CONTINUED FROM PAGE 11 just as it always should be but so often gets overshadowed by the demands of medical complexity and emergent situations that require all-handson-deck from nurses and doctors . Of course the parent will step into the background to let the NICU staff do what needs to be done for their baby , but how do they find their place as the caregiver in such a medically-intimidating environment ?
Rather than solely focusing on just the patient – the infant – we can structure our therapy sessions to incorporate caregiver role-development during these early life experiences . We can teach parents how to recognize subtle infant stress cues and , subsequently , what actions they can take to calm their baby during each vitals assessment , diaper change , and bedside medical procedure . We can help with supporting kangaroo care and bonding , because there is nothing more nurturing than an infant resting skin-to-skin with their parent to feel their heartbeat , absorb their body heat , smell their familiar smell , feel their touch , and hear their comforting voice they have grown to recognize from within the womb . How important it is to find space for these bonding interactions when almost all other interactions will have strictly a medical focus .
Every single experience that reaches an infant – every touch , smell , sound , light exposure , and taste – is paving new neuropathways . As the infant ’ s sensory system and brain are rapidly developing , the infant is learning whether they need to brace for impact when someone walks up and unswaddles them , or whether they will receive nurturing , positive experiences . The infant needs to have positive experiences to combat the noxious , yet necessary , medical experiences . The good news is that we can help . As occupational therapy practitioners , we get to collaborate with nursing staff and doctors to discuss how we can best support the baby during his medical care . We get to take ownership of establishing and enforcing the parents ’ footprint throughout the entire NICU admission and put them in the foreground rather than background of their baby ’ s NICU stay .
What does a treatment session in the NICU actually look like ? Therapy sessions will be scheduled based on the infant ’ s nursing assessments and feeding schedules , so as not to wake the infant between assessment times . Across all disciplines , it is always a goal to cluster the care in the NICU to allow for uninterrupted sleep between each assessment . When possible , therapy sessions are planned during a time when a parent will be at the bedside so that the caregiver ’ s role and education on their infant ’ s development can be a primary focus of the session . Working alongside nursing , the occupational therapy practitioner will provide calming strategies for the infant during the nursing assessment and diaper change to ensure that he is supported and as comfortable as possible during his assessment . If the infant is old enough and tolerating his assessment with stable vitals , the therapist may slowly transition him through the developmental positions of supine , sidelying , supported sit , and prone while monitoring what kind of motor responses and postural activation is elicited . Simultaneously , the therapist is observing infant stress cues and honoring when he may need a break , need assistance to calm and regulate , or need to be done with therapy if he is no longer tolerating this level of handling . In the case that the infant is tolerating handling well , the therapist is offering sensory strategies to assist him in achieving a quiet and alert state , in order to support the upcoming task of feeding that will occur right after the therapy session if he is beginning to feed by mouth ( rather than through tube-feeds or IV nutrition ). Occupational therapy in the NICU thrives off of coaching a parent so that they are gaining experience being hands-on and building up confidence on how to handle and support their baby in the intimidating environment of the NICU . When the parent is present , the occupational therapy practitioner will incorporate education throughout the session on recognizing their baby ’ s stress cues and how to provide calming strategies while carrying out caregiver tasks of diaper changes , swaddled baths , or transfers in and out of the crib .
In addition to focusing on calming strategies , the infant ’ s ability to regulate his sleep-wake cycle , motor development , and caregiver education , the occupational therapy practitioner will also support the selection of safe and appropriate developmental positioners in the infant ’ s bed . These positioners
CONTINUED ON PAGE 13 Illinois Occupational Therapy Association | 2022 ISSUE 1 12