Development and Family Centre – Are they Calm?

What are development and family centred care – Are they calm?

The notion of calm refers to the impact the environment has on the infant as well as an inclusive approach to families in these processes.  

Developmental and family-centred care practices are foundational to the role of nurses and midwives in the special care nursery (SCN), as they prioritise the holistic needs of both the infant and the family.

Developmental care refers to a range of strategies aimed at neurological protection by reducing environmental stressors by supporting the physical and emotional development of premature or unwell infant, while Family-centred care (FCC) recognises how parents are an essential member of the care team.

They are not only strategies they are integral to everything nurses and midwives do in the neonatal nursery. These strategies ensure that care is individualised, compassionate, and developmentally appropriate, promoting the best outcomes for vulnerable infants and their families and underpin the three notions of warm, sweet and pink.

(Gardner et al 2021, Kain and Mannix 2023, Safer Care Victoria 2023)

Developmental care

The aim of development care is to support the infant’s neurodevelopmental needs by minimising stressors. It is believed that oxygen consumption can increase by up to 6mls/kg/min with handling putting the infant at increased the risk of hypoxia.

Developmental care practices help reduce stress and support the infant’s growth and development. Creating a supportive environment fosters better outcomes for the infant’s development. The infant’s response to sensory input (via the subsystems – the autonomic, motor, state & attention/interactive ability) interacts with each other to try to achieve balance however infant can be overwhelmed potentially leading to an altered neurodevelopment (from pain, thermal changes, olfactory, auditory, vestibular & visual stimuli). Interventions taken to support the behavioural organization of each individual infant, enhancing physiological stability, protecting sleep rhythms and promoting growth and maturation.

Key concepts of Developmental care include:

Minimise noise: Monitoring and reducing noise levels should be encouraged. The threshold for cochlear damage for adults is 80-85 decibels, and the infant will have a lower threshold than this as the immature cochlear is more sensitive. In the nursery noises of this magnitude include closing portholes with a snap or placing bottles on the top of the plexiglass incubator. Reducing noise promotes adaptive motor development and reduce stress/abnormally high levels of cortisol secretion, decibel monitor, respond to alarms promptly, quiet voices, educate parents on noise

Minimise light: Constant bright light in the nursery can interfere with natural diurnal rhythms and overstimulate the infant, reduce lighting promotes sleep & REM sleep states, less stressful environment, promotes weight gains, cover incubator with quilt, avoid direct light into infant’s eyes (exam light)

Skin-skin/kangaroo care: is a method of holding an infant skin to skin against a parent’s bare chest. It is especially beneficial for preterm or low-birth-weight infants, supporting their physical health, enhancing bonding, and aiding in breastfeeding. Evidence supports that this practice has shown to improve infant outcomes such as temperature regulation, and improve both growth, and developmental outcomes. It should only be implemented if medically supported, to promote stable cardio-respiratory and thermoregulation only if the infant is hemodynamically stable. Infants under phototherapy may be able to have Kangaroo Care using a Biliblanket as the infant may not be able to be out of ‘lights’ due to elevated serum bilirubin (SBR) however the biliblanket enables the infant to have breast contact/feeds

Woman in pink and white floral robe wearing eyeglasses by Jimmy Conover used under Unsplash licence

Positioning: Infants should be provided with developmentally supportive positioning to optimise musculoskeletal development and behavioural organisation. Midline flexion & containment of limbs, the aim of correct positioning is to ensure comfort, prevent pain or discomfort and not to cause any injury (pressure areas)

Nesting: refers to the use of soft and supportive boundaries (like rolled blankets, towels or specially designed positioning aids) placed around the infant in the in incubator to mimic ‘uterine life’. The ‘nest’ helps the infant feel secure and supported similar to containment in utero. When nesting an infant ensure hands are positioned to the midline (near face) to enable/ encourage the infant to self-soothe also ensuring hips are correctly aligned to avoid incorrect posture.

Minimal handling: As sleep is the main organisational state of the preterm infant, sleep protection is very important for optimal brain development. Sleep deprivation can have long term effects on growth and development. Promote sleep protection – cluster care, avoid/minimize tests & invasive procedures

Clustering of cares encourages a minimum handling approach and protects periods of deep sleep by minimising the number of times an infant is needed to be woken up or disturbed.

Cue-based care: This involves caring for the infant while recognising the behavioural cues or stress responses and providing an appropriate strategy such as timeout or modification of care as appropriate. Implement feeding/sucking when showing signs of readiness, relationship-based feeding approach, Non-Nutritive Sucking (NNS) during Nasogastric Tube (NGT) feeding based on infant cues/readiness, swaddle bathing when stable/neurologically ready. Positive feeding experiences (safe, nutritious, nurturing).

Non-Nutritive Sucking (NNS): Non-nutritive sucking provides opportunity for self-soothing/ self-calming and is helpful in the transition to suck feeds. It

Pain management strategies: NNS, sucrose, swaddling during procedures, contain limbs gently, position, read cues & cease/delay when becoming distressed

Promote olfactory development by reducing noxious, strong odours: avoid strong perfumes, open alcohol wipes outside of incubator, place expressed breast milk (EBM) scented items near infant, skin-skin, utilize EBM for mouth care.

(Gardner et al 2021, Kain and Mannix 2023, Safer Care Victoria 2023)

Family Centred Care 

Family-centred care (FFC) aims to involve parents in the shared decision-making process for the welfare and wellbeing of their infant. It involves supporting the family, promoting bonding of the family unit as well as providing emotional support to parents and their families.

FFC enhances both the infant’s and the family’s experience, improving outcomes and fostering a supportive environment. It reshapes the healthcare experience to include support and empowering families as essential partners in their infant’s care.

Key concepts of FFC include:

Effective Communication: Use of clear, warm, non-technical language, reinforces the importance of the parent’s connection with the infant

Encouragement of Parent-Infant Bonding: Encourages the parent’s role in caregiving, highlights ways the parent can contribute to the infant’s comfort and care e.g. involves in cares (nappy changes), temperature monitoring

Collaboration Between Parents and Healthcare Providers (Shared Decision-Making): Actively involves the parent in care planning, invites discussion of concerns and incorporates parent input into care decisions.

Provide Emotional Support: Validates the parent’s emotional experience. Offers empathy, reassurance, or appropriate resources for support. Offer counselling and support services to help families cope with the stress of having a premature infant.

Education: Provide information to parents about conditions, treatment, and care routines. Explain the use and intra venous therapy (IVT), and how these support the infant’s health.

Respect for Family Preferences and Values: Acknowledges and affirms the family’s cultural, emotional, and caregiving values.

(Gardner et al 2021, Kain and Mannix 2023, Safer Care Victoria 2023)

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