The importance of touch in medicine

30 March 2022

Skin is the largest organ in our bodies and sends good and bad touch sensations to our brains. From birth until the day we die, we have a need for physical contact. Early in life touch is important in building relationships and bonding through stimulation of oxytocin. Touch can reduce heart rate and blood pressure and help us to feel calmer and less stressed. Touch reduces the release of cortisol and seems to have a beneficial role in our immune response.

Touch can strongly transmit a sense of being accepted and cared for and can reduce a sense of loneliness. While hugging is more common within families and close friends, hand holding is an important way to provide comfort in many situations including in healthcare.

Not everyone enjoys human touch in the same way. For many people, trust is important before they can allow and enjoy touch. If during childhood, negative experiences have been associated with touch or if caring touch has been lacking, this can lead to aversion to touch. Some people on the neurodiverse spectrum also report an aversion to touch. Consent to touch is essential and from early childhood it is important to seek consent before touching a child. Children should never be forced to hug or kiss relatives or be subject to tickling without their permission.

During the COVID-19 pandemic, the opportunity for touch has often been limited. This may be due to a requirement to wear PPE, avoidance of handshaking, working from home and physical isolation which limits social interaction. Phone calls, videocalls and videoconferencing have been our main means of contact with friends, work colleagues and family members who live further away.

Being touch starved, also known as skin hunger or touch deprivation, occurs when someone experiences little to no touch from other living things. This is very common in the elderly who live alone and do not have many opportunities to socialise. There are heart breaking stories of the elderly living in isolation to avoid COVID-19 and having minimal contact with anyone. All those who lived alone during the COVID-19 lockdowns will have experienced minimal physical contact for long periods of time. Many healthcare workers also found the barrier of PPE and restrictions on physical contact with patients during COVID -19 very hard, especially when they wanted to show compassion and provide comfort.

In aged care facilities and residential care, much of the touch is functional to assist with hygiene and dressing rather than caring touch such as holding a hand or a gentle back rub or hand massage. This clinical contact lacks warmth and can even be uncomfortable or painful at times, especially if a resident resists care or experiences discomfort due to injury or a medical condition. At times this can lead to behavioural issues and further resistance or aggression, which can result in further pain due to force being applied by carers who need to complete a task. Incorporating caring touch into the activities of daily living may reduce resistance. It is essential to work with each resident to determine and follow their touch preferences.

Touch is also important in paediatric care. Skin to skin contact is encouraged immediately after birth. Likewise in the Neonatal Intensive Care Unit premature babies are, whenever possible, given skin to skin contact with parents and gentle touch is encouraged even when babies are confined to their humidicrib. Some special care nurseries and children’s wards engage volunteers to cuddle babies when parents are not able to be present. Babies are swaddled to make them feel more secure.

In the absence of friends and family, other sources of touch could include:

For anyone who is not able to be touched by others, it is possible to simulate touch by taking long, hot baths or showers, wrapping up in blankets or using a weighted blanket. Cuddling and stroking or patting a pet is a good substitute to human touch. Self-hugging or rubbing in moisturiser to the skin or massaging scalp when washing hair are also alternatives.

Touch can convey a whole range of emotions – reassurance, empathy, comfort, love, compassion and sadness. Touch is an important aspect of medical care as well as to each of us as individuals for our own wellbeing.

Kay Dunkley
AMA Victoria Coordinator of Doctor Wellbeing

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