The NICU

By: Shelley Nortje (Clinical Psychologist)

Ububele has recently begun offering their services at a local hospital’s Neonatal Intensive Care Unit (NICU). The intervention offered involves offering support to mothers whose babies are admitted in this NICU ward. This usually happens if the baby is born preterm, has a very low birthweight or if there are other medical complications. This is a difficult space to be in as an infant mental health professional, for medical staff, for mothers and their families, as well as for these small babies.

The experience of mothers in this situation is one of trauma and uncertainty. These mothers may become depressed and may feel helpless as they rely on medical staff with specialized knowledge, that isn’t always shared or explained, to assist their babies. One mother for example expressed how confusing and scary the different machines attached to her baby, and the sounds they made, were for her. Mothers are also separated from their babies for certain times during the day. The small babies appear quite vulnerable and alone in their incubators. Mothers are encouraged to feed their babies and touch them however, the contact seems limited and hesitant as mothers appear scared to touch their tiny babies in case they should cause them more harm. One mother apologised to her baby when the baby’s leg tremored when mom touched her sensitive skin. These preterm babies are more sensitive and easily dysregulated, and mothers may feel guilty about their ways of interacting with their baby without sufficient knowledge about their babies’ experience. When the baby reaches a certain weight babies are eligible for discharge. Mothers may at this time begin to panic. Their insecurity and lack of confidence in their ability to care for a preterm baby may be evident.

Preterm babies, unlike full term babies, may behave in slightly different ways. On average, preterm babies are less responsive to sight and sound, their communications may be more difficult to read or understand, they have a limited ability to self-regulate, their sensory thresholds are reached more easily (ie: are easily over stimulated) and it usually takes them more effort and energy to respond. These characteristics of the preterm infant can make it harder for a mother to always understand what the baby needs and how to soothe and support their development.

A mental health professional, with a solid understanding of infant development and infant mental health can offer helpful support at this time for babies and their families. They can help parents understand their baby’s behaviours and share their observations about their baby’s bodily communications and capacities. For these babies that have a more difficult start to life, having this extra support and guidance may be valuable.

Should you or someone you know be struggling to understand babies’ communications please contact Ububele for assistance in strengthening and building these important relationships.

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Good enough parenting

By Hayley Haynes-Rolando (Educational Psychologist)

 

Somehow it feels impossible to write a blog on parenting. The fantasy that one could apply a step by step programme or a set of guiding principles for all parents to follow – is just that – a FANTASY. Whilst parenting comes with little to no training, it is one of the toughest and most important tasks, often wrought with little support. Parents are often left feeling overwhelmed, inadequate and at times facing the scrutiny and judgements from other parents, family, teachers and other professionals working with children.

 

Well, I am here to offer some good news! There are no one size fits all models for parenting and there is certainly no perfect style – the only thing that we can offer our children is our attention, time and an ability to keep on trying despite the failures and pitfalls that coming with having a family. In my opinion, a parent that tries their best, doesn’t stop trying and is passionate about building a healthy, connected relationship with their child is a good enough parent. Whilst these ideas are not exhaustive, I will attempt to offer some thoughts on what I understand to be good enough parenting, from courses like the Incredible Years and Circle of security parenting[1].

 

A healthy relationship

I was once told that children spell love, T-I-M-E. This very simple thought suggests that children thrive and appreciate it when their caregivers are able to spend time with them. Building a healthy relationship with your child involves a conscious effort to spend quality time with them. This does not mean planning elaborate play dates with fancy activities, it does however suggest, being present and available to your child. I think what you choose to do with your child during this special time is far less important than you being available and interested in their thoughts, ideas and experiences.

Developing a healthy relationship with a child, builds self-esteem, self-confidence and allows parents to understand and intervene when their children are having difficulties. Being present and available to your children allows you to observe their behaviour and listen to them. This encourages them to express their emotions and in a sense helps to develop their emotional intelligence.

Being aware of your shortcomings

Developing a healthy relationship with your child is not as easy as it sounds. Often our own experiences of being parented, past hurts and current circumstances can make it difficult to spend time with our children. Whilst these experiences often can’t be avoided, realising that our past experiences can impact on our relationships and affect the way in which we respond to them is a good start.

Being able to admit our mistakes, and making efforts to repair the ruptures in our relationships with children, not only helps to repair our relationships but also helps them to understand that mistakes do happen, and they can be repaired.

 

Dealing with children’s challenging behaviour

Oftentimes when children act out, caregivers struggle to separate the child from the behaviour. Circle of security parenting suggests that good children do bad things and that often cries for attentions are their attempts at making a connection with their caregiver. Whilst this is not always easy to realise or hold onto in the moment, understanding that all behaviour is a communication could help caregivers to deal with the challenging behaviour with more understanding. Continuously working on the relationship and being intentional about spending special time could also help to reduce the acting out.

Consistency and clarity in limit setting also help to make children feel safe and secure. When deciding on consequences for undesirable behaviour, involving the child and talking through it together helps to get their buy-in. It may also help them to understand why the behaviour should not be repeated. The consequences should be natural and logical, so that they are able to apply this learning to other areas of their life. Praising and rewarding good behaviour is another strategy that reinforces positive rather than negative reactions from children.

 

Whilst this list of tools and ideas about how to deal with children’s different or challenging behaviour is not exhaustive, what must be reiterated is this idea that what matters most is the relationship that is developed, and that it is never too late to build a connection with your child.

 

For further information on parenting support please contact Ububele. We run parenting groups for children between 0 and 7 years old and 8 – 14 years old.

 

[1] Webster-Stratton, C. (2015). THE INCREDIBLE YEARS® SERIES. Family-Based Prevention Programs for Children and Adolescents and Powell, B., Cooper, G., Hoffman, K., & Marvin, R. S. (2009). The circle of security.

How do baby’s show their distress?

By: Shelley Nortje (Clinical Psychologist)

For many years it was believed that babies did not have complex feelings or abilities to communicate until they were much older. However, over recent years of research it has been established that babies do in fact experience and express their feeling states and communicate these to their caregivers in quite specific ways.

A more obvious way that babies communicate is through their cries, however there are also more subtle ways that they are able to let us know what they need and how they are feeling. Babies do not have verbal abilities yet though and so they rely more on their bodies to express themselves.

Babies may become stressed when they are moving from one state to another (for example from sleep to wake), if they are tired, hungry, too hot or too cold, if they have been stimulated or played with too much, or if they experience something painful such as their immunization injections.

Here are a few signs that newborn babies give when they are stressed:

  • Constantly fussing and crying
  • Irregular breathing
  • Mottled skin or changes in skin colour
  • Frequent sneezing, hiccoughing, yawning, sighing
  • Spitting up or gagging
  • Frequent tremors and startles
  • Avoiding making eye-contact
  • Pushing their tongue out their mouth

Now that we know a bit more about how to read baby’s signals, it is also important to think about ways to help babies soothe and bring themselves back to a regulated state. Here are a few ways that babies can be soothed. Remember each baby is unique and may prefer different ways of being held or handled.

  • Take a ‘time out’ if the baby is overstimulated to give him or her time to recover
  • Change the way you are interacting with your baby (e.g.: lower your voice if the baby seems more sensitive to loud sounds)
  • Speak to a baby
  • Offer support to the baby in the form of swaddling, holding or sucking
  • Babies are also sometimes able to soothe themselves, and may even use their own body to soothe, for example in sucking their own hand

This brief outline emphasises that babies are capable and unique little people. With time and careful observations, caregivers can attend to these subtle signs and communications to learn to know their child better and to develop a more meaningful and responsive relationship with them.