
character of the contact was also not determined, as this
was not the thrust of this study.
The Findings
The two questions proposed in this study asked how
much bodily contact was provided a hospitalized infant by
the caretaker and what was the character or quality of that
contact.
Contact comfort was defined as the infant's bodily
contact to the torso of the caretaker.
Data pertaining to
the characteristics of the sample and findings related to
quality and quantity of contact are summarized in Table 1.
The data presented in the first table do not reflect
the total time the child received adult contact,
In ob­
servation number one, the infant was given to its mother by
the caretaker.
The mother held the child close to her body
with torso contact for twenty more minutes»
Observation
number two was the only subject fed in an infant seat and
therefore had the least torso contact time by the assigned
caretaker.
When that same infant was handed to a fellow
nurse, the child received twenty more minutes of close
torso contact as the nurse held the infant cradled in her
arms close to her torso as for the nursing position.
The
infant in observation three was held in close torso con­
tact by the unit clerk for ten minutes before the assigned
Table 1.
Caretaker
Nursing
Status
Ethnic
Identity
1
LPN
Cauc
.
I
'4,
'.
Characteristics of the Sample
- Assigned
Caretaker
Torso Contact-'
Timek
Assigned
Caretaker
Total Time
wit h Child
20 m i n .
'•
_ '.
. .5 m m
... 56 m i n
; •• ’
Subject
Sex
2-1/2 hours
.
1
Fe
6 mo.
0
Logan Bow
Age
Equipment
41 min
2 hours
2
Male
3 mo.
. • 2 5 min
25" m in
1^1/2 hours
3
Fe
3 wks.
Cauc
25 m i n
"• /26 m i n
2 hours.
4
Fe
2 mo.
RN
Cauc
3 9 min
1-1/2 hours
5
Male
1--1/2 mo.
0 .
6
RN
. Cauc
15 min
•3 5 m i n
• 1-1/2 hours
6
Male
1 mo.
IV
7a
RN
Cauc
20 mi n
50 m i n
1-1/2 hours
7
Fe
2 mo.
0.
8a
RN
Cauc
25 m i n .
2 hours
8
Male
5 mo.
IV
9a
LPN
M-A
20 m i n
3 9 min
1-1/2 hours
9
Male
3 mo.
0
ioa
LPN
M-rA
• 15 m i n
22 m i n
10
Male
1 mo.
0
2a
RN
Cauc
3
RN
■Cauc
,4a
RN
5
■
;
Researcher
Observation
• Time
52 mi n .
x‘ 48 m i n
.
1 hour.
■o
■
2, 7 indicate one caretaker;
•;!
1
Consisted of: 1. Horizontal placement of the infant to the torso of the caretaker and cradled
in the arms as in the nursing position..
2. Upright placement of the infant to the torso or shoulder of
, : •
. /• •
!
■ the caretaker. ■
: . ,
• .v.'
'■
!
^Caretakers observed t w i c e . Numbers 9, 10 indicate one caretaker;
8 indicate one" c a r e t a k e r ,
,
0
'
b
:
to
H
32
caretaker assumed holding the baby.
Observation numbers
one, six, and nine had less torso contact because the care­
takers fed the infants in a holding position in which the
head, was leaning against an extended elbow some distance
from the torso of the caretaker.
Observation numbers one
and seven were the only infants who received a bath in the
sink.
Bathing was not considered close body contact because
the infants were held away from the body and supported with
only the arms and hands of the caretakers.
The infant in
observation number eight was in acute respiratory distress
with hyperventilation and the caretaker spent twenty-three
minutes in and out of the room, observing the child without
touching him and using some of that time to contact the
doctor and report the infant's condition.
Caretaker Activities
Most caretaker activities began in the infant's
room.
At the beginning of the observation sessions five
subjects were located in the crib in the room; two were in
isolettes in the room; two in bassinettes; one in a playpen
in the hall.
Of the ten infants observed three were seated
in an infant seat (two in their cribs and one in the play­
pen).
Three were lying on their stomachs in the cribs and
four on their backs.
A taxonomy of caretaker activities is summarized
in Figures 1 and 2.
The activities were divided into
33
bathes
burps
carries
changes linen
cleans
combs hair
diapers
dresses
dries
feeds ---
r
L
by bottle
by spoon .
. . . ,
,, /holding in arms
in bed
gives med
t _
.
P in bed
gives postural drainage — [ Qn
neck
head
groin
chest-abdomen
inspects
positions
rinses
shampoos
slides
suctions
nose
mouth
.takes rectal temp
with bulb syringe
lying on stomach
L lying on back
mother
_ r-
transfers child to another person
fellow nurse
unit assistant
undresses
undiapers
wraps
Figure 1.
with baby blanket
with bath towel
Functional Units of Caretaker Activities
34
blows hair on head
bounces knee
caresses face
gazes
holds
kisses
rtongue
makes sounds with ---- - lips
- rattle
talks
taps
touches
pats
rubs
strokes
supports
swivels baby
1
r in chair
r o c k 3 ----------- — { w i t h b o a y ■
picks child up
plays
puts child down
Figure 2.
Nonfunctional Units of Caretaker Activities
functional and nonfunctional units.
The nonfunctional units
were a part of the functional activities.
This researcher
perceived that every action made by the caretakers toward
the infants began as a functional task; the other activities
occurred during these functional procedures.
Play was seen
during feeding times but was not observed to be initiated
per se.
The caretakers always began a functional task first
and incorporated the nonfunctional units into their
functional pursuits.
