NICU nurses resistant to holding babies?

fergus51 · May 23, 2004

I have been known to hold them away from me a bit when bottle feeding simply because I am trying to see what they are doing better. Overall, I don't see a huge problem in how much a nurse chooses to hold a stable baby. I won't spend all shift holding them, especially at night because they won't be getting that at home and it doesn't help them to establish a routine. But, I won't just let them scream either (I'll help them find their hands to suck or just pat them or rub their backs, bundle them, whatever). I think it is important to encourage self soothing behaviors.

Gompers, BSN, RN · May 23, 2004

One more question-why do some nurses hold babies away from them in their lap, with the baby facing them during bottle feeding? Is there some reason to avoid holding a baby against you (one arm supporting them, their head in the crook of your elbow)?

I almost always feed babies the first way you described, unless they're huge full-term kids who have no feeding problems. For one thing, when you hold a smaller preemie in the crook or your elbow, they're more likely to slip down until their chins are tucked against their chests and then they don't breath as well, since their necks are so floppy. For another, most babies fall asleep a lot faster in this snuggly position and don't finish the feeding - this is the biggest problem parents seem to have because they always want to feed their babies this way. Having the baby on your knee, facing you, makes it so much easier to keep the baby alert, control the baby's head and neck, and to provide any chin/cheek support necessary to help with the feeding. It's also a better position for babies who aren't coordinated yet, since you can really see when they're passing out and turning blue and intervene. This is even the way speech therapy advises us to feed all the babies until they are bigger and having no problems with their bottles.

As far as "spoiling" the bigger, chronic babies...well, yeah, it can happen. It's not that we don't want to hold that baby and really love him/her to death. It's just that when you have a heavier assignment, which they might give you once you've gotten more experience, you can't be over there holding the poor kiddo all the time. Usually the time they want to be held is the time when you're busy with your other baby or babies, so they really need to learn some routines and self-consoling. We're not trying to be mean - but if the baby is ALWAYS held when he's crying, he's never going to learn to calm himself. We get this alot when parents hold their babies for 12 hours a day and then go home. We understand that they want to be close to their baby and they have every right in the world to do it - but these are often the babies that just scream all the time unless they're held.

What we try to do with these babies is get them into swings, bouncy seats, strollers, high chairs, etc. Sometimes just sitting up and being able to look around and watch the unit activity is enough to calm the baby down. The older they get, the more they enjoy this. I don't blame an older baby for screaming all day in his crib - he's tired of laying down and really just wants some attention. We try to instill routines on them - along with scheduled feeds, we try to schedule naps and playtime and baths. The chronic babies we try to put down to sleep at about 10pm after their baths, and then don't bother them until about 6am. Once they get into that routine of getting good sleep at night, they're much happier during the day and less irritable.

Energizer Bunny · May 23, 2004

Okay, I'm not actually a nurse, but I want to chime in on the "spoiling" part....I have three little children. All were held a lot during their infancy and none of them had a problem when we started to let them go. Of course, at about 8 months they all got clingy (which is happening now with my last) but that is a normal part of development. Now, I can see where if you had more patients, you would be unable to spend as much time with that infant and that would be a concern, but as far as actually spoiling long term, I don't believe it can happen and everything I have read says it can't either.

lisaloulou · May 23, 2004

Back in my Nicu days, I'd always take the opportunity to hold the stable babies. After all the poking and prodding and painful procedures,I felt that contact that didnt involve a sharp object was very therapeutic. I disagree that you can "spoil" a sick child by comforting it. Human soothing is important to growth and development- look at the experiments with the wire mother vs the soft mother done on infant primates. I do not think that infants need to "buck up and take it" or learn to be alone, but thats just my humble opinion.

dawngloves, BSN, RN · May 23, 2004

You can't "spoil" a baby by holding it too much. That statment belong in the "OB Myths" thread. If me or my co workers ahve time, we take a minute to hold a crying baby or even a non crying baby. Otherwise we do swaddle or give them a pacifier or if we have one available, but them in a vibrating chair.

The chronics are the worst, but I don't think it's because they are spoiled.There are many factors that make those kids cry.

Mimi2RN, ASN, RN · May 23, 2004

If I have a few minutes, and I can unplug the baby from the monitors, no IV, I'll pick up the baby and pack them around. Sometimes that's all they need. I sit up a fussy baby in an isolette, talk to him/her...give them a lecture..that's after checking diapers. When the baby has calmed down, I'll reposition and tuck the baby in. I wish we always had time to hold crying babies, but sometimes that's not what they need!

