I’m about to confirm something that you, as a neonatal therapist, know all too well.
While survival rates for premature infants have increased tremendously in the past decades, there is much work to be done to improve long-term neurodevelopmental outcomes. This is why we do what we do. We’re wired (and educated) to use every interaction as a foundation for future development.
We witness the infant in the NICU – sensory systems bombarded by noise, repetitive and ‘unannounced’ procedural touch, abrupt changes in position, pain, temperature changes, and gravity and wonder how he’ll do standing in the middle of the recess line at age 7. Will the slightest bump or touch by a classmate make him shut down or lash out? And will he want to eat at lunchtime or will he view food as noxious or simply uninteresting? Will he be able to listen in class while blocking out the noise of the floor buffer in the hallway? Does he have the postural support to hold himself up in order to pay attention in class?
You get this. This is our perspective, the lens through which neonatal therapists see. Yet it’s sometimes difficult to make a case for the importance of prevention, early therapeutic involvement, and ‘softer’ quality of life outcomes which can be harder to quantify with data and yet vitally important to parents and children (and our healthcare dollars).
I want to tell you about a resource that provides much of what we’ve been searching for as we attempt to infuse our neurodevelopmental perspective and practice into an intensive care environment.
Transformative Nursing in the NICU: Trauma-Informed Age Appropriate Care is a book written by Mary Coughlin, RN, MS, NNP. She was our keynote speaker at the NANT Conference this year and presented this topic to us with such passion that a standing ovation was inevitable.
Below are a few excerpts from Ms. Coughlin’s book:
“Developmental trauma is a traumatic event that occurs during a sensitive or critical period of growth and maturation for the neonate. Hospitalization in the NICU is an example of a very complex developmental trauma to the infant as well as the parents and the family as a whole.”
“Having knowledge of this embryological reality informs the NICU clinician to understand the heightened vulnerability of these regions (i.e. perioral area) to procedural touch and manage these experiences compassionately and consistently.”
“Pathophysiologic sequelae associated with various medical conditions warranting NICU hospitalization can confound the individual’s ability to self-regulate and establish a secure base with an attachment figure.”
“Traumatic experiences occurring during sensitive and vulnerable periods of development have been specifically linked with immune reactivity and altered HPA axis performance.”
And this quote by Dr. Bruce Perry: “Experience can become biology.”
The above quotes are just a taste of what you’ll find in the pages of this book which is part of my neuro-geek summer reading list. Both trauma-informed care and age- appropriate care support what we assess, provide, facilitate and educate about in the NICU.
I don’t know of another resource quite like it.
And to our patients I say this (an excerpt from a poem I wrote long ago):
We are proficient at aiding survival but you are more than survival, more than yes or no.
YOU are the nuances, almost indefinable in your uniqueness.
In many ways you are unexplored.
We promise to follow your lead knowing at last we have listened, responded, and acted in synch with the privileged space you so openly share.