In honor of NICU awareness month, I welcome two medical professionals who work hard in taking care of our precious babies in the NICU.

I welcome Dr. Kate Rubey (@drkater on Instagram) who is a Neonatologist. We discuss:

• Interventions that are done in the NICU
• What happens on NICU rounds
• What she wishes every parent would know about the NICU

I also welcome Katie Ross (@bloominglittles on Instagram) who is an Occupational Therapist in the Neonatal ICU. We discuss:

• Five ways parents can support their baby’s development in the NICU
• How to participate in care in the NICU

00;00;09;05 – 00;00;26;24

Dr. Mona

Welcome to this week’s episode in honor of NICU Awareness Month, a month that celebrates families who have had NICU babies and the caregivers and medical professionals that take care of them. I am welcoming Doctor Kate Ruby to this episode, who is a new metallurgist, and I’ll also be welcoming another.

 

00;00;27;28 – 00;00;43;19

Dr. Mona

Kate, who. Is a Oti who specializes in development in the new Natal Intensive Care unit. Doctor Kate is joining me today to talk about what you can expect in the NICU. What happens on NICU Rounds? With the NICU team and so much more. Thank you so much for joining us today, Kate.

 

00;00;43;21 – 00;00;45;27

Dr. Kate Rubey

Of course. Thank you for inviting me.

 

00;00;46;00 – 00;01;04;28

Dr. Mona

I’m so excited that you were able to join me, because I had a son in the NICU. We had a term baby in the NICU, which is one of those more unexpected, NICU admissions. You know, I know a lot of the times parents may have a prenatal visit, and they have the expectation that there may be an ICU admission pending.

 

00;01;05;02 – 00;01;19;17

Dr. Mona

But for so many families, it’s a surprise. You know, we’re going to be talking about just what to expect overall in the NICU, what may be happening in terms of interventions, what the goals are for discharge overall. But before we start, tell us a little bit more about yourself.

 

00;01;19;20 – 00;01;47;27

Dr. Kate Rubey

Yeah. So, Kate, I, did my residency in pediatrics in Wisconsin, and then I came out to Philadelphia to do three additional years of neonatology training to become an expert in everything baby related. And I got to graduate in 2020, actually. So I’m just starting my second year as a clinical attending in the Nick U. And I actually split my time between the NICU and a research lab.

 

00;01;47;27 – 00;01;59;00

Dr. Kate Rubey

So I spend about 80% of my time doing research in lab, and then the other 20% is in the next year taking care of babies. And I just happy to be here today.

 

00;01;59;03 – 00;02;02;22

Dr. Mona

Oh. That’s awesome. What is your research on?

 

00;02;02;24 – 00;02;24;21

Dr. Kate Rubey

So I actually am doing some interesting research right now using nanoparticles, and we’re hoping that we can encapsulate different pharmaceuticals to direct to where they go in the body and change the way we treat some diseases. Specifically looking kind of at antimicrobials and bacterial infection. So hopefully more to come on that in the coming years.

 

00;02;24;23 – 00;02;45;26

Dr. Mona

I’m so grateful to have you on. Obviously you’re doing such amazing work with research and then all the work you do clinically. And like I said earlier, you know, this is not going to be all encompassing about everything that happens in the next year. We don’t have enough time to talk about that. And, this is just for families that may find themselves, with an admission to the ICU, in that very delicate, you know, phase of life.

 

00;02;45;26 – 00;03;08;02

Dr. Mona

Right? A newborn baby. Sometimes there’s an expectation that we are going to go home right away, and parents are shocked by that. So my goal of this episode was to really create awareness and really celebrate you, and the whole Nic team, from personal experience as well. I will always say this, that the NICU team, the doctors, the nurses, all the developmental specialists, everyone who sets foot in the nCCU has a heart of gold.

 

00;03;08;05 – 00;03;16;24

Dr. Mona

So truly, thank you for all the work you do. I know it’s not always easy, but from a pediatrician mom who had a child in the nCCU, I really want to just thank you for all that you do.

 

00;03;16;26 – 00;03;37;05

Dr. Kate Rubey

I think the NICU is the specialist place to actually work, and I agree that I look at my team every day, and I just think everyone there is so incredible and amazing. And, you know, I always one time an OB told me, you know, the NICU wasn’t part of their birth plan. And I said, the Nicky’s not part of most people’s birth plans.

 

00;03;37;08 – 00;03;53;10

Dr. Kate Rubey

So I completely agree with you. It is, most of the time, I think a little bit of a deviation from what people envisioned. And I think as a team, we all do our best to come together to make the the new path that we’re all on as a group. As you know, easy and good as we can.

 

00;03;53;12 – 00;04;10;19

Dr. Mona

I can attest to that from being on the side of the patient, obviously a mother of a patient, and then also from my experience in residency, obviously I didn’t do fellowship in the you, but the experiences we have is pretty intense in the, you know, residency years. I love the nCCU. I mean, I thought I would go into it, I just loved everything about it.

 

00;04;10;19 – 00;04;36;18

Dr. Mona

I love the procedures. I love, you know, watching these babies overcome obstacles. It’s like the most fascinating thing ever for me. So again, we’re going to be talking about, the first question I have is, what are the important assessments and interventions done in the NICU? From the beginning, you know, and the delivery, but also just in general, like, what are the things that you all are managing, looking out for when a baby’s admitted to the ICU?

 

00;04;36;20 – 00;04;56;03

Dr. Kate Rubey

Yeah. And that’s a great question. And kind of like you said, there’s so many things to cover within the Nic because there’s such a wide berth of babies that we see from very premature babies to full term babies, surgical babies, so it is a tough one to answer. You know, I usually think about going to deliveries.

 

00;04;56;03 – 00;05;26;02

Dr. Kate Rubey

I tell people, you know, when we’re going to be called to a delivery at anything that’s not a straightforward, completely normal vaginal delivery. So the list of reasons that a neonatologist or just the pedes, you know, team in general is called is quite long, actually. And I always feel bad because I don’t think everyone knows that. And so then, you know, five people storm into the room and majority of the time that I’m there, we dry the baby off.

