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Ten Pearls of NIDCAP Wisdom for Parents
of Hospitalized Babies
Pearls signify confidence, strength and peacefulness in facing life’s challenges.
They represent wisdom gained through experience.
The evidence-based Newborn Individualized Developmental Care and Assessment Program (NIDCAP) is a comprehensive model and approach to care. It provides guidance in support of the earliest development of the most vulnerable newborns and their families in newborn and other intensive care settings.
– D. Buehler, PhD, President, NIDCAP Federation International
Premature and medically high-risk birth may impede the earliest experiences between newborns and their parents, and have a lifelong impact on the family, the baby’s future development and overall health, as well as the parents’ well-being. Parents might worry that their relationship with their hospitalized newborn feels so different from what they had hoped. There are many ways parents get to know their babies to improve their well-being. Babies rely on their parents to be strong supporters and advocates.
These NIDCAP-based considerations are for parents with hospitalized babies in the intensive care nursery. They were developed to support parents and their babies to get to know one another and build close and trusting relationships. Babies feel and experience their parents and the world around them through all of their senses. The baby’s behavior guides the parent. How parents interact with their infant is much more important than what they do. The parents’ gentle caresses and soft smiles, and the tone of their voice provide comfort and assurance. A parent’s presence and love provides invaluable healing medicine for their baby.
1. Plan Time and Be Present
Organize your time to be with your baby for as long and as often as possible. Seek ways to delegate your other responsibilities to family members and friends. This is an important time to accept help and support from others to care for your family and your home. At this time, more than at any other time in your baby’s life, your baby will benefit from the consistency and familiarity of your assuring presence and love. Collaborate with your baby’s health care team to plan whom you wish to be with your baby when you must be away from your baby. Provide your baby’s health care team with a 24-hour rotation list that includes members of your family or close friends whom you trust to be with your baby in your absence.This might include grandmother, grandfather, older sibling, or a close friend who would be available reliably throughout your baby’s time in the nursery. A small reliable group of such persons may be wonderful and consistent parents’ extenders for your baby. They could hold your baby skin-to-skin and become skilled participants in your baby’s care; they could feed and diaper your baby and speak and sing to your baby and provide the familiar nurturing presence your baby seeks throughout day and night. Advise the health care team of you and your extenders’ calendar and availability for the coming week and ensure that you and they are included in all aspects of the care of your baby.
2. Participate as the Primary Caregiver(s)
Inform your baby’s health care team that you wish to be an active participant in all of your baby’s care. Ask about how your baby has been since you last were with your baby. Articulate and communicate your questions, concerns and expectations, as you are your baby’s strongest supporter and advocate. Discuss with the team how you can take part in your baby’s specific daily care practices. Every interaction with your baby is an opportunity to build trust and nurturance. Observe your baby’s behavior, to learn how best to respond to your baby’s cues. Take care of your baby together with the professional health care team; collaborate and partner with the health care team to identify more and more ways to support your baby. You will gradually feel more secure and independent in being with your baby and providing your baby’s care. This will create a strong bond between you and your baby and will help you gain the practice and confidence.
3. Seek Information Actively
Ask the health care team about your baby’s feelings of wellbeing, medical status, progress and challenges. Request updates about your baby’s sleep, comfort, preferences, behaviors, personality, condition, medications, weight, how well your baby takes the milk offered, as well as about new developmental steps and achievements. Consider these topics part of your everyday dialogue with the health care team who care for your baby. Make sure you meet frequently with the multidisciplinary health care team, who participate in your baby’s care, for example, the Attending Physician, Bedside Nurses, Nurse Practitioner, Developmental Specialist, Physical Therapist, Occupational Therapist, Speech Therapist, Social Worker, Psychologist, and others. Ask for their guidance and insights. Share your impressions of your baby with the health care team. Also share the progress you observe in your baby, how your baby may have changed and appears different. Share your concerns and how you have learned to read your baby’s behavior.
4. Shape the Environment
Keep your baby’s surroundings in the nursery as calm and nurturing as possible. This will help your baby hear and respond with joy to your voice, experience fully your touch and delight in the sight of your face. When your baby rests on your chest, or when necessary in the incubator or crib, make sure that your baby’s face is protected at all times from direct bright light and loud sounds. Inquire from your baby’s health care team whether you may bring in personal belongings such as soft blankets, soft well-fitting clothes, soft sheets on which to lie, or other belongings that provide you with a sense of familiarity and comfort at your baby’s bed space. Consider wearing a soft cloth close to your body to place near your baby’s face so your baby can smell your unique familiar scent when you must be away from your baby.
