OCCUPATIONAL THERAPY IN THE NICU : AN IMPACTFUL PRESENCE
Kristen J . Bochenek , MSOT , OTR / L
It is my belief that every expecting parent spends an immense amount of time preparing for and idealizing their birthing experience and what the transition home with their newborn baby will look like . At risk of sounding naive , I image that narratives are written about childbirths that go according to plan : what it will feel like to be buckling their newborn infant into his car seat as they leave the hospital and the overjoyed feeling of walking into their home with their new , happy and healthy member of their family for the very first time . Ready to provide a warm , nurturing upbringing and a lifetime of happy memories watching this new baby grow into a smart , courageous young child , teenager , and then adult . But what do we know about the parents ’ experience when they go into labor at just 26 weeks gestational age ? Or when they are told that their baby has abnormal heart sounds at one of their routine ultrasounds and will require cardiac surgery right from the delivery room if they will survive ? Or when their baby is turning blue after birth , unable to sufficiently oxygenate his or her own blood – for whatever reason – and will require bag ventilation , emergent intubation , and ongoing respiratory support ? And what about the babies who were exposed to harmful drugs or alcohol during pregnancy and will be born feeling the pain of withdrawing from a substance they have grown dependent on ? What can we even begin to understand about their experience in the Neonatal
Intensive Care Unit ( NICU ) and how these early challenges will impact their development for years to come , priming both their reactions and interactions with the world around them ? Where do we as occupational therapy practitioners fit into this narrative ? How can we help ?
The NICU experience – while medically necessary for survival and support – is anything but natural for the infant and his caregivers . Blood pressure checks , heel sticks , diaper changes , temperature checks , and medications every four hours around the clock each day until the infant is ready to come home . Constant ‘ whooshing ’ of the oxygen support inside the isolette , nearby alarms ringing from the vitals monitors every time his oxygen saturations dip too low or his heart rate falls outside of the set parameters . The NICU is an over-stimulating environment for an infant with an underdeveloped sensory system , to say the least . How long will he need to stay in the NICU ? Maybe two days . Maybe four months . How long until he can take a full bottle or breastfeed ? When can he come off of supplemental oxygen or come out of the isolette ? Are we close to going home soon ? No certainties are offered when the answers to all of these questions are contingent on how the infant is medically progressing . This reality is far from the beautiful , joyful homecoming that the parents had in mind .
11 Illinois Occupational Therapy Association | 2022 ISSUE 1
As occupational therapy practitioners , we have a unique avenue to address the primary occupations of infancy including sleeping , feeding , and caregiver bonding . Through ongoing education and specialized learning , we can become experts in understanding infant motor development , sensory system development , and infant state control and state regulation . We learn to recognize typical infant motor development versus atypical motor development and how to facilitate more typical motor patterns , tone , and range of motion ( ROM ) when poor motor presentation is observed . We fabricate splints for ROM impairments while also ensuring the integrity of the fragile newborn integumentary system . We observe what specific stress cues an infant presents with and what kind of calming strategies are effective so that the infant does not expend energy crying during his assessments , but will be able to use his limited store of energy to regulate his temperature , gain weight , and get through the huge feat of staying awake long enough to learn to coordinate his suck , swallow , and breathing when he is ready to start oral feeding trials .
What can we do to support the mother , father , and primary caregivers ? We can use our expertise on infant development and combine this with our knowledge of caregiver role-acquisition to foster meaningful therapy sessions that welcome and solidify the caregiver as a core part of the infant ’ s experience ,
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