Parenting in the NICU

Thank you for choosing to partner with CHOC Children’s to care for your baby in the NICU. We not only tend to needs of our patients, but also to the needs of our parents and families. The NICU is different than any other area of the hospital, and there are many new people to meet who all work together with you as a team to care for your baby.

Bonding with Your Baby in the NICU

Becoming involved with your baby’s care can help give you a sense of control. In fact, taking an active role in your infant’s care will not only allow you to better understand how to care for your child in the future but will create a strong and loving bond that will last far beyond the walls of CHOC.

We always encourage parents to touch, talk to, hold and care for their baby as much and as the baby’s condition will allow. The idea of caring for a small baby connected to tubes or machinery may seem intimidating, but our team will work with you to ensure that you are able to have as much one-on-one time with your baby as possible. Not only will time with your baby help you bond with your child, but studies have shown that being close to and even just hearing parents close by is a very powerful and important factor in a baby’s development and prognosis. Once a baby’s condition is stable, parents are encouraged to hold and rock the baby, change diapers and help with as many of the baby’s procedures as possible.

It is important to learn as much as possible about your child while in the NICU. We encourage parents to:
•    Keep a journal of what takes place with your baby and write down questions for the child’s health care team ahead of time.
•    Never feel like there is a “dumb” question or silly for asking the same questions over and over. There is a lot of information to understand when caring for a baby in the NICU.
•    If you have problems with transportation, childcare for other siblings or other aspects that limit your time in the unit, please discuss it with our social workers. They may be able to help.

Because of work and tending to other children in the family, it’s impossible for parents to be in the hospital all the time. Our lovie dolls make it easier for babies to always feel close to mom, even when she’s not in the NICU. Lovie dolls are small, soft fabric dolls that moms carry under their shirt or clothing so that the dolls absorb mom’s smell. When mom visits her baby at CHOC, she leaves the doll in the baby’s isolette and takes another with her to exchange the next time.

In an effort to make sure that the family-centered care at CHOC embraces more than just the baby’s parents and siblings, we have developed a surrogate program so that up to four select family members can be with the baby when the parents are unavailable. Learn more about our NICU surrogate program.

NICU Life

No parent expects complications of pregnancy or their baby to be sick or premature. Some common responses to the experience of having a baby in the NICU may include the following:

•    Shock over the unexpected birth
•    Mother’s physical weakness after birth
•    Disappointment over not having a healthy baby
•    Feelings of helplessness
•    Fear about procedures and tests
•    Separation from baby
•    Anger at self and others
•    Feelings of guilt over things done or not done
•    Crying, sadness, emotional upset
•    Fears of the future, worries about long-term outcome

These feelings are perfectly normal and as times change you may feel different emotions at different times as you experience highs and lows. It’s important for parents to take a step back and address how they are feeling. If parents don’t take care of themselves, it will be even more difficult to take care of their baby.

•    Connect with other NICU parents. Ask our staff about opportunities to meet other families who going through the NICU experience.
•    Don’t bottle up your emotions. Give yourself permission to cry, feel frustrated or angry. If you feel like those feelings are beginning to get the best of you, be sure to speak with one of the NICU’s social workers, as they can provide you with a shoulder to lean on or can connect you with one of our specially trained psychologists.
•    Establish a routine and stick to it. By creating a predictable pattern of how you will spend your days, you will feel a lot less anxious and can more easily create a balance between your time at home, work and the hospital.
•    Make time to be with your partner. While dealing with the ups and downs of the NICU, it’s easy for parents to forget to check in with one another emotionally. It’s important for the two of you to share your feelings and carve out time just for the two of you to be a couple.

“Baby Blues” and Postpartum Depression

Even after delivering a full-term healthy baby, many moms experience “baby blues.” Mothers who have the “blues” may cry, feel overwhelmed, be crabby or feel restless and nervous. These feelings can be unpleasant but they usually go away on their own in less than two weeks.

When new mothers combine the emotional roller coaster of having a NICU baby with the “baby blues,” those sad feelings may last longer. Dads may also feel sadness. It is important to reach out for help from your health care provider, NICU social worker or NICU psychologist if you are experiencing the “blues” longer than two weeks.

With normal pregnancies, about one in 10 new mothers feel depressed for more than a couple of weeks. These feelings of sadness are referred to as postpartum depression.  Women with postpartum depression may:

•    Feel hopeless
•    Think about harming themselves or their babies
•    Not feel close to their babies
•    Feel that things are not right
•    Less energy or motivation to do things
•    Difficulty sleeping and/or eating

Having a baby in the NICU can sometimes compound the feelings of hopelessness or depression. The good news is that depression can be treated. Let your health care provider, NICU social worker or NICU psychologist know if you think you are depressed. They can connect you with resources or a treatment that can help.

