Therapeutic Handling
Infants suffering from drug withdrawal symptoms need specialized
handling to keep them medically safe and manageable. It is imperative
that the caregiver receive appropriate training to help the infants control
their bodies and emotions. Learning comforting techniques and reading
signs and signals are critical to these infants.
It is not necessary for drug-exposed infants to cry for
hours on end. They need not be frantic or to suffer. The key is
therapeutic handling. At the Pediatric Interim Care Center, we know this works because we have seen it work
hundreds of times with the most severely affected drug-exposed infant.
Each type of drug exposure presents a somewhat different challenge for
caregivers but the basic principles of handling are the same for all
of these infants.
-Basic Principle #1:
Swaddling
Drug exposed infants cannot do three things
simultaneously. They cannot control their bodies, breathe and suck at
the same time. If they are focused on trying to control the discomfort
in their bodies, they cannot focus on feeding or sleeping. We
can’t eat, sleep or breathe for them but we can help control their
bodies for them. We do that by swaddling or wrapping them snugly to
control their movements and provide comfort.
Holding or laying a baby in a “C-position”
increases the infant’s sense of control and ability to relax. Hold the
baby firmly and curl the head and legs into a “C”. In doing so, the
baby’s chin is resting near his chest with the arms midline; his back is
slightly rounded with legs bent in an upright position. If he is allowed
to stiffen his back, arms or legs, he is increasing his body tone and
burning precious calories that he needs to grow. It is also possible
that by holding him close to your body, it is too stimulating for him.
When laying the baby down while trying to maintain the “C-position”,
place him on his side and wrap a blanket into a roll and ring it around
his body to ensure he remains positioned. As the symptoms
diminish, introduce the back sleeping position recommended by the
Academy of Pediatrics.
-Basic Principle #3: Head to Toe
Movement
Common techniques like back and forth rocking, a
swing, and bouncing your infant are not recommended. These motions are
jarring and stimulating to a drug-affected baby’s nervous system. A
slow, rhythmic swaying following a line from head to toe with the baby
swaddled and held firmly in the C-position is calming. Keeping your
movements slow and rhythmic will help to relax and settle the infant.
When you are holding a baby who is frantic and very
hard to calm, you can maintain a C-position hold directly in front of
you, with the infant two inches away from your body and facing away.
Then slowly and rhythmically move the baby up and down. This head-
to-toe movement is soothing to the baby’s neurological system, as is
keeping the baby away from your body.
-Basic Principle #5: Clapping
Another technique that can help the baby relax is
to clap his diapered and blanketed bottom. By cupping your hand and
clapping or patting slowly and rhythmically, you will be able to feel
the baby’s muscles relax. This principle can be very soothing for some
but can, for hypersensitive infants, have the opposite effect and cause
over-stimulation.
-Basic Principle #6:
Feeding
Babies withdrawing from opiates suck frantically.
This may make it difficult for them to take in enough formula because their
suck may be also disorganized. Their stress levels are so high that they
simply cannot organize an effective suck without help. The key to
feeding is to get your baby into a therapeutic hold and relaxed enough
to suck. Always feed in a low-stimulus environment--no bright lights,
music, noise or other distractions. Make sure the baby is swaddled and
held in a C-position.
-Basic Principle #7: Controlling the
Environment
In order for the therapeutic handling to be
effective, limit the number of caregivers and offer a calm surrounding.
Loud noises increase their distress. It is best to turn down TVs and
music and to limit loud voices surrounding the baby. Also, during the
first weeks of withdrawal, overhead lights may be over stimulating.
An environment that is comfortable for an infant is also created by
the soothing and calm presence of the caregiver. Routine is very
important. The baby will respond more positively when caregivers use
soft voices and speak and move slowly.
-Basic Principle #8: Introducing Stimuli
All babies need stimulation for healthy
development. A drug exposed infant needs to have stimulation introduced
in small doses and on a schedule dictated by his individual ability to
adjust. It is best to go slowly and introduce stimuli one at a time.
(This can include light, sound, touch, voice, etc). First, for
instance, see how he responds to having his swaddling loosened. Then try
gentle rocking or talking. If he shows signs of stress. (see
Managing Infants, Step 2 )
return to the therapeutic handling techniques for a while longer. This
introducing of stimuli can take time and patience on the caregiver’s
part, and will be also determined by the baby and his tolerance levels.
Watch for clues from the baby. Interact with the baby when she is ready
and in an active/alert state. Not just because you want to.
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