Every year on Super Bowl Sunday and other holidays or days of national importance the staff in the neonatal intensive care unit where I work know what to expect. Parents will likely stop by briefly in the morning to visit their children. But for most of the afternoon and evening, the floor will be empty of families visiting their babies.
Understandably, parents need a break from the hospital for a bit of fun and escape for a sports tradition. But for some babies, the chronic lack of family visits is not limited to a celebrated football game day. And it is detrimental to their health.
As a neonatologist at a large children’s hospital, I frequently walk by a baby’s room and see no one by the bedside—day or night. The tiny premature babies spend entire days inside incubators without being held. Bigger babies who are beginning to develop social skills cry anxiously, wanting attention from someone—anyone—even from the cleaning crew in passing.
Aside from the heartbreak of seeing a baby alone, lack of family visits can have negative consequences to an infant’s developmental outcome. Premature infants of caregivers who were visited and held more often had better neurobehavior such as better quality of movement and less arousal and excitability. Fewer visits by parents have been associated with negative outcomes such as child abuse, abandonment, and less than optimal emotional functioning.
There is also evidence that failing to bond with the premature infant interferes with early attachment process. Early child-parent relationship is particularly difficult when a baby is born prematurely, as the separation alters parental interaction and roles of parenthood, generating stress, loneliness, fear of loss and risk of insecure attachment.
On the other hand, mothers who practiced frequent skin-to-skin contact as part of what’s known as kangaroo mother care, have reported feeling more competent. Such kangaroo care has also been shown to substantially reduce mortality and morbidity.
Increased parental presence can build relationships with medical teams, facilitate communication, enhance education and satisfaction as parents participate in decision-making. This so-called patient- and family-centered care model has been shown to reduce non-urgent emergency department visits of children after discharge, decrease total length of stay and improve weight gain in premature babies.
Still, there are many reasons that parents don’t, and sometimes can’t,visit.
The stress of having a baby in the hospital can result in emotional and even physical withdrawal, as a reflection of anxiety, exhaustion, anger, guilt, or depression. For some parents, withdrawal is their way of coping, but does not necessarily diminish emotional closeness. One mother recently told me that she wants to stay hopeful, so she refrains from staying too long at her baby’s bedside, to protect the baby from her fears and sadness.
Even with the patient- and family-centered care model, one based on the understanding that the family is the child’s primary source of strength and support, some parents feel powerless and helpless, as if there is nothing for them to do.
For instance, fathers of premature babies report feelings of lack of control; they are often relegated to a supportive role, helping their wives and internalizing their own emotions. Many fathers have asked, “At least the mom can pump breastmilk, but what am I supposed to do?”
Finally, there are staggering physical and financial barriers to visiting the hospital every day. And this is where social disparities become starkly evident. Some parents cannot afford childcare for their older children, or transportation to the hospital from afar. Some choose to postpone maternity leave for the period after the baby is discharged, and return to work while the baby is still hospitalized.
Unlike European countries with generous family leave policies where parents can visit almost every day throughout NICU hospitalization, paid maternity leave in the U.S. is years behind other countries.
The NICU is not a calm environment. The constant alarms, bright lights, traffic of physicians and nurses can be disruptive to any bonding process or sense of privacy. But when parents were provided separate rooms with beds for both parents and a private bathroom, an NICU in Sweden was able to reduce the total length of stay for premature infants—demonstrating an example of a systematic change that improved the lives of parents and babies.
The medical profession can do a lot more.
We need to listen to parental experiences of having a baby in the NICU and learn how best to support them, emotionally and physically. We must seek ways to partner with families who are unable to visit for whatever reason, without bias or judgment.
More research is needed to determine additional benefits of parental presence, and the detrimental effects of its absence. When barriers to visits are identified, a multidisciplinary team can advocate for resources to help parents visit, and ensure that the visit is productive for both parent and infant—even long after the Super Bowl is over.