HUG Your Baby: An Evidence-Based Strategy
for Teaching Professionals in a Community Setting How to Help Parents Understand the Language of their Newborn (2013)
By Gale Touger, BSN, FNP, IBCLC and Maryam Mozafarinia, MSN, BSN
The purpose of this study was to determine if HUG Your Baby’s one-day community-wide training increases the knowledge and confidence of professionals providing outpatient, community-based care to parents about a newborn’s eating, crying, sleeping and parent-child interaction.
|Gale Touger teaching in Dominican Republic|
Traditionally, parent teaching came primarily in the form of information passed from one generation to another. However, today’s new parents face challenges in information delivery. Such challenges include: living apart from extended family; parents working full-time; difficulty attending prenatal educational classes; and short hospital stays.
Early teaching matters. Neurons to Neighborhoods: The Science of Early Childhood Development describes the first year of life as a period of neural plasticity and rapid adjustment to stimuli that allow the infant’s brain to develop to its maximum potential or not, depending on early life experiences (Shonkoff 2000). Dr. T. Berry Brazelton’s work describes the essential elements of anticipatory guidance for parents (Brazelton, 1975) and suggests effective ways for them to respond to their infants. (Hagan, Shaw & Duncan, 2008). In addition, research shows that a mother’s perception of her baby’s satisfaction with breastfeeding can make the difference between continuing to breastfeed and switching to formula feeding (Karl, 2004).
|Maryam Mozafarinia (center) teaching in Montreal|
HUG Your Baby (HUG Your Baby, 2018) is an educational program created to enhance the care that birth and early parenting professionals provide to new parents. A one-day, community- wide training distills extensive research and literature about newborn behavior and parenting concerns around baby’s eating, sleeping, crying and parent-child interaction. In addition, participants explore the HUG Strategies (Tedder & Register, 2007) in this training. These Strategies include learning the power of Broadcasting a baby’s behavior (describing a baby’s specific behaviors) and Commentating on this behavior (explaining the importance of this behavior.) Multi-cultural video, case studies, and role-playing help professionals imagine how to communicate this information most effectively.
This study collected data from two HUG Your Baby workshops, providing feedback from thirty-six participants (primarily nurses and doulas working in a variety of settings).
Educators in biological and other sciences use class-average normalized gain in pre and post-test scores to gauge the effectiveness of a course (Colt, 2010). Therefore, the first fifteen, multiple-choice questions in the study tool were designed to measure participants’ knowledge of the information covered. Because a provider’s confidence to teach impacts how teaching is delivered, questions 16-30 ask participants to report on their confidence to explain, and to demonstrate, elements of the material taught. (For example, participants responded to “I can explain how a newborn’s body changes in response to over-stimulation” on a 4-point Likert Scale.)
Recognizing that a gap often exists between one’s grasp of new material and one’s ability to put new information and skills into practice, this study tool was completed by participants before training, immediately following training, and again at one month.
Thirty-four participants returned pre- and post-tests. Twenty-one returned one-month post-tests as well. This study included data only from participants who completed all three tests.
Content areas were evaluated to ascertain participants’ knowledge before the training and to identify areas identified as needing more teaching.
Data confirmed a 30.1% increase in mean test scores of knowledge immediately after completing the training. Only a small drop in scores was observed between the immediate post-test and the post-test administered one month later.
Participants came to the program understanding Signs of Overstimulation (SOS). Before training, participants answered incorrectly questions about Zones and Crying. However, post-test scores increased 33% and 40% respectively.
Data showed that participants also increased their confidence to explain and demonstrate the information and skills covered in this training. At the one-month mark, all respondents agreed or strongly agreed that they were confident they could effectively teach parents about newborn behavior.
This study of HUG Your Baby’s one-day, community-wide training indicated that such training effectively increases both the knowledge and confidence of outpatient, community-based professionals who teach new parents about baby’s eating, crying, sleeping and parent-child interaction.
Enhancing professionals’ ability to provide such information and skills helps parents appreciate their baby’s capacity to interact. This study, and the mission of HUG Your Baby, reflect the work of Dr. Brazelton, who reminds us that “emphasiz[ing] the individuality of the infant … enhances the capacity of the family to offer him or her an optimal nurturing environment” (Brazelton, 1974).
