Long is gone the time when the infant, and, especially, the newborn baby, was considered merely a passive receptacle, with merely physiological and hygienic needs. More and more attention is paid to the affective needs of the infant, his interactions with the adults; and, what is more, since the early sensory, cognitive, and learning ability of infants was discovered, people seem to have almost forgotten that he has a body, too, that infants and young children live, feel, learn, and express themselves above all through their body.
Doctors and other professionals of health care paid attention only to physiology, physical growth, somatic diseases, and occasional anomalies when talking about the body for a long time. Psychologists and pedagogues, on the other hand, do not care about the child’s body, because they only think about his emotions, relations, abilities, motor development, and mental development (what he knows and what he does not know).
Observing from outside, the physical needs of the infant appear purely physiological, and bodily care is still considered a purely sanitary technical operation by many. However, at this age, physiological and psychological needs are not separated from each other, or they may be about to start separating, and the infant’s needs appear in a complex psychological space, so their satisfaction also happens in this space.
The child brings the innate ability of growing and developing, but in order for the program to realize in the best possible direction, certain conditions have to be fulfilled. High-quality care—starting from the prenatal period through the entire development—belongs to these conditions.
By “high-quality care” we do not only mean the care procedures in the strictest sense, but also the satisfaction of the affective and activity needs of the child, as well as the careful organization of his everyday life suiting his development. High-quality care enables the child, by his innate ability, to get to know about and “live in” his body, to find pleasure in its functioning and to learn from it, and to realize that his skin forms a natural boundary between himself and the rest of the world, or, borrowing an expression from Winnicott (1965), “his skin is the membrane that separates the ‘I’ from the ‘not-I.’”
The image of the own body forms gradually. According to Wallon (1984), the image of the own body at the time of its forming is more significant than the other procedures of psychogenesis, because the closest relation between the interoceptive needs and the external world is found here, and it is the most necessary for the development of the self-consciousness.
The young child has two ways, starting from being born, to become acquainted with his own body:
1. By everything he does to his own body (i.e., by the activities of his own body);
2. By everything that is done to his body when it is touched, held, fed, nursed.
The sight of the bodies of others and his experience with the bodies of others probably also contribute to becoming acquainted with his own body, and other factors may also play an important role—but his experience acquired through his own body seems to be essential.
These two aspects—what the infant does to his own body, and what is done to his body—can hardly be separated; they are closely related to each other. Yet, we are going to deal with only the second aspect here. But we must continuously keep in mind the interaction of the two aspects. As far as the second is concerned: we attribute the utmost importance to physical care, and [to] everything that happens between the adult and the child during care.
Those who know the work of our Institute just a little know that we consider the minutes of care to be the most important and the most intimate in the interaction between the adult and the child. We believe that, if the infant experiences affective security during care, he will be able to utilize the opportunities of activity after care, and will turn towards the external world with interest and pleasure without the intervention of an adult.
The infant gets to know himself and the adult primarily during the care, the satisfaction of his physical needs. Initially, he experiences his physical needs as an unpleasant but uncertain tension, torture. He does not “know” that he is hungry, thirsty, cold, or hot, or that he is in pain. It is the adult’s taking care of him that relieves him of these bad feelings, and the best way to achieve that is by understanding his signals. This way, the adult teaches the infant to signal, to express his needs. And he does, in an uncertain way initially, and in more and more elaborate ways as the time passes, and he also learns to express his contentment after his needs have been satisfied.
To put it simply, it is a learning process during which the child, repeatedly experiencing that by his signal the adult relieves him of his unpleasant tension, learns to express his needs. He connects his own signals with the adult’s reactions, as a consequence of which his tensions (hunger, thirst, cold . . .) cease. He associates his sense of physical security, and, through this, also his emotional security, with the adult’s taking care of him.
The infant learns about the need itself (being hungry or thirsty, etc.), and also the fact that it is he who is hungry or thirsty, through the sensing of those needs and the response received for expressing them. Furthermore, he learns that even though it is the adult who relieves the tensions, he himself can facilitate it by giving out the proper signals in order to get relief. If the adult pays attention to the signals of the child, and feeds, bathes, dresses, or undresses him with those signals in mind, then she allows him from the very beginning to “have a say” in the process of his care and in the ways of the satisfaction of his needs: the rhythm of feeding, the quantity and temperature of the food, the rhythm of the moves of dressing-undressing, the quantity and the temperature of the bathing water . . .
