Very young children, the ailing, and the elderly are the most vulnerable members of society, so it’s only logical that they should be treated with even more thoughtfulness and respect than those capable of expressing their needs or fending for themselves. Unfortunately, society doesn’t always follow logic. Instead, we think nothing of abruptly scooping infants and toddlers up, shuttling them around, poking and prodding without even a word of warning and talking over them as if they are things rather than people.
The first time I witnessed someone talking to a baby respectfully – just like any other ‘real’ person — I thought it truly bizarre. I got used to it, though, and now I hope someday it will seem illogical to everyone not to treat babies this way.
The note below greatly encouraged me. It’s from a nurse working in Neonatal Intensive Care who has begun implementing Magda Gerber’s RIE philosophy in the nursery and is already marveling at the results of her efforts to:
1. Communicate with babies, especially to prepare them for the things that will happen to them.
2. Give babies undivided attention during caregiving activities (feedings, diapering, etc.)
3. Be a play “follower”, allowing babies to initiate activities and interactions.
Hi Janet,
I found your site several months ago. While I’m not yet a parent, my spouse and I have been trying for a little one for over a year. What Magda Gerber said (and what you re-iterate and illustrate through real life examples) resonates with me deeply, and we have applied RIE principles already towards each other — to practice, and because I have an incredibly difficult time expressing myself.
I am also an NICU nurse at the highest level nursery in the province I live in. We take the smallest and sickest babies from all over the province. My job is incredibly rewarding, sad, challenging and often full of joy (and tears, frustration, etc). I started ruminating on how to apply RIE to my job, and if it would even be successful, considering the incredible turn-over rate we have between nurses caring for each baby.
Turns out, it actually works pretty well! Your recent posts about how to communicate with a child who ABSOLUTELY DOES NOT WANT SOMETHING were incredibly helpful, considering we poke and prod and cause a lot of pain in the tiny patients.
There are some principles of RIE which I have modified to fit with our NICU requirements. For example, babies in NICU have little to say (or are unable) to express their needs for food. They are given a regulated amount of nutrition to satisfy caloric requirements so they can grow, heal and go home. We feed babies on a routine schedule (either every 2 or every 3 hours), usually via a small tube that is placed in their nose and feeds into their tummies (since at 1200g, most babies lack the energy to take enough calories by oral feeding, and they are usually on some kind of breathing support which does not allow oral feeding for safety/logistical reasons). Diapers, temperatures and assessments are done around these feeding schedules, which often interrupt a baby’s sleep schedule. This is a hard part, because the tiny ones do not wake in response to hunger anyways!
There has also been repeated research to show that talking to premies activates the part of their brain that processes sound and develops language at the right rate, and that delayed language acquisition in this population is a bigger problem than initially thought. By using RIE, I am talking to babies, talking them through procedures, diapers, temperatures, turns, weights, moving, EVERYTHING. I’m nattering at the impossibly tiny babies all day long (because I have more than 1 at a time). It’s exhausting, but even since starting I have noticed a small difference!
The biggest change I have noticed is that I am calmer, especially when confronted with a screaming and inconsolable baby at 3 am, who has done nothing but fuss all day long and is clearly exhausted and uncomfortable. While it’s not perfect and I have my moments of wanting to pull my hair out, it’s a good change (and walking away from some of these babies is impossible, as is letting them cry, as their lungs are too damaged to tolerate crying).
I am more present while bottle feeding babies, and encourage the parents I work with to BE PRESENT when feeding/changing. It’s hard not to have your heart melt with the little one you’ve watched grow from 600g into a 4kg hunk of baby look up at you with shining eyes as he swiftly and calmly learns to breastfeed and bottle-feed.
In the diaper changes with the babies, the most marked changes I see are with the baby I deal with every single shift, my “primary”. He is the first one I’ve applied RIE to, so he’s sort of my guinea pig! He’s much, much, much calmer during temperatures (which all babies hate with a passion and scream about).
