Attachment in America

Note: “attachment” in this article refers to attachment theory, not the Attachment Parenting style.

By four months old, “the baby begins to tell people apart and lets them know who she prefers. With those closest to her… patterns of mutual interaction meet her need for intimacy. She is falling in love. Strong emotional ties form a strong base from which she can go on to face the world” (Touchpoints, p 3).

I have to admit, despite all my knowledge of infant development, I was shocked by how much Dani had established her “preferred people” by 3-4 months old. Her attachment to us is developing, and looks quite different than it will in its mature form next year. Currently, she does not have a cognitive understanding of who we are, but a diffuse and sensory based awareness of our presence. She has begun to associate comfort and security with the unique rhythms of our nurturing behaviors – the particular touches, sights, scents and sounds of the parents she is learning to love.

Attachment is the “complex, reciprocal system of caregiver and infant bonding that promotes maximal proximity over the first few years of life.” (Gaskins, p 47). John Bowlby developed attachment theory after studying orphans in institutions following the second world war. These children had all their physical needs met, but were deprived of emotional nurturing, and experienced a plethora of long term consequences. He concluded that, “the young child’s hunger for his mother’s love and presence is as great as his hunger for food” (Sykes, p 4). This was a radical break from Freud, who believed that infants associated their mothers with food alone. Bowlby theorized that attachment developed quite separately from feeding, as another biologically driven set of behaviors, and just as necessary for survival. The human infant is born so immature that it must ensure proximity to the caregivers it so utterly depends upon. The initial attachment behavior is the newborn infant’s cry, particularly the cry for comfort in the absence of physiological needs. Parents experience an intense, hormonally driven need to respond to that cry. For those of us in the midst of this, it is no less than the deep, all-consuming, heart-opening bliss of falling in love: the kind of love that will drag you out of bed a dozen times a night, and have you gazing in rapt awe at the little being whose diaper just exploded all over your sheets, again, at 4am.

When we respond sensitively to an infant’s needs most of the time, it creates a secure attachment – a sense of trust that they will be taken care of, and that the world is a safe place.  Bowlby argued that the level of trust we develop in the first year of life has a profound impact upon our sense of self, and our expectations for all future relationships. Neuroscience has proven this to be true.  Sensitive, attuned care literally builds structures in the brain that maximize its capacity to be “adaptive, stable and flexible… well integrated and organized” (Siegel p 125). Secure attachment is now seen as the root of “emotional regulation, resilience, confidence, sense of self, autonomy, language, exploration, problem solving, cooperation, pretend play, empathy, trust, commitment to relationships, and capacity for repair” (George) – in short, it is the very heart of psychological well-being.

For Bowlby, attachment was synonymous with mother-love. His work, and the research that validated it, focused exclusively on the mother-child dyad. A product of his time, he could not see beyond the American social structure and cultural ideal of “the attentive, supportive stay-at-home middle-class mom” (Quinn, p 11). His original theory had little room for multiple caregivers – co-parents or extended family – or for out-of-home care.

In the ensuing years, studies of infants and fathers have begun to bridge this gap, and it is now well established that children develop separate attachments to each primary caregiver (George). But most studies are still embedded in the American norm of the nuclear family, and the criteria for secure attachment are defined by American standards. Challenges to orthodox attachment theory demonstrate that children develop securely across the spectrum of early environments found around the world. This includes traditional tribal cultures that practice “diffuse” caregiving, in which infants are nurtured, and nursed, by multiple people. Among the Efé in the Congo, for example, infants are passed among as many as 14 caregivers per day (Brandt). Arguably, this style of caregiving is quite adaptive, as babies come to place their trust in multiple people, develop a much more complex working model of relationships, and are protected from the profound devastation that Bowlby documented when one’s solitary attachment figure disappears. (Gaskins, p 68)

Still, even the most vocal critics of mother-centered attachment acknowledge the biology behind the primary mother-infant bond. Studies have shown that “Infants recognize their mothers within hours after birth by smell, preferentially orienting toward their mothers’ breasts and showing increased rates of suckling… when presented experimentally with their mothers’ odor versus that of an unrelated female” (Quinn, p 30). During the neuro-physiological stage of regulation (0-3 months), comfort is associated with the scents, sounds and rhythms of the womb and the breast, making mom – when she is available – the primary source.

