Crack babies, need advice

prmenrs, RN · May 27, 2005

If I were you, I would ask the nurses in the unit you're assigned what their tricks are. They will have lots of tips.

tvccrn, ASN, RN · May 27, 2005

I don't know about the policy in your facility and the only exposure I had with drug babies wasn't specifically crack, but I'm told it all works the same. Saying that, here are a few pointers I picked up while working in the PICU:

Low lighting and quiet atmosphere

Bundle them up tightly, not dangerously tight, but enough to minimize movement

Space out care so you are doing a little bit at a time with lots of time in between cares

The point is to minimize stimulation and what stim you do give is in little bitty tiny doses.

All the kids I worked with touched me, but the babies who were addicted through no fault of their own really got to me. I know a lot of nurses can't handle the constant crying, but it never got on my nerves. I found I had infinite patience with the tiny, tiny beings who only wanted to survive.

Good luck.

bigmona · May 27, 2005

bundling the babies tightly works well, as the previous poster mentioned. a lot of them are poor feeders and may need chin support while being fed. also, for some reason the NAS babies love to be patted firmly on the butt - maybe it's a sensation that distracts them from feeling pain. get familiar with the NAS scoring system and know signs of withdrawal, such as tremors, excessive yawning or sucking, high pitched crying, difficulty sleeping.

some of the babies do cry excessively and are inconsoleable, and you really do need a lot of patience to care for them. for me, though, the problem wasn't with the infant's crying- it was the parents of these children who quickly wore on my patience and nerves. i think it is for this reason i don't think i could handle working long term with this kind of population.

good luck to you!

Mermaid4 · May 27, 2005

All those suggestions and for long term babies on formula asking the pediatrician to order mylicon is sometimes helpful.

pigtails · May 28, 2005

Stay away from the parents. They are more often than not still using and very angry. I had one baby who needed an IV. Her veins were difficult, probably due to the drugs. The mother was crazed outside of the nursery screaming, "What are you doing to my baby!"

All I could think was, " It's not what we are doing, it's what you did!"

Mermaid4 · May 28, 2005

Pigtails I have to say that although you are and should be upset and even angry at these moms choices, you are not omnipotent...That is, as a nurse, you don't "stay away from these parents." Their guilt is horrible. They made horrible choices yes, but they are the parents. Not all of them stay. Most of them continue to make bad choices, but it is not up to you or any nurse to play God and make judgements. They say the difference between a mom using heroin and one using cocaine/crack is that the heroin mom will do what she has to do to get formula and baby clothes. The cocaine mom will sell the baby clothes. So it is horrible and it stinks but a crack mom screaming about you hurting her baby may still feel terrible at what she has done and knows that ultimately it is her that caused the most pain. Would you be so cavalier and judgemental to a couple with a proven genetic disorder who took a chance and attempted to bypass the disorder in the hopes that they "might" have a child free of the disease? To me that is at least as selfish a choice just to have a child, especially if there is a fifty fifty chance that an abnormal pregnancy may result. Each choice is selfish because each choice makes it likely that the child will suffer, but I would imagine that you are more forgiving if the parents are not drug abusers but merely a couple who tried to bypass the genetic odds. I hate that people use. I hate that they make that choice. I hate all of it, but they are still people and nursing eventually hopefully teaches us all that it isn't up to us to be so judgemental whatEVER we may feel personally. That perhaps is the most important thing to keep in mind in ANY difficult rotation. Sometimes it takes years to figure out that first you react to something based on your individual belief systems THEN you have to find a way to feel some sort of compassion/empathy for those who are directly opposite from you in beliefs and choices...

PicklesRN, RN · May 29, 2005

...Most of them continue to make bad choices, but it is not up to you or any nurse to play God and make judgements. ...

While what you say is true I'm not so sure it is "wrong" to be a bit judgmental. When I say that I don't mean that it is up to the nurse to go and tell Mom what a dirtball she is, I don't mean that at all. But I'm not so sure any compassionate human can avoid thinking creepy thoughts about Mom and/or Dad. You are looking at, working with, caring for, and holding a tiny little human that is suffering in a way that no baby should have to suffer. It's mighty difficult not to become angry with the people/person that did this to the poor, innocent little baby.

It isn't a matter of who should or should not play god, it is a matter of being human and feeling anger for what people do to their children. Would you feel the same about someone who molests children? What's the difference here, they are both doing severe and sometimes permanent harm to an innocent child and there is NO excuse or justification for doing that to another human being.

If someone is preggers and they make the choice to keep that baby they have a huge responsibility to that child. The responsibility doesn't start after the child is born, the responsibility starts before she becomes preggers.

I'd be a big fat liar if I claimed not to be judgmental in a situation such as this. That doesn't mean it affects my nursing in any way, that doesn't mean I would express my opinions to Mom. But to pretend I am neutral would be dishonest. And just for the record I am not claiming my way is the right way, it isn't. It simply is.

