Developmental care encompasses a range of interventions that aim to optimise & promote the babies development whilst on the neonatal unit. There is growing evidence that very stressful medical interventions impact on an infant's neuromotor , behavioural & cognitive milestones & development .
We need to find a way to care for these babies to enhance their developmental capacity . We also need to empower & educate parents to allow them to play a full role as possible in their babies care.
Developmental Care is such an approach. It should be carried out by everyone involved with the baby. Parents & baby are at the centre of care, with neonatal nursing staff, physiotherapists and medical nursing staff being the facilitators.
We will now describe how developmentally friendly care is carried out at the Manor Hospital . By understanding your baby's behaviour, adapting to environment & positioning & handling your baby appropriately, you can help to achieve optimal outcomes .
The Neo-Natal Environment
The harsh reality of the outside world compared with the environment inside the womb (intra uterine environment) can be very overwhelming for most premature infants.
Inside the womb everything is quiet and dark with a regular temperature and consistent positioning.
The neonatal unit can be a very bright & noisy place, therefore procedures & policies are in place to ensure that we try & mimic the womb as much as possible.
Bright lighting can affect your baby's sleep wake cycle & cause them to become over stimulated & aroused. Several measures can help to minimise this.
- 1] Bright lighting is only used during medical procedures & emergencies.
- 2] Lights are dimmed or switched off at all other times.
- 3] Incubators are covered with a soft fabric cover that reduces light but still allows your baby to be observed.
- 4] Baby's position is monitored & adjusted so that they are not directly under a light at any time.
Excessive noise can cause the baby to become distressed & display signs of disengagement.
- 1] Staff & visitors are reminded to talk quietly & to avoid talking over the incubator /cot .
- 2] Close incubator doors & bins softly.
- 3] Set quiet periods during the day where baby is not interrupted.
Although all efforts are made to keep noise levels to a minimum it may be difficult during busy working times such as a ward round or an emergency. Parent can help their babies during these times by talking softly to them & providing containment holds (see later) .
Premature & poorly babies cannot regulate their temperature like term infants. They are therefore nursed in incubators where their temperature can be carefully monitored. Parents can still cuddle & hold their baby & are especially encouraged to carry out 'Kangaroo Care 'as research suggests this helps to regulate babies temperature.
Communicating with your baby
At first a neonatal unit can seem very daunting & you as a parent may feel unsure what you can do to help support & comfort your baby
This section will help you understand your babies communication signs or cues, so you can respond to them appropriately.
Preterm or unwell infants find it difficult to cope with stressful or painful situations & express this as a number of well recognized signs or cues.
Disengagement cues or Behaviours
- 1] Frowning
- 2] Gaze aversion (looking away)
- 3] Crying
- 4] Arching back, struggling movements.
- 5] Splaying fingers & toes.
- 6] Raised hand in stop sign
- 7] Yawning, hiccupping
- 8] Taking hand to eyes/ears/face
Other physiological signs include
- 1] Rapid breathing
- 2] Colour changes
- 3] Rapid heartbeat
- 4] Low weight gain over a longer period of time
This is your baby's way of telling you that they are stressed with what is happening & need some help. You can support your baby in the following ways.
- 1] Speak gently, quietly in a calm voice before touching or moving your baby.
- 2] If possible dim lights & keep incubator covered.
- 3] Give baby a dummy to suck or a finger to grasp during painful procedures.
- 4] Place one hand softly over the head and the other over the chest/tummy [containment technique], before you move your baby.
- 5] Take hands to face & arms & legs to the middle.
Your baby can also let you know when they are happy & settled & ready to engage with you.
- 1] Sustained eye to eye contact
- 2] Alert yet relaxed facial expression
- 3] Assuming feeding posture
- 4] Relaxed posture & muscle tone
- 5] Brow rising
- 6] Clear, robust sleep states
- 7] Smooth respiration rate & stable heart rate
Positioning and handling your special baby
There is more and more evidence that supportive positioning and handling of premature infants may promote more normal motor development and minimise the chances of developing abnormal movement patterns.
Premature babies have decreased muscle tone which puts them at risk of developing postural problems if left in one position too long. Therefore you will see that your baby is nursed in a variety of positions to minimize this. They may also be contained in a boundary to make them feel safe & secure. Gel cushions are placed to prevent moulding or flattening of baby's head.
The main positions your baby will be nursed in are
- 1] Supine : Lying in their back
- 2] Prone : Lying on tummy
- 3] Sidelying : Lying on left or right side .
All these positions aim to encourage
- 1] A balance between bending (flexion) & straightening (extension) of the large muscle groups.
- 2] Encourage the arms & legs towards midline & maintain body symmetry.
- 3] Prevent abnormal posturing & malformations.
It is important to remember that all these positions and gel supports are safe in the neonatal unit as your baby is very closely monitored. It is not recommended that gel supports are used when your baby goes home, but speak to the nurse or physiotherapist caring for your baby for further advice.
Follow up care
All extremely low birth weight & premature babies have their development monitored by the specialist physiotherapy team until they are 12 months corrected age. This is to support parents in optimising their baby's development, identify any problems early on and provide early intervention and support. In addition baby will have neonatal follow up by Consultant with special attention to developmental progress. All the babies born before 32 weeks of gestational age will have a thorough developmental follow up at around 2 years corrected age.
All preterm infants should have their age corrected for their developmental assessment (from the EDD).
Once baby is home give them some floor time (20-30 minutes) every day so that they can freely move their arms and legs.
Babies should normally sleep on their back.
Tummy time can be started from 6/52 corrected age when baby is awake and happy and you supervise them.
Check baby is turning head to both sides equally.
Supported sitting is a good position when baby is awake, happy and ready to engage.