Mental health articles

Parental involvement during infant hospitalisation In recent years efforts have been made to facilitate parents’ participation in the care of their infants through the introduction of such programs as the Newborn Individualised Developmental Care and Assessment Program (NIDCAP) (Als, 1982, 1986, 1991) and family-centred neonatal care (Sizun, Ratynski & Boussard, 1999; Symington & Pinelli, 2003). Parents are encouraged to visit frequently, gently touch and talk to their baby, express milk, nurse their baby when the baby is stable enough to be held and assist in care of their baby as their baby matures. As soon as possible, parents are encouraged to feed their babies, usually with a bottle initially and then the breast. In some nurseries, parents are encouraged to hold their baby skin to skin underneath their clothing, known as ‘kangaroo care’. This method of care, introduced once the infant is stable for a few hours a day, is believed to help the infant to maintain body temperature, conserve energy (Feldman & Eidelman, 2003) and show less negative affect (Feldman, Weller, Sirota & Eidelman, 2003). If the nursery has an individualised, family-centred approach to care, then as early as possible the parents are encouraged to observe their baby and identify cues for hunger and comfort, and signs of distress and tiredness. A program that involves the parents in the care of their baby addresses the problem frequently expressed by parents of premature infants, that the baby did not belong to them but to the staff. Where parents feel that the baby does not belong to them there is a danger that the parents visit less often, believing that the baby is better cared for by the experts, the nurses and doctors. Parents who are supported and involved in the care of their infants in the Neonatal Intensive Care Unit (NICU) have the opportunity to get to know their infants, which facilitates the interaction between the parents and the infant and increases the parents’ confidence as they take their baby home. For the premature infant, it is now known that the environmental sensory input affects her development. For the stable premature baby, evidence suggests that the best sensory environment ‘is his or her parents’ faces, voices and bodies (Als, 1998; Als & Gilkerson, 1997; Glass, 1999). They are familiar, appropriately complex, multimodal, specific to the infant’s individual expectations and needs and can readily modify themselves according to the baby’s responses’ .

After the birth of a premature infant some women stay in the hospital in a
post-natal ward for a few days before moving to other accommodation on the
hospital site if the family lives some distance from the hospital. Some tertiary
hospitals provide family accommodation. Prior to discharge, most tertiary
hospitals provide accommodation on the ward for parents to ‘room in’ with their
baby for one or two nights.
EXAMPLE: LISA, ANDREW AND ROBERT
Lisa and Andrew were very excited, yet apprehensive in anticipation of taking
baby Robert home. It had been a long three months with Robert having been born
at 27 weeks’ gestation. Initially, Robert had difficulty with his breathing and
was on a ventilator for five days. He then got an infection, which caused a lot of
anxiety until the infection passed and he continued to grow and put on weight.
Lisa had been visiting the hospital daily, offering Robert the breast for three feeds a day. In preparation for discharge a plan was made for Lisa to come in to hospital for two nights to give her the opportunity to breastfeed each feed. Given that this would be the first night Lisa would be getting up to Robert through the night, she was concerned about how she and Andrew would cope. The first night neither Lisa nor Andrew slept as Robert’s noises kept them awake, although
Robert had slept soundly between feeds. Robert had fed well at each feed and Lisa
was pleased that Robert had no difficulty doing so. Lisa and Andrew wanted to talk to the staff about Robert’s noises and were pleased they had a second night in the hospital.
During the time of the baby’s hospitalisation the parents have contact with
other parents of premature infants either informally on the ward and around the hospital or formally in a group, conducted by a staff member or sometimes by parents of older premature infants.

Tags: infant