How do I help here?

[inkandpaper]

I have a nanny job starting in a few weeks for newborn triplets that were born at 27 weeks.  Now, they are a little over 4 months, but their adjusted age is not yet 6 weeks.  The mother told me she had read Babywise.  I visited them a few days ago, now that all the babies are home, and I was there for a feeding and learned quite a bit that worried me.  They are on a strict feeding schedule and eat every 4 hours during the day (less often at night, I suspect).  When it is time to eat, they are picked up out of their cribs, fed, and held (if there are enough arms) for a few minutes until they get sleepy.  When I was there, the entire process was maybe 45 minutes.  Then they are put back in their cribs and left until next feeding time about 3.5 hours later.  Even if they cry.  The mother said that only once had she picked up a baby before feeding time, and she would often turn off the baby monitor if they were crying.  

So basically, I am concerned about these little babies.  I think they need to eat more often than every 4 hours.  Two have GERD and one is losing weight.  I think they need to be held more for their own socio-emotional development.  I have been doing extensive research to back me up, and I'd like to present it to the mom, but I don't really know how.  First of all, I don't want to present it in an adversarial manner.  I know the parents love their children and are feeling overwhelmed.  The mom told me that this was the only way to manage three babies.  I do not think they have a lot of experience with babies.  Also, I am their employee.  I can't just waltz in and order them around.  We need to be a team.  How do I do this?

[kjoy2]

How heartbreaking.  If you can go in and earn the parent's trust a bit before you start making suggestions, I think that may be best.  Even if you only wait a few days... !!!  

But you can DO things before you SAY things, right?  So, you could hold a baby when it cries during the day.  You could bring out a play mat, interact with them, etc.  Placing babies back in their cribs after every feeding of the day is just awful.  They will fail to thrive without touch and interaction.  You could learn about baby massage (internet, books) and introduce that as a way to make sure the babies are being touched - it might work since it could be incorporated as part of the schedule.  

Since 2 babies have GERD, wouldn't it be better for them to be in an upright position after feedings?  Perhaps you could take a wrap or baby carrier with you to wear one baby upright (you can make your own cheap version of a Moby wrap by purchasing 5-6 yards of clearance stretch jersey cotton then cutting it in half lengthwise - voila! TWO stretchy wraps!  Then use wrapping instructions found on the Moby website).  You could place them upright in bouncy seats and interact with them there, too.  

I can understand the need for a schedule with triplets, and I've heard that NICU babies are often on a schedule that is easy to continue at home.  However, the parents seem negligent in this case.  So above all, try what you can, stay true to your values, and if you cannot make enough positive changes to keep yourself going in that situation, remember that in the end they aren't your babies and the best thing for you might be to walk away.  I'm just saying - you may have the ability to real turn the situation around, but don't take it personally if you can't, and don't stay in the situation if it's too heartbreaking.  

Thank you for caring!!!  Hearing things like this just makes me so sad.  

[hergrace]

One thing to remember is that the parents are probably in shock right now.  And overwhelmed. I was home with my kids and the nanny and had the experience of an older child, and I still leaned hard on the nanny. It really was eighteen months before I stopped being in shock. In my case, the nanny was more mainstream than I am and she helped me get a rhythm to the day that eased the chaos.

You need to figure out if the parents are open to suggestion.  If they aren't, then it will probably break your heart to work for them.  On the other hand, if they are doing this because they can't see any other way to be, you have room to encourage changes. If you do things without talking about them and they work, you can have a huge impact.  Also, if you ask questions about the reasons behind things and ask for permission to try something different.

The feeding schedule is probably the most contentious thing. If the mother is adamant about Babywise, have a look at the book.  I believe that even Babywise says a 6-week old should be being fed every 2.5-3.5 hours, not every 4. 

However, if the babies have been on a 4-hour feeding schedule in the NICU, the parents trust that.  I would ask what the doctor has said about the feeding schedule, the weight loss and the GERD. Depending on the answers, you could ask whether the doctor has talked about more frequent feedings or upright positioning, because you are aware that that can help with the GERD. And, you might ask if you could try that and see if it helps.

