The role of parents in medical procedures

Common procedures your baby might have

Your baby will likely have some necessary tests and procedures as part of their care. Here are some of the more common procedures your baby might have:

• Blood tests - usually done by a heel prick, using a pin, to check how your baby’s care and health is progressing
• Cannula placement – putting a small tube into a vein to give medication or fluids
• Intubation and extubation – putting in a small breathing tube into their lungs or removing the breathing tube
• Vaccinations - injections to teach the baby’s immune system to create the antibodies they need to fight infections
• Feeding tube insertion – when a tube is placed in a baby's nose or mouth and down to their stomach to give them frequent small nutritional feeds
• Eye examinations, usually to screen for Retinopathy of Prematurity (ROP)
• Lumbar punctures – where liquid is taken from around the spinal cord to test for infections, for example, meningitis

Non-medical regular cares that may cause discomfort or stress

Apart from medical procedures, there are other daily cares and interventions that may cause your baby stress or discomfort, for example, nappy changing.

We have more information about how you can be involved and comfort your baby during these cares and look after your baby on the neonatal unit.

Your choices and your baby’s procedures

You should be given the choice to help comfort your baby during their procedures. This can be different from unit to unit, so the choice may not always be offered. We provide some more information later in this section to help you talk to staff if you would like to be more involved.

Some parents choose to be involved with procedures, and others choose not to be. Some parents simply cannot always be there for many different reasons.

It’s important to remember that there is no right or wrong decision here – it’s about making the choice that feels right for you and your baby at that time.

Parents who wish to be present for procedures should make neonatal staff aware of their choice. See our guide to conversations with healthcare professionals for ideas about how you can approach this.

It may be possible to cuddle, hold or touch your baby, or you may be able to talk, read or sing to them. However, if something needs to be done under sterile conditions (in a completely clean, germ-free environment) it may be more difficult for parents to be involved. Some procedures may also need to happen in an emergency, where parents are either not present, or the neonatal team need space to work quickly.

In this section, we look at the different ways that you can help comfort your baby before, during and after procedures.

Spotting signs of stress, pain and discomfort

Your baby will give you cues that show how they are feeling. This includes if they are calm, stressed or in pain. Over time you will learn what these are, and the neonatal care team might also be able to help you recognise these cues.

Here are some useful guides to understanding your baby’s cues:

• You can download our guide ‘Look at me, I’m talking to you’ for free from the Bliss Shop, for more information on your baby’s cues.
• NHS South Tees Hospitals also have a useful page on their website about baby cues to help you understand how your baby is feeling and if they might need comforting.
• Sensory Beginnings have a short leaflet about recognising signs of discomfort.

Techniques for comforting your baby

In this section we outline a number of different ways that you can help to comfort your baby, including when they are having a procedure. This is not a full list of everything you can do and some of these suggestions may not always be the best option for your baby.

You can talk to the care team about these suggestions and any others that may be helpful. You can also ask for support in providing comfort if you are unsure.

Comfort holding (also called ‘steady hands’ and ‘gentle human touch’)

There are several different names for this kind of hold, which involves placing still hands on your baby while they are lying in an incubator or a cot.

First, wash your hands and then warm them either with warm water, by rubbing them together, or placing them in the incubator. Speak to your baby for a bit before you place your hands on them, so that they know you’re there. Cradle your baby’s head with one hand and put your other hand on their back, bottom, or feet, keeping your hands still.

Another way is to hold their arms and legs, so they are gently tucked in close to their body. This is sometimes called “facilitated tucking”.

This form of steady touch can be used from birth and is a good opportunity for bonding with very preterm babies. This is because they are likely to be in an incubator and sometimes cannot be moved for the first few days after they are born.

Procedures will take place in the incubator and neonatal staff can show you the best type of hold for your baby while this happens. You may be able to start the hold before the procedure, keep it throughout and continue holding once it’s complete, to help settle your baby. Research shows that this can help reduce the pain your baby feels during certain tests and procedures.

Skin-to-skin or ‘Kangaroo care’

Skin-to-skin or ‘Kangaroo Care’ is when a baby is placed against the bare skin of their parent’s chest, so that the baby's and parent’s skin is touching.