 

00;05;26;02 – 00;05;46;14

Dr. Kate Rubey

We say, happy birthday. We wait, get our pictures with the weight and the hat and give them back to their parents and say like, congratulations and leave, you know, and then another smaller part of the time, we do a little bit of help with the baby because essentially they’re coming out of a pool and trying to learn how to breathe air like we’ve all been doing.

 

00;05;46;16 – 00;06;04;10

Dr. Kate Rubey

And so they need just a little extra help. And then we do the same thing with the weight and graduations and we leave. And then another very tiny part of the time. But an important part of the time, especially if it’s your baby, something is going on that we need to continue addressing. And so we have to take the baby with us.

 

00;06;04;12 – 00;06;23;06

Dr. Kate Rubey

And I think that’s one of the hardest things is, you know, telling a mom who just her baby, especially when she’s not expecting it, you know, like you kind of mentioned before, if it’s a premature baby, we are meeting with the family before the delivery happens. Most of the time we’re talking about, you know, who’s going to be at the delivery, what’s going to happen to the baby afterwards?

 

00;06;23;06 – 00;06;39;03

Dr. Kate Rubey

So they get at least a little bit of a frame, just of what it’s going to look like. But when it’s a baby that we’re not sure is going to need extra help, it’s, you know, really hard for us to say, I’m sorry you have to take your baby with us. But, you know, it’s always for the best.

 

00;06;39;03 – 00;06;58;22

Dr. Kate Rubey

For the baby. And then once they get upstairs, you know, most of the stuff that we’re looking at is kind of breathing oxygen levels. You know how well the heart is functioning. And then when the babies are small, we’re looking at waiting for them to grow big enough that they can do the things we need them to do, which is gain weight and eat.

 

00;06;58;22 – 00;07;06;05

Dr. Kate Rubey

So there’s not a lot of expectations for the little ones, but they’re hard things for them to do and for them to learn how to do.

 

00;07;06;07 – 00;07;30;14

Dr. Mona

That’s amazing. And you’re so right. I mean, the experience when everyone comes rushing into the delivery room, can be so overwhelming. Because obviously a parent is delivering a baby and then all of a sudden you’re like, what’s going on? Why is everyone coming? And why is everyone panic? And, you know, I obviously have been on the other side from a medical professional standpoint, but when it was me on the table on a C-section, I remember making eye contact with one of the nurses that came down.

 

00;07;30;20 – 00;07;44;20

Dr. Mona

And like, I literally just locked eyes with her. And I knew, like, I knew something was not right and that they were going to take Ryan. She didn’t even come to me to tell me that they were taking him because I had my own issues. But like, I literally like, remember locking eyes and I was like, yep, I know, I get it.

 

00;07;44;20 – 00;08;01;03

Dr. Mona

I’m it doesn’t make it any easier. But it’s like, you know, you know, when you have the medical understanding, you’re like, yep, you need to go. This is not going to be something that’s resolved now. But it can be really hard. And like I said, from the perspective, of someone who’s been there from the mother’s side, I know how hard it is.

 

00;08;01;03 – 00;08;17;14

Dr. Mona

I know it feels like, well, where did my baby go? But then if you team is there to obviously keep that baby at its best, you know? And that’s so important to remember. I know it’s so hard sometimes, but like I said, the team is fantastic and their goal is to support the baby in what they need.

 

00;08;17;16 – 00;08;32;03

Dr. Mona

And so you mentioned, like, obviously when the baby goes, depending on prematurity, depending on age, depending on what the concern is that brought them to the Nic, you, you’re literally just monitoring obviously all their major organ systems that are directed towards their diagnosis. Right?

 

00;08;32;05 – 00;08;52;02

Dr. Kate Rubey

Yeah. So every baby that comes gets a tailored assessment to the concern that we had, whether it be something that we were planning for or, you know, based on what we knew prenatally about the baby before they came out or what we see in the delivery room. But by the time we bring them up to the Nicky, they all get their own individualized plan.

 

00;08;52;05 – 00;08;54;17

Dr. Kate Rubey

Based on what our concerns are.

 

00;08;54;19 – 00;09;16;18

Dr. Mona

That’s amazing. And tell me more what happens on Nicky Rounds. So this is something that obviously is really important. And I know maybe it may work differently in different Nicus, but what are the goals? You know, generally for Nicky Rounds, what would you want parents to ask? What would you want parents to remember? You know, you have this platform on this podcast, for what happens on these, rounds.

 

00;09;16;20 – 00;09;48;14

Dr. Kate Rubey

Of course. Yeah. So I think of Nicky rounds and into separate parts. Right. And so the first part is going through all the numbers and all the things that happened overnight. And I think that can be very overwhelming for many of the parents that I have worked with in the past. And I think that’s very normal. Thinking about the fact that, you know, to run rounds, I did four years of medical school and then six years of training after that, just to be, you know, in charge of running them.

 

00;09;48;14 – 00;10;14;24

Dr. Kate Rubey

And everyone else on the team has also done so much training, so much schooling. And so I think there’s that first part that happens. And then the next part is really on the providers within the team to explain what do all of these numbers actually mean in a way that’s not something that requires ten extra years of learning to figure out, and that’s the perfect spot for parents to be present with us if they can.

 

00;10;14;24 – 00;10;33;22

Dr. Kate Rubey

We actually in our nick, you have a lot of parents who can’t come in for various reasons, which completely understandable because even after you have a baby, you still have a whole life that existed before that baby got there. So we call them during rounds. If they want to be present, we can call afterwards with updates. You know, every family has something different that works for them.

 

00;10;33;25 – 00;10;52;23

Dr. Kate Rubey

And, you know, I feel like as a provider team, we’re here to figure out what works best for each family for their baby. But that second part is really important because that’s where parents have the floor to say, this is something I saw because they are at the bedside frequently. When we are not. So sometimes they see things that we haven’t seen.

 

00;10;52;23 – 00;11;13;17

Dr. Kate Rubey

They see patterns that we haven’t come across yet. And then they can also just say, you know, you guys said X, Y or Z yesterday and I’m confused. Tell us more about what that means. And so the the question asking part is so important because, I hate for any family to ever feel like they don’t know what’s happening with their baby.

