The Challenges to Promoting Attachment for Hospitalised Infants with NAS
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design of the Study
2.2. Recruitment
2.3. Data Collection
2.4. Data Analysis
2.5. Ethical Considerations
3. Results
3.1. Description of the Study Participants
3.2. Themes
3.2.1. Facilitating the Attachment Relationship
“I think if it’s done right and done consistently then NAS would—there’d be less symptoms of it. I think that what I saw was a baby settled better, fed better, and certainly grew, put on weight, developed, reached its milestones, maybe not right on when they should, but certainly reached them than compared to those who didn’t go through attachment responses. So I think all in all it was a positive thing.”RN 1
“The benefits are, well they settle better, they feed better, they have a routine, if the parents are attached well…. The baby settles, it puts on weight, it feeds better and is generally just a more settled baby, even though it might be being treated with opiates for withdrawal.”RN 8
“I think attachment in the nursery for a baby always reduces the length of stay and enhances effective treatment.”RN 8
“I’m sure the more attachment they have the length of stay is often reduced because they become more settled. You can wean medication a lot quicker and attachment with their [parent is]—In the long-term I think the best measure of successful attachment is length of stay. I think sometimes they may stay longer than—I think that the discharge time would be reduced so that we’d actually get babies home earlier if they were treated with the parents.”RN 6
“I think it’s important because attachment is extremely important for NAS baby because the baby constantly will not settle. Withdrawal syndrome, the baby does need someone reliable to be there when he or she has a need to be calm. We don’t know when we don’t facilitate the attachment when the baby is in the middle of withdrawal syndrome what kind of negative impact to this child when he or she grow up.”RN 5
“I think a parent who is attached well to their baby handles their baby differently to someone who’s not attached, and visits like once every now and again, whereas someone who visits regularly has a bit of a routine.”RN 8
3.2.2. Barriers to Promoting Attachment
“…because at the end of the day they are a really high needs child and they can get quite challenging when they’re withdrawing and quite inconsolable.”RN 9
“I think it’s—it must be awfully traumatic to have a baby that you just can’t do anything with. You can cuddle, cuddle and cuddle and feed, and feed and feed, and they just won’t settle.”RN 3
“It’s very difficult I think, it would be from the mother’s point of view, to attach to a baby who’s screaming all the time, and just won’t settle.”RN 3
“So I think often mothers sometimes find it hard to attach to the baby because they’re screaming all the time and they take it personally that the baby doesn’t like them or that it’s something—they’re not holding them right or whatever rather than it’s just a symptom of their withdrawal.”RN 7
“It would be very difficult for a mum to attach to her baby when it’s away from her. But, oh, I don’t know—it’s—it—I just would find it very difficult for any sort of attachment, especially in those first few days when the baby’s at its worst.”RN 3
“We often find that if they’re not actually present, they don’t attach to the babies very well. It’s hard and they seem to be a bit—a lot more distant from them.”RN 6
“She didn’t have a car so she couldn’t get in very often. She depended on rides in the cab and the taxi.”RN 4
“Usually by this stage they are discharged so it means they have to make their way into the hospital and often they don’t have transport, and they find it hard to pay for parking or bus fares and things like that. So it makes it difficult for some parents to actually come in and be with their babies.”RN 7
“Sometimes the parents have restricted visiting because the baby might already be identified as at risk and under the care of community services who stipulate when the parents can and can’t visit or it’s supervised visits only with a case worker.”RN 2
“You would always see the mother come in when she was allowed to visit and the baby would become agitated again. That’s because she didn’t have the confidence, or she was squeezing baby too tight because she just wanted to keep with that baby. I don’t know.”RN 1
“It has happened a couple times. Like babies that are—like you said, that are separated legally from the mothers, and the mother actually can’t come in and nobody is coming in. That’s—there’s been one baby like that in the nursery when I was there, so it actually had nobody.”RN 4
“If they’ve been absolutely relinquished or the parents have still got visitation rights, or if they’re just not going home with the parents but they’ve still got visitation rights, sometimes that becomes quite complex. So it becomes a sort of time of detachment and the foster mother still doesn’t really know the baby, so you get no real attachment.”RN 8
“I suppose that’s often the problem with these babies whose parents either don’t visit or they’ve totally been removed and can’t visit; that they miss out on that normal infant bonding things of being held and you cry and someone picks you up and all that kind of thing because the nurses are busy.”RN 7
