Parenting in the NICU
STAGE 1 (High Level of Intensive Care)
What can you do?
Watch your infant:
Get to know their special characteristics and learn how they communicate. Notice the changing facial expressions and take note of the hand and feet movements.
Watch your infant’s breathing and note changes in speed, depth and rhythm that tell you if your infant is feeling more settled or wakeful, or more tired or restless.
Notice variations in your infant’s skin tones. Dusky tinges around the eyes or mouth or blotchy patterns on the body can become more marked during care-giving. They can indicate that your infant needs to pause , requires comfort or a change in position. Preterm infants often get hiccoughs, yawn, sneeze or posit (bring up some milk) or make squirming movements when they are tired or overwhelmed. If the infants cheeks look slack with the mouth open he is telling you that he has run out of energy for movement and requires a break. Infants use protective gestures by bracing their feet against something, raising their arms with the hands wide open, shielding the face, ears and eyes or turning away.
Infants make little twitchy and tremulous movements which are very common and are signs of immaturity. Neonates find it difficult to co-ordinate movements and tend to lose energy quickly after bursts of activity. A limp looking infant is seeking additional support and comfort. Arching the back or stretching the limbs out stiffly or even lifting them off the bed are signs that the infant requires help to get comfortable.
Infants use self soothing gestures such as bringing their hands to their mouths, sucking, holding onto something, clasping their hands together or resting one foot against the other to get comfortable or ready to interact with you.
Touch your infant:
In the early days neonates may not like being stroked or touched as it can be too stressful for them and they can only tolerate one form of interaction at a time. Infants protect themselves against stressful overstimulation situations by engaging in frantic activity, stiffening their limbs, appearing drowsy, showing a panicked facial expression , gaze aversion, hand-to-mouth manoeuvres or bracing their feet against the side of the incubator. If the infant shows signs of distress, give them time to recover or rest.
Ensure that hands are clean and warm. Start by offering a finger for the infant to hold, or by cupping your infant’s feet, body and head in your hand. Gently open the incubator doors, talk to the infant and let them know that you are present. Comfort Hold is a form of positive touch and helps the infant to feel secure and relaxed. It is often used after a medical procedure.
How To Do “Comfort Hold”
- Cup your warm still hand around the infant’s head and/or feet.
- Gently rest the other hand around the infant’s shoulders or hold their arms across their chest.
- Refrain from using light stroking.
- Breathe slowly and deeply and keep your hands relaxed.
- Comfort hold the infant until he/she feels settled.
- To finish, slowly remove one hand and only remove the remaining hand if the infant continues to remain relaxed.
The voice of the parent will be the only familiar thing in your infant’s world. The infant may find it soothing to listen to your talking quietly, humming or singing.
Shade your infant’s eyes if the light is bright in the unit. Ask for an incubator cover to be placed over your infant’s incubator with a corner folded back so that the infant can be observed while keeping his face in the shade.
Express Your Breast Milk
This is one of the special things that only a mother can do for her infant. Breast Milk helps protect infants and do not be surprised if you are asked to express breast milk within a few hours of the birth. Talk to the Lactation Consultant attached to the unit who will help you establish expressing. Starting early and expressing frequently helps to ensure that you can provide breast milk for as long as your infant requires it.
STAGE 2 (stable but requiring breathing assistance)
What can you do?
Kangaroo Mother Care
Kangaroo Mother Care (KMC) is where the infant is placed next to Mum or Dad’s skin on the chest. The benefits are multi-factorial for both parties involved in KMC:
- It helps to calm the infant.
- Regulates heart rate and breathing.
- Encourages deeper sleep which improves
- Helps establish the parent/infant bonding process.
- Helps stimulate breast milk production.
- Maintains body temperature.
- Conserves infants’ energy.
- Improves neuro-behavioural responses.
- Helps build a sense of wellbeing and self confidence for parents.