 

00;11;13;20 – 00;11;34;23

Dr. Kate Rubey

I’ve never had a baby, so I cannot understand, but based on what I’ve heard from parents that I’ve worked with is, you know, if your child and it’s not normal to not be with them right away. And so some of it’s very difficult in the NICU experience is that there’s a team taking care of your baby, and you kind of don’t exactly know what’s going on.

 

00;11;34;23 – 00;11;53;28

Dr. Kate Rubey

And that’s why I think, you know, what’s so important is for us to all work together because parents know the most about their own baby, and then we come in with our own, expertise and knowledge, and we work together as a team to get the baby to a spot where they’re healthy enough to be able to go back home with their parents.

 

00;11;54;00 – 00;12;14;16

Dr. Kate Rubey

And so that’s why I think it’s so important for parents to be involved with us so they can ask the questions and we can all be on the same page together. And like you asked, you know, exactly what happens on rounds is different in every hospital. You know, I’m at a very large, children’s hospital. So at our hospital, we have many people around us.

 

00;12;14;16 – 00;12;39;16

Dr. Kate Rubey

We have a dietician, we have, a pharmacist, we have a nurse. So we have a lot of people, which is nice. And there’s lots of brains thinking about every baby, every day. But there’s other institutions where it’s just the neonatologist or just the neonatologist and the nurse. And that’s also a really great forum, because then you have a very concrete number of people that you need to get together to talk.

 

00;12;39;19 – 00;12;58;18

Dr. Kate Rubey

But I think it’s just such a good opportunity for parents to ask the questions and to get more clarity about what are the goals of the day. Because what happens in the NICU frequently is we’re talking about days like today. This is what we’re going to do tomorrow, this is what we want to do. And those days then turn into longer term trajectories over time.

 

00;12;58;20 – 00;13;17;22

Dr. Mona

Yeah. I loved, you know, most of the nikias that I’ve worked at, I’ve been in three from obviously my experience with Ryan, but also just, in residency and rotations whatnot. But, you know, they have a board in there that says, you know, the nurses name for the day, the attendings name, and then also, yes, like the goals for the day, which, like you said, it’s baby steps many times.

 

00;13;17;24 – 00;13;32;07

Dr. Mona

And it’s really hard to kind of understand that sometimes until you’re in it, but how important it is to look at the day versus, well, when are we going to go home? When are we going to go home? Right? I know everyone’s goal is to go home, but it is important to look at day by day. And I love that you mentioned, the different sizes of the team.

 

00;13;32;14 – 00;13;34;19

Dr. Mona

You are at a teaching hospital, right? Like an academic.

 

00;13;34;19 – 00;13;36;07

Dr. Kate Rubey

Institution, yes, I.

 

00;13;36;07 – 00;13;42;29

Dr. Mona

Am, yeah. So I mean, usually the academic institution. So these are places that have, residents sometimes as well, right?

 

00;13;43;01 – 00;13;52;14

Dr. Kate Rubey

Yep. So we have residents on some of our teams. We have neonatal nurse practitioners, physician assistants. We have the whole gamut of options.

 

00;13;52;14 – 00;14;11;29

Dr. Mona

Yeah. And so those teams can seem obviously very big. And I’m so glad we’re talking about that because sometimes that can be overwhelming for someone who may be new to that or not know what to expect if they’re going to have a baby in the NICU. When everyone shows up to talk about their baby, whether it’s premature term, you know, that little baby that’s there, you’re like, wait, why is everyone talking about this?

 

00;14;11;29 – 00;14;13;18

Dr. Mona

And what are these numbers all mean?

 

00;14;13;20 – 00;14;18;09

Dr. Kate Rubey

Why do we need so many people? Like, why do we need it? Like, not at home?

 

00;14;18;11 – 00;14;37;06

Dr. Mona

Exactly. It can seem scary. Like what’s wrong, right? But no, it’s so important. Like the conversations that happen. And usually it’s one person talking first and then, you know, the ideas are bounced off each other. But I think it’s so important to also reiterate that during may not always be around because of whatever reason. And that’s okay.

 

00;14;37;08 – 00;14;55;06

Dr. Mona

It’s just important to, you know, if you have concerns, you communicate with your nurse and communicate with the team. Because it is a team effort, for everything. Right. Like you said, sometimes we notice things or have questions about our child that may not have been answered. And that’s what the team is. Therefore, in terms of the big picture of helping you navigate that as parents.

 

00;14;55;06 – 00;15;14;06

Dr. Mona

So you’re never alone, even though it can seem so isolating when you are a NICU parent. I know that from personal experience. Please know that your team like you know, Doctor Kate and her team, for example, they’re just there to really help that baby and help you and just, you know, have the best outcome possible for that baby.

 

00;15;14;06 – 00;15;31;22

Dr. Mona

I know that’s true. So what do you wish that every parent who has a child in the NICU would know about your work and the work of your staff, like if you could say like, hey, this is what I wish you could know about or, how to prepare or something like that. What would be your message to these parents.

 

00;15;31;24 – 00;16;07;08

Dr. Kate Rubey

Who, that’s a tough one. I think what I would emphasize to every family is that every person who is on the team is there for the baby, and so we all want what is best for the baby. And we are here to partner with families to get that baby into whatever the best situation for them is, in whatever time frame works for the baby.

 

00;16;07;08 – 00;16;32;00

Dr. Kate Rubey

I always tell people, like, listen, they come out and they just want you to know that they’re the boss. So, like, I can pretend that I’m the boss, but I am not. I can only do as much as they let me. And I think, you know, we get a lot of messaging. It’s through our culture, through friends, through families, and people feel that there’s an expectation.

 

00;16;32;03 – 00;16;58;18

Dr. Kate Rubey

And in the nick, I always tell my family’s business a judgment free zone. I have no expectations. I cannot tell you what works for your family, what works for your family life, what is the quality of life that you were hoping for your baby? And so when we are making difficult decisions with families, I just wish everyone could release the guilt.

