Experimental research on newborns and infants
Published in: Journal of the Norwegian Psychological Association, 2004, 41, 736-739
Translated from Norwegian by Trine Beate Frigstad.
Each year experimental research is conducted worldwide on a substantial number of newborns and infants. One might question the ethical aspects of some of the methods used to obtain new knowledge: Newborns come into the world with a set of expectations, such as continuous physical contact with a caretaker. This aspect has not been taken into consideration in experimental research. Ethical guidelines clearly state that human dignity means that each of us have interests that cannot be denied in order to acquire knowledge or benefit society in any other way. The particular interests of the young test persons should be protected by clearly defined ethical guidelines concerning experimental research on newborns and infants.
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Solveig Albrecht Wahl
Resent research has resulted in a new way of perceiving the competence of newborn babies and young infants. Up to a few years ago, human beings belonging to this age group were neither attributed consciousness or the ability to learn. Experimental research on newborns and infants has shown that an infant already during the first hours, days and weeks of their lives, possesses the ability to expect, recollect and imitate. Film recordings were made showing newborns stretching out a hand to reach an object, for instance a face (Klaus & Klaus, 1998), and the observations attracted attention. The scientific methods which are used to produce this knowledge, however, does raise questions of an ethical nature. For this reason it is important to look at the ethical guidelines subject to human research.
Ethical requirements for researchers
The Helsinki Declaration, Section 21 states: “All experimental subjects have the right to have their integrity protected at all times”. Section 22 states further: “The subject of an experiment shall be informed of his/her right to withdraw from a given consent at any moment of time…” (World Medical Association, 2002). When a person is subject to an experiment, there is a fundamental and absolute requirement about the informed and voluntary consent of the person. The subject of the experiment may however possess reduced autonomy, where the ability and intention to make independent decisions in one’s own interest is not fully developed (Tranøy, 1994). In cases where consent is difficult because of a person’s reduced autonomy, the interests of the person may in some situations be taken care of by assuring consent from parents or guardians (The National Committee for Ethics within Research, in Norway,1999). It is however not certain that the parents’ interests will be in the interest of the child (Ruyter & Nyquist, 1999).
The above mentioned “guidelines for research ethics” (The National Committee of Ethics within Research, 1999, Norway), states that “the value of human life implies that each one of us possesses interests which cannot be put aside in order to gain insight or benefit society in other ways”(p.11) This raises another important issue: Out of which criteria will we be able to tell what the interests of the infant are? Further it states that “Research is necessary to promote human worth, but it may also be a threat” (p.11). An infant is not able to express itself in the language of a scientist, and the language accessible to the infant could therefore easily be neglect, except the infants crying and screaming. In this way the subject of the experiment has few possibilities to withdraw at any moment of time. This is a threat to the human value of the infant’s life.
If the value of human life implies that each one of us possesses interests which cannot be put aside in order to gain insight or benefit society in other ways, we have to look at the specific interests of every infant and newborn child. Because the genetic adaptation develops slower than the cultural, in some areas a human being may be genetically considered as hunter and gatherer of the stone age (Mysterud, 2003). Our starting point will be man’s genetically conditioned expectations – the expectation to be in a more or less continuous bodily contact with a caring person (Hardy, 2000); Wahl, 2001). As all other primates, the human being enters the world with his own agenda. The newborn is equipped with certain innate “inherited coordinations”, which will safeguard the chance of survival, through screaming, sending out signals, clinging onto and in an emotional way desperately asking for care, a primate infant will do anything to feel safe (Hardy, 2000).
For millions of years, primate infants have possessed the indispensable strategy of survival of clinging onto fur. This is why primates are equipped with grip reflexes and the mororeflex (Hess, 1997), a tool which safeguards close bodily contact. Even if we have ‘lost’ our fur, we are still born with these reflexes. This provides a firm basis to assume that these reflexes indicate that human beings also possess an innate expectation to be in close bodily contact, i.e. to be carried.
Studies show that when a newborn child is placed close to the mother’s body, the child’s crying immediately stops. Scientists interpret therefore their crying as a call for help to restore the bodily contact (Christensson, Cabera, Christensson, Uvnäs-Moberg & Winberg, 1995) This contact may reduce the negative consequences of being born, it saves energy – the temperature is being maintained, it accelerates the metabolic adjustment (Bysrova et al., 2003; Christensson et al.,1992). Further studies show that infants who are being carried three hours a day, cry a lot less than those who receive the type of care which is normal within our culture (Hunziker & Barr, 1986). Field studies from cultures where continuous bodily contact between the infant and the bearer is the norm, indicates that persistent crying, so to say, does not exist. This kind of care seems to evolve from the evolutionary experience of human kind (see Schiefenhovel & Schiefenhovel, 1996) Close bodily contact has a double function: The child gets an emotionally, psychologically and physically safe foundation, it arouses a feeling of well-being (Restak, 1979). The carrying person develops a sensitivity towards the infant’s signals, which may be interpreted more quickly.
