I love a good mythbuster! And the NICU is full of them.

Let’s go ahead and bust 5 myths you may have (or have not heard!) about your baby’s development in the NICU.

Myth #1 Babies don’t know or recognize their parents when they’re born premature.

If you’re the parent of a preemie, been at the bedside and thought to yourself “Does it even matter that I’m here? There’s no way my baby even knows who I am?”, you’re not alone.

My sweet friend, I’ve spent a lot of time in the NICU as a neonatal occupational therapist, and I’ve heard parents make statements like these all the time.

“Can he even hear me right now?”

“He’s so early, I didn’t think he would even know who I am.”

“I didn’t really visit at the beginning because he couldn’t do anything.”

These feelings and thoughts are SO natural! But as the developmental guru, I’m here to tell you that YOU MATTER. When a baby is born at 24 weeks, they are able to hear your voice, they’ve been experiencing touch in the womb, and your mama scent is already known and comforting to them.

Your baby’s development doesn’t start after their due date. They’ve been building skills and developing a close relationship with you before they were born. Yes, even though they were born early. I want to challenge you to take note of those things that feel small. The mini behaviors your baby has right now, like their ability to feel your comforting touch during a hand hug, or the way they calm when a scent cloth is in their incubator or bed.

These early developmental skills set the foundation for your relationship with your baby and support good development and brain growth. YOU are important!

I once heard a NICU mom say she felt like she was sharing her baby. There’s an entire medical team interacting and getting to know your little one…it can make you feel like you have to take a step back. Here’s the thing though. Your baby’s nurse doesn’t have your unique smell. She doesn’t have your familiar voice. Only you!

And here’s something cool!

Not only does your presence at your baby’s bedside support the development of your baby’s sensory systems, but parents who are present at the bedside have NICU babies with better neurobehavioral scores (scores that look at your baby’s movement patterns, stress, alertness etc.)

So the next time you wonder if it matters that you’re sitting at the bedside, unable to “interact”…know that every 3 hours when you get to change that diaper, your presence is actively forming positive neural connections in your baby’s brain.

Want some more reasons why you should be jumping in to change your baby’s diaper? Let me further convince you by peeking at this post!

 

Myth #2 Babies don’t feel pain.

If there is one myth that pops up every now and that really ruffles my feathers…it’s this.

“Babies don’t feel pain.”

Y’all, this gets me fired up! Thankfully, this myth is becoming more and more extinct, but it’s still out there.

Early on in my NICU career, I had to pull a lot of research articles to prove to an ophthalmologist that babies experience pain and stress during infant eye exams (Ahhh!). She held the belief that the babies weren’t feeling any pain. 

Just like I had to bust this myth for my eye doctor friend, I’m going to share some information that will help you know the truth about infant pain.

Decades ago, there was a belief that babies couldn’t feel pain because they were unable to perceive it mentally or emotionally. Since then, there has been an abundance of research that indisputably tells us that babies do, in fact, feel and experience pain.

Not only do they experience it, but early painful experiences can change the structure of a baby’s brain and impact long-term development.

This myth is a dangerous one if you’re caring for medically fragile babies. NICU babies can have an average of 10 to 70 painful procedures a day according to research, and historically, baby pain hasn’t been managed well.

One of the big reasons this has been a long-held myth in the NICU is because medically fragile babies don’t have the ability to respond robustly to pain. Meaning, it’s not always super obvious.

Their behaviors (sometimes subtle ones), are the clues that tell us what they are feeling. There are a lot of behaviors, movements and facial expressions that let us know what babies need. Need to know more now? Go ahead and dive into this post to learn some of your baby’s unique cues

interested in learning about how you can provide pain relief for your baby?

Learn 2 easy-to-apply techniques you can easily start using today! Proven to comfort your baby.
Click Here

Myth #3 “Leave them alone, don’t touch” is the best approach.

“She doesn’t like to be touched.”

“Please leave her alone for the rest of the day.”

Have you heard any of these phrases whispered around the NICU?

Because of their immature body systems and need for medical intervention, babies in the NICU are more susceptible to stress with interaction. Sometimes, babies get labeled a “touch-me-not” if they have a really hard time tolerating care.

The hard part is, they need medical care and hands-on intervention, even before their body may be ready to tolerate it. So do we leave them alone except for mandatory medical care?

I would argue no.

Now, there is definitely a time and place for being hands off. And in some circumstances, that may be what is best for your baby. It’s important to trust your bedside nurse and talk through what is appropriate given your baby’s unique medical situation.

 One of the most important things we can do for babies as they heal and grow is protect their sleep.

But, the myth we’re discussing is that leaving medically fragile babies alone entirely can’t be the universal rule when babies show signs of stress or overstimulation during care. Avoiding touch and interaction all together only deprives them of important sensory experiences, specifically, positive touch and sound experiences.

We can focus on positive touch and handling experiences, even when a baby is a “touch-me-not”. Think about the power of a containment hold or hand hug, singing quietly at the bedside, or holding your baby skin-to-skin.

