Part 2: Strategies and skill building

HUG Strategies - Course Objectives

  1. Describe three HUG strategies.

Course Outline

  • 1) Introduction
    • a) Components of Program
      • i) Explanation of HUG Strategies
      • ii) Video clips from teaching in Durham, NC
      • iii) Role playing
  • 2) Development of The HUG Strategies
  • 3) Hug Strategies
    • a) Start Here, not There
      • i) What do parents want and need from pediatric professionals?
      • ii) Studies: The Commonwealth Survey of Parents of Young Children, National Survey of Early Childhood, Promoting Healthy Development, AAP Fellows Study, Zero to Three
      • iii) Consider their agenda, not yours
      • iv) Why some would choose to “Start There not Here”
      • v) Experienced professionals have the luxury and experience to “Start Here not There”
    • b) See, then Share
      • i) In order to ”see” behavior, need to know what you are looking for: “eyball Exercises”
      • ii) “Broadcasting” behavior - describe what you SEE
      • iii) “Commentating” on behavior -  describe MEANING of what you see
      • iv) Be specific instead of global
    • c) Gaze, then Engage
      • i) Psycho-social surrounding a new family.
      • ii) Secure attachment characteristics, risk factors, symptoms, and consequences of anxious and insecure attachment
      • iii) Trajectory when child’s behavior is misunderstood
      • iv) Misunderstanding newborn behavior could interfere with the developing parent-child relationship.
      • v) Consider “Sticky Points”
  • 4) Resources for Parents:
  • 5) Resources for Professionals:

HUG Skill Building - Course Objectives

  1. Describe research on crying and techniques for calming a baby.
  2. Describe a baby’s normal sleep, tips for helping parents (and their babies) get a good night’s sleep, and impact of sleep issues on families.
  3. Describe impact of non-feeding cues on a mother’s decision to continue breastfeeding.
  4. Describe the literature on baby’s interactive abilities and how to demonstrate these to mothers and fathers.
  5. Describe The HUG educational resources for parents and professionals.

Course Outline

  • 6) Help calming a baby
      • a) Normal crying: Increases at 2 weeks, peaks at 6 weeks, decreases by 12 weeks
      • b) “Learned Helplessness”
      • c) ”Best out come with “difficult babies” is when parents could be very objective about their baby (Thomas and Chess)
      • d) Self-calming maneuvers
        • i) Hand-to-mouth, tilt to side, tuck into fetal position
        • ii) Hold own hands, sucking movement
        • iii) Space Out, Switch Off, Shut Down
      • e) What T.O. Do”
        • i) “T” – Talk to baby. Soft sing-song voice can comfort baby
        • ii) “O” – Observe – Does baby take actions to self-comfort? (bring hand to mouth, make sucking movements, use fencing reflex, demonstrate behavioral SOSs – “Switching Off”, “Spacing Out”, “Shutting Down”)
        • iii) “Do” actions: Step-wise approach (Brazelton) hold hands to chest, swaddling, encourage sucking, swaying, Dr Harvey Karp’s “shoshing, and side position
  • 7) Help baby sleep well
    • a) Two Types of Sleep
    • b) Sleep problems: infant in parent’s bed, being nurse at all light sleep, taking longer to fall asleep, waking more often, taking short naps) associated with depression (high scores on Edinburgh)
    • c) Typical Adult vs infant sleep
      • i) Adult: 6 hours quiet/2 hours active, enters deep sleep first, 90 minute cycles
      • ii) Infant: enters light sleep first, 50-60 minute cycles. There prolonged and repeated active sleep is protective
    • d) What’s happening during Active/light sleep: increased blood supply to part of brain which controls breathing, increased production of nerve proteins that build the brain
    • e) Concept of nighttime Parenting (Dr. Sears) -“Re-settlers or self-soothers” can get self back to deep sleep, others need your help
  • 8) Help baby eat well
    • a) Consider how mom’s temperament contributes to baby’s eating
    • b) Consider baby’s Zone Organization, temperament – “No one told me the baby would have anything to do with all this breastfeeding.” (Lothian, 1995)
    • c) Arousal Model
      • i) Over-aroused and cannot settle
      • ii) Under-aroused and cannot latch, suckle
    • d) Seeing baby “as satisfied” : calms down, organizes Zones, Cuddles, Becomes alert, Makes and maintains eye contact for continued breastfeeding
  • 9) Help baby play so s/he can grow and learn
    • a) Baby’s abilities
      • i) Baby’s vision: Initially near sighted, but like adults by 6 months, Newborns distinguish red from gray, and 4 primary colors by 3 months, “Programmed” to look at faces
      • ii) Baby’s hearing: Prefers music over noise, Prefers high to low pitch, Prefers “child directed” speech: exaggerated intonations, singsong rhythm, abbreviated utterances, repetition
      • iii) Varying ability to orient: brief attention then fall off, several jerks, smooth movement
      • iv) Tactile intake at 8 weeks, taste at 14 weeks, and hearing at 20 weeks gestation
      • v) Watch for multi-tasking
    • b) What value do we give to “engaging” and “disengaging” (Barnard)
    • c) Babies are more responsive when we FOLLOW or imitate rather than STIMULATE or lead.