Signs of stress- the child’s expression of willpower
Stress and dissatisfaction may be expressed not only through crying: “Vertical frowning” is a sign of strain and stress. If the body bends backwards, it is a sign of fear. Other signs may be wide and vacant eyes, grimaces, unstable breathing, clenched fists, gesticulating or lack of gesticulating.
So: Children experience the highest form of security when their whole body is in close physical contact with the mother’s body. It has to be ventro-ventral (Hess, 1997; Hrdy, 2000). Here we are talking about the offspring of other great primates, but the same applies to human offspring.
Signs of stress among the youngest objects of the experiments, may be seen as adequate reactions due to lack of bodily contact. These reactions will occur particularly in unfamiliar situations and surroundings. The behavior should in fact be interpreted as a non-verbally transmission that the child withdraws the parents’ consent. It is in the child’s own interest to observe events while being carried by a well-known body.
In the following I will present four examples of experimental tests with newborns and infants. The question is whether there is a logical coherence between the youngest subjects’ vital interests and their rights to withdraw at any moment in time, and the reality of the experimental situation in which the individuals find themselves.
Are newborns able to imitate?
“Metzoff and Moore have done a replication of their first experiment. … They tested 40 children less than 72 hours old, the youngest child was born only 42 minutes before the start of the experiment ”… (Smith & Ulvund, 1991, p. 47). …
Let us direct our attention to the 42 minutes old newborn infant. The separation from the mother while the experiment was carried out, may illustrate the dilemma the experiments can end up in, because the child was born into the world with his own agenda: Previously it was almost taboo to think that human behavior connected to labor would be the same as with animals: “controlled by a program” (Nordstrøm, 1993). When a newborn child is placed on his mother’s belly and is left alone, he is then going to rest for about ten minutes, doze a little, then he will move his head, open his eyes, look at his mother, move his hand to his mouth (the taste and smell of the amniotic fluid on the hands is identical with the smell of his mother’s breast), begin to smack his lips and search with his mouth. The child then begins to crawl. And after he has rested a few times, he reaches his mother’s nipple, at the earliest approximately after 39 minutes (about the same time as the above mentioned newborn was a subject in the experiment). And at the earliest 59 minutes he begins to suck. The mother and her offspring experience intense eye-contact (Klaus & Klaus, 1998; Richard & Alade, 1990; Widstrøm et al, 1987).
A healthy newborn infant who is not being disturbed or influenced by medication, where his mother’s pregnancy has been uncomplicated, may follow the above mentioned pattern (Ransjø-Arvidson et al., 2001). This innate competence indicates that the fetus does expect to have skin-to-skin contact with his mother after delivery. To be removed from his mother to take part in an experiment, will thus be in conflict with the subject’s own interest.
Amund- a subject of an experiment
From the radio channel, the intense crying of an infant is heard. The crying becomes fainter and eventually it dies out. “Now Amund fell asleep. He could do so with a good conscience”, I hear the producer of the program comment (Verd å Vite, 27.10.1998, Norwegian radio channel P2). Amund is only one month old and has just been part of an experiment where he was “placed on his back in a baby cot consisting of a table with a nursing pillow. His head was held in a straight position by a vacuum fixation pillow” (Gjessingen, 1999, p. 27). Loudspeakers were attached to each hand and measuring instruments to each wrist. Then his mother was left in a soundproof room with windows facing one way. From this room she gained Amund’s attention and adapted his state of mind by singing or humming through a microphone. Amund could listen to his mother’s voice softly coming through the left or right loudspeaker.
The report states that some of the subjects in this experiment fell asleep and had to be woken up. There was also a lot of crying and restlessness during the experiments. As expected, several infants clearly showed a protest-behaviour, but the recordings continued until at least 16 results were registered.
Newborn infants can learn to expect
“Blass and his colleagues have shown that infants already from two hours after birth, can learn to expect reactions or events. A conditional stimulus was used, consisting of contact with the forehead. This stimulus was originally neutral according to the unconditional response, which was orientation of head and sucking with pout. The unconditional stimulus consisted of a sugar dissolution and was given into the child mouth by means of a dropper. Training took place two hours after a meal and it lasted almost an hour… During the terminal phase of extinction, it is interesting to notice that the children in the experimental group showed an expression of surprise, followed by frowning or anger, resulting in whining and crying. After a few waves of sobs, the children fell asleep.” (Smith & Ulvund, 1991, p.44).
