The Neuroscience of Birth, and the case for ZERO SEPARATION · Slide by: Jack P. Shonkoff, M.D....
Transcript of The Neuroscience of Birth, and the case for ZERO SEPARATION · Slide by: Jack P. Shonkoff, M.D....
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Dr Nils Bergman
MB ChB, DCH, MPH, MD
Cape Town, RSA
www.skintoskincontact.com
The Neuroscience of Birth, and the case for
ZERO SEPARATION
Disclosure of Financial Interest
• I, Nils Bergman, DO have a financial interest with
one or more organizations that could be perceived as
a real or apparent conflict of interest in the context of
the subject of this presentation, they are:• Affiliation/Financial Interest Name of Organization(s)
• Owner / Director NINO Academy
• NINO Academy produces educational and
promotional materials related to Kangaroo Mother
Care, and a garment for skin-to-skin contact.
600gr, 26 w GA, 48 hrs Even at 600gr,26 w GA
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What is going on in that brain?
EYE CONTACTThe Neuroscience of Birth,
and the case for ZERO SEPARATION
What is going on in that brain?
The Neuroscience of Birth, and the case for
ZERO SEPARATION
Garner 2011
Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes
in stress hormone levels.
• An important and necessary aspect of healthy
development that occurs in the context of
stable and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D. CORTISOL
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Shonkoff 2012
The basic
science of
pediatrics.
Shonkoff J P et al.
Pediatrics 2012;
129:e232-e246
©2012 by American Academy of Pediatrics
6. The consequences of significant adversity early in life prompt an urgent call for
innovative strategies to reduce toxic stress within the
context of a coordinated system of policies and services guided by an
integrated science of early childhood and early brain development.
EARLY YEARS → LIFE SPAN
LearningBehavior
Physical well beingMental well being
TOXIC STRESS
EARLY LIFE ADVERSITY
MAKES POORER LinguisticCognitiveEmotionalAdaption
responsivity→ unhealthy lifestyle
→Chronic disease→health disparity
MASSIVE COST $$$$
REDUCETOXIC STRESS
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
MICRO-RNA
HISTONE MODIFICATION
DNA METHYLATION
The Neuroscience of Birth & Breastfeeding
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NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & Breastfeeding
REMNR1NR2NR3SWS
ACQUISITION CONSOLIDATION MEMORYFORMATION
poly-sensory input transfer information P wavesshort-term memory “SNR” strong signals returns infostored cortex amygdala / to neocortex:
hippocampus organizedAwake and REM NREM stage 4 REM
SLEEP CYCLING - BRAIN WIRING
Stanley Graven 2006
1. Messages are
collected in cortex
4. End of sleep
cycle - circuit
completed
3. In REM sleep –
fire to front of brain
(approach/ avoid)
2. In SWS sleep –
moved to emotional
brain (amygdala)
Peirano 2003
Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”
Sequence• Neural circuits that process basic information
are wired earlier than those that process more
complex information.
Slide by: Jack P. Shonkoff, M.D.
Brain Architecture and Skills are Built in a Hierarchical “Bottom-Up”
Sequence• Neural circuits that process basic information
are wired earlier than those that process more
complex information.
• Higher circuits build on lower circuits, and
skill development at higher levels is more
difficult if lower level circuits are not wired
properly.
Slide by: Jack P. Shonkoff, M.D.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
• Higher circuits build on lower circuits, and
skill development at higher levels is more
difficult if lower level circuits are not wired
properly.
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & Breastfeeding
Developmental timetable
CRITICAL PERIODS of development
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NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
HIGHLY CONSERVED NEURO-ENDOCRINE
BEHAVIOR
“LIFE SCIENCES THEORY”
The Neuroscience of Birth & Breastfeeding
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
HIGHLY CONSERVED NEURO-ENDOCRINE
BEHAVIOR
The Neuroscience of Birth & Breastfeeding
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & Breastfeeding
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
“For species such as primates, the mother IS the environment.”
