I was told it was important to bond with my baby. But I did not know how to bond with a child I couldn’t feed, hold or bathe. One that weighed a little more than a pound and was clinging to life on a respirator. I was so scared to touch him because I knew his fragile skin could easily tear. I was told not to speak to him in a voice above a whisper for fear of over stimulation. I honestly felt like a bull in a china shop — more like a bystander than his mother.
When my son was about a week old, a very patient and wise NICU nurse encouraged me to change my son’s diaper for the first time. I will never forget how my hands shook as we maneuvered wires to delicately dab his tiny bottom with a cotton ball. I have no doubt she could have completed the task in less than a minute, but she took the extra ten minutes to help me have that important bonding experience with my son. It was the first time I truly took part in his daily care. And in many ways, it was our first bonding experience. The hug I had been waiting for.
When a full-term, healthy baby is born, parent interaction with the baby is almost immediate including holding, feeding and soothing. But the NICU presents monumental barriers to an emotional connection with the baby. This disruption in the bonding process is associated with feelings of grief, loss and maternal helplessness. It is also associated with an elevated risk for anxiety disorders, including post-traumatic stress disorder.
A strong, positive, healthy bond between parent and child is critical to optimal development of the child’s emotional, intellectual and physical well-being. It is also critical for the parents’ mental health. Studies have found that strengthening the parent-child bond can result in more competent parenting over the child’s life.
For me, and many other NICU parents who are unable to hold their babies soon after birth, diapering becomes an important part of our bonding process and serves as one of our first opportunities to participate in their care. So while a simple task, diapering can impact the psychological state of an infant and parent.
The act of changing a baby’s diaper is often seen as a repetitive, routine, unskilled care task by both nurses and parents, but studies have found that even standard caretaking procedures like diapering can lead to increased pain and stress responses in premature infants.
In 2016, I had the opportunity to serve on the Huggies® Nurse Advisory Council, which identified the need for better education for care providers and parents about diapering in a holistic manner. The result was Every Change Matters: A Guide to Developmental Diapering Care, which includes a guide and handy tool for every day clinical use offering practical information on how nurses and parents can incorporate elements of developmental care into their diapering practices.
Because sleep is very important for enhancing core functions in the immune system, reducing stress, and supporting brain development, Every Change Matters includes recommendations that champion sleep, encouraging care providers not to wake the baby unless the wetness indicators on the diaper suggest the baby needs to be changed.
The guidelines also include recommendations to support a parent’s confidence and closeness with their baby suggesting healthcare professionals reserve intentional care measures for families to implement with their infant. Healthcare professionals are also encouraged to share the importance of proper positioning and handling during diapering.
Bonding is a process that takes time and is not an instantaneous action. It begins when you become pregnant and continues throughout your relationship with your child. While the process may be harder for NICU parents, we must seek out every opportunity to bond with our babies, not only for their physical and emotional well being, but our own. And while it may seem a simple step, changing the first diaper can be our first hug and our first step to bonding with our babies and becoming confident caregivers for years to come.
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