 

00;16;58;18 – 00;17;20;03

Dr. Kate Rubey

I know that’s like we would be living in a perfect world, right? If everyone could feel guilt free. But I get a lot of families who end up getting so much input and they just feel like they don’t know what to do. And I want all of them to know that in that situation, in the Nicky, your team is there to support you.

 

00;17;20;05 – 00;17;45;03

Dr. Kate Rubey

And we’re in no way judging whatever decisions that you need to make, have to make. We’re here to just present the options that are available, and we’re here to support you through which everyone works for your family, because everyone is different and everyone’s in a different, you know, place in life and what families look like and how families function is unique to every single family unit.

 

00;17;45;06 – 00;18;13;20

Dr. Kate Rubey

And so I just want everyone out there to know, like anyone who’s in the NICU is there to do what’s best for babies. And they just want to do whatever they can to make this kind of unexpected. A lot of times, I think unwanted time in the nick you as like, nice is a bad word, but, you know, as nice as it could be, because it is, like you said, nothing that anyone usually plans for.

 

00;18;13;22 – 00;18;35;03

Dr. Kate Rubey

So we’re very understanding that this is not where anyone thought it would be. And so now we all get to be on a journey together, and we really just want to partner with families and we want to, you know, get their baby wherever they need to be in the quickest and safest way possible. And, you know, we always hope that’s home with them.

 

00;18;35;06 – 00;18;43;22

Dr. Kate Rubey

And unfortunately, that’s not always the case. But we are here for every baby, no matter what the outcome looks like.

 

00;18;43;25 – 00;19;06;25

Dr. Mona

Thank you so much. Yeah, that is so great. And I love that message. Because it is a team. It definitely is some hard choices sometimes, and some hard choices that are never expected, you know, like you are deciding, well, you know, with a new diagnosis, for example, or, you know, you have to start a medicine or whatever intervention it may be, you know, presenting the choices, like you said, and then just career options.

 

00;19;06;25 – 00;19;22;27

Dr. Mona

Here’s what we know. You know, that is so important for people to understand from a medical professional that’s taking care of their child that it is a team, and that we are giving you all the options and helping guide you in what decision you want for your family is such an important message. So thank you for that course.

 

00;19;22;28 – 00;19;36;18

Dr. Kate Rubey

Yeah. And you know, everyone has their just loves babies. Yes. That’s what gets me, you know, out of bed in the morning. Until I go into the next year. It’s a privilege to be able to work with families and, you know, CQ babies every day.

 

00;19;36;18 – 00;20;01;26

Dr. Mona

So well. It’s a privilege to know you through social media and on this podcast. I really want to really thank you so much. I get a little emotional because you’re not my son’s NICU or attending, but I truly have such a very, very big place in my heart for the NICU team. You know, it is not easy doing what you all do at all, like anyone in the medical field, but to take care of families at this very delicate time.

 

00;20;01;26 – 00;20;20;11

Dr. Mona

You know, their newborn baby in an ICU. I mean, that combo is very heartbreaking for so many families. That, again, you said we deal with guilt. We deal with, you know, what could have been, what did I do? And, you know, you just literally have all these emotions. And then the compassion from a health care team like you is just so sweet.

 

00;20;20;11 – 00;20;25;16

Dr. Mona

So thank you again. Where can people find you on social media?

 

00;20;25;18 – 00;20;42;00

Dr. Kate Rubey

So I am on Instagram at Doctor Kate. Which is Dr. Carter. And I occasionally make kind of funny TikToks or not funny TikToks. It depends on the day. And that’s Doctor Kate armed on TikTok.

 

00;20;42;03 – 00;20;55;20

Dr. Mona

Awesome. And I’m going to add all this to the shownotes, so that you can follow her. But again, she brings light into obviously a time that can be very delicate, which I think is so important. And again, thank you for joining me today on this episode.

 

00;20;55;23 – 00;20;59;01

Dr. Kate Rubey

Of course, it was great. I’m so glad we got to talk.

 

00;20;59;03 – 00;21;24;14

Dr. Mona

This episode is brought to you by the New Moms Survival Guide, an online digital course and community created by me, Doctor Mona Amin. Using my experience as a board certified pediatrician and mom, I created this course to guide you through your first year of motherhood. From the foundations of parenting, newborn feeding, sleep in the first year, introduction of solids, and understanding child behavior and development.

 

00;21;24;21 – 00;21;41;00

Dr. Mona

I will be your guide and support you throughout this incredible journey. Make sure to visit Pedes Doc talk.com and be one of the first to get your hands on this incredible resource created to support and empower you as you embark on the joyous path of parenthood.

 

00;21;41;02 – 00;22;01;14

Dr. Mona

Next I have Katie Ross. She is a occupational therapist in the neonatal ICU, and she’s going to be talking about how parents can engage with their baby and somehow enjoy that experience in the near you. As hard as it may be, with practical ways to help their development. Thank you so much for being here today, Katie.

 

00;22;01;17 – 00;22;04;28

Katie Ross

How are you? So welcome! I’m so excited to be here.

 

00;22;05;00 – 00;22;12;20

Dr. Mona

Katie is on Instagram as Blooming littles. I’m going to be attaching that to my show notes. But tell us a little bit more about yourself.

 

00;22;12;22 – 00;22;42;18

Katie Ross

So again my name is Katie and I am an occupational therapist and I’m certified as a neonatal therapist, which means I work in the neonatal Intensive Care unit or NICU. And I started this online resource in community called Blooming Littles. Honestly, it stemmed kind of from the birth of this pandemic when visitation to the NICU U, shut down a little bit and I’m like, how are parents for us to learn about their babies, when they’re not allowed at the bedside.

 

00;22;42;18 – 00;23;02;13

Katie Ross

So I just kind of started sharing education and pulled in some of the other things that I talk about with parents. I work in a hundred bed level for NICU U and so we get the sickest, most fragile babies and just kind of started pulling some information from that and sharing it out in the world. And it’s been really fun.

