July 2017

Introducing the term 'trauma' into the NICU lexicon has been met with mixed responses. For many clinicians, the term is 'too loaded', for others, the term is rejected out of hand with statements like: 'I am not a source of trauma for my patients, I am trying to save lives'. And then, there are many who feel the term does indeed describe the infant-family experience in the NICU and, even has implications for the clinician.

The journey I have been on with this idea of adopting trauma-informed care as a model for care in the NICU, PICU, and beyond originates from what is known about early life adversity, childhood trauma, and toxic stress. The word trauma is a loaded word, it is a strong word that upends how we view the critically ill infant's experience of care - it is unsettling but that doesn't make it any less appropriate or accurate. In the great words of William Shakespeare "a rose by any other name would still smell just as sweet".

In Chapter 4 of the book 'Scared Sick' the authors talk about 'Little Traumas - Prenatal and Perinatal'. The chapter opens with the history of 'baby pain' and the pioneering work of Dr. Sunny Anand. Dr. Anand's work transformed the surgical care of critically ill infants and slowly began to tear down decades of skepticism regarding infant and fetal pain that characterized much of 20th century research and clinical practice.

An exhaustive list of prolific researchers have compiled more than enough evidence to validate that infants and even fetuses experience pain, yet we continue to deny or minimize these experiences - could this not be considered traumatic?

Despite what is known about the traumatic effects of maternal separation on the neonate, NICUs across the globe are challenged with ensuring parental presence and parent-infant closeness in the NICU.

I could go through each of the original, NANN endorsed core measure sets highlighting how we still struggle, for various reasons, to consistently and reliably provide developmentally supportive, age-appropriate care for hospitalized newborns, infants and families but it's probably time to get off my soap box.

The word trauma is harsh and harshly accurate. It's powerfully descriptive and gives us thought to pause and reflect on the actual lived experience of our patients and their families. 

Maybe, just maybe, the word trauma is strong enough to catalyze a change in NICU culture that is long overdue.