12.4 Psychosocial Needs of a Healthy Newborn

Psychosocial development occurs as infants and children form relationships, interact with others, and understand and manage their feelings. During emotional and social development, forming healthy attachments is the major social milestone of infancy, beginning in the immediate newborn period. The mother-child bond is driven by more than the basic desire for the newborn to receive nourishment. Feelings of comfort and security are the critical components of maternal-infant bonding, which leads to healthy psychosocial development.^[1]

Attachment and Bonding

Researcher John Bowlby first defined attachment as the affectional bond or tie that an infant forms with the mother. Attachment is a form of imprinting or an instinctive behavior of the newborn toward the mother. Bowlby believed that an infant must form this bond with a primary caregiver to have normal social and emotional development. Two things are needed for a healthy attachment: the caregiver must be responsive to the child’s physical, social, and emotional needs, and the caregiver and child must engage in mutually enjoyable interactions, such as feeding.^[2],[3]

In Erickson’s Psychosocial Stages of Development, the developmental task of the newborn is the establishment of a sense of trust. Infants are dependent and must rely on others to meet their basic physical needs, as well as their needs for stimulation and comfort. A caregiver who consistently meets these needs instills a sense of trust or the belief that the world is a safe and trustworthy place.^[4]

Nurses can help facilitate attachment by encouraging the mother and other caregivers to be attentive to the basic needs of the newborn, such as nutrition, warmth, and comfort. Responding early to feeding cues, keeping the newborn warm and comfortable, and quickly changing wet or soiled diapers help establish a sense of trust for the newborn.^[5]

Bonding is the process of a parent establishing a strong emotional connection to the newborn in the hours and days following delivery. The nurse can facilitate bonding by encouraging skin-to-skin contact and active participation in caring for the newborn. Nurses recognize when certain situations might negatively impact the process of parental bonding and intervene accordingly. For example, if the mother is experiencing pain during breastfeeding, alternative positioning or other techniques are emphasized. If the newborn is separated from the parent(s) for medical interventions, such as phototherapy or neonatal intensive care, the nurse encourages other opportunities for bonding.^[6],[7]

Nurses must be aware of potential cultural differences in how families view attachment and bonding. Most research on mother–infant bonding is based on Western cultures and conducted in European and American countries. Research indicates that basic maternal behaviors manifest differently across cultures, suggesting that mother–infant interactions serve to culturally socialize the expression and regulation of emotion.^[8]

Family Dynamics

As parents bring a newborn into the family, the dynamics of family member relationships often change. While parents are learning to adapt to their new role, they also establish new norms within their relationship. There may be feelings of resentment if one parent spends the majority of their time meeting the needs of the newborn. Additionally, anxiety about caring for a newborn, lack of sleep, and the process of healing from birth can also impact how partners interact with one another. The physical changes that happen as a result of pregnancy and childbirth can also impact intimacy within a relationship. Nurses can help family members adapt to changes by providing anticipatory guidance, sharing common challenges that families experience as they adapt to the new dynamics, and promoting resources to help them adapt to these changes.

There are additional considerations relating to family dynamics when bringing a newborn home to a sibling. Parents should expect a period of adjustment as the older child or children adapt to the presence of another child in the home. Parents can ease this transition by including older children in the homecoming process. Toddlers may show regression as a response to their desire for more attention, such as regression (backward steps) in toilet training, wanting to drink from a bottle, or sleeping issues. These behaviors should not be punished but rather recognized as the toddler’s desire for more time with the parents. The demands of caring for a newborn can leave the parents with little energy or time, but nurses encourage parents to provide opportunities for one-on-one time with the other children.^[9]