Parenting in the NICU - a quick look

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Learning about the NICU and ways of helping and bonding with your preemie can help you manage some of the stress and uncertainty associated with a preterm birth.


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Finding special ways to connect & understand preterm birth

The joy of childbirth is often short-lived for parents of preterm babies. Isolation from your newborn, extended hospital stays, and the uncertainty associated with medical procedures, takes a massive emotional and physical toll. This section has been created to help you navigate your way through some tough times. It covers everything from family-centred care, tips on how to bond with your preemie, helping out in the NICU, what to bring, to learning to read your prem's body language

 


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Bonding with your preemie : Positive Touch

Research has shown that touch affects physical development and psychological wellbeing.

Research has shown that touch affects physical development and psychological wellbeing.

Studies examining the affect of massage therapy on preterm infants have reported a 30% to 47% greater weight gain following three 15 minute sessions per day for 5 to 10 days, compared with preterm babies who received standard medical treatment.

Baby Massage is often too stimulating for very unwell and small preemies and can result in too many avoidance reactions.

Positive touch is a term used to describe touch that is adapted to baby’s individual behavioural and physiological states, making it appropriate for even the smallest and sickest of preterm babies in the neonatal intensive care unit. Positive touch helps parents connect and bond with their baby.

Experts describe positive touch as an “interactive dialogue”

Main areas covered in this article:

Aims of positive touch

  • To balance out the unpleasant experiences in the NICU
  • To empower parents to take control over taking care of their baby in a challenging and uncertain environment
  • To view each baby as an individual
  • To enhance preterm infants sensory experience
  • To help limit the damaging effects of the stress of the NICU on infant development
  • To prevent preterm infants from avoiding touch
  • To be conscious of preterm infants’ skin as a dynamic and interactive boundary, which represents the baby’s biological functioning

The 5 Step Dialogue

1.Preparation & Observation

Always consider the environment before starting. Choose a time when you are calm, it’s quiet, and not too bright. Organise your environment so you can maintain contact with your preemie. Take some time to observe your baby before you start, check out their breathing rhythm, body language, and skin colour.

2.Permission

Prepare your baby for touch by offering a few thoughts or words of your intention to approach. This demonstrates acknowledgement that even tiny, unwell babies can communicate and can be active in any care giving activity. Rubbing your hands together before touching so your baby can hear is also a good way to increase warmth in your hands so your preemie can sense you are about to touch them.

3.Tuning-in to Baby & Pacing

It is important to respond to your preemie’s individual signs to help guide the pace of your touch. Being receptive to your baby’s cues and reactions help let you know when to engage and disengage, lets you know when your baby is trying to self-regulate and when they are trying to interact, which all help maintain appropriate and safe touching. It is usually best to start with a body part your baby seems to like, such as head or hands.

4.Intervention

Is any type of touch interaction, from medical or nursing procedure to a loving parental connection. Start all touching with a still resting hand so your baby is aware of your presence and to prevent a startle or stress response. For preterm babies that are very sick, sedated, or recovering from surgery you can keep your hands a few centrimetres away from your baby. Breathe slowly and talk quietly to your baby, recite a poem or visualise a calming color, whatever makes you feel comfortable.

5.Completion

Ending the interaction is an important step in maintaining balance for your premature baby. The process should start with you resting your hand and offering a verbal or silent gesture which communicates your intention to stop. Departure should be slow and sensitive. Adjust your baby’s position, bedding, or environment to help them settle.

Types of Positive Touch

Connection without Touch

Often used for extremely preterm infants, or those preemies recovering from surgery, are very sick, or sedated. Parents can still make their presence felt. Parents warm their hands and keep them a few centimetres away from their premmie. Parents should breathe slowly and visualise something peaceful and positive.

Still Touch

Still touch is exactly as it sounds a resting hand which stays motionless. This can promote a sense of calm and helps settle premature babies. Babies are given the opportunity to process where they are being touched and helps them maintain physiological and medical stability.

Containment

Containment provides preemie with a secure and nurturing human-boundary. This method of providing stability and predictability enables parents to gain confidence, especially during the early days in the NICU. Containment is useful for preemies who are medically unstable, fretful, or recovering from surgery. It can also be used during procedures where your prem needs support and comfort.

All interactions with your preemie are tolerated better if you start with a gentle still hold.

Movement

Your preemie’s nervous system is stimulated as soon as you start movement over their skin. Keep an eye out for behavioural cues which might suggest slowing down or stopping.

Behavioural Cues

Understanding your preemie baby’s body language, knowing when to approach and when to take a break.

Approach Cues: “I am content and ready for contact”

  • Awake alert and bright eyes
  • Mouthing, sucking, or making an ooh expression
  • Relaxed and smooth body movements

Avoidance Cues:I’ve had enough,it’s too much,slow down or stop”

  • Yawning, sneezing, or hiccupping
  • Startled look, glazed or floating look in the eyes
  • Gagging or spitting up
  • Face is gaping with mouth drooping
  • Legs and/or arms extended into mid air
  • Fingers are extended and splaying, or held in a very tight fist
  • Toes clenched looking tense or splayed out
  • Arching the body, fussiness or crying
  • Colour changes, i.e. pale, red, dusky, or webbed

Self-regulation Cue: “I am trying to settle myself”

  • Hands on face or mouth, clasping or grasping
  • Grasping or holding onto something
  • Sucking
  • Trying to get in a curled or tucked position
  • Finding a boundary to rest against
  • Shutting their eyes and taking a break
  • Looking far away into the distance
(Ferber et al., 2002; Field, Diego, & Hernandez-Reif, 2010; Field, Diego, Hernandez-Reif, Deeds, & Figuereido, 2006; Liu et al., 2007; Lott & Hoath, 1998)

 


Technical Reference List

Ferber, S. G., Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., et al. (2002). Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Hum Dev, 67(1-2), 37-45. Field, T., Diego, M., & Hernandez-Reif, M. (2010). Preterm infant massage therapy research: a review. Infant Behav Dev, 33(2), 115-124. Field, T., Diego, M. A., Hernandez-Reif, M., Deeds, O., & Figuereido, B. (2006). Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behav Dev, 29(4), 574-578. Liu, W. F., Laudert, S., Perkins, B., Macmillan-York, E., Martin, S., Graven, S., et al. (2007). The development of potentially better practices to support the neurodevelopment of infants in the NICU. J Perinatol, 27 Suppl 2, S48-74. Lott, J. W., & Hoath, S. B. (1998). Neonatal skin: the ideal nursing interface. J Pediatr Nurs, 13(5), 302-306.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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