“But it seemed like after a while he kind of would give up, if we couldn’t come and if he was crying but I had four other babies to feed or whatever. It just—sometimes I felt sorry for him, because I just thought he just gave up.”RN 4
“So we realised that he hadn’t bonded with anybody and because he was that bit older he cried and didn’t actually expect anyone to come.”RN 7
“I think sometimes we’re missing it sometimes. So the babies are missing out on that opportunity. I don’t know why we’re not transferring that across the board. Like yep, birthing unit, baby’s born. Skin on skin, wrap that blanket around, stay there, but different and if we’re not—we don’t have a lightbulb blinking sometimes to remind us yes, this infant has been removed from mum but don’t forget, how can we ensure that we don’t sort of—that this doesn’t go by the wayside, that we don’t miss an opportunity sort of thing—particularly I think NAS babies I think are dealt a [short] straw.”RN 2
“I think we just assume—or I think a lot of people assume that it’s just about mum and that if mum can’t be there, oh well that’s a shame but we did the best we can sort of thing. Not if we don’t get this right, what are the implications for this child as opposed to this infant kind of thing, that it’s not just limited to this neonatal period or for the first three months of this infant’s life.”RN 2
“Even if baby is not going home to mum, if mum is able and willing to visit then that baby coming out and developing an attachment to mum although will be discontinuous and the baby won’t be going to mum’s care, developing an attachment to her and having that discontinue, baby will transfer that attachment to whoever becomes their next carer but if we don’t do that in that initial phase and wait three months until the carer goes—until the child goes home, we’re missing a really important step.”RN 2
“But also too we had a little Aboriginal boy who was going into care and he was an early baby but he also needed oxygen, and had all these other medical problems and things like that. We realised—so he was a couple—or nearly three months corrected and he was still in the nursery because they couldn’t find anywhere for him to go because they were trying to place him with an Indigenous family, but no one could smoke in the household.”RN 7
“So they will find a foster family as soon as they can, unless the baby’s sick of course, and there are other issues, but if it’s a basically well baby, then, yeah, they’ll find a carer.”RN 3
“I found it really challenging when the baby was going into foster care but [Child Protective Services] were taking the baby directly so we didn’t really get to interact with the carer themselves, or have the carer get to know the baby.”RN 9
“Yeah, so I was a bit concerned about the baby’s attachment with the mother because the mother couldn’t come in as often as would have been good. So I think that’s probably why I felt a bit more attached to the baby, because I knew that he wasn’t getting what he needed from his mother.”RN 4
“I remember on night duty holding those babies myself. I couldn’t do skin-to-skin, but we had the babies close and you keep them swaddled and essentially they can hear your heartbeat and smell the smells and hear those natural noises that were around.”RN 1
“So it was kind of up to us to give him comfort when he was having all that distress.”RN 4
“We also have—we do have older ladies that come in and volunteer, and they actually sit and cuddle babies. So we’ll call on them if we need to, if the baby has nobody, they’re just lying there all day with nobody to cuddle besides us.”RN 4
“But then you had a problem overnight, because they [volunteers] weren’t there overnight. So we’d always rely on the actual nurse to be able to do that and the staffing didn’t always allow that. So you sometimes had a really crappy night trying to deal with the unsettled baby, with the other ones, so that made it hard.”RN 1
“They would tend to go backwards. So you’d get this baby into a routine and then all of a sudden there’s no one around to hold them, or to swaddle them, or to just soothe them.”RN 1
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Main Theme | Sub-Theme |
---|---|
Facilitating The Attachment Relationship | The benefits to the infant—“Attachment’s quite vital to their outcomes” |
Barriers to Promoting Attachment | The symptoms of NAS—“Mothers sometimes find it hard to attach to the baby because they’re screaming all the time” |
Biological parents’ unique circumstances—“Mothers of NAS babies need that extra support” | |
Child protective services—“They couldn’t find anywhere for him to go” | |
In the absence of the mother—“ I guess we just do what we can” |
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Shannon, J.; Peters, K.; Blythe, S. The Challenges to Promoting Attachment for Hospitalised Infants with NAS. Children 2021, 8, 167. https://doi.org/10.3390/children8020167
Shannon J, Peters K, Blythe S. The Challenges to Promoting Attachment for Hospitalised Infants with NAS. Children. 2021; 8(2):167. https://doi.org/10.3390/children8020167
Chicago/Turabian StyleShannon, Jaylene, Kath Peters, and Stacy Blythe. 2021. "The Challenges to Promoting Attachment for Hospitalised Infants with NAS" Children 8, no. 2: 167. https://doi.org/10.3390/children8020167