The teen pregnancy rate in this country was on a steady decline until 2001, but then increased dramatically by 5 percent between 2005 and 2007. Because teens are 50 percent more likely to have low-birth-weight and premature babies, the growing number of teen pregnancies also translated into more teenage mothers in the neonatal intensive care unit (NICU). But what do these adolescent parents understand about the status of their newborn and his or her care? What do neonatologists and pediatricians know about them?
Until a recent study by Hopkins Children’s neonatologist Renee Boss, not much, noted pediatric resident Erin Mack at a recent Grand Rounds. It has been known, Mack said, that teen mothers are less likely to graduate from high school, face an increased risk for intimate-partner violence, and are more likely to be single parents. Ill-equipped with immature coping strategies, teen moms are at greater risk of post partum depression and of not having their post partum depression identified (Committee on Adolescence, Pediatrics 2001). They’re also less likely to seek prenatal care and follow maternal nutritional guidelines.
“Not many pregnant teenagers take folic acid supplementation,” Mack said. “And facing the pressure to be thin, they’re vulnerable to fad diets.”
The subsequent risks for their child? Mack noted that infants born to teenage mothers are more likely to experience a developmental disability, abuse or neglect, and decreased performance on standardized tests. Also, females born to teen moms are at greater risk of becoming adolescent parents themselves compared with those borne by older moms. Also, males born to teen moms face a greater risk of incarceration.
Neonatologists can make a difference in these outcomes, noted Mack, through overcoming barriers to effective communication with adolescent parents, who tend to suffer greater stress levels in intensive-care settings. In Boss’s study, she noted that only 60 percent of teen moms in the NICU ever reported speaking with a physician (Journal of Perinatology 2010:30;286–290). Most of the mothers reported receiving daily updates only from the nurses with no discussion of the care plan, and only talked to physicians when something bad happened. Physicians tended to underestimate the ability of the adolescent parent to understand NICU care, and consequently avoided discussions with them.
“A lot of times we tend to avoid adolescent parents, or seek out their parents as opposed to talking to them,” Mack said. “But Dr. Boss showed that physician interaction with grandparents of the infant had no impact on maternal understanding. Talking to the grandparent is not filtering down to the parent, which can create barriers to post-discharge care.”
In the discussions that did occur with physicians, adolescent mothers expressed frustration about the overuse of medical terms, which contributed to their reluctance to ask questions. Consequently these mothers were less likely to accurately gauge the severity of their babies’ illness, either underestimating or overestimating their health status. The study found that while 46 percent of babies met criteria for being critically ill, only 17 percent of those babies were identified as “very sick” by their teen mothers.
“One of the biggest discrepancies was how parents estimated the severity of their child’s illness vs. how the medical professionals rated it,” said Mack.
Incorporating more of a family-centered care approach in the NICU with a focus on communication free of medical jargon can make a big difference, Mack concluded.
“Adolescent parents face unique challenges in the NICU, so it’s up to the entire medical team to ensure that communication is appropriate, current and honest,” said Mack. “It’s really important to empower adolescent parents to ask questions and not take silence as understanding, because it really can affect post-discharge care.”
For more information contact the division of Neonatal-Perinatal Medicine.