 

00;23;02;16 – 00;23;19;16

Dr. Mona

I am so glad I found your account. So I found your account and I was like, wow, this is such great information. Because what Katie talks about, like she said, is how a parent who finds themselves in the NICU, how they can engage with their baby, fostering that development, you know, we’re going to go into ways that parents can engage with their baby.

 

00;23;19;16 – 00;23;38;06

Dr. Mona

And I just think it’s so important because child development is one of my most favorite things to talk about. And especially when we have babies in the NICU, it can be so hard to figure out, well, how am I supposed to do this with all of the machines and wires? And if they’re, you know, premature if they’re so tiny, what am I supposed to do here?

 

00;23;38;06 – 00;23;44;12

Dr. Mona

And I just think this is going to be a great conversation to empower parents who may find themselves in the NICU with their baby.

 

00;23;44;14 – 00;24;09;29

Katie Ross

Absolutely. And that is honestly the goal behind everything I do is to I feel like the NICU is almost like a secret, and it’s especially development in the NICU and the use of like physical therapists and occupational therapists in the NICU. And really we get to look at development from the earliest point of care and really help advocate for the use of parents and, the important role they play within their babies, within such a fragile medical environment.

 

00;24;09;29 – 00;24;16;21

Katie Ross

So it’ll be exciting to share some practical ways that we can really support development as parents and staff.

 

00;24;16;23 – 00;24;40;21

Dr. Mona

And the reason why I’m so happy that we’re recording this is, when I was in residency, I did a lot of research in development and ICU, situations. We looked at the effect of reading in the NICU. Oh, you know, and all the developmental things that we do. And I do believe that the environment and the impact we have, whether it’s in the NICU, after the NICU, has a huge effect on child development.

 

00;24;40;21 – 00;24;59;07

Dr. Mona

So even if the child is born really premature, we see great outcomes with engaging environment. So that’s why I think it’s so important that we teach about all of these things so that a parent can start to foster it in the NICU, but also understand, hey, what can we do after the NICU to and we’re going to be focusing on that NICU experience.

 

00;24;59;07 – 00;25;19;00

Dr. Mona

So the first question I have, is really the main thing for this episode are what are some ways I think you had come up with five ways. I’m sure there’s plenty more. Yes, parent can support their babies development in the NICU. Of course there can be more, but I just want to hear what are some things parents can do to start off, if they have a baby in the ICU.

 

00;25;19;02 – 00;25;49;07

Katie Ross

So yeah, so many, so many ways that I’m going to touch on some of the really big ones that are not only just rooted in research and what we know about how it influences our baby’s outcomes while they’re in the neck, as well as long term years and years down the road. But also just things clinically that I hear from parents and I’ve experienced with families that have talked about how beneficial that was not only for the development their baby, but also for the development of that bonding experience and coming into that role as a mom or dad in the NICU.

 

00;25;49;10 – 00;26;14;09

Katie Ross

So the first, way that parents can really support their babies is through skin to skin holding. And this is kind of a buzzword around the NICU. Skin to skin care is also called kangaroo care. So they’re the same kind of thing. And this is where a baby is placed, naked with only a diaper on mom or dad’s chest and left there for hopefully at least an hour.

 

00;26;14;09 – 00;26;36;10

Katie Ross

But as long as the nipple allows that the baby is in and there are just so many benefits to skin to skin care. I mean, the research just goes back to the 70s. It was developed out of the country of Columbia, actually, when they realized, oh my gosh, if we put babies on mom’s chest, dad’s chest who were premature, wow.

 

00;26;36;10 – 00;27;00;08

Katie Ross

They do really well. Like their heart rate comes up and their oxygen comes up. And they have all these improved medical outcomes. So again, not only is skin to skin something that is beneficial, but it’s very accessible. So when you visit the NICU as a parent, you’ll usually have the option of holding your baby skin to skin even when they’re really medically fragile.

 

00;27;00;08 – 00;27;13;26

Katie Ross

And you know, you have 2425 week babies term babies, two tons of term babies, spend time in the NICU. And they also benefit equally from the skin to skin experience.

 

00;27;13;28 – 00;27;34;07

Dr. Mona

And how do you, kind of teach families to do that with all of the wires, like, you know, in terms of if they’re super young, like, I know it’s hard to talk about on a podcast, but is there certain things that a family, you know, if may feel very nervous, you know, to do that? How would you kind of talk to them or reframe that, so that they don’t feel as nervous and that they can enjoy that experience?

 

00;27;34;10 – 00;27;53;14

Katie Ross

Yeah. And I think that’s very natural. And that’s really what I want parents to know, that how ever you feel doing things that we say, oh, that’s so good for development. That’s going to help you bond with your baby. If it doesn’t, if you’re terrified and you’re sitting there, that is so okay. That is an okay behavior to feel as a parent.

 

00;27;53;14 – 00;28;13;26

Katie Ross

Just let us know and we will walk through it as slowly or start somewhere else to if we need to. I personally like to, talk through lines and tubes most of the time. I’ve learned that when parents know what something is and I break it down as like a high risk line or a low risk line.

 

00;28;13;28 – 00;28;30;13

Katie Ross

So we’ll look at a baby before we get that baby out for skin to skin. And I’ll ask Nick, you know, are you familiar with their medical lines? Let’s go ahead and walk through these so that you can know, you know, what’s a really high risk line that, you know, your nurse and I are going to be really cautious with.

 

00;28;30;13 – 00;28;49;04

Katie Ross

And then what’s a low risk line where it’s it falls off. It’s okay. It’s a sticker. So I love to break it down because it can look like a baby has a ton of medical lines and medical equipment, but in reality some of them may be very low risk. So I love to cover that. First. I think that helps parents feel a lot.

 

00;28;49;04 – 00;28;50;00

Dr. Kate Rubey

More comfortable.

 

00;28;50;00 – 00;29;01;23

Katie Ross

Learning that, oh, this little wire on their tummy, you know, that’s just a temperature probe. You know, that’s not something like an IV going into the belly button or something. I think that’s super helpful. And then.

 

00;29;01;23 – 00;29;02;00

Dr. Kate Rubey

I.

