Original Skin. Maryrose Cuskelly

challenge.

      THE SKIN, it has been said, is the surface of the brain. Certainly, as anyone who endures an attack of hives or a sudden flare-up of eczema as a result of stress could tell you, the skin and the processes of the mind are not entirely separate.

      In fact, there exists at a very fundamental level a link between our skin and our psyche. As the foetus develops in the womb, the skin and the central nervous system, which includes the brain, develop from the same ectodermal origins. The ectoderm is the outermost layer of the three primary layers of the embryo. From our very beginning, then, our mind and our skin are intertwined.

      Given this connection on such a basic physiological level, it follows a certain logic that researchers in the field of touch have noted the benefits that massage can have on a variety of psychological disorders. Studies have found that regular massages improve the behaviour of children diagnosed with attentiondeficit /hyperactivity disorder (ADHD) and make them feel happier. Massage can help girls with eating disorders develop less distorted body images and improve their eating habits. Other studies have suggested that the aggressive behaviour associated with boys may be due to them being touched less than girls.

      American researcher Tiffany Field, director of the Touch Research Institutes at the University of Miami School of Medicine, has proposed that teenage sexual promiscuity and pregnancy are on the increase partly because young people rarely receive appropriate, positive touch from their teachers, sporting coaches, and other adults who shape and influence their lives.

      We live within a climate that regards adults touching children with suspicion. Fear of being charged with sexual assault has resulted in teachers being instructed not to touch students, or only to do so within tightly prescribed guidelines. Maintaining concern about sexual abuse is entirely appropriate given the shameful revelation over recent years of systematic abuse of children within various institutions, including within religious and welfare organisations. But at what cost do we starve our young people of positive experiences of being touched?

      We know that our bodies and our minds both suffer when we are denied touch. In 1990, after the fall of the dictator Nicolae Ceausescu, distressing images from Romanian orphanages flashed around the world. Stricken children, wizened and undersized, with empty, sunken eyes lay motionless in their cribs. Under-resourced and understaffed, these institutions struggled to care for the children living there. The children languished in their cribs, rarely touched. Their emaciated forms and lustreless eyes demonstrated, in the most graphic and heartbreaking way, the detrimental effects on growth and development of not being touched.

      The images prompted a flood of offers to adopt the children abandoned in these orphanages, and many of them found their way to Western countries and new homes. Years later, most of these children were still physically smaller and developmentally delayed compared with other children their age.

      CAROL NEWNHAM is a neuropsychologist who works in the Parent—Infant Research Institute at the Austin Hospital in Melbourne. Her work assists parents of preterm babies learn how to interact with their children to overcome the many barriers to their development that often exist. These barriers may result directly from the fact of their premature birth, or from the demands of the care to keep these tiny babies alive.

      ‘The medical intervention that is required for babies born at or below 30 weeks often means that babies are denied contact with their mothers, something we know is essential for their growth and development,’ Carol says, obviously engaged by her topic and moved by the plight of the families she deals with. ‘In addition to this deprivation are the many, and often painful, procedures the babies must undergo.’

      Preterm babies must be kept in isolettes, the heated, plastic boxes that maintain the babies’ temperature. They are also routinely subjected to painful medical interventions that may include having their heels pricked and blood squeezed out sometimes several times a day, suction may have to be applied to clear their lungs, IVs inserted into their veins, lumbar punctures performed, and tubes inserted to aid ventilation. All this, according to Carol, can have the unintended, but hardly surprising, result that the babies become frightened of being touched, even by their mothers.

      Skin and skin contact has a lot to do with the first months of a healthy baby’s life: ‘The baby’s been in a body, and with a full-term baby they then do a lot on that mother’s body,’ Carol explains. For babies born prematurely, this contact, which includes touching and massaging, smelling and tasting, and vestibular (whole body) movement, is severely disrupted. For the parents, too, the need to caress and hold their child is almost overwhelming, but the result of a baby associating touch with pain and stress can turn even the simple task of changing a nappy, or giving the baby a bath, into a heartbreaking clash of conflicting needs, high anxiety, unread signals, and tears.

      Many of us assume when we become parents that we will intuitively know how to touch our babies, to give them comfort, to soothe them when they cry. The mother—infant dance is what Carol and her team call that ‘happy state’, when everything falls into place and mother and child react and respond to each other in concert. Her description of this phenomenon reminds me of a documentary that I saw about the separation of a pair of conjoined twins. The babies were joined along the front of their torsos and, prior to their separation, their mother was the only person who was able to lift and hold them in a way that the babies found comfortable.

      However, the mother—infant dance, where the partners in that most vital of relationships can read each other, is not always easy. In fact, Carol says she’s often stunned by how often it simply doesn’t happen. Much of her role revolves around teaching a mother how to read her baby’s signals of distress. This is more difficult than it sounds, given that preterm babies cry much less than babies born at full-term. However, with a little patience and care, parents can be taught to recognise when their baby is stressed and unhappy—dysregulated, as Carol calls it.

      These signals may include a screwed-up facial expression, clenched fists, stiff arms, and even the colour of the baby’s skin changing so that it becomes mottled, red, or sometimes blue. In the face of these changes in their baby’s behaviour and appearance, the mother is encouraged to slow her movements down, pacing her actions and the way she touches the baby to a tempo that it can cope with.

      Carol’s observations of babies and their mothers are helpful to her now, as a grandmother, and they have informed the way she went about bonding with her grandchildren when they were born. Of course, she says, she was just dying to immediately touch and hold them but, because of her work with prem babies and their mothers, she was able to pace her approach to her grandchildren, reading the subtle signals they gave that let her know she was proceeding at the rate they were comfortable with.

      Often, the way she advises parents to interact with their prematurely born baby may actually result in them touching their babies less. She tells me a story about a father she observed who was visiting his little daughter in the hospital while she was still confined to an isolette. ‘He was rubbing his thumb up and down the sole of her foot and every time he did it, she moved her foot away. So he’d follow her and he’d do it again, very lovingly, lovingly,’ she emphasises, ‘touching this little girl.’

      ‘Does she like that?’ Carol asked the father, hoping to prompt him to really observe his daughter and read the signals she was sending.

      ‘Oh, yeah,’ he told her, ‘you can tell she likes it, because every time I do it she moves.’

      Carol pauses and for a moment we both contemplate the scene she has just described. ‘Can you see how,’ she asks me, ‘with the best will in the world, parents can actually make their babies move away from them rather then towards them?’

      Preliminary research that Carol and her team have conducted into the brain development of the preterm babies whose mothers they have been working with has indicated some interesting results. They were hoping to see increased brain volume in the babies but, while this did not appear to be occurring, what they did observe was that the molecules of the myelinated nerve cells in the brain, through which electrical impulses travel, showed an improvement in the way that they lined up, allowing for enhanced transmission of impulses.

      Carol is familiar with the work of Tiffany