What Snakes Taught Me about the Neonatal Intensive Care Unit
I would say that my upbringing was typical for the most part with the exception of one thing- my pets growing up did not include dogs, cats, fish or turtles but primarily snakes. The snakes were not little Gardner snakes one may find in the yard but instead PYTHONS- ten to twelve foot pythons or boa constrictors to be exact, anywhere from 1-3 in our household at a time. They were just part of our family in a strange way and I never ever remember thinking they were something to fear-until I saw people’s reactions to them! I have thought a lot about my snakes over the years and have come to the conclusion that I learned a lot about life through the forked tongues and slithering bodies of snakes. When I first entered the NICU 16 years ago, one of my first thoughts was, “THIS is what people must have felt like the first time they saw our snakes!” Raw fear, difficulty thought processing, intense anxiety, and so forth and so on. I have decided that the NICU and snakes have a lot in common (stay with me here . . . I promise to prove my point):
People are REALLY afraid of snakes
When I first began paying attention to people’s reactions to our snakes, I just remember the fear, the inability to speak clearly, complete silence, loss of color in the face, tears! When parents first come into the NICU to see their precious newborn who is not the full term healthy infant they had been waiting for, I see the same behaviors-very quiet, afraid to ask questions, afraid to touch their own child, tears! The evidence of parental stress in the NICU is now being well documented. A study conducted by Holditch-Davis et al. in 2003 reported that of 30 mothers in the Neonatal Intensive Care Unit (NICU), all had at least one symptom of Post-Traumatic Stress Syndrome (PTSD) and 50% had 3 symptoms of PTSD which include but are not limited tosymptoms of depression, anxiety, insomnia, aggression,and emotional withdrawal from their child. Another study by Pierrehumbert et al. (2003) showed that 41% of mothers reported PTSD scores in the clinical range. Fathers have been shown to show a delayed onset of symptoms; a study conducted by Stanford University School of Medicine reported that in theirresearch sample, 33% of fathers and 9% of mothers met criteria for (PTSD) at four months post-discharge of their infant from the NICU. The presence of these symptoms places a significant negative influence on the family dynamic, and inhibits parental capacity as a caregiver. Furthermore, parental stress can have a long lasting impact on the preterm infant’s brain development. If the parent is unable to attend to the infant’s needs and help their infant cope with the stress they encounter on a daily basis, the infant is at an increased risk of sensorimotor imbalances, attention deficit disorder, “hidden” learning disabilities, and poor cognitive outcomes. (Maroney, 2010).
To ease people’s fears around our snakes, my father would gently say, “Just touch the tail . . . feel his skin . . . don’t be afraid.” And what do you know, people of all ages would do just that; begin by just simply touching the snake’s tail, commenting on the feel of it, the look of it, etc. and the fear for the most part would visibly leave their faces. In the NICU, we can do the same thing. . .begin by just simply showing the parents how to “touch” their preterm infant in the isolette, explain why we touch the baby in this way and how much they are helping their baby just through touch alone. Describe in terms the parent can understand, the impact they can have on their child’s brain development. The infant’s brain, for example, at 35 weeks weighs onlytwo-thirds of what it will weigh at 40 weeks.(Engle, 2007). Explain simply that wiring of the baby’s brain, with its millions of connections and pathways is occurring as we speak. I see the same look in these parents faces as I didas a child watching my father sharing his snakes with others-the fear being diminished, a look of, “I can do this-it will be ok.”
As time went on, my father would entice neighbors and good friends to interact with our snakes more. He would say, “The snake will not react unless you drop him or he is startled or very hungry . . . would you like to hold just part of him and I will hold near his head?” Sure enough, many would do just that! And they enjoyed it although noticeably apprehensive. In the NICU, it is our job along with other staff members’ to support the parent infant bond and ease parents into doing more and more for their child. Helping a parent read their infant’s avoidance cues and respond appropriately through facilitation of coping skills is critical to parent empowerment and stress reduction. Ask the parent to complete a simple caregiving task such as taking the infant’s temperature. While the parent is taking the temperature ask them to point out or read some of the infant’s cues and show the parent how to help their baby cope. Review all of the cues the infant may show and talk about the various ways the parent can help. Be positive, supportive, and present in all of your interactions with parents.