His attention span is pretty fantastic for the most part, although now that he’s big enough to pick up, his parents rarely put him down, which I totally understand, since they only got to hold him for an hour a day for the first 10 weeks of his life. Most of our babies have great attention spans, since they are left to their own devices and really only attended to if they need something.
This was fully demonstrated to me when I went to visit another former primary who was in NICU for 4 months and very nearly died at birth. She’s got some chronic issues from her condition, and I went upstairs to the pediatric ward to visit her when she was last in the hospital. Now at 18 months, she’s a vivacious, amazing toddler with some serious attitude.
I was horrified to discover that peds staff (nurses, doctors, etc) don’t actually talk TO the baby, just to the parents, and then wonder why the toddler screams bloody murder during assessments!!! Yeesh! I chatted WITH the baby, told her I was just there to see her, followed her game of playing with cups, and she let me into her personal bubble and even snuggled up to me for a quick hug (her choice, and her mother’s jaw was on the floor, since she’s really not a snuggly kid — she’s far too interested in being independent than cuddling). That incident cemented RIE as the way to go in my professional practice.
So, thanks for putting everything out there. I really appreciate it, especially getting to apply Magda’s principles to an environment where babies lack control over absolutely everything in their lives. While they may not get a choice about their feeding schedules, where they are, the noise they are exposed to, who looks after them, etc, I do what I can to make small changes!
Sincerely,
Elizabeth, BSN, RN
Nurse Elizabeth, thank you so much for all you do!
Learn more about the power of respectful care in my book, Elevating Child Care: A Guide to Respectful Parenting
(Photo by didbygraham on Flickr)
What a wonderful, wonderful post. I am so happy to see your work {the RIE Method} finding its way into hospitals! These little ones so need it. So many of the children that I have worked who have had substantial medical intervention are so hungry for respect and trust in their ability to grow and thrive. To hear stories of the RIE Method finding its way into hospitals truly makes my heart sing.
Me, too, Buffy!
This was such a joy to read Elizabeth… My son (who is now 16 months old) was born 8 weeks prematurely, and spent almost 5 weeks in the NICU. I think it is amazing to hear that you are using these RIE concepts with babies in your care, and whole- heartedly believe that it will impact those little ones in a positive way. Nurses give so much while they care for others, and the energy can really be felt. I always appreciated hearing nurses speak kindly to my son while he was in the NICU, and their positive encouragement helped to make my experience a more manageable one, especially during such a challenging time.
Now at 16 months old, my son is a bundle of energy! I try each day to communicate with him using RIE philosophy and methods, and have noticed how well he responds. People comment on how receptive he is, and I honestly owe much of that to Janet! Having this blog as a resource has made me a better parent, child care provider and person! Thank you!
Thank you, Kasia! Sharing Magda Gerber’s wisdom has been my great pleasure. It has been deeply gratifying for me to know that people are picking up these life-changing tools and putting them into practice all over the world. One thing that all babies have in common is that they respond to respect. Glad it’s helping, Kasia.
I love this post! As a mom of two boys, one currently three months of age, and having been an infant teacher for nine years, I know how true and important all of this is! Wonderful information that all parents and caregivers should know and put into practice. I’m thankful that my baby’s doctors and nurses (he has CF, so it’s a lifelong illness) do talk to us, but they also talk to him every visit! 🙂
Fabulous post. Thank you for sharing. And thank you to the nicu nurse. My son was a preemie and spent almost 4 weeks in the nicu and i appreciated any kindness shown us. One thing I would like to say though, I was a first- time, single, without family support mom and was scared to death of touching my tiny one. I did KNOW him…I was only allowed to spend one actual hour with him a day (1/2 hr twice a day) but my mind and heart were with him the other 23. Once in awhile, I wish the nurses had asked ME what I thought was best for my son. e.g., they often swaddle the babies. And many babies like that. My son hated it. Cried, screamed, squirmed, turned purple and fussed till I could get him out of their burrito like packaging. One militant swaddler who had been there 20+ years insited all babies loved it. And trying to discreetly get him out of the wrapping without her telling me it was best for him, kept him warm, etc., ruined our time together. Seriously, i wanted to love, hug, feed and care for him and often I was holding a miserable child who I couldn’t help get out of what was bugging him because the nurse would chastise me. I conveniently knocked all the hard scratchy head coverings off too…he’d rather have none then something that made his skin red. So please, as much as treating the child with respect, do the same with the nervous, unsure, yet convinced parents who really do want what is best for their child.
