Many parents think that a neonatologist’s care ends when the baby is 28 days old. This is one of the most common myths faced by Dr. Justyna Fiałkowska, a neonatologist, a physician in training in pediatric neurology, a lactation consultant, and a perinatal psychotherapist in training. In her view, neonatology is long-term, holistic care deeply rooted in relationships, because it is through relationships that a child’s brain develops.

When does a neonatologist's care actually end?

Typically, a neonatologist cares for a child until the child turns one year old. For children born prematurely—before the 37th week of pregnancy—as well as those with congenital defects or perinatal hypoxia, this care may be extended until the child is three years old.

The difference between a neonatologist and a pediatrician isn’t simply a matter of the child’s age. It’s a different perspective on the developmental stages that stem from the perinatal period. A neonatologist knows how to interpret the story of a child’s early life and how it translates into the child’s later neurological, emotional, and physical development. Parents can and should come to these appointments with a list of questions, even if they seem trivial, because every concern a parent has is important for the child’s well-being.

A Table with Four Legs: A Holistic Approach to Newborn Care

Dr. Fiałkowska describes her approach to newborn care using the metaphor of a table with four legs. Physical health, emotions, the family system, and neurological development are the pillars that must all be present at the same time for a child to develop properly. Removing just one leg causes the entire table to tip over.

This perspective changes the nature of a visit to the neonatologist. It’s not just about measuring the baby’s weight and assessing reflexes. It’s about how the mother is feeling, how the family is functioning, whether the baby has the opportunity to form secure attachments, and whether the baby’s nervous system is getting what it needs to mature properly.

Modern Care in the Neonatal Intensive Care Unit

The NIDCAP philosophy is being increasingly implemented in neonatal intensive care units; its goal is to minimize invasive procedures and actively support the brain development of preterm infants. In practice, this means positioning newborns in so-called “cocoons,” which replicate the fetal position and give the baby a sense of security. It also involves protecting the baby from excessive light and noise and maintaining a circadian rhythm, which is crucial for the maturing nervous system.

Another innovative solution is the ability to view a baby in an incubator via a camera, known as the “baby monitor.” When parents cannot be physically present, this technology allows them to bond with their child and feel like they are part of the baby’s first moments.

Feeding as a relationship, not just as nutrition

Dr. Fiałkowska views feeding through the lens of relationships. Lactation is not merely the provision of food with a specific nutritional composition. It is the building of a responsive bond in which the mother responds to the baby’s cues, and the baby learns that its needs are recognized and met.

The key concept the expert uses is a “nurturing relationship,” which refers to the emotional exchange between a caregiver and a child. If a mother cannot or does not want to breastfeed, it is more important for her to feel good and be emotionally present than for the milk to have a specific composition. A calm, present parent is better nourishment for a newborn than a mother’s milk given by a stressed-out woman whose mind is elsewhere.

The Mother Is More Important Than the Child: A Metaphor of the Oxygen Mask

One of the most powerful messages of the conversation is a statement that many parents hear with surprise: the mother is far more important than the child. Dr. Fiałkowska explains this precisely. Just as on an airplane, where you put on your own oxygen mask first and then help your child, a mother who does not take care of her own recovery and emotional well-being will not be able to care for her newborn.

Maternity leave is not just a vacation. Research suggests that hormonal and neurological changes in a woman’s body can last up to two years after childbirth. Meanwhile, modern mothers often have to manage without a so-called “support village”—without a network of loved ones who could help during the first few months. This exacerbates stress, fatigue, and the risk of postpartum depression.

Postpartum depression is a topic that Dr. Fiałkowska addresses without mincing words. Children crave emotional connection. A lack of facial expressions in a parent—for example, due to depression—causes a newborn to withdraw and give up. This phenomenon is documented by an experiment called the Still Face Test, which clearly shows how quickly an infant reacts to a caregiver’s emotional absence. For mothers who want to assess their own emotional state, the Beck Depression Inventory is available online—a simple tool that can serve as the first sign to seek professional support.

Therapeutic Hypothermia and Early Neurological Diagnosis

In the field of neonatal neurology, Dr. Fiałkowska discusses two important topics. The first is therapeutic hypothermia, a standard method for treating children who have experienced perinatal hypoxia. It involves the controlled cooling of the child’s body to a temperature of approximately 33 to 34 degrees Celsius for 72 hours. This treatment halts the cascade of damage in the brain, which, following hypoxia, continues long after the episode itself has ended.

The second issue is the early assessment of the risk of disability using the Prechtl and Hammersmith scales. These tools enable the early detection of abnormalities in a newborn’s neurological development, which opens a window of opportunity for the rapid implementation of effective physical therapy before the changes become permanent and more difficult to address.

A parent has the right to ask about anything

Dr. Fiałkowska concludes her message with a clear invitation to parents. A visit to a neonatologist is not just about examining the baby. It’s a space where parents can and should ask questions about anything that concerns them, from neurological issues to choosing the right diapers. Every question that helps a parent feel more confident and at ease benefits the child. Because a calm, supported parent is the best neurodevelopmental therapy a newborn can receive.