About feedings, I often sit them facing me, I need to see what the babe is doing. Especially if they have a habit of losing their feedings!

ayndim · May 23, 2004

Not a nicu nurse but I am a mom. I suppose some people would consider my kids spoilt babies. My first I held all the time and she slept with us. She napped in my arms. She went to her own bed with no problems when her baby brother came home from the hospital (she was 2 1/2), he stayed in our bed until aged 2 when my youngest was born (now 8 months). He crawls in bed with his sister sometimes and now that the baby is bigger he will sometimes crawl into bed with us. Last night he did this and he and the baby were holding hands this morning. I know the no-no's of co-sleeping but we have never had a problem. I will say this with #2 and #3 I got wiser and they slept in a swing during the day. But I don't regret having "spoilt" babes. It will be soon enough they don't want to snuggle or crawl in bed with mom and dad. I loved holding mine at every opportunity.

prmenrs, RN · May 23, 2004

Gompers is right on re: feeding small preemies. Feeding them in the crook of your elbow is NOT a good plan, esp. if you're not sure they're mature enough to nipple yet.

I have always held babies a lot. Now that I'm retired from Level III (working part time in a Level II), I volunteer @ the old place as a "cuddler", holding babies who are fussy, 'chronic', or just growing premies. I very rarely hold them supine in my arms, usually upright against my chest (see avatar) so that they don't reflux, they don't have to interact, they can REST (nice soft boob, heartbeat, etc).

Older babies need play time, but only if they are healthy enough. If they're crying frantically, they need to calm down before anything else.

Your instinct is correct, babies NEED to be held. I don't think you can find a developmental specialist that would disagree w/that. It's hard, if not impossible, to spoil a small baby. Remember Erickson's stages? First task, trust vs mistrust. All these babies need to learn that the world will meet their needs. If they're crying, pick 'em up, figure out their problem and comfort them--that simple.

So, bottom line, hold anyone you want to--with my blessing.

Gompers, BSN, RN · May 23, 2004

Just wanted to point out that there is a HUGE difference between "spoiling" a baby at home versus one in an ICU. At home, while there may be other kids and responsibilites, that baby is still going to get tons of attention. These kids we're talking about, they're paired or tripled with other babies in the ICU, sometimes very sick ones. We simply don't have our entire shift to hold the babies if they're crying. We have loads of other responsibilities. Of course whenever someone has a second they'll be comforting that baby! But the kind of "spoiling" we're talking about is a little different, so please understand that. When an ICU baby is ONLY comforted by holding, it becomes a problem because that's not always an option, so we need to work on other comfort measures. That's why we're talking about self-soothing, putting babies in seats or swings, etc. Because when you have other sick babies to care for, you can't spend every waking moment with that one crying baby. I hope this doesn't sound mean, I'm just trying to explain what the reality is. Of course it breaks my heart when a baby is crying. But I have to find other ways for that baby to get comfort other than constantly holding him or her.

ayndim · May 23, 2004

Just wanted to point out that there is a HUGE difference between "spoiling" a baby at home versus one in an ICU. At home, while there may be other kids and responsibilites, that baby is still going to get tons of attention. These kids we're talking about, they're paired or tripled with other babies in the ICU, sometimes very sick ones. We simply don't have our entire shift to hold the babies if they're crying. We have loads of other responsibilities. Of course whenever someone has a second they'll be comforting that baby! But the kind of "spoiling" we're talking about is a little different, so please understand that. When an ICU baby is ONLY comforted by holding, it becomes a problem because that's not always an option, so we need to work on other comfort measures. That's why we're talking about self-soothing, putting babies in seats or swings, etc. Because when you have other sick babies to care for, you can't spend every waking moment with that one crying baby. I hope this doesn't sound mean, I'm just trying to explain what the reality is. Of course it breaks my heart when a baby is crying. But I have to find other ways for that baby to get comfort other than constantly holding him or her.

Obviously it is different when you have to care for multiple sick babies. I didn't mean to imply that you wouldn't want to hold them. I was trying to say that it is nice to snuggle and cuddle with them but after the first one I did let them nap during the day without being on me or in my arms. My first would never sleep anywhere but with me as a baby the others did sleep other places during the day. But I always got the "you are spoiling them" when I picked them up after the first cries. I wanted to smack people who said that. In the hospital it is different as nurses have many other things to do. Obviously you cannot stop treating a sick baby to comfort one who just wants to be held. Sorry if my post came off wrong. I am just a student nurse but I have great respect for nurses, the work they do and the bs they put up with (not the babes).

fergus51 · May 24, 2004

I don't like the use of the word "spoiling" either. I just think it's more about getting them used to a routine. Most of our kids will not be held 24 hours a day when they go home, so we need to encourage the development of self-soothing behaviors. I don't think either extreme (being held too much or not enough) are good for the babies. Like everything in the unit, it's about balance!