Long-Term Impact of NICU Experience on Parents: What Providers Need to Know

SHEENA L. CARTER, PH.D.

APPLIED DEVELOPMENTAL PSYCHOLOGIST

Developmental Progress Clinic

Department of Pediatrics

Division of Neonatal Perinatal Medicine

I have no Financial or Non-Financial Relationships to disclose.

NEONATAL INTENSIVE CARE UNIT (NICU)

KEY TERMS

- Stressors (Things that are stressful)

- Stress Response (The way your brain, body, and hormonal

systems respond to stressors)

- Chronic Stress (When stress is ongoing)

- Coping (how stress is managed)

- Trauma (ability to cope is overwhelmed by threat or injury)

-Traumatic Event (actual or threatened serious injury)

-PTSD (Condition that can develop after trauma)

- Anxiety (uneasiness, apprehension, fear)

- Depression (mood disturbance)

- Grief (deep sorrow in response to a loss)

- Neuroendocrine (interaction of hormones and nervous system)

- Autonomic nervous system (unconscious regulation of body

functions)

Factors That Increase Parental Stress After Discharge

•Higher neonatal medical risk

•Lower parental education level

•Economic insecurity

•Adverse child outcomes

•Long-term maternal medical complications

PARENTING IN THE NICU

•Unexpected

•Traumatic

•New, very vulnerable infant

•Parents and infants are biologically and socially prepared for drastically experience (including contact vs separation)

•Role of parent

•Challenges to established means of coping

•All parents can be expected to need increased social support with increased stressors

If stressors overwhelm coping, day-t0-day functioning can become impaired

•Acute Stress Disorder

•Post Traumatic Stress Disorder

•Anxiety

•Depression

•Substance Abuse

Differences in How Parents Cope:

•Parents cope most often by communicating with others and seeking social support

•Mothers: Emotional or psychological support from their spouses – or for those without pre-existing support networks, from other mothers

• Fathers: indicated that information from health care providers helped them cope

•Huge cultural differences in how parents cope

•Mental health history and prior level of coping are important considerations

“Don’t talk to me now, I’m scanning for danger”

AFTER THE NICU

-Transition Home

-Changing Roles

-Medical Needs

-Developmental Challenges

-Changing Social Support Needs

-Changing Needs with Development

-Educational Challenges

-Multiple Agencies ... sometimes to none

-Interaction Patterns and Recurrent “Triggers”

Guidelines for Engagement

•Stay Calm

•Acknowledge Memory Compromise

•Start with something the parent clearly understands /agrees

•Be PRESENT and LISTEN

•Provide reassurance

•Help prioritize effort

•Help to see “The Big Picture”

•Focus on the positives

Deconstructing Stress

Stress: Break it

Apart

T

R

S

S

E

S

N.U.T.S.Research has shown that for a situation to be stressful it must contain one or more of the following characteristics:

•N - novelty; something new

•U - unpredictability; no way of knowing it could occur

•T - threat to the ego; feeling your competence is questioned

•S - sense of control; feeling you have little or no control in a situation

– Sonia Lupien, Ph.D. https://humanstress.ca/https://heartmindonline.org/resources/nuts-

understanding-stress

Resources

• Georgia Crisis and Access Line 1-800-715-4225

• NAMI 1-800-950-6264

• Parent to Parent 1-800-229-2038

• Developmental Progress Clinic

• Chris 180 – New Generation: http://v6y.a7e.myftpupload.com/newgeneration

• Resources for Post-Partum Depression:

Emory Women’s Mental Health Program

http://womensmentalhealth.emory.edu

Grady PPD Clinic: 404-616-4444

• Apps – Listed Separately

APPS

• https://www.hsq.dukehealth.org/tools/

• https://www.mobile.va.gov/app/covid-coach (which is more geared toward trauma and not just for Veterans).

• Insight Timer (https://insighttimer.com/)

• Headspace (free for healthcare providers)

• (https://www.headspace.com/health-covid-19)

• Calm (https://www.calm.com/)

• This one was also recommended for the NICU parents:

• (Hypnosis)http://imaginaction.stanford.edu/

Sheena L. Carter, Ph.D.

Applied Developmental Psychologist

Developmental Progress Clinic

Emory Regional Perinatal Center

404-778-1451

scart01@emory.edu

DPCWebsite:

www.pediatrics.emory.edu/divisions/neonatology/dpc

/index.html “EMORY DPC”