Als, H., (2004). Individualized Developmental Care for Preterm Infants. Department of Psychiatry, Harvard Medical School: Neurobehavioral Infant and Child Studies, Children’s Hospital Boston, USA.
Als H. (1982). Toward a syntactive theory of development: Promise for the assessment and support of infant individuality. Infant Mental Health Journal, 3(4),229- 243.
Barnard, K.E. (2010). Keys to Developing Early Parent-Child Relationships, in Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton (ed. B.M. Lester and J. D. Sparrow), Wiley-Blackwell, Oxford, UK.
Barnes, M., Pratt, J. & Finlayson, K. (2008). Learning about baby: What new mothers would like to know. Journal of Perinatal Education, 17(3), 33-41.
Brazelton, T.B., Koslowski, B. & Main, M. (1974). The origins of reciprocity: The early infant interaction. In M. Lewis & L. Rosenblum (ed.), The effect of the infant on its caregiver. New York: Wiley.
Brazelton, T. B. Symposium on behavioral pediatrics. Anticipatory guidance. (1975). Pediatric Clinics of North America, 22, 533-544.
Carey, W. B. (1998). Teaching parents about infant temperament. Pediatrics, 102 (Supplement E1), 1311-1316.
Colt, H. G., Davoudi, M., Murgu, S., & Zamanian, R. N. (2011). Measuring learning gain during a one-day introductory bronchoscopy course. Surgical Endoscopy, 25(1), 207-216.
Defense Centers of Excellence. Measuring and Reinforcing Learning. Retrieved from http://www.dcoe.health.mil/Content/Navigation/Documents/Measuring%20and%20Reinforcing%20Learning.pdf
Gomes-Pedro, J., Nugent, K., Young, G. & Brazelton, T. B. eds. (2002). The Infant and Family in the Twenty-First Century. Brunner-Routledge, New York and Hove.
Hagan J., Shaw J., Duncan P. (2008). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics.
HUG Your Baby. (2018). Retrieved from
Karl D. (2004). Behavioral state organization: Breastfeeding. MCN: The American Journal of Maternal/Child Nursing, 29, 293–298.
Keefer, C., Johnson, L., Minear, S. (2009). Relationship-Based Practice in the Nursery: Thoughts for the Pediatric Professional. In Nugent, K., Petrauskas, B., Brazelton, T. B., The Newborn as a Person: Enabling Healthy Infant Development Worldwide. John Wiley and Sons.
Labbok, Miriam. (2012). Community Interventions to Promote Optimal Breastfeeding. Infant & Young Child Nutrition Project. USAID.
Manning, K. (2009). Health Supervision Visits of Very Young Children: Time Addressing 3 Key Topics. Clinical Pediatrics, 48 (9), 931-938.
Nugent, K., Keefer, C., Minear, S. Johnston, L., & Blanchard, Y. (2007). Understanding Newborn Behavior & Early Relationships: The Newborn Behavioral Observations (NBO) System Handbook. Paul H. Brookes.
Papousek, M., Schieche, M., Wurmser, H (2007). Disorders of Behavioral and Emotional Regulation in the First Years of Life: Early Risks and Intervention in the Developing Parent-infant Relationships. Zero to Three Press.
Shonkoff J., Phillips D., eds. (2000). National Research Council and Institute of Medicine, Committee on Integrating the Science of Early Childhood Development. From Neurons to Neighborhoods: The Science of Early Childhood Development. National Academy Press.
Smith, K.M. (2007). Sleep and kangaroo care: clinical practice in the newborn intensive care unit: where the baby sleeps. Journal of Perinatal Neonatal Nursing, 21(2), 151-7.
Spencer, R. L., Greatrex-White, S., Fraser. D. (2010). Practice improvement, breastfeeding duration and health visitors. Community Practitioner, 83(9), 19-22.
Tedder, J. (2012). Teaching for Birth and Beyond: Online Program Incorporated into Birthing and Parenting Certification. International Journal of Childbirth Education, 27 (3), 65-68.
Tedder, J. & Register, N. (2007). The HUG: an innovative approach to pediatric nursing care. Journal of Maternal Child Nursing, 32(4).
World Health Organization. (2002). Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life. Geneva: World Health Organization.