NICU Occupational and Physical Therapy
Occupational and Physical Therapy
The pediatric Physical and Occupational Therapist’s role in the NICU is to provide support to the infant, the family and the medical team. Therapists work with parents on handling techniques for calming and soothing. Parents are assisted in handling techniques, calming and general developmental care appropriate to the infant’s gestational age. Parent education is a primary focus of occupational and physical therapy in the NICU so that parents can connect to their babies and promote the best possible outcome. We monitor your baby’s development by using the baby’s corrected age for prematurity and not their chronological age.
The staff and the medical team are encouraged and supported to learn environmental modification assistance techniques such as turning cribs for improved neck movement, cycling of lighting consistent with the babies’ gestational age. Careful attention is given to each individual patient in a collaboration with multiple disciplines.
Babies are seen for positioning, calming techniques, developmental care, passive range of motion and massage when appropriate due to the baby’s many specialized concerns. These activities have been shown to be beneficial for the premature infant’s development.
The Importance of Maintaining a Calm State
When babies are in the NICU, calming techniques to assist in “state” control are the best way to promote healing, growth and improved development to move the baby toward a calm state of arousal and good sleep. When the infant has sudden change in vital signs, it stresses their system to gain control. Less exposure to stress or good management of unavoidable stressors can help the infant have the strength to fight infection or feed well from a bottle. Energy conservation is a priority for NICU patients.
You can help your baby when there is an unavoidable stressor such as a heel stick or being woken for rounds. Your baby is comforted by your voice, holding your finger, or, even simply sensing that you are in the room. It is wonderful when you can be there for your baby to hold your finger or to help her suck a pacifier, tell soothing stories, sing soft songs or provide comfort with your voice.
If you have any concerns about your baby’s development please schedule an appointment to follow up with ICD PT or OT after you are discharged from the hospital. We recommend setting up an evaluation approximately 2 months after your expected due date. Please call to schedule an ICD PT or OT evaluation.
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The Institute for Child Development (ICD) has gained a national and international reputation for providing superior diagnostic and treatment services to children with special needs. Our mission is to help children with neurodevelopmental and behavioral disorders and complex medical needs achieve their maximum potential while providing guidance and support to their families, as well as education and community outreach.
Suggestions and Advice From the PT and OT for NICU families
If you can gain an understanding of your baby’s stage of development by asking the staff or reading the laminated guide in your alcove, it will help you to learn what to expect from your baby.
Try to get involved – do as much as you can for your baby’s care and provide comforting touch or voice when your baby is being handled by the medical staff whenever possible.
Giving Kangaroo care at at least an hour each time you visit your baby, can help your baby grow and develop. Studies show that kangaroo care reduces pain, promotes calmness with less periods of crying and improves overall developmental outcomes.
Upon arriving, always check with your baby’s nurse about the schedule so that you promote rest when it is time for the baby to sleep. When entering the baby’s room, let your baby know that you are there by talking in a soft voice. Loud voices may startle your baby.
Suggestions for When Your Baby is Discharged From the NICU and Able to Go Home
Congratulations on your graduation from the NICU! Now that you are taking your baby home from the NICU, here are some guidelines from the Institute for Child Development Occupational and Physical Therapy Department for helping your little one’s development.
Alternating the position of your baby often throughout the day is very important for developing proper neck strength and flexibility. Changing the baby’s position often will also encourage the development of a symmetrical (rounded) head shape. As your baby matures he/ she will turn to see activity/you/music/noise. Therefore it is optimal to position your baby in order that there will be stimulation to both sides wherever he is place throughout the day. When a baby has a preference for turning to only one side, often the muscles of the neck become tightened and the baby’s head shape may become misshapen from lying on only one side of the head. If you are concerned that your baby is only turning their head primarily to one side or their head is flatter on one side than the other, it is an indication that you should talk to your pediatrician and begin more frequent position changes throughout the day. You should also consider having your baby evaluated by a pediatric physical or occupational therapist to determine if therapy is indicated.
When your baby is awake, it is important to provide opportunities for “tummy time” which is very important to encourage your baby’s motor development. Make sure to provide “tummy time” every day throughout the day – a few minutes every hour that your baby is awake is recommended. Placing the baby over your lap, or on your chest also counts as “tummy time”.
The most effective way to have your baby develop their gross motor skills is to have them play on the floor / rug / mat often throughout the day. In this way your baby can practice lifting and holding their head, learn to roll and push up on their arms. It is highly recommended to limit “container” usage to 20 minutes maximum and only 1 – 2 times/day. Containers are items such as a bouncy or any baby “chair,” swing, and/or “exersaucer”. Baby walkers and Jolly Jumpers are potentially harmful and are not recommended.
An infant’s favorite position typically is the “fetal” position – hands together at chest or by mouth and legs curled up. Babies prefer not to have their arms outstretched away from their bodies. You can help your baby bring their hands together and to their mouth to help him/her learn to calm themselves.
Swaddling is also a very effective way for calming a baby. Sometimes your baby will push against the wrap at first but don’t assume this means that the baby is unhappy in the blanket, often the pushing and feeling a boundary can be very reassuring, so give the baby a chance to settle down. You can hold and rock the baby to help settle him/her. Do not swaddle too tightly and there are also swaddling blankets that can be purchased.
Sucking on a pacifier or thumb/finger is very appropriate for soothing at this stage and should not be discouraged.
When your infant is tired, shaking a rattle or cooing in the baby’s face may not be soothing at this time and can increase agitation. Try to know what your baby looks like when he/she is tired so that you can respond appropriately with swaddling, providing a pacifier, remove the baby from a noisy environment, and /or dim the lights, etc.