Indeed, Dani’s preference for me was established early on, and much exacerbated by her discomfort with bottle feeding. In the beginning, it was clearly the breast that made me stand out from among her caregivers. But by the fourth month of life, regulation is accomplished via sensorimotor experiences. To the increasingly aware baby, mom is not just a breast but a particular configuration of sights, sounds, motions and touches associated with the familiar comforts of breast and womb. And unless mom is totally isolated with her baby, she is not the only one whose sounds and rhythms have become familiar and soothing in the ever-expanding unknown of the outer world. Babies recognize and prefer the comfort of co-parents and other primary caregivers as well. The balance of these preferences, though, is unique to every baby and family system. Just as “some kids are born to need more safety than independence and vice versa” (Hornstein), some children’s temperament may allow the establishment of multiple attachments sooner, and easier, than others.

Dani is one of those babies for whom this has not been easy. Now quite independent of hunger, she still very much prefers my particular set of sensory associations for soothing. This has been incredibly hard on my wife, who has sometimes spent hours trying everything to soothe an increasingly distressed baby in my absence. And of course, incredibly hard on Dani, who must cope more and more with such absences as I move back into the work world. On the other hand, Dani is establishing distinctive, and equally valuable, patterns of relating to each parent: I am soothing and my wife is exciting, and Dani has begun to giggle at her very approach. Still, Dani can seem like an entirely different, far less content, baby when I am not around.

This is how “the 4-month Touchpoint tests the attachment system, challenging the sense of intimacy ” between parents and baby as we all move outwards into the world (Hornstein). This dynamic will continue to unfold throughout the upcoming months, as I, like many parents, find myself increasingly ready to embrace some of my pre-parent roles. At the same time, babies are increasingly stressed by their budding awareness of the great big world, and ever more reliant on the comfort of familiar caregivers to cope with their new-found perceptions (Touchpoints, p 3). Between now and the maturing of our secure attachment relationship, lie the major developmental challenges of object-permanence (Dani will soon become aware that I continue to exist when out of sight, prompting attempts to control my coming and going), separation anxiety (the emotional consequence of object-permanence) and stranger anxiety (the cognitive awareness that the world is full of people she doesn’t know). All that to come, and already my leaving is proving to be so hard on us all. Yikes.

And here we come upon the uniquely modern American attachment dilemma. I am lucky enough to have some amount of choice, and I am slowly transitioning back to work at 4.5 months. Many mothers are forced to leave their infants much sooner, and more abruptly, in the care of others. American mothers today are in a double-bind. Isolated in nuclear or single-parent families, we are still expected (by society and our own infants) to conform to the ideal of Bowlby’s time: the ever attentive, always present, primary caregiver. Yet we are forced out of the home by an economy that demands two working adults to maintain the standard of living provided by one person in Bowlby’s day. Exacerbating this dilemma is America’s abject failure to provide even minimal support for the critical task of establishing a healthy attachment with our children. The “wealthiest” country in the world, yet the U.S. is one of just three nations that does not guarantee any paid maternity leave. (We are alone with Suriname and Papua New Guinea in this well of shame) (Rosen).

Additional stress is placed on our attachment system by the disturbing lack of political-economic support for young children in out-of-home care. Even though infants and toddlers of working mothers spend an average of 35 hours / week in daycare, it is one of the poorest paying careers on the market. Recently, a study compared Italian and American mothers’ reactions to preparing for daycare. The American mothers nearly all cried at the mention of having to leave their babies, while the Italian mothers did not. The Italian mothers knew their daycare providers well, and knew that they were leaving their children in quality care (Hornstein). Similarly, in the book “Bringing up Bébé”, author Pamela Druckerman notes that many French mothers are eager to leave their children in daycare. Not only do France’s maternity leave policies offer them much greater choice and flexibility about when to do so, their childcare policies include extensive funding for a public daycare system in which teachers are well paid, well trained and well respected.