The age of the youngest subjects indicate that either the practice started early, during the first ninety minutes after labour, while a newborn infant is still “wide awake” and should have had skin-to-skin contact with his mother, or that the needed sleep afterwards was being prevented through manipulation. The young infants would hardly have had time to be fed two hours before the experiment started, they were not even born. The adequate reactions this manipulating experiment triggered off, show how sensitive young infants are and how nuanced their emotional expressions already are. This non-verbal imparting of surprise, disappointment and anger will hopefully influence the researchers in their decisions to avoid similar experiments.
Papousek carried out conditional experiments involving 130 infants, of whom 40 were newborns (Smith & Ulvund, 1991, p.126, 127). The basis for the test was found in the “rooting reflex”. Before the experiment started, the researchers had to register how many reflex conditioned turns each individual made with their head. An electric bell or humming sound was then introduced just before contact was made. Afterwards the infant was given milk when responding in the right way, when the head was turned in the left direction, responding to sound, and contact was made on the left side of the mouth. When the infant had understood that the sound of bells, contact with the left side of the mouth and turning of the head to the left signified getting food, it was possible to leave out the process of making contact. The child was conditioned to the sound. The experiments were carried out ten times a day, with an interval of approximately one minute between each experiment.
When the subject had learned how to get food from this procedure, he no longer was given this “reward”, although the turning of the head on a given signal was correct. Again the infant was being fed as reward when showing the right behavior. But now a new problem was introduced, the problem of discrimination: Either the child was given milk when turning the head to the right on the bell-sound signal, or by turning the head to the left on the humming-sound. After three weeks and 177 experiments, the researcher was beginning to feel satisfied.
For the youngest infants it took two and a half months until the criteria of discrimination between bell-sound and humming-sound was eliminated. If the conditioning experiments exceeded ten a day, the young infants hunger would soon be satisfied. But he would still carry on turning his head at given signals of sound. Papousek’s observations during the learning process are interesting: Non-specific orientation, like wide and vacant eyes, restriction of other bodily activities and change of the breathing rhythm. The infants belonging to the group of newborns were restless, they did many grimaces and they showed signs of distaste as a result of the sound.
Generally, infants have not developed a sense of time, but for the infant who is being carried this is no disadvantage, because it feels safe. It is however a disadvantage in a situation where an experiment is taking place and where the infant is left on his own. The subject is not able to even hope that the experiment would soon come to and end. Whereas an adult in a similar situation would have the opportunity to withdraw from such an absurd experiment, the young infant must carry on like a robot to the bitter end.
The number of psychological experiments involving infants, on a worldwide basis, is considerable. They have, as a matter of fact, become very popular during recent years. (Smith & Ulvund, 1991). Research on newborns and infants should therefore be treated as a separate matter, concerning ethical doubts and guidelines. It is not possible, however, to find separate paragraphs dealing specifically with infants involved in experiments. The matter is hardly discussed in publicly, and this is worrying since infants undoubtedly do belong to the group of persons with reduced autonomy. (Tranøy,1994)
As we have seen the lack of language is not equivalent with the fact that the youngest research subjects can not express themselves. The researcher may lack the knowledge to interpret the expressions and as in our culture hinder us from acting appropriately That the infant who lies or sits by themselves for short periods can be distracted and attentive when something “ interesting” or “amusing” is presented, need not be synonymous. The process of the experiment may still be stressing them. Half an hour after the experiment with twelve months old infants had taken place, an increase of the stress hormone cortisol, was found in some of the subject’s saliva (Spangler& Grossmann, 1993)
According to the National Committee for Ethics within Research in Norway (1999), does human values imply that we are all assigned interests which cannot be put aside in order to gain insight, or to benefit society in other ways. The infants’ vital interest is to have close body contact with the care-person. Not to take into consideration the child’s non-verbal communication of stress an anxiety – released a lack of body contact, and not to interpret this as a “no”, may even further reduced the already reduced autonomy. The researcher will place themselves above the subject’s right to defend their own integrity. The researcher can only wait for public permission, if they can safeguard the research subjects vital interests – when risk for damage is at a minimum. The subjective emotional an psychological aspects must be included within the risks. (Montgomery,2001).
If there is a logical coherence between the ethics within the research guidelines and the actual care of newborn and infants’ vital interests, I conclude with the following:
The human infant does most probably expect to be in close physical contact with the mother soon after delivery, and is “programmed” to find the breast. This contact may reduce the negative consequences of the stress of being born, the temperature is thereby maintained, it accelerates the metabolic adjustment, and it prevents crying and stress caused by the fear of separation: a perfect adjustment which probably has evolved during human evolution. These factors should justify the claim that the newly born child must be exempted from all experimentation.
On the basis of our insight into the importance of close bodily contact, it should further become a requirement that experiments are generally designed in a way which allow the infant subjects to be in direct contact with the mother’s tummy, or alternatively be able to sit on the hip of a close caring person.