If the parents see you as a resource with knowledge, you can ask to try things differently or suggest that "in my experience" something works. 

[ShanaV]

Wow, so heartbreaking!!

First off, do you have experience working with other families with multiples? We have a family friend who is a night nanny for multiples, and we have gone to her for a lot of advice. She turns out to be far more mainstream than I am, but still, she is very good with babies, really helped encourage me with BFing, and does have a lot of experience.

It might be that you have to "show" rather than "tell." Like, do something with the baby, baby gets happy, mom sees it works, and lets you continue to do that thing or even emulates it herself. Once she sees what you do working, maybe offer her a better book to read. "I read the Dr Sears book and I find that it has worked really well with all of the babies I've cared for," or something.

I remember my ped saying to me once also that "It's totally different once the babies come home and you can get them off that crazy nicu schedule!" So maybe say something like that too.l

Also, do they need help sooner rather than in a few weeks? The very beginning is the hardest, hardest time. Maybe go over there sooner?

[Freeman]

Originally Posted by hergrace 

 You need to figure out if the parents are open to suggestion.  If they aren't, then it will probably break your heart to work for them.  On the other hand, if they are doing this because they can't see any other way to be, you have room to encourage changes. If you do things without talking about them and they work, you can have a huge impact.  Also, if you ask questions about the reasons behind things and ask for permission to try something different.

If the parents see you as a resource with knowledge, you can ask to try things differently or suggest that "in my experience" something works. 

This is what I was going to say. They may be doing this b/c they are overwhelmed and just don't know how to go about this any other way. If they have not had any help prior to you starting, they may not have seen another way to handle it. You can find out if they are really committed to using these methods or if they've just been doing them b/c they are too overwhelmed to do anything else. Now that they have help and another pair of hands w/ you starting, they could hopefully be more open to other suggestions. Having some help there may make a huge difference in what they are willing to do/try with the triplets.
 

[inkandpaper]

Thanks for all the ideas.  I agree that a big part of this is that they are overwhelmed, and I definitely think I need to spend a little time earning trust.  Technically, I have their trust.  When they hired me, they said they wanted my expertise and experience with multiples, and seemed open to my ideas.  That gives me hope.  

I planned to visit again to help out, but one of the babies ended up in the hospital, so that didn't work out.  I start next week, and the first week, the mom will be there too.  I hope that we'll get a chance to be comfortable with each other, and hear each other's ideas.  From what I've seen and heard from her, she seems pretty committed to Babywise principles, unfortunately.  To the point where she won't let helpers go upstairs to rock a crying baby.  I'm hoping it'll be different with me, but I don't know.  Another obstacle is that she seems to really dislike her moby wrap.  I had planned on sort of using that as a starting point, showing her how to use it and how it keeps the babies upright, etc.  But she very recently posted on her blog that she tried it and hated it, and apparently the babies hated it too.  So I don't know if that will work for me anymore.

I guess I really don't know exactly what my starting point will be.  I'll just start next week and see how it goes.  I've been doing loads of research on everything from babywise to the psychological attachment theory so that I don't end up sounding like I only have advice and opinions, rather than knowledge and experience.  But anyway, we shall see how it goes...

[LessTraveledBy]

I bet there are "this is what happens without proper attachment" sort of stories online, even talking about Babywise. Maybe, after some time, you could try to gently explain that this particular book has already been found detrinmental... I really wish more parents knew about what we know about attachment. (We, as in science.) It really gets to me how otherwise bright people still lean on the principles they had learned in the 70's from their parents. Talking about some friends, not this couple.

[treeoflife3]

There is a very famous study about baby monkeys (chimps... some smaller primate) and how they would go to the dummy mother wrapped in a soft warm blanket before they'd go to the hard cold dummy mother with food.  Even ignoring the feeding schedule, they need to be held more than just when they eat.  Its a biological necessity to be held and touched.  I can't imagine how hard it would be to be in your position.  I personally couldn't work for them if they aren't willing to allow you to hold the babies between feedings, especially when they cry.  that just breaks my heart.

