As the NFI (NIDCAP Federation International) launches its first blog, it seems appropriate to share how the seeds of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) germinated. The purpose of the NFI’s blog is to build awareness for our organization and its visionary and dedicated members, who, quite literally, change lives. This and future posts by NIDCAP Researchers, Trainers, NIDCAP Professionals, parents of preterm infants, members of our Board of Directors, and special guest bloggers will provide an opportunity to convey the NFI’s perspective and to receive your comments and questions.
Life puts us in places that we may come to appreciate in their full significance only later. While a child in Germany during World War II, I saw again and again how overcoming extreme difficulties builds character. This, and all the other hardships around me, shaped me and it inspired me to study how people, from early on, are molded by their environment.
When I came to the United States as a graduate student at the University of Pennsylvania, I had the good fortune to visit the newborn intensive care unit (NICU) at Philadelphia General Hospital, one of the earliest NICUs in the U.S. at the time. Convinced that the dearth of appropriate experiences in the NICU was harmful for these immature human infants, Margaret (Peggy) Williams, MD, a pioneer neonatologist, collaborated with my advisor, Sandra Scarr, PhD, a developmental psychologist, to improve not only the infants’ chances of survival but also their cognitive and emotional well-being and that of their inner city mothers. These insightful researchers innovated the first preterm infant developmental care program. Colorful mobile birds moved gently above the infants within the incubators. A group of specially trained nurses on this project was encouraged to speak to and gently stroke the infants as well as hold, feed, and rock them. Skilled guidance counselor social workers supported the mothers’ well-being resulting in significant positive improvements for both infants and parents.1-3

Maria Delivoria Papadopoulos, MD
I had the opportunity to collect the infants’ one-year outcome data, which meant home visits mainly in West Philadelphia’s housing project neighborhoods where most taxis refused to go. I met amazing young women, strong grandmothers, and tough appearing young men, all proud of their tiny babies, who had ‘made it’. Jackdocconosdi . I witnessed and was humbled by these families’ many strengths. Just a year or so later, Maria Delivoria Papadopoulos, MD invited me into the NICU at the Hospital of the University of Pennsylvania, where I was studying the first interactions of full-term newborn infants with their adolescent inner-city mothers. I jumped at the opportunity to have the chance to watch tiny preterm infants close-up. Never mind that I was the ‘bagger’ trying to help the infants breath, and the ‘dabber’ of the neonatologists’ brows as they attempted to exchange fresh blood for the infants’ poorly oxygenated blood in a valiant effort to combat dreaded lung disease.4 My fascination and awe was for the determination of these infants, who curled up, fought against the hands that tried to hold them down and keep them still, and swiped against anything that came towards them. They flailed, arched, and gave their all to get back to what they had been doing in the womb, sucking on their hands and fingers, tucking themselves up into little curled up balls, and cradling and hugging themselves into cozy comfortable positions. When Nilsson published his first incredible fiber-optic photographs of the fetus,5 I immediately saw how competent, yet misunderstood, these babies were, and how distinct and individual their different personalities expressed themselves in their behavior. This is when I resolved to figure out how to do justice to their competence, and to warrant and gain their trust.
When I gave birth to an infant son of my own, it turned out that he had a neurological problem. I drew from all my life experiences, personal and professional, to understand better what my son was trying to tell me in his own way while he struggled to do his very best.
Though NIDCAP has grown over the past 40 years through the dedication of my many colleagues, who are all driven by the passion to care for preterm infants and their parents, it has been the infants themselves, believed in and supported by their parents, who have done the hardest work to reach their potentials. To them, I am ever grateful for the lessons of strengths, courage, and hope that they have taught me.
It behooves us to listen closely to the voices of all children, no matter how small at birth, and to their families,
Heidelise Als, PhD
- Williams ML, Scarr S. Effects of short-term intervention on performance in low-birthweight, disadvantaged children. Pediatrics 1971; 47:289-298.
- Scarr-Salapatek S, Williams ML. A stimulation program for low birth weight infants. Am J Public Health 1972; 62:662-667.
- Scarr-Salapatek S, Williams ML. The effect of early stimulation on low-birthweight infants. Child Dev 1973; 44:94-101.
- Delivoria-Papadopoulos M, Morrow G, Oski FA. Exchange transfusion in the newborn infant with fresh and “old” blood: the role of storage on 2, 3-diphosphoglycerate, hemoglobin-oxygen affinity, and oxygen release. Peds 1971; 79: 898-903.
- Nilsson L. Behold Man. Boston: Little, Brown and Company; 1973.
Thanks for sharing both the story and the journey.
This brief blog is such a wealth of information and represents our true multidisciplinary pioneers for NIDCAP and its origins. Many thanks to Heidelise Als for her enduring scientific interest and personal compassion in recognizing and committing her professional career to our smallest humans, their families, staff who care for all of them and the communities in which they live.
Thank you for sharing your story and insights with respect to the evolving development of the preterm infant while advocating for the soft, intuitive and mindful approach to caring for the infant and her/his family. NIDCAP provides the guiding light to the development of a humanistic, relationship-based, family-centered approach to caregiving that needs to be emulated in newborn intensive care nurseries throughout the world.
Thank you Heidi.
Rodd
Thank you for sharing the essence of the NIDCAP origins, articulating the value of the process while sustaining the individual infant and family’s perspective with all of the challenges and opportunities that are generated from living in the Newborn Intensive Care Nursery. I also appreciated your acknowledgement of how truly amazing the infant is…
Thank you for this story. You see, then help others see with your words. You’ve certainly helped me better understand what I see and how to convey this to others.
Wonderful stories of the pioneers in our field…Mothers included. How gracious of Heidi to share her personal experience with Christopher. One can see the beginnings of NIDCAP and APIB emerging as a result of her own personal observations. So many families and professionals are indebted to her for those observations. Great stories! Thank you!!! jean G Cole
Dr Als,
I will be attending the NIDCAP trainers meeting in October. This is a long awaited dream of mine.
I am a long time student of the work you have provided us. It has guided my practice and shaped me as a professional and a human. I am so looking forward to this time to increase my understanding and build more supportive relationships to strengthen my evolution into caring for families.
Your son had good luck to meet you in his life, and we have had good luck to meet you in our lives. Thanks