Multisensorial Stimulation

and
Happy, Healthy Baby Development

Dr.Riham Elhyawy
Clinical Nutrition Consultant
Head of Clinical Nutrition Department of Miser International
Hospital, Head of Clinical Nutrition Department of Elamal and
Elhayh hospital

Johnson & Johnson Consumer Companies, Inc. 2015

Objective
Increase awareness of the importance of
multisensorial stimulation in healthy baby
development
For healthy babies development adequate nutrition
for mothers during pregnancy is very crucial that
will be reflected on healthy baby development
during first year.
Initiate and drive dialogues among HCPs to create
an impact across the region
1. Clemo HR, Keniston LP, Merideith MA. Structural basis of multisensory processing: Convergence. In: Murray MM, Wallace MT, editors. The Neural Basis of
Multisensory Processes. 2012; 1-8.

Multisensory stimulation defined:

The concurrent stimulation of touch, sight, hearing,
and/or smell, occurs when there is convergence of
stimuli from different sensory inputs into the brain
allowing integration and establishment of a
relationship between these different sensory
inputs.1

Each sensory stimulation leads to long-term happy,

healthy baby development
1. Clemo HR, Keniston LP, Merideith MA. Structural basis of multisensory processing: Convergence. In: Murray MM, Wallace MT, editors. The Neural Basis of
Multisensory Processes. 2012; 1-8.

The World of Multisensorial Stimulation

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Hernandez-Reif M, Diego M, Field T. Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behav Dev. 2007;30(4):557-561.
Fejio L, Hernandez-Reif M. Sleep problems in infants decrease following massage therapy. Infant Behavior and Development. 2006;476-480.
Diego MA, Field T, Hernandez-Reif M, et al. Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated with greater weight gain. Acta Paedi
2007;96:1588-1591.
Farroni T, Csibra G, Simion F, et al. Eye contact detection in humans from birth. Proc Natl Acad Sci U S A. 2002;99(14):9602-9605.
Sullivan RM, Taborsky-Barba S, Mendoza R, et al. Olfactory classical conditioning in neonates. Pediatrics. 1991;87(4):511-518.
Herz RS. A naturalistic analysis of autobiographical memories triggered by olfactory visual and auditory stimuli. Chem Senses. 2004; 29:217-224.
Field T, Cullen C, Largie S, Diego M, Schanberg S, Kuhn C. Lavender bath oil reduces stress and crying and enhances sleep in very young infants. Early Hum Dev. 2008;84(6):399-401
Graven SN, Browne JV. Auditory development in the fetus and infant. Newborn Infant Nurs Rev. 2008; 8:187-193.
Loewy J, Stewart K, Dassler A, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics. 2013; 131:902- 918.

Multisensory stimulation can help promote

improved social, emotional, cognitive, and
physical development in infants

A babys brain creates up to 1.8 million

new synaptic connections per second1

Multisensorial stimulation what a

baby feels, sees, hears and smells
promotes the long-term survival of
these synaptic connections during
brain development1

Within the first 3 years of life, there is

rapid development of most of the
brains neural pathways supporting
communication, understanding, social
development and emotional wellbeing1
1. Eliot L. Whats Going On in There? How the Brain and Mind Develop in the First Five Years of Life. New York, NY: Bantam Books; 1999.

Because the fetal brain grows dramatically during

the third trimester, DHA is especially important in
the maternal diet. Good source of DHA are oily
fish ,Its also found in lesser amounts in tuna,
chicken and eggs

The omega-3 polyunsaturated fatty acid (DHA)

docsohexanoic acid has been found uniquely critical
for both neurologic and eye development

Pregnant women who eat large fish should be

aware of potential of mercury contamination as
even a limited intake of mercury during pregnancy
can impair a fetus developing nervous system.

By age three, 85% of a babys brain is

developed;
every experience leading up to this time
helps to
shape a babys brain1
The environment in which a child grows up
has a profound impact on sculpting the brain 2
Experiences that are repetitive, consistent,
predictable and nurturing can promote the
healthy development of a childs brain2

1. Bruner, Charles, et al. "Early Learning Left Out: An Examination of Public Investments in Education and Development by Child Age." Voices for
America's Children (2004)
2. World Health Organization. Integrating Early Childhood Development (ECD) activities into Nutrition Programmes in Emergencies. Why, What and How.
2014;1-16.
3. Perry, Bruce D. "Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of
Therapeutics." Journal of Loss and Trauma 14.4 (2009): 240-255.