Most of the touching, movement, sound,
and other behaviors were also initiated during a functional
procedure.
Characteristics of Caretaker Contact.
Caretaker
contact was noted to occur in a variety of forms.
episodes of caretaker behavior were identified.
include:
Nine .
These
pats, strokes, rubs, kisses, taps, caresses,
percussion, touch, and support.
This variety of charac­
teristics of contact was divided into areas and frequency
of infant body contact and summarized in Table 2.
Each of
the nine episodes present distinctive features and are
defined as follows:
Pats were noted as motions used to burp
an infant by gently slapping with the hand.
Pats were also
observed as motions of comfort used when the infant was
crying and for spontaneous reasons unknown to the researcher
when the child was being held or carried.
Strokes were
viewed as motions of sliding the hand or fingers in one
Table .2,
Frequencies of Contact According to Infant Body Area
Rubbed
Body Area
Caressed
Body Area
f
Patted
Body Area
f
Kissed
Body Area
f
SuoDorted
Body Area
f
Tapped
Body Area
f
Percussed
Body Area
Face
1
Abdomen
1
Cheek
2
Buttocks
2
Cheek
1
Chest
3 min.
Head
1
Back
Forehead
2
Under chin
4
Chin
1
Back
8 min.
Top of
Head
5
Back of
21
head & neck
Lower lip
1
8
Chest &
Abd.
15
Head
1
4
Entire
body
83
Nose
1
a. horizontal
42
Touched
Body Area
f
Stroked
Body Area
Ana
2
Arm
Buttocks
5
Back
8 plus
bath
Buttocks
1
Back
5
Buttocks
bath &
Desitin
Chest
1.
Buttocks
1
Cheek
7
Cheek
4
Groin
1
Chest
Chin
5
Chin
4
Head
shampoo
Thigh
Ear
2
Ear
1
Legs
lotioned
Finger
1
Feet
1
b. Upright 41
Hand
2
Forehead
1
Ankles and 12
lower legs
Head
1
Groin
Desitin
Under arms 59
Lip
1
Hand &
.finger
Nose
1
Knees
Shoulders
4
Lip
1
Testes
1
Meek
3
Thigh of
leg.
8
Top of
head
Whole leg
2
1
2
lotioned
19
Back
9 plus
bath
60
Hand
1
Feet
1
Thigh
4
f
direction along the baby's body or part thereof, with light
pressure.
Strokes accompanied rubs during burping and were
used alone during the bath and application of lotion or
ointment to parts of the infant's body.
One caretaker used
strokes in between episodes of feeding and burping when she
stroked the infant's cheek and head several times.
Rubs
consisted of constant hand motion with friction of faster
and shorter duration than strokes.
The direction for rubs
was either circular, up and down, back and forth, or any
combination of the above,
Kisses occurred occasionally and
consisted of the infant being touched with the lips of the
caretaker.
Taps were demonstrated by one caretaker in
particular, and consisted of light, brief blows applied to
the infant's body or parts thereof, with the fingertips.
Caresses occurred occasionally and were noted as a light
touch of the caretaker's face to areas of the infant's body
Percussion, the motion of rhythmically beating the chest or
back for the purpose of postural drainage was observed in
two instances.
Here, the hand or an infant-sized rubber
face mask was used„
Touches were noted when the hand of
the caretaker was resting on any part of the infant's body.
Supports occurred when the infant's body or various parts
thereof were touched in order to hold or maintain a grasp.
In deciding the frequencies the number of separate
strokes were not counted during bath time nor during
application of Desitin ointment and baby lotion, as this
38
was a different order of information than in what the
researcher was interested.
The exact number of strokes were
counted when they occurred at times other than the above
because they occurred infrequently and could be noted with­
out difficulty.
Rubs and pats were considered as cumulative epi­
sodes.
Each episode counted contained an unknown number of
individual pats or rubs.
During the shampoo, as well as
during burping episodes, the individual number of rubs
that occurred were not counted.
Other frequencies like
kisses, caresses, taps, touches, could be counted exactly
as they occurred so infrequently.
Areas percussed are noted in minutes because the
number of individual pats percussed are unknown.
Caretaker
number six percussed the infant while
on her lap for three
minutes on his chest and four minutes
on his back.
Care­
taker number nine percussed her infant, who was lying on his
stomach in the crib, for four minutes
on his back only.
In areas supported, the buttocks were lifted up and
supported to bring a nightshirt down to the infant's feet
and to lift up and hold a position on the side while a
blanket roll could be placed to sustain that position.
The
category chin support was observed mainly during burping
as the child was sitting on the lap of the caretaker and
was leaned forward to pat on the back.
The back of the head
and neck support occurred when the infant was either picked
39
up and carried or when feeding the infant to maintain a
sitting position on the lap.
Chest and abdomen support
occurred when maintaining the infant in a sitting postion on
the lap and when holding the infant against the abdomen of
the caretaker.
The back and entire body was supported
mainly when holding the child upright over the shoulder or
against the chest and when cradled horizontally next to the
torso.
The provision ,of the latter was the type of contact
comfort in which this study was most interested.
Ankles
and lower legs were held or supported for diapering and
carrying to the sink for a bath.
supported when the infant
The under arms were
was picked up and put down. The
hand and feet were held for brief moments for unknown
reasons when a caretaker was standing near and looking at
the child.
The thigh was grasped and supported with the
caretaker's hand when holding the child on the lap and
during the bath.
Taxonomy of Holding Patterns.
