Supporting Infant Mental Health in the NICU

Introduction

Have you ever heard the term infant mental health? Keep reading to learn how you, as a parent or caregiver of an infant, can positively shape and support a baby’s early social and emotional skills so they are able to build long-lasting connections in the future! You will not want to miss this episode if you are a parent or member of the NICU care team – it is one of my favorite episodes we’ve done so far!

On today’s podcast, I am joined by Katie Ross, a Certified Neonatal Occupational Therapist. She is very passionate about positively fostering the development of our specialized NICU population from the earliest stage of life.

We discuss infant mental health, what it actually means, and how it applies to our high risk NICU population. We as NICU caregivers in close collaboration with the parents have the ability to positively change the trajectory of the developmental outcomes for our NICU babies. Katie and I are both very passionate about parental involvement and engagement. Together, we discuss ways NICU care team members can support, educate, and empower NICU parents to become actively engaged in their infant’s daily cares including skin-to-skin care!

The theme we focus on is simplicity! Plain and simple, parents of a NICU baby need to be involved, they are the therapy for their infant! Tune in to learn ways we can all work together to foster and encourage parental support and involvement! Studies have shown that parental engagement actually influences the neurobiology of the infant’s brain and promotes physiological changes in the parents as well – meaning, with parental contact during skin-to-skin care, levels of oxytocin increase which reduces stress and facilitates increased feelings of comfort and attachment, and leads to positive physiological stability in both the baby and the parents! Isn’t that amazing! So do not underestimate your role as parents, even if your baby is in the NICU! Continue reading as we educate, guide and empower parents on the best ways to work through your grief, trauma, and fear so you can simply love on your baby.

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Episode 26

Meet Our Guest

Katie Ross

Dr. Katie Ross is a certified neonatal therapist with a Doctorate degree in Occupational Therapy and over 6 years of experience working in a large children’s hospital in a 100+ bed, level IV neonatal intensive care unit. She specializes in supporting positive developmental experiences and fostering confidence among NICU caregivers. She holds additional certifications in neonatal touch and massage, as well as lactation. Katie is also the owner and founder of Blooming Littles, LLC, an online educational resource aimed at equipping NICU families with the education they need to take more confident steps at the NICU bedside. In her free time, she enjoys exploring different playgrounds and baking with her husband and young sons.

How Katie became a Neonatal Occupational Therapist

Katie is a Neonatal Occupational Therapist who absolutely loves her work. She works in a 100+ bed Level IV NICU and works with the most fragile and critical infants. She is the proud mother of two boys, who are currently 2 years old and 2 months old. She and her husband, who is an physical therapist, personally experienced the NICU journey with their youngest son who spent a small amount of time in the NICU.

Katie has been an neonatal occupational therapist (OT) for 6 years and knew that she always wanted to work with children. Once she started her specialized training during graduate school in the NICU, she fell in love with the intensity of the medical space, but also the vulnerability of families and the resiliency of our NICU babies. She is very passionate about fostering infant development from the earliest stage of life possible.

Infant Mental Health

Especially since the pandemic, we now hear a lot about adult mental health, and it has brought light to the mental health community in general and how can we best support one another. Infant mental health tends to be clumped together with early childhood mental health. Katie enjoys bringing awareness to infant mental health because in the NICU, we especially are able to focus on supporting the mental health needs of our high risk population.

What is infant mental health?

Katie described infant mental health as the ability of the baby to regulate and adapt to their environment. It involves supporting the early social and emotional skills and ensuring they have the foundation they need to build connections with other people to build and maintain long-lasting relationships.

Why is it even more crucial for NICU babies?

Katie points out that it’s more difficult to support infant mental health in the NICU because of the negative NICU environment. In the NICU, infants are surrounded by and bombarded with negative, inconsistent input, that at times is painful. The medical procedures are essential to care for NICU infants, but Katie acknowledges that it’s part of her job to find alternative, supportive measures to minimize the negative input. When NICU infants are supported better through the negative input, it actually changes their brain’s architecture and neuronal connections. Or in other words, we are supporting their ability to connect and develop trust in their caregivers during a time when nothing is consistent in their life.

Relationship between negative experiences and developmental outcomes

The relationship between an infant’s environment and the support they receive especially from their parents, but also clinicians changes the trajectory of their developmental outcomes. Adverse childhood experiences and repetitive toxic exposure are very influential on an infant’s psychosocial outcomes in the future. Katie said 60-70% of people with at least one adverse childhood experience are at an increased risk for future mental health conditions.