The brains processes for learning are

enhanced when multiple senses are
stimulated, as compared with the use of just
one sense1,2

1. Shams, Ladan, and Aaron R. Seitz. "Benefits of Multisensory Learning." Trends in Cognitive Sciences 12.11 (2008): 411-417.
2. Sullivan RM, Taborsky-Barba S, Mendoza R, et al. Olfactory classical conditioning in neonates. Pediatrics. 1991; 87:511-518.

While genes play a role in brain development,

experiences have a significant impact on how it
develops1
Stable, caring and interactive relationships with
adults promote healthy brain development2
The brain develops and organizes as a reflection
of developmental experience3

1. Shelov, Steven P.Caring for Your Baby and Young Child: Birth to Age 5. New and Revised Sixth/Bantam Books Trade Paperback ed. Vol. 5. 2009. 154-57. Print.
2. 10 Facts About Early Child Development as a Social Determinant of Health." Maternal, Newborn, Child and Adolescent Health. World Health Organization,
2014. Web. 29 Dec. 2014.
3. Perry, Bruce D. "Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics."
Journal of Loss and Trauma 14.4 (2009): 240-255

Everyday rituals such as bath time are ideal

opportunities for multisensorial
stimulation.
Bathing can be a calming, soothing experience for
baby and promotes bonding between baby and
parent or caregiver.1
It is an opportunity for increased skin-to-skin contact
Bathing has been shown to be helpful in decreasing
stress (cortisol) levels.2

1. Blume-Peytavi U, Cork M, Faergemann J, Szczapa J, Vanaclocha F, Gelmetti C. Bathing and cleansing newborns from day 1 to first year of life:
recommendations from a European round table meeting. J Eur Acad Dermatol Venereol. 2009; 23:7519.
2. Field T, Cullen C, Largie S, Diego M, Schanberg S, Kuhn C. Lavender bath oil reduces stress and crying and enhances sleep in very young
infants. Early Hum Dev. 2008;84(6):399-401.

An everyday bath time ritual that includes a warm

bath, massage and quiet time is a simple behavioral
intervention that:
Increases quantity and quality of sleep in babies 1
Improves mothers mood1

Making Bath
Time Part of a
Ritual Improves
Sleep

1. Mindell J, Lorena S, Telofski BA, et al. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep.
2009;23:599-606.

Studies have shown that babies bathed with a

fragranced bath product (compared to those who
were not):
Displayed 30% more engagement cues (mutual
gaze, smile, verbalization) with their parent
after bath1
Stress (cortisol) levels of the baby and parent
decreased during bath time with a scented
product2

1. White-Traut R, et al. Poster presented at: Third National Congress on the State of the Science in Nursing Research. October 7, 2004. Washington, DC. (Clinical study
report enclosed: BRN Main Manuscript File.)
2. Field T, Cullen C, Largie S, Diego M, Schanberg S, Kuhn C. Lavender bath oil reduces stress and crying and enhances sleep in very young infants. Early Hum Dev.
2008;84(6):399-401.

A study of 206 mother-infant pairs found that infants

who followed a bedtime routine (bath, massage, quiet
time), which included a warm bath with a fragranced
bath product, took 37% less time to fall asleep and had
a significant improvement in mood in the morning.1

1. Mindell J, Telofski LS, et al. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep. 2009;23:599-606.

Benefits of Touch
Skin is the first organ to develop prenatally,
making touch the first sense to
develop1
One of the babys first sensory stimulations
comes from touch while still in the womb1
Touch is so important that some consider
skin to be the external nervous system2

1. Field, Tiffany. "Touch Hunger."Touch. Cambridge, Mass.: MIT, 2014. 7. Print.

2. Field, Tiffany. "Touch Messages to the Brain."Touch. Cambridge, Mass.: MIT, 2014. 89. Print.

Babys first emotional bonds are built from physical

contact, or touch.
Skin-to-skin contact for 25-120 minutes after
birth has been shown to positively affect
interactions between
mom and baby one
year later1

1.

Bystrova, Ksenia, et al. "Early Contact Versus Separation: Effects on MotherInfant Interaction One Year Later." Birth 36.2 (2009): 97-109.

Routine touch and massage have been shown to

benefit growth and development, communication
and learning
According to a study, infants who experienced routine
touch
and massage (compared to those who
did not) were:1
50% more likely to make eye contact
3x more likely to have an overall positive expression
(smiling, eye contact)

1. Pelez-Nogueras, Martha, et al. "Infants' Preference for Touch Stimulation in Face-to-Face Interactions."Journal of Applied Developmental Psychology17.2 (1996):
199-213.

