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Overview

Infant- and family-centred developmental care (IFCDC) is a descriptive term for a framework of newborn care that incorporates the theories and concepts of neurodevelopment, neuro-behaviour, parent-infant interaction, parental involvement, breastfeeding promotion, environmental adaptation, and change of hospital systems. It is based on the leading-edge work of Als and her colleagues in the NIDCAP Federation International (NFI) (1,2) and Brazelton (3) and on the World Association for Infant Mental Health Declaration of Infants’ Rights. (4)

The core pillars of IFCDC are: sensitive care based on infant behavioural communication and cues gives the infant a voice (1,2) and is beneficial for brain growth (5), parent engagement supports parental wellbeing and infant development (6–10), and customised adaptations of the NICU environment and hospital system as a whole. (11)

The strategies for implementing this approach are based on supporting the unity of infant and parents, i.e. family access and integration into all care, early bonding, shared-decision-making, and parental involvement as the primary caregivers. (12,13) The practical implementation is assured by early and continuous skin-to-skin contact between mother or father and the newborn infant, as well as by the promotion and support of breastfeeding. (14) Sensory and environmental expectations of the newborn infant are paramount, since early sensory experiences have been shown to have significant impact on neurodevelopment. The model, therefore, advocates protection from deleterious environmental stimuli in newborn intensive care units (NICU) and access to positive sensory stimulation from parents and other caregivers. (15–18) Support strategies for families play a major role, including socioeconomic, mental health, and spiritual services as well as an individual case management plan for each newborn infant. This case management plan is established in collaboration with parents. (11) Well trained and supported healthcare professionals who receive counselling and regular clinical supervision in communicating with and providing emotional support for parents is the prerequisite for proficient successful implementation of IFCDC. (8,19,20)

The role of the Topic Expert Group on Infant- and family-centred developmental care focuses on defining practice standards for the implementation of newborn care that is centred around the infant and the infant’s family and their close supporters in order to support optimally the infant´s health and development.

Sources

  1. Als H. A Synactive Model of Neonatal Behavioral Organization: Phys Occup Ther Pediatr. 1986 Jan 1;6(3–4):3–53.
  2. NIDCAP. Program Guide – Newborn Individualized Developmental Care and Assessment Program (NIDCAP). An education and training program for health care professionals [Internet]. 2015. Available from: http://nidcap.org/wp-content/uploads/2014/09/Program-Guide-Rev-22Sep2014.pdf
  3. Brazelton TB, Nugent KJ. Clinics in Developmental Medicine. Neonatal Behavioral Assessment Scale. 3rd ed. London: Mac Keith Press;
  4. World Association for Infant Mental Health. Declaration of Infant’s Right [Internet]. WAIMH; 2016. Available from: https://perspectives.waimh.org/2016/06/15/waimh-position-paper-on-the-rights-of-infants/
  5. Als H, Duffy FH, McAnulty G, Butler SC, Lightbody L, Kosta S, et al. NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction. J Perinatol. 2012 Feb 2;32:797.
  6. McAnulty G, Duffy FH, Kosta S, Weisenfeld NI, Warfield SK, Butler SC, et al. School-age effects of the newborn individualized developmental care and assessment program for preterm infants with intrauterine growth restriction: preliminary findings. BMC Pediatr. 2013 Feb 19;13:25.
  7. Als H, Gilkerson L, Duffy FH, McAnulty GB, Buehler DM, Vandenberg K, et al. A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr JDBP. 2003 Dec;24(6):399–408.
  8. Gilkerson L, Als H. Role of reflective process in the implementation of developmentally supportive care in the newborn intensive care nursery: Infants Young Child. 1995 Apr;7(4):20–8.
  9. Westrup B. Family-Centered Developmentally Supportive Care. NeoReviews. 2014 Aug 1;15(8):e325–35.
  10. Roué J-M, Kuhn P, Lopez Maestro M, Maastrup RA, Mitanchez D, Westrup B, et al. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child – Fetal Neonatal Ed. 2017 Jul;102(4):F364–8.
  11. Smith K, Buehler D, Als H. Nursery Assessment Manual. NIDCAP Nursery Program. [Internet]. NIDCAP Federation International (NFI); 2015. Available from: http://nidcap.org
  12. Ortenstrand A, Westrup B, Broström EB, Sarman I, Akerström S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics. 2010 Feb;125(2):e278-285.
  13. Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev. 2015 Jan;91(1):63–70.
  14. Conde-Agudelo A, Belizán JM, Diaz-Rossello J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD002771.
  15. Caskey M, Stephens B, Tucker R, Vohr B. Importance of parent talk on the development of preterm infant vocalizations. Pediatrics. 2011 Nov;128(5):910–6.
  16. Filippa M, Panza C, Ferrari F, Frassoldati R, Kuhn P, Balduzzi S, et al. Systematic review of maternal voice interventions demonstrates increased stability in preterm infants. Acta Paediatr Oslo Nor 1992. 2017 Aug;106(8):1220–9.
  17. Frie J, Bartocci M, Lagercrantz H, Kuhn P. Cortical Responses to Alien Odors in Newborns: An fNIRS Study. Cereb Cortex N Y N 1991. 2017 Aug 1;1–12.
  18. Kuhn P, Zores C, Pebayle T, Hoeft A, Langlet C, Escande B, et al. Infants born very preterm react to variations of the acoustic environment in their incubator from a minimum signal-to-noise ratio threshold of 5 to 10 dBA. Pediatr Res. 2012 Apr;71(4 Pt 1):386–92.
  19. Hall SL, Phillips R, Hynan MT. Transforming NICU Care to Provide Comprehensive Family Support. Newborn Infant Nurs Rev. 2016 Jun;16(2):69–73.
  20. Hyrkäs K, Appelqvist-Schmidlechner K, Haataja R. Efficacy of clinical supervision: influence on job satisfaction, burnout and quality of care. J Adv Nurs. 2006 Aug;55(4):521–35.

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Case management and transition to home

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Clinical consultation and supervision for healthcare professionals on supporting families

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Education and training for infant- and family-centred developmental care (IFCDC)

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Family access

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Family support services

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Management of the acoustic environment

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Parental involvement

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Support for parental-infant bonding

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Supportive sensory environment

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Very early and continuous skin-to-skin contact

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