Wow, thank you for sharing. As the mum of a bubba that was in Nicu I can only hope some of the nurses adopted the practices you have described. Well done and thank you for doing this for the babies And their families.
Janet –
Great article! Our daughter was in the NICU for 8 weeks and required two significant surgeries during her stay. I have to say I think the best NICU nurses that we worked with (and there were so, so many wonderful nurses)intuitively do this stuff so beautifully, and modeled it for us as new parents. However, I’ll never forget ONE of her Doctors (Dr. Vincent Ten at Colombia) who embodied this as well. He spent so much more time observing our daughter than any other doctor. Just watching her and being with her- and used that (as opposed to tests sometimes) as the basis for his care. We were so blown away by him. Anyway – great article. Dena
Great article indeed!
This is making me think about Harvey Karp’s “Happiest Toddler on the Block” book. He recommends talking with toddlers like they are neanderthals. Have you heard of this?
Hi Michelle! Yes, I’ve heard of Dr. Karp and I wholeheartedly disagree with his advice for both infants and toddlers. Babies and toddlers are not Neanderthals and “aping” their early attempts at language is beyond disrespectful, in my opinion. They have been listening to our language beginning in the womb and understand far more than they can express. How rude it is for us to talk down to them! Here’s something I wrote about that: https://www.janetlansbury.com/2010/05/talking-to-toddlers-4-secrets-that-bring-you-closer/ But, no offense, Michelle… I admit to having a passionate distaste for Karp’s work.
Ah, thank you for sharing that post. I have been asking around for books on toddlerhood. I recently read 1, 2, 3… The Toddler Years, which resonated with me. Then a friend recommended Karp’s toddler book, and I thought I’d give it a shot, since I’d heard of his 5 S’s for working with babies and the swaddling in particular was a lifesaver for my son. Anyway, I’m only a few chapters into it and I’m already feeling very uncomfortable. For starters, the tone feels off (I’m not used to self-help books I guess). And although I somewhat agree with a couple of his broader points about some of the developmental changes during toddlerhood (I’m the poster from a few weeks ago who is a professor of developmental psychology), I’m having trouble understanding his justification for talking to toddlers like that. Sure, toddlers are less emotionally sophisticated than adults and do not have the same kind of impulse control as we do, but how does talking to them like that help anything?
Here’s the link this friend sent me to explain the method:
http://www.youtube.com/watch?v=lrxBKvV1p-A
Michelle, our children have been listening to every word we’ve uttered from the moment they were born (and even in the womb). They know the way we speak to others and they have always understood volumes more than they could express. What message do we send children when we suddenly talk to them like they’re imbeciles? I don’t doubt it stops tantrums in their tracks when children hear their parents speak so strangely. Perhaps Karp believes we have calmed them and made them happy?!
When we make a loud “shhhh” noise directly into and infant’s ear while also rocking her and shoving a pacifier into her mouth (I’ve seen Karp’s appalling video demo of this), we overload their senses and shut them down. Karp seems to foolishly believe this is “success” — a quiet baby! Karp’s way of making babies quiet isn’t “happy” OR healthy.
This was a great article! My daughter spent 3 1/2 months in the NICU (she was born 3 months early). Most of our nurses were great, but some of them felt it was best for her to have a completely quiet room so that it would be more like being in the womb. The developmental specialist in particular often upset me with this sort of advice. I once asked her if it would be okay for me to sing to my baby, and she said that I shouldn’t because it would be too stressful for the baby. I asked some of my more favorite nurses about this and they said do what feels right to you; you’re the mom. So I sang softly to my daughter and talked to her like a normal person because that’s what felt right. Now she’s a spunky almost 2 year old and she’s doing great! While she was in the NICU, the doctors and nurses told us that babies in the NICU will all have ups and downs along the way and that some days she would make progress and other days she’d take a step backward, but my daughter never had a bad day. She made progress every single day, and all of the nurses and the doctors were completely amazed with her. I’m glad that there are other people out there who agree with talking to babies in the NICU. They need all the love and attention they can get while their parents aren’t able to be with them.
