A large part of being a neonatal nurse is learning to quickly recognise and react appropriately to child protection concerns.
In many cases it’s not because we think that the parents may harm their baby on purpose but that there are any number of issues (domestic violence, substance or alcohol abuse, non-malicious neglect) that may mean that the care and safety of the baby may end up not being the parent’s main priority.
However, there have been rare occasions where we have had to involve social services because we have good reason to believe that the parents are very likely to do something that will harm their baby directly.
The most difficult of these cases was a little girl whose parents would not accept that their actions would harm their child. They had no intention of hurting her on purpose, they just couldn’t see that what they were doing was wrong.
Their daughter had been unexpectedly born with a medical condition that affected her muscles and as a result she was not able to suck and swallow properly, which meant that she couldn’t breastfeed or have milk from a bottle.
We waited several weeks to see if her condition would improve as she got bigger and stronger but after repeated testing and input from various specialists she still struggled. As team we came to the conclusion that it was not safe to give the little girl oral feeds.
From the moment their daughter was admitted to NICU we had spent hours sitting with her parents and explaining what the condition could mean for the little girl. We explained in depth that for the time being the only way should could be fed was via a feeding tube that led directly into her stomach and if she was given milk by mouth she was likely to aspirate.
Aspiration is dangerous for a number of reasons and can cause the baby to become severely ill or even to die. This is because the baby can not only choke but the milk that ends up in the lungs as a result can cause a serious infection which can then lead to breathing difficulties.
Each time we explained the parents stated that they understood and then a short time later we would catch mum or dad attempting to to feed her milk from a syringe.
There were no language barriers and they had been able to understand our explanations for every other aspect of their daughter’s condition. But as far as feeding her went, they knew what we were saying and the understood us completely; they just refused to believe that what we were saying was true.
On this day we had just had a large meeting with the aim of getting the little girl ready to go home with her parents. Myself, the lead consultant, a social worker and representatives from the various teams that were involved in the care of the little girl all attended so that we could discuss any concerns that we had.
Every single one of us was worried that the parents would try to push oral feeding as soon as they were out of the hospital and the disastrous consequences this could have.
After the meeting the consultant came to see the parents to let them know that their daughter had reached the stage where we could start planning for them to take her home but that they had to understand that under no circumstances were they to put any food of liquid in their daughter’s mouth.
Even though it had been said a dozen times before she patiently outlined the reasons why and the consequences their actions could have. After each point she made she checked if they understood and asked them to paraphrase what she had said so that she could be certain there was no misunderstanding.
The consultant had left the room less than five minutes ago when I spotted mum with a syringe of breast milk in her hand.
She tried to hide the syringe as I approached; knowing that what she was doing was wrong but still believing that as a mother she knew best. Not wanting to make her feel attacked or persecuted I gently reminded her that her daughter must not have any oral feeds.
My heart sank as she tried to tell me that no one had explained that to her and that she wasn’t doing anything wrong.
I discreetly spoke to the three other nurses working in the room with me and both of the domestic staff who popped in and out over the course of the shift. I told them what had been discussed during the discharge meeting and that if the parents continued we would have to escalate our concerns into an official child protection issue.
I asked them not to challenge the parents but to alert me to what they were doing so that I could see how often they tried to feed their daughter before I escalated my concerns.
I could have cried when one of the domestic staff came to me to tell me that not only had she spotted mum trying to feed her baby with a syringe but that when spotted mum had tried to justify her reasons.
Mum had told the domestic that she was sure what we were saying was wrong and we weren’t giving the little girl a chance to show that she could feed orally. She knew that if they just kept trying to feed her daughter she would be able to practice and learn and soon she would be drinking from a bottle just like any other baby.
It was with a heavy heart that I wrote down everything that had been said and then went to find the consultant to tell her that we needed to contact social services.
When I found her she hadn’t even had time to finish writing about the discharge meeting in the little girl’s hospital notes and when I told her what had happened she was just as shocked and confused as I was.
It was decided that it was just not safe for the parents to take their daughter home and it feel to the consultant to tell them why their daughter’s discharge would have to be put on hold.
This was shortly before I found out I was pregnant and ended up not going back to work for 14 months.
I’ve never asked anyone what actually happened to the little girl and her family. It may seem like and abrupt end to the story but I don’t want to ask someone only to find out that the little girl ended up going into foster care.
Those parents loved their daughter and thought that they were doing what was best for her but they just couldn’t or wouldn’t understand that their actions would harm their daughter instead of helping her.