Centering responsive caregiving is key to fostering secure attachment.
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An application of attachment theory in nursing practice to promote healthy attachment
Attachment theory, first proposed by John Bowlby, continues to be the primary paradigm for studying early childhood development and relationship between caregivers. Many researchers moved to investigate the impact of secure attachment on health, and clinical practice started with an emphasis on the importance of achieving secure attachment (Schore, 2012a; Schonkoff et al., 2000), especially as clinicians such as nurses are uniquely positioned to impact parent-child bonding during these critical periods. Nurses may help facilitate secure attachment (Granqvist et al., 2020) among parents by eliciting behaviors such as emotional responsiveness, physical closeness, consistent caregiving, and reflective attunement—all of which provide the opportunity for optimal emotional and neurological development in infants.
Centreing responsive caregiving is key to fostering secure attachment. When caregivers respond in a timely way to a baby’s cues — feeding when hungry, soothing when distressed — it fosters trust and security. Nurses can educate and coach parents on how to identify and respond to their infant’s nonverbal cues in order support parents to become more attuned to their child’s needs (Cooijmans et al., 2021). This attunement not only enhances infant emotional regulation but also deepens the dyadic bond between parent and child.
Another behavior that promotes attachment is encouraging positive physical interaction. Physical touch (skin-to-skin contact), soft touch and steady holding stimulate oxytocin levels and pave the way for neurobiological pathways connected with trust and bonding (Hardin et al., 2020). Nurses also can model and demonstrate practices such as kangaroo care, particularly in the neonatal or postpartum setting, to facilitate physiological and emotional synchrony between parent and child.
Being consistent and flexible in his caregiving routines also helps him develop secure attachment pattern. When infants are exposed to predictable, structured care — regular schedules of feeding and sleep, for example — they feel safe, and they learn to trust that their caregiver will be there when needed. The provision of routine (predictable) time with emotional security can be developed and enhanced by nurses working with parents (McKelvey et al., 2021).
Furthermore, the development of emotional attunement—the tuned-in caregiver who reflects and validates the child’s emotional experience—is important, too. More specific strategies, such as reflective question asking and emotional coaching, allow nurses to teach parents to recognize their infant’s emotional states, as well as how to respond to them in a way that is appropriate to their developmental stage. Such emotional validation aids the cultivation of emotional intelligence and guides the infant in learning how to manage stress (Ensink et al., 2021).
Lastly, promoting parental mental health is essential for healthy attachment. The sensitivity and responsiveness needed as a parent can be impaired by parental depression, anxiety, and stress. Nurses should screen for risk factors and refer moms to the appropriate psychological or community resources as indicated (Zajicek-Farber et al., 2022). So addressing these barriers also makes sure that we are emotionally available, where the caregiver is emotionally available — and that a secure attachment can form between the caregiver and the child.
Overall, nurses can encourage families to promote secure attachment by modelling and promoting responsive caregiving, physical closeness, routine, emotional attunement and mental health support. These science-based practice strategies are based on current attachment research and can improve life trajectory for both parents and children.
References
Cooijmans, K. H., Beijers, R., Rovers, A. C., & de Weerth, C. (2021). Maternal prenatal anxiety and infant behavior: The mediating role of maternal postpartum sensitivity. Journal of Child and Family Studies, 30(1), 136–147. https://doi.org/10.1007/s10826-020-01823-5
Ensink, K., Normandin, L., & Fonagy, P. (2021). Parental reflective functioning and its association with parenting behaviors in infancy and early childhood: A meta-analytic review. Attachment & Human Development, 23(5), 479–501. https://doi.org/10.1080/14616734.2020.1840760
Granqvist, P., Forslund, T., Fransson, M., Springer, L., Duschinsky, R., & Sroufe, L. A. (2020). Disorganized attachment in infancy: A review of the phenomenon and its implications for clinicians and policy-makers. Attachment & Human Development, 22(3), 309–329. https://doi.org/10.1080/14616734.2019.1589055
Hardin, H. K., Jones, K. D., & Muddana, A. (2020). Promoting parent-infant bonding and attachment in the NICU: Evidence-based interventions. Advances in Neonatal Care, 20(1), 68–76. https://doi.org/10.1097/ANC.0000000000000662
McKelvey, L., Edge, N., Mesman, G. R., Whiteside-Mansell, L., & Bradley, R. H. (2021). Adverse experiences in infancy and toddlerhood: Relations to parenting and attachment security. Child Abuse & Neglect, 111, 104772. https://doi.org/10.1016/j.chiabu.2020.104772
Zajicek-Farber, M. L., Mayer, L. M., & Kaufman, R. L. (2022). Integrating maternal mental health and infant attachment: A clinical model for early intervention. Infant Mental Health Journal, 43(2), 243–261. https://doi.org/10.1002/imhj.21967