Routine touch and massage have been shown to

benefit growth and development, communication
and learning
Routine massage leads to improved cognitive
performance
and increased alertness and
attentiveness1
Routine massage in premature babies was also
shown to result in increased physical activity2
In premature infants, routine massage has also been
shown to improve immune function4

1. Hart, Sybil, et al. "Preschoolers' Cognitive Performance Improves Following Massage." Early Child Development and Care 143.1 (1998): 59-64.
2. Lee, H. K. "The Effect of Infant Massage on Weight Gain, Physiological and Behavioral Responses in Premature Infants." Taehan Kanho Hakhoe Chi 35.8
(2005): 1451-1460.

Routine touch and massage can lead to benefits for

mothers1

Forty mothers whose preterm infants were about to be discharged

from the Neonatal Intermediate Care Unit (NICU) were randomly
assigned to two groups: the first group of mothers conducted
preterm infant massage and the second group only observed their
preterm infants receiving massage.

Both groups of mothers had lower depressed mood scores following

the session. However, only the group who massaged their infants
had lower anxiety scores after the session.

p<.05

Adapted from Feijo, 2006

1. Fejio L, Hernandez-Reif M, Field T, Burns W, Valley-Gray S, Simco E. Mothers depressed mood and anxiety levels are reduced after massaging their
preterm infants. Infant Behavior and Development. 2006; 476-480

Enhancing tactile stimulation:

Skin-to-skin contact between newborns and parents
improves mother-infant attachment and
increases parental sense of well-being1
An infant massage with oil has greater soothing
effects
than a massage alone 2

1.
2.

Anderzen-Carlsson A, Lamy ZC, Tingvall M, Eriksson M. Parental experiences of providing skin-to-skin care to their newborn infant Part 2: A qualitative
meta-synthesis. Int J Qual Stud Health Well-being. 2014; 9:24907.
Field T, Schangerb S, Davalos M, Malphurs J. Massage with oil has more positive effects on normal infants. Pre and Perinatal Psychology Journal. 1996;
11:75- 80.

Enhancing tactile stimulation:

Using the right emollients can:
Improve skin barrier function1
Support the natural lipids found in skin,
promoting effective natural barrier function2
Act as a barrier to water loss, leading to higher
levels of skin hydration3
Enhance the infant massage experience4

1. Garcia Bartels N, Scheufele R, Prosch F, Schink T, Proquitte H, Wauer R, Blume-Peytavi U. Effect of Standardized Skin Care Regimens on Neonatal Skin
Barrier Function in Different Body Areas. Pediatr Dermatol. 2010; 27: 18.
2. Overgaard Olsen L et al. Acta Dermatol-Venereologica 1993; 73: 404406.
3. Stamatas GN et al. J Dermatol Sci 2008; 50: 135142.
4. Field T et al. Dev Review 2007; 27: 7589.

Benefits of visual stimulation:

Facilitates early communication1
Demonstrates enhanced neural processing1
Provides foundation for social development1

From the moment they

are born, babies prefer
visual
stimulation
with wide open eyes
and a direct gaze1

Duration of Infant Eye Contact with

a Direct or Averted Visual
Stimulation

Adapted from Farroni, et al. 2002

1.Farroni T, Csibra G, Simion F, et al. Eye contact detection in humans from birth. Proc Natl Acad Sci U S A. 2002;99(14):9602-9605.

Benefits of auditory stimulation

The auditory system becomes functional
around
weeks of gestation1

25

From 25 weeks gestation to 5 or 6 months of

age is most critical to the development of the
neurosensory part of the auditory system1
Development of the auditory system supports
development of language1

1. Graven SN, Browne JV. Auditory development in the fetus and infant. Newborn Infant Nurs Rev. 2008; 8:187-193.

Benefits of auditory stimulation:

Infants hearing their mothers voice (rather than a

strangers voice or music) showed enhanced brain activity
in the area for linguistic processing suggesting a role in
language development.1

Studies show infants who are spoken with more have larger
vocabularies by 24 months of age2

Boxplot of the individual activations averaged

over the left and right clusters for each of the
auditory stimulus (arbitrary units). There is a
significant left/right asymmetry
for both speech conditions (mothers voice:
F(1,6) = 18.52, p = .005; strangers voice:
F(1,6) = 6.04, p = .049) but not for music
F(1,6) < 1).

Adapted from Dehaene-Lambertz, 2010

1. Dehaene-Lambertz G, Montavont A, Jobert A, et al. Language or music, mother or Mozart? Structural and environmental influences on infants language networks. Brains
Lang. 2010; 114:53-65.
2. Weisleder, Adriana, and Anne Fernald. "Talking to children matters early language experience strengthens processing and builds vocabulary." Psychological science 24.11
(2013): 2143-2152.

