Trauma-Informed Developmental Care: The Five Guiding Principles in the NICU

"The guiding principles are at the heart of Trauma-Informed Developmental Care, weaving together safety, trust, connection, and equity to create a sanctuary where every soul is seen, valued, and nurtured." - Mary Coughlin

I’m Mary Coughlin, founder of Caring Essentials Collaborative, and today I want to explore the five core principles of Trauma-Informed Developmental Care (TIDC). These principles—Safety, Transparency & Trust, Healthy Relationships and Interactions, Empowerment, Voice & Choice, and Equity, Anti-Bias Efforts & Cultural/Gender Affirmation — are not just guidelines; they are the foundation of compassionate care in the NICU. Each principle serves a vital role in ensuring that every baby, family, and clinician feels supported, valued, and empowered. I'll be diving into them individually in the following weeks

1. Safety

Safety is the bedrock of TIDC, and in the NICU, it goes far beyond physical protection. It means creating an environment where babies, families, and clinicians feel emotionally secure and supported.

For Babies: Newborns, especially those in the NICU, are highly vulnerable. Ensuring their safety involves providing gentle, consistent care that minimizes stress and promotes healing. This includes protecting them from unnecessary pain, reducing environmental stressors like noise and bright lights, and creating a calming atmosphere.

For Families: Safety for families means feeling emotionally and psychologically supported. It’s about knowing their baby is receiving the best possible care, and that they too are cared for in their journey. This involves clear communication, compassionate support, and ensuring that parents feel welcome and included in their baby’s care.

For Clinicians: Clinician safety is about fostering a work environment where they feel emotionally supported and respected. When clinicians feel safe, they can focus fully on providing the best care for their patients, reducing stress and burnout in the process.

2. Transparency & Trust

Trust is at the heart of trauma-informed care, and transparency is what builds it. In the NICU, fostering an atmosphere of openness ensures that families and clinicians can work together in the best interests of the baby.

For Babies: While babies cannot communicate verbally, they respond to the environment around them. By establishing predictable routines and reducing unnecessary disruptions, we create a sense of trust and security for the baby.

For Families: Families in the NICU are often overwhelmed with emotions and information. Transparent communication helps build trust, ensuring that parents understand their baby’s condition, the care being provided, and how they can be involved. This openness reassures families, empowering them to participate fully in their baby’s care.

For Clinicians: Trust among clinicians fosters collaboration and effective teamwork. By promoting transparency within the care team, we create an environment where everyone is informed, aligned, and working together for the well-being of the babies.

3. Healthy Relationships and Interactions

At the core of TIDC is the belief that relationships are healing. Healthy, compassionate interactions between babies, families, and clinicians form the foundation for trust, healing, and growth in the NICU.

For Babies: Babies thrive on nurturing interactions. Every touch, every moment of eye contact, and every soothing voice fosters brain development and emotional stability. In the NICU, these interactions are essential for promoting attachment and reducing stress.

For Families: Families need to feel like they are part of a supportive, compassionate care team. When families experience healthy, respectful interactions with clinicians, they feel empowered, valued, and more connected to their baby’s journey.

For Clinicians: Fostering healthy relationships among the care team is crucial for delivering high-quality care. Positive, collaborative interactions create a culture of support, reducing burnout and enhancing job satisfaction.

4. Empowerment, Voice & Choice

Empowering families and clinicians with voice and choice is essential to TIDC. This principle ensures that everyone involved in the care process feels heard, respected, and able to make informed decisions.

For Babies: While babies cannot make choices themselves, empowering their care team to advocate for their needs ensures that their voice is always heard. This includes recognizing their cues and providing developmentally appropriate care that respects their individuality.

For Families: Empowering families means involving them in every aspect of their baby’s care. Parents need to feel that their concerns are heard, their choices are respected, and that they play a vital role in their baby’s healing journey. When families are empowered, they are better equipped to advocate for their baby’s needs and feel more in control during a challenging time.

For Clinicians: Clinicians need to feel empowered to make decisions that are in the best interest of their patients. This includes having a voice in the care process, being able to advocate for best practices, and being supported in their professional development.

5. Equity, Anti-Bias Efforts & Cultural/Gender Affirmation

Equity ensures that every baby, family, and clinician receives the care and support they need, regardless of their background or circumstances. TIDC prioritizes anti-bias efforts and affirms cultural and gender identities to create a truly inclusive environment.

For Babies: Every baby in the NICU is unique, and their care should reflect that. Providing equitable care means recognizing each baby’s individual needs and ensuring that they receive the same high-quality, compassionate care, regardless of their background.

For Families: Families come from diverse cultural and gender backgrounds, and it’s essential to provide care that respects and affirms their identities. By addressing biases and ensuring that care is culturally sensitive and inclusive, we create a space where all families feel welcome, respected, and supported.

For Clinicians: Clinicians also come from diverse backgrounds, and fostering an inclusive work environment is crucial for delivering equitable care. By addressing biases and promoting cultural and gender affirmation within the care team, we ensure that everyone feels valued and respected, creating a more cohesive and effective team.

The Path Forward

Trauma-Informed Developmental Care is more than just a set of principles; it’s a philosophy that guides every action and interaction in the NICU. By embracing these five core principles — Safety, Transparency & Trust, Healthy Relationships and Interactions, Empowerment, Voice & Choice, and Equity, Anti-Bias Efforts & Cultural/Gender Affirmation—we create a healing environment that supports the growth, development, and well-being of babies, families, and clinicians.

Let’s continue to bring these principles to life in our daily practice, ensuring that every baby, family, and clinician feels safe, valued, and empowered in their journey.

With deep commitment,

Mary Coughlin

I’d love to hear your thoughts and experiences about applying these principles in the NICU. Together, we can continue to enhance our practice and make a profound difference in the lives of the babies and families we serve.