The Skin, Feeding and Early Speech

By Dr Melodie de Jager and Cozette Laubser |

Your skin is your largest and some would say most important sensory organ in your body. Our skin acts as the protective barrier between our internal body systems and the outside world. Its ability to perceive touch sensations gives our brains a wealth of information about the environment around us, such as temperature, pain, and proprioceptive pressure. Without the skin and our sense of touch, it would be very hard to get around in this world! We wouldn’t feel our feet hitting the floor when we walked, we wouldn’t sense when something sharp cut us, and we wouldn’t feel the warm sun on our skin. It is truly amazing how much information we receive about the world through our sense of touch.

THE SKIN AND THE SENSE OF TOUCH

WHERE DOES IT ALL BEGIN?

In the fourth week of pregnancy the ball of cells that is developing into a baby is the size of a poppy seed. It’s at this very early stage of development that the cells divide into 3 distinct layers from which a baby’s internal organs and skin will develop.

1. The outermost layer is called the ectoderm.
2. The middle layer is called the mesoderm.
3. The inner most layer is called the endoderm.

The neural tube – from which the baby’s brain, spinal cord, nerves, and backbone will sprout – is starting to develop in the top layer, called the ectoderm. This layer will also give rise to his skin, hair, nails, mammary and sweat glands, and tooth enamel.

His heart and circulatory system begin to form in the middle layer, or mesoderm. (In fact, his tiny heart begins to divide into chambers and beat and pump blood.) The mesoderm will also form your baby’s muscles, cartilage, bone, and subcutaneous (under the skin) tissue.

The third layer, or endoderm, will house his lungs, intestines, and early urinary system, as well as his thyroid, liver, and pancreas. In the meantime, the primitive placenta and umbilical cord, which deliver nourishment and oxygen to your baby, are already on the job.

What is important to note is that the brain, nervous system, skin and intestines are all intricately linked from very early on.

 

A DEVELOPMENTAL TAKE ON TOUCH

Dr Melodie de Jager, the founder of BabyGym®, says:

• In the very first weeks in-utero, a baby’s first response to touch is one of avoidance. Avoidance is a protective response, because baby wants to live, grow and glow. It is only once mom knows that she is pregnant and involuntary touches her tummy that the baby’s avoidance response is reversed – instead of avoiding touch, baby now starts seeking loving touch.
• The reflex to avoid touch is called a withdrawal reflex and is an involuntary reaction prompted by primitive reflexes. This involuntary reaction is an intrauterine reflex, which means it should wire the skin, reflex brain and muscles while baby is still in the womb, but must go to rest (retire from avoidance behaviour) before birth, otherwise baby may battle to feed, be comforted and generally seem very unhappy.
• Baby’s skin pays attention to four different kinds of sensations, each with its own wiring system: temperature, pain, proprioception and touch.
• The contractions of labour provide baby with an intense deep tissue massage that activates proprioceptive and touch receptors.
• The skin is the largest of the sensory organs and the reason why baby puts everything in his mouth – initially he literally ‘sees’ better when he first touches and then ‘sees some more’ with his mouth.

THE SKIN AND THE DIGESTIVE SYSTEM

As you were formed in your mother’s womb, your skin and gut were formed at the same time. In fact, your gut is an extension of your skin. That is why dermatologists and nutritionists alike often see skin problems mirrored in the gut, and vice versa.

Did you know?

Gut refers to the gastrointestinal tract– the human system of digestive organs. The gut includes everything from the mouth all the way through to the anus – it’s responsible for absorbing nutrients, housing both helpful and harmful bacteria and excreting waste.

At the BabyGym Institute we have found that massage inhibits the withdrawal reflex and/ or tactile defensiveness. Massage relaxes baby, and because we understand the link between the skin and the gut, or digestive tract, we also see the soothing effect massage has on feeding, colic and reflux.

RECOGNISING TACTILE DEFENSIVENESS IN YOUR BABY AND TODDLER

• Baby resists cuddling and swaddling
• Cries easily
• Dislikes getting dressed and undressed
• Dislikes getting into water / dislikes bath-time
• Prefers either numerous layers of clothes or no clothes at all
• Avoids touch in totality including people, animals and things.

CAUSES OF TACTILE DEFENSIVENESS CAN BE NUMEROUS AND INCLUDES:

• Excessive stress during pregnancy
• Placenta insufficiency
• Premature birth
• Post term birth
• Complications during birth
• Separation from mom at birth
• Repeated medical interventions like extended NICU stays involving piercing of the skin, drawing bloods etc.