 

00;29;02;00 – 00;29;29;07

Katie Ross

Always like to advocate for the use of the safest kind of transfer for a baby. Getting out for skin to skin. So always communicating with family, walking through it before they even have their baby, communicating with the nurse and making sure we’re all on the same page. That way parents can ask questions before the scary part happens where they’re getting their baby out and they’re holding their medically fragile baby for the first time.

 

00;29;29;10 – 00;29;53;00

Katie Ross

And it’s just it is a scary thing. Yeah. I think that, you know, we can normalize it being a very intimidating experience. And not every mom or dad feels this blissful state when they’re in skin, the skin. It’s amazing for development, but it’s not always this cuddly, loving feeling.

 

00;29;53;03 – 00;30;08;08

Dr. Mona

Totally. And that’s so great that you how your frame it. And I love that you walk through what each of the lines do and what everything’s for. I think that can sometimes help families so much when they’re just shocked if they didn’t expect a next day, or they’re just confused and it just helps kind of put some labels.

 

00;30;08;08 – 00;30;24;20

Dr. Mona

And I find that so many of my nephew families tend to be. So they almost are like nurses now, right? Because they are so well equipped with understanding how these things work. And, you know, when I meet them in my office, they’re throwing out numbers and they’re throwing out lines that we’re in, and I’m like, oh, wow. I’m like, are you a medical professional?

 

00;30;24;20 – 00;30;38;01

Dr. Mona

And they’re like, no, you just get that. You just learn so much by being in it, you know? Right. I think that’s so that’s so cute. I love what you also said about it may be something that a family may not want to do. You know, but it’s just knowing if you want to do it, how to do it.

 

00;30;38;03 – 00;30;45;14

Dr. Mona

The next one you had talked, you know, about on your Instagram and, on resources is learning their cues. What would that look like in the NICU?

 

00;30;45;16 – 00;31;01;20

Katie Ross

Yeah. So I’m always advocates one of the first things that I teach parents, when I meet them at the bedside after they find out they’re spending some time in the Navy, is to talk about those cues. And cues are essentially just baby behaviors. And in the NICU, they really look a lot like they can be.

 

00;31;01;20 – 00;31;03;00

Dr. Kate Rubey

Motor patterns.

 

00;31;03;00 – 00;31;26;13

Katie Ross

Or the way a baby’s holding their body or it can even be an autonomic response. So it can even be like something like their monitor alarms, their oxygen drops, their, heart rate drops, something like that. And it’s similar to I talk about parenting like, it’s just like learning about your baby when you bring them home for the first time as a newborn, you’re like, are you crying because of this or crying because of that?

 

00;31;26;13 – 00;31;53;07

Katie Ross

You’re reading and learning about your baby’s cues, and then the next you we really break it down to, you know, is my baby showing stress signs? Is my baby showing me that they’re in pain? Is my baby overwhelmed or hungry, or are they content and ready for a little interaction? I think that when you learn what what your baby’s doing and what their body looks like, it really helps you feel empowered to know how you can interact with your baby.

 

00;31;53;09 – 00;32;15;26

Katie Ross

And it makes you feel more comfortable knowing, oh wow when they put their hand up and it looks like a stop hand is what we call it a halt hand. And it kind of looks like a baby’s giving you a high five. And like, it’s so cute. But when you learn that that’s actually a sign that says, hold up, I need a minute, let me kind of reorganize myself and feel a little more comfortable.

 

00;32;15;26 – 00;32;27;23

Katie Ross

Then parents are like, oh, okay, that means she needs a break. So we’ll back off a little bit, and it just helps you transition into that role of a parent in an environment that doesn’t always support that.

 

00;32;27;25 – 00;32;41;14

Dr. Mona

Oh, that’s so great to know. And yeah, that’s a great point. I think many parents won’t know about that until they find themselves, in that experience. And it’s so important in any baby, but especially in the NICU. What would be another one for the top five?

 

00;32;41;16 – 00;33;08;12

Katie Ross

So the third way that I really think parents can support their baby’s development is through just participating in care and getting comfortable participating in care. You know, sometimes parents do know that they’re going to be spending time in the nipple, but a lot of times it’s a surprise experience where they find themselves just thrust into it all into the language and the medical equipment and then their nurses caring for their baby.

 

00;33;08;15 – 00;33;39;05

Katie Ross

So there’s this shift that kind of has to happen as a parent, as a mom and a dad that we witness, or they’re watching the nurse be the mom figure to their baby, and they’re figuring out, how do I start caring for my own baby? But I’m terrified. So doing things like doing diaper changes and taking your baby’s temperature and repositioning them or providing some oral care where we clean their mouth out with breast milk, something like that.

 

00;33;39;07 – 00;34;00;24

Katie Ross

That’s what care looks like for a NICU baby. So and those are all things that parents can do. So it’s sad that we have to think about inviting parents to the bedside, but really inviting parents in to be a part of that and parents just knowing that you can do that 100%, you can do diaper changes with your fragile baby.

 

00;34;00;26 – 00;34;19;19

Katie Ross

And a lot of parents become the experts in and are awesome at it, and that by the end of their, you know, changing ostomy bags and central line dressings and they’re do like you said, they are in the know, in the knowledge about everything. And they can just tell you more about your baby than anyone else knows.

 

00;34;19;21 – 00;34;39;16

Dr. Mona

Yeah. And I love what you said about the fact that when you have a baby in the NICU and you look at the NICU nurse, you see that NICU nurse, take such great care of your child. And when you don’t know how to care for that child, whether it’s because of all the stuff that’s on them or because they’re small or they have a medical diagnosis, it can actually make you feel not so great.

 

00;34;39;16 – 00;34;58;09

Dr. Mona

I mean, I remember even for myself, like my son was a term baby in the NICU and I had physical issues that I couldn’t be there a lot. And it was very guilt provoking, you know, and it really came down to finding that relationship with that nurse to make sure that they communicate with me when I wasn’t there, making sure that I could be there for, you know, touch time.

 

00;34;58;12 – 00;35;21;08

Dr. Mona

That’s what we call it, right? A time when touch time. Right? Yeah. So when it’s that time where, we’re doing feedings and changing and all of that. And it was so important for me and, you know, from that aspect, for all of you listening, if you find yourself in the experience of being a new parent. Make sure you communicate with your nurse, like when everything’s happening, you know, what time or things, if you are downstairs, you know, on another floor because you on labor and delivery.

