Aim: Touch is the first sense to develop during fetal life. Sensory exploration in preterm infants may underlie early sensory self-awareness. This study aimed to demonstrate the emergence of sensory self-awareness in preterm infants by analysing behavioural responses of the rooting reflex.

Methods: This single-centre, prospective study included preterm infants born between 24 and 37 weeks gestational age (wGA). The rooting reflex was assessed via video in two conditions: external stimulation and facilitated self-stimulation. The rooting reflex was characterised by four progressively complex behavioural responses. The primary outcome was the relative frequency of these behaviours, compared between the two stimulation types.

Results: Twenty-seven children were included (mean gestational age: 30.5 wGA; mean birth weight: 1416 g). Behaviour 3 (mouth opening and/or tongue protrusion without head movement) was significantly more frequent during self-stimulation than external stimulation (35.7% vs. 24.9%, p = 0.005). No significant differences were observed for other behaviours.

Conclusion: The rooting reflex response in preterm infants depends on stimulation type, with a preference for self-stimulation. This suggests an early ability to distinguish self from non-self, supporting the idea that the rooting reflex reflects implicit sensory self-awareness. These findings offer novel insights into preterm infant sensory processing and developmental care.

Trial registration: Favourable opinion from the committee for the protection of individuals CPP N2023-A02220-45. Favourable opinion of Clinical Trial: NCT NI38RC23.0354.