If the child can trust to be able to influence the events happening to him, if he can feel that he is not a passive receiver, but an active participant of his care, then his sense of competence will grow stronger. If he is never dealt with as if he was an object—be it either precious or worthless—but as a human being who feels, watches, remembers, and understands or will understand . . . , if the words and gestures are not only nice but they also consider the sensitivity of the child continuously, then a real dialogue will form between the two partners during nursing, starting at the youngest age.
During this dialogue, the infant has more and more tools to influence the events happening to him. In return, the adult will also have more and more tools to make the child understand what she is going to do with him, and to adapt her activities to the needs expressed by the child, so that the child will participate with pleasure in what she expects him to.
The activities repeated permanently during the daily care facilitate the development of communication. Through the gestures and the almost constant words following the gestures, which are repeated in a constant sequence, the child learns to prepare himself for the upcoming events.
The right physical care unites mutual understanding and pleasure simultaneously. The quality of the moves of the adult determines the tone of the child, and the physical trust of the child. If the adult touches the child tactfully, and expects his gestures as one who understands, the sense of being accepted will become stronger in the child.
According to Winnicott (1965), the most primitive and most destructive distress is caused by the uncertainty that is created by the holding and the lifting of the infant. Winnicott’s term “holding” does not mean only the holding of the baby in the physical sense, but it includes everything his environment provides for him and everything that it has provided so far. This concept refers to a three-dimensional space, to which time is attached gradually.
The right “holding” protects the child from physical danger; it takes into account the sensitivity of the skin, the sensitivity to sounds, the sensitivity to light, and the fear of falling. The right “holding” of the child means the caring in its entirety, continuously adjusting to the development of the child. When the adult lifts the infant, carries him in her arms, takes him in her lap, puts him in the bath or on the changing surface, puts him in his play area, she must protect him with absolute security from the fear of falling, or even of losing balance.
The good technique of care provides the child with the sense of security. If he is held in secure and gentle hands, he relaxes his muscles. This does not imply a hypotonic state, but—in the interpretation by Agnes Szanto2—a “tonically relaxed” state. Therefore the child must always be lifted, carried, and put down in a position he is accustomed to and he can hold himself in.
As in the vertical position, the danger of losing balance threatens the infant; he must be lifted, carried, and put down in a horizontal position until he himself takes up a vertical position. And even then, it is best to lift and carry him in the already customary position when he has already reached a more developed state. He always has to be lifted and carried with the largest possible portion of his body being securely supported. When taken into the arms, the entire vertebral column of the young infant must be supported, and his head must be protected from even the slightest swaying and swinging, and the balance among the different parts of his body must be kept.
Therefore, the child must never be touched with sudden moves. Eye contact and a dialog must be established with him. He can be prepared through words for what is going to happen to him, especially when it comes to the change of the position of his body, or certain body parts. Adapting to the developmental level of the child, the adult waits a few minutes for the spontaneous or intentional moves of the child, and then she touches him with a sensitive, gentle hand.
The authentic behavior of the adult is part of the good care. What this means is that every detail of the child’s well-being, every reaction, mimic, tone, and intonation of his body, is important to her, and she is aware that what she is doing with him has an effect on not only him in the present but also his future.
In order to adjust to the needs of the child, she has to feel that, when she deals with the child, she deals with the child’s personality, and not with his organs, his skin, his bottom, his genitals, and his stomach independently. When she is cleaning his ears or creams his bottom, her glance keeps going back to the child’s face and her words express that the cleanliness of his skin, hair, and nails is important, too, but what is of primary importance for her is the child himself. During the feeding she is not interested in whether the child eats all the food offered to him or leaves some of it, but the fact that2 [psychologist and specialist in early motor development] he eats what he eats with a hearty appetite and with pleasure, that he explores the pleasure of good tastes and the satisfaction of the feeling of fullness.
