The pregnant mother on the other side of the room was gently stroking her bulging abdomen, smiling, while connecting to her unborn baby. In the background the voice of the tutor was droning. I was oblivious of the content of the training. Specialising in attachment, I was fascinated by observing the mother-foetal attachment.
Two months later, the same setting and the same seats. The mother opposite me was now cuddling her newborn baby who could not keep her eyes off her mother. The prolonged staring, smiling stroking and cuddling emphasised the mother-infant attachment. There was a sense that the attachment was so special it could be seen and felt in the room. Once again I revelled in the healthy attachment relationship being formed in front of my eyes.
Three months later, the picture on the other side of the room changed radically. The baby, now 14-weeks old, looked pale, she was crying and it appeared that she deliberately refused eye contact with her mother. I frowned, wondering what happened? Finally the crying of little Michelle became incessant and the mother got up and went to the far end of the room, still in my full view. The mother was struggling to feed Michelle. What I thought would be a normal process unfolded in a nightmare for mother and infant. Little Michelle was flailing her body, arching her back and screaming at the top of her voice, refusing to take the bottle. The struggle increased between mother and child.
Clearly the baby was extremely hungry but there appeared no way that the mother could get her to feed. After an intense struggle the baby threw her head back and finally started to
feed facing away from the mother and the mother holding the bottle on the other side of the baby.
‘What an awkward position? Surely this is not normal’, I thought. The next moment Michelle started to cry, screamed and the mother and baby started their struggle all over again. I became more puzzled by the scenario unfolding in front of me. What happened between the last time I saw the amazing attachment between mother and child and now?
There is clearly a total disconnection between mother and child and no sign of the once idealistic attachment I observed. During the break, I immediately enquired what was going on. Slowly the story started to unfold.
Michelle started to struggle with feeding some time ago. After multiple visits to the doctors and the paediatricians Michelle was diagnosed with ankyloglossia (tongue tie) at the age of 10 weeks. It impacted negatively on her sucking reflex. It was suggested that she needs a frenotomy as soon as possible. A frenotomy is a small operation to divide the frenulum, which is a little piece of skin under the tongue. In most cases in the UK this operation is done without any anaesthetics as it is presumed that it will be painful – but not too much! NICE (National Institute on Clinical Excellence) Guidelines suggests that no anaesthetics is needed in the “early months”, but is needed later in infancy. “Early months” is not defined.
The parents, both professionals discussed some form of anaesthetics for their baby during the procedure, but it was refused. The procedure was done and the mother was asked to hold the baby after the procedure and to feed her immediately. According to both parents Michelle appeared to be in shock when she was given to the mother after the operation and she did not make a sound and appeared frozen.
Michelle also immediately started to refuse eye contact with the mother, did not want to feed and slowly but steadily the feeding problems worsened to the point where Michelle started to lose weight. She was only able to take in 85 ml of milk per feed with a huge struggle, crying, and turning her face away from the mother when she finally fed in short bursts while screaming, crying and struggling to free herself from the grip of her mother. At that stage, Michelle was supposed to have 200 ml per feed and she continued to loose weight and condition. The next step would be to start to tube feed Michelle. The mother was crying as she shared her dilemma. One of her worst concerns was that it felt that she lost her attachment to her little baby daughter.
While the mother was talking, finally Michelle started to suck her bottle again. I touched her bare legs with my very cold hands. Michelle did not flinch. I tried to make eye contact with her. Michelle’s eye’s stared through me – she was not seeing me at all. I tried to move an object in front of her – there was no response while she was sucking her bottle. I then tested her Babinski reflex and there was no response at all. It was evident that while Michelle was sucking the bottle, she was in total dissociation. It was evident that Michelle was traumatised by the operation.
The fact that the mother tried to feed Michelle directly after the operation, connected the mother to the trauma. Hence the total disconnection between mother and child. It was also evident that Michelle experienced the operation traumatic enough that she was only able to feed intermittently through screaming while she was in a total dissociated state. The mother, crying, was pleading for help. The decision to start with tube feeding would be made during the next week.
“There is interplay between trauma and attachment as it relates to the development of dissociation in children. Theoretically, dissociation is part of normal development but becomes problematic when it changes the course of normal development and causes difficulty in the child’s life. Children who experience distress or abuse in their relationships with their primary caregivers often find survival and attachment at odds, thus causing distress for the child. To cope and survive, children often dissociate.” (Adler-Tappia & Settle 2008).
It was also evident that Michelle was replaying the trauma, as she was only able to suckle once she pushed her head backward, which is also the position that the frenotomy was done in. Each time the mother was feeding Michelle, the trauma of the frenotomy was replayed and the damage to the mother infant attachment was reinforced. This was clearly a no win situation for a mother and baby who was in the process of establishing a secure attachment. The profound dissociation of Michelle and her inability to feel or respond with her body on normal external stimuli was also of concern. It appeared that she also had some form of somatoform dissociation.
“The brain in trauma has lost its ability to distinguish past from present, and as a result it cannot adapt to the future. The confusion of time further immobilised the trauma victim, who still remains immobilized by a thwarted freeze discharge” (Shaer, 2005).
