Today’s high-tech neonatal intensive care units (NICUs) buzz with staff doing what they can to ensure the smallest and sickest of newborns survive. Yet amid the machines, equipment, and attentive nurses and doctors, there might be ordinary people, called cuddlers, softly singing to, talking to, cuddling, and gently rocking the preemies and convalescing newborns with neonatal abstinence syndrome (NAS), known as opioid withdrawal.
As it turns out, low-tech cuddling, or hugging, also plays a role in helping these babies to survive and, even, thrive, according to Edmund F. La Gamma, MD, chief of Newborn Medicine and professor of Pediatrics, Biochemistry and Molecular Biology at Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York.
“This whole concept of human contact is something that we often don’t pay attention to in the environment of a hospital and intensive care unit. Often, we become focused on lab values and blood gases because that’s keeping patients alive,” La Gamma says. “Sometimes, the aspect of humanness . . . is lost in the shuffle of intensive care.”
The need for touch is especially important for babies born prematurely or addicted to drugs like opioids. Take the babies who are born at weights below 1000 grams and earlier than 28 weeks’ gestation, for example. In the best case scenarios, those babies will be hospitalized for 2 to 3 months in order to grow from their extremely small size, La Gamma says.
These babies are exposed to many sounds, lights, and external stimuli not normally experienced in utero during normal brain development and often have problems with organization of motor function, La Gamma says.
“Normally, they would be in the uterus, rolled up like a ball, nice and quiet and in the dark,” he says. “But no matter how you provide services in intensive care, there is going to be light and much more disruption. The hugging is calming and tends to focus their attention, decrease motor activity, and embrace the sound to a human voice.”1,2
Nurses on these units are often busy with lifesaving measures and care, and parents can’t always be there to provide that nurturing touch. So, to address the softer side of care for patients in NICUs, pediatric inpatient units and sometimes birthing pavilions and hospitals nationwide are offering cuddling programs, in which volunteer trained cuddlers maintain cuddling when parents and staff can’t.
“Volunteer cuddler programs have the potential to enhance the human caring aspects of complex technological nursing care provided premature infants,” according to a paper published in 1990.3
“Although the fragile premature infant may not always appear to respond overtly, the weight gain, and social and mental development of the cuddled babies give testimony to the effectiveness of human attention. The infants' improved well-being and subsequent earlier hospital discharge as a result of cuddling are convincing rationale to implement a cuddler program,” the study authors write.
Addressing the need
In 2015, Kimberly-Clark Corporation (Dallas, Texas), manufacturer of the Huggies diaper brand, worked with the Canadian Association of Pediatric Health Centers to summarize the evidence of the powerful and positive impact a caregiver’s touch can have on babies’ comfort and development of brains and bodies, according to Aric Melzl, Baby and Child Healthcare general manager in North America. The resulting Huggies-funded white paper “The Power of Human Touch for Babies” cites research suggesting human touch offers many benefits for babies—from improved physiologic stability and regulation to enhanced immune system development and improved parent-baby bonding.4
“[I]t became clear that too few babies, especially those in neonatal intensive care units (NICUs), receive the optimal amount of beneficial touch from parents or caregivers. Volunteer hugger programs can help fill this important need. And so, the No Baby Unhugged grant program launched in Canada in 2015 and was brought to the United States in 2016,” Melzl says.
No Baby Unhugged provides $10,000 grants to US hospital NICUs for hugging, or cuddling, programs. So far, 19 hospitals (15 in the United States and 4 in Canada) have received the money to launch new volunteer hugging programs or enhancing those they have.
“Huggies will continue to award grants in 2018, and hospitals interested in applying can visit HuggiesHealthcare.com to complete an application,” Melzl says.
The need for hugging programs could be on the rise, as the number of US babies who could benefit from such programs grows. During the past 25 years, preterm births in the United States have increased more than 35%, according to a study published in 2010.5
Thanks to advances in care, infants can survive at 22 weeks’ gestation, but the result is spiraling healthcare costs. This makes it imperative, the same authors suggest, for hospitals to focus on making clinical improvements that not only result in healthier babies but also help to manage costs.5
“Volunteer hugger programs can facilitate improved overall development of baby, improved parent-baby connection, and shorter stays in the NICU—in addition to freeing up time for nurses to continue their vital duties,” according to Melzl.
1. Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics. 2013;131(5):902-918.
2. Zentner M, Eerola T. Rhythmic engagement with music in infancy. Proc Natl Acad Sci U S A. 2010;107(13):5768-5773.
3. Fritsch-deBruyn R, Capalbo M, Rea A, Siano B. Cuddler Program provides soothing answers. Neonatal Netw. 1990;8(6):45-49.
4. Benoit B, Boerner K, Campbell-Yeo M, Chambers C. The power of human touch for babies. Canadian Association of Paediatric Health Centres. Available at: https://www.huggieshealthcare.com/en-us/power-of-hugs/human-touch-for-babies. Accessed April 5, 2018.
5. Kornhauser M, Schneiderman R. How plans can improve outcomes and cut costs for preterm infant care. Manag Care. 2010;19(1):28-30.
6. Caparros-Gonzalez RA, de la Torre-Luque A, Diaz-Piedra C, Vico FJ, Buela-Casal G. Listening to relaxing music improves physiological responses in premature infants: a randomized controlled trial. Adv Neonatal Care. 2018;18(1):58-69.
7. Dore S, Esser, M, Fitzgerald F, et al; Huggies Nursing Advisory Council. Every change matters: a guide to developmental diapering care. Available at: https://www.huggieshealthcare.com/en-us/clinical-resources/every-change-matters/quick-guide-to-developmental-diapering-care. Published October 6, 2016. Accessed April 5, 2018.
8. Esser M. Diaper dermatitis: What do we do next? Adv Neonatal Care. 2016;16(suppl 5S):S21-S25.