I'm not so sure it is a bad thing to feel anger for what is going on. As nurses we can only take so much before we can't take anymore. I think it is okay to feel the emotion albeit good or bad, work through it, and move on.

It is quite easy to suggest someone in this position shouldn't be judgmental however that doesn't really address the problem. The problem is what the nurse is feeling and what her coping skills are made up of.

Euskadi1946 · May 29, 2005

Pigtails I have to say that although you are and should be upset and even angry at these moms choices, you are not omnipotent...That is, as a nurse, you don't "stay away from these parents." Their guilt is horrible. They made horrible choices yes, but they are the parents. Not all of them stay. Most of them continue to make bad choices, but it is not up to you or any nurse to play God and make judgements. They say the difference between a mom using heroin and one using cocaine/crack is that the heroin mom will do what she has to do to get formula and baby clothes. The cocaine mom will sell the baby clothes. So it is horrible and it stinks but a crack mom screaming about you hurting her baby may still feel terrible at what she has done and knows that ultimately it is her that caused the most pain. Would you be so cavalier and judgemental to a couple with a proven genetic disorder who took a chance and attempted to bypass the disorder in the hopes that they "might" have a child free of the disease? To me that is at least as selfish a choice just to have a child, especially if there is a fifty fifty chance that an abnormal pregnancy may result. Each choice is selfish because each choice makes it likely that the child will suffer, but I would imagine that you are more forgiving if the parents are not drug abusers but merely a couple who tried to bypass the genetic odds. I hate that people use. I hate that they make that choice. I hate all of it, but they are still people and nursing eventually hopefully teaches us all that it isn't up to us to be so judgemental whatEVER we may feel personally. That perhaps is the most important thing to keep in mind in ANY difficult rotation. Sometimes it takes years to figure out that first you react to something based on your individual belief systems THEN you have to find a way to feel some sort of compassion/empathy for those who are directly opposite from you in beliefs and choices...[/quote
You need to go down to the local DCFS Office and talk to the case workers who deal with this on a 24/7 basis. True, as nurses we are not supposed to be judgemental but we are also patient advocates especially for the most fragile and defenseless of the population, babies. It's hard not to be judgemental towards mothers who use drugs, alcohol and cigarettes while they're pregnant then see the fruits of their labors when these kids are born. When both mom and baby test positive for drugs, per state laws, nurses must report this to the state and that baby is picked up by DCFS and immediately placed in foster care. Kids are pulled from their drug addicted parents for a reason and that reason being is for their own safety. I case manage kids in foster care and trust me, you really want to get the bio parents who take drugs and abuse their kids and bang their heads in with a cast iron frying pan!!!!

bigmona · May 29, 2005

They say the difference between a mom using heroin and one using cocaine/crack is that the heroin mom will do what she has to do to get formula and baby clothes. The cocaine mom will sell the baby clothes. So it is horrible and it stinks but a crack mom screaming about you hurting her baby may still feel terrible at what she has done and knows that ultimately it is her that caused the most pain.

I don't understand where you got those ideas... aren't they sort of judgements in and of themselves? I know a mom who was on heroin who sold her child's toys and video games for drug money and then told her son they were robbed.

Of course nurses need to be compassionate and provide care without being judgemental, but nurses are humans first. when you see a parent who is so high on something that she can barely keep her baby in her arms, it's really really difficult to NOT get angry. that doesn't mean you take it out on the mom, that means you do your best to ensure the baby's safety and care for his needs.

Mermaid4 · May 29, 2005

I didn't think I would have to spell it out that passing judgements isn't necessarily the same as being judgemental. If you treat someone badly because you disagree with their life choices, that is being judgemental. As a rape victim and child molestation victim I would also offer that the scenarios you describe are akin to apples and oranges and really don't have a place here in my opinion with this particular discussion. You don't have to prove a point to me and being defensive doesn't change my opinion either. I bring twenty five years of nursing experience to the table and thats all I can offer. I don't like the choices people make a lot of the times and it sickens me with some of the choices but I limit set (despite it no longer being the popular thing to do in a liberally laden society these days), I'm straight with people, patients and visitors who choose not to follow the rules or act out inappropriately and despite all of that, I choose not to sacrifice my compassion....So, while I am not certain what points you are attempting to put forth my way, let me just say again that there but for the grace of God go any of us....Not that people plan to get in situations that bother or disgust any one of us but when and if it should happen, I for one think I should be treated decently. And just because I wouldn't even think of doing some of the things we see patients or patient families doing, doesn't mean I don't treat people at least as fairly or as decently as I expect to be treated..Period. So pull in the claws people. I'm on your side. Read between the lines....I try to...

prmenrs, RN · May 29, 2005

Obviously, this is an emotionally laden topic: the baby who needs comfort and care; the mother who needs sorting out; and the nurses complex feelings about how the baby got into the situation it's in.

The OP is a student; I may be wrong, but I believe she is requesting tips on how to care for and comfort an infant having symptoms of withdrawal. Can we help her out here? Thanks!