Sarah Blaffer Hrdy, Mother Nature (1999)
The Neuroscience of Birth & Breastfeeding
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
Nothing an infant can or
cannot do makes sense,
except in light of mother’s body
The Neuroscience of Birth & Breastfeeding
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Brain
EPIGENETICS
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
Skin-to-skin contact
except in light of mother’s body
The Neuroscience of Birth & Breastfeeding
ENVIRONMENT SKIN-TO-SKIN CONTACT
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NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
Shonkoff 2012
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
raises its own temperature,has a higher blood glucose,metabolic adaptation faster.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
“The newbornmay appear
helpless, but
TRANSITIONENVIRONMENT SKIN-TO-SKIN CONTACT
Images courtesy of Prof Peter Hartmann, UWA
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATIONENVIRONMENT SKIN-TO-SKIN CONTACT
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATIONENVIRONMENT SKIN-TO-SKIN CONTACT
Transition score
Heart rate score
Breathing score
Heart stability
Resp’ stability
CVS stability
Oxygen sat’
Apnoea
Temperature
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The BOND is made up of the
sensory inputs from the parent to the infant
Bowlby 1969, 1973, 1980
Attachment Theory
The BOND is made up of the
sensory inputs from the parent to the infant
REGULATION
Bowlby 1969, 1973, 1980
Through “hidden maternal regulators” ...
warmth → activity levelmilk → heart rate
“ physiological set points “internal working modelsscripts – templates
a mother precisely controls everyelement of her infant’s physiology,
from its heart rate to its release of hormones
from its appetite to the intensity of its activity
(Gallagher 1992)
Through “hidden maternal regulators” ...
Warming, feeding and
protection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994) Skin-to-skin “causes” breastfeeding
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Warming, feeding and
protection behaviours areintricately, inseparablylinked to the right place.
(Alberts 1994)
MICROBIOTA
3. NEUROLOGICAL DEVELOPMENT
2. METABOLIC FUNCTION
1. IMMUNITY
2. METABOLIC FUNCTION
1. IMMUNITY
3. NEUROLOGICAL DEVELOPMENT
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… microbiota disturbances with antibiotic use,
cesarean section, and formula feeding that may
contribute to obesity, asthma, and other disorders.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
intricately, inseparablylinked to the right place→ ZERO SEPARATION
(Alberts 1994)
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
BIRTH
ENVIRONMENT SKIN-TO-SKIN CONTACT
intricately, inseparablylinked to the right place→ ZERO SEPARATION
AT BIRTH
SMELL vanilla / colostrum / water (control)
read NIRS activity FRONTAL LOBE
• This was confirmed by
demonstration of a statistically
significant negative correlation
between changes in [Hb O2] and
postnatal age (r 520.64, p 5 0.001
with 95% confidence interval) (Fig.
4). Those babies showing the
greatest increase in [Hb O2] were
between 6 and 24 h old at testing
• In the 14 babies older than 24 h
there was no significant difference
between the changes in [Hb O2]
during control and colostrum
exposure
APPROACH RESPONSE
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In the 14 babies
older than 24 h
there was
no significant
difference
between the
changes in [Hb
O2] during control
and colostrum
exposure
Those babies
showing the
greatest
increase in
[Hb O2] were
between 6 and
24 h old at
testing
The first hours after birth are a
CRITICAL PERIOD
APPROACH RESPONSE
Smell
Skin contact
TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACTconnect direct to the amygdala
AT BIRTH,
the brain has TWO CRITICAL SENSORY NEEDS:
SMELL & CONTACTconnect direct to the amygdala
THE NEWBORN
BRAIN
SKIN-TO-SKINCONTACT
fires and wires
the amygdala-prefronto-orbital cortical pathway (PFOC)Schore 2001
AMYGDALA:EmotionalProcessingUnit CPU
Prefrontal cortexExecutive
function
SOCIAL and EMOTIONAL
INTELLIGENCE
SOCIAL EMOTIONALINTELLIGENCE INTELLIGENCE
Behavioural activation systemreward-based(dopamine)
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Welch 2013
Als 2004
Smell
Skin contact
Lenzi 2009
The newborn can imitate –
Mirror neurons
Meltzoff 1999
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In humans, oxytocin increases gaze to the
eye region of human faces and enhances
interpersonal trust and the ability to infer
the emotions of others from facial cues.