Benefits of Smell
Babies are able to smell before they are born
about 28 weeks into
pregnancy1-3
Newborns use the sense of smell from birth to
familiarize themselves more than any other sense 4
At birth, babies begin linking different smells with
different objects, words, places and people 5-6

1. Schaal, Benoist, Pierre Orgeur, and Christian Rognon. "Odor Sensing in the Human Fetus: Anatomical, Functional, and Chemoecological Bases." In Prenatal
Development, A Psychobiological Perspective (eds. J.P. Lecanuet, N.A. Krasnegor, W.A. Fifer and W. Smotherman). Hillsdale, NJ: Lawrence Erlbaum Associates, 1995.
205-237. Print.
2. Pyatkina, G. A. "Development of the Olfactory Epithelium in Man." Zeitschrift fur mikroskopisch-anatomische Forschung 96.2 (1981): 361-372.
3. Schaal, Benoist, Luc Marlier, and Robert Soussignan. "Olfactory Function in the Human Fetus: Evidence from Selective Neonatal Responsiveness to the Odor of
Amniotic Fluid." Behavioral neuroscience 112.6 (1998): 1438-1449.
4. Varendi, H., and R. H. Porter. Breast Odour as the Only Maternal Stimulus Elicits Crawling Towards the Odour Source. Acta Paediatricia 90.4 (2001): 372-375.
5. Porter, Richard H., Jennifer M. Cernoch, and Shannon Perry. "The Importance of Odors in MotherInfant Interactions." Maternal-Child Nursing Journal (1983).
6. RoveeCollier, Carolyn Kent, and Joanne Bitetti Capatides. "Positive Behavioral Contrast In 3MonthOld Infants On Multiple Conjugate Reinforcement Schedules."
Journal of the Experimental Analysis of Behavior 32.1 (1979): 15-27.

Research has shown memories evoked by smell

are more emotional and pleasant than those
evoked by other senses1
Smell is the sense that is most directly linked to
memory1-3
Enjoyable and familiar scents have been shown to
improve mood, calmness and alertness.4-6
The scent of a mother can help reduce crying, which
can make babys bedtime easier7

1. Herz, Rachel S. "A Naturalistic Analysis of Autobiographical Memories Triggered by Olfactory Visual and Auditory Stimuli." Chemical Senses
29.3 (2004): 217-224
2. Zelano, Christina, and Noam Sobel. "Humans as an animal model for systems-level organization of olfaction." Neuron 48.3 (2005): 431-454.
3. Willander, Johan, and Maria Larsson. "Olfaction and Emotion: The Case of Autobiographical Memory."Memory & Cognition35.7 (2007): 16591663.
4. Weber, Sandra T., and Eva Heuberger. "The Impact of Natural Odors on Affective States in Humans."Chemical senses33.5 (2008): 441-447.
5. Chen, Denise, and Pamela Dalton. "The Effect of Emotion and Personality on Olfactory Perception." Chemical Senses 30.4 (2005): 345-351.
6. Warrenburg, Stephen. "Effects of Fragrance on Emotions: Moods and Physiology."Chemical Senses30.suppl 1 (2005): i248-i249.
7. Sullivan, Regina M., and Paul Toubas. "Clinical Usefulness of Maternal Odor in Newborns: Soothing and Feeding Preparatory
Responses."Neonatology74.6 (1998): 402-408.

Enhancing olfactory stimulation:

Mothers who gave their babies a scented bath were
more relaxed, smiled and touched their infants more
during the bath1
Infants given a scented bath looked at their mothers
a greater percentage of the bath time, cried less
and spent more time in deep sleep after bath 1

1. Field T, Cullen C, Largie S, Diego M, Schanberg S, Kuhn C. Lavender bath oil reduces stress and crying and enhances sleep in very
young infants. Early Hum Dev. 2008;84(6):399-401.

Enhancing olfactory stimulation:

Stress (cortisol) levels of the baby and parent
decreased during bath time with a scented product 1
Cortisol Levels of
Parents and Babies
Decrease During
Bath Time with
Scent

1. Field T, Cullen C, Largie S, Diego M, Schanberg S, Kuhn C. Lavender bath oil reduces stress and crying and enhances sleep in very
young infants. Early Hum Dev. 2008;84(6):399-401.

Infant Care
On a practical level
Extended breastfeeding on demand
Day: Close physical contact to mothers for
most of the time, until ambulant (carried on
caregivers bodies: front/ back/ hip)
Bathing practice & bed time ritual
Night: Co-sleeping of parents & children

Key messages
Babies are born ready to learn
Multi sensorial stimulation is critical to
brain development & learning
Best learning happens in nurturing
relationships: Kids learn through being
engaged & doing, watching & copying.

Thank you.

Johnson & Johnson Consumer Companies, Inc. 2015