January 21, 2025
In November 2024, our Supporting Early Mind Research Network hosted Dr Julia Petty and Dr Lisa Whiting, University of Hertfordshire and Professor Emerita Celia Harding, City, University of London to discuss neonatal nurses’ and parents’ understanding of the factors that both enhance and hinder communication and early interaction between pre-term babies and parents.
They explained that infants born pre-term are at a high risk of potentially developing a range of speech, language and communication problems. However, if parents, nursing staff, and allied health professionals are supported to consider the key skills necessary for helping speech, language, and communication development, it may be possible to help people develop a very positive and comprehensive and supportive communication environment.
Much has been written about how speech, language, and communication difficulties can reduce educational and social achievement once in school. Approximately 1.2 million children in the UK have significant speech, language, and communication needs. This number includes a wide range of difficulties, including those born pre-term, those with a range of learning needs and difficulties and those with specific language and communication problems.
As well as describing specific difficulties such as delayed first word acquisition and grammar rule learning, the team highlighted that infants born under 32 weeks gestational age are at a higher risk of smaller expressive vocabularies and difficulties combining words. It is reported that some continue to have persistent speech, language, and communication needs at 18-22 months corrected age.
One of the things that they thought was important to consider was the neonatal environment. A lot of research already considers the problems of managing this unfamiliar environment for parents and families. With its noises and frequent interruptions, it is difficult for parents to develop the carer skills and early interaction which is so necessary with this vulnerable population. It is very challenging to manage this complex setting to support early communication. But there are still many examples of practice where the environment is nurturing and supportive.
Rapid transition from the intrauterine environment which has a primarily low frequency acoustic stimulation can shock pre-term infants when they are born early. Then there is the deficit in language exposure that infants experience post this early birth.
Staff in neonatal settings are generally very busy and do not have the time to provide language stimulation or to interact with the infants as the parents might want to. Research finds that much of the language used is limited in short interactive bursts rather than sustained talking with an infant. Furthermore, caring for an unwell infant within a neonatal setting often has a negative impact on parent mental health and wellbeing. This further affects parent-infant interactions.
Language learning is complicated, involving listening, anticipation, turn taking and linking keywords to familiar routines, using routines to build interaction and developing receptive language abilities. So understanding of language is happening alongside expressive language skills. We know that infants are socially pre-disposed to seek familiar faces and engage in social interaction. So skills such as eye contact, sustaining eye contact, having attention to another, listening and appreciation of familiar faces provide a really important foundation for language learning.
They reported research which shows that the first 15 to 50 hours of life are really important for an infant in learning to map on to a familiar parent or family face. Additionally, gaze is vitally important in early interaction towards the human face. So listening to the baby, responding to them using facial expression, sustaining eye contact and using all that important natural gesture as well as the important natural gestures is as important as repeating the key vocabulary so that your baby can hear and learn.
The team felt that in order to address these issues, they wanted to investigate what parents and nurses were understanding as the factors that enhance or prevent the development of communication and interaction between pre-term infants and parents within the neonatal setting.
Through the Burdett Trust for Nursing, they were able to fund a study with ethical approval on ‘Exploring the barriers and enablers of communication between premature babies, their parents, and nursing staff’. The study took place in one NHS Trust in North London in two neonatal units. They recruited 8 parents altogether and 9 neonatal staff. They took a qualitative approach in the form of narrative interviewing and analysis. Changes were made to the data collection tools based on feedback from their Parent Advisory group. Interviews were unstructured, conducted by one researcher, another analysed parent data set and another analysed the nursing staff data set.
Inevitably, as the parents spoke about their experiences, they reported barriers to communication. These included the equipment such as incubator care, the lines, the tubes, the interference during interventions that the babies had to undergo, being moved around. Some families had other children at home and thus parents could not be present all of the time. They also reported the general hectic environment of the neonatal ward. Another important aspect of the study was that the babies involved were all born during COVID-19 which had a definite barrier to communication in terms of face masks and visiting times.
However, the parents also mentioned the transition from neonatal unit to home, which often raised new issues that they had not really thought about before. Then the parents found themselves at home with a very vulnerable, very small baby and not always sure about the best way to communicate. They also had other areas to consider in terms of physical skills around oxygen and feeding. So for parents of pre-term babies, this was an area of strong concern as they had to figure things out without the support of the neonatal staff.
The interviews with staff tended to focus on them explaining their professional experiences and where they were in their careers. The most positive theme that came out was around their attitude to their work and their pride in how they carried it out and how far they tried to support the parents. They took it very seriously in terms of working with parents to find ways of connecting with their babies. They had a recognition around the emotional side of care and the significance of bonding and attachment, which has equal importance to the more clinical aspects of care.
It was noted however that, through no fault of their own, staff were often very busy and over-worked, meaning that they were not always able to acknowledge these communication needs as they might wish. Parents sometimes voiced that their communication required a little more sensitivity and consistency. Parents did speak highly of the communication strategies that they were taught by professionals but advice was varied and levels of support differed, particularly post-discharge.
Additionally, while nursing staff rated communication as being very important, they were often not able to describe what they meant from a linguistic perspective. They talked about skin-to-skin and reading to babies, which are both important things but not so much linked to later linguistic development and language skills.
There is a need for clear, consistent, and culturally appropriate communication strategies with a greater awareness of how to facilitate them, particularly for pre-term babies who are at a high risk of developing speech, language, and communication problems.
The team plan to work further in this area, with several publications in the works and also a further plan to develop a website on Prematurity and Communication which will have resources to support parents and allied health staff. The link will be made available here after launch.
You can watch the webinar in full on the Supporting Early Minds website.
Or, to find out more about infant mental health and book a place on an upcoming Supporting Early Minds webinar visit: Webinars – Supporting Early Minds (mhid.org.uk)