In the NICU, there are many layers of trauma and difficult dynamics that can negatively affect the infant’s future. But Katie likes to focus on how can we as clinicians in the NICU can layer in the positive experiences that will mediate and buffer all of the negative experiences.

Parental Involvement in the NICU

Importance of parental involvement in the NICU

A child’s brain is the most pliable in the first 3 years of life. It is one of the many reasons Katie loves to empower parents to participate because they can contribute to positive changes in their baby that will affect their future! When parents are present with their babies in the NICU and responding to their cues, feeding them, holding them and loving on them, oxytocin is released in the parents and baby. The increased levels of oxytocin cause positive physiological changes in the brain structure. With skin-to-skin care, it reduces stress and facilitates increased feelings of comfort and attachment, and leads to positive physiological stability in both the baby and the parents. For parents, it gives them hope to know that by simply loving on their infant, they can have a positive and monumental impact on their infant’s future.

Parents are the therapy!

Parents are exactly what their baby needs. By being present in the NICU, participating in two-person care or kangaroo care, or feeding them consistently makes all the difference. NICU parents often underestimate their role as parents as they watch the NICU nurses care for their infant so effortlessly. Sadly, it can make them feel incompetent as a parent and they may retreat further or stop visiting all together.

We, as NICU care team members, need to encourage parents to participate and become involved in their infants cares. It is the consistency of parental involvement in the NICU that will contribute to not just improved outcomes for the baby, but the entire family unit. The concept of parental involvement in the NICU is incredibly simple, but sadly still not done enough. Parents need daily, if not hourly reminders on the importance of their role as parents to their baby in the NICU everyday!

Katie’s reflection on her time as a parent in the NICU

Katie shared how her personal experience with her son in the NICU made her even more aware of some of the common barriers for NICU parents. She personally remembers her son being dusky, not crying, and being whisked away to the NICU. As someone whose job is to teach and encourage parental involvement, she was shocked by who she became as a parent on the other side. She found herself stand-offish and not nearly as active as she thought she would be. After some reflection, she now realizes how stunned and traumatized she was and admits that she did not feel like a mom.

We do not realize or can quickly forget what NICU parents go through. Every parent and their reaction to their baby’s admission and time in the NICU will be different, and whatever reaction they have is okay.

Meeting parents at their comfort level

It is best to facilitate parental involvement in a way that matches their comfort level. For clinicians, it is as simple as inviting the parents up to the bedside, sometimes they need the reminder and the invitation. Many parents feel as though they are being intrusive, in the way, or a “guest” in our house. It is our job as NICU care team members to support, encourage, and educate parents.

What are some of the most common barriers that inhibit parental involvement in the NICU?

In Katie’s professional experience and research has shown that many parents are stressed or concerned about the appearance of their infant in the NICU. Once parents see the medical intensity of the wires and tubes, they begin to feel even more disconnected.

Many parents are fearful because they do not know what to do or are afraid of harming their infant. Clinicians in the NICU need to help break down the barriers and ensure that parents know they can help care for their infant regardless of their gestational age. We as clinicians often forget that the appearance of an extremely low birthweight infant or a term infant with several tubes and wires can be very intimidating, especially for parents.

High risk and low risk lines

Katie explains to parents that her comfort in caring for such fragile and sick infants comes from the knowledge of knowing the purpose of each line connected to the infant. She educates parents on high risk and low risk lines and encourages parents to get involved and to ask questions. Parents will begin to feel more comfortable in caring for their infant by not only asking what each line is, but by also understanding its’ purpose. Once they begin to learn and understand more, it helps parents move forward beyond their fear. Knowledge is Power!

Parents also need to remember that if a line does become dislodged, even if it is a high risk line, it does not mean it was their fault. Additionally, do not let that previous negative experience inhibit you from helping with cares or holding your baby skin-to-skin in the future!

Closing

It was such a joy to be joined by Katie on the podcast. We cannot thank her enough for sharing her passion and expertise! Katie’s knowledge and passion for our high risk NICU population is inspiring! We want parents to become knowledgeable and empowered! Remember, you as parents are the therapy for your baby! So please do not doubt your role or underestimate the importance of you being present and actively engaged while your baby is in the NICU. We completely acknowledge your fears, and we both personally understand the NICU experience, but we want you to ask questions and feel empowered to step into your role!

Parents, in collaboration with the NICU care team have the ability to buffer the negative experiences common to the NICU environment. You can actually change the trajectory of your infant’s developmental outcomes by being present, learning and responding to your infant’s cues, and by giving them the love they need!

On our next podcast, Katie and I continue our discussion on why parental presence is so monumental to our NICU babies and we continue to offer support and suggestions for both NICU Parents and members of the NICU care team! Until next time!