Interpersonal awareness
Emotions
Kerstin
Uvnas-Moberg
Ross 2009
Smell
Skin contact
Smell
Skin contact
FACE RECOGNITIONCENTRE
OXYTOCIN
EMOTIONCONTROL CENTRE
The infant brain is not
blank!Resting activity
-“stream of
consciousness”
Fransson 2007
A primary visual areas,
B somatosensory motor cortex
C primary auditorycortex
D parietal cortex & cerebellum
E m l anterior pre-frontal cortex
Fransson 2007
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Smell
Skin contact
EMOTIONCONTROL CENTRE
FACE RECOGNITIONCENTRE
OXYTOCIN
E prefrontal
A primary visual
B somatosensory
C primary auditory
D parietal& cerebellum
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
Smell
Skin contact
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
BABY
BONDING
ZERO SEPARATIONthe science behind the concept
Suckling and expression should start very early!
Effect of early breastmilk expression Parker LA. J
Perinatol. 2012Parker LA. Breastfeeding Medicine 2015
. • First hour expression ( vs. hrs. 2-6) ↓ time to lactogenesis and ↑production by 130% at 6 weeks (613.0 vs. 267.2)
Milk Volumes From Day 1 To 6 Weeks
Parker, J Perinatol, 2012
3 weeks 6 weeks
Suckling and expression should start very early!
Slides thanks to
Jane Morton
Skin-to-skin “causes” breastfeeding
SUCKLING precedes breastfeeding
Skin-to-skin “causes” breastfeeding
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NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
BABY
BONDING
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Smell
Skin contact
Milk making NUTRITION
Hypothalamus→Pituitary:PROLACTIN →
Maternal ferocityPROTECTION
OXYTOCIN→ Gaze increase:→ BONDING
OXYTOCINCingulate Suppressed →
REGULATION
Amygdala:CHOLECYSTOKININ→ Emotion / satiety
Hypothalamus→Pituitary:
Cingulate
Amygdala
… infant cues - suckling, vocalisation and tactile stimulation - stimulate
OXYTOCINrelease in the hypothalamus, which may result in the activation
of the DOPAMINEreward pathway leading to behavioural reinforcement
SENSITIZATION
0
5
10
15
20
25
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
SENSITIZATION
Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security
15
0
5
10
15
20
25
-0.2 0 0.2 0.4 0.6 0.8 1
Maternal Behavior Q-Sort
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesMaternal behaviour Q SortPredicts attachment security
SENSITIZATION
0
5
10
15
20
25
25 27 29 31 33 35 37 39 41 43 45
Maternal Behavior Subscale of the NCATS
Ho
urs
of
SS
C i
n In
fan
ts' F
irst
24 H
ou
rs
Dose of SCC first 24 hours correlatesNCATS ( Nursing Child Assessment Teaching Scale )
Predicts cognitive outcomeEPDS (depression) score DECREASED
significantly for first two visits.
JOGNN, 41, 369-382; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
Control
SSC
… infant cues - suckling, vocalisation and tactile stimulation - stimulate
OXYTOCINrelease in the hypothalamus, which may result in the activation
of the DOPAMINEreward pathway leading to behavioural reinforcement
EARLY !!BIDIRECTIONAL !!
Affect regulation
“Human brains are RELATIONAL”
… co-creating touch… signature unique to caregiver
PRATHIBA REEBYE
BONDING Sensitization
Secure attachment
Attuned parenting
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
MOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
EMOTIONAL INTELLIGENCE
SOCIAL INTELLIGENCE
The first hours after birth are a
CRITICAL PERIOD
mutual psycho-neuro-physiological
caregivers
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Critical period concept :
“Windows of opportunity in early life when a child’s brain is exquisitely primed to receive sensory input in order to develop more advanced neural systems.”
a mother’s brain …
SENSITIZATION
ENVIRONMENT
BIRTH
Maternal sensitization
BREASTFEEDINGFeed → Sleep Cycling
BABY
BONDING Sensitization
Secure attachment
Attuned parenting
SKIN-TO-SKIN CONTACT
ZERO SEPARATIONthe science behind the concept
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D. CORTISOL
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience
HEALTH
Toxic stress
… infant cues - suckling, vocalisation and tactile stimulation - stimulate
OXYTOCINrelease in the hypothalamus, which may result in the activation
of the DOPAMINEreward pathway leading to behavioural reinforcement
key biological systems … that contribute to maternal caregiving behaviour … the oxytocinergic and dopaminergic systems.
