Infant massage and the development of early intersubjectivity

This dissertation presents three empirical studies that have been carried out to investigate the impact of infant massage on the development of mother-infant communication in the first three months of life. It is well known that mother-infant communication is a dynamic process in which both mother and infant influence each other. Especially from the second month of life ‒that is marked by the acquisition of the exogenous control‒ along with the presence of social smiling, head control, and a more active alert state, reciprocal interaction between mother and infant begins. Furthermore, the infant's early sense of self as an agent, and the infant’s first social knowledge develop with his/her understanding of the connection between his/her own actions and caregiver's social responses; this helps the infants to develop sense of efficacy in their social exchanges and expectations toward the others’ social behaviors. Especially during the first months of life, touch is a fundamental component of mother-infant interaction: it is an influential channel of communication between infant and caregiver, both for communicating emotional state and developing the attachment relationship. In particular, it has been shown that infant massage has several benefits both on infant's development and on mother-infant interaction, especially in case of preterm birth and in presence of maternal depression. Research on benefits of infant massage in mother-infant relationship in typical population, that is, in non-clinical and not at-risk population are still scarce. 42 mothers and their infants participated in the research project. 22 mother-infant dyads were recruited and randomly assigned to a Target Group and 20 dyads to a Control Group. At 1 month, mother-infant dyads were videotaped (5 min) during spontaneous interaction in a naturally occurring context in their homes. From 5 to 9 weeks, dyads in the Target group were involved in a 5-week-massage training (IAIM program) conducted by a certified IAIM trainer. At 2 months mother-infant dyads were videotaped during interaction in the Still-Face experimental procedure in the Lab at University. Finally, at 3 months, mother-infant dyads were videotaped (5 min) during spontaneous interaction in a naturally occurring context in their homes. The first study aimed to analyze whether the qualitative (types) and quantitative (duration) aspects of maternal touch addressed to the infant during spontaneous interaction change -and how- after the massage training. Videotaped mother-infant interactions were analyzed using the Ordinalized Maternal Touch Scale (Beebe et al., 2010). The results showed that at 3 months the overall quantity of touch addressed to the infant decreased significantly only in the Control Group; even if mothers could use less touch due to a more emotional competence of infants, mothers who participated at the infant massage program demonstrated to give great importance to the touch as a communicative modality. Furthermore, Affectionate Touch, that is strictly related to the development of a secure attachment, decreased in both groups at 3 months, but it remained significantly higher in the Target Group. Playful Touch, that is used by mothers to maintain their infant's attention, increased in both groups but it was significantly higher in mothers who used infant massage in their everyday routine. These results suggest that infant massage could be a modality to improve mother-infant interaction through the specific messages that are conveyed by maternal touch. The second study aimed to assess whether mother-infant dyads engaged in the infant massage training show any qualitative change in their spontaneous interaction (except for changes due to the increased infant’s age) at 3 months. Videotaped mother-infant face-to-face interaction were analyzed using Lavelli and Fogel (2013) coding scheme. Results showed a significant increase in maternal Stimulating behavior in the Target Group, and more time spent gazing at mother and Cooing behavior in infants in the Target Group. These behaviors are indices of a more active interaction between mothers and infants that experimented infant massage in their everyday routine. The third study aimed to investigate whether the practice of infant massage promotes infants’ social expectations for their mothers’ behavior, i.e., whether infants in the target group show more social expectations for their mothers’ behavior than their peers in the control group. Dyads participated in an experimental paradigm, the Still-Face, in which mothers, after a couple of minutes of normal face-to-face interaction with their infants, have to stop to interact with their infants but still looking at them, for one minute and a half; after this period, mother and infant can resume the normal interaction. Normally, during the Still-Face phase, infants show a decrease in positive affect and an increase in negative affect, with a carryover effect in the reunion phase. In our sample, infants in both group behaved similarly, but with some differences: during the Still-Face phase infants in both groups increased their active behavior in order to resume their mother's attention, during the reunion phase, infant in the Target Group lowered their Negative affect at the level of the initial interaction, while in the Control Group the infants’ negative affect remained significantly higher than in the initial phase. With regard to infant Social Monitoring, after a general decrease during the Still-Face phase, only in the Target Group increased in the reunion phase: this indicates that infants who experimented infant massage spent more time looking at the mother face after a frustrating situation. However, Positive Monitoring in infants in the Target Group did not return at the initial level. These results suggest that infants who received infant massage are more active in attempt to resume interaction with their mother when the emotional contingency is violated. Furthermore, they demonstrate to have a less negative carryover effect during the reunion phase, showing a better ability to participate again in the interaction after a frustrating episode. In the whole, the results of the three studies suggest that the infant massage experience in the first month of life could be a modality to enhance mother-infant interaction also in non-clinical and not at-risk population.