Parental involvement

< Back to Infant- & family-centred developmental care

Authors

Pallás Alonso C, Westrup B, Kuhn P, Daly M, Guerra P

Click on the image to read the standard in brief.

Target group

Infants, parents of infants hospitalised in the neonatal intensive care units (NICUs) at all levels, and families


User group

Healthcare professionals, neonatal units, hospitals, and health services


Statement of standard

Parents are members of the caregiving team and, with individualised support, assume the primary role in the provision of care of their infant, and are active partners in decision-making processes.


Rationale

The goal is to ensure the parental involvement in the care of the infant. Most parents have a sensitive understanding of their newborn infant. Contingent with infant cues, parents normally and intuitively presentwell-timed interactions in multimodal forms involving the mediums of voice, proximity, touch and gestures to regulate infants’ physiological, behavioural and emotional responses, and responding to their nutritional needs. (1) However, infants in neonatal intensive care units (NICUs) usually are physically and emotionally separated from their parents, making it difficult for the parents to assume this expected role of caregiver. (2)

Prematurity and illness imply infant fragility and behaviour quite different from that of healthy full-term infants, but implementing parent involvement can significantly improve the well-being of both parent and infant.

Although the majority of units in eight European countries reported a policy of encouraging both parents to participate in the care of their infants, the intensity and ways of involve­ment as well as the role played by parents varied within and between countries. (3) Parents are willing to practice new skills through guided participation, even for more complex care. (4) They experienced contrasted emotions during their first participation of care, with a prevalence of negative and ambivalent feelings, requiring the support of staff members to reach emotional resilience. (5)

Parental integration enables their participation in the medical discussions and decision-making about their infant. The full integration of families into the neonatal team to actively provide much of their infant’s care is beneficial for both parents and the infants themselves.

Educational programmes can be established to involve parents in the care of their infant. They can have a more theoretical (6–8) or more practical (9,10) foundation. Care based on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) (11) and other forms of integrated care models such as family integrated care (FICare) (1,2,6,8) or Close Collaboration with Parents (12,13), which in recent years have been implemented in different countries, enable parents to become active caregivers for their infant by participating as integral members of the care team. However, implemented programmes have to be adapted to the characteristics and resources of each unit.


Benefits

Short-term benefits

Long-term benefits


Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

  1. Parents and family are informed by healthcare professionals about the importance of their involvement in the provision of care for their infant during the stay on the neonatal unit. (16,19,26,34)

A (High quality)

B (High quality)

Patient information sheet1

  1. Parents are the primary caregivers for their infant. (16,19,26,34,35)

A (High quality)

B (Moderate quality)

C (High quality)

Parent feedback

  1. Parents participate in medical rounds. (3,6,7,10,16,19,26,34)

A (High quality)
B (Moderate quality)

Parent feedback

  1. Parents are partners in decision-making processes. (3,6,7,10,16,19,26,34)

A (High quality)
B (Moderate quality)

Parent feedback

  1. Parents have access to medical records. (3,19)

A (High quality)
B (Moderate quality)

Guideline, parent feedback

For healthcare professionals

  1. A unit guideline on parental involvement in terms of being the primary caregivers, participation in medical rounds, and partnering in decision-making is adhered to by all healthcare professionals. (3,6,7,10,16,19,26,34)

A (Moderate quality)
B (High quality)

Guideline

  1. Training on integrating parents into the neonatal unit is attended by all responsible healthcare professionals. (3,7,9,10,14,16,19)

A (Moderate quality)
B (High quality)

Training documentation

  1. The role as educator, coach, and facilitator of care and bonding is undertaken. (3,7,9,10,14,19)

A (High quality)
B (High quality)

Healthcare professional feedback

  1. Support parental presence throughout the 24 hours. (3,6,7,10,16–21,26,34)

A (High quality)

B (Moderate quality)

Guideline

  1. Support specific father presence and participation in the NICU. (36–38)

A ((High quality)

B (High quality)

Guideline

For neonatal unit

  1. A unit guideline on parental involvement in terms of being the primary caregivers, participation in medical rounds, and partnering in decision-making is available and regularly updated. (3,6,7,10,16,19)

B (High quality)

Guideline

  1. A parent advisory panel is engaged in appropriate planning and decision-making processes. (3,9,10,14,16,19)

B (Moderate quality)

Parent feedback

  1. Conduct ongoing quality assurance of parent participation. (3,6,7,16,19,26,34)

A (Moderate quality)

B (Moderate quality)

Parent feedback

  1. Provide a unit guideline for parental and family presence throughout the 24 hours. (3,6,7,16,19,26,34)

A (Moderate quality) B (Moderate quality)