Ideally, we should have at least a year of parental leave, so families have the option to keep their infants within the circle of well-known primary caregivers, with a higher adult to child ratio than out-of-home care can offer.  At about 1-year old, children have established their secure attachments and are ready for the increased peer interactions of daycare (Brazelton). But children can indeed form healthy attachments with daycare providers that can help to promote successful development. In fact, studies have shown that among 4-year olds, secure teacher attachment is more important than secure parent attachment for positive peer interaction and socialization. (Brandt). However, “successful attachment to childcare providers requires that mom have minimal stress over the use of care” (George) – again, the double-bind. Unlike Italy and France, where professional out-of-home care integrates fluidly with the needs of the family, and unlike the Efé, where infants and toddlers naturally “experience a changing pattern of multiple, simultaneous relationships” (Tronick, p 576), the American system of early childcare is disturbingly fragmented, with frequent disruptions in relationships.

Ecological models suggest that attachment “is community specific, resulting in individuals who have a sense of self and others that is also community specific” (Tronick, p 576). In other words, attachment is not just about survival, it is about enculturation. Differences in the amount and variety of caregiver contact, and differences in caregiving strategies, prepare securely attached children to thrive in the particular cultural context in which they are raised. What does that mean in America, where the emotional health of our youngest children is barely a blip on the radar of national priorities? What does it mean to raise children to thrive in a broken culture? And how can we help them to simultaneously grow to be agents of change, so that our grandchildren may flourish within a circle of healthy attachment relationships, embedded in a community that supports their developmental needs?

I have no answers to these questions. When I am supporting another mother as she processes the intense guilt of failing to be “super mom,” simultaneously meeting the competing demands of nurturing and providing for her young children. When I am dealing with my own profound grief and distress in coming home to learn that my baby cried for most of my absence. All I can do is remind us that what matters most are the moment-to-moment, micro-interactions. If we can return our focus to the present moment with our children, if we can attune to and offer what they need here and now, they will grow to be securely attached. And may the rest of the answers unfold from there.


Brandt, K. (January 19, 2014). Core Concepts in IPMH. Lecture conducted from IPMHPCP, Napa, CA.

Brazelton, T. Berry. (April 26, 2014) The Neuro-Relational / Neuro-Developmental Touchpoints.  Lecture conducted from IPMHPCP, Napa, CA.

Druckerman, Pamela. Bringing Up Bebe: One American Mother Discovers the Wisdom of French Parenting. New York, NY. Penguin Press, 2012.

Gaskins, Suzanne. “The Puzzle of Attachment: Unscrambling Maturational and Cultural Contributions to the Development of Early Emotional Bonds.”  Attachment Reconsidered: Cultural Perspectives on a Western Theory. Ed. Naomi Quinn & Jeannette Marie Mageo. New York, NY. Palgrave Macmillan, 2013.

George, C. (April 25, 2014). Child and Adult Attachment and the Mental Health Implications. Lecture conducted from IPMHPCP, Napa, CA.

Hornstein, J. (January 9, 2015) Learning, Play and Childhood Development. Lecture conducted from IPMHPCP, Napa, CA.

Quinn, Naomi and Jeannette Marie Mageo. “Attachment and Culture: An Introduction.” Attachment Reconsidered: Cultural Perspectives on a Western Theory. Ed. Naomi Quinn & Jeannette Marie Mageo. New York, NY. Palgrave Macmillan, 2013.

Siegel, Daniel J. and M. Hartzell. Parenting from the Inside Out. New York, NY. Penguin Press, 2014.

Sykes, Wylie and Lynn Turner. “The Attuned Therapist. Does Attachment Theory Really Matter?” Psychotherapy Networker. web. Retrieved from on January 2, 2015.

“Touchpoints at a Glance.” Adapted for the For 2014-2015 Napa Case Workbook from materials produced by the Touchpoints Project at the Child Development Unit of Children’s Hospital, Boston MA.

Tronick, Ed, et al. “The Efé Forager Infant and Toddler’s Pattern of Social Relationships: Multiple and Simultaneous.” Developmental Psychology 28(4) 1992. pp 568-577.

Rosen, Rebecca J. “A Map of Maternity Leave Policies Around the World.” The Atlantic. June 20,2014. web, retrieved from, January 16, 2015.


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