Attachment and premature babies

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All babies are born relationship ready. Babies are also born with attachment-based behaviours (crying) that cue their caregiver when they are in distress and need them close. Learn how the baby’s cry and the caregiver’s response to the cry develops the attachment relationship.

Key points

  • Attachment is the emotional relationship that develops between a baby and their caregiver.
  • Attachment is developed based on the caregiver’s behaviours/response to the infant when distressed and needs closeness.
  • There are four several types of developed attachment patterns between caregiver and infant. They are secure, insecure/avoidant, insecure/ambivalent/resistant and insecure/disorganized/disoriented.
  • While the neonatal intensive care unit (NICU) can postpone the development of attachment to some extent, long-term research shows that children born prematurely have the same attachment patterns as children born full term.

Attachment is the developed relationship between your baby and their caregivers. Attachment is a pattern that is formed after repeated experiences between you and your baby at times when they cue their need to be close to you, and you respond to that cue. So, attachment describes the relationship and not the baby or you, the caregiver. Generally, your baby will want to make contact with you when they are frightened, ill or hurt. In fact, any sort of discomfort could lead them to cue for comfort and closeness from you. Their cry tells you they need you.

Attachment and premature babies

Attachment develops in part through interaction between caregivers and their babies. If your opportunities to interact with your pre-term child were reduced because of the circumstances of their birth and their stay in the neonatal intensive care unit (NICU), do not worry—attachment is an ongoing process that begins in the first few months and continues to develop over years.

While it is true that the experience of the NICU may delay attachment to some extent, in the long term, children born prematurely have the same attachment patterns as children born full term. It seems that reduced opportunities for an infant to cue closeness and for a parent to respond, which is often a consequence of being in the NICU, do not have a lasting effect. Studies have shown that by 2 years corrected age, in terms of attachment patterns, children born prematurely develop similar attachment patterns with their caregivers compared to those of children born full term.

One reason may be that attachment takes place over an extended period of time, much longer than any child would be in the NICU. Caregivers are also advised to take advantage of as many moments they can get with their child in the NICU.

Although some of these suggestions may be hard for some caregivers to take advantage of while in the NICU, others will be easier to apply. Ask the staff at the NICU how you can maximize your interactions with your baby and use techniques such as kangaroo care. You can also ask your infant’s health-care provider to give you information specific to the NICU.

It should also be remembered that attachment in the relationship takes place over the first 12 months. Because it is a long-term endeavour, caregivers will be able to practice responding many times when their baby returns home.

What is attachment?

Attachment is the emotional tie between your baby and you, their caregiver. Attachment goes both ways: from you to your baby and from your baby to you. It is the system of behaviours your baby displays in order to get and stay close to you when they are in distress based on their experience of what you do when they need to be close.

Babies need a special person called an "attachment figure" to make them feel safe and secure. Ideally, every baby has at least two such figures and therefore two attachment relationships available to them. This will be very important in shaping how they relate to other people in the future.

Your baby’s system of attachment will slowly emerge over the first 12 months of life. As your child gets older, their sense of attachment will influence how they perceive and interact with other people.

Types of attachment

In the first year, infants tend to take on a specific attachment style when they are in distress, which affects how they react in situations that are stressful to them. The style of attachment that defines a parent-child relationship is shaped by a parent’s caregiving responses to their child over that first year, particularly when the child is frightened, tired, upset or ill.

  1. Secure attachment: The infant knows how to cue the caregiver when they are in distress, and the caregiver knows to comfort the infant and help them return to calm.
  2. Insecure/avoidant attachment: The infant will minimize their need for comfort or not display it because the caregiver has often rejected their need for comfort or not attended to it. This creates a situation where the infant needs to figure out how to return themselves to calm. Sometimes their strategies are not helpful to them.
  3. Insecure/ambivalent/resistant attachment: The infant overexaggerates their distress or sometimes cues it prematurely because their caregiver has often not been emotionally available. This means that the infant cannot trust the caregiver to respond, and that makes the infant more resistant to comfort.
  4. Insecure/disorganized/disoriented attachment: The infant has experienced the caregiver as the source of the distress and, as a result, has trouble knowing whether to seek closeness and potentially make things worse or stay away and stay in distress. The caregiver has often made decisions to be punitive, harsh and/or frightened of their infant’s distress, based on their own needs. As a result, the caregiver did not provide a return to calm but rather exaggerated the distress.

Further information

For more information about attachment, please see the following pages:

Last updated: April 12th 2023