… dopamine pathways contribute to the processing of infant-related sensory cues leading to a behavioural response.
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key biological systems … that contribute to maternal caregiving behaviour … the oxytocinergic and dopaminergic systems.
… dopamine pathways contribute to the processing of infant-related sensory cues leading to a behavioural response.
SEPARATION
Toxic stress
Insensitiveparenting
REPRODUCTIVE FITNESS
OXYTOCIN
OXYTOCIN is PULSATILE
Cervical dilatation
Skin-to-skin contact
Breastfeeding
Eye-to-eye contact
What about PITOCIN ?(Synthetic OXYTOCIN)
What about PITOCIN ?(Synthetic OXYTOCIN)
Olza 2012 Acta Paed 101 (7): 749-754
… intrapartum exogenous oxytocin
seems to disturb sucking and
breastfeeding duration
Association of peripartum synthetic oxytocin
administration and depressive and anxiety
disorders within the first postpartum year.
n 9684
n 37048
OXT inperipartum
No OXT
given
Depression 1yr
36% more (if before)32% more (if not)
doi: 10.1002/da.22599.
CONCLUSIONS:
Contrary to our hypothesis, results indicate ….
a higher risk of receiving a documented depressive
or anxiety disorder diagnosis
Kroll-Desrosiers 2016
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
HEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
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NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONBABY
BONDING Toxic stress
•Disrupts brain architecture and leads to stress management systems that
respond at relatively lower thresholds, thereby
increasing the risk of stress-
related physical and mental illness.
CORTISOL
Positive Stress
• Moderate, short-lived stress responses, such
as brief increases in heart rate or mild changes
in stress hormone levels.
• An important and necessary aspect of healthy
development that occurs in the context of
stable and supportive relationships.
Slide by: Jack P. Shonkoff, M.D.
Under-activity
EUSTRESS
Over-activity
Positive Stress
= Eustress
• An important and necessary
aspect of healthy development
that occurs in the context of
stable and supportive relationships.
Tolerable Stress
• Stress responses that could disrupt brain
architecture, but are buffered by supportive
relationships that facilitate adaptive coping.
• Generally occurs within a time-limited period,
which gives the brain an opportunity to recover
from potentially damaging effects.
Slide by: Jack P. Shonkoff, M.D.
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
JACK SHONKOFF
“Buffering
protection
of adult support”
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PROTEST –DESPAIR
OXYTOCIN CORTISOL
OXYTOCIN
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D.
SEPARATION DYSREGULATES
OXYTOCIN
CORTISOL
SEPARATION
Toxic stress
absence
SEPARATION DYSREGULATES
CORTISOL
OXYTOCIN
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CORTISOL
MICHAEL MEANEY epigenetics
CORTISOL
Unsafe environment activates HPAaxis (autonomic nervous system, ANS).
Psychobiology
and molecular
genetics of
resilience
Adriana Feder*, Eric
J. Nestler‡, and
Dennis S. Charney‡ Nat Rev Neurosci. 2009 June ; 10(6): 446–457. doi:10.1038/nrn2649
HG BABY HG BABYLOW Grooming care
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
UNHEALTHYadult
LOW Grooming LG
Makes MOTHER
CORTISOL
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
Early stress alters gene expression,with health impact across lifespan.
REGULATIONIn simple system
ONLY environment → reversibleice – water – steam
In complex system -irreversible = development
(PREDICTIVE ADAPTIVE RESPONSE)
Barak Morgan 2013
Early stress alters gene expression,with health impact across lifespan.
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CANALISATION
Developmental programming is therefore
VERY EARLY ONCE OFFFOREVER
Barak Morgan 2013
(PREDICTIVE ADAPTIVE RESPONSE)
Early stress alters gene expression,with health impact across lifespan.
