How Your Baby Communicates
It's true, babies communicate. From the first moment a parent looks into their child's eyes there is a communication established. It may not be words like you and I use but it is communication none the less.
Under ideal circumstances parents have an immediate opportunity to start this process of understanding. In the situation where a baby is premature or sick the baby is swooped away to the Neonatal ICU after a very brief hello, that communication is interrupted. This is something that all would prefer to avoid but if the baby needs attention it becomes unavoidable. When a parent then gets to the NICU the baby may have breathing tubes in place, be sedated or sleeping, or a number of other potential situations preventing that communication to start. There then needs to be a more in depth understanding of the way a baby communicates to the parents as well as his/her caregivers.
Your Preemie's Development
In order to understand how a baby communicates you have to understand a bit about how they develop and when they accomplish certain goals. Please keep in mind that as with all things in life a baby's development is very individual and will vary from baby to baby.
Signs of Stress
Ok, now knowing what your baby should normally be doing, lets talk about signs of stress. Signs of stress are shown in different systems so let's divide them up so you can see how they become disorganized in all body systems: Autonomic (automatic), Motor System (movements), State System (alertness).
Pauses, tachypnea (fast breathing),gasping apnea (forget to breath) which may lead to bradycardia(low heart rate). May become floppy or flaccid of body, extremities and or face
Twitches, sounds, jerky moves, irregular respirations, whimpers, grimace, fussy in sleep
May become pale, dusky around the mouth, mottled, blue, gray. May extend legs, arch back, spread fingers out, stick tongue out or hold fists clenched tightly. AwakeEye floating, glassy eyed, fussy, avoids looking at you, irritable, staring, panicked looking.
Hiccups, gagging, grunting,Spit up, straining as like to stool. May hold body, extremities, face tightly.
Seizures, tremors, startles, twitching, coughing , sneezing, yawning, sighing. May have frantic diffuse activity.
The Term Baby and Stress
The term baby who is sick may demonstrate the same signs of disorganization. When a baby is sick they need all their energy to focus on the basics, for example, breathing and getting better. Thus they may become easily over stimulated and disorganized.
You may hear the term minimal stimulation. Now knowing how easy it is for babies to become disorganized there must be a way to help prevent this disorganization. Our answer is minimal stimulation. During minimal stimulation we cover babies eyes and ears if they are in an open warmer. We will ask people to please keep sound to a minimal near baby. Some babies are so sensitive that even if you talk quietly at their bedside, they drop their oxygen level. Care is clustered to allow baby as much time with out stimulation as possible. If baby tolerates some minimal touch, it may be suggested that you hold your hands steady and firmly in one place on the infant. Do not stroke them, which is the tendency, as this tickles and over stimulates sick babies.
Positioning of Your Baby
Proper positioning of your baby helps to not only prevent disorganization but also helps to get your baby into the optimal flexion that he/she would be in utero. This will help later on in muscular development and meeting developmental goals such as turning, creeping and crawling. These positions may vary as long as there body alignment( spine kept straight) is maintained and they help contain the baby in a flexed position, similar to that of in the uterus. In the first few days of life, especially with preemies), it is important to avoid turning head away from midline as much as possible. The reason for this is to maintain consistent blood flow to the brain, without increasing pressure to the fragile vessels.
Kangaroo Care-Skin to Skin Contact:
Kangaroo Care is defined as skin to skin contact. The infant is placed on the mother or father's bare chest. The infant wears a hat and diaper and a blanket is placed over the infant. Privacy screens are placed around the parents, the lights are dimmed and soft music may be played during the holding session. A mirror is provided so you can view your infant during Kangarooing. Kangaroo Care can be provided to all families with only a few exclusions. These include infants who have arterial and/or umbilical catheter lines in place and infants who are on high frequency ventilation as well as infants who are septic or unstable. The nurses and doctors along with parents will develop a plan of when to initiate and how long and how often Kangaroo Care will take place. Usually Kangaroo Care lasts a minimum of one hour and will take place 3-4 times a week, as long as the infant tolerates it.
Benefits to the Infants Who Kangaroo:
Parents body temperature rises and falls to maintain the infants temperature in the neutral state. Infants have improved oxygenation during and after Kangarooing. An example of this is our ability to wean the amount of oxygen being administered to the infant. Infants have fewer episodes of periodic breathing, apnea and/or bradycardia. Infants who Kangaroo have lower resting heart rates, have increased deep sleep, and decreased episodes of crying. Infants may also gain weight at a steadier rate.
Benefits of maternal/paternal Kangaroo Sessions:
For mothers who plan to breast feed, Kangaroo Care helps with breast milk production and helps to maintain supply. For the parents, it helps to establish the role as primary care givers and decreases feelings of helplessness and frustration. Touching, holding and soothing your infant helps restore the bond as a family in a high tech environment. Providing Kangaroo Care for your infant is a personal choice for a family to make based on the family's comfort and readiness. The staff in the NICU or CCN Nursery will provide a comfortable and pleasant experience for the family wishing to experience Kangaroo Care.
We have been doing multiple bedding with twins and triplets for several years now with good success. Once babies become eligible for Continuing Care Nursery, they become eligible for multiple bedding. At the present time it is required that there is no IV in place. They may have feeding tubes and monitors in place. There is a consent form to sign. There is a protocol that explains the details of the procedure of labeling and such to prevent mix ups. If one baby becomes sick they do have to be separated. They may be separated at the nurses discretion. There will of course be communication with parents about the situation. It is a wonderful opportunity and babies have proven to do well with better growth patterns and less apnea and bradycardia. Please ask your nurse about this option if you are interested.