Babies with an active outer tactile defensive response (skin oversensitivity) often show signs of inner tactile defensiveness (food allergies or digestive problems), which can also manifest as oral tactile defensiveness. Typical symptoms would include:

• Avoidance of most textures in and around the mouth, because anything that is unfamiliar, is perceived as a potential threat. The instinctive response to a threat is to reject, withdraw and cry
• Latching and feeding difficulties arise and the nipple, bottle teat and dummy may be rejected
• Difficulties in handling solids
• Avoidance of textured foods with ‘bits’
• Sometimes mashed food is also avoided
• Gagging if baby is forced to eat foods he or she is unfamiliar or uncomfortable with
• Messy eating in an older child.

Oral tactile defensiveness can result in poor development of tactile perception and discrimination of the lips, tongue and cheeks, and it may impact adversely on the child’s ability to manipulate food in the mouth. What this basically translates to is that instead of the mouth identifying the food as a nutritious substance to be discovered and enjoyed it is automatically disregarded as a threat, with behavior showing dislike or even disgust for textured food.

Without the opportunity to eat food that provides resistance to the mouth (for example broccoli, butternut and meat), muscle tone is compromised.  Chewing becomes strenuous and tiring when there is low muscle tone in the jaw and oral muscles. This results in open-mouth chewing and a preference for pureed foods.

PLAN OF ACTION

NEWBORN BABIES

• Massaging baby is recommended to first de-sensitise the outer skin before de-sensitising the inner skin. Movements need to be firm and loving. Persist even if baby resists – everyday a little more for a little longer.
• Gentle oral de-sensitisation is also needed by using a clean finger and later textured toothbrushes to massage around the lips; inside the lips; the gums, cheeks and the tongue.

OLDER BABIES

• Encourage a variety of textured toys for the baby to touch and explore with his hands, while securely on mom’s lap. Reassure him and talk to him to lower his anxiety. Encourage a curiosity to explore different textures with his hands to overcome the defensive response and to elicit the discriminatory response. In time he will want to explore the textures with his mouth too.
• Teething rings can slowly be introduced moving from a smooth surface and neutral temperature, to warmer and cooler temperatures, and various textured surfaces.

Introducing solids to your 4-6 month old baby

Introducing solids is not only about a whole new world of tastes, colors and textures, it is also an opportunity to develop your baby’s speech and articulation!

Introducing solids is a huge leap for your baby. Her readiness depends on the development of her tongue; if she is ready, she will ‘lap it up’ (like a dog laps up water) meaning her tongue will move backwards pushing the food into her mouth. If she’s not “lapping” her food, it means she will be pushing her tongue forward, pushing the food out of her mouth; she will not be eating and will be hungry.

All speech therapists will tell you that feeding is closely related to speaking. Your baby needs to co-ordinate the muscles of her lips, tongue and cheeks with swallowing and breathing in order to eat successfully. When you introduce solids – and in time, different textures – you are giving your little one a wonderful opportunity to develop the mechanics necessary for beautiful articulation one day.

TODDLERS AND CHILDREN

• Gently but firmly trace the silhouette of the body from head to feet when child is lying down or if he is standing. Hold the feet to foster a sense of being grounded and of security. If the child is standing – apply pressure to the ankles as though to ‘plant’ the feet in the ground.
• Encourage play with textured toys, to play with raw rice or lentils; to play with sand; to play with different textures while in water and to walk with bare feet on a variety of surfaces– start with smooth surface and gradually increase the variety and the number of textures to which the child is exposed.
• Make meal times special and fun times. Refrain from getting anxious and ready to battle.
• Encourage the toddler or child to choose a table mat, bowl, plate and spoon or fork. Gradually introduce food which offers texture and resistance.
• Offer a variety of finger foods to coincide with the toddler or child’s increasing sense of independence.
• Gradually introduce texture to mushy foods. By encouraging him to mix a bit of textured food into the mushy food himself, a child feels more in control and less anxious.

Bibliography

De Jager, M, 2017. Play Learn Grow. Johannesburg: Mind Moves Institute

De Jager, M. 2011. Brain development MILESTONES & learning. Johannesburg: Mind Moves Institute.

De Jager, M. 2010. BabyGym. Welgemoed: Metz Press.