Babywearing As a Tool to Decrease Pain and Stress Associated with Neonatal Abstinence Syndrome

Background and Purpose: Prescription opioid sales in the U.S. has almost quadrupled from 1999 to 2014; correspondingly, infants diagnosed with Neonatal Abstinence Syndrome (NAS) has increased more than fivefold. NAS is commonly associated with maternal opioid use and includes symptoms such as high-pitched crying, tremors, and poor feeding. Infants with NAS are accustomed to drug exposure in utero; consequently, when the drug is no longer present, the absence of the stimuli is painful. Elevated heart rate (HR) is synonymous with increased infant pain and stress in adults. Research on skin-to-skin or kangaroo care has found decreased perceptions of pain (i.e., HR) during heel prick procedures. The proposed study will be the first to demonstrate that physical contact through Babywearing (i.e. holding or carrying a baby in a cloth carrier that is worn on the body) can have similar pain-reducing and stress-relieving benefits and potentially promote maternal-infant attachment. 

Methods: This repeated-measure study took place in a Neonatal Intensive Care Unit (NICU) in the Southwest USA. Starting when infants were four days old, physiological readings (N=97 readings; N=15 infants; 53% White, 20% Hispanic, 13% African American; 53% female) were assessed daily; heart rates of infants and Individuals Wearing the Infant (IWI; 16% mothers/5% fathers) were taken every 15-seconds before, during, and after carrying the infant in an infant carrier (approximately an hour and a half procedure from start to finish, allowing 30 minutes for each phase). A finger plethysmograph, also known as a pulse oximeter, measured heart rate for the IWI. Infants were continuously monitored by cardiopulmonary machines using a pulse oximeter wrapped around their foot. We used a 3-Level Hierarchical Linear Model in order to account for the nested data (HRs nested within readings, nested within infant-adult dyads) at three time points (before, during, and after babywearing). 

Results: We found that compared to baseline (infant calm/asleep and without contact), infants and IWIs heart rates’ declined significantly (B=-1.84, SE=.20, p<.001, and B=-.65, SE=.10, p<.001, respectively), indicating reduced pain and stress, both during (20 minutes in the carrier) and after (30 minutes following) using the carrier. There was no significant difference by IWI (mother, father, nurse/volunteer). Infants being treated pharmacologically (morphine, clonidine) had a lower baseline heart rate (B=-10.59, SE=3.28, p=.002) but no significant interaction effects with carrier use. 

Conclusions and Implications: Babywearing infants with NAS can decrease infant pain and caregiver stress. Incorporating babywearing into NAS treatment protocol in the NICU can reduce expenditures by eliminating the use of expensive pharmacological interventions and long hospital stays. Additionally, promoting Babywearing as a hospital norm and policy can reduce risk for child abuse and neglect on a more macro level. Parents who are able to calm and sooth their infants perceive their infant as less difficult, have greater parenting confidence, and are more likely to develop a secure caregiver-infant attachment.