Managing Stress

Trying to be with your baby as often as possible, trying to express breast milk, and helping siblings, family and friends understand what is happening to the baby all demand enormous amounts of time and energy. The best thing that parents can do for themselves is to try to simplify their lives and ask for help.

•    Ask a family member or friend to relay your baby’s health news to others. CHOC provides free online Care Pages. A member of the NICU team can provide more information or you can start a Care Page now.
•    Accept offers of help from your friends and relatives – let them help you with meals, housework, rides to the hospital, etc.
•    Take an occasional time out – a dinner, a day off or an outing with your older children to help you remember there is another world besides the NICU.
•    Perhaps most important, be sure to get enough rest and try to avoid getting run down.

Learn more about the support services we provide our families.

Infection Control

It is important that all family members, including parents and visitors, follow hospital visiting and isolation policies. Anyone with signs of a communicable disease or infection, including colds and flu, should not come to see patients who are hospitalized. During flu season, we may enact additional visitor guidelines for the safety of our patients.

Hand-washing is the single most important means of preventing the spread of infection. Because we are always worried about infection, you are asked to wash your hands and arms for 15 seconds each time you enter the NICU and before touching and handling your baby. Here is what you need to know:

1.    Enter the scrub room through the door outside the NICU.
2.    Take off your watch, bracelets and non-wedding rings and put them in your pocket or purse.
3.    Squirt soap into your hands and then wash your hands and arms up to your elbows.
4.    Dry your hands with paper towels and then put the towels in the trash.
5.    Parents of more than one baby in the NICU must wash their hands before touching EACH baby.
6.    Please keep all valuables (purses, rings, watches, etc.) with you. Do not leave them in the scrub room.

If you choose to use the waterless procedure:

1.    Enter the scrub room through the door outside the NICU.
2.    Take off your watch, bracelets and non-wedding rings and put them in your pocket or purse.
3.    Apply one pump of alcohol hand rub or foam.
4.    Spread hand rub or foam thoroughly over hands.
5.    Rub hands together until dry.
6.    Parents of more than one baby in the NICU must clean their hands before touching EACH baby.
7.    Please keep all valuables (purses, rings, watches, etc.) with you. Do not leave them in the scrub room.

Going Home

A specific discharge date is nearly impossible to predict. Each patient’s care team carefully considers the following criteria:

1.    Baby is nursing or nippling all feedings well.
2.    Baby is consistently gaining weight.
3.    Baby can maintain his/her temperature in an open crib.
4.    Parents are prepared to take the baby home and have all of the necessary equipment supplies to care for the baby.

The day a baby goes home is a wonderful occasion. In order to help parents feel prepared to continue caring for your child at home, we provide the opportunity to “room-in” with your child before heading home in one of our private rooms. Rooming-in allows parents to experience what it will be like caring for their child at home while still being able to lean on our nurses for advice and support.

When the big day arrives, there are several things you will need to do before you take your baby home:

1.    Learn infant CPR.
2.    Choose a pediatrician. Keep in mind that this decision may be driven by insurance. Insurance companies offer online lists of their pediatricians or can answer questions over the phone.
3.    Get a carseat and know how to fit the baby in the seat and install it in the car.
4.    Purchase the appropriate formula if the baby is not drinking breast milk.
5.    Have a supply of diapers and other baby supplies ready.
6.    Get any medications the baby may need.

On the day the baby is discharged, please bring the following items to the NICU:

1.    Clothes for the baby
2.    Several receiving blankets
3.    Carseat
4.    A photo ID, such as a driver’s license
5.    Your yellow ID band

After the nurse verifies the parent’s (guardian’s) yellow ID band with the baby’s ID and the numbers match up, the baby’s ID band will be removed and the child’s legal guardian signs the discharge form.

The discharge summary will include information on the child’s follow-up care plan. Parents are also given an extra copy of the discharge summary for the child’s pediatrician. The case manager will arrange for any special medical equipment or supplies the baby will need before the child is discharged to go home. The case manager will discuss all of the arrangements with the family and list them on the discharge summary, as well. (The case manager’s duties are performed by the social workers at CHOC at Mission.)

Within a few days of discharge, caregivers receive a follow-up call from one of the NICU nurses. The nurse will check on how the baby is doing at home and will also check to see if the family has questions about the patient’s follow-up appointments with specialists and our High-Risk Infant Follow-Up Clinic.