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
HEALTHYadult
HIGH Grooming HG
Makes MOTHER
Earliest care at birth matters
Same gene → switched
LG BABY LG BABYHIGH grooming care
OXYTOCIN
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
SEPARATIONBABY
BONDING Toxic stress
OXYTOCIN CORTISOL
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BABY
BONDING
SEPARATION
Toxic stress
OXYTOCIN CORTISOL
Perry: Responses to threat
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
OXYTOCIN
Perry: Responses to threat - FAR
VIGILANCE
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response Vasopressin
22
Perry: Responses to threat - NEAR
FREEZE
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
CORTISOL
Perry: Responses to threat
DISSOCIATION
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
Perry: Responses to threat
REFLEXIVE
Adaptative
Response
REST
(Adult Male)
VIGILANCE FREEZE FLIGHT FIGHT
Hyperarousa
l
Continuum
REST
(Male Child)
VIGILANCE
(Crying)
RESISTANCE
Freeze
DEFIANCE
‘Posturing’
AGGRESSION
Dissociative
Continuum
REST
(Female
Child)
AVOIDANCE
(Crying)
COMPLIANCE
Freeze
DISSOCIATION
‘Numbing’FAINTING
‘Mini-
psychosis’
PRIMARY
secondary
Brain Areas
NEOCORTEX
Subcortex
SUBCORTEX
LimbicLIMBIC
Midbrain
MIDBRAIN
Brainstem
BRAINSTEM
Autonomic
Cognition ABSTRACT CONCRETE ‘EMOTIONAL’ REACTIVE REFLEXIVE
Mental State CALM AROUSAL FEAR TERROR
SSHHH!!
Moro reflex –often called a STARTLE REFLEX
because it occurs when a baby is startled by a loud sound or movement
Moro reflexSTARTLE
Thumb flexfinger claw
FREEZE
23
Perry: Responses to threat
DISSOCIATION
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
TERRORFEARAROUSALCALMMental State
REFLEXIVEREACTIVE‘EMOTIONAL’CONCRETEABSTRACTCognition
BRAINSTEM
Autonomic
MIDBRAIN
Brainstem
LIMBIC
Midbrain
SUBCORTEX
LimbicNEOCORTEX
Subcortex
PRIMARY
secondary
Brain Areas
FAINTING
‘Mini-
psychosis’
DISSOCIATION
‘Numbing’COMPLIANCE
Freeze
AVOIDANCE
(Crying)
REST
(Female
Child)
Dissociative
Continuum
AGGRESSIONDEFIANCE
‘Posturing’
RESISTANCE
Freeze
VIGILANCE
(Crying)
REST
(Male Child)
Hyperarousal
Continuum
FIGHTFLIGHTFREEZEVIGILANCEREST
(Adult Male)Adaptative
Response
Jacksonian Dissolution
The more threatened the individual,the more 'primitive' (or regressed) becomes the style of thinking and behaving.
Perry 1995
DVC
VVC
SNS
CORTISOL
Toxic Stress
• Strong and prolonged activation of the body’s
stress management systems in the absence of
the buffering protection of adult support.
• Disrupts brain architecture and leads to stress
management systems that respond at relatively
lower thresholds, thereby increasing the risk of
stress-related physical and mental illness.
Slide by: Jack P. Shonkoff, M.D.
CORTISOL
Primate separation studies
Maternal Separation Paradigm0w 1w 2w 3w 4w 5w 6w →→ 12w
n 4 Mat MNS→group reared no mothern 4 Mat → → → MNS→ group as aboven 4 Mat → → → → → → (control)
Gene specific for the AMYGDALA( GUYC1A3)
Separated at 1 week:
LOW gene expression
Increased self soothing→ Anxiety
Decreased sociality→ Depression
24
Primate separation studies
Maternal Separation ParadigmEarly Deprivation (ED) vs control (CON)
0d 2d → →28d → → 48wED n 11 Mat 30 -120 min daily →
CON n 4 Mat → → → → → → 48w
Repeated shortseparations:
LOW gene expression
Correlate to human adult depression
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
Adults with depression, suicides:LOW gene expression
smalller hippocampal volumereduced expression frontal lobe
These findings translate previous results from rats / monkeys to humans
2ND
KNOCK
25
DOHAD
Developmental Origins of
Health and Adult Disease
… very early, once off, and forever.
Early stress alters gene expression,with health impact across lifespan.
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
Sabatini
Arabadzisz
Nelson &
Panksepp 1998
SAFE UNSAFE
MICHAEL MEANEY epigenetics
CORTISOL
Unsafe environment activates HPAaxis (autonomic nervous system, ANS).
26
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
Early stress alters gene expression,with health impact across lifespan.