Course (Part II) Bibliography:

  1. Atkinson, M. (2004). Lend me your ears. New York: Oxford University Press.
  2. Barnard, E, & Summer, G. (2002) Promoting awareness of the infant’s behavioral patterns: Elements of anticipatory guidance for parents. In Gomes-Pedro, J, Nugent, J, Young, J, & Brazelton, T (Eds), The infant and family in the twenty-first century. New York: Brunner-Routledge.
  3. Barnes, M., Pratt, J., Finlayson, K., (2008). Learning about baby: What new mothers would like to know. Jo of Perinatal Education. 17(3):33-41.
  4. Beck, C. (2008). State of the science on postpartum depression: What nurse researchers have contributed Part 2. MCN. 33(3)151-156..
  5. Brazelton, T.B. (1995). Neonatal Behavioral Assessment Scale. London: Mac Knight Press.
  6. Dennis, C., McQueen, K. (2009). The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 123(4): e736-751.
  7. Drake, E. Humenick, S., Amankwaa, L. et al. (2007). Predictors of maternal responsiveness. Journal of Nursing Scholarship. 39(2) 119-125.
  8. Gardner, M., & Deatrick, J. (2006). Understanding interventions and outcomes in mothers of infants. Issues in Comprehensive Pediatric Nursing, 29, 25–44.
  9. Gerhardt, Sue. (2009). Why Love Matters. Routledge: London.
  10. Goines, L. (2008). The importance of quiet in the home: Teaching noise awareness to parents before the infant is discharged from the NICU. Neonatal Network 27(3): 171-176.
  11. Goodman, J. (2005). Becoming an involved father of an infant. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 34, 190–200.
  12. Hake-Brooks, S. & Anderson, G. (2008). Kangaroo care and breastfeeding of mother-preterm infant dyads 0-19 months: A randomized, controlled trial. Neonatal Network 27(3):151-159.
  13. Hotelling, B. (2004). Newborn capabilities: Parent teaching is a necessity. Journal of Perinatal Education, 13(4), 43–49.
  14. Karl, D. (2004). Behavioral state organization: Breastfeeding. MCN: The American Journal of Maternal/Child Nursing, 29, 293–298.
  15. Karp, H. (2004). The happiest baby on the block: The new way to calm crying and help your newborn baby sleep longer. NY, NY: Bantam Press.
  16. Lamb, M., Bornstein, M., Teti, D. (2002). Development in Infancy. Mahwah, NJ: Lawrence Erlbaum Associates.
  17. Li, R., Fein, S., Grunner-Strawn, L. (2010).  Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics. 125(6): e1386-e1393.
  18. Manian, N., Bornstein, M. (2009). Dynamics of Emotion Regulation in infants of clinically depressed and nondepressed mothers. J Child Psycho Psychiatry 50(11): 1410-1418.
  19. Markova, G. & Legerstee, M. (2008). How infants come to learn about the minds of others. Zero to Three 28(5): 26-31.
  20. McRury, JM., Zolotor, AJ. (2010). A Randomized, Controlled Trial of a Behavioral Intervention to Reduce Crying among Infants. J of Am Board of Fam Med 23(3): 315-322.
