Supporting the Infant-Parent Bond in the NICCU

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 Supporting the Infant-Parent Bond in the NICCU

 Jim Windell

            It’s a given that attachment between infants and their parents is vital – right from the moment of birth.

           In fact, there has been considerable research in the past 20 years that has shown a strong connection between a baby’s neurodevelopment and an infant having a solid relationship with the primary caregiver, often the mother.

           But what happens when a baby is born several weeks premature and spends the first few days or weeks in a NICCU – a Newborn Infant Critical Care Unit?

            Angelica Moreyra, Psy.D., has been a full-time clinical psychologist embedded in the Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit in the Children’s Hospital Los Angeles. She recently talked to Newswise, a web-based forum for medical and science news for journalists, about work as a neonatologist helping support the mental health of infants and families.

            Dr. Moreyra began the interview by saying that a lot of the work she and her colleagues do at bedside is to guide parents to engage with their infant in a developmentally appropriate way to enhance the bonding they’re able to experience. “By supporting this baby-parent relationship,” she said, “we’re supporting that child’s neurodevelopment.”

            She noted that many parents feel uncomfortable with a tiny preemie and sometimes are fearful of touching their baby. This then leads to feelings of guilt and anxiety. “If parents are constantly feeling like they’re not meeting their infant’s needs,” she said, “it really impacts their confidence in parenting, which then impacts their availability at bedside. If you don’t feel confident, you’re not going to try to swaddle or change the diaper or take the temperature. And then that slowly starts to chip away at the parent-infant relationship, which we know is very critical in the first year.”

           She said that parents of vulnerable newborns often feel lost at the bedside. “One thing that can really help is to bring them into the medical interventions, when possible,” Angelica Moreya said. “Rather than just doing the exam, narrate it. Explain what it is you’re doing, and why. It may take a little longer, but it goes a long way in helping the parent feel more like a part of the team and less like an outsider.”

           She went on to say that she would also encourage neonatologists to become familiar with all the resources available in their unit to support families. “Often, those resources get triggered in a crisis,” she added, “but if you can think about those resources when you’re first connecting with a family, it may help to prevent a crisis later on.”

           Moreya said that it is very important for neonatologists to understand what families are experiencing in a NICCU.  “One of the challenging parts of working in a high-acuity environment is you become desensitized to it,” she explained. “Say there’s a full-term infant in the unit being treated for jaundice. A lot of times providers will have this idea [that] that’s nothing. In the scale of severity that we see, that is on the mildest end. But it doesn’t feel mild to families. For them, this is the worst moment of their lives with their baby in an intensive care unit.”

           So, she added, that instead of the care provider saying something like “You are so lucky! Your infant is healthy,” they should instead focus more on the facts of the infant’s medical status. For example, “Your infant is meeting all of these milestones today that are letting us know that he or she is on the way toward going home,” she said. “When you can hold families’ perspectives in mind, you create a much stronger partnership with them.”

           Moreya also said that it is important for care providers in NICCUs to support their own mental health. She said it is huge for providers. “One thing that happens in a high-acuity unit – at Children’s Hospital Los Angeles, we’re a level IV NICCU, which means we are seeing babies with the most severe and critical conditions – is that you are going to experience some losses. It’s part of the job. But it’s really important to take a moment to honor a loss when it happens.

           “I have seen providers leaving a patient room with tears in their eyes. But if they are just immediately running off to the next patient, it can lead to burnout. Creating opportunities for you and the providers around you to debrief is important not just for the morale of the team, but for your own sustainability in working in a NICCU.” She went on to say that in her unit she schedules staff debriefings if it’s been a particularly stressful time. Moreya herself is also part of a peer-to-peer staff support group called Swaddle Your Soul. “Part of my role is to support mental health for staff, too,” she said.

           But, of course, it is not just staff who experience emotional problems. Parents do as well. That, too, is something Moreya and her staff address. “We are currently piloting a caregiver screening program for depression, anxiety and trauma symptoms,” she said. “The goal is to eventually screen every caregiver who comes into the NICCU, two weeks post-admission. The idea is to identify families who need support, especially before they transition home.”

           Also, Moreya and her team are adapting a group intervention model that she worked on at Stanford and brought to Children’s Hospital Los Angeles. That model is about preventing depression, anxiety and trauma in parents of pre-term babies and Moreya says they are now adapting it for families with full-term infants in their NICCU.

           “Overall, our team really tries to help instill confidence, competence and some autonomy with parents so that the transition home isn’t as overwhelming,” she said. “It’s still going to be challenging, and we can’t take that away. But we can give them the tools to cope and succeed, and to keep building that bond with their baby.”

           To read the original article, find it here.

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