Helping Parents Bond With Premature Babies in the NICU

Newswise — For any newborn, adjusting to a world outside the womb is overstimulating and uncomfortable at first. The womb essentially provides a sustained “hug” that acts as a shield from sound, light, touch, temperature changes—and even gravity—in the outside world.

For babies born prematurely, this discomfort is amplified. With delicate and still-developing brains, lungs, ears, eyes, and skin, life outside the womb can be especially harsh and even harmful.

Inside the Small Baby Unit—an area of Children’s Hospital Los Angeles’ Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit (NICCU)—a trained team of specialists helps ensure these tiny infants stay safe and receive the highest level of care, while receiving the essential engagement and stimulation they need to thrive.

“I think parents with preemies are worried that their babies are too fragile—that they can’t touch them at all,” says Jennifer Shepherd, MD, neonatologist and Medical Director of the NICCU. “We’re here to guide them on the ways that they can engage with their baby through gentle stimulation, and have it be a safe and positive experience for everyone.”

What is the Small Baby Unit?

A small baby is a baby born very prematurely, meaning they were delivered at 32 weeks of gestation or earlier. These small, preterm babies’ brains, skin, and lungs are exceptionally fragile, and they often require complex, high-level care.

The Small Baby Unit is separate from the rest of the NICCU, in rooms with lower foot traffic, dimmer lights, and highly regulated noise control. Most importantly, every clinician within the Small Baby Unit is specially trained to care for the unique needs of these very premature babies and their families.

Fostering positive sensory experiences for preemies

Positive and negative sensory experiences differ based on where each baby is in their development, often referred to as their “gestational age.” Small Baby Unit clinicians help to customize each room and care plan, while guiding parents on how to bond with and care for their baby.

“Guidance and support in this scenario are essential,” says Dr. Shepherd. “You have experts and people at the bedside who are available for around-the-clock care. They’re trained to answer parents’ questions and help them understand what engagements are best for their baby’s gestational age.”

Examples of positive sensory experiences for very premature babies:

• Noise control. Rooms in the Small Baby Unit are equipped with noise detectors that provide a warning when the surrounding environment may be too loud.

• Low light. Keeping lights dimmed helps protect sensitive and still-developing eyes, and timed light schedules help babies establish their sleep-wake cycles.

• Smell. Babies develop a sense of smell around the 13th to 15th week of pregnancy and can recognize their parent’s scent outside the womb. Close contact, either through physical touch, breast milk, or materials that smell like the parent, is comforting.

• Touch. Slow, sustained touch and holding positions that mimic the “hug” of the womb help babies feel secure.
• Movement. Targeted positioning supports alignment and promotes range of motion.
• Music therapy. Babies who are 29 weeks and older may benefit from short music listening sessions led by a certified music therapist.

The power of good touch—from hand hugs to kangaroo care

Dr. Shepherd explains that most touch guidance focuses on replicating the environment of the womb: “Babies are used to being in a tight space. They’re all curled up, and it’s almost like being hugged.”

To ensure a consistent standard of care across the NICCU, neonatal specialists at CHLA use an evidence-based program called SENSE—short for Supporting and Enhancing NICU Sensory Experiences. 

“This approach relies on our nursing team, physical therapists, and occupational therapists who have been trained specifically in the developmental needs of very premature babies,” says Dr. Shepherd.

“These clinicians have expert-level experience and training to be able to not only provide that care, but to teach others how to provide that care,” she adds.

A major focus of the SENSE approach is encouraging positive touch, which might not always feel intuitive to new parents of preemies. 

For example, patting or stroking, which is a common way to engage a full-term baby, may be uncomfortable and even painful for a very premature baby. These team members guide parents through a variety of engagements like hand hugs, skin-to-skin (kangaroo care), or swaddling, and even changing diapers and comforting their baby during medical care.

Smart sensory care for better long-term outcomes

Ultimately, these guided positive sensory experiences aim to foster a critical bond between baby and parent during what can be a traumatic time.

Research reveals that this approach can aid neurodevelopmental growth and social development, boost sensory system development, enhance physiological and emotional regulation, reduce pain and stress, and even shorten the length of hospital stays.

Dr. Shepherd points out that, importantly, the guidance parents receive in the hospital is geared to follow them home. “Our expert team is here to help guide these positive sensory experiences during each family’s hospital stay, but we’re also aiming to empower parents and strengthen their bond for when they’re finally ready to go home,” says Dr. Shepherd. “The tools families gain here will help support their child’s wellbeing for their lifetime.”

Learn more about the Fetal and Neonatal Institute at CHLA.