SAME CORTISOL RECEPTOR SWITCHED OFF BY STRESS
Early stress alters gene expression,with health impact across lifespan.
DISEASEHEALTH
CORTISOLOXYTOCIN
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
DISEASEHEALTH
CORTISOLOXYTOCIN
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
SOCIALITY
becomes
REWARDING
… IN BOTHMOTHER
AND BABY.
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
27
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
WELL-BEING → SUSCEPTIBILITY →MORBIDITY → MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
… there is considerable overlap in the brain structures associated with these neural mechanisms … functional interactions among the circuits.
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
An overly responsive fear circuit … may negatively influence functioning of the reward system.
… a properly functioning reward circuit may be necessary for …positive social behaviors.
Resilience Vulnerability
DISEASEHEALTH
CONCLUSIONSScientific findings do not support the perceived benefits of permanent, preweaningmother–infant separation.
PR - Peer Reared
MR – Mother Reared
Plasma CORTISOL response to STRESS (2y)
RESILIENCE:“capacity to maintain
healthy emotional functioning in the after-
math of stressful experiences”
DISEASEHEALTH MR PR
RESILIENCE(= STRESS RESISTANCE)
“capacity to maintain healthy emotional functioning in the after-math of stressful experiences”
Resilience Vulnerability
DISEASEHEALTH
28
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
1 Transition2 Regulation3 Breastfeeding4 Microbiota5 Bonding6 Sensitization7 SEPARATION → HARM !!!
ZERO SEPARATIONthe science behind the concept
ENVIRONMENT SKIN-TO-SKIN CONTACT
AT BIRTH
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
1 Transition2 Regulation3 Breastfeeding4 Microbiota5 Bonding6 Sensitization7 SEPARATION → HARM !!!
ZERO SEPARATIONthe science behind the concept
ENVIRONMENT SKIN-TO-SKIN CONTACT
AT BIRTH
1 Maternal insensitivity to cues2 Maternal OXT receptor dysfunction,3 Maternal depression4 Neonatal cortisol receptor decrease5 Neonatal limbic brain: loss resilience6 Neonatal feeding problems, DOHAD
7 etc, SEPARATION → HARM !!!
ZERO SEPARATIONthe science behind the concept
ENVIRONMENT SEPARATION
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
1 Maternal insensitivity to cues2 Maternal OXT receptor dysfunction,3 Maternal depression4 Neonatal cortisol receptor decrease5 Neonatal limbic brain: loss resilience6 Neonatal feeding problems, DOHAD
7 etc, SEPARATION → HARM !!!
ZERO SEPARATIONthe science behind the concept
ENVIRONMENT SEPARATION
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Neuroscience of Birth & BreastfeedingThe Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
29
BIRTH BONDING Sensitization Toxic stress
IT MATTERS
HOW WE ARE BORN
SEPARATION
DISEASE
Toxic stress
TOXIC STRESS = absence of the buffering protection of adult support.
SEPARATION IS A STRESSOR FOR FULL TERM NEONATES
SEPARATION
DISEASE
Toxic stress
TOXIC STRESS = absence of the buffering protection of adult support.
SEPARATION IS A STRESSOR FOR FULL TERM NEONATES
preterms have less resilience:
SEPARATION IS A SEVERE STRESSORFOR PRETERMS
REGULATION vs STIMULATION
Expected vs UnexpectedEcologic salience vs Potential threatResource growth vs threat readiness
OXYTOCIN vs CORTISOL HOMEORHESIS vs HOMEOSTASIS
MOTHER vs OTHER
Our NORMAL biology
Skin-to-skin
contact
IS MORE
essential for
premature
newborns!
Our NORMAL biology
Slide courtesy of Susie Ludington-Hoe
30
(Modi & Glover 1998, Mooncey et al 1997)
“Non-pharmacological reduction of
hypercortisolaemia in preterm infants”
Preterm infants experience prolonged severe stresswith tenfold increases in stress hormones.
Stress hormones at such levels are neurotoxic.
RCT on methods to reduce of stress (at one hour):
Cortisol EndorphinMassage slightly lower no change
Soft music no change no change
Skin-to-skin 66% lower 74% lower
CORTISOL
Preterm infants experience prolonged severe stresswith tenfold increases in stress hormones.
Stress hormones at such levels are neurotoxic.