If the human value of this age group is to be taken better care of, the above mentioned conditions must be included in the guidelines for research within ethics.
Bystrova, K., Widstrøm, A. - M., Mathiesen, A.- S., Randsjø-Arvidson, A. B.,Welles-Nystrøm, B., Wassberg, C., Vonontsov, I & Ulvnäs-Moberg, K.(2003). Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg . Acta Pædiatrica, 92 , 320–326.
Christensson, K., Siles, C., Moreno, L., Belaustequi, A., De La Furente, P., Lagerkrantz, H., Puyol, P. & Winberg, J.(1992). Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin to skin or in a cot. Acta Pædatrica, 81 , 488-493.
Christensson, K., Cabrera, T., Christensson, E., Uvnäs-Moberg, K. & Winberg, J . (1995). Separation distress call in the human neonate in the absence of maternal body contact. Acta Pædiatrica, 84 , 468–473.
Den nasjonale forskningsetiske komité(1999). Forskningsetiske retningslinjer for samfunnsvitenskap, jus og humaniora . Vedtatt 15.februar 1999. Oslo: Komitéen.
Gjessingen, A. E.( 1999). Auditiv lokalisering av armer hos 3–6 uker gamle spedbarn. Hovedfagoppgave i psykologi, del II. Norges teknisk-naturvitenskapelige universitet.
Hess, J.(1997). Menschenaffen Mutter und Kind. Basel: F. Reinhardt.
Hrdy, S. B . (2000). Mother nature – nurturing. Maternal instincts & the shaping of the species . London : Vintage.
Hunziker, U. A., & Barr, R. G. (1986). Increased carrying reduces infant crying: A randomized controlled trial. Pediatrics, 77 , 641–648.
Klaus, M. H., & Klaus, P. H.(1998). Your amazing newborn. Massachusetts : Perseus Books.
Montgomery, J . (2001). Informed consent and clinical research with children. I L. Doyal & J. S. Tobias (Eds.), Informed consent in medical research (ss.173-181). London : BMJ Publishing Group.
Mysterud, I.(2003). Mennesket og moderne evolusjonsteori. Oslo: Gyldendal Akademisk
Nordstrøm, M.(1993, 30. januar). Styrt av instinkter. Intervju med Ann-Marie Widstrøm Aftenposten , A-Magasinet, 13 – 14.
Ransjø-Arvidsom, A.-B., Matthiesen, A.-S., Lilja, G., Nissen, E., Widstrøm, A.-M., & Uvnäs-Moberg, K.(2001). Maternal analgesia during labor disturbs newborn behavior: Effects on breastfeeding, temperature, and crying. Birth, 28 , 5–12
Restak, R. M.(1979). The brain. The last frontier . New York : Doubleday
Righard, L., & Alade, M. O.(1990). Effect of delivery room routines on success of first breast-feed. The Lancet, 336, 1105–1107.
Ruyter, K., & Nyquist, I. (1999). Medisinsk forskning med barn. I R. Bugge, R. (Red.), Etikk og forskning med barn. De nasjonale forskningsetiske komitéer (NEM, NENT, NESH).
Schiefenhövel, S., & Schiefenhövel, W.(1996). Am evolutionären Modell – Stillen und frühe Kindheit bei den Trobriandern . I Ch. Gottschalk-Batschkus & J. Schule (Red.), Ethnomedizinische Perspektiven zur frühen Kindheit (ss. 263–282). Berlin: Verlag für Wissenschaft und Bildung.
Smith, L., & Ulvund, S. E.(1991). Spedbarnsalderen . Oslo: Universitetsforlaget.
Spangler, G., & Grossmann, K. E.(1993). Biobehavioral Organization in securely and insecurely attached infants. Child Development, 64 , 1439–1450.
Tranøy, K. E.(1994). Om forskningsetikk – Noen generelle retningslinjer . Forskning på mennesker. Lover, regler og retningslinjer. www.etikkkom.no/NEM/REK/forskmnesk.htm
Wahl, S. A.(2001). Omsorg for og sosialisering av spedbarn – en evolusjonær modell. Impuls, 55 (3), 46–57. (Caring, and socialization of infants – an evolutionary model)
Widstrøm, A.-M., Randsjø-Arvidson, A. B., Christenson, K., Matthiesen, A.-S., Winberg, J. & Uvnäs-Moberg, K.(1987). Gastric suction in healthy newborn infants. Effects on circulation and developing behaviour. Acta Pædiatrica Scand 76 , 566–572
World Medical Association(2002). Helsinki-declaration. Ethical Principles for Medical Research Involving Human Subjects. http://www.wma.net/e/policy/b3.htm
Caring, and socialization of infants –
an evolutionary model