5. Provide Slow and Responsive Care and Interactions
Your baby’s brain is still immature and processes the world more slowly than you. Slowing down all of your actions will support your baby’s brain development. Your presence makes it easier for your baby to process each experience, all motions and changes in position as well as each touch and sound and all that your baby sees. You help your baby to take in all experiences calmly and comfortably. Observe your baby’s behavior to learn how best to support and make adjustments in response to your baby’s readiness. This will help your baby use all energy for the next steps in development and growth and make your baby feel successful and strong. For instance, always first watch your baby to find out what your baby is ready for at that moment; when your baby breathes calmly, the face is pink, and your baby appears comfortable, begin to speak to your baby softly letting your baby know that you are there; gently introduce your hands to your baby, for instance cradle your hand softly around your baby’s back and head helping your baby recognize your familiar touch to feel assured. Then open your baby’s blanket slowly, use your soft voice to tell your baby what it is that you are doing, and keep your hand and voice in contact with your baby throughout any care and social interaction. With your gentle steady touch and calm voice, you help your baby wake up gradually, and become ready for the next step. Your presence, soft voice, holding and gentle touch will support your baby also to settle back into sleep after being awake for a while. Remaining calm and slowing down is a very important part of all you do with your baby. Observing your baby’s behavior to see what is being communicated and to understand what may be best to offer next, is always the best approach in being with your baby. This will enhance your parenting confidence to be your baby’s best supporter and advocate.
6. Protect Sleep
Sleep is crucial for the development of your baby’s brain. Many important processes take place while your baby sleeps. For example, the development of the sensory organs and functions, the consolidation of memory and learning, and healthy growth. Be mindful of keeping your baby’s environment quiet and calm, so that sleep is steady and uninterrupted by disturbing sounds, too much activity, or bright lights. Remember that sleep is oftentimes more restful when you hold your baby skin-to-skin. Discuss with the health care team how to protect consistently your baby’s sleep.
7. Connect and Communicate through Touch
Touch is the earliest and most essential way of connection and communication between you and your baby. Touching your baby will help you learn about your baby’s behavior and preferences. Your baby will experience comfort and safety and feel your love through your touch. Watch for how your baby responds and let that guide your interaction. Touch your baby gently, to let your baby feel the steady and calm nurturing touch of your hands; perhaps cuddle one hand around the soles of your baby’s feet, and with your other hand cradle the top of your baby’s head or around the baby’s body while the baby’s arms and legs are tucked. This will convey to your baby a sense of steadiness, safety and trust in you that will help your baby stay calm and feel comforted. When you have questions or concerns, please speak with your baby’s health care team in the nursery about how best to provide your baby with your touch in the gentle and comforting way that suits your baby as a unique being with particular medical conditions and circumstances.
8. Care with Skin-to-Skin Holding
Give your baby the opportunity to be really close to you. With your baby wearing only a diaper, hold your baby on your bare chest (be sure to remove your bra). This is often referred to as skin-to-skin or kangaroo care. Begin to hold your baby skin-to-skin as soon as possible after birth as your baby’s medical condition allows, and when possible for as long each day as you prefer. There is much evidence regarding the benefits to your baby, as well as to you, for skin-to-skin contact every day, especially with very small or sick babies. These benefits, among many others, include improved short and long term developmental and cognitive outcomes.
9. Offer Human Milk and Nursing
Human milk is by far the best nutrition for your baby, and your milk is ideal for your baby. Prior to your baby’s birth, or when possible as soon as our baby is born, discuss with the health care team in the nursery when and how you may express milk from your breasts. The earliest part of your milk, the colostrum, is liquid gold for your baby and valuable for many reasons. Therefore, every drop of milk you express (pump) counts. Seek the support of a Lactation Consultant, when such a specialist is available in the nursery, or that of an experienced nurse. Make sure that you pump your breasts while looking at or touching your baby and/or holding a blanket or cloth that carries your baby’s unique scent. This will help your milk flow more easily. Should for any reason there be challenges that you are not able to provide enough milk, be sure to inquire about the availability of donor human milk. Consider opportunities for your baby to rest against your bare chest to smell, lick and nuzzle your nipples from very early on. This will help your milk flow and help your baby find your nipple gradually and suck on it. Early on your baby may receive your milk through a thin tube into the nose that goes into the stomach when smelling and nuzzling your breast. Gradually suckling will become stronger and easier for your baby. Ensure that you make all feeding a pleasurable and positive experience for your baby and yourself. Your presence and calm touch will comfort your baby during feeding; hold the milk syringe so that you can pace the milk flow according to your baby’s behavior during feeding. By being part of your baby’s feeding from early on, you are setting the stage for pleasurable and comfortable feeding experiences in the future. Breast feed your baby for as long as your body allows. There are many benefits to your baby, as well as to you, when you provide your milk.
10. Promote Sucking for Comfort and Security
From about twenty weeks on, while growing in the womb, babies suck on their fingers and hands. They continue to seek out their fingers to suck on when they are in the nursery. It appears to soothe and calm them. At times it may be difficult for your baby to hold a finger or thumb in the mouth long enough to suck with pleasure. This may frustrate your baby and lead to more upset and searching to suck on something. Consider gently offering a small, size-appropriate pacifier when your baby wants to suck. This likely will help your baby calm and fall asleep contently. By supporting your baby’s pleasurable sucking, you are supporting your baby’s competence in learning to feel soothed and calm.
Most importantly, trust your baby and trust yourself.
© NIDCAP Federation International, 2020
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