Parent feedback

For hospital

  1. Training on integrating parents into the neonatal unit and resources for the parents as primary caregivers is ensured. (3,7,9,10,14,19)

A (High quality)
B (High quality)

Training documentation

  1. Appropriate resources are provided to support infant- and family-centred developmental care. (3,9,10,14,19)

A (High quality)
B (High quality)

Audit report2

  1. Provide facilities for parents to reside in the neonatal unit (see NICU design). (3,10)

A (Moderate quality) B (Moderate quality)

Audit report2

For health service

  1. A national guideline on the role of parents as primary caregivers of their infants and on the role of parents of advisory functions in hospitals is available and regularly updated. (3,9,10,14,19)

B (High quality)

Guideline


1The indicator ‘patient information sheet’ is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

2The indicator ‘audit report’ can also be defined as a benchmarking report.

Where to go – further development of care

Further development

Grading of evidence

For parents and family

  • Parents give input to both written and electronic medical records. (3,10)

A (Moderate quality)
B (Moderate quality)

For healthcare professionals

  • Consider and support the diversity among parents and families. (38)

A (Moderate quality)
B (Moderate quality)

For neonatal unit

  • Provide unit guideline on full parental access and input to both written and electronic medical records by the parents. (3,6,7,10)

A (Moderate quality)
B (Moderate quality)

For hospital

  • Include parents in hospital patient advisory committee. (3,6,7,10)

A (Moderate quality)
B (Moderate quality)

  • Be prepared to maintain the presence of parents in the NICU in exceptional situations (pandemic). (5,39–47)

A (High quality)
B (High quality)

For health service

  • Be prepared to maintain the presence of parents in the NICU in exceptional situations (pandemic). (5,39–47)

A (High quality)
B (High quality)


Getting started

Initial steps

For parents and family

  • Parents are verbally informed by healthcare professionals about the importance of their involvement in the provision of care for their infant. (3,6,7,10,16,18–21,26,34,39)
  • Parents are involved in daily care procedures, e.g. changing nappies, measuring temperature, hygiene of the mouth, bathing etc. (3,6,7,10,16,18–21,26,34,39)

For healthcare professionals

  • Attend training on infant- and family-centred developmental care. (3,6,7,10,16,18–21,26,34,39)
  • Welcome parents as active participants in the care. (3,6,7,10,16,18–21,26,34,39)

For neonatal unit

  • Develop and implement a unit guideline on parental involvement in terms of being the primary caregivers, participation in medical rounds, and partnering in decision-making. (3,6,7,10,19)
  • Develop information material on care and treatment of infants for parents. (16,19,26,34)

For hospital

  • Support healthcare professionals to participate in training on infant- and family-centred developmental care. (3,6,7,10,16,18–21,26,34,39)

For health service

  • Develop and implement a national guideline on family involvement in the care of their infant. (3,6,7,10)

According to natural order, parents expect to be the primary caregiver of their newborn infant. Although the medical professionals in most neonatal units attempt to involve parents in the care of their infant it is generally accepted that the type of care required in the neonatal unit is highly complex and should therefore be a responsibility of experienced professionals. Inadvertently, this approach makes the parents feel like passive spectators regarding the care of their infant and tend to make them feel insecure, more stressed, anxious and less competent when they later take the infant home at discharge from the hospital. (48)

Despite the challenging circumstances, under the guidance and supervision of the healthcare professionals, the parents can gradually learn how to adjust the normal parent behaviour and carryout even the more complex tasks of caring for their infant. Subsequently – according to the individual competencies of the parents – the professionals will progressively be able to delegate most, if not all, nursing tasks to the parents.

Challenges associated with the involvement of the parents

It is possible that the parents may not detect changes that require prompt medical attention in their infant’s condition. However, healthcare professionals retain primary responsibility for the infant and supervise parents closely, which should ensure that appropriate care is given. Another concern is that parents may become overly anxious about providing care for their sick infant. (5) However, the provision of care procedures by parents is introduced gradually and individualised according both to the situation of the infant and the parents. Most parents involved in these programmes report decreased anxiety and stress because they feel in control and well informed when given a purposeful role in the care of their infant. (9,26)

Parents’ involvement in the care of their newborn infants admitted to the NICU is beneficial to the newborn infant and the family. However, certain ethical aspects must be considered because otherwise families can be harmed. Parents cannot perceive that the care of their child is imposed on them. Professionals have to know how to adapt to the reality of each family and each NICU. Changes must be made progressively so that families can adapt. (49)

The role of fathers in the NICU

Most studies on the care of preterm infants are focused on mothers. In the first days of the newborn infant’s admission to the NICU, fathers often play an important role if the mothers are with medical complications. However, soon the mother assumes the main role in the care of the infant and the father is relegated. (36) Interventions that involved mothers and fathers showed similar general positive effects in the infants with additional beneficial effects on paternal affective and mental health. Few differential effects were seen between maternal and paternal interventions. (37) Therefore, professionals must provide the father with greater support to increase his presence and participation while his newborn infant is admitted to the NICU. This aspect is essential to achieve gender equality and promote co-parenting.