Holding patterns are
classified according to the relationship of the infant's
body to parts of the caretaker's body.
accordingly:
(1) recumbent lap, (2) horizontal torso,
horizontal underarm,
torso,
(4) upright shoulder,
(6) sedentary lap,
sedentary lap,
They are labeled
(5) upright
(7) supine or prone
(9) flexed abdomen,
(3)
(10) prone
lap, (8)
semi-
abdomen,
(11)
40
upright reclining torso.
Table 3 summarizes these posi­
tional patterns.
The manner in which the infants were carried, and
the ways they were held, were overlapping categories.
Figures 3 and 4 summarize distinguishing features of care­
taker holding and carrying patterns.
In numbers 9 and 10 of
Figure 3 the child was three weeks old and quite small.
Thus he could be safely and comfortably held in this posi­
tion.
bed.
Infants were held in the arms, on the lap, and on the
Two infants were held seated on the bed and a third
was held standing on the bed.
The infant was carried to numerous places.
include:
These
to the sink for a bath, to bed, to a chair so the
caretaker could sit down, to the nurses' station.
the infant was carried to the nurses' station were:
Reasons
to
fetch the charge nurse; to fetch jellow water, formula, or
a nipple; to sit at the nurses' station and feed.the infant;
to show a doctor where otoscopes were kept; to talk to
fellow nurses; to obtain a medicine from the med cart.
Infants were also carried to another room while the care­
taker went to check on another patient, an IV, or search
for an infant seat.
One caretaker carried her infant to
the diaper pail a few feet away, then to turn on the TV and
to fetch a chair from across the room.
Another carried the
infant from a playpen in the hall to the room and back to
bed.
Table 3.
Holding Patterns; Relationship of Infant to Caretaker
Infanta
Caretaker
Horizontal
Recumbent
Knees
Flexed
Vertical
Horizontal
Prone
Position 6.1
Lap
Position 1
Position 8
Position 6,2
Position 7
Torso
front
Position 2a
Position 9
Position 5
Positon 10
Torso
side
Position 3
Arm
Position 2b
Shoulder
Vertical
Reclining
Position 4
^Position numbers are related to numbered pictures in Figure 3.
Position 11
42
Recumbent lap
1.
The infant was placed on his
stomach across the caretaker's
thighs. One of her hands
supported the chin and one
hand rested on the back.
Horizontal torso
2.
The infant was held
horizontal to the
torso of the caretaker
a, with torso contact,
that is, cradled
in the arms, as in
the nursing posi­
tion .
b. without torso
contact, leaning
against the arm
and away from the
torso,
Figure 3,
Description of Holding Patterns of Caretakers
43
Horizontal underarm
3,
The infant's body was held
horizontally under an arm
like a football for shampoo,
Upright shoulder
4.
The infant was held
upright over the
shoulder or upright
against the chest,
Upright torso
5.
The hands of the caretaker
were under the arms of
the infant.
Figure 3.— Continued Description of Holding Patterns of
Caretakers
Sedentary lap
6.
The infant was seated on
the lap
6.1 away from the care­
taker's torso with
(6.1a) knee lean and
(6.1b) without knee
lean.
6.2 with torso contact.
Supine or Prone lap
7.
7
The infant was placed lying
on the caretaker's lap on
his back or stomach;
slanted downward or on a
straight plane.
Figure 3.— -Continued Description of Holding Patterns of
Caretakers
45
Semi-sedentary lap
8.
The infant was held in a
semi-sitting position by
the hands of the caretaker
on her lap.
Flexed abdomen
9.
The infant was placed
against the caretaker's
abdomen with the head
hanging forward and the
caretaker's arm across
the infant's chest.
Figure 3.— Continued Description of Holding Patterns of
Caretakers
46
Prone abdomen
10
10. The infant was placed in
horizontal position on the
stomach over the care­
taker's left arm which was
against her body. Later the
caretaker placed her right
arm over the infant.
Upright reclining torso
11
11. The infant was lying on the
abdomen and chest of the
caretaker as she leaned
back in a chair.
Figure 3.--Continued Description of Holding Patterns of
Caretakers
47
1.
The infant's ankles were
grabbed with one hand and the
back of the head was supported
with the other hand.
2.
The infant was carried
horizontal to and in contact
with the torso of the care­
taker and cradled in the
arms, as in the nursing
position.
3.
The infant was carried
upright over the
shoulder or upright
against the chest.
Figure 4.
Description of Carrying Patterns of Caretakers
48
4.
The infant was carried against
the caretaker's abdomen with
the child's head hanging
forward and the caretaker's
arm across the infant's chest.
5.
The infant was placed and
carried in a horizontal
position on the stomach over
the caretaker's arm which was
against her body. One hand
was over the back and buttocks
6,
The infant was carried with
the right hand over the
buttocks and under the groin
through the crotch. The left
hand and arm was placed across
the infant's chest with the
child facing the floor.
4
.6
Figure 4.— Continued Description of Carrying Patterns of
Caretakers
49
7.
The infant was carried
horizontally across the
abdomen of the caretaker
with one hand under the
shoulder and one under
the buttock. The child
was facing upward.
Figure 4.— Continued Description of Carrying Patterns of
Caretakers
50
Figure 5 presents places where infants were carried
by their caretakers.
Caretaker number two and number seven
is the same individual; four and eight is the same person
and nine and ten indicates one individual.
Number two care­
taker transferred her infant from the bed to a chair then
gave the infant to another nurse who carried the child to the
nurses
station and back to bed.