  21. Meedya, S., Fahy, K., Kable, A. (2010). Factors that positively influence breastfeeding duration to 6 months: A literature review. Women Birth March 17.
  22. Mercer, R., & Walker, J. (2006). A review of nursing interventions to foster becoming a mother. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35, 568–582.
  23. Mohrbacher, N. (2010). Rethinking Swaddling. Intern’l Jo of Childbirth Education 25(3) 7-10.
  24. Nugent, K. (1985). Using the NBAS with infants and their families. White Plains, NY: March of Dimes Birth Defects Foundation.
  25. Nugent, K., Petrauskas, B. Brazelton, T. (2009).The Newborn as  Person: Enabling Healthy Infant Development Worldwide.
  26. O’Connor, N. Tanabe, K. Siadaty, M. et al. (2009). Pacifiers and Breastfeeding: A systematic review. Arch Pediatric Adolesc Med 163: 378-382.
  27. Otoo, G., Lartey, A. Perez-Escamilla, R. et al. (2008). The calming effect of a maternal breast milk odor on the human newborn infant. Neuroscience Research. 63(1): 66-71.
  28. Papousek, M., Schieche, M., & Wurmser, H. (2008). Disorders of Behavioral and Emotional Regulation in the First Years of Life. Washington, DC.: Zero to Three Press.
  29. Romano, A. & Lothian, J. (2008). Promoting, protecting, and supporting normal birth: A look at the evidence. JOGNN 37(1):94-105.
  30. Sanders, L., & Buckner, E. (2006). The Newborn Behavioral Observations System as a nursing intervention to enhance engagement in first-time mothers: Feasibility and desirability. Pediatric Nursing, 32, 456–459.
  31. Shonkoff, J. & Phillips, D. (Eds.) (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.
  32. Tedder, J. (2007). The HUG: An innovative approach to pediatric nursing care. MCN, 32(4), 210-214.
  33. Tedder, J. (2007). HUG educational website:
  34. Tedder. J. (2008). Educational Blog:
  35. Tedder, J. (Spring, 2008). Give the HUG: An innovative approach to helping parents understand the language of their newborn. Jo of Perinatal Education. 17(2): 14-20.
  36. Thompson, R.A. (2008). The psychologist in the baby. Zero to Three 28(5): 5-12.
  37. Thulier, D., Mercer, J. (2009). Variable associated with Breastfeeding durantion. JOGNN May/June 38(3): 259-268.
  38. Tronick, E. (2007). The Neurobehavioral and Social Emotional Development of Infants & Children Norton, W. W. & Company, Inc.
  39. Tronick, E. (2009).  Infants of depressed mothers. Harvard Rev Psychiatry. 17(2): 147-56.
  40. Van Sleuwen, B., Boere-Boonekamp, M., Kuis, W., et al. (2007). Swaddling: A systematic review. Pediatrics. 120 (4) e1097-1106.
  41. Wilheim, S., Rodehorst, T., Stepans, M., et al. (2008). Influence of intention and self-efficacy levels on duration of breastfeeding for Midwest rural mothers. Applied Nursing Research. 21(3): 123-130.
  42. Zolotor, A., Burchinal, M., Skinner, D., et al. (2008). Maternal Psychological Adjustment and Knowledge of infant development as predictors of home safety practices in rural low-income communities. Pediatrics. 121 (6): e1668-1675.