A few months ago, I started volunteering as a “cuddler,” holding and comforting sick and premature babies in a neonatal intensive care unit (NICU). According to Children’s Healthcare Canada, “science clearly supports that caregiver touch has a powerful effect on babies’ brains and bodies, optimizing healthy growth and development, both in the short and long term.”
Parents always have priority and are the best source of comfort for their own newborns, but when they can’t be there, volunteer cuddlers (who are thoroughly screened and trained) can step in to fill the gap. Below, I describe my experiences and those of other volunteer cuddlers.
Thursday, 9 a.m.: I arrive at the NICU at the University Hospital of Northern British Columbia (UHNBC) in Prince George for my two-hour volunteer cuddling shift. (Yes, holding and comforting hospitalized newborns is actually called “cuddling.” I love this and find it hilarious to get emails from the volunteer coordinators with the salutation, “Hello, Cuddlers!”)
NICUs, also known as intensive care nurseries, provide special care for babies who were born prematurely or with other health challenges. At UHNBC, the largest of the Northern Health’s 18 hospitals, each tiny patient in the NICU has their own private room and a nurse dedicated to their care. In addition to a bassinet or incubator, each room also has a closet, mini fridge, and double-size adult bed to make it easy for parents to spend time with their little ones.
This is a concept called “dyad care”, which has been shown to result in better health outcomes for newborns (the word “dyad” is based on Latin and Greek words meaning “two.”) According to Health Canada, “… the early mother–infant dyad experience profoundly affects infant and child development and the health of the family.”
“We’re very lucky to have the private rooms, and it’s amazing to have the adult bed in here so the parent can stay, if they’re able,” says Tabitha O’Donnell of Prince George, who slept several nights in the NICU with her premature baby Amelia.
Today all the other babies in the NICU have family with them, so the nurses direct me to Room 6 to cuddle little Bryce. (Except where parents gave permission in writing, all the babies’ names and details have been changed to protect their privacy.)
According to the whiteboard in his room, he currently weighs just 4 pounds 11 ounces (2.1 kilograms). It may not seem like much, but he’s made great progress from when he was born at 29 weeks, weighing just over 3 pounds (1.4 kilograms).
The nurses in the NICU are understandably protective of babies’ and families’ privacy, so the only information I and the other cuddlers are privy to is what’s displayed on the whiteboards in each room: the baby’s and parents’ first names (no last names, ever!), plus the baby’s birth weight, current weight, and feeding details.
I gently lift the tiny blanket-wrapped bundle out of the bassinet and settle myself in a large armchair. Bryce sighs in his sleep and nestles against me. “Enjoy your snuggles!” says the nurse as she leaves the room. Could this be the best volunteer role ever?
Cuddling benefits newborns in many ways
Cuddling premature or sick newborns provides many benefits for their health. As mentioned in Perinatal Services BC’s Newborn Nursing Care Pathway, the World Health Organization lists “nurturing, cuddling” as essential needs for newborns. One reason they’re so important is that cuddling promotes the release of oxytocin, often referred to as the "love hormone." It plays a crucial role in bonding and social connection, and can help create a sense of security and comfort for fragile newborns, reducing their stress levels and helping them cope with the challenges of being born too soon.
As well, the warmth of another human body helps premature babies sleep better and maintain stable oxygen levels and body temperature.
“A lot of times with our premature babies, if they’re having lots of dips in their oxygen levels, they can really benefit from snuggling -- it brings their levels back up,” says NICU nurse Nicole P. “It also helps with their heart rate and breathing; they regulate those things with the person they’re snuggling with.”
Finally, studies show that preemies who experience more cuddling tend to gain weight more quickly, which helps them go home with their families sooner – the goal everyone in the NICU is striving for.
“It’s really the best medicine – a loving person, rather than medication,” says Dr. Simon Earl, a Prince George pediatrician. “Babies are in the NICU for a shorter period, they recover better, and I’m pretty sure their long-term outcomes are better.”
Saturday, 6 p.m.: I’m at UHNBC for another NICU shift; I usually do one two-hour shift a week. This time, I’m directed to the room of premature twins Ellie and Rolf. My first twins! I’m excited, but nervous. The nurse offers to hand them both to me, but I feel this might be too much and opt to cuddle only little Ellie.