That same person as care­
taker number seven carried subject seven to eight different
places.
In observation number three, the infant was given
to the caretaker by the unit clerk at the nurses? station.
and the caretaker carried the child to the room for a diaper
change and then back to the nurses station to feed.
The
individual numbered four and eight carried each subject four
times with slight variation.
The individual numbered nine
and ten diverged much more, with subject nine.
The sequence
of variation among caretakers was dependent upon the need or
want of the moment.
There were numerous position changes which supplied
the infant with brief vestibular-proprioceptive stimulation.
These changes in infant body position were most noticeable
when the infant was picked up or burped during feeding.
Caretakers were noted to pick up infants in several ways.
Table 4 summarizes these patterns and gives the frequency
related to each example.
The child was noted to be picked
up when the caretaker transferred the infant from some
surface area to her arms, usually the bed or infant seat.
51
Caretaker
#1 :
Caretaker
#2 ;
Caretaker
#3 :
Caretaker
#4:
to sink for bath
to bed
to chair
to nurses station to fetch charge nurse
to room to see another patient
to med cart at nurses station
back to room
to nurses station to fetch jello water
•to chair
to room
to nurses station
to corner of station to show otoscopes
to doctor ■ '
to another area of nurses station to
talk to nurses
to
to
to
to
nurses station for formula
room, to rocking chair
nurses station for nipple
bed
Caretaker
#5:
to
to
to
to
to
Caretaker
#6 :
•to chair
-to bed
Caretaker
#7
Figure 5.
nurses station for formula
chair
room to check IV
bed
nurses station to sit and resume
feeding
back to room where held while changed
blanket on bed
to rocking chair
to bed
to sink for bath
to rocking chair
to bed
out of room to find infant seat
back to room to bed
Places Carried by Individual Caretakers
52
Caretaker
#8 :
to
to
to
to
Caretaker
#9:..
to diaper pail
to bed
to turn on TV
to get chair
to bed
to chair
.
out of room to find infant seat
back to room to bed
Caretaker
#10:
chair
bed
chair
bed
from playpen in hall to room to bed
to chair
to bed
Figure 5.— Continued
53
Table 4.
Pick Up Patterns of Caretakers
Frequency
1.
2,
3.
4.
5,
6,
The hands of the caretaker are placed under
the arms of the infant.
59
One hand was placed under the infant's head .
while the other hand was under the buttocks.
4
One hand was around both feet and the other
hand supported the back of the infants head.
3
When the infant was lying on the right side,
the caretaker placed her right hand over the
buttocks and under the groin, through the
crotch. The left hand and arm was across
the chest,
1
The right arm of the caretaker was placed
under the infant's shoulder and the left arm
.under the buttocks.
.6
The hands of the caretaker were placed over
and behind the infant's shoulders.
1
54
The frequencies are approximate and were counted every time
the researcher noted the position specifically in her notes.
In pick up pattern number six, the infant was a small one
month old and the caretaker's hands were large enough to
cover the infant from the shoulders to the back.
An intrinsic part of the feeding pattern included
a
the burp.
«A burp is help given a baby to expell air from
the stomach.
The pattern consisted of strokes on the back,
pats on the back or chest, rubs on the back, or a combina­
tion of pats and rubs on the back.
The rub and pat combina­
tions included a rhythm of three pats and three rubs by one
caretaker and circular rubs plus pats by another.
The positions for burps are summarized in Table 5.
In the case of position number four (the child in the infant
seat) the movement of the seat was rapid and in a period of
ten minutes the infant had been moved up and down seven
times.
Another procedure performed in caring for infants
was the diaper change, an action which removes the used
diaper and replaces it with a clean one.
the steps observed during this change.
Table 6 summarizes
There are numerous
variations of this task, depending on what type of cleansing
is required.
served,
Only one stool-filled diaper change was ob­
The others were quick and easy changes in that
there was no leaving the bedside for a quick dose of water.
The diaper changes observed followed the touching patterns
55
Table 5.
Positions and Related Frequencies of the Burp
Frequency
1.
3.
Seated on the lap with the neck supported
under the chin.
Placed upright over the shoulder
11
Seated on the lap, with the body of the
infant leaning forward. One hand of the
caretaker supported the chest and abdomen»
15
4.
Seated in an infant seat. Here, the whole
seat was moved upward and forward and
after the burp downward and backward.
5.
Seated with one of the caretaker's arms
across the chest of the infant and under
his arms.
56
Table 6.
The Diaper Change
1.
The diaper was unfastened.
2.
The buttocks and/or groins were wiped. These areas were
wiped without water when only urine was present. When
stool was present, the clean top part of the diaper was
placed Over the stool and water was used to wipe clean.
3.
The ankles of both feet were! grasped and held, while the
feet and legs were lifted into the air.
»
4.
The infant's used diaper was removed.
5.
A clean diaper was slipped under the buttocks.
6,
The feet and legs were lowered onto the clean diaper.
7,
The diaper was fastened with safety pins or adhesive
tapes.
57
described in Table 6,
All caretakers grasped the ankles and
lifted the feet and legs into the air.
Some altered the
order of touching patterns„
Various patterns for cleaning the child were also
osbserved.
Cleaning consisted of actions which freed the
head, trunk, and extremities or parts thereof, from stains
of liquid or solid.
Cleaning was performed by immersing
the infant’s body into a sink with water during bath time;
by wiping the buttocks and groin area during a diaper
change; by wiping the infant's mouth with Kleenex, a corner
of the baby blanket, or washcloth during feeding time; by
a shampoo of the head.