[hergrace]

In your original description of the scenario you observed was that she was feeding the babies on a 4-hour schedule.  That means she was following the Babywise schedule as though they were their chronological age rather than their adjusted age.  At that point, even the Babywise schedule would have had them on a 2-3 hour schedule based on their adjusted age. 

If she is committed to Babywise and isn't open to other approaches, I would be going through that book with a fine tooth comb looking for every mention of flexibility or discretion.

[f&p'smama]

Oh that is so sad!  I wonder if she is experiencing post-partum depression?  I hope you're able to help them come up with a more humane system of managing the needs, both physical and emotional, of 3 babies.  

[MistyP]

Sounds to me that she is very overwhelmed.

I have friends that have used Babywise and that is NOT at all how they parent.  I would recommend pulling out the good parts of BabyWise since she is set on using it.  I don't think it recommends newborn feedings every 4 hrs and it also says to have activity time with babies after feeding.  Reminded me of the Baby Whisperer (eat, activity, sleep...) routine. 

Definitely encourage her to look at their adjusted age....

[inkandpaper]

I just finished my first week with them.  Overall, I think they will be a little more flexible than I had anticipated.  The mother was at home this week, so I got to see how they interact.  I do not think there is ppd at play, but that's just my opinion.  They do get attention after they eat most of the time.  The parents just seem to think that babies need to learn how to be self-reliant (I disagree).  In their thinking a crying baby is saying, "I dropped my binky," "I am physically uncomfortable," or "I'm being fussy," and the last category doesn't need a response (again, I disagree).  The mom told me that I may have a lower tolerance for crying, and I could do what I was comfortable doing without changing the schedule.  She even told me I could pick up or lie down with a crying baby, but as a last resort.  The dad said something that rubbed me the wrong way, though.  He was talking about letting them cry, and said, "They're getting to the age where they're going to have to pull it together."    Um, no.  They are two months adjusted age.  

I asked about the 4 hour feeding schedule, and they said that they tried to switch it to 3 hours when the babies came home from the NICU, but it the babies didn't tolerate it (?).  They also said that their pediatrician is okay with this schedule, but they are thinking about switching to 3.5 hours during the day.  The little boy especially has trouble with reflux.  He eats 135 ml every 4 hours, but I wonder what would happen if he ate half that amount every 2 hours?  Also, his mom told me that she was told to keep him at a 30 degree incline after eating for the GERD, whereas I'd heard upright was best?

So far, I've been holding the babies as much as I can.  They seem stiffer than other babies I've taken care of.

[Shuli]

This must be so hard for you. I'm sure that as time goes on and they grow to trust you more, they'll be open to more/different ideas. Could you also check out books from the library or get information on line that might help you to get them better information and see if you can give it to the mom in a non threatening way? Would that help?

[inkandpaper]

Well, I just wanted to give an update - I am no longer working there.  It has actually been a few months.  I loved taking care of the babies, but at the same time it was difficult, probably my most ethically challenging job.  I was not able to care for them in a way that made me comfortable, and I was not there alone - I had a helper too, and I know the mom would talk to the helpers.  Once I made an offhand comment to a helper about Babywise (it was on the table), and that evening, I got an email from the mother asking me what I thought about the book.  I spent hours composing a letter that explained all the problems with it, and I got a very short dismissive response that showed that she wasn't going to consider any of what I had said.  I also tried explaining why I wanted to use a wrap or carrier, but she was very opposed to me using one, and didn't want me to coddle them at all.  In the end, it technically wasn't our differences in opinion that ended it (that I know of), but a friend offered do take my position (plus cooking and cleaning) for a lower cost.  To be honest, I was relieved.  Thanks for all the advice and ideas that were given.  I really wish I could have made more of a difference, but it was, like i said, ethically challenging.  

[~Adorkable~]

im sorry to hear how this ended up, that must have been hard. im sure you did everything you could.