 

00;35;21;11 – 00;35;37;08

Dr. Mona

Just ask them, you know, like, hey, what time is this? I want to be here. Even if it’s just to watch and even if you need some time. Because, you know, I went through a lot of emotions, and I didn’t want to be there for touching time initially, because I was still so shocked by everything. And I just said, you know, I’m not going to make it.

 

00;35;37;08 – 00;35;50;19

Dr. Mona

And I made that very clear as to why I’m not going to be there. My nurse was so nice about it. And then I came into my own time, you know, of wanting to be there. So, like you said beautifully, Katie, every parent is going to be very different in what they’re comfortable with and listen to yourself.

 

00;35;50;19 – 00;35;53;17

Dr. Mona

But communicate with your nurse too. And the medical team.

 

00;35;53;19 – 00;36;18;15

Katie Ross

Yeah. And I love that you’re sharing that vulnerable piece of your journey in the NICU, because more people need to understand that that is an okay response. Everyone responds differently to trauma and the shock of an experience. So, you know, you have to take care of yourselves to take care of your baby. And you have wonderful nursing staff to care for your little one in the meantime until you’re ready to be there.

 

00;36;18;17 – 00;36;25;25

Dr. Mona

Now, that’s so great. What would be, something else like you, you know, would want to tell parents about how they can support their baby’s development.

 

00;36;25;28 – 00;36;50;19

Katie Ross

Okay, so this next one is, a tough one for parents, to jump into. But I do want to expose you. If you’re a parent who’s been in the NICU or is currently walking that journey right now is just one thing we can do to support excellent brain development that supports overall development is decreasing the pain and the stress experiences that your baby’s having in this medical environment.

 

00;36;50;21 – 00;37;17;24

Katie Ross

And this is a really tough conversation to have with parents, honestly, because I don’t want any parent to acknowledge that their baby is in pain. I, as a parent don’t want to acknowledge and my baby’s in pain. So, unfortunately, it’s something we have to do. Life saving measures need to occur to take care of these babies, but there are things that you can do as a parent that will decrease your baby’s stress and decrease your baby’s pain.

 

00;37;17;27 – 00;37;51;11

Katie Ross

And that’s what I like to point out, is like the power of the parent and the power of the caregiver in doing things that we can teach during, you know, a baby getting a heel stick, or if a baby’s getting a feeding tube placed down their nose or placed into their mouth, or, if a baby’s getting suctioned, if they’re on a ventilator, those kinds of things are stressful for babies, and we can do some comforting techniques that can help ease that pain and stress experience, which helps and shapes a brain.

 

00;37;51;14 – 00;38;04;05

Katie Ross

So if we can kind of get rid of all those negative experiences and transition them to positive experiences with the presence of a parent, then we are really setting that baby up for success after discharge.

 

00;38;04;07 – 00;38;07;29

Dr. Mona

What would be the final one? Would you say?

 

00;38;08;01 – 00;38;28;07

Katie Ross

So the final one, I broke it down into things that you can do to support development, that you can do when you are not at the bedside. So like you said, you weren’t ready to come to the bedside. And there’s so many reasons why parents aren’t at the bedside. And depending on what area of the country you’re in, what level?

 

00;38;28;07 – 00;38;48;20

Katie Ross

NICU, you’re. And I work personally work in a very large, urban nature where we take kids from six hours away, eight hours away. So parents physically can’t always be there to provide these kinds of things. And, like, you use the word guilt, that guilt that you can feel when you want to be there for your baby, but you feel like mentally and emotionally you can’t.

 

00;38;48;22 – 00;38;49;10

Dr. Kate Rubey

 

00;38;49;13 – 00;39;24;05

Katie Ross

And then there’s also people who don’t have the resources. So I like to bring up some things that can help parents feel like, oh, I’m supporting my baby when I’m not there. And one of those is making sure that when you are there that you’re providing a scent cloth for your baby. So a scent cloth is something that mom wears, usually just in her bra, like a little piece of cotton, a lovey and then that’s left with the baby in the isolate or in the crib so that they can smell mom scent, because it’s very comforting and calming and just change it out whenever you come and visit.

 

00;39;24;05 – 00;39;52;03

Katie Ross

And then the other thing you can do is pump breast milk. And this is something that I’ve had so many parents tell me, well, you know, I couldn’t do this, but at least I knew that I was pumping some breast milk. And that is a journey that is very tough for a lot of women. But, breast milk is just something that parents can feel like, okay, this is something special that I’m providing for me to you, and I can do it when I’m not at the bedside.

 

00;39;52;06 – 00;40;00;26

Katie Ross

So I always like to advocate and encourage my parents to be proud of themselves when they’re doing that, because it’s a really tough thing to do.

 

00;40;00;28 – 00;40;17;04

Dr. Mona

These are great tips. And, you know, I wish we could do like all of the tips that you have. And again, your Instagram is such a great source of information. What would be something else that we can do when we’re not technically at the bedside? I know you talked about leaving the lovey or like the scent cloth, the pumping milk, but what else can we do?

 

00;40;17;07 – 00;40;37;01

Katie Ross

So the last thing that I kind of mention that you can do and you can’t be at the bedside, is something you actually already mentioned, which is making sure that you are communicating with the bedside staff, your bedside nurse, building a relationship with them so that you can plan on participate in whatever you want to be doing. Whenever you do come and visit.

 

00;40;37;04 – 00;41;05;27

Katie Ross

A lot of times there’s this break in communication that happens where, oh, we didn’t know mom was coming in today. I already gave her her bath this morning or oh, I’ve already done their care for today. We don’t want to wake them up and get them out for holding. And that kind of stuff is so sad because when parents miss out on these opportunities, and especially when they live far away, or it’s tough to get into the unit, I want you to be able to learn and get comfortable participating in your baby’s care and doing some of these things that are natural and good parenting things.

