Count to Ten

I can recognize a baby who is failure-to-thrive almost immediately. At three months old, she barely had any body fat, she couldn't track or engage visually, and she had a patch of hair missing from the back of her head, which indicates she spent a lot of time lying on her back.

Mom is 19, there is no Dad involved. The baby lives in a house with Mom and three of her girlfriends. Infant care is shared by all, as well as smoking. Doesn't sound like an ideal environment in which to raise a child, but with my patient population, this family situation has become the norm.

As I enter the room I see that Mom has already laid the baby in the crib and she and another friend are sitting a short distance away. I observe the infant: dark brown hair, blue eyes, pale skin, and a distant affect. She is a pretty baby, but very disengaged. A healthy three-month-old will smile, laugh, make eye contact, and track with me. She gazes off and does not respond to my voice as I coo over her.

Mom also seems very checked out, though not tripping (which is always good). She cannot answer specific quesitons about her baby, such as how many hours a night the infant sleeps, and defers to her friend, who is also unable to answer the question. As I complete my admission assessment, it becomes very apparent to me that this sweet little baby, whom I will call Kara, is nothing more than a burden to these girls... one more pain-in-the-ass thing that they have to take care of, one more hinderance to their dating/party life.

As Kara began to cry, I observed Mom propping a bottle on a blanket, and then returning to her chair. I was furious. Infants do not begin to grasp their own bottle until about eight months of age, and even then it is most beneficial to the child's development to hold her while she's eating, even though she can hold her own bottle. Bottle-propping is detrimental to an infant for many reasons... it hinders bonding and development of the baby, increases frequency of ear infections, and tooth decay (as soon as teeth appear). I believe that the most dangerous side effect of bottle propping is that infants are left alone in their cribs, and their needs for affection, touch, and interaction are sorely unmet. This can deter their physical and psychological growth and development, as well as reinforcing long-term emotional deficits.

I immediately told Mom that bottle propping would hurt her baby, and why. She seemed to be paying attention while I was talking to her, however, within the first few hours of Kara's hospital stay, I heard her crying and ran down the hall to find her alone in her room. Mom was out on a smoke break with her friends, and the bottle had fallen off the blanket. Kara was hungry. Her cry was weak and helpless, as if she knew that no one was going to come.

I picked her up, she wouldn't look at me. I tried to talk to her, but she would not engage. In her brief three months of life, she had learned that people didn't care, and that trying to communicate with anyone was hopeless. I looked at the bald patch on the back of her head. They are ruining her, I thought to myself.

I called the social worker on this case immediately. This was a neglect situation and a child was suffering. It's never easy, and can be a tough call, but some situations just scream "help" to me.

I made a lot of internal judgements about Kara's mother. Every time I walked out of her room I was thinking about how selfish this woman was, how heartless, how clueless (I'm sure I thought worser things as well). I wanted so much to help Kara, but that help took on a much different form than I ever would have anticipated.

Much in the same way that I was, the other nurses were very judgemental of Kara's Mom. "Protective Services" was mentioned more than once. But it was strange... the more time I spent with this Mom, the more I found myself feeling compassion for her just as much as I did for her baby. I watched the grandmother interact with Mom and it became very apparent to me, that Kara's Mom had no idea what she was doing as a Mom, because she hadn't had a loving, attentive mother herself. How can we expect people to be parents when they don't know how, when they themselves have not had good parents?

My attitude changed. I decided to treat Kara's Mom with extreme respect. I went into her room the next day, and asked her if I could massage her baby. She agreed. I spoke to Kara softly and tenderly, and rubbed her little legs and feet with gentle touch. Mom watched, and said nothing.

When I returned to the room a half hour later, Mom was sitting in the crib, holding Kara in her lap and talking to her in a soft voice.

I spoke with the social worker later that day and we decided to get Kara's Mom set up with some parenting classes. I hope that they helped. It was just a brief moment that I interfaced with this Mom and her baby, but they taught me something very valuable... count to ten before you judge someone. We have no idea where people have been, what they have been through, what they have not been through. To help this baby, I needed to help her Mom, to treat her with respect, and patience. Not everyone is going to demonstrate teachability like she did, but everyone deserves the benefit of the doubt.

I sure am glad there's a learning curve in this thing called life...