Nursing gestures in early childhood nursing, therapy and education

In the art of healing and the art of education, it is not only WHAT is done, but HOW it is done that matters. The HOW is influenced by many conscious and unconscious factors. Conscious factors, for example, are knowledge, understanding, experience and one’s inner attitude. Semiconscious factors can be sympathy, antipathy, preferences and habits. Factors that tend to be unconscious are habits, moods, stress, joy etc.

The HOW appears in a person’s posture, gestures and facial expressions—and also in the context in which something is said or done. Only in context—in a relationship—is the WHAT experienced as being either coherent or dissonant. If something is done at the wrong time or place, it can be offensive. Finally, the effect of an action (or word) depends on WHO does or says it. Here it is not just the WHAT or the HOW, it is the being of the therapist, nurse, doctor or educator that has an effect. 

We speak of a gesture when the HOW is used consciously regarding its effect on another person. It is called a therapeutic gesture in therapy, a pedagogical gesture in education and a nursing gesture in nursing. 

In early childhood, care and education are still inseparably linked. All mental, emotional and spiritual needs of the child are connected to its body. To be able to imitate, it requires a perceptible model. Social behavior is first experienced and learned during body care, feeding (or breastfeeding), being clothed, moving and being moved and in caring for the room. Only gradually does the relationship to the child’s soul and spirit develop more independently of the care being given to the child’s body. Pure eye contact, such as after breastfeeding, as an expression of an intimate relationship, while making sounds, singing and rocking prepare the space for what will later be “play”. The habitual care of the infant and the rhythms of the day are mainly structured by bedtimes and mealtimes. Times of solitude and togetherness are usually determined by the availability of the people caring for the infant. With increasing age, they form an arena that must become increasingly independent of the satisfaction of physical needs.

Education, especially in the first seven years, is based on establishing the physical foundations of movement, language and thought development. This means that it has immediate consequences for nursing care. In this sense, to provide care is to educate, and to educate is to provide care. 

The nursing, therapeutic and pedagogical gestures described below can already be observed in the first hours after a child is born. The gestures then appear in the most varied metamorphoses in the further course of the child’s life. You can see a diagram of the gestures here.

By “gestures” we do not mean the intentions or actions of the person providing nursing care or therapy. Rather, the term denotes a specific power that is at work in our relationship with the child. The gestures appear as the HOW in education, nursing care and therapy.

1.   Cleansing

The baby is delivered. Its airways are cleared of mucous, the umbilical cord is cut, the remnants of its life in the uterus are removed. Everyone’s joyful attention is focused on the newborn child. Matter-of-fact attention is paid to removing what is no longer needed. The specific HOW of this action is called cleansing. In the gesture of cleansing, doctors and educators will always look at and point to what is healthy, developing. Anything that has become troublesome or ill is ascertained matter-of-factly. 

2.   Nurturing

The newborn is breastfed. In breastfeeding, the substance in the mother’s milk flows with the mother’s love to the child. A mood of giving and sacrifice permeates the gesture of nurturing. The gesture always pays attention to the “digestibility” of the nourishment on the one hand, and the recipient’s ability to accept the gift on the other. The preparation and administration of nourishment are part of this gesture, as is the process of gradually differentiating between physical, emotional and spiritual nourishment.

3.   Relieving, helping

The newborn is released from the weightlessness of the womb into the heaviness of gravity. Now people carry it and thus relieve it from heaviness, take it up into lightness. The gesture of relieving or helping is the assumption of a burden with the aim that the person so relieved can develop and achieve something that is important for him or her. The gesture does not primarily focus on the weakness or inability of the child. Rather, these are only opportunities for providing relief or assistance, so that a forthcoming step in development can happen. This gesture establishes the ability to live socially together, where mutual help can be experienced and practiced. It is the foundation of the division of labor.

4.    Protecting, defending

The newborn’s skin, respiration, warmth and immune defenses are not yet completely aligned with the living conditions outside the womb. There therefore needs to be protection and defense against the impressions streaming into the child. The gesture of protecting or defending creates the shelter within which the child can develop. Hygienic measures such as protecting the newborn from a herpes infection of the mother, or keeping computers and TVs away from the infant, are essential. On the other hand, too much defense, such as preparing a “germ-free” children’s room, or fear-controlled restrictions of the child’s freedom of movement, is harmful to its development.

