This developmental programme for premature infants is designed to promote the sensory development of babies born before 32 weeks gestation.
Babies born prematurely are at risk of motor, cognitive and sensory development disorders due to arriving too early. The aim of the programme is to facilitate your child’s development as close as we can to their previous environment in the womb.
Experienced specialist paediatric physiotherapists, speech and language therapists and occupational therapists facilitate the programme alongside nursing staff, neonatologists and parents. Parents will be able to take part in all of the areas and provide feedback to the therapists about the baby’s progress as well as ask for advice and education at different parts of the baby’s development.
The programme focusses on the baby’s five main sensory systems:
- Touch
- Vestibular/movement
- Sight
- Visual
- Auditory
The therapists will monitor your baby on a weekly basis and progress the programme dependent on parental and nursing staff feedback, as well as assessing the baby’s response to the interventions. Every baby on the programme will have a special board next to their bedside where we can track at what stage the baby is and parents will be able to leave feedback on this.
Baby Signals
Baby wanting to interact:
- Baby awake, quiet and alert
- Bright eyed and may make eye contact
- Body relaxed and respiratory rate steady
Baby settled and self-calming:
- Foot bracing – put one foot on top of other
- Sucking – on pacifiers or breathing tube if ventilated
- Finger grasping
Baby needing a rest:
- Yawning
- Hands splaying with arms up
- Staring gaze / hyper alert
- Looking away
- Not responding to stimulation
- Change in respiratory rate / drop in oxygen levels
- Increased heart rate
Touch
Why?
- Touch between a preterm baby and parent can support infant development, accelerate breastfeeding establishment, prevent hypothermia, increase oxytocin levels in baby and parent and support parental-baby attachment.
Non-touch touch (24 weeks to 27 weeks)
When:
- From 24 weeks gestational age
- Baby is stable on or off ventilator
- No interventions are taking place
How:
- Hand inside incubator resting next to baby
- Finger hold
How often:
- As often as parents are in the NICU
Precautions:
- Parents’ hands are washed as per hand washing protocol
- Wrists clear of clothing, jewellery and watches
- Parents are not unwell
Gentle human touch (27 weeks+)
When:
- From 27 weeks gestational age
- Baby is stable on or off ventilator
- No interventions are taking place
How:
- Supine (baby on their back): one hand on head, one hand on abdomen
- Prone (baby on their tummy): one hand on back, one hand on head
How often:
- 15 minutes up to three times per day at 27 weeks corrected age, to at least three hours at 40 weeks corrected age
- Therapists to establish how long depending on baby’s progress
Precautions:
- Parents’ hands are washed as per hand washing protocol
- Wrists clear of clothing, jewellery and watches
- Baby stable and tolerating gentle hold
- Parents are not unwell
Kangaroo care (28 weeks+)
- Baby to be seven days post-delivery, weighing more than 1000g
- Starting at approximately 30 minutes per day and increasing time depending on therapy assessment
- Nursing staff to follow separate hospital protocol for kangaroo care and to facilitate and guide parents with the precautions and technique
Vestibular
Free Movement
Why?
- Allows baby to have