The Positive Effects of Parental Engagement in the NICU

Introduction

If your baby is currently in the NICU, this podcast episode is for you! I hope as NICU parents you have been educated on the importance of your involvement with your baby – even while they are in the NICU! Parental engagement in the NICU has a plethora of benefits and not just for your baby, but for you as parents as well!

We want you to know that as NICU parents, although you may feel completely powerless, you play a major role in the success of your baby by being present and simply loving on your infant! In the NICU, we cannot have positive outcomes for our infants without empowering and involving the parents! This is not meant to put additional pressure on you as a parent, but to simply remind you and ensure that you know your role is incredibly important, even in the NICU! Keep reading to learn how your involvement as a parent can positively change the trajectory of the developmental outcomes for your baby.

For podcast episode 27, I continued my discussion with our guest, Katie Ross. She is a Neonatal Occupational Therapist and is very passionate about positively fostering the development of our specialized NICU population from the earliest stage of life.

We continued our discussion on infant mental health and how it can be positively affected by parental involvement. Katie and I are both very passionate about parents being actively engaged with their NICU infant. We have both seen how impactful parental participation can be for NICU babies and the family unit as a whole.

After I had my son William at 23 weeks and I personally witnessed his NICU journey and in the years that have followed, it has become even more apparent to me just how important parental engagement is for NICU babies. With my unique perspective as a NNP, but also a mother to a former micropreemie, it is my mission to educate both NICU parents and clinicians on the benefits of parental involvement and how impactful it can be for the infant and the entire family unit.

Empowering NICU parents, our podcast and our NICU journal were all created to support, educate, and empower NICU parents. I believe that if we as clinicians can provide psychosocial support, education, and encouragement to NICU parents, they will embrace that knowledge, become empowered and ultimately more involved in their baby’s daily care. It is also why I recently became a partner at Families Bridge to Caring Hands and I fully support the mission to improve the experience of NICU families. Despite the NICU journey being incredibly difficult, we want to help parents create meaningful connections with the NICU care team prior to their baby’s admission and during their time in the NICU with evidence-based education that engages parents in the care of their infant. Not only do we strongly believe in the power of parental participation, but research has shown that when parents are present, they do skin-to-skin care, begin to respond to their infants’ cues, and learn to care for their own baby, it results in positive short and long-term outcomes for the baby.

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Our NICU Roadmap

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Episode 27

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. She is the proud mother of two boys, who are currently 2 years old and 2 months old. She and her husband, who is a physical therapist, personally experienced the NICU journey with their youngest son who spent a small amount of time in the NICU. In her free time, she enjoys exploring different playgrounds and baking with her husband and young sons.

On our last episode

On episode 26, Katie and I discussed Infant Mental Health and how it applies to our high risk NICU population. We shared how 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 reviewed 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!

We discussed 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! We reviewed tangible ways parents can work through grief, trauma, and fear so they can simply love on their baby.

It is a great episode and I recommend you go back and listen!

Episode 26

Parental Involvement

We concluded the last podcast episode speaking on the importance of parental engagement in the NICU. Katie spoke about the importance of educating parents on high risk and low risk lines. She encourages parents to ask questions so they can gain a better understanding of the different lines and tubes on our around your infant, but also we also encourage you to understand their purpose.

Once parents are educated, they gain knowledge, but most importantly, they develop an increase in their confidence as parents in caring for their own infant.

The NICU is rehearsal for home

Katie refers to the NICU as rehearsal for home. It is a safe space where parents can learn from the clinicians. It is important for providers to meet the parents where they’re at in their NICU journey. Some parents are ready to jump in and learn, whereas other parents may need more encouragement. Overall, as clinicians, it is empowering to help parents learn how to care for their baby even while they are in the NICU.

Positive praise reinforces parental engagement

When our son William was in the NICU, I taught my husband to do the standing transfer for skin-to-skin care. Once he tried the standing transfer and was successful with it, I praised him for it. With the positive praise, it built his confidence and encouraged him to continue skin-to-skin care with William when he was able to visit.

One day William was having several episodes and we were encouraged to not get him out and do kangaroo care with him. So we both sat there feeling helpless. Eventually, my husband stood up and said, “forget it! I am getting him out!” Of course with the approval of the nurses, Josh held him skin-to-skin and William immediately improved. My husband would not have been able to do that without confidence and practice.

Creating positive parental experiences

Katie touches on the importance of the parent’s initial experience with either skin-to-skin care or during a transfer being positive. In maintaining a positive experience, it not only minimizes the flight or fight response in parents, but it also encourages their continued involvement. Additionally, NICU parents need praise and encouragement when they do something well.

Minimizing parental guilt

NICU parents, especially mothers also endure many feelings of guilt once their infant has been admitted to the NICU. So the need to create positive experiences and to frequently and willingly praise our NICU parents is crucial to build their confidence and create improved parent-child bonding and attachment.

How Parental Involvement in the NICU Impacts Infant Mental Health

Parental engagement impacts outcomes of NICU infants

Katie states it very simply, we are unable to have positive outcomes for infants without involving parents and empowering them. We as clinicians in the NICU need to give parents the tools they need to care for their baby. The parents and caregivers are the bridge to our babies’ world!