Lastly, diversity among parents and families should be considered. For example, not all parents are biologically related to their newborn infant, and families may include one or more parents, and parents of the same or different gender. Professionals must approach each of these particular situations with sensitivity, encouraging the family to become involved in the care of the newborn infant. (38)

The barriers to implementing the involvement of parents

For extremely ill infants who require mechanical ventilation or other complex treatments and where parents are not able to room-in, parental involvement in care giving is more challenging. Having parents as the primary caregivers in an intensive care setting represents a substantial shift in the current model of neonatal care in most countries. There are numerous barriers to widespread implementation of this model of care. Parents can feel stressed, over-whelmed and over-burdened when providing newborn infant care. (5,50) Thus, it is really important to give them continuous support and on an individual level, gradually introduce parents as the primary caregivers. On the other hand, healthcare professionals may feel uncomfortable about reducing their control of the infant’s care. (51) Thus, also healthcare professionals could benefit from support and training concerning parental involvement. (3,6,7,10)

The involvement of parents in exceptional situations

The COVID-19 pandemic has highlighted the vulnerability of programmes that support parental involvement in the care of their newborn infants in the NICU. (39) In many cases, it has been difficult for more than one parent to be present and truly incorporated as members of the team caring for their newborn infant. (41) In some hospitals the father has not been able to care for his newborn infant in the NICU for several weeks. The restriction to fathers’ access to the NICU acted as a significant obstacle to infant-father bonding and led to loneliness and isolation by the mothers. Thus, these COVID-19 measures might have had adverse consequences for infants and families. (42,44–47) It seems that when single family rooms were available, the restrictions were less important. (40) On the other hand, the stress and depression of the parents could be contained if the participation in the care of their newborn infants was maintained. (43)

In the face of new emergency situations, all necessary security measures must be taken, but always with the aim of keeping parents in the neonatal unit, supporting their role as caregivers. New technologies and the availability of single-family rooms can help ensure that restrictions, if they are essential, are as few as possible.

