(But not for­get­ting Smell and Taste)

I had lunch today with my new friend M who has Alzheimer’s. She’s 101 years old and has lit­tle else wrong with her except her mem­o­ry and hear­ing. She lives in an assist­ed liv­ing facility.

She has won­der­ful eye­sight (does­n’t wear glass­es!) and obvi­ous­ly uses her eyes to take an inter­est in the world around us. That start­ed me think­ing about how you can’t see a person’s eyes when they’re wear­ing sun­glass­es. Lots of peo­ple don’t remove their sun­glass­es when talk­ing to oth­ers but I feel it incum­bent upon me to do so at all times.

Since we dri­ve to lunch when we’re talk­ing I try and make sure I’m not wear­ing my sun­glass­es. I’m remind­ed if she says “I don’t know what you said”. Even­tu­al­ly I turn my sen­tence around, make sure I’m talk­ing towards her ‘good’ ear and that she is look­ing at my face and then she understands.

All of us also par­tial­ly lip-read every con­ver­sa­tion. Watch a children’s car­toon with­out the sound and you will soon real­ize how impor­tant lip-read­ing is in our under­stand­ing of lan­guage – most crit­i­cal with the youngest in our soci­ety. From a silent car­toon it is hard to dis­cern clear speech — that’s what very young chil­dren see near­ly every day, per­haps account­ing for some speech delays. 

With­out look­ing in someone’s face we obvi­ous­ly can’t lip-read espe­cial­ly once our hear­ing starts to fail as we age or if we are younger with a hear­ing impair­ment. Thus the act of look­ing an infant or young child in the face should be a pri­ma­ry focus in teach­ing them to speak. 

Many par­ents and care­givers of young chil­dren tell me that they read to their chil­dren. It has late­ly become a greater focus and a more praise­wor­thy act of par­ent­ing. The thing that’s for­got­ten (or maybe not even thought of) is that a child is only lis­ten­ing, not look­ing at the parent’s face, when he or she is being read to, since the par­ent is usu­al­ly along­side them.

Touch is the first sense as we emerge from the body at birth. Touch can be gen­tle or star­tling depend­ing on the style or urgency of the birth. 

Hear­ing comes next. The voic­es we hear dur­ing deliv­ery will be either noisy or calm depend­ing again on the cir­cum­stance of the birth.

Sight, imma­ture though it may be, is affect­ed by the lights in the deliv­ery room, which are often bright for the adults to see what they’re doing!. Thus the lights are not sub­dued and gen­tle to infan­t’s eyes.

If we are lucky we will next smell our mother’s body and not the blan­ket placed around us as we are whipped away for our post birth Apgar test.

Last­ly, also if we are lucky, comes the taste of mother’s milk (some­times not til the day fol­low­ing birth) or for­mu­la, depend­ing on the mother’s desire and any com­pli­ca­tions of a C‑section.

Our first impres­sion of the world is from our three pri­ma­ry sens­es. The first two of the pri­ma­ry sens­es are our most pow­er­ful right after we are born, sim­ply because very often we aren’t gen­tly or con­sis­tent­ly touched as newborns.

The sen­si­bil­i­ty of lay­ing the baby on mother’s chest right after nat­ur­al child­birth “to ensure bond­ing” is often soon put aside in the name of con­ve­nience for all the adults involved.

Touch and smell come into play when a moth­er starts nurs­ing her baby although I do have some queries when I observe some of the unnat­ur­al ways infants are nursed today. Bot­tle fed babies don’t seem to be held much these days. The baby sits in its baby­seat or is propped on its parent’s lap and the bot­tle gets put in its mouth, the adult often show­ing no par­tic­u­lar inter­est in the child.

So, assum­ing a baby is bot­tle-fed and touch no longer mat­ters, we are left with sight and hear­ing as an infant’s pri­ma­ry means of learn­ing about his or her world. Clear vision takes a while and par­ents don’t seem to be engag­ing their infant’s sight with much reg­u­lar face to face con­tact so we are left with hear­ing only!

Loud nois­es like the fam­i­ly dog bark­ing, adults talk­ing loud­ly, door­bell ring­ing, may star­tle an infant. But the reas­sur­ing sound of a care­giver’s voice (even bet­ter if cou­pled with touch) can quick­ly set an infant or young child at ease.

The eas­i­est way to reas­sure a child is when they are safe in the arms of some­one they trust, lev­el with and look­ing at that person’s face and lis­ten­ing to the reas­sur­ing words that per­son has to say.

When the noise hap­pens again a few days lat­er you can phys­i­cal­ly and ver­bal­ly help the child recall what hap­pened pre­vi­ous­ly and reas­sure them in the same way. After a while just your words are enough and then over time those reas­sur­ances become internalized.

An infant who is not reas­sured by its care­giv­er will quick­ly and reg­u­lar­ly show signs of anx­i­ety, a con­di­tion which takes hours of effort over sev­er­al years to resolve. Anx­i­ety is known to appear with child­hood devel­op­men­tal delays and with Alzheimer’s patients. 

My expe­ri­ence and obser­va­tions have shown that those who are held/touched the least, spo­ken to the least and looked at face to face the least, are the most anx­ious. It applies in every age group need­ing care. Anx­i­ety affects mem­o­ry in all of us and that’s when learn­ing and progress fails to take place, thus we end up with lan­guage (devel­op­men­tal delay) and mem­o­ry (Alzheimer’s) deficits.

My research has been con­tin­u­ous for near­ly 30 years. It doesn’t mat­ter if I’m work­ing with some­one who’s 101 years old with Alzheimer’s, an adult being rehabbed, Down’s syn­drome adults or a very young child, in each case sen­si­bil­i­ty to the three pri­ma­ry sens­es real­ly makes a difference.

The social nature of eat­ing togeth­er has a big effect on all ages, as does the nutri­tion­al nature of the food and how it smells.

But the biggest miss­ing piece of the puz­zle is warm touch. Most peo­ple who work with any of the spe­cial needs pop­u­la­tions do not touch the children/adults they deal with. It becomes a req­ui­site of the job not to touch the client.

In the nat­ur­al care giv­ing envi­ron­ment touch is as much a part of care as every­thing else – those patients/clients who are touched because they are cared for by warm and close fam­i­ly mem­bers show marked progress in their devel­op­ment, no mat­ter their obvi­ous dis­abil­i­ties (such as stroke vic­tims and those with Down’s syndrome).

The three pri­ma­ry sens­es plus the oth­er two are crit­i­cal to the suc­cess­ful progress in every pop­u­la­tion but most essen­tial in all spe­cial needs populations.