In thinking of infant mental health, you cannot help to also think how it relates to parent mental health. As clinicians in the NICU, we want our patients discharged home to healthy and happy families where the parents are confident in caring for them, responding to their cues, and bonding appropriately.

If the parents are not competent in caring for their infant in the NICU and eventually at home, it will affect the baby and their developmental outcomes. As NICU clinicians, it is a huge part of our job to ensure that parents are competent and comfortable in caring for their own infants.

What are Pandemials?

Pandemials are all infants born during the COVID pandemic. Katie points out that both of her boys are pandemials and like her, many parents may have several questions and concerns regarding how the pandemic will impact their social and emotional skills. But, Katie said her developmental background has helped her to keep a level head and a sense of peace. She has remained calm knowing how powerful the buffer of a parent and the family’s close circle including grandparents and friends can be after the residual effects that may follow negative circumstances.

How Parental Involvement in the NICU Benefits the Infant and Parents

Benefits to the parents

Research has shown that parental presence and involvement in the NICU has a multitude of benefits, especially with skin-to-skin care. Specifically for mothers, it has shown positive maternal health outcomes. Katie points out that although there are not many studies involving fathers, the research is growing regarding father participation in the NICU. One study did show that when fathers held their infants skin-to-skin, the infants had greater weight gain. When fathers are involved, the rates of maternal postpartum depression have been found to decrease. All of the studies reiterate the importance of the parents and their participation in caring for their infant in the NICU.

Benefits to the infant

Studies have shown that infants who have the benefit of consistent parental involvement have a decreased length of the stay in the NICU, greater weight gain, and they get to feedings by mouth faster. Katie points out that these are tangible, medical goals that all parents want for their NICU babies.

Developmentally, NICU infants who are held more, are found to have better language scores at 4-5 years of age. Additionally, a study from a few years ago looked simply at parental presence in the NICU and found those children to have better fine and gross motor development at 4-5 years and better social-emotional regulation at 14-15 years of age.

We want to remind parents that you can have a significant impact on your children’s life even years down the road by simply being present and especially with your early involvement including skin-to-skin care. As a NICU parent, I fully understand the difficulty in being able to look beyond the NICU days. While your infant is in the NICU, you are living in an acute state worried about the immediate health of your baby, but we want you to know that your involvement and engagement is impactful much beyond your baby’s time in the NICU. As a parent of a micropreemie who is now almost 8 years old and in his school-aged years, I can personally tell you that it does make a difference.

The clinician’s role

As clinicians, we have the honor of buffering the relationship of the parent and family in the infant’s life. So we need to all become empowered to to talk to parents about the importance of positive touch and kangaroo care even if it feels as though it’s the least of your worries in that moment, because it does make a huge difference in the outcomes for our NICU babies.

Common sensory processing dysfunction in NICU babies

We also discussed that despite parents being involved and with the appropriate developmental considerations in place, some infants will still experience sensory processing issues.

Katie said she spoke with a mother whose daughter had several medical complications while she was in the NICU including but not limited to CLD, ROP, laser eye surgery, and NEC. She made it through all of those complications, but now as a 6-year old, she struggles with sensory issues. Despite all of the medical concerns fading away, it is now the sensory issues that affect how she is able to engage with the world and inhibit her from participating in activities she would like to do.

I also spoke about some of William’s sensory issues that hold him back from activities. He loves basketball and can shoot the ball really well, but he is so concerned with the buzzer going off, that he is unable to play on a team. He does not like to attend some of our family’s athletic events as well for the same reason. We have also discovered that he does not do well when we used to sing “Happy Birthday” to him or even during praise and worship at church.

We want parents to know that despite being actively present and involved while your baby is in the NICU, your child may still have some lingering effects that might not become apparent until the school-aged years. It is not atypical for NICU babies to have neurological or sensory issues and it does not mean that you, as parents did anything wrong.

In the NICU, we use what we know supports your baby’s development to mediate the potential negative effects. We cannot always predict what the effects will be, but we will do everything we can to support a positive outcome.

Blooming Littles

Katie created Blooming Littles as a passion project during the pandemic. She realized that parents were unable to actively learn about their child’s development and wanted to provide them with an accessible resource. Follow her on Instagram, Facebook, Pinterest, and on the website which houses a blog for parents as well as encouragement, hope, and education. She has additional specialists who offer insight and has some upcoming webinars as well.

Closing

I want to thank Katie for joining us and sharing her expertise and passion for our high risk NICU population. Remember, the NICU is a safe rehearsal space for you to learn to care for your baby at your own pace. It is the time you can openly ask the care team questions, begin to learn your baby’s cues, and become engaged whether it is with positive touch, skin-to-skin care, or feeding your baby with a full support system around you! Do not underestimate your purpose as a parent, even if your baby is in the NICU. You not only matter to your infant and their success – you are the therapy for your baby and they need you!

Use the knowledge you obtain during your baby’s time in the NICU and become empowered to care for them so when they are ready to go home, you will be confident and prepared. Once you recognize the importance of your role as a parent to your baby, even in the NICU, your anxiety and stress will decrease, it will enhance your ability to bond with your baby, promote continued engagement, and ultimately result in positive developmental outcomes for your baby! Yes, you as a parent 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!