 

00;41;05;27 – 00;41;23;12

Katie Ross

So when you, are in the next you calling and getting on the same page and saying, hey, I’m planning on coming up today at 2:00, I would love to hold her when I get there. That is so helpful for people on the other side of your providers who are planning their day to figure out how am I going to do all the things?

 

00;41;23;12 – 00;41;45;02

Katie Ross

Or even if it’s like, oh, they’re getting a bath tomorrow, I can’t be there tomorrow, but can we do it today? Instead of asking things like that? We act very rigid in the NICU, like we’re on this crazy schedule and everything is at these crazy times, but in reality, we should be a little more flexible when it comes to involving parents in those activities that are parenting activities.

 

00;41;45;02 – 00;42;01;03

Katie Ross

So asking, can we do the baths today? I haven’t done a bath yet, things like that. That just really helps you feel more empowered as a parent and I’m giving you permission. You are allowed to ask. You are allowed. Allowed to, kind of make a change for your baby.

 

00;42;01;05 – 00;42;16;06

Dr. Mona

Oh, yes. And it’s so simple. You would think like, yeah, it would be there for the bath. But that happened to us too, right? Like I couldn’t be there. And we pushed back his first bath like a week and a half, you know, a week and a half like it was four days because I couldn’t be down there and it was totally fine.

 

00;42;16;06 – 00;42;44;04

Dr. Mona

I mean, usually it happens much earlier, but it sounds like it’s such a simple thing. But sometimes I think parents forget that they can ask these things, and I think it comes from a place of just being overwhelmed. Like I said, you you may not have expected to be there, and even if you did just say you, you knew that there may be a preterm delivery, in the calves, even if you had an expectation, it’s still is different when you’re finally there and you see everything happening, you see the NICU team come around, you see where your baby’s at, the wires, all of that.

 

00;42;44;04 – 00;42;59;29

Dr. Mona

And it’s like, it’s a shock, right? You’re like, what is going on? What can I do? And I just think, like you said, like this episode is just so great to talk about all of that and how we as parents are part of the picture and the outcome for that child, for sure. I do appreciate the medical team greatly.

 

00;42;59;29 – 00;43;19;10

Dr. Mona

I mean, obviously they do so much, but our communication, our advocacy as parents for anyone listening is so vital. You know, you’re going to be there, you know, your baby, even if you think that your nurse may know your baby best, because of their, you know, you’re in the NICU, you know, you’re a baby and you’re going to learn about that baby, and you’re going to advocate for that baby.

 

00;43;19;10 – 00;43;27;04

Dr. Mona

And I think everything’s Katie saying is going to empower you to feel that way. And I just am so appreciative of all the stuff that you’ve added to this, episode today.

 

00;43;27;07 – 00;43;30;06

Katie Ross

Yes. Little League and my pleasure.

 

00;43;30;08 – 00;43;40;00

Dr. Mona

And what would be like a final message for everyone listening? You know, if they find themselves in the NICU or, you know, just something that you’d want to leave everyone with today?

 

00;43;40;02 – 00;44;09;23

Katie Ross

So many things. But again, I’m going to think eventually. I always want parents to know that whenever their baby is born, whatever is going on, whether it is a genetic, congenital anomaly, whether it is a birth injury, whether it’s prematurity, whatever it is, when your baby is born, they do know you. There is this perception that my baby isn’t going to know me, but in reality, your baby has been in your womb and listening to you.

 

00;44;09;23 – 00;44;31;28

Katie Ross

And weirdly enough, smelling your amniotic fluid. And and when they emerge, even when they’re 23 weeks, they know their parent and there is, no one who can take place in that role. You had said that you think the nurse knows your baby better, and I like to switch it and think like your baby knows you better.

 

00;44;32;01 – 00;44;56;13

Katie Ross

As a parent. And I never, ever want a parent to think that their role is less important because we know that your baby knows you uniquely, and you offer so much comfort and positive energy to your sweet baby as they’re healing and growing. And then also that your journey is completely unique. And we’ve already talked about this. This is something I want parents to know.

 

00;44;56;13 – 00;45;17;15

Katie Ross

There’s this natural guilt everyone carries as a parent, no matter what journey you’re on. But when your baby ends up in the NICU, there’s just this extra layer of trauma that’s there. Start where you’re comfortable. Again. You already said, you know, I couldn’t be there. I couldn’t get down there mentally to take care of my kiddo. And that is okay.

 

00;45;17;17 – 00;45;29;25

Katie Ross

That is okay. And you have to start. If you’re not ready to do scan the scan, because the idea of getting your baby out, who’s on a ventilator and has all these medical lines is enough to make you feel like you’re going to faint.

 

00;45;29;28 – 00;45;30;15

Dr. Mona

Yeah.

 

00;45;30;18 – 00;45;40;16

Katie Ross

You know, start somewhere else. Put your finger in your baby’s hand. That is beautiful. And that lets your baby know that you’re there. So wherever you start is perfect.

 

00;45;40;18 – 00;45;54;00

Dr. Mona

That is such a great message. Oh, man. Katie, that is just so. That final word, you know, wherever you start is perfect is exactly what it is. And everyone’s going to be so different. And so I just again, appreciate you so much. Where can everyone find you again?

 

00;45;54;03 – 00;46;15;18

Katie Ross

So my Instagram handle is blooming Littles. And then we also have an online resource and website that is Blooming littles.com, which offers some free resources and webinars. It’s geared specifically for families while you are in the U.S it’s one of the only resources out there for families about development, and we have some exciting things coming up in 2022.

 

00;46;15;18 – 00;46;23;12

Katie Ross

So, if you’re a family in the nick, you or know that you’re going to be there at some point, we are happy to help you walk along that journey.

 

00;46;23;15 – 00;46;35;04

Dr. Mona

Thank you so much. And I will be adding this to my show notes. So everyone, please take a listen. And a look at, her Instagram account as well as a look at her website. And thanks again for joining me today, Katie.

 

00;46;35;09 – 00;46;38;04

Katie Ross

And absolutely, thank you so much.

 

00;46;38;06 – 00;46;53;27

Dr. Mona

Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV. We’ll talk to you soon.