(Modi & Glover 1998, Mooncey et al 1997)
RCT on methods to reduce of stress (at one hour):
Cortisol EndorphinMassage slightly lower no change
Soft music no change no change
Skin-to-skin 66% lower 74% lower
SSC – PROTECTION
SEPARATION RAISESSTRESS HORMONES
CORTISOL
Separation from mother is stressful for humans.Salivary cortisol is a good measure of stress.
RCT (Anderson et al 1998)
Two groups of newborns,
both given best care, only
one separated from mother
at one hour age
Cortisol levels measured
every hour.
Cortisol separate = 9Cortisol with mom = 4
SEPARATION = STRESS
CORTISOL IN NEWBORNS
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4 5 6
TIME (hours)
Separated Mother contact
BIR
TH
SE
PA
RA
TIO
N
9
4
SSC – RESEARCH protection
CORTISOL
Both babies and their parents may experience a stay in
the newborn intensive care unit (NICU) as a traumatic or
a ‘toxic stress,’ which can lead to dysregulation of the
hypothalamic–pituitary–adrenal axis and ultimately to
poorly controlled cortisol secretion.
… strongly linked to poor health outcomes
… trauma-informed care is an approach to caregiving
based on the recognition of this relationship.
STRESSES IN PREGNANT WOMEN
STRESSES IN NICU INFANTS
MODIFICATION OF THE STRESS RESPONSE THROUGH SOCIAL
CONNECTEDNESS
THE POLYVAGAL THEORY IN THE NICU
ADAPTATION OF PRINCIPLES OF TRAUMA-INFORMED CARE TO
THE NICU SETTING
TRAUMA-INFORMED CARE OF THE FAMILY AND BABY:
NEWBORN INTENSIVE PARENTING UNITS
PROACTIVE COMMUNICATION AND EDUCATIONAL STRATEGIES
PROVIDING TRAUMA-INFORMED SUPPORTS TO STAFF
CARING FOR PREGNANT WOMEN, NEW MOTHERS,
FAMILIES AND BABIES
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
The Science behind Family Centred Care
31
SEPARATION
Vulnerability
DISEASE
Disordered attachment
Toxic stress
Insensitiveparenting
Feb 19, 2018Conclusions and Relevance:
Extremely or very preterm children born in the antenatal
corticosteroids and surfactant era show large deficits in
intelligence. No improvement in cognitive outcome was
observed between 1990 and 2008.
…
Bronchopulmonary dysplasia was found to be a crucial
factor for cognitive outcome. Lowering the high
incidence of BPD may be key to improving long-term
outcomes after EP/VP birth.
n = 366CONCLUSIONS This study demonstrated a reduction in total length of hospital stay for infants born prematurely by providing facilities for parents to stay in the NICU 24 hours/day from admission to discharge. Analyses of secondary outcomes also suggested a reduction in pulmonary morbidity, such as moderate-to-severe BPD.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
The Science behind Family Centred Care
32
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
The Science behind Family Centred Care
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
MOTHERBABY
BONDING Sensitization
The Science behind Family Centred Care
Early Experience and the Development of Stress
Reactivity and Regulation in Children (Gunnar 2010)
Neurosci Biobehav Rev. 2010 May ; 34(6): 867–876. doi:10.1016/j.neubiorev.2009.05.007.
Nelson &
Panksepp 1998
SAFE UNSAFE
HG - High Grooming Low Grooming LG
HG BABY LG BABY
MOTHER MOTHER
Healthy UNHEALTHYadult adult
HG – High Grooming Low Grooming - LG
Makes MOTHER Makes MOTHER
Early stress alters gene expression,with health impact across lifespan.
NURTURESCIENCE
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
WELL-BEING → SUSCEPTIBILITY →MORBIDITY → MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
… there is considerable overlap in the brain structures associated with these neural mechanisms … functional interactions among the circuits.
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
NURTURESCIENCE
MARTHA WELCH Meyers, Hofer, Fifer, Ludwig etc
33
Nurturescience program now planned for
KAROLINSKA, Stockholm
BJORN WESTRUPULRIKA ADEN NILS BERGMAN
NURTURESCIENCEEssentially ecological:
BREASTFEEDINGFeed → Sleep Cycling
MOTHERBABY
BONDING Sensitization
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
(from Greek: οἶκος, "house", or "environment"; -λογία, "study of")
The branch of biology that deals with the relations of
organisms to one another and to their physical surroundings.
