Parent-Infant Attachment in the NICU

Hey everyone, today we’re delving deep into the topic of parent-infant attachment in the Neonatal Intensive Care Unit (NICU). This post is inspired by an enlightening presentation from Dr. Marilyn Sanders, a renowned neonatologist, which was part of the 2021 NeuroNICU Nurse Ed Conference.

Understanding the Disruption of Normal Parent-Infant Attachment in the NICU

The NICU experience often interrupts the normal process of parent-infant attachment between parents and infants. Dr. Sanders gives us a comprehensive overview of the science and history behind this topic, dating back to the 1950s and 60s. This interruption is particularly poignant in the context of the COVID-19 pandemic, affecting family-centered care.

The Science Behind Parent-Infant Attachment

Dr. Sanders provides a comprehensive overview of the biological and evolutionary underpinnings of social connectedness and attachment. This section delves into the critical roles played by both the sympathetic and parasympathetic nervous systems in fostering a secure environment for infants.

The Role of the Parasympathetic Nervous System in the Parent-Infant Attachment

Understanding how the nervous system influences attachment processes is crucial. Dr. Sanders explains that a balance between the sympathetic and parasympathetic systems is necessary for creating a nurturing environment for infants, promoting feelings of security and social connectedness.

The Impact of COVID-19 on NICU Attachment Practices

The pandemic brought unprecedented challenges to the NICU environment, exacerbating stress and attachment issues. This section explores how these challenges affected families and healthcare professionals, and the adaptations made to ensure continuous support for parent-infant bonding.

Stress and Attachment in the NICU Environment

Life is inherently stressful, and the NICU is no exception. Dr. Sanders discusses the heightened stress in the NICU during the pandemic, emphasizing the need for supportive measures to maintain parent-infant connections.

NICU environment is very stressful and traumatic. There are lots of noise increased lighting lots of procedures going on and sometimes unavoidable separation of the infants and parents yet this is an environment where these pre-term infants grow… Click To Tweet

The Historical Perspective of Attachment Theory

Dr. Sanders takes us through the history of attachment theory, with a nod to pioneers like John Bowlby. He observed young men separated from their mothers during World War II and developed his theory from these observations.

Bowlby’s work highlighted the importance of ongoing engagement between mothers and their infants. He pointed out that significant disruptions during early childhood could lead to attachment issues.

John Bowlby’s observations during World War II laid the groundwork for understanding the importance of continuous parent-infant engagement. His work underscores the long-term impacts of early attachment experiences.

Addressing Parent-Infant Attachment Challenges in the NICU

Recognizing and addressing parent-infant attachment challenges in the NICU setting is crucial for the well-being of both infants and parents. The NICU staff plays a crucial role in facilitating attachment, especially during disruptions like the COVID-19 pandemic. Dr. Sanders advocates for understanding each family’s unique situation and working towards repairing and fostering attachment.

Here’s how NICU nurses can actively support this essential connection:

Assisting in Comforting Touch and Embraces

NICU nurses guide parents in understanding their baby’s unique needs, especially in terms of touch and holding. They teach parents about gentle containment holds or ‘hand hugs‘, which are particularly beneficial for very ill or premature infants. In cases where babies can tolerate it, nurses encourage skin-to-skin contact, known as kangaroo care. They instruct parents on how to safely hold their infants, even those with medical tubes and wires, ensuring that both the baby and the parents experience the benefits of this close contact.

Fostering Engagement and Understanding

Nurses help parents in recognizing and interpreting their baby’s cues and states. This understanding boosts parents’ confidence, leading to more meaningful interactions and potentially stronger bonds. Nurses observe and assist parents in initiating gentle interactions, paying close attention to the baby’s responses, such as eye contact or signs of discomfort. They also encourage parents to engage in activities like singing or reading, providing resources like the NICU’s special library of books.

Navigating Feeding Challenges

Feeding is often a complex aspect in the NICU, and nurses are there to support parents through this journey. They help parents in adapting to new feeding plans, providing emotional support and understanding as parents navigate a range of emotions that may impact bonding. NICU nurses connect families with specialists, such as Speech-Language Pathologists or Certified Breastfeeding Counselors, and guide them in providing comfort during tube or IV feeds, such as holding the baby or offering a pacifier.

The Long-Term Impact of Secure Attachments

Secure attachments, as Dr. Sanders explains, are associated with health and well-being throughout life. She encourages us to view this as an “iterative safety circuit” – feeling safe leads to social connection, which in turn fosters further safety and attachment.

Expanding the Scope: Beyond the NICU

While the focus of Dr. Sanders’ presentation is on the NICU, the principles of attachment are not just confined to the parent-child relationship in early childhood but are applicable across various life stages and care settings. Understanding and nurturing secure attachment can have far-reaching positive effects on individuals and society as a whole.

Early Childhood: The Foundation of Attachment

The first year of life is critical for attachment formation. Initially, infants are indiscriminate in their affection, comfortable with any caregiver. However, between six months to a year, they start preferring certain caregivers – those who consistently meet their needs. This period is crucial for parents to establish themselves as primary attachment figures, rather than leaving this role to nannies or other caregivers.

For working parents, this poses a dilemma. Balancing career and family life without compromising on the child’s need for secure attachment is challenging. Some parents prioritize their careers, while others may choose to put the child’s needs first, often leading to one parent sacrificing their career. The ideal scenario is where both parents play an active role in caregiving, ensuring the child forms a secure attachment with both.

The Importance of Secure Attachment

Secure attachment, defined by consistency and reliability of caregivers, leads to numerous positive outcomes. Securely attached children tend to be more resilient, perform better academically and socially, and enjoy better physical and mental health. Unfortunately, not all children form secure attachments. Those with insecure attachments often face poorer outcomes, including lower academic achievement and increased susceptibility to mental health issues. Thus, nurturing secure attachment in the first nine months is vital.

Attachment in Different Care Settings

In settings like foster care or elderly care facilities, the principles of attachment remain relevant. Caregivers in these settings can adopt practices that foster a sense of security and consistency, similar to what a primary caregiver would provide. In elder care, for instance, consistent and empathetic caregiving can create a secure base for the elderly, enhancing their sense of well-being and potentially improving their mental health.

Adulthood and Attachment

The effects of attachment extend into adulthood. Adult relationships, be it romantic partnerships, friendships, or professional relationships, are influenced by early attachment styles. Adults with secure attachment tend to have healthier, more stable relationships. Understanding one’s attachment style can lead to more informed and conscious efforts in personal and professional relationships.

The Role of Society

Society plays a significant role in supporting families in nurturing secure attachments. Pushing for laws and policies that accommodate the needs of modern families, such as parental leave and flexible work arrangements, is crucial. Recognizing the importance of early attachment can lead to societal changes that prioritize the well-being of children and families.

Whether it’s in the NICU or at home, nurturing attachment is essential. Dr. Sanders highlights the importance of consistent, caring interactions, regardless of the setting.


Bonding with Your Baby in the NICU | Lurie Children’s ( Importance of Secure Attachment (
Attachment: The What, the Why, and the Long-Term Effects · Frontiers for Young Minds (
The Importance of Secure Attachment (

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