Not ALL snakes fit in doll houses
My twin sister and I would often play various games with our snakes-having them crawl through our child made obstacle courses or letting them crawl through various items-one of these being our doll houses. One doll house I remember best was 3 stories high and had the tiny beds, various rooms, complete with little figurines. We first let our older sisters small snake crawl through the doll house without difficulty and decided Arnie, our 10 foot python, should go through. We put him at the front door and sure enough he began winding his way up the stairs to the second level and found his way then up to the third level, his large body now overtaking the entire dollhouse!! We giggled and screamed with delight anticipating Arnie’s next move and watching him intently. But then the unexpected . . . Arnie became agitated and when snakes become agitated their bodies EXPAND!! So, in essence Arnie became stuck! My sister and I could not get him out and my father’s words were ringing in my ears; “He will not hurt you unless he is startled”. . .ummmm. . .I think the snake was a bit startled to put it mildly. My dad eventually released the snake from the vengeance of our doll house and my twin and I were in BIG trouble but I learned a valuable lesson. In the NICU, each baby is so different. As therapists we have our “repertoire” of treatment techniques, but we must decide which treatment techniques are appropriate for the individual infant. In our NICU, we look at our possibility of treatments in the form of a ladder. As the infant is able to integrate and respond to more sensory stimuli, the therapist may move one rung up the ladder. If the infant shows you through avoidance cues or physiological instability that they are not handling a certain treatment, the therapist moves one step back down the ladder. In the end, one baby may meet his goals and go home at 36 weeks corrected and another 46 weeks! Each baby and family must be treated individually and the baby must be treated at his or her own pace.
Having snakes as pets made me unique
I can say with 100% certainty that I had the best show and tell from kindergarten through 6th grade! I learned from a very young age that my pet snakes made me different, unique, and special. I had stories to tell about my snakes and do to this day. Infants in the NICU are special and unique-they, along with their parents, will always have a story to tell about their NICU stay. This uniqueness should be celebrated and parents congratulated! With that said, caregivers of preterm infants need to understand the unique qualities of preterm infants as well as the difficulties they may face as they grow. Research consistently shows that preterm infants (even those born 32-36 weeks of age) exhibit poorer academic achievement, increased behavioral problems, and diminished brain function in the areas of planning, cognitive flexibility, and abstract thinking.(Maroney, 2010). Furthermore, former preterms are at higher risk for anxiety and depression, abnormal sensory issues, social challenges, balance and visual-spatial issues, and feeding problems. (Maroney, 2010). Nurses, parents, therapists, and even doctors need to understand that they are affecting the infant’s neuronal pathways with each and every interaction. Our job is to create adaptive responses versus maladaptive responses to their environment as they grow and develop into children and adults. Simply succeeding in keeping the infant alive is no longer acceptable. Treatment techniques that help the brain “wire” correctly include proprioceptive input, positive touch, and infant massage as well as educating parents about the importance of kangaroo care and encouraging all staff to decrease an infant’s stress during every interaction with the infant.
I miss my snakes . . . kind of
When I see a snake at the zoo or read about them with one of my children, I smile and am transported back in time to fond memories and fun with snakes! I would say that I may even miss my snakes. When I think about it further, however, this is not entirely true. I miss the “times” I had while the snakes were in my life, times at art shows and with my family, the adventures with my twin. Do I want to go out and purchase a pet snake for my family? Um . . . that would be a “no”. Our NICU families, I believe, feel the same way. They hopefully think back to their infant’s stay in our NICU and remember the support and excellent care they received. But if you ask them if they would like to have another child born prematurely, I can guarantee it would be a definite and resounding “no”. We want families to miss us and look at their child who was once in our NICU and be thankful in knowing we did everything we could to promote optimal development.
References
Engle, W.A., et al, and the Committee on Fetus and Newborn. (2007).“Late-Preterm” Infants: A Population at Risk.Pediatrics,120(6), 1390-1401.
Holditch-Davis D, Bartlett R, BlickmanAK, Miles MS. (2003). Post-traumatic stress symptoms on mothers of premature infants. Journal of Obstetric, Gynacological and Neonatal Nursing, 32(2), 161-71.
Maroney, Dianne I. (2010). How family centered care affects preterm infants and their families. Nurse Currents, 4, 1-8.
PierrehumbertB, NicoleA, Muller-NixC, Forcada-GuexM, AnsermetF. (2003).Parental post-traumatic reactions after premature birth: Implications for sleeping and eating problems in the infant.Archives of Disease in Childhood: Fetal and Neonatal Edition, 91(6):F404.
Shaw, Richard J., et al. (2007). The Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder in the Neonatal Intensive Care Unit.StanfordUniversitySchool of Medicine.