5.   Creating order

In the womb, the child’s life was determined by temporal rhythms. After birth, these rhythms must be brought into harmony with the rhythms of life on earth, with the social rhythms of the parents and with the needs of the child. The gesture of creating order creates structure in time and space. This structure is at first determined by the rhythm of eating and the rhythm of waking and sleeping. Spatial and temporal arrangements appropriate to the child must be matched with the existing arrangements in the family. To develop this dynamic structure is the greatest challenge for families today and it also requires nurses, educators and doctors giving them advice to have a flexible sense for healthy structuring of time, space and interaction.

6.   Enveloping

The child comes (physically) from a completely enveloping, protecting womb. After birth it is naked. The care of its parents now envelops it physically, emotionally, mentally and spiritually. Enveloping refers to all the gestures that surround the child like a nest and give it a place to develop in. All enclosures become too cramped over time. This is the reason for birth. The child’s new spatial and temporal surroundings, as well as the relationships in which it feels safe, are also gradually widened until they can be abandoned in an act of liberation. The memory of these protective sheaths shapes our concept of “home”.

7.   Balancing

All extremes must be balanced to a level that is beneficial to the newborn. Balancing refers to the ongoing creation of states of equilibrium, for example in the regulation of body temperature by means of clothing. Self-regulation, self-care and—from puberty—self-education are ways into autonomy. It is necessary to find the middle between dissolving and hardening, world and ego, freedom and responsibility. 

8.   Stimulating

Physical and emotional processes can be stimulated by external interventions. Stimulation refers to all those gestures that trigger or reinforce a physical or mental state through targeted intervention. Examples are the triggering of the sucking reflex by touching the lips, the relaxation of the abdominal muscles by rubbing them with chamomile oil, and the provision of suitable play materials.

9.   Challenging

Challenging is a gesture that trusts the child to overcome obstacles on its own, and actively omits doing anything that would inhibit the development of the child’s abilities. It takes a great deal of educational and nursing experience to determine when a challenge is justified and when it is excessive. In our performance-oriented society we tend to demand developmental steps very early—often too early. This puts children and adults under stress. It also leads to celebrating “results” that were not achieved through the child’s own independent steps in development.

10. Awakening

Our active accompaniment of the sensory perceptions of the child, our attentive perception of her increasing openness to the outside world and her later differentiation between the inside world and the outside world happens in a gesture of awakening. In contrast to the stimulating gesture, it is not a stimulus to awaken the child, but the amazed sympathy of the nurse, educator or therapist as the child’s soul opens up. Accompanying the child on its way to sleep also follows the inner movement of this gesture. Sleep is an “awakening” on the other side of consciousness. Just as we wake up from our head downwards, experiencing our breathing and then the circulation in our limbs, so do we guide a child into sleep by laying down its limbs, calming its breathing through singing and rocking (rituals), releasing the activity of its senses in a familiar environment, and thoughts of the true, the good and the beautiful.

11. Affirming

Our regard for the child, our respect for its dignity, our confidence in its physical, mental and spiritual development, our affirmation of its individuality, which underlies all therapeutic, nursing or educational action, is the gesture of affirming. Our naming of the child’s perceptions, sensations and intentions, for which the child does not yet have expression, is also this gesture of affirming. Our loving interest in the objects named, our patient expression of the feelings and intentions of the child, develops its ability to bring together perceptions and concepts as preparation for speaking and thinking. In this sense, to comfort means to give pain a name and to connect it with the hope that transformation and development are possible. Making the power of hope active in oneself is a decisive prerequisite for successful therapy, nursing care and education.

12. Uprightness

The goal of education, nursing care and therapy is the child’s increasing independence and freedom on the way to adulthood. These attributes are expressed in upright walking, in language and in thinking. Acting as a model in walking, speaking and thinking is expressed in the gesture of uprightness. Premature development of movement, speech and thought are just as harmful here as is their blockage by predominantly moving the baby passively, fixating it in a shell seat, blocking speech with pacifiers, or confusing its thought development by giving it unfathomable—e.g., computer-controlled—toys. The child brings the power to become upright with it into the world, along with its impulse to move and play. It shapes this power through the example of upright and sincere people. Independence develops in the interaction between the example of others and the child’s willingness to enter the world and find her own standpoint within it.