When you envisage the birth of your child and watching them grow, you never picture them in a hospital or medical setting. You don’t picture doctors, nurses, specialists or allied health staff. You don’t picture machines, cords, procedures. You don’t picture the anxiety and fear associated with having a sick baby. And you don’t picture your baby’s ‘firsts’ to be in a sterile and unfamiliar environment.
The reality of having an infant in hospital or medical setting is so different from the picture that most people have in their minds before a diagnosis. It is so important to seek out support where you can from family, friends, support groups or professionals to help you process and manage these experiences.
Alongside all these fears, worries and grief is a little one who is also navigating their first experiences in the world. In the first year of life your baby’s development is exponential. You may have heard people talking about the term Neuroplasticity which can be broken down into two parts:
Neuro: Relating to the brain and neurons - the nerve cells that power the brain.
Plasticity: Having the ability to be shaped or molded.
So essentially, Neuroplasticity is the shaping and development of our brain.
In your baby’s first year of life, they are a forming approximately 1 MILLION new neural pathways every second! These pathways lay the foundation for the way we learn, understand and process the world as we grow older. And while babies are often too young to have conscious memories, they can develop unconscious memories that are shaped by their neural pathway connections.
The good news is that even though your baby or infant is in hospital, there are still plenty of ways that we can support the development of positive neural pathways through positive sensory experiences. If your baby is needing to undergo procedures or medical interventions, there are procedural supports that can be put in place to help your little one have a more positive experience.
Research tells us that “a range of non-pharmacological and pharmacological interventions have been shown to be effective for procedural pain management in infants; and children and are most effective when used in combination”. This means the ways that your baby can be supported, either with medical/chemical interventions such as medication and sedation options or non-medical ways such as comfort, positioning and sensory input.
When thinking about medical procedures for your infant, it is important that both aspects are considered. Pharmacological support will depend on the condition of your baby; but also, the type of procedure that they are needing to have done and the level of anticipated pain or discomfort. It is totally ok for you to speak to your medical team about whether it is appropriate for your baby to have sedation or pain relief if the procedure is likely to cause high distress.
Developing a plan with your team around procedures is really important. You might hear them talking about clustering cares. This is when they complete multiple interventions at the same time. If your infant does need to have sedation or pain relief on board, it is a good idea to get everything that needs to be done completed during this time if possible. Again, you can speak to your team about what the medical plans are for the day and ask if they can cluster any cares together.
Ideally, interventions do not begin while your baby is asleep in the hope that they don’t wake up! This can cause them to wake in a startle and interfere with sleep patterns moving forward. The best time to begin procedures is when your infant is in an awake, quiet and alert state. It is important that you talk to your baby and let them know that something is going to happen. If they need a heel prick, you can tell them this and rub their heel before, so they are more aware of an upcoming experience. If your baby is asleep and they need to complete a procedure, ask for some time to quietly wake your baby using your voice and touch.
The environment can also play an important role in the procedure. Where possible, reduce stimuli, such as harsh lighting. There is also a growing body of evidence to suggest that skin-to-skin contact can be beneficial during procedures to reduce infant distress. You can chat to your team to see if this is a possibility for you and your baby.
Additionally, there are comfort positions that can be used depending on the procedure. It is recommended that infants under 6 months old are contained with swaddling, keeping the required limb out necessary for the procedure. After the intervention, you can cuddle and swaddle your baby to help promote settling and recovery. If you can’t hold your infant, your nurse can help you with facilitated tucking and containment using ‘nests’ made from rolled up linen. This can allow for your infant to still feel safe and supported while allowing for parental interaction. Allow your baby to see your face and talk to them soothingly, providing reassurance. Distraction can also be positive with small rattles, contrast toys, books or small light up toys.
After 6 months of age, it is recommended that infants are supported to ‘sit up’ for procedures. This means that they can be put in a comfort hold where they are positioned upright to allow for more control. Your baby will have a more innate sense of safety if they can see what is happening; and, it also allows for distraction to play more of a role. You can sing to them, use a toy, read a book or blow bubbles. Remember, it is important to let them know what is happening. Even if they don’t consciously understand, they will be learning through associations.
We also want to make sure, where possible, that there are no further painful or uncomfortable procedures until at least 2 hours after the initial intervention, to allow your baby time to settle and regulate.
Non-nutritive sucking is an infant’s natural response to stress. If your child is breastfeeding, they may be able to be put to the breast during procedures. Breast feeding has been associated with lower pain responses during procedures; also allowing close face contact with your child. The use of other pacifiers may also be helpful.
Sucrose solution is a special preparation of sugar mixed with sterile water and preservatives. It can provide short-term comfort and pain relief during procedures for infants up to 18 months of age. It has an instant calming effect on infants and triggers the body to release its own pain-relieving responses.
Sucrose solution is given by mouth (on the sides of the mouth or on/under the tongue). It is sometimes given with a dummy, which can be particularly helpful because sucking also provides comfort to young children. The solution is given two minutes before the start of the procedure, and further small amounts may be given throughout.
Remember that it is not only ok but important for you to advocate for your baby as you are their voice. Chat to your medical team about developing a procedural plan and the best ways that you can support your infant during procedures. It will not only assist in a more positive experience for your little one now but will also help shape their medical experiences in the future.
For more information on comfort positioning for infants, please see the Royal Children’s Hospital resource:
Kate Strickland is a community-based Child Life Therapist with a background in Occupational Therapy and Education. She works with infants, children, and young people along with their families in managing the stresses associated with health care encounters, procedures, hospitalisation and medical trauma. Visit healingheartsbeyond.com.au for more information.
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