Looking for a way to provide intentional, comforting, and positive touch for your baby while they’re in the NICU? There is a method of comforting touch every NICU parent should know, because every medically fragile baby needs it. I’m going over what a hand hug is, how you actually do it (no matter where they are positioned!), when you can provide appropriate touch, and why it is SO amazing for your baby. This is something we talk about in The Preemie Interaction Guide (plus, you get bonus videos with demos!).

I want to help give you every tool you need to take care of your baby while they’re receiving care in the NICU…even the tools you didn’t even know existed.

Y’all, if there was a list of the must have things I wish NICU parents knew about, a hand hug would definitely make the list.

It’s one of the things I teach every single family that I work with, because it is so incredibly beneficial for you and your baby.

Here you’ll learn:

1. What a hand hug is.
2. How to give your baby a hand hug.
3. Which babies need a hand hug.
4. When to give your baby a hand hug.
5. How a hand hug supports your baby.
6. The many benefits of a hand hug according to research.

Here we go!

WHAT IS A HAND HUG?

If you have spent any time in the NICU, then you know your baby likely receives a lot of medical and procedure-based touch. That is touch received during medical care like placing an IV, taking a blood pressure, changing a diaper, repositioning, even surgery. 

A hand hug is an amazing comfort measure you can provide for your baby while they’re in the NICU (even during procedures or assessments!). 

It has MAJOR benefits for your little one, and anyone can do it!

A hand hug is when you place one hand on your baby’s head and the other hand is either

1. cupping your baby’s feet OR
2. placed over their arms/tummy while your baby is supported in a flexed (tucked) position.

A hand hug can also be called a ‘containment hold’, ‘hand swaddling’, or in therapy terms, ‘facilitated tuck’.

HOW TO GIVE YOUR NICU BABY A HAND HUG

A hand hug is a gentle, nurturing, and static touch that has the power to minimize your preterm baby’s pain.

It can be important to know the type of touch and exactly how to position your hands, so you can provide your baby with the GREATEST benefits.

TYPE OF TOUCH

When your hands are on your premature baby in a hand hug, it’s important that when you touch them, you try and avoid stroking their skin. Y’all, this can be a really hard thing to do. 

I swear it is in our mama instinct to stroke and caress our sweet babies.

For premature babies, or any medically fragile infant who is processing a lot of sensory input during their NICU stay, the tickly touch of stroking can be very overstimulating for your little one. 

Instead, your baby will love a firm, static hand.

It won’t be like that forever, your baby can have lots of caressing and tickling once they’re older and have a more mature nervous system.

PROVIDING A HAND HUG BASED ON YOUR BABY’S POSITION

Let’s talk about how to position your hands when providing a hand hug for your baby, no matter where they are positioned.

There’s no need to flip your baby on their back to provide a hand hug if they’re already cozy on their tummy.

Just a tip: Pay careful attention to any IVs or lines your baby has. Many babies will have IVs in their head or feet. You may have to adjust your hand position slightly so you aren’t jostling or putting pressure on any surgical or IV sites.

You can always put one hand across your baby’s torso and the other hand cupping their feet (to avoid their head all together) if you need to.

When your baby is on their back

Place one hand on your baby’s head and place the other hand either…

1) cupping their feet, or 

2) on top of their arms while they’re supported in a flexed position with their hands near their face.

When your baby is on their side

Place one hand on your baby’s head and place the other hand either…

1) cupping their feet, or 

2) on top of their exposed arm/side while they’re supported in a flexed position with their hands near their face

When your baby is on their tummy

Place one hand on your baby’s head and place the other hand either…

1) cupping their bottom/feet, or

2) on top of their back

WHICH BABIES BENEFIT FROM A HAND HUG?

Every. Single. Baby!!!

One of the most amazing things about a hand hug is how it can be used with every baby, even the most medically fragile. 

You can provide your baby with a hand hug even when they are requiring invasive medical interventions.

A 24 week old baby on a ventilator with a breathing tube—YES!

A baby with gastroschisis (a condition where part of the digestive tract extends outside of the abdominal wall) waiting on their abdominal repair—YES!

A term baby getting antibiotics and oxygen support—YES!

A 32 week old baby on CPAP (type of breathing support)—YES!

A baby born with Down Syndrome—YES!

A one month old who is recovering from open heart surgery—YES!

I could go on and on….the point is—a hand hug can be adapted to accommodate ANY medically fragile baby in the NICU.

Use the neonatal therapist in your unit and/or bedside nurse to learn any adaptations your baby may need! You can even show them this post to get y’all started, if it’s not something your baby’s unit is familiar with.

Blooming Littles has a downloadable eBook that covers your preemies development from birth to their due date! Plus, you get bonus videos showing you some of the ways you can give your baby a hand hug, plus other helpful NICU parenting strategies. You can download The Preemie Interaction guide here.

WHEN TO GIVE YOUR NICU BABY A HAND HUG

As with all information on Blooming Littles, please discuss everything with your baby’s bedside nurse or neonatal therapist before doing any kind of intervention with your little one— I am not there with you in person to walk you through it and help to adapt if needed. I’m a NICU occupational therapist, but I’m not your baby’s occupational therapist—even though I wish I was!

WHAT AGE?

According to research, certain types of touch interventions (like a hand hug!) can begin when a premature baby is as young as 23 weeks gestation. Yep—it can begin that early on in life when done appropriately!

Always remember, any touch provided to an extremely premature baby needs to be intentional and appropriate (such as skin-to-skin care or hand hugs).

WHAT TIME OF DAY IS BEST?

I truly believe that parents should provide positive, nurturing touch whenever possible. 

• DURING and AFTER any uncomfortable procedures.

Including procedures like heel sticks, vaccinations, blood pressures, eye exams, or when the nurse needs to suction out their breathing tube.

