Providing Support for Parents

Appropriate support for parents of prematurely born children is an important part of providing adequate follow-up services.  We cannot lose sight of the fact these parents have special needs.  The impact of being separated from their newborns for extended periods of time, making difficult treatment decisions for their children, and, for some, being told their infant might die or a specific complication would likely have serious, long-term, developmental effects, can have profound consequences for the way they parent and how they interact with professionals.

Some infants may still be experiencing medical complications at the time of hospital discharge.  Within the first few months at home most babies will stabilize and start to thrive.  However, this is also a time when some of the babies' developmental problems may begin to emerge.  After the NICU experience parents may not be receptive to hearing about new problems with their baby.  On the other hand they may feel they have been here before: doctors gave dire predictions that did not come true in the NICU, this is just more negativity.  If they are aware of emerging problems they may feel decisions they made in the NICU are the cause and feel guilt and/or anger.  Anger may be directed towards the medical community for causing the current problem or for not making them really understand what the future would hold for their child.  Parents may be tired both physically and emotionally.  These factors can make working with families a challenge.  To begin a working relationship we need to be aware of their interpretation of where their baby has come from and what they understand can be expected as an outcome.

All parents have fantasies of what having a baby will mean in their life and how they will interact with their baby.  When you have a premature infant your fantasies are shattered beginning with labor and for many continuing even after the long anticipated discharge from the NICU.  Until the baby is completely recovered many prematurely born infants may not participate in the parent/infant "dance" the way a full term baby might.  For example, because of  immaturity and health issues most preterm infants cry infrequently during their stay in the NICU.  As they mature and reach term many infants become more active, sleep less, and increase the amount of time spent crying.  Frequently infants are discharged from the NICU around term.  These changes in behavior can make a parent feel that the baby liked the hospital and nurses more than they like the parent, or a parent may feel incompetent in handling the baby.  Parents have commented to us, "My baby was happier in the hospital, she cries since she has been home and she never cried in the NICU."

Another barrier to parents feeling successful in parenting their prematurely born baby is some of these infants are over reactive to handling, visual stimuli and sounds.  This can make parenting very difficult.  These babies are easily over stimulated and can be difficult to console once upset.  It may not be easy to read their behavioral cues or they may not carry out their part in everyday adult/infant interaction.  This may cause parents to decrease the amount of time they spend interacting with their infant because they feel the baby wants to be left alone, or a parent might end up working very hard to maintain a weak and unsatisfying interaction, doing the work for both the adult and the infant.  Parents need understanding and support to realize things may take some time to work smoothly.  There are things parents can be made aware of that can make interacting with their infant more satisfying and helpful to their baby.  Click here for some suggestions.