Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life

Ruth Feldman, Zehava Rosenthal, Arthur I. Eidelman

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399 Scopus citations


Background Maternal-newborn contact enhances organization of the infant's physiological systems, including stress reactivity, autonomic functioning, and sleep patterns, and supports maturation of the prefrontal cortex and its ensuing effects on cognitive and behavioral control. Premature birth disrupts brain development and is associated with maternal separation and disturbances of contact-sensitive systems. However, it is unknown whether the provision of maternal-preterm contact can improve long-term functioning of these systems. Methods We used the Kangaroo Care (KC) intervention and provided maternal-newborn skin-to-skin contact to 73 premature infants for 14 consecutive days compared with 73 case-matched control subjects receiving standard incubator care. Children were then followed seven times across the first decade of life and multiple physiologic, cognitive, parental mental health, and mother-child relational measures were assessed. Results KC increased autonomic functioning (respiratory sinus arrhythmia, RSA) and maternal attachment behavior in the postpartum period, reduced maternal anxiety, and enhanced child cognitive development and executive functions from 6 months to 10 years. By 10 years of age, children receiving KC showed attenuated stress response, improved RSA, organized sleep, and better cognitive control. RSA and maternal behavior were dynamically interrelated over time, leading to improved physiology, executive functions, and mother-child reciprocity at 10 years. Conclusions These findings are the first to demonstrate long-term effects of early touch-based intervention on children's physiologic organization and behavioral control and have salient implications for the care practices of premature infants. Results demonstrate the dynamic cascades of child physiological regulation and parental provisions in shaping developmental outcome and may inform the construction of more targeted early interventions.

Original languageEnglish
Pages (from-to)56-64
Number of pages9
JournalBiological Psychiatry
Issue number1
StatePublished - 1 Jan 2014

Bibliographical note

Funding Information:
Research at Dr. Feldman’s lab was supported by the Israel Science Foundation (Grant No. 1318/08), the German-Israeli Science Foundation (Grant No. 1114-101.4/2010), the U.S.-Israel Bi-National Science Foundation, and the Irving B. Harris Foundation .


  • Kangaroo Care
  • cortisol
  • executive functions (EF)
  • longitudinal studies
  • mother-infant relationship
  • premature infants
  • respiratory sinus arrhythmia (RSA)


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