It is advisable that parents agree a suitable time to do KMC with the medical team ie when the infant is out of the incubator for weighing or due a feed. KMC is generally not initiated after a feed as delicate infants may be uncomfortable being moved on a full stomach. Infants can be fed during KMC. Generally the infant is naked apart from wearing a nappy and is placed on the parent’s chest inside their clothes. The medical team will facilitate the transfer of the infant from the incubator onto the parent’s chest and will check the infant’s position, ensure that the infant’s head is supported adequately and where necessary a little hat may be placed on the infant’s head to keep him warm.
Kangaroo Care is possible even when the infant requires additional breathing assistance. The medical team will help the parent manage the wires and tubes.
There may be situations where KMC is not possible:
- If the infant requires high humidity.
- If the infant has umbilical IV lines in situ.
- If the infant is receiving phototherapy.
Parents may take part in cleaning their infant’s mouth when the infant is awake and comfortable. Breast milk or sterile water placed on a cotton bud swab can be used to cleant the infant’s lips and mouth with a gentle “press and scoop” action on the lips. If the infant has a tube feed in situ a cotton bud can be used to wiped around the inside of the syringe where there will be some fatty deposits that can be used to moisturize the infant’s lips.
Infants who are not strong enough to breastfeed will require feeding through a feeding tube. Parents can perform the tube feed either when the infant is in the incubator or outside.
How to Tube-Feed your infant
- Sit comfortably in a chair that supports your back.
- Hold the infant in a supported position either next to your breast, in the crook of the arm or resting on a padded blanket on top of bended knees.
- The nurse will ensure that the feeding tube is in the correct position.
- The nurse will prepare the feed in a syringe.
- Gently lift the syringe until the milk begins to flow.
- Lower the syringe if the flow is too fast.
- Watch the infant’s behavior for signs of stress or discomfort (wriggling) and take a break if the infant indicates that he/she requires a rest.
- Encourage the infant to suck on a soother during tube feeds (the soother can be dipped in breast milk).
- Continue to watch or hold your infant for 20/30 minutes after the feed to make sure he is comfortable.
Parents can learn how to change their infant’s nappy by observing the nursing team as they perform the daily cares for the infant. The myriad of tubes and lines may appear daunting to the new parent however it is advisable to learn the task of nappy changing working backwards from the finishing off of the nappy change and settling the infant, step by step, until you feel confident to do the entire nappy change. It can be helpful to do the nappy change with someone else present who can concentrate on ensuring that the infant is comfortable during the process. If the infant becomes active, uncomfortable or unstable during the nappy change, pause for a moment and rest your hands over the body until he/she quietens and relaxes again.
Expressing Breast Milk
Continue to express Breast Milk, 8-12 times per day to keep your supply of this valuable food going.
Sharing Quiet Moments
Your infant may be ready to be quietly awake, eyes open for a few moments during gentle care giving. Treasure these moments by quietly holding and talking softly talking to the infant.
STAGE 3 (Progressing to a Cot)
What can you do?
Continue to provide comfort especially when your infant needs an upsetting or tiring procedure such as a heel prick.
Washing and Bathing
Continue with mouth cleaning, washing, nappy changes and discuss plans to give the first bath.
Once infants have transferred to an open cot parents are permitted to bring clothes from home onto the unit. This is an ideal opportunity to learn how to dress and undress your infant.
The infant will be showing increased interest in sucking and will begin to wake for feeds. You can take this opportunity to place your infant to your breast.
Looking and Listening
Your infant starts to respond to your greetings to show that he/she knows that you are there. Speak softly and gently and allow the infant time to respond.
STAGE 4 (Ready for Home)
What can you do?
Where possible be available for as many of your infant’s feeds. Make plans to room in overnight to ensure that you are confident caring for your infant on discharge.
The first bath is a very special occasion and is worth careful planning with the nursing team. Wrapped bathing (where the infant is bathed wrapped in a sheet or muslin cloth whilst slowly lowered into the bath feet first) is often the most relaxed option for the parent. Ensure that you talk gently to your infant and observe his responses for any signs of a stress reaction.
Encourage our infant to settle to sleep on his back and learn to deal with emergencies at home ie CPR. The nursing team will instruct you on how to administer your infant’s medications.
You can spend long periods of each day doing kangaroo care. During these sessions encourage your infant to be quietly awake and to listen to you as you talk. Watch your infant for signs of stress.