This week’s blog comes from Dr. Julia Petty and Dr. Lisa Whiting from the University of Hertfordshire and Professor Celia Harding from City University of London, who are sharing thoughts on how nurses can support parents to communicate with their premature babies.
Babies born prematurely are at increased risk of developing speech, language and communication problems (Harding et al., 2019; Rabie et al, 2015) which can significantly impact on educational achievements and the ability to engage socially during early years. These difficulties can be wide ranging and include problems with being able to learn and use words, developing word linkage and grammar, turn taking using words, being able to sequence speech sounds accurately and understand spoken language (Harding et al., 2022).
For parents who experience a premature birth, learning to interact with their baby can be exacerbated as a result of the barriers imposed by admission to a neonatal unit. Time is needed to develop confidence when learning to care for and be close to their baby in such a setting. This was emphasised during the COVID-19 pandemic, when use of staff and parent face masks, along with reduced parent contact in neonatal unit, was recognised as a matter of concern (Green et al, 2020) specifically in relation to bonding, developing confident infant care skills, and learning to be a supportive and responsive communication partner (both neonatal staff and parents). Early bonding, through involvement in care within the neonatal environment, can enhance physical and emotional closeness for both the baby and parents; in addition, it provides important skills for developing early interaction and communication (Harding et al., 2022). Promoting early communication strategies to enhance parental sensitivity to babies through use of eye contact, talking with and responding to babies using natural gestures and facial expressions can not only increase attachment and bonding, but they also support improved parent wellbeing, reduce parental mental health problems, and enhance the interpretation of early communication signals during everyday care (Evans et al, 2014).
Few studies have described early communication with premature babies and we believe that there is a critical need to do so. Additionally, there is limited research which explores, in detail, the specific nature of early communication strategies that can be used between premature babies and their parents on a neonatal unit, and whether communication interventions are effective (Harding et al, 2019). Studies have investigated approaches such as early feeding and skin to skin care, which are important for bonding and parent mental health outcomes (Baley et al., 2015). However, such research has not addressed the outcomes in terms of language development. We recognise that such approaches are important precursors for communication; however, many of these studies fail to address the necessary skills to facilitate it; there is also a lack of identification of specific language and communication skills (Harding et al, 2019) as well as how to address this omission.
Given the need to prevent future speech, language, and communication problems in premature babies, we believe that it is essential for communication to be improved and enriched for parents caring for their babies on neonatal units. Providing support for parents can maximise the potential for an enhanced communication environment and give families the confidence to use appropriate strategies for inclusive communication wherever possible. We also acknowledge that explicit and fundamental skills, necessary to enable positive communication environments, for both premature babies and parents, can be poorly understood by neonatal nursing staff, therefore potentially limiting the support given to parents when trying to develop communication skills for their babies. Our current research aimed to study this further by exploring parental and staff understanding of communication, including the barriers and enablers within neonatal care. Our work, now submitted for publication and dissemination, will inform the development of future tailored resources in this important area for both parents and neonatal staff, which we believe is essential.
Dr Julia Petty is an Associate Professor [Learning & Teaching] and Senior Lecturer, Children’s Nursing at School of Health & Social Work, University of Hertfordshire. You can follow Julia on X: @petty_julia
Dr. Lisa Whiting is an Associate Professor [Research] and Professional Lead, Children’s Nursing at School of Health & Social Work, University of Hertfordshire. You can follow Lisa on X: @LisaWhi35145237
Professor Celia Harding is an Honorary Professor Emerita, Division of Language and Communication Science, City University of London. You can follow Celia on X: @CELIAHARDING13
Baley J., and the Committee on fetus and newborn. (2015). Skin-to-Skin Care for Term and Preterm Infants in the Neonatal ICU. Pediatrics. 136(3):596-599.
Evans, T., Whittingham, K., Sanders, M., Colditz, P., & Boyd, R. N. (2014). Are parenting interventions effective in improving the relationship between mothers and their preterm infants? Infant behavior and development, 37(2), 131-154.
Green, J., Petty, J., Staff, L., Bromley, P., & Jones, L. (2020). The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paper. Journal of Neonatal Nursing. 27(1), 21 – 25.
Harding, C., Levin, A., Crossley, S. L., Murphy, R., & Van den Engel–Hoek, L. (2019). Effects of early communication intervention on speech and communication skills of preterm infants in the neonatal intensive care unit (NICU): a systematic review. Journal of Neonatal Nursing, 25(4), 177-188.
Harding, C., Whiting, L., Petty, J., Edney, S., Murphy, R., & Crossley, S. L. (2022). Infant communication. How should we define this, and is it important? Journal of Neonatal Nursing. 28(6), 452-454.
Rabie, N. Z., Bird, T. M., Magann, E. F., Hall, R. W., & McKelvey, S. S. (2015). ADHD and developmental speech/language disorders in late preterm, early term and term infants. Journal of Perinatology, 35(8), 660.