The descriptive material presented in this study
shows that certain individual caretakers offered more body
movement in the form of rocking, swiveling, and bouncing
than others.
Some were more prone to rubbing, patting,
stroking, and kissing.
Popular forms of contact were the
upright over the shoulder and the horizontal against the
torso placement of the infant.
These positions were the
ones which interested this researcher.
variety of reasons.
They were used for a
In order to encapsulate individual
style a summary of the content of contact behavior by indi­
vidual caretakers is presented in Table 7.
Caretaker number two was the only person who patted
the chest of the infant and this was done for burping
purposes.
During the course of feeding, position changes
58
Table 7.
Summary of Content of Contact Behavior by
Individual Caretakers
Caretaker #1:
Patted infant's back four times. Stroked
during the bath, application of desitin to
groin and buttocks, and during application of
lotion to neck, Rubbed to bathe and to dry
after the bath. The back was rubbed twice,
accompanied by a patting sequence of three
pats to three rubs„ The infant was placed
upright over the shoulder to burp and to hold
once, to carry, three times. The horizontal
nursing position with torso contact was used
three times in feeding, once to carry, and
once to give medication.
Caretaker #2:
Patted infant's back five times and chest
eight times. No strokes or rubs were noted.
The infant was placed upright over the
shoulder once to burp and once to carry.
Caretaker #3:
Patted infant's back five times. No strokes
or rubs were noted. The caretaker rocked her
body forward and backward mostly? occasionally
she moved from side to side for a total of
seventeen minutes of almost continuous body
motion. The infant was placed in the
horizontal nursing position with! torso
contact for a total of twenty minutes,
seventeen of those minutes with, body rocking.
Caretaker #4:
Patted back six times. No strokes or rubs
were noted. Sat in rocking chair and rocked
thirteen minutes continuously. The infant
was placed upright over the shoulder once to
wrap, once to carry, four times to burp, and
twice to hold. The upright position against
the chest was used once to carry. The
horizontal nursing position with torso
contact was used six times during feeding,
once to hold, and twice to carry the infant.
59
Table 7.— Continued Summary of Content of Contact Behavior
by Individual Caretakers
Caretaker #5:
Patted back thirteen times, buttocks once,
and thigh four times. Stroked buttocks with
a moist cloth to clean, several times„ The
head, neck, and back of the infant were each
stroked twice, and an unknown number of
strokes were used.to apply lotion to the
knees. The back was rubbed with a circular
motion four times and once with an up and .
down motion. The cheek was kissed twice and
the head five times. The face was caressed
once as was the head of the infant. The
child was placed upright against the chest
once to hold and once to carry. The upright
over the shoulder position was used three
times to burp, twice to carry, and once to
wrap the infant. The horizontal nursing
position with torso contact was used four
times during the feeding, once to carry and
once to hold. The caretaker rocked her body
forward and backward for a nine minute inter­
val, then she swiveled her body from right to
left. The first swivel episode contained
approximately four swivels, the second about
six. She then reverted back to body rocking
for three more minutes and bounced the infant
on her knee three times. She swiveled her
body with the infant on her knee from right
to left twice and resumed body rocking for
two minutes. The infant was then given five
more body swivels. Swivel movements totaled
nineteen and knee bounces, three. The body
rocking totaled approximately fourteen
minutes with an on and off sequence ?
Caretaker #6:
Patted back four times. Head was stroked
four times„ No rubs were noted. The
infant's back was percussed for four minutes
and chest for three minutes« Body rocking
was begun from side to side after percussion
which was accomplished on the lap. After one
minute of body rocking the movement stopped
and was not resumed. The infant was placed
upright over the shoulder once to burp and
twice to carry. The horizontal position with,
the infant leaning against the arm with no
■torso contact was used during feeding,
60
Table 7.--Continued Summary of Content of Contact Behavior
by Individual Caretakers
Caretaker #7;
Patted back nine times and abdomen once.
Stroked back with up and down motion twice
and twice with a back and forth movement.
The body was stroked during the bath. The
infant was stroked twice under the chin and
once on the head. The back was rubbed with a
circular motion three .times, The body was
rubbed an unknown number of times during the
bath and during the drying period. The head
was rubbed vigorously an unknown number of
times during the shampoo and head drying
period. Lotion was rubbed on both legs,
chest r groin, and buttocks after the bath.
The caretaker sat in a rocking chair and
rocked continuously for fifteen minutes
during feeding. The infant was not placed
upright over the shoulder during the time the
caretaker was with the infant. The upright
position against the chest was used twice to
carry and the horizontal nursing position
with torso contact was used three times
during feeding, twice to carry, and twice to
hold»
Caretaker'#8■:
Stroked the infant's hand twice. No pats or
rubs were noted, The infant's head was
touched twice, the arm and fingers once, The
upright over the shoulder position was not .
used. The horizontal nursing position with
torso contact was used twice to carry and
once during bottle feeding. The infant was
seated upright on the lap against the torso
to feed baby foods by spoon,
Caretaker #9;
Patted infant's back ten times. Stroked
once under the chin, once the chin and lip,
once the ear. The top of the head was stroked
five times, the cheek four and the back of
the head, three. No rubs were noted. The
forehead, cheek, and chest were tapped once
with a small Baby rattle. The forehead was
kissed once. The infant's cheek was touched
with a finger and the buttocks with a hand
while the back was being percussed. The back
was percussed for four minutes while the
child was lying on the stomach in the crib,
61
Table 7.— Continued Summary of Content of Contact Behavior
by Individual Caretakers
The infant was placed upright over the
shoulder twice to carry and once to burp.
