NICU … Now what?

By: Cassidy McCoy PT, DPT and Celine Skertich, PT, MS,PCS

Having an infant born prematurely can be a scary experience. The team of physicians, nurses, and therapists that work with your infant until discharge do their best to assist in whatever your child may need during their stay. But once the baby is discharged, what can you do to continue to promote the appropriate development of your child?

Preemies develop differently, compared to full term infants, so here are a few tips and tricks from what you can do at home.

1. Head position changes

Typically, the preterm infant’s head size is large compared to their body, and are at a greater risk for developing Torticollis and/or positional plagiocephaly. Frequently changing the position of their head is important to prevent these types of concerns.

• Tummy time
• Turning their head to the left and right when on their back
• Alternating side lying

2. Reach, Prop and Play

Preemies tend to utilize their shoulder muscles to assist with breathing. It is important to transition them to using their shoulder girdle muscles to reach, prop, and play. Gravity can be your friend as you carry or position your baby in more upright positions to promote flexion and midline.

3. Promote flexion

Low tone is a common disorder that is seen with premature infants due to entering the world before they have had a chance to develop “physiologic flexion.”  These positioning ideas help to promote flexion and can aid in normal development for a premature infant

• Carrying your baby: be sure your baby’s arms are forward and hips and knees are bent to promote flexion.
• Swaddling
• Laying on stomach (prone) with arms bent with hand near mouth, head to one side and legs flexed underneath them
• Bouncy seat (such as the Baby Bjorn): promotes midline flexion in an upright position to aid in digestion. Gravity will also assist to relax the shoulders.
• Boppy Pillow

4. Promote Symmetry and Midline

• Swaddling is important for this
• Feeding with baby’s head and hands in midline (center of chest) and hips and knees bent
• Playing with toys (on back or on side), to promote swiping their hands towards midline
• Prone positioning – Remember back for sleeping, Tummy to play!

5. Support Social Interaction

• Black and white toys

At this point, your child’s vision is continuing to develop. Up until 4 months of age, a child can see black and white toys, or highly contrasted colors, better than distinguishing between colors. Red and Yellow are the first colors they can begin to see.

• Present your face at an appropriate distance

For the same reasons as above, present your face or a toy 8-10 inches away from your child when interacting/playing with them.

Know the signs of overload: Infants who are born prematurely can get more easily overloaded compared to an infant born at full term. Signs of overload include:

• Visual avoidance or wide eyes
• Splaying of the hands
• Hiccups
• Arching backwards
• Squirming

For most children who have undergone a stay in the NICU, it is recommended to have continued care through a NICU Follow-Up clinic.  The purpose of the NICU Follow-up Care is to monitor and manage ongoing medical conditions, provide support and guidance to parents and caregivers of the high-risk infant, monitor developmental progress to identify delays, identify need for referrals to other medical professionals a needed.

The ultimate goal at the Neonatal Follow-Up Clinic at Easter Seals DuPage & Fox Valley is to assist your baby in being the best that he or she can be. Click here to learn more about our clinic.