1. Blackburn, Susan PhD, RN, FAAN

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This column is part of an ongoing series on selected Internet resources that are useful for clinical practice or teaching. The sites discussed in this column are 2 resources from the March of Dimes that were developed for parents to enhance understanding of infant behavior. Infants communicate their needs through their cues, which are physiologic and behavioral parameters that signal the infant's state or needs. Types of cues include infant states of sleep and awake; behavioral abilities such as attentiveness, cuddliness, and consolability; indicators of stability/instability and engagement/disengagement; and coping strategies. Cues provide information about an infant's status, needs, handling of sensory input, development of stress or sensory overload, tolerance for stimuli, and need for rest and time-out.


Infants have their unique style of interacting with their parents. Understanding an infant's cues is a critical part of parenting that helps to form the basis for early interactions and the development of attachment between the infant and his or her parents. Nurses must understand infant's cues and work with parents to understand and interpret a given infant's cues. By understanding how their infant responds and the strategies that infant uses to indicate his or her status and needs, parents can better interpret the baby's behavior and respond appropriately. The March of Dimes has developed 2 Internet sites,* one directed toward families of term newborns and one for families of preterm infants, to help parents better understand their infant's behavior.


The first site, titled Understand Your Newborn: "Things That Make Me ME" (, is an online interactive educational tool about infant states and behaviors. The site was developed for parents of term infants, although it is also applicable for parents of preterm infants, particularly as they mature and following discharge. The site is organized around the following main units: states of awareness, infant sleep, senses, reflexes and movement, crying and playing, and break time. Infant cartoon-like figures (one for each unit) act as guides. The site is interactive with simple games parents can play to test their understanding and downloadable handouts. Units within the site contain video clips, illustrations, photographs and animations, "Did you Know" (hints and tips), activities for parents to do with their own infant, reminders, and a glossary. Important points are presented in different formats and reinforced. Parents can move around between units or just focus on one area of interest.


The second site is titled: Understanding Your Premature Infant ( This site focuses on the behavior and cues of premature infants of different gestational ages. The site is organized around the stories of 3 families who share their experiences relating to understanding their premature infants' behavior. The families include parents of a 25-week-gestation infant, a 32-week-gestation infant, and a 35-week-gestation infant. A summary of these 3 families' stories is provided. The site is organized around the following main units: infant cues (including definitions, why these are important and examples of cues including physiologic/autonomic cues), body and movement, sleep and awake, crying and fussing, senses, interacting, and feeding. Parents are encouraged to observe their infant's responses and strategies for interacting and areas for parents to observe with their own infant and suggestions for activities are provided. Changes as a baby matures are also discussed. Units within the site also contain video clips, illustrations, photographs of premature infants of various gestations, and animations, "Did you Know" (hints and tips), and definitions of specific terms with which parent may be unfamiliar are included in boxes. Important points are presented in different formats and reinforced by the experiences of the families highlighted on the site. Parents can move around between units or just focus on one area of interest.


Susan Blackburn, PhD, RN, FAAN




Department of Family and Child Nursing


University of Washington, Seattle


* Disclosure: Susan Blackburn was involved in developing these sites and received an honorarium from the March of Dimes upon completion. She has no current financial interest in these sites. The sites are the property of the March of Dimes and are available free to the public on the March of Dimes Web site. [Context Link]