Those experiences have the power to protect and support your baby as they learn about touch and develop a more mature sensory system. By prioritizing these positive sensory experiences, you’re teaching your baby that not all touch is bad. That’s an important lesson for your baby to learn when we think about the wiring of their brain and bodies as they interact with the world.

Please remember, there are developmentally supportive and safe ways to interact and provide touch experiences for medically fragile babies in the NICU. Interacting with your baby in the NICU requires additional education and support from trained medical professionals to ensure your baby is as safe as possible. Always trust and consult your baby’s medical team when applying any information seen on Blooming Littles. 

Interested in learning more about the best ways to interact with babies who can’t tolerate touch, check out ….PRACTICAL, MUST-HAVE STRATEGIES TO USE WHEN CARING FOR A TOUCH-ME-NOT.

Myth #4 It doesn’t matter what the baby’s body position looks like, as long as they can breathe and their vitals look good.

As a neonatal occupational therapist, I’m labled an expert in positioning infants in the NICU.

Not only HOW to position babies, but I have some in-depth knowledge about the different ways a baby’s body position can impact the rest of their body systems and future development.

Sometimes, in the NICU, making sure babies are supported in a good developmental position gets put to the side. And I get it, oftentimes, medical team members are focused on other things.

BUT, in busting this myth…I want you to know that your baby’s body position can have a MAJOR impact on their developmental and medical goals.

Prioritizing good positioning is one of the most important developmental principles in the NICU. There are specific positioning guidelines that set a developmental foundation for every infant needing care in the NICU.

Here’s a list of 6 major positioning goals we have for babies in the NICU as neonatal therapists.

1. Arms should be tucked in towards the middle of the body.

2. Hands are near your baby’s face (but not pulling on lines and tubes, hehe!)

3. No arching or bridging of their back and legs.

4. Their legs are tucked in towards their belly.

5. Their torso is in a straight line, not bent one way or the other.

6. There are boundaries at the head and the feet.

Focusing on your baby’s body position when they’re resting between care times is not only to support the alignment of your baby’s muscles and joints, but certain body positions can actually support the muscles your baby uses to breathe, stool, digest, etc. How cool (and important!).

For example, there have been numerous research studies examining the different ways a baby’s body position impacts their ability to breathe. Most of the research comes to the conclusion that babies who are positioned on their bellies have better oxygen exchange, and it’s simply easier to breathe. Always remember, babies sometimes sleep on their bellies while they are admitted to the NICU.

Once your baby is discharged, it’s important to follow ‘Back to Sleep’ recommendations so your baby is in a safe sleep environment.

So, now that you know how important your baby’s body position is when they’re resting, go ahead and take some time to reposition them at their care time in a way that you know isn’t only keeping them comfy, but is also supporting their stability, digestion and breathing.

Myth #5 If my baby can suck on their pacifier really well, they’re going to be good at taking bottles and breast-feeding.

Where are my feeding therapists at?

Can I get a hallelujah for addressing this last myth?

How many times have I heard in the NICU, “Oh my gosh he loves his paci, he’s gonna do so good taking bottles.”? (hint: SO MANY!). If you’re shocked reading this because you’ve heard the same thing, I totally get it. I can see how tempting it is to say and believe this statement.

And if I can be honest? I have even been caught saying it myself.

It seems like the transition from sucking on a pacifier to eating from a bottle or breast-feeding would correlate perfectly with one another. And sometimes it does!

Sometimes the baby that LOVES their pacifier and has been sucking on it like a champ for months…is also successful when taking a bottle.

But sometimes, that champion pacifier sucker isn’t able to safely take a bottle, or doesn’t take large volumes. We’re not going to take a huge dive into the topic of feeding, but when babies suck on a pacifier, the only skills they need to coordinate are sucking and breathing. When a bottle or breast is introduced, the baby now has to coordinate sucking, breathing, AND swallowing. Not only do babies have to demonstrate the skill of each of those, but they have to learn to coordinate them together so they swallow safely. Oftentimes, adding in the swallowing part of the puzzle is difficult and takes some practice.

Be patient if your baby loves their paci but didn’t completely take off with a bottle or breastfeeding. They are practicing a new developmental skill, and your patience will set them up for long-term feeding success!

So what did you think about these NICU developmental myths? Have you heard of them before?

 

References

Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain. 2015;31:355–62.

Reynolds LC, Duncan MM, Smith GC, et al. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol. 2013;33:636–41.

Gorzilio DM, Garrido E, Gaspardo CM, Martinez FE, Linhares MB. Neurobehavioral development prior to term-age of preterm infants and acute stressful events during neonatal hospitalization. Early Hum Dev. 2015;91:769–75.

Cong, X., Wu, J., Vittner, D., Xu, W., Hussain, N., Galvin, S., … & Henderson, W. A. (2017). The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU. Early human development, 108, 9-16.

Bozzette, M. (1993). Observation of pain behavior in the NICU: An exploratory study. The Journal of perinatal & neonatal nursing, 7(1), 76-87.