  1. Hofer MA. Early relationships as regulators of infant physiology and behavior. Acta Paediatr Oslo Nor 1992 Suppl. 1994 Jun;397:9–18.
  2. Feldman R, Eidelman AI. Maternal postpartum behavior and the emergence of infant-mother and infant-father synchrony in preterm and full-term infants: the role of neonatal vagal tone. Dev Psychobiol. 2007 Apr;49(3):290–302.
  3. O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, et al. A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth. 2013;13 Suppl 1:S12.
  4. Casper C, Caeymaex L, Dicky O, Akrich M, Reynaud A, Bouvard C, et al. [Parental perception of their involvement in the care of their children in French neonatal units]. Arch Pediatr Organe Off Soc Francaise Pediatr. 2016 Sep;23(9):974–82.
  5. Dicky O, Kuhn P, Akrich M, Reynaud A, Caeymaex L, Tscherning C. Emotional responses of parents participating for the first time in caregiving for their baby in a neonatal unit. Paediatr Perinat Epidemiol [Internet]. 2021 Mar [cited 2022 Jun 7];35(2). Available from: https://pubmed.ncbi.nlm.nih.gov/33029809/
  6. Westrup B. Family-centered developmentally supportive care: the Swedish example. Arch Pediatr Organe Off Soc Francaise Pediatr. 2015 Oct;22(10):1086–91.
  7. Warren I. Family and Infant Neurodevelopmental Education: an innovative, educational pathway for neonatal healthcare professionals. Infant J. 2017;13(5):200–3.
  8. Ahlqvist-Björkroth S, Boukydis Z, Axelin AM, Lehtonen L. Close Collaboration with ParentsTM intervention to improve parents’ psychological well-being and child development: Description of the intervention and study protocol. Behav Brain Res. 2017 15;325(Pt B):303–10.
  9. Lee SK, O’Brien K. Parents as primary caregivers in the neonatal intensive care unit. CMAJ Can Med Assoc J J Assoc Medicale Can. 2014 Aug 5;186(11):845–7.
  10. Ortenstrand A, Westrup B, Brostrom EB, Sarman I, Akerstrom S, Brune T, et al. The Stockholm Neonatal Family Centered Care Study: Effects on Length of Stay and Infant Morbidity. PEDIATRICS. 2010 Feb 1;125(2):e278–85.
  11. Klein V, Zores-Koenig C, Dillenseger L, Langlet C, Escande B, Astruc D, et al. Changes of Infant- and Family-Centered Care Practices Administered to Extremely Preterm Infants During Implementation of the NIDCAP Program. Front Pediatr. 2021;9:718813.
  12. Toivonen M, Lehtonen L, Löyttyniemi E, Ahlqvist-Björkroth S, Axelin A. Close collaboration with parents intervention improves family-centered care in different neonatal unit contexts: a pre–post study. Pediatr Res. 2020;88(3):421–8.
  13. He FB, Axelin A, Ahlqvist-Björkroth S, Raiskila S, Löyttyniemi E, Lehtonen L. Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatr. 2021 Jan 11;21(1):28.
  14. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006 Nov;118(5):e1414-1427.
  15. Narayanan I, Kumar H, Singhal PK, Dutta AK. Maternal participation in the care of the high risk infant: follow-up evaluation. Indian Pediatr. 1991 Feb;28(2):161–7.
  16. Hei M, Gao X, Gao X, Nong S, Zhang A, Zhang Q, et al. Is family integrated care in neonatal intensive care units feasible and good for preterm infants in China: study protocol for a cluster randomized controlled trial. Trials. 2016 Jan 13;17:22.
  17. van Veenendaal NR, van der Schoor SRD, Heideman WH, Rijnhart JJM, Heymans MW, Twisk JWR, et al. Family integrated care in single family rooms for preterm infants and late-onset sepsis: a retrospective study and mediation analysis. Pediatr Res. 2020 Oct;88(4):593–600.
  18. Banerjee J, Aloysius A, Mitchell K, Silva I, Rallis D, Godambe SV, et al. Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application. Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):172–7.
  19. O’Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health [Internet]. 2018 Feb 8; Available from: http://www.sciencedirect.com/science/article/pii/S2352464218300397
  20. He SW, Xiong YE, Zhu LH, Lv B, Gao XR, Xiong H, et al. Impact of family integrated care on infants’ clinical outcomes in two children’s hospitals in China: a pre-post intervention study. Ital J Pediatr. 2018 Jun 5;44(1):65.
  21. van Veenendaal NR, van Kempen AAMW, Franck LS, O’Brien K, Limpens J, van der Lee JH, et al. Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents. EClinicalMedicine. 2020 Jun;23:100388.
  22. Matricardi S, Agostino R, Fedeli C, Montirosso R. Mothers are not fathers: differences between parents in the reduction of stress levels after a parental intervention in a NICU. Acta Paediatr Oslo Nor 1992. 2013 Jan;102(1):8–14.
  23. Franck LS, Oulton K, Nderitu S, Lim M, Fang S, Kaiser A. Parent involvement in pain management for NICU infants: a randomized controlled trial. Pediatrics. 2011 Sep;128(3):510–8.
  24. Voos KC, Ross G, Ward MJ, Yohay AL, Osorio SN, Perlman JM. Effects of implementing family-centered rounds (FCRs) in a neonatal intensive care unit (NICU). J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2011 Nov;24(11):1403–6.
  25. Erdeve O, Arsan S, Yigit S, Armangil D, Atasay B, Korkmaz A. The impact of individual room on rehospitalization and health service utilization in preterms after discharge. Acta Paediatr Oslo Nor 1992. 2008 Oct;97(10):1351–7.
