The Family Nurture Intervention

Advances in modern medicine have made it possible for many children born prematurally to survive when they would not have in the past. However, it is often necessary to physically separate the mother and infant to administer specialized treatments in the neonatal intensive care unit (NICU). This separation interrupts several natural processes between mother and child.

Mother and infant are highly reliant upon one another during gestation and after birth. Physical contact between the two involves a complex mixture of mutual stimulation, emotional communication and interactions that impact physiological, endocrinological and behavioral mechanisms in both mother and infant.

Premature birth and the mother-infant separation can have a traumatic effect on the autonomic nervous systems of both mother and infant. This trauma can lead to a visceral response to stress. Theoretically, the trauma conditions an uncontrolled emotional response between mother and infant that can have a devastating impact on development. The separation trauma results in what neuroscientists call a general state of toxic stress.

The Family Nurture Intervention (FNI) utilizes a calming process between mother and infant that is as old as the human species itself. We know from many decades of research that mammalian developmental systems are highly dependent on the interactive behavior of both the mother and the infant, as well as on hormonal and other physiological mechanisms. We also know that variations in maternal nurturing can affect a person’s response to stress throughout life.

FNI restores activities between the mother and infant that are critical to development. It does so by means of what we call a mother-infant calming cycle routine. These calming sessions are central to FNI.

Theoretically, over time the repeated calming interactions will lead to an emotional engagement and increased attraction between mother and infant. This process leads to more rapid reductions of discomfort and distress in both the mother and the infant. Ultimately, the repeated process leads to the establishment of a calming cycle routine that can continue at home, after leaving the NICU, and give the mother an important parenting tool with which she can calm her infant when distressed.

The goal of the calming cycle is to restore a state of “co-regulation” between mother and infant. Co-regulation allows the two to become mutually attuned to one another’s emotional, physiological and behavioral cues. This process bolsters the mother’s confidence in her ability to fully care for her preterm infant and enhances her maternal behavior.

How it is Done:

• FNI takes place over the course of a preterm infant’s stay in the NICU. The intervention focuses on enabling mothers to engage in nurturing mother-infant interactions as early as possible, within the constraints of the NICU environment.

• The first interactions begin while the infant is confined to an incubator. Incubators in the NICU were designed to keep babies warm in a moist, clean environment, and help to protect the baby from noise, drafts, infection, and excess handling. FNI gives the mother an active role in the care of the infant at this stage of treatment. Interactions include odor-cloth exchange, firm sustained touch, vocal soothing, and eye contact.

• As soon as the infant can leave the incubator and be held and fed by the mother, interactions include holding and calming session activities.

• During a calming session, the mother is instructed to hold her infant safely and securely skin-to-skin and chest-to-chest, between her breasts and under her clothes. This is done in an upright position while seated in a designated reclining chair. The infant’s head is tilted up to ensure the airway is not constricted and a blanket is placed over the infant’s back to help maintain temperature. Once initiated, the mother is encouraged to engage in the calming activity for a minimum of one hour, but longer if possible.

• As calming sessions proceed, the mother learns to identify four phases through which mothers and infants cycle: 1) separate mother and infant discomfort/distress; 2) mutually shared distress; 3) mutual resolution of discomfort/distress; 4) mutual calm that may include periods of eye-to-eye contact and/or sleep.

The intervention can include sessions with additional family members whenever possible, including the father and grandparents. These sessions provide the family with strategies to support the mother as she continues these interactions with her infant within the NICU and at home.

The implications of the FNI are exciting. Results from our first randomized controlled trial suggest that the negative effects of the stress and trauma of preterm birth are not necessarily permanent. The results also show that a small dose of the intervention can lead to relatively large effects that are sustained throughout the critical 18-month stage following discharge.

Future studies will test whether implementing FNI in another institution can replicate our findings. In another study we hope to test whether FNI can be implemented by NICU staff and incorporated into standard care.