I’ve been thinking a lot about the gaps in research in the medically complex paediatric population, and the disparities in care as a direct consequence.
One example of this is the abundance of literature about skin to skin in the neonatal setting.
I’m not for a moment suggesting that skin to skin or kangaroo mother care is universally adopted as normal practice in every single neonatal unit. I know full well that there is work to be done, and so much progress to be made in many units.
However, the disparity between the neonatal unit and paediatric setting is stark. While there are hundreds of studies that explore the benefits and impacts of skin to skin for preterm neonates, guess how many studies have explored the impact of skin to skin care in the paediatric ward or paediatric intensive care unit? You guessed it – zero.
There are rat studies, and there are studies of preterm babies and healthy term newborns, and there are also studies that have explored this in cardiac critical care, but none that explore whether skin to skin in sick babies and toddlers beyond the neonatal period is a good idea. To be clear, the paediatric ward and PICU will admit children from as young as 1 day old. So why don’t we have any research on this clinical setting?
Is skin to skin only useful to a preterm baby or a healthy newborn? Or a rat pup? Do we genuinely think that a sick 5 day old baby, or a 3 month old baby, or a 10 month old baby will not benefit from the calming, regulating presence of their mother or parent?
It’s ridiculous isn’t it?
So – the argument could be that it is obvious by definition. Perhaps we don’t need research because it is so well-researched in other settings that it would be superfluous to repeat the studies in a different population group? Or maybe we assume that children who are older won’t benefit from it? Or that parents of older children won’t want to? Maybe we assume that because skin to skin is promoted in the healthy newborn setting, and the neonatal setting, this will carry through to all children in the paediatric setting?
I’ll save you some time. None of these arguments hold any water.
Firstly, paediatrics is an entirely separate directorate from the maternity and neonatal settings. This means that there are different staff, different budgets, different statutory and mandatory trainings, different budgets, different specialist services.
Secondly, it isn’t obvious. Not if you’ve not had any training. Not if it’s not the culture on the ward. Not if you’ve never seen it. Not if nobody else is talking about and advocating for it. Not if there is no research study to back you up. When a senior colleague chews you out and asks you for the peer reviewed paper proving it’s safe and a good idea… the problem is that there isn’t one. So although it makes total sense, and there is no physiological reason why it wouldn’t be a good idea, it’s not something we can (currently) back up.
Do parents not want to do it then? Or do babies and children resist skin to skin? What do you think? I won’t insult your intelligence here. I hear from parents every week who tell me they feel disconnected from their critically sick child. They tell me that they feel like a spare part, uninvolved, and disempowered. Many tell me they asked for skin to skin but were told it couldn’t happen. Or they asked for it and it was allowed, but they were the only ones, and they felt like people were giving them strange looks.
We need to make skin to skin on the paediatric ward and PICU commonplace. It should be standard care. Like optimal cord clamping or family integrated care. It should be assumed and normal. Not weird or a bit alternative. We need to stop defaulting to ‘it’s not safe’ or ‘it’s not done’. This is nonsense.
I could tell you stories all day of the babies whose conditions were turned around by skin to skin and breastfeeding after major surgery, intubation, critical illness, intractable pain and so on.
I long to repeat my literature review on skin to skin and find that there are studies that have been conducted in the paediatric setting. We need this research. It’s not enough to assume that because the research exists in the neonatal setting that this means we don’t need a new study in paediatrics. I’m tired of hearing from families that have had to fight for this most basic and obvious intervention.
Sometimes I feel a little overwhelmed by all the work that needs to be done in paediatrics. It’s daunting to say the least, but it keeps me fired up!
If this topic leaves you wanting more, you can check out my book Breastfeeding the Brave, as well as the 1-day course by the same name, and feel free to swing my designated website www.breastfeedingthebrave.com where I’ve collated all my work on this topic, including my published articles.
Lyndsey Hookway is a paediatric nurse, health visitor, IBCLC, holistic sleep coach, PhD researcher, international speaker and author of 4 books. Lyndsey is also the Co-founder and Clinical Director of the Holistic Sleep Coaching Program, co-founder of the Thought Rebellion, and founder of the Breastfeeding the Brave project. Check Lyndsey’s speaker bio and talk brochure, as well as book her to speak at your event by visiting this page. All Lyndsey’s books, digital guides, courses and webinars can be purchased here, and you can also sign up for her free monthly newsletter here.