I asked the mother when the worst feeding time was. The mother said it was the early evening feed. I arranged to be present during this feed and shortly explained to the mother
the possibility of doing EMDR. The mother eagerly agreed.
I arrived early, explained to the parents about EMDR and that at that stage there was no baby protocol for EMDR available and I was unable to predict the outcome of the EMDR.
The parents were absolutely desperate and requested that I should try to do EMDR with Michelle. After further discussion it was finally time for the evening feed.
Both parents were present. Michelle was clearly very hungry and the mother started to try and feed Michelle. The same pattern happened than what I observed during the morning.
Michelle was flailing her arms and legs, trying to move her body away from the mother who was holding her. Her head was moving rapidly away from the bottle and she did not want to
take the nipple of the bottle. As the struggle increased, I placed the buzzers on low intensity and a relatively high speed on the cheeks of Michelle.
As there was clearly somatoform dissociation in her body I hoped that at least the sound of the buzzers would have the desired effect. It was a difficult procedure while I was following
Michelle’s head trying to move away from the bottle, crying, screaming as if the mother was hurting her! Finally Michelle threw her head backwards, turned her head away from the
mother and started to feed. Intermittently she was screaming and fighting not to feed and the struggle would start all over again! I followed Michelle with the buzzers on her cheeks. I asked the mother to explain to Michelle why she had to have the operation. As the struggle continued, I also asked the mother to explain to Michelle that she and the father did not
want her to have the operation without anaesthetics.
Both parents apologised to Michelle that they allowed the doctor to hurt her and that they did not help her. At this stage, the mother looked up and said. “Her crying just changed”.
I asked the mother what she meant. The mother said that the crying turned from ‘angry’ to ‘sad’. I know that only a mother can distinguish this differentiated crying of her little baby.
I explained to Michelle that we all understand that she was really angry with her mother and father who allowed her to be hurt in her mouth. We also could see that she was very sad
about what happened to her. At that stage, I could sense the tension in my body. There was a mixture of my own anxiety about using the EMDR on such a young child and the immensely painful experience of seeing how this little girl was suffering to take in her basic nutrients. I asked the parents to stop the feeding for a while. Michelle was crying – a mixture between hunger and frustration.
After Michelle was calmed down, we started the second attempt to feed Michelle again. I noticed that Michelle was able to feel her legs and feet again while feeding and moved the buzzers at the same speed of earlier to her feet while she was feeding, still crying intermittently, but now the struggle to take her bottle appeared to be less. I installed the calmness just being with the mother. This was done with the buzzers on slow speed. I left the parents after the feed, which was still the bare minimum of 85 ml and asked the parents to keep me updated. I promised to continue the therapy process the next morning.
Early the next morning I received a text from the mother stating that Michelle was able to take her next bottle with no struggle and drank 200 mi with no problems. It was the first
full feed that Michelle had in weeks! I was amazed. Early the next morning in the training, Michelle and her mother was in their usual spot. Michelle still could not make any eye contact with her mother during play. There was a radical change after only one session of EMDR with the feeding and Michelle continued to feed with no struggle, but did not make eye contact.
I did a second session of processing with Michelle, with the buzzers on her feet while talking to her while she was feeding. I told her that I know that she was still angry with her mother, but that her mother was really sorry and that it was ok for her to look at her mother again and for them to resume the nice times that they had. During the next session, Michelle started to make eye contact with her mother again during play.
During the last session of EMDR in the afternoon, I took my buzzers out and while Michelle took the bottle without any problems, she was still looking away from her mother and avoided eye contact with her mother. While I held the buzzers on her feet, I finally managed to catch her eyes and slowly moved around until I stood behind her mother. Michelle followed me and ended up making eye contact with her mother. When she looked away I repeated this action. Michelle finally started to make consistent eye contact with her mother while
feeding. The mother responded loving and talking to Michelle while the normal eye contact was restored and installed with the buzzers on slow speed.
The parents continued to provide feedback to me over the next couple of years. Michelle maintained good feeding and good eye contact with her mother. Mother and infant were able to resume developing a secure attachment. Michelle’s developmental milestones were all very early. She said 35 words at the age of 1 year and drew pictures well above her age at the age of 3 years. Michelle continues to thrive and is a healthy, happy little girl 5 years after the EMDR.
It is evident that one single medical procedure has the capacity to traumatise an infant. Depending on the situation the infant also has the capacity to connect this traumatic experience to the attachment figure, which can profoundly affect and alter the cause of the infant’s attachment development. One single medical procedure, which traumatises an infant, can also causes profound dissociation as well as somatoform dissociation. It was evident in this case that this one single medical trauma started to alter the physical, attachment, emotional, social and psychological development of this child.
EMDR or bilateral stimulation of a traumatised infant can enable the infant to process trauma when it is applied at the time of recalling of the trauma.
EMDR can also change the impact on the physical, emotional, attachment and psychological development of the baby and ensure that the baby moves back to the normal trajectory of
development. EMDR also appears to have the capacity to change the level of dissociation in an infant that developed to protect him/her from the trauma.