Handling

Infants suffering from drug withdrawal symptoms need specialized handling to keep them medically safe and manageable. It is imperative that the caregiver receive appropriate training to help the infants control their bodies and emotions. Learning comforting techniques and reading signs and signals are critical to these infants. It is not necessary for drug-exposed infants to cry for hours on end. They need not be frantic or to suffer. The key is therapeutic handling. At the Pediatric Interim Care Center, we know this works because we have seen it work hundreds of times with the most severely affected drug-exposed infant. Each type of drug exposure presents a somewhat different challenge for caregivers, but the basic principles of handling are the same for all of these infants.

Basic Principle #1: Swaddling
Drug exposed infants cannot do three things simultaneously. They cannot control their bodies, breathe, and suck at the same time. If they are focused on trying to control the discomfort in their bodies, they cannot focus on feeding or sleeping. We can’t eat, sleep or breathe for them but we can help control their bodies for them. We do that by swaddling or wrapping them snugly to control their movements and provide comfort.

Basic Principle #2: The C-Position
Holding or laying a baby in a “C-position” increases the infant’s sense of control and ability to relax. Hold the baby firmly and curl the head and legs into a “C”. In doing so, the baby’s chin is resting near his chest with the arms midline; his back is slightly rounded with legs bent in an upright position. If he is allowed to stiffen his back, arms or legs, he is increasing his body tone and burning precious calories that he needs to grow. It is also possible that by holding him close to your body, it is too stimulating for him. When laying the baby down while trying to maintain the “C-position”, place him on his side and wrap a blanket into a roll and ring it around his body to ensure he remains positioned. As the symptoms diminish, introduce the back sleeping position recommended by the Academy of Pediatrics.

Basic Principle #3: Head to Toe Movement
Common techniques like back and forth rocking, a swing, and bouncing your infant are not recommended. These motions are jarring and stimulating to a drug-affected baby’s nervous system. A slow, rhythmic swaying following a line from head to toe with the baby swaddled and held firmly in the C-position is calming. Keeping your movements slow and rhythmic will help to relax and settle the infant.

Basic Principle #4: Vertical Rock
When you are holding a baby who is frantic and very hard to calm, you can maintain a C-position hold directly in front of you, with the infant two inches away from your body and facing away. Then slowly and rhythmically move the baby up and down. This head- to-toe movement is soothing to the baby’s neurological system, as is keeping the baby away from your body.

Basic Principle #5: Clapping
Another technique that can help the baby relax is to clap his diapered and blanketed bottom. By cupping your hand and clapping or patting slowly and rhythmically, you will be able to feel the baby’s muscles relax. This principle can be very soothing for some but can, for hypersensitive infants, have the opposite effect and cause over-stimulation.

Basic Principle #6: Feeding Babies
Babies withdrawing from opiates suck frantically. This may make it difficult for them to take in enough formula because their suck may be also disorganized. Their stress levels are so high that they simply cannot organize an effective suck without help. The key to feeding is to get your baby into a therapeutic hold and relaxed enough to suck. Always feed in a low-stimulus environment--no bright lights, music, noise or other distractions. Make sure the baby is swaddled and held in a C-position.

Basic Principle #7: Controlling the Environment
In order for the therapeutic handling to be effective, limit the number of caregivers and offer a calm surrounding. Loud noises increase their distress. It is best to turn down TVs and music and to limit loud voices surrounding the baby. Also, during the first weeks of withdrawal, overhead lights may be over stimulating. An environment that is comfortable for an infant is also created by the soothing and calm presence of the caregiver. Routine is very important. The baby will respond more positively when caregivers use soft voices and speak and move slowly.

Basic Principle #8: Introducing Stimuli
All babies need stimulation for healthy development. A drug exposed infant needs to have stimulation introduced in small doses and on a schedule dictated by his individual ability to adjust. It is best to go slowly and introduce stimuli one at a time. (This can include light, sound, touch, voice, etc.). First, for instance, see how he responds to having his swaddling loosened. Then try gentle rocking or talking. If he shows signs of stress. (see Managing Infants, Step 2) return to the therapeutic handling techniques for a while longer. This introducing of stimuli can take time and patience on the caregiver’s part and will be also determined by the baby and his tolerance levels. Watch for clues from the baby. Interact with the baby when she is ready and in an active/alert state. Not just because you want to.