Enf.ª Teresa Almeida

Student of the Master's
Degree in Child and
Paediatric Health Nursing

Enf.ª Adriana Ramos

Specialist Nurse in Child and Paediatric Health Nursing
Neonatal Intensive Care Unit

Promoting parenting in prematurity

HPA Magazine 23 // 2025

Parenting is the set of responsibilities and attitudes performed by parents to ensure the survival and development of the child, aiming not only to satisfy their physical and emotional needs but also to guide their moral, social, cognitive, and psychological development.

Parenting a preterm baby, born before 37 weeks of gestation, differs significantly from parenting a full-term baby due to the unique and challenging conditions surrounding prematurity.
This moment is full of emotional, psychological, and physical challenges.
In addition to concerns about the baby's health, parents face the difficulty of establishing an immediate bond due to the separation imposed by the need for the newborn to be hospitalized in the Neonatal Intensive Care Unit (NICU).
The bonding process between parents and newborn begins in the prenatal period when the pregnancy is planned and desired, with the idealization of the imaginary baby.
This bond becomes even greater after birth, especially between mother and newborn, as the first contacts between them promote hormonal and physiological changes in the mother triggered by the presence of the baby.
Prematurity causes a rupture in the bonding process between parents and premature babies, as the baby may have physical characteristics different from what was idealized. 
This discrepancy between the real baby and the imagined one can lead to challenges in bonding, as premature babies often require more complex care and present a fragile appearance.
The physical separation experienced due to hospitalization in a NICU is a significant factor influencing the attachment process.
The technological, hostile, and intimidating environment of NICUs further complicates the parental role and transition to parenthood.
Barriers to attachment in this setting include the presence of technology, physical separation, the baby's physiological instability, fear of attachment and subsequent loss due to the baby's death, and a lack of information from health professionals about the baby's condition and prognosis.
Parenting a premature baby is emotionally draining, with parents expressing feelings of anguish, sadness, insecurity, guilt, helplessness, failure, fear, and uncertainty about the future.
It is crucial to implement strategies to support parents in developing their parental skills, including emotional, practical, and cognitive skills, to help them feel more confident in their new role and promote a smoother transition to parenthood. There are documented strategies that can be implemented to promote bonding, focusing on interactions between parents and premature newborns, as well as interactions between parents and healthcare professionals, particularly the nursing team.
 

The Nurse Specialist in Child Health and Paediatrics is responsible not only for promoting the bond but also for implementing and managing, in partnership with parents, a health plan that promotes parenthood.
In this sense, they are the main people responsible for implementing these strategies, and in order to promote interaction between parents and premature newborns, these professionals must encourage the participation and involvement of parents in the care provided to the baby.
In other words, care must be planned and carried out in partnership so that they feel included, useful, and with the feeling that they are effectively the main caregivers.
Furthermore, it is crucial to encourage physical closeness, namely, encouraging parents to be present, to caress the baby through touch, placing their hands, massaging, and holding, as these small gestures are essential for the hemodynamic stability of the newborn, for pain control in invasive procedures, for parental training, among others.
However, the strategy with the greatest impact in promoting attachment is, arguably, skin-to-skin contact or kangaroo care. This method allows parents to have a greater connection with their child, while reducing anxiety and strengthening their self-esteem as parents, feeling more capable of caring for their baby, generating a positive effect on both their mental health and the process of adaptation to parenthood. In addition to the above, the kangaroo method and extracting milk together with the baby increase the success of breastfeeding at a later stage and increase the amount of milk expressed. Although most of these babies, due to their immaturity, cannot be breastfed, it is essential to inform mothers about the benefits of breast milk for the health of premature babies.
Finally, promoting interaction between parents and health professionals is based on communication and emotional support. Communication must be clear, concrete, and empathetic, using language free of technical and scientific terms that make understanding difficult, in order to respect the parents' capabilities, value their role, and reduce their anxiety.
Nurses play a crucial role in offering continuous emotional support to parents throughout the hospitalization process, providing moments of active listening and sharing feelings and emotions.
In short, it can be said that parenting in prematurity can be full of challenges and doubts; however, with the implementation of the aforementioned strategies, it is possible to promote bonding and self-confidence, reminding parents that they will always be the best caregivers for their children.