Thank you Elizabeth. This was so heartening to someone who’s had some bad experiences with medical professionals. Wonderful letter!
I just brought my baby girl home from the NICU after spending 7 of the longest weeks of my life there. Thank you to the nurse for practicing this with her babies, I think it’s awesome that you are pushing yourself to be an even better nurse despite the long hours and intense work load. You are beyond appreciated and have inspired me to set some new parenting goals at home.
It’s so nice to see this article! So often children with medical issues are only seen as “the patient” and not as a “child” first. They are infants and children.
Medical professionals that see babies and children as just that, will have a completely different experience and much greater success with children and families than those that don’t.
We have way too much experience with this topic. Our older son spent five long months in two different NICU’s. He also spent many many more months in and out of PICU’s throughout his life. Appointments, tests, procedures… standard, and part of life for him.
As parents, we quickly learned that nurses, doctors, therapists and others that interacted with our son, for the most part were not “natural” at treating him with respect. We often had to speak with them about what worked for him, how he needed things to be done, what was and was not helpful. We had to tell them to talk “to him”, not “about him”…. that it was important to include him in some conversations, but not in ALL conversations. We had to remind them that this was HIS body, and not just an object for them to “practice medicine on”… it was important for them to explain things to all of us and to give time for us to help him process his thoughts and feelings. It is sad, but true. There were only a few who really seemed to grasp that children truly are children… showing respect, and earning that child’s trust are the keys to a positive relationship.
We still work hard at speaking to medical professionals about patient and family-centric care. It’s vitally important especially for children who have significantly complex health care needs, but also for the typical child going into the ER for a broken bone, or the OR for ear tubes. All children deserve to be treated with respect and dignity.
Amazing ✨ what a beautiful, committed medical professional.. making every little difference she can and inspiring peers and parents around her ✨ thank you Janet & Magda
At the start of this post you make the point that babies, the elderly and those who are ailing are the most vulnerable members of society and should be treated with more thoughtfulness and respect. Whenever I am unsure how to respond to my boys I try to picture myself with Alzheimer’s and living in their homes. How would I want them to treat me? That image has been a great help to me when we are ‘in the moment’ and I don’t know what to do next.
Amy, thank you for sharing. I’ve used that one myself!
This is a brilliant post. Thank you so much for writing and sharing it. My wife (Meg) and I currently have a baby in the NICU. She’s been there for a month so far and will likely be there for a while longer.
We follow Janet’s blog pretty closely and have wondered how to integrate RIE into our daily interactions. While she’s in the NICU it isn’t so hard, as she isn’t very mobile yet. We do everything you mentioned and you’re absolutely right, it makes a world of difference.
One of the things we do daily is a dressing change. She has a giant omphalocele–basically her liver, stomach and small bowel are in a contained sac outside of her body. Because of this we have to apply antibiotic cream and wrap her abdomen in gauze and compression bandages everyday. She almost never cries. We talk her through each part, from the unwrapping of the old to the final placement of her monitor leads. She just looks up at us, sucks on her pacifier and waits! All of her nurses and doctors remark at how calm she is. She has a remarkable attention span, as you mentioned.
It is safe to say we completely support the RIE methods. Moving forward we know that will need to modify those methods to support our family. Eventually we will come upon some developmental delays, as our daughter will not be able to choose her own timeline for tummy time and things like that. So we may not be able to follow her cues in that regard. But we make every effort to give her the space she requires and respect her as a person. And it pays off!
Thank you so much for your insightful words.
Gratefully yours,
Two tired moms!
I am a child life specialist and I also talk to all my patients in the special care unit and on pediatrics; I can confirm it makes a huge difference.