The horizontal nursing position with torso
contact was used five times during feeding,
four times to carry, three times to hold,
once to wrap in a baby blanket.
Caretaker #10: Patted back four times. Stroked head four
times. The neck and forehead each were
stroked one time. Thre were no rubs noted.
The lower lip was tapped once with a finger
as was the cheek, chin and head. The right
outer ear was lifted with the finger twice
during inspection of the scalp. This care­
taker twice blew on the infant's head and
hair as she combed the hair. The forehead
was kissed one time. Body movement was
initiated for a few seconds from side to side
and ceased. The infant was placed upright
over the shoulder twice to carry. The
horizontal nursing position with torso contact
was used three times during the feeding and
once to hold.
62
were numerous.
When deciding how often the upright over
shoulder and horizontal torso positions were used during
feeding, every position which began in the upright or
horizontal torso contact position was counted as one, as
was every reversion back to that position.
Also noted were
the number of times these positions were used for reasons
other than feeding.
It was observed that the upright and
horizontal positions were also used to burp, hold, wrap,
and carry.
The horizontal torso position was used to give
medication by caretaker number one.
Infant number eight was
the only child observed who was fed baby food by spoon.
Two
other caretakers giving infants baby food, fed the solids
before the researcher arrived and therefore only bottle
feedings were observed except in the above mentioned case.
In Table 7 a pattern of behavior can be discerned in which
some people seem to "specialize."
We observed patters,
rubbers, sbrokers, tappers, body rockers, swivelers,
bouncers, and body blowers.
Blowing on the skin was per­
ceived as an extension of the idea of touch.
Back and chest
patters were observed with back patters being the most
common.
Behaviors Accompanying Touch
In the statement of the problem, the question posed
concerned the character of contact provided.
occur in isolation.
Touch does not
An interesting array of behavior
63
accompanied touch.
content.
Table 8 summarizes the behavior and its
The primary modes consisted of sound and body
movement.
Sound was divided into three categories:
articulate, inarticulate, and sonic.
Some sounds were
words, others were noises made with the tongue or lips,
while another was made with a rattle.
Sonic was used to
describe the noises made from sources other than the care­
taker.
Talk sounds were divided into baby talk and conver­
sation talk.
Baby sounds heard were "goo,'"
do," and "ba ba do do da."
"di di do do
Utterances were further sub­
divided into phrases and sentences said in a normal tone of
voice and those said in a high-pitched sing-song tone
(Appendix C).
The inarticulate tongue and lip sounds were
made very close to the infant's ear.
Another category was gaze.
in four caretakers.
Gaze was most noticeable
Observer notes mentioned "gazing at
child" twice as often in observations four, five, nine, and
ten than any others.
individual.
The caretaker for nine and ten is one
Gazing time was not noted because the re­
searcher was more occupied with observing contact positions.
The items listed under play were so designated
because they were done in a light, sportive manner as if to
amuse.
Dangling the stethoscope in front of the infant's
eyes, shaking the rattle, and the bobbing of the caretaker's
head toward the infant's chest along with bringing the face
Table 8.
Sound
Behavior of Caretakers which Accompanied Touch
Body Movement
Play
Gaze
A, Rock
A. Dangled.
A. Articulate
A prolonged,
1, in rocking
stethoscope
fixed, intent
1, Baby talk
chair
in front of
2. Conversa­
look at the
2, with body,
infant's eyes infant's face.
tion talka
a, forward
and moved it
a, normal
side to side.
& back­
tone
ward
b. Sing­
song
b. Side to B. Shook a
tone
side
rattle in the
air and
tapped infant
B, Inarticulate B, Swivel
1, Use of
1„ A right to
on the nose
tongue
left swing
with rattle.
a , soft
of body in
a chair,
C. Bobbed head
click
toward infant 's
b. dull
chest, coming
cluk
C, Bounce
c . soft
1, of knee
close but no
contact,
tkftkf
2, Use of
lips
D, Brought face
a, soft
close to
infant's face
P^P-P
without con­
C f Sonic
tact.
1. Use of
small toy
.rattle
Blow
A current of
air sent from
the mouth to
infant's head
& hair.
aAppendix C notes all the phrases or sentences categorized in this manner.
65
close to the infant's face were noted as play for that
reason.
Only one caretaker, number ten, was observed blowing
the head and hair of her infant.
The child had a yellow
scaling on the scalp and was given a shampoo earlier.
The
caretaker inspected the head to check if the cradle cap had
been removed.
It was at this time she blew on the head and
hair, combed the hair, blew, and again combed, apparently
satisfied the child's scalp was clean.
Summary
A large volume of raw data was collected in ten
observations lasting approximately one and one-half to two
hours each for a total of seventeen hours.
A wide variety
of individual patterns were observed and categorized.
Common behaviors such as carrying, holding, diapering,
burping, patting, and rocking were analyzed according to
individual patterns and quantity and quality of contact was
summarized.
Touch was the main vehicle by which caretakers in
this institution communicated with infants.
The descriptive
material shows that the hospitalized infant is provided with
a variety of contact and movement along with a number of
other behaviors that accompany touch.
\
CHAPTER 5
INTERPRETATION OF THE FINDINGS
Presented in this chapter are the generalizations,
conclusions, implications for nursing, and recommendations
of this study.