NURTURESCIENCE
3 primary occupations:
BREASTFEEDINGSLEEPING
CONNECTING
BREASTFEEDINGFeed → Sleep Cycling
MOTHERBABY
BONDING Sensitization
NURTURESCIENCE
Neuroscience developed
in the old paradigm of
maternal-infant separation.
NURTURESCIENCE
Nurturescience now engulfed or embedded in current
neuroscience paradigms,
Needs dissecting out →
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to birth to 1
month1 month – 3 years (ECD)
Comparison of nurturescience and neuroscience
First 1000 seconds (1st hour) TRANSITIONFirst 1000 minutes (1st day) SENSITIZATION First 1000 hours (6 weeks) CONNECTION→ First 1000 days ECD
AT BIRTHImmediate
34
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to
birth to 1 month
1 month – 3 years
(ECD)
First 1000 minutes First 1000 days
ANS purpose HOMEORHESIS HOMEOSTASIS
Dyadic / family (plural) Individual (singular)
Dynamic systems theory Reductionistic logic
KEY
OUT-
COME
CONNECTION
RESILIENCE
ATTACHMENT
COGNITION
Comparison of nurturescience and neuroscience
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to birth to 1
month1 month – 3 years (ECD)
Comparison of nurturescience and neuroscience
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
The Science behind Family Centred Care
FEARCONTROL
CENTRE
REWARDCONTROL
CENTRE
SOCIALCONTROL CENTRE
OXYTOCINDOPAMINE
CORTISOL
EMOTIONCONTROL CENTRE
WELL-BEING → SUSCEPTIBILITY →MORBIDITY → MORTALITY
DISEASEHEALTH
RESILIENCE VULNERABILITY
… there is considerable overlap in the brain structures associated with these neural mechanisms … functional interactions among the circuits.
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to birth to 1
month1 month – 3 years (ECD)
Emotions
Regulatory
mechanism
Viscera / ANS / limbic brain Limbic brain / neocortex
Maternal regulation then co-
regulationSelf-regulation (within self)
Open feedback loop (with others) Closed feed-back loop (within self)
Comparison of nurturescience and neuroscience
REGULATION vs STIMULATION
Expected vs UnexpectedEcologic salience vs Potential threatResource growth vs threat readiness
OXYTOCIN vs CORTISOL HOMEORHESIS vs HOMEOSTASIS
MOTHER vs OTHER
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to birth to 1
month1 month – 3 years (ECD)
Emotions
Regulatory
mechanism
Viscera / ANS / limbic brain Limbic brain / neocortex
Maternal regulation then co-
regulationSelf-regulation (within self)
Open feedback loop (with others) Closed feed-back loop (within self)
Comparison of nurturescience and neuroscience
CORTISOL
NURTURESCIENCE NEUROSCIENCE
Key time
period
Perinatal, conception to birth to 1
month1 month – 3 years (ECD)
Emotions
Regulatory
mechanism
Viscera / ANS / limbic brain Limbic brain / neocortex
Maternal regulation then co-
regulationSelf-regulation (within self)
Open feedback loop (with others) Closed feed-back loop (within self)
Emotions
Learning
mechanism
ANS influences on behavior CNS influences on behavior
Autonomic learning
(Pavlovian conditioning)Operant conditioning
Critical periods (brief) Sensitive periods (long)
Brain adaptation Brain maturation
KEY
OUTCOME
CONNECTION
RESILIENCE
ATTACHMENT
COGNITION
Comparison of nurturescience and neuroscience
NEURODEVELOPMENT
The DNA Behaviour
EVOLUTIONARY BIOLOGY
ENVIRONMENT EXPERIENCE REPRODUCTIVE FITNESSADAPTATION
The Brain
EPIGENETICS
BIRTH
BEYOND BREASTFEEDINGFeed → Sleep Cycling
SEPARATIONMOTHERBABY
BONDING Sensitization
Secure attachment
Attuned parenting
Resilience Vulnerability
DISEASEHEALTH
Disordered attachment
Toxic stress
Insensitiveparenting
NURTURESCIENCE