• JUST BEFORE your baby’s assessment. 

Before reaching in to change your baby’s diaper or take their temperature, provide a hand hug to let your little one know things are about to get started. Waking up with a hand hug is a lot more pleasant than being startled.

• DURING your baby’s assessment. 

You can provide a hand hug while the nurse takes your baby’s temperature, takes their blood pressure, or listens to their lungs and heart. 

• AFTER your baby’s assessment. 

Once your baby is repositioned and cozy, a hand hug can provide positive input and help them transition to a deep sleep.

WATCH FOR YOUR BABY’S CUES

Many NICU parents are desperate to interact with their baby, but too anxious or nervous to take the plunge. 

On the other hand, sometimes caregivers can get so eager to touch and love on their NICU baby, that they forget just how difficult it can be for their baby to tolerate even the most well intended interaction.

That interaction may occur at the expense of your NICU baby’s medical stability.

Those of us who work in the NICU and help care for your sweet babe want you to interact and engage with your baby. It’s important to know when the right time is and make sure it isn’t going to affect your little one’s sleep or stability (heart rate, breathing rate, or oxygen rate).

Pay attention to your baby’s cues (behaviors).

If they are showing any signs of stress or discomfort, then provide your little one with a hand hug to help them re-organize.

You can stop your hand hug and continue on with activity and interaction once your babe has is showing you cues they are calm and organized.

**It is best to avoid providing touch or hand hugs between your baby’s assessment times. It’s important to protect your baby’s sleep as much as possible, because it supports their weight gain, helps their brains grow, and promotes healing. 

**If you visit your sweet one, and they are already back to sleep, wait until your baby’s next care time (or if they wake up early!) to touch and interact with them.

HOW A HAND HUG SUPPORTS YOUR NICU BABY?

Wondering how exactly a hand hug works to help your baby? What’s the mechanism behind it?

Here’s part of the nerdy stuff—there is a ton of evidence supporting a hand hug. 

A hand hug benefits your baby in several ways, and specifically supports their little nervous systems and developing brain.

1. Supports flexion (tucked position)
2. Activates the parasympathetic nervous system (“rest and digest response”)
3. Proprioceptive input (organizing pressure into your baby’s joints)
4. Positive, deep tactile input (touch input)

Each of these things helps to regulate your baby’s nervous system and promotes self-regulation.

THE RESEARCH BEHIND WHY A HAND HUG IS SO AMAZING FOR YOUR NICU BABY

I just described how a hand hug works to promote good feels for your baby, but now I want to share just some of the AMAZING benefits a hand hug or “facilitated tuck” can have for your baby. 

There is a LOT of research out there related to premature infants and appropriate touch—with a lot of focus on “facilitated tuck” (it’s the same thing as a hand hug, just our fancy, therapy word!).

Here’s just a taste of some of the goodness!

• Facilitated tucking decreases premature baby’s pain expressions.
• Hand hugs and sucking on a pacifier leads to a faster pain recovery after a heel stick. 
• Relates to a lower heart rate, shorter crying time and fewer sleep disruptions after a heel stick.
• Contributes to better weight gain, more stable body temperature, and a more stable heart rate.
• Can increase your baby’s energy for appropriate functional tasks (like feeding!), because it leads to more oxygen going to the brain.
• Increase in serotonin levels, leading to better sleep for your baby.
• Reduces your baby’s fight or flight response (stress response).
• Providing a hand hug with your baby when they are on their tummy reduces their pain and stress.
• Calms your baby when they are fussy—which makes you feel good!
• Facilitated tucking decreases and prevents pain during NICU procedures.
• Hand hugs create successful bonding and attachment between families and their babies.
• Helps to regulate breathing and body temperature.
• Provides a sense of security and trust.
• May decrease your baby’s length of stay in the NICU.

When I was getting certified in neonatal touch and massage, the amazing instructor said she had a goal of making over 95% of all touch in the NICU positive! 

That is a goal I can get behind—let’s help her get there!

#handhugsforall

I can tell you one thing. Every single baby in the NICU would benefit from more intentional, positive, and comforting touch experiences.

I have chills right now thinking about how this information can change your baby’s life—and yours. 

Send me some pictures of you providing a hand hug with your baby, plus a story about your sweet one. 

I can’t wait to hear from you. 

I hope you have a hope-filled day with your precious baby!

References

Consensus Statement for the Prevention and Management of Pain in the Newborn. J. S. Anand, MBBS, DPhil; and the International Evidence-Based Group for Neonatal Pain. 

Corff, K.E., Seideman, R., Venkataraman, P.S., Lutes, L. and Yates, B. (1995), Facilitated Tucking: A Nonpharmacologic Comfort Measure for Pain in Preterm Neonates. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 24: 143-148. 

Hartley KA, Miller CS, Gephart SM. Facilitated tucking to reduce pain in neonates: evidence for best practice. Adv Neonatal Care. 2015;15(3):201-208. 

Maharani Y, Suwondo A, Hardjanti TS, Hadisaputro S, Fatmasari D. The Impact of gentle human touch in increasing baby weight, body temperature, and pulse stability on preterm baby. Belitung Nursing Journal. 2017;3(4):307- 315.

Oral Sucrose and ”Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial. Eva L. Cignacco, Gila Sellam, Lillian Stoffel, Roland Gerull, Mathias Nelle, Kanwaljeet J. S. Anand and Sandra Engberg. Pediatrics 2012;129;299

Perroteau A, Nanquette MC, Rousseau A, et al. Efficacy of facilitated tucking combined with non-nutritive sucking on very preterm infants’ pain during the heel-stick procedure: A randomized controlled trial. Int J Nurs Stud. 2018;86:29-35.