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Home : Specialty Care : Newborn Intensive Care Unit : The Social Environment

The Social Environment

The NICU is your preemie's home away from home. It is where he/she begins to learn about people, how they respond to him/her, and how it feels to be talked to, held, soothed - or left alone. You are the most important part of that social home, even if you cannot be there much of the time.
  
Why might the preemie's social environment be a concern?
There are many reasons to be concerned about the preemie's early social environment:

  • You as parent(s) are the baby's most important social partner(s), but you are not able to be with your preemie as much as you would were he/she at home.
  • There are many people with whom your preemie must interact, therefore he/she has to learn about many more people than does a full term infant and there is more chance that those people won't understand him/her.
  • The isolette provides support for your preemie, but it also cuts him/her off from people. For example, it can make it hard for the preemie to know that voices are attached to people, or that people are more than hands.

What is important to know about interacting with my preemie?
An infant interacts with those around him/her in many ways: by looking (attending), listening, and touching/feeling. When the baby attends, he/she focuses on and follows things (tracks), and makes eye contact.
 
There are other ways in which preemies attend: listening, feeling your touch, turning the head towards you. Being aware of these is important, especially for those preemies who are slow in being able to be alert, or those who have problems with seeing.
  
Guiding all forms of attention are our feelings or emotions. It is what we feel that makes us want to go towards something or to pull away, to interact with someone or turn inward.Your preemie does have feelings. This may not be very clear other than when he/she cries or is cranky; then we are sure that the baby does not feel good about things. But how do we know when the baby does feel good?
 
Feeling comfortable, feeling a gentle touch, hearing a familiar voice, all give the baby positive feelings, and he/she lets us know these feelings in several ways. These include not showing signs of stress, looking relaxed, having a relaxed expression, and as he/she grows, attending visually.
 
It is important that the baby know, through the way that people respond, that his/her feelings are important and have been recognized. If the way people respond has nothing to do with the way the baby is feeling, he/she may soon learn that what he/she feels is not important and that trying to interact with people does not work. Some babies may even give up trying and come to dislike interacting with people.
  
Interacting through touch and holding
 
In most NICUs, parents are encouraged to touch their babies right away. NICUs have different policies about when it is all right to hold the baby, either inside or outside of the isolette.
  
Kangaroo Care
A form of holding encouraged in many NICUs is known as Kangaroo Care. This is holding your infant inside your shirt/blouse, against your skin. It also is known as "skin-to-skin contact". This form of holding was adopted from countries where isolettes to keep preemies warm are scarce. Holding the baby against the parent's skin was found to be very effective in keeping temperature normal. Studies show that the mother's body temperature adjusts to keep the baby's temperature at the right level. The baby's breathing also becomes more even, and heart rate and blood oxygen levels stay steady.

Early kangaroo care is holding the baby as soon as he/she is stable after birth, and may not be possible for many preemies. Intermediate kangaroo care is holding after the infant has become relatively stable, although extra oxygen and monitoring for apnea and heart rate dips may still be necessary. Late kangaroo care is holding after the baby is stable and breathing room air.
 
Both parents can give kangaroo care. You will be asked to wear a loose top or wear a scrub gown open in the front. The baby is dressed with only a diaper (and maybe a hat), and is placed on your chest between your breasts. The blouse or gown is closed over the baby to maintain warmth. The baby's temperature, heart rate and respiration will be checked by the nurse, or the monitors may be left on during kangaroo care.
 
Parents report that kangaroo care is a wonderful way to feel close to their preemie. Studies show that the babies do well during kangaroo care, and that if repeated often, it may be helpful for the baby's development.