As always, I’m grateful for the nurse’s help as he hands me the tiny girl. Like most of the babies I cuddle, she’s hooked up to multiple sensors that monitor her heart rate, blood oxygen, and breathing, and managing all the leads is sometimes difficult. As well, I notice that she has a tiny feeding tube snaking into her nose.
Many premature babies need feeding tubes because their ability to swallow is still developing, and the tubes allow formula or breastmilk to be delivered directly to their stomachs. I notice on the twins’ whiteboard that Ellie gets 43 ml of formula every three hours around the clock (a grand total of 1.2 cups of food a day), and that she’s gained almost a pound (454 g) since birth – you go, girl!
The readings from Ellie’s and Rolf’s sensors are displayed on monitors in their room, as well as on duplicate monitors at the nurses’ station just outside the door. I notice that both twins tend to stop breathing for seconds at a time, triggering alarms. Am I doing something wrong?
Thankfully the nurse explains that although it’s nerve-wracking to witness, this “apnea of prematurity” is common in premature babies. It happens because the parts of the brain responsible for breathing are still under development. Each time it happens for more than a few seconds, he comes in to check, but all is well – both babies have good colour and are able to restart their breathing on their own.
Part way through my two-hour shift, I ask the nurse if I should switch babies – I’m worried that although he’s sleeping peacefully, baby Rolf is missing out on the snuggles. However, the nurse explains this isn’t a good idea because too much stimulation (such as being taken in and out of their cribs) is bad for preemies, so it’s best if I spend my entire shift focused on just one baby. For the same reason, rocking and singing are discouraged for some babies, and their rooms are kept dim and quiet. For preemies, the outside world is often an assault on the senses, and just being held quietly can be stimulation enough.
Some newborns aren’t strong enough to be cuddled – or even to cry
When I was being trained for the cuddling role, I worried a lot about the babies I’d be working with. If they were crying or in pain, would I be able to comfort them? If they were ill, would I inadvertently make things worse? I was relieved to learn that volunteer cuddlers never even encounter the sickest and tiniest babies, because cuddling would stress these fragile newborns too much.
“If a baby is extremely sick or very small and fragile, cuddling may not be appropriate,” says NICU nurse Kelsey. “They often need their sleep as a priority.”
Nurse Nicole P. agrees. “A lot of our really premature babies only get handled during feed times, and we try not to handle them too much,” she says. “Some babies might be further along than others and might be able to have snuggles sooner, though – you really have to play it baby by baby.”
Most of the babies that we volunteers cuddle – although tiny and seemingly fragile – are on a clear upward path to good health. With lots of rest, nourishment, and snuggles, it’s only a matter of time before they’re strong enough to go home with their families.
In a place that cares for medically fragile babies, you might expect the air to be loud with crying. I was surprised to find that this isn’t the case in the NICU -- it's quiet and peaceful (and smells deliciously of clean laundry!) One reason for the quiet is that many premature babies show their discomfort in ways other than crying.
Nurse Nicole P. explained that when preemies are unhappy, their heart rates might increase, they might show changes in breathing patterns or skin colour (“events”), or they might squirm or grimace. “They’ll start showing stress cues, they’ll start splaying their hands and they’ll start having events,” she says. These are the silent signs of distress that volunteer cuddlers are trained to watch for.
Cuddlers love their work
Cuddling is among the most popular volunteer roles in healthcare, with a year-long waiting list to cuddle here in northern BC, and more than 100 volunteers on the waiting list at Interior Health’s Kelowna General Hospital in southern BC.
“I’ve always been a baby person,” says Valli Pasemko, a grandmother who’s been cuddling at UHNBC since spring 2023. “I think I'm going to have to keep doing this for a while. It's too satisfying and too heartwarming. This is what I was meant to do – look after babies!”
Cuddler Ruth Marshall of Prince George brings a special perspective to the role, having given birth to a premature baby herself many years ago. “I'm very aware of the benefits of helping these little people,” says the grandmother of eight. “I like holding them; they're so content and happy. You feel like you're contributing."
The cuddlers I spoke to agreed that the benefits definitely flow in both directions. When cuddling, you’re forced to be in the moment and fully present.
“What's nice about it is you don't have anything else to do,” says Marshall. “You're not trying to do a load of laundry at the same time, the way you would at home with your own child or grandchild. It's not just good for the baby, it's beneficial for us as well.”