Generalizations
Touch is an essential form of communication to the
neonate and young child.
Loving and affectionate feelings
are expressed through the sense of touch.
Almost simul­
taneous with the feeling of liking something is the urge to
reach out, to touch and experience it directly.
In this study almost all contact between the care­
taker and infant involved movement.
Brief position changes
during the course of feeding were numerous.
A variety of
contact and movement patterns were observed because of indi­
vidual differences in caretaker performance.
The various
behaviors were seen as byproducts of procedures performed.
It would seem there are several forms of stimulation
involved in contact comfort, including tactile, cutaneous,
thermal, auditory, and kinesthetic.
The most popular form
of contact involved physical contact with the upright and
horizontal positioning of the infant against the caretaker's
I
torso.
Touching mannerisms, sound, cutaneous blowing, and
67
rocking were perceived as an integral part,of individual
caretaking style.
Conclusions
From the data presented in the preceding pages and
considered in the perspective of the review of literature,
the following conclusions were derived:
1.
Individual caretakers offer a variety of touchmovement forms.
2.
The touch pattern of patting was common to all care­
takers.
. 3.
Caretakers were commonly observed to pick up,
handle,fand carry infants.
4.
Body position changes were frequently observed to
occur during feeding time.
5.
The most popular forms of contact were the upright
over the shoulder and horizontal against the torso
placement of the infant.
i
6.
Behaviors such as sound, gazing, blowing, body
movement, and play accompanied contact.
Implications for Nursing
In dealing with infants and small children, the
nurse should be aware of the need for contact comfort.
The
infant requires close body contact accompanied by a variety
of body movement, to insure healthy neurophysiological and
psychosocial development.
The findings of Casler (1965),
Ainsworth
et al.
(1967), Korner and Thoman (1972), and Pedersen
(1972) document that somatosensory stimulation,
particularly physical holding and carrying, is necessary for
infant development.
Sharing the care of an infant among
members of the pediatric staff can offer individual varia­
tion in touch'-movement forms.
An atmosphere conducive to
fulfilling the touch-movement needs of infants and small
children seems to be one where there is freedom to carry
the child out of the confines of his room to varied per­
sonnel and places of activity.
In instances where this is
not possible, such as isolation cases, the nurse needs to
bring activity and varied personnel to the confines of the
infant's room for frequent short holding and movement
periods.
Recommendations for Further Studies
Recommendations arising from this study are:
1.
Replication of this study in other hospital settings
to compare differences of caretaker contact comfort
patterns.
2.
A study comparing amount of nursing experience and
education and quantity of contact of the caretaker.
3.
A study investigating play forms between infant and
caretaker in a hospital setting.
A study investigating various cultural groups and
infant contact comfort patterns for cross-cultural
comparisons.
A study investigating the number and type of brief
position changes, during feeding time.
CHAPTER 6
SUMMARY
The questions which led to the inception of this
study were twofold.
they touch them?
Do caretakers touch babies?
How do
The purpose of this study was to observe
and describe an assigned caretaker's contact with a hospi­
talized infant.
The setting comprised an inpatient pediatric ward
at a local medical center in a large metropolitan community
in the southwestern United States.
The conceptual framework was based on the idea that
there is a need for intimate physical contact in human
infants and that this contact plays a role in the develop­
ment of affectional responses.
This theory was derived
from controlled experimental studies of nonhuman primates
and has serious implications for the infant's psychosocial
development.
Review of the literature focused on three areas:
tactile stimulation, animal studies, and maternal activities.
Neurophysiological development requires stimulation.
The
research indicated that contact comfort involved a variety
of stimulation of which movement was most important.
70
71
Movement was found to be essential for the infant's neurophysiological development.
The investigator utilized direct observation with
continuous notes.
Times were noted at the beginning and
end of each session, caretaker's entrance and exit from the
room, and beginning and end of behavior episodes.
infant-caretaker units constituted the sample.
ranged in age from three weeks to six months.
The infants
A total of
seven different caretaker-persons were observed.
female.
Ten
All were
Five were registered nurses and two were licensed
practical nurses.
(There was one male on the personnel
roster; he was not observed.)
Six caretakers who were
observed worked on the day shift.
One worked nights.
Most
observations were taken on the day shift between eight and
three o'clock in the afternoon.
There were no observations
between three and eleven in the evening.
One observation
occurred between two-thirty and four o'clock in the morning.
It was this observation that most impressed me with the
variety of contact"movement forms.
The data for this study were categorized by care­
taker activities; characteristics of caretaker contact;
area and frequency of infant body contact; holding, carrying,
and pick up patterns of caretakers; places carried by indi­
vidual caretakers; position and related frequency of the
burp; positions of the diaper change; summary of the content
72
of contact behavior by individual caretakers; and behavior
content which accompanied touch.
The limitations of the study were:
of selected children was small,
(1) the sample
(2) the sample of observa­
tions was confined to those caretaker activities given to
newborns through six months of age with various medical
problems,
(3) the observations were made by only one ob­
server for a limited period of time,
(4) the observer was
unable to select and describe many significant aspects of
the total activities,
(5) the possible cultural taboos
present in individual caretakers regarding touch and pro­
fessional behavior, and (6) the study was carried out in
only one community hospital inpatient health care setting.
The nature of the contact was not analyzed for
cultural differences but for individual differences.
Whether these individual differences were based on culture
was not determined.
Neither were differences of contact
analyzed between female-male infants nor professional status
of the caretaker for any bearing on the character of contact.
