Parents know what’s best - and that's just as true for their baby in hospital

Six-month-old Fionn Plunkett can’t sing or laugh due to a medical condition. He is being treated in Crumlin children’s hospital, where the psychological team prioritises the central role his parents play in his care and development

Ashlinn Plunkett and six-month-old son Fionn. Picture: Brendan Bergin

WHEN you bring your newborn home, you want to know who this little baby is. What does he/she like, dislike? How is he/she speaking to you? And you can explore and enjoy these questions in the relaxed safe cocoon of home. In that early phase, you can luxuriate in discovering what your baby is revealing about himself.

But what if your newborn can’t come home straightaway? What if your child is very unwell, has an underlying condition and needs surgery?

“Some babies arrive into the hospital in the very early hours of their lives, sometimes without a parent, if the parent has had a C-section. Or a baby might be in a cot in ICU (intensive care unit), post-surgery, and you can’t pick them up, cuddle them,” says senior clinical psychologist Dr Anne-Marie Casey, who works at Children’s Health Ireland (CHI) Crumlin.

She explains that babies are wired for connection. “The ways we interact with them shapes their development.”

This year’s Infant Mental Health Awareness Week runs from June 12 to 18 at CHI, which sees 1,800 infants yearly. A multidisciplinary week of activities for families/staff across four hospital sites (Crumlin, Temple Street, Connolly, Tallaght), it aims to enhance awareness of and promote infant mental health practices.

“When people hear ‘infant mental health’, they think a baby can’t have mental health. But it’s about developing the capacity in the infant’s first three years of life to experience, regulate and express emotions — this helps them form close relationships — and to be able to explore their environment and learn,” says Casey, who is a member of the Psychological Society of Ireland.

In hospital, the family is navigating a very stressful environment, and the role of the psychology department is to support parents to be responsive to their infant and to discover who their baby is and to enjoy them as much as possible.

“We want to empower parents to look after their baby in a setting that can feel disempowering — where parents can feel ‘everybody else is looking after my baby to keep them alive’.

“It’s about letting that pause happen for parents to connect with their baby.”

Send-and-return messaging

So much crucial development happens in the “serve-and-return” interactions between parents and infant, Casey says. “You’re changing your infant and they don’t like it. They start wriggling, crying. Mum or Dad calls them by name, says ‘Oh, you don’t like this. Oh, I know it’s hard when I change you, and it’s a little bit cold’, and puts a hand on their chest to reassure them, maybe sings a song — and of course gets baby changed as quickly as possible.”

These “baby-sends-message/parent-responds” interactions happen multiple times daily when parents are caring/playing with their infant, and Casey explains this is crucial in developing baby’s trust, attachment and confidence that the parent “is going to respond to what I need”.

“In the send-and-return, parents are tending to the growing relationship with their baby — this growing relationship builds the architecture of the brain. It lays a foundation for the social and emotional wellbeing of the infant.”

But in a hospital environment, amid multiple assessments and procedures, this delicate parenting routine gets interrupted. “Very simple routines and practices that you’d naturally do with your baby get interrupted. If a baby has complex medical needs, you’re catapulted into a rollercoaster of stress.

“You mightn’t be able to change your baby or breastfeed. You’re trying to get baby to sleep in a hospital ward with the lights on. You don’t get to control the noise levels, the alarms. For parents, so many things are out of your reach, out of your control.”

Ashlinn Plunkett and six-month-old son Fionn. Picture: Brendan Bergin

So how can parents in this environment look after their baby, so the child can internalise their care and feel seen in the relationship? “The simple things are what matters,” says Casey. “If Mum is still in another hospital, can she sleep with a little knitted square and then send it to baby, who can sense her even when she isn’t fully present?

“If you can’t have baby in your arms, can you give them a hand hug? Put your hand into the cot so they feel connected. Can you talk, sing, read to your baby? Can you rub baby’s head, put Vaseline on their lips to keep them hydrated? All the simple things parents do to look after their baby.”

It’s about normalising a very unusual environment, and about empowering parents to ask: ‘Is my baby stable enough to have a cuddle today? Can I change/bath him?’

Casey likes the approach of psychologist Dr Kevin Nugent, who works at Boston Children’s Hospital. “He says it’s about being curious with the parent about who their baby is — and that even when you go into ICU, metaphorically it’s the parent’s kitchen. So I always ask a parent, ‘Is it OK for me to visit?’”

Casey says babies are all the time leading the way — if we can only attune to what they’re telling us. With this in mind, staff ask what the baby likes and dislikes. And parents might say: “Oh, my baby loves when the music therapist comes around” or, “She doesn’t like when the radiographer puts the cold probe on her chest.”

Parents know best, says Casey. It is just as true for a baby in hospital. “Parents are collaborators in the medical setting. We want them front and centre, as the people who know their baby best.”

Life with a hospital-based baby

Fionn Plunkett loves when his parents sing ‘Incy Wincy Spider’ and do all the actions on his belly. He loves when dad, Robbie, blows on his belly. But Fionn’s parents can’t hear their six-month-old laugh — or cry — because at barely five days old, he had a tracheostomy (a surgically created airway into the windpipe) due to a severely restricted airway.

“But we know he is laughing because we can see the big smile on his face and he’s wriggling around. And we know when he’s crying because of his facial expression,” says his mum, Ashlinn.

Fionn was born with an imperforate anus — the opening to the anus is missing/blocked. He had a colostomy bag fitted the same day he had the tracheostomy. “Two massive surgeries,” says Ashlinn. Fionn has since had posterior sagittal anorectoplasty surgery to repair the imperforate anus and it is hoped to reverse the colostomy bag soon. “We’re looking to do a reconstruction of his airway when he’s 18 months to two years. They’ve warned it could take two or three surgeries.”

Currently waiting for a HSE homecare package that will allow them to take their baby home, Ashlinn and Robbie are juggling parenting a hospital-based infant and two other young children: Fionn’s twin, Seán, and three-year-old sister, Emma.

On the day I speak with Ashlinn, Emma has chickenpox and Robbie is in with Fionn. “We’ve a childminder two days a week. I go in for full days then, but we can’t be in as much as we’d like.”

Fionn is aptly named, Ashlinn says. “He’s a little warrior. He has bounced back, recovered incredibly well. He’s meeting all his milestones. He’s a really happy child. He examines you, follows you around the room with his eyes. He’s the smiliest little fellow, a real character with a glint in his eye. After all he’s been through it’s just mind-blowing.”

But the hardest part is not being able to hear him. “That’s really tough. When you hear Seán at home chuckling, you wonder what Fionn sounds like. I think he’d have a really hearty laugh because he’s always bouncing when he’s laughing.

“And he loves to snuggle right into your arms. I lift him and we go to the door of the ward and he loves watching people go by.”

When Fionn spots his parents arriving in, he knows them straight off. “He has this big smile on his face, he gets so excited — and he relaxes so much when he hears our voices.”

Infant Mental Health Awareness Week begins June 12, with talks/contributions from hospital disciplines including physio, nursing, occupational, speech and language and music therapies, chaplaincy, psychiatry, psychology, play specialism and dietician. Supports include meditations to help parents manage stress, developmental play leaflets, soundbank of nursery rhymes/songs to sing to baby in ICU, peer support groups for parents expressing/feeding, baby books and baby massage tips.

• Tuesday, June 13, 12.30-1.30pm, Dr Claire Crowe and Joanne McClelland will present a webinar on infant mental health at play. Register in advance: exa.mn/infant-mental-health