CONTINUED FROM PAGE 12 place the infant in a position that mimics the comforting boundaries of the uterine space and supports the development of physiologic flexion during the weeks that he is still considered preterm , or when he may require extra support to calm . The calming effect of these positioner boundaries will assist the infant in maintaining more stable vitals , as well as helping him achieve deep sleep more readily until he is more adept at regulating these factors on his own . Positioning interventions will also focus on prevention of pressure sores , as well as with targeting the infant ’ s head shape , as his skull is still so malleable and viable to deformities if not positioned properly during these early stages of development . As the infant grows and requires less support to calm and achieve deep sleep , he will need to gradually learn to self-soothe with just a swaddle prior to going home to ensure safe sleep practices by the time of discharge . The occupational therapy practitioner , in collaboration with nursing and other therapy disciplines , will assist in guiding the removal of these boundaries , as appropriate and tolerated throughout the NICU admission , with the goal of safe sleep practices established by discharge .
Offering occupational therapy services in the NICU is a privilege as much as a responsibility . It is imperative that the occupational therapy practitioner has a deep understanding of medical considerations in the NICU ( diagnoses , medical equipment , infant vitals , etc .) to ensure safe therapy practice , as well as an expertise on infant motor and sensory development . Occupational therapy practitioners have the ability to provide a positive impact on the infant ’ s experience in the NICU and can help pave a path for caregivers to transition into their parental role at a time in their lives that likely feels frightening and unsettling . Through a delicate balance of education and hands-on intervention , occupational therapy practitioners can help bridge the transition from the hospital to home and facilitate nurturing experiences that will positively impact the infant ’ s development , as well as provide invaluable memories of bonding for the infant and his caregivers at a time when they need it most .
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Examples of Infant Stress Cues
• Crying
• Grimacing or wincing
• Finger splay
• Arching
• Hiccoughing
• Gaze aversion
• Repetitive sneezing or yawning
• Abrupt transition between awake and sleep states (“ shutting down ”)
• Changes in vitals
Examples of Calming Strategies
• Swaddle
• Containment
• Static Touch
• Pacifier for non-nutritive suck
• Guiding hands near face or midline
• Providing boundaries using developmental positioners
• Decrease environmental stimulation
• Slow-paced transitions between positions
• Therapeutic pauses or breaks
Kristen J . Bochenek , MSOT , OTR / L , NTMTC :
Kristen services the inpatient pediatrics population at Advocate Children ’ s Hospital and Ann & Robert H . Lurie Children ’ s Hospital with her primary focus in the NICU , PICU , and General Medicine floors . She has a passion for working in the ICU ’ s and is currently certified in Neonatal Touch & Massage ( NTMTC ).
13 Illinois Occupational Therapy Association | 2022 ISSUE 1