The child must be allowed time to express what he wants and whether he accepts what is suggested to him. At a task to be executed—putting on the sleeve, raising the leg—the child’s movements must be the starting point, and we have to wait for his movements before our movements. But the movement is not obligatory; only the possibility is suggested. The child may feel that the adult is satisfied when he has fulfilled a task, but even without it he can feel accepted and appreciated.
Knowing that in early childhood the physical needs of the child and their satisfaction fundamentally determine the child’s relation to himself and to his environment, we teach our caregivers the thorough observation of the child and a coherent and uniform care technique. The regulatedness of the gestures suits the child’s needs and serves his well-being. It also provides the adult the security of “knowing how to do,” relieving [the caregiver] of hesitations, improvisations, and forgetting something important. Predictability also provides security for the child: it protects him from unexpected gestures and events, even in an institute where several different people care for him taking turns according to their schedules.
There must also be a danger in the regulatedness of gestures. If the gestures are not followed by genuine attention, if they lack personality, warmth, they may easily turn empty, caricature-like, and [turn] the conditioning into a false cooperation. In this case the infant cannot be competent; he does not experience that he can influence his environment, even though the appearance is that he cooperates; he actually performs only the well-trained auxiliary movements.
The genuinely participating infant takes part in the care with the pleasure of “I am doing it myself.” From time to time he also allows himself to concentrate on something else, to move around, or to turn the adult’s attention to something else, and the cooperating adult accepts these detours as much as possible.
The mental health of a person builds on his care during infancy, and if all goes well, we are not even aware of it. If, however, the appropriate care is missing, and if things are not going right, if the person feels bad, he will not feel the lack of good care during infancy, but the “indisposition” resulting from it.
We must mention another aspect of physical care, the importance of which is undeniable—namely, the tactile stimuli and the bodily contact between the adult and the child. Many times it is thought that bodily contact is limited to taking in the arms, seating in the lap, hugging, kissing, and caressing. Other—just as important, if not more—types of bodily contacts with which the infant’s needs are satisfied through the bodily contact are more rarely considered.
During the recent decades we could witness a more gentle way of conducting childbirth. We can see tendencies of facilitating the initial communication between the mother and her newborn baby. It is important what happens to the child during birth and directly after it, but it is just as important what he experiences later on. If the infant is not well cared for, if the gestures of the adult are not gentle and tender, but indifferent, quick, “professional,” if her hand that lifts, holds, carries the infant does not provide security but distress resulting from uncertainty, then all the technical knowledge, the professional skills, are useless, as the child will not find pleasure in this contact. Then the care, the physical contact, will not mean pleasure, but uncertainty and distress to the child. It also applies to families, but it is even more important in institutes, nurseries, kindergartens, and hospitals where there is no way of compensating. If the adult wants to get over with the feeding, the changing of the diaper, the bathing, the dressing quickly, the child will not only feel the abrupt, mechanical moves unpleasant, but he will also feel that the time spent together is dreary for both of them.
The image that the young infant creates of his own body, based on the experiences of the first few months or years of his life, will deeply influence his future. His care during infancy will affect his entire life, [his] personality, his self-image, the development of his self-consciousness and his sexual orientation, and his adult behavior as a parent. His relationship to his own body and its functioning depends on the quality of the care, its being pleasant or unpleasant, and the good or bad feeling of the adult nursing him.
1 [Hungarian-language publication: Falk, J. (2002). Ha a csecsemő testét érintjük. In I. Csatári (Ed.), Fürdetés: A gondozás művészete. Budapest, Hungary: Pikler-Lóczy Társaság, pp. 5–13. English-language publication: Falk, J. (2006). When we touch the infant’s body. In V. Tényi (Ed.), Bathing the baby: The art of caring. Budapest, Hungary: Pikler-Lóczy Társaság, pp. 5–13.]
2 [psychologist and specialist in early motor development]
Judit Falk, MD of the Pikler Institute.
From the RIE Manual.
Wallon, H. (1984). In G. Voyat (Ed.), The world of Henri Wallon. New York, NY: Jason Aronson.
Winnicott, D. W. (1965). Maturational processes and the facilitating environment: Studies in the theory of emotional development. New York, NY: International Universities Press.