This can be done within the parent’s clothing if they prefer to keep their chest covered. If removing the baby’s clothes is distressing for them, the closeness of this hold will still benefit them with their clothes on. You can also ask if the unit has any privacy screens to create a private area around you.

Research has shown Kangaroo Care is effective in reducing pain in some babies during heel pricks for blood tests. Some units and staff encourage skin-to-skin for other procedures, such as cannula placements and vaccinations. It’s also a good way to promote the production of breast milk and bond with your baby.

Massage therapy

Studies show that massaging an area before a painful procedure can help reduce or prevent pain. The impact of this depends on the body part being massaged, how long and intense the massage is and the level of pressure.

Nurses, occupational therapists and physiotherapists can help you understand if this is a good form of touch for your baby, and if so how you can best massage your baby. Over time you will also learn to recognise signs in how your baby responds, helping you understand whether massage is welcome or not.

Gentle rocking

When your baby is well enough to be out of the incubator, gentle rocking can be soothing and may be most useful before and after a painful procedure to help calm your baby. Not all babies will respond well to rocking, so talk to the care team to decide if it is a good option for your baby.

Breastmilk

If your baby is breastfeeding, this can be a very effective way of calming your baby after a painful or upsetting procedure. This is because it gives your baby comforting touch, smell, sound, and taste.

If your baby isn’t breastfeeding but is having breastmilk, feeding them a small drop of breastmilk on their tongue can also help soothe them. If breastmilk is not available, you can talk to your care team about using formula, donor milk, or sucrose (sugar water).

Dummy and non-nutritive sucking

Babies can learn to soothe themselves from stress or pain through sucking on a finger, hand or dummy (pacifier). Check with the neonatal team if this is a suitable option for your baby. Offering your baby a dummy before, during and after painful procedures can be a good way to help prevent or reduce their pain.

Talking, singing or reading

If you are unable to hold your baby or would prefer not to, talking, singing and reading can help your baby to know that you’re there. Your baby will know your voice, so hearing your voice can help bring comfort.

As you spend more time with your baby, you’ll get to know their likes and dislikes, what makes them comfortable and what can cause them stress. There are a few things you can do to help make your baby’s surroundings as calm as possible.

Reduce stressful touch

Some babies may find it stressful to have 'moving' touch, such as stroking, on their skin, and may prefer 'still' touch, like comfort holding. This is particularly common with babies born before 28 weeks.

As with everybody, they will have their preferences on how and when they are held. If your baby gives signs that they are upset, give them space. Neonatal staff can help you find the best ways to comfort your baby with touch.

If your unit has access to an occupational therapist or a physiotherapist, they can help you understand and respond to your baby’s cues.

Adjust the lights

Bright lights can be upsetting to babies and affect the way they respond to or cope with procedures. The unit staff should be aware of this, but if you are concerned, you can ask them about dimming the lights.

You can also ask staff about shielding your baby’s eyes during periods of quiet rest or sleep. For example, putting a blanket over the top of the incubator or crib may limit some exposure to light.

Sometimes, additional lights will be needed for procedures. This can include phototherapy lights for jaundice treatment. You can ask your baby’s nurse about shielding their eyes from direct light if this hasn’t been done already. When you are holding your baby outside the incubator or crib, you may need to use your hand to protect their eyes.

Keep noise to a minimum

Loud noises can be upsetting to babies. When you close the door to the incubator, try to do it quietly. Avoid putting hard objects on top of the incubator and you can ask other people not to put things on it or use it as a writing table.

Try to talk quietly around the incubator or crib. Move away for conversations and do not be afraid to ask the care team to talk more quietly around your baby. It can be difficult for the neonatal staff to keep their voices low all the time, although they know how important it is. They will not be offended if you let them know your concern.

If your baby is on a breathing machine, water in the tubing can sound much louder in the incubator. If you notice this sound, you can speak to the neonatal staff to see if they can reduce it.

If there is a noise that seems to upset your baby, such as a telephone ringing, then you can ask the nurses if there is a way to reduce the noise or move your baby to a quieter area.