Bringing a newborn baby home is usually a joyful occasion; however, significant stress and uncertainty often accompanies that feeling of joy—even under the best of situations. The families of newborns who start their lives needing the support of the neonatal intensive care unit (NICU) and various services, such as lactation therapists and pediatric feeding and swallowing specialists, may experience an added level of worry and responsibility.
To best support these families, medical staff and therapists spend a significant amount of time training the family on protocols for providing feeding by mouth. When that support weans and babies head home, families begin to follow the protocols recommended by their medical team and must consult specialists during follow-up visits.
Preparing Families for the Changes Brought About by COVID-19
During the current pandemic, many outpatient services have transitioned to teletherapy, and in many areas around the country, previous methods of providing care to families have either been altered for social distancing or made unavailable.
Previously, newborns and their families left their supportive network in the hospital, but once home, a new supportive network would begin to form. The social distance requirements brought about by the pandemic now force families returning home to make further adjustments and receive services to assist in safely nurturing their new baby using nonconventional means.
Families need to be equipped with knowledge from professionals and made to feel confident in applying that knowledge at home with fewer physical visits and more teletherapy appointments. To make best use of the baby’s time in the NICU—and the subsequent telepractice appointments—it is important that parents, medical staff, and therapists all actively communicate clearly with each other.
Providing families with these recommendations can help ensure the continuation of appropriate feeding services for babies under your treatment.
Bringing Newborns Safely Home During COVID-19: 8 Steps
1. Prepare for the transition to home.
Parents have the right to request training and educational opportunities while they remain in the hospital with their baby. This is an excellent time to prepare parents with the education, training, and tools they need to care for their baby. This may include talking about scenarios of care should the baby need additional support.
2. Ensure that families have all the necessary medication supplies and types of formula, if needed.
Feeding and swallowing therapists should work with their medical provider and nutritionist colleagues to identify the type and quantity of supplies required. Education regarding the type of bottle, nipple, formula, and other equipment is vital. Maintaining enough supply is also extremely important during these uncertain times. Provide families with a list of websites that carry the required materials along with additional options and alternatives.
3. Teach parents to use the equipment.
It is crucial for families to learn the appropriate usage of the equipment needed to feed their baby. Provide information about possible problems that may occur with the equipment, along with the solutions for those problems.
Ask parents to demonstrate equipment use in front of you so that you can provide feedback and any additional guidance needed. This is also a good opportunity to troubleshoot any difficulties parents may have using this new and unfamiliar equipment.
4. Teach parents to use appropriate positioning.
Appropriate positioning is crucial for feeding and swallowing. Ensure that parents have the opportunity to observe and learn to know when to use specific positions and for how long.
Encourage them to ask questions and ask them to practice these positions, such as the elevated side-lying position and standard cradle-holding position, in front of you.
5. Provide guidance in identifying and reading signs provided by the newborn.
Help parents learn to recognize the signs and cues their newborn will show to communicate needs like:
6. Ensure parents can recognize red flags.
Feeding and swallowing therapists in the NICU are trained to recognize red flags during feeding times. Take time to provide parents with information about which visible symptoms indicate that they should seek medical attention. For example, signs or cues of stress such as color changes, unusual sleepiness, breath holding, irritability, or position changes during feeding may indicate that the baby is struggling or something is not working correctly.
These initial signs of stress generally come before episodes of turning blue or choking and identifying them earlier buys parents valuable time when something is wrong.
7. Provide your contact information along with the information for local outpatient services.
Make sure parents know who to contact in case of emergency as well as ongoing care.
8. Assist with setting up appointments.
Offer guidelines to help families work with their medical team to set up any needed follow-up appointments. For instance, let families know to call the office in advance to understand how the appointments will be run, since offices will often bring newborns directly into treatment rooms without making the baby wait in a lobby or community area, especially in the case of a premature baby. This is more true than ever now, especially with COVID-related precautions medical offices must take.
The following list of resources will provide more information for both you and the families in your care: