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Fall 2013 - When Baby Arrives

A question & answer with Dr. Heidelise Als

Earlier this year, WakeMed hosted a seminar featuring Heidelise Als, PhD, clinical and developmental psychologist and expert in infant behavior and early childhood development. Her visit coincided with WakeMed's recent NIDCAP Nursery Certification.

Q: Is there a single, most important thing that you encourage all parents to do in the early days after the birth of a child?

Be Available – The number one focus should be on building a relationship with the baby so you can figure things out together. If you are paying attention, they will let you know when they need something.

This is often easier said than done for parents who need to work and are facing socioeconomic challenges. You see it all around. I see it every day with hard working staff at hospitals. Everyone wishes for more time, but you have to create it when you are bringing a baby into the family so you have time to notice when they need something and can find what helps bring your baby back to a calm and happy state.

Making ‘space’ is more than an attractive nursery or corner of your room. Expectant mothers should start by making emotional space to enjoy the pregnancy so they can tune into their child. Parents also need to understand the importance of taking time to reflect on having a new family member and how it will change all the connections they've previously had.

Take Care of Yourself, Too – There is an emotional growing process for parents when they are engaging with a new baby - it is demanding and thrilling. Giving so much means you aren't in the center of your world anymore.

Remember, it is normal to have some anxiety as a parent, but the baby knows it when you are under stress. You both can begin to spiral. So build in some de-stress appointments for yourself – go for walks, have a date night, get your hair done and spend time with people you are close to – whatever helps you return with a renewed focus on your parenting opportunities.

Q: What are the top challenges and developmental issues that premature babies face after birth?

Early Separation from Mother

When a baby is born prematurely, the brain is dealing with a lot of things that it isn't ready for pain, light, feeding, breathing, quick movement and noise. The amazing thing about preemies is that they expected many more weeks in the womb, and they are working extremely hard to survive as they continue to develop. They still have fetus brains, and they need to be protected and cradled to provide external womb-like support.

A parent's presence (your smell, your voice, your heartbeat) provides a baby comfort through the continuation of something they already know. They need a nurturing, supportive envelope to shield them from dealing with too much at once.

It can be very challenging for babies if parents don’t participate in hospital care. Parents need to make sure they become part of the caregiving team from the beginning. Some parents have anxiety around medical equipment, and others fear that they will be perceived as a difficult parent. Parents should be supported to voice their concerns, ask questions and get involved. Parents are the best monitors that we can have for babies – even in the hospital. And babies truly need the comfort of the parents.


Premature babies can face breathing challenges because their lungs are not mature when they are born. When preemies do start to cry, it can shock parents because they were likely quiet in the Neonatal Intensive Care Unit. Parents should think of crying as an accomplishment because it means their baby has the strength to breathe and cry. The next step is to learn to help them return to a calm state.


Contrary to common belief, prematurely born babies don’t initially need extra stimulation (they are not ready for mobiles, toys, visitors, etc.). They are still making new connections in the brain and learning how to come back from excitement to a calm and balanced state.

Be cautious about too much interaction with family and friends in the beginning. Avoid rowdy, loud or overly interactive visitors. Premature babies aren't ready for loud environments yet. Be alert to what is on TV and keep volumes low. Be sure to keep your own emotions in check as well. When you take a break or go to work, don't return out of balance. Focus on staying calm and reassuring.

Ignore people who tell you that you are spoiling your baby or being too cautious. Remember to take it slow, hold your child and avoid adding in extra stimulation too early.

Q: Why do premature babies face more challenges than most fullterm babies?

The earlier they come, the more immature other organs may be. They have to learn to breathe, eat, and digest. They also have very fragile skin. Parents of premature babies are also worried more; the child feels that stress. Parents should do their best to show trust in the child as they accomplish new things. Show happiness and be excited for each step – remember that swallowing and breathing on their own are major milestones!

Q: What are some of the most common misconceptions about the care of premature babies?

There can be a lot of focus on weight, but too much feeding can over stimulate a baby. Giving the bottle immediately may not be best when a preemie is upset. Sometimes they simply want to be supported and calmed. They may simply be struggling with the transition between sleeping and being awake – even adults have trouble with this. Some of us never become ‘morning people.’


Meet Heidelise Als, PhD

FF fall 2013 baby doc

Professor of Psychology in the Department of Psychiatry, Harvard Medical School, Senior Associate in Psychiatry and Director of Neurobehavioral Infant and Child Studies, Boston Children's Hospital, and Research Associate in Newborn Medicine at the Brigham and Women’s Hospital, Boston, Massachusetts. Dr. Als is a clinician and researcher who is concerned with the neurodevelopment of full term, high risk and preterm newborns, how they are influenced by the environment, the care they receive, and the role their parents play in brain development. Her goal is to improve the future for all newborns and especially those born early and/or with special challenges that require intensive medical care.

Dr. Als is the originator of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Her research has documented significant improvement in the neurodevelopment of preterm infants who receive NIDCAP care compared to those infants cared for in traditional ways. Her work has changed the training and education of staff as well as the design of and care delivered in NICUs in the US and increasingly many other countries. The NIDCAP Federation International (NFI) ( assures the quality of this innovative, individualized model of education, training, research and care implementation.

FF fall 2013 baby 1


Dr. Als shared some helpful warning signs and tips for navigating through tough times as a new parent.

Feeling Separated
When parents take turns with their partners, return to work and try to juggle it all alone, they can lose their own together time. Think about your support systems - family, friends, neighbors who can help give both of you some time off together. Don't wait until you are in tears. Prevent unnecessary stress for you and your baby. When you feel good, your baby feels good.

Sleep Deprived
Exhaustion can lead to frustration, confusion and an all around lack of ability to be a good parent. Attune to it and adjust your schedule to find balance. It’s in the baby’s best interest that you get adequate rest.

Emotional or Depressed
Pre and post-partum depression is real, and you may not know you are dealing with it. During early pregnancy, make sure you ask people to be there for you later when you need it. Listen to those you trust if they express concerns about your emotions.

FF fall 2013 baby 2

Digitally Distracted?

Adults seem to be constantly on their cell phones, and that can interfere directly with baby bonding. Children adjust to this lack of attention by turning to something else - a toy, another adult, etc. Give yourself permission to turn off your phone. Don't open your email inbox for a couple days. Be respectful of your family time and ask others to do the same thing. They will understand and appreciate you for doing so.

“There are some alarming symptoms of young parents attending to their tablets or phones more than their children,” said Dr. Als. “A parent’s face is the most important thing for a baby, and an ignored child will begin to turn their attention away from their own parents.”

Interaction builds confidence and mutual trust through looking, touching, smiling, speaking, exchange of sounds – these are key for emotional and motor skills development. Infants expect and deserve to feel like they are the most special to their parents. We all need to be cherished by someone who we can "go back" to throughout life – that typically is and should be a parent.

Some people misunderstand breastfeeding and think it only gives babies nourishment. Babies are comforted and strengthened through the process of breastfeeding, and it is good for mothers as well.

Many people think the incubator is the best, quiet and protective place for a baby. The fact is that it separates the baby from the parent. If a baby can be resting on their parent’s skin, that is much better for them.

Q: Are there specific things parents should do to help create the best possible experience for their baby in the NICU and when transitioning to home?

Learn to take over the care - diapering, bathing, taking temperature and weighing - these do not need to be staff jobs. Parents should get involved as early as possible to increase time with their baby, build confidence and allow for a smooth transition to home.

Q: At what age are parents likely to have a full grasp of how a premature birth has affected their child's development?

This is a complex question. Each individual baby has a different experience. We have to watch for their needs as they grow. Social phases can be a challenge, and they might need help fostering friendships.

Something you notice early on may repeat itself as a child gets older. It could be something as simple as needing extra sleep – that can even follow them into college and adulthood.

One of the noticeable behaviors of children and adults who were born prematurely is a tendency to be hyper goal-oriented - they are fighters. They didn’t give up when they were born, and that may follow them through life.

For others, things may be going too fast at times. Parents may need to help children who were born prematurely to articulate when they are overwhelmed.

Regardless of the challenge or unique needs, the same topics will most likely surface at different stages – start of school, middle school, college and other major life events. The parent, and later in life the child, may need to be supported to express that their needs are different; explain if they need to sit up front, ask for extra time on a project or other accommodations that aren’t always obvious to others.

Treat each child as an individual – no two children need the exact same things. There is no manual, and there is no perfect recipe. It is a lifelong process.

Learn from your missteps and figure it out together. When you are stuck, be sure to take advantage of the professional guidance that is available. Counseling or artistic/play activities can help them grow and gain confidence. No matter what, learn to listen, look and respond. Teach them you are there for them.




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