  26. McLean MA, Scoten OC, Yu WK, Ye XY, Petrie J, Church P, et al. Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 months: Follow-up of a Cluster Randomized Trial of NICU Family Integrated Care. J Pediatr. 2021;
  27. Montirosso R, Giusti L, Del Prete A, Zanini R, Bellù R, Borgatti R. Does quality of developmental care in NICUs affect health-related quality of life in 5-y-old children born preterm? Pediatr Res. 2016;80(6):824–8.
  28. Westrup B, Böhm B, Lagercrantz H, Stjernqvist K. Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Acta Paediatr Oslo Nor 1992. 2004 Apr;93(4):498–507.
  29. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014 Jan 1;75(1):56–64.
  30. Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, et al. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry. 2015 Nov;56(11):1202–11.
  31. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J, et al. Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics. 2017 Jan;139(1).
  32. Melnyk BM, Alpert-Gillis L, Feinstein NF, Fairbanks E, Schultz-Czarniak J, Hust D, et al. Improving cognitive development of low-birth-weight premature infants with the COPE program: A pilot study of the benefit of early NICU intervention with mothers. Res Nurs Health. 2001 Oct;24(5):373–89.
  33. Lester BM, Salisbury AL, Hawes K, Dansereau LM, Bigsby R, Laptook A, et al. 18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit. J Pediatr. 2016 Oct;177:84–9.
  34. Church PT, Grunau RE, Mirea L, Petrie J, Soraisham AS, Synnes A, et al. Family Integrated Care (FICare): Positive impact on behavioural outcomes at 18 months. Early Hum Dev. 2020 Dec;151:105196.
  35. UNICEF. The United Nations Convention on the Rights of the Child [Internet]. 1990. Available from: https://downloads.unicef.org.uk/wp-content/uploads/2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.pdf?_ga=2.163550268.1218459234.1527076484-403558301.1527076484
  36. Baldoni F, Ancora G, Latour JM. Being the Father of a Preterm-Born Child: Contemporary Research and Recommendations for NICU Staff. Front Pediatr. 2021;9:724992.
  37. 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.
  38. Treyvaud K, Spittle A, Anderson PJ, O’Brien K. A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant. Early Hum Dev. 2019 Dec;139:104838.
  39. Waddington C, van Veenendaal NR, O’Brien K, Patel N, International Steering Committee for Family Integrated Care. Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig. 2021 Jun;5(2):148–54.
  40. Darcy Mahoney A, White RD, Velasquez A, Barrett TS, Clark RH, Ahmad KA. Impact of restrictions on parental presence in neonatal intensive care units related to coronavirus disease 2019. J Perinatol. 2020 Sep;40(S1):36–46.
  41. Carter BS, Willis T, Knackstedt A. Neonatal family-centered care in a pandemic. J Perinatol Off J Calif Perinat Assoc. 2021 May;41(5):1177–9.
  42. Garfield H, Westgate B, Chaudhary R, King M, O’Curry S, Archibald S. Parental and staff experiences of restricted parental presence on a Neonatal Intensive Care Unit during COVID‐19. Acta Paediatr. 2021 Sep;apa.16085.
  43. Bua J, Mariani I, Girardelli M, Tomadin M, Tripani A, Travan L, et al. Parental Stress, Depression, and Participation in Care Before and During the COVID-19 Pandemic: A Prospective Observational Study in an Italian Neonatal Intensive Care Unit. Front Pediatr. 2021;9:737089.
  44. Vance AJ, Malin KJ, Miller J, Shuman CJ, Moore TA, Benjamin A. Parents’ pandemic NICU experience in the United States: a qualitative study. BMC Pediatr. 2021 Dec 9;21(1):558.
  45. McCulloch H, Campbell-Yeo M, Richardson B, Dol J, Hundert A, Dorling J, et al. The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated Care in the NICU: A Qualitative Study. HERD. 2022 Apr;15(2):49–62.
  46. Kynø NM, Fugelseth D, Knudsen LMM, Tandberg BS. Starting parenting in isolation a qualitative user-initiated study of parents’ experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic. PloS One. 2021;16(10):e0258358.
  47. Tscherning C, Sizun J, Kuhn P. Promoting attachment between parents and neonates despite the COVID‐19 pandemic. Acta Paediatr. 2020 Oct;109(10):1937–43.
  48. Montirosso R, Provenzi L, Calciolari G, Borgatti R, NEO-ACQUA Study Group. Measuring maternal stress and perceived support in 25 Italian NICUs. Acta Paediatr Oslo Nor 1992. 2012 Feb;101(2):136–42.
  49. Janvier A, Asaad MA, Reichherzer M, Cantin C, Sureau M, Prince J, et al. The ethics of family integrated care in the NICU: Improving care for families without causing harm. Semin Perinatol. 2022 Apr;46(3):151528.
  50. Cooper LG, Gooding JS, Gallagher J, Sternesky L, Ledsky R, Berns SD. Impact of a family-centered care initiative on NICU care, staff and families. J Perinatol Off J Calif Perinat Assoc. 2007 Dec;27 Suppl 2:S32-37.
  51. Fenwick J, Barclay L, Schmied V. Craving closeness: a grounded theory analysis of women’s experiences of mothering in the Special Care Nursery. Women Birth J Aust Coll Midwives. 2008 Jun;21(2):71–85.

September 2022 / 2nd edition / previous edition reviewed by McKechnie L / next revision: 2025


Recommended citation

EFCNI, Pallás-Alonso C, Westrup B et al., European Standards of Care for Newborn Health: Parental involvement. 2022.