“It's very calming; I can feel the space open up when I'm there for a couple of hours,” says cuddler Angie Bonazzo of Prince George. “It's very restorative for both the baby and the cuddler. They heal us too; it’s powerful stuff.”
Cuddler David agrees. "I find it enables me to unplug from a stressful life and just go in there and focus on the babies' needs,” he says. “I don't need to think about what's going in the world or in my life; I just focus on that little one in my arms. Life gets busy and sometimes I think of rescheduling, but I'm always glad afterwards that I did the volunteer shift.”
Volunteer cuddlers are carefully screened and trained
Like all volunteer cuddlers, I went through a meticulous screening and training process that included a Criminal Record Check with the Ministry of Public Safety, references collected from two people, and an hour-long in-person interview with Northern Health’s Volunteer Resources team. Once I was accepted into the role, I was required to complete several hours of online training, followed by an in-person orientation to the NICU. This in-depth process ensures that volunteers are well suited for the role.
Training for volunteer cuddlers covers both general aspects and specific details about newborns and the NICU. Developed in-house by Northern Health, the training not only equips volunteers with practical skills, but also highlights the positive impact of cuddling on babies’ well-being. As well, knowing that the professionals are always at hand is reassuring for volunteer cuddlers.
Cuddler David was impressed by the program's thoroughness. “It’s excellent,” he says. “You’re supported right from the interview, to the onboarding, to support in the unit, to the scheduling system. The process for getting into it was quite rigorous, which was absolutely appropriate. They're looking for fit for the role.”
“The nursing staff and the medical staff are very welcoming and supportive of the cuddling program,” says David. “I'm comforted by the fact that nurses come in to check. I've always got the call bell, but I've never needed to use it. I don't need to concern myself with when alarms are going off and so on; the nurses come in and take care of it. They really know what they're doing.” This collaborative effort ensures a seamless experience for volunteers and, most importantly, for newborns and their families.
Comforting newborns who face substance exposure
According to the BC's Provincial Health Services Authority (PHSA), when newborns are exposed to substances before birth, they may experience Neonatal Abstinence Syndrome (NAS) as they withdraw. Symptoms include challenges with sleeping, feeding, and being comforted.
At UHNBC’s NICU, confidentiality is a priority, and all the medical and nursing staff are extremely protective of families’ privacy. Because of this, volunteer cuddlers like myself have no idea (and rightfully so!) whether the babies we’re cuddling have NAS. What we do know, though, is that cuddling helps support all fragile newborns – whether they have NAS or not – as they get stronger.
“For brain development in your time of need [i.e., withdrawal], if someone isn’t there to comfort you, if affects the development of brain pathways, with long-term effects on the development of love, trust, and confidence,” says Dr. Earl. “Previously, babies with NAS were going on morphine for six weeks, but with cuddling, it’s about two weeks – it’s a huge difference.”
“The UHNBC cuddlers are supporting the Eat, Sleep, Console program,” says Jennifer Boon, Perinatal Mental Health & Substance Use Educator. “This program supports families whose babies are experiencing substance use withdrawal. Its intent is to keep babies and families together, while decreasing the length of hospital stay.”
According to the PHSA and Perinatal Services BC, the program “is based on normal newborn behaviour … and has been shown to decrease the length of hospital stay, decrease the use of pharmacological management, and improve family attachment and breast/chest feeding rates … .” The program uses tools such as human contact and cuddling, rhythmic movement, and a quiet, low-light environment.
Why I cuddle
I know the babies I cuddle won’t remember me, but it feels so satisfying to contribute in a small way to improving their health. It also warms my heart when families say things like, “Thank you for loving her!” I think I’ll continue doing this as long as I can.
David, a father of four, agrees. “I could see myself doing this for a long time,” he says. “It's filling a few things for me: my desire to volunteer in the community; my enjoyment of interacting with infants; and my wish to make a difference. It's also providing me with some well-needed restorative time. I do feel privileged to be able to do this.”
And finally, as Kerry Williams said during an orientation session, “Our volunteers make a difference!”
Are you interested in becoming a volunteer cuddler? In the Northern Health region, UHNBC in Prince George is the only hospital with a cuddling program. To apply or learn more, email volunteers@northernhealth.ca.
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