The results of this study indicate that nurses offer
a wide variety of cpntact-movement stimulation in a setting
where personnel seem free to carry infants to areas outside
the confines of the assigned room.
Caretakers offered a
variety of pick up, holding, and carrying patterns with
movement to different spatial areas.
Certain individual
caretakers offered more body movement in the form of rocking.
73
swiveling, and bouncing than others.
talking, gazing, and playing.
patting, stroking, and kissing.
Some offered more
Others were more prone to
This investigation revealed
there was more contact and movement given the infants that I
had thought would be provided.
The most popular forms of contact were the upright
over the shoulder and horizontal against the torso placement
of the infant.
These data indicate that the tender inti­
macies which define this study's concept of contact comfort
were bestowed on infants in a hospital setting.
APPENDIX A
THE FACE SHEET
Appendix A contains the information gathered about
the caretaker and the infant.
Caretaker A:
\
_____ RN; _____LPN;
NA.
White
Mexican-American
Black
_Indian
_0r iental
Male
Subject A:
Female
Birthdate
; Male
74
Female_
APPENDIX B
SCHEDULE OF CARETAKING ACTIVITIES
Appendix B contains the schedule of observations
used in the study.
al.
This list is adapted from Chamorro et
(1973).
1. Holds— supporting the infant's entire body in arms or
lap.
2. Supports— in crib or isolette.
Occurs when the back
and neck of the subject are held as for a s-itting
position.
3. Caresses face— gentle stroking of infant's face with
the caretaker's hand or fingers.
Kissing or snuggling
of the caretaker's face against the infant's face.
4. Pats— includes motions of burping the baby and any body
caresses.
not.
Pats can occur whether the child is held or
Consists of stroking of any part of the child's
body with the apparent intent of soothing or burping.
5. Touches— noted when the hands of the caretaker rest on
any part of the infant's body.
6. Picks child up—-transfers the child from some surface
to arms.
75
76
7.
Picks child up and holds upright— so that the body of
the infant is in physical contact with the torso or
shoulder of the caretaker.
8 . Picks child up and holds horizontally— to the torso of
the caretaker and cradled in the arms as in the
nursing position.
9.
Puts child down— transfers child from her arms to
another surface.
10 . Bathes— cleansing any part of the body other than the
head.
11 . Shampoo— cleansing the head.
12 .
Feeds by bottle— direct contact with the nipple.
13.
Diapers.
14.
Dresses.
15.
Wraps in blanket— includes both wrapping and unwrapping
the infant.
•
Noted if any part of the act takes place
during the period of observation.
16.
Adjusts position— manipulation or rearranging of the
child's body to make him more comfortable, for better
oxygenation, or other therapeutic reasons.
Position may
be adjusted whether the child is in the caretaker's
arms, lap, or in the crib or isolette.
17.
Rocks— in rocking chair or with motion of caretaker's
body.
18.
Other— specify.
Example:
takes temp or gives med.
77
19.
Location of the subect— whether in the crib, .arms,
seated in an infant seat, in or out of the room.
If
out of the room, specify.
20.
Position of the subject— whether lateral, on stomach,
back, or seated.
APPENDIX C
CONVERSATION ACCOMPANYING TOUCH
Appendix C contains direct quotes made to the infant
the assigned caretaker.
Part A.
Phrases and Sentences Spoken
in a Normal Tone'
"That's what you wanted isn't it?"
The child had just
been removed from an infant seat and placed on the
stomach.
"Momma's here."
This was stated as mother entered the
room.
"Here we go."
'
A formula feeding from a syringe was
about to be given the infant with the cleft lip repair.
"Ok, ok, take it easy, we're almost done."
This
pertains to the syringe feeding for the cleft lip
repair.
"Are you wet and dirty?"
Said as caretaker approached
the crib.
"Don't wave that hand around."
The hand had an IV.
"Now don't you have a stool, you're all clean."
Said
after a diaper change.
"You want to watch Sesame Street?"
taker went to turn on the TV.
Said as the care­
79
9.
"You sure are funny."
Said as the caretaker was
looking at the child.
10,
"That just scared you."
The child had burped and
began to cry immediately afterward.
11.
"You're not eating well, what am I going to do with
you?"
12 .
"Don't go away. I'll be right back with my stetho­
scope. "
13.
"Guess I'll have to call the doctor and tell her
you're having difficulty in breathing."
14.
"I called the doctor to come and look at you."
15.
"That feels good, huh?"
Said as the caretaker per­
cussed the infant's back.
16.
"Guess I'll put this on you" (shirt).
17.
"I'll be right back."
The caretaker forgot to bring
in a nipple and left to get one,
18.
"Have you had enough?"
19.
"You like that?"
(formula).
Said as the caretaker moved the
nipple around in the infant's mouth.
20 .
"Your head got a good scrubbing, your head looks much
better."
Said as the caretaker inspected the head for
cradle cap, which she had removed earlier with a
shampoo.
21 .
"I'm sorry I forgot."
The caretaker had put the infant
to bed and remembered a medicine had to be given him.
"That's all now."
Said as the medication was emptied
from the squeeze tube.
Part B. Phrases and Sentences Spoken
in a High Pitched Sing-Song Tone
"You're like a little bird."
"Tell me a story."
"What are you staring at, Angela?"
"What are you looking at?"
"All done"
(dressing).
"I'm sorry, yes."
Said as suture line of cleft lip
repair was being cleansed.
"You act so tired, like it takes all your strength
to breath."
"Not interested, are you?" (in feeding).
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