Development in Infancy & Toddlerhood

Vignette

Misty arrived at 28 weeks’ gestation, right at 7 months into the pregnancy. She spent several weeks in the neonatal unit but showed positive growth in development during this time. Her mother, Pam, was able to spend time with Misty daily but was not allowed to hold or touch her very often in the beginning due to needs for respiratory support. Pam held her as often as she could to provide comfort, cherishing the increased time each day brought but also worried about how the limited physical contact would affect their bond. The hospital has reported Pam will be able to take Misty home in a few days and she is meeting with the Social Worker to plan for discharge. The Social Worker has provided support for the family with connection to resources for developmental supports and plans for a home visit to follow up in a few weeks.

The Social Worker arrives for the follow up appointment and Pam reports taking care of Misty is “so much harder than I ever thought. She didn’t seem to cry this much when we were at the hospital and she won’t stay asleep longer than an hour at a time, it’s just so much and I don’t know how to help her or make her feel better”. Pam reports she has taken Misty to the doctor two times due to her concerns and was told they were not able to find any physical issues with Misty. Pam reported “I just feel so helpless, the doctors weren’t any help, they just told me I needed to give it some more time and she would eventually settle but I’m just not sure, it doesn’t seem to be settling, it seems like it’s just getting worse”. Pam also reports “I’ve been reading a lot of stuff online too about premature babies and attachment and it’s really scaring me because there are so many stories about how some babies really struggle with development and then all the stuff about poor attachment and all the stuff that happens if a baby doesn’t have a good attachment, it’s just all so scary…”. The Social Worker takes notes on areas of concern Pam reports with Misty and then explored use of the resources Pam had been given at discharge. Pam looks down and reports “No, I haven’t called any of them. It’s just been so crazy and hard with Misty that I haven’t even thought about them”. The Social Worker reflects how hard it must be trying to manage a new baby and battle so many concerns related to the baby’s health and well-being. The Social Worker discusses working to set a schedule and increasing some of the structure for their day to see if this may help provide some supports for both Pam and Misty. Pam reports being open to “anything that will help” and schedules to meet with the Social Worker the following week.

Pam shares “nothing has changed” when the Social Worker arrives for their next meeting. The Social Worker allows Pam to share continued struggles with trying to comfort Misty and continued feelings of failure when “nothing works”. She states, “I just don’t understand. Is it me? Is something wrong with her? I just don’t understand and don’t know what to do. I tried all the stuff we talked about for a couple of days, but it didn’t seem to work so I stopped”. The Social Worker acknowledges how hard change can be and then explores options to make a referral for assessments in areas of Occupational and Mental Health supports, discussing while the pediatrician reports nothing is physically wrong with Misty, there may be some sensory issues presenting that would need a specific assessment by an Occupational Therapist. The Social Worker also discussed how Misty’s premature arrival can be felt as a trauma by both Misty and Pam and benefits of exploring this with a Mental Health provider for supports. Pam states “I’m willing to try anything at this point. Send me to as many places you think would help”. 

The Social Worker arrives for a follow up visit approximately 6 weeks after referrals were made. Pam arrives at the door smiling. The Social Worker recognizes this and comments on the difference from their last visit. Pam states “It’s still been rough but better. We have started Occupational Therapy for some sensory issues that were found when we went for our assessment. We’ve also started seeing a therapist that focuses on work with parents and infants and it’s been life changing for me to have a better understanding of how our experiences have impacted us both, as well as learning some coping skills for when I’m feeling overwhelmed. We’ve also been doing some attachment work and I’m starting to feel more connected to Misty and can tell she’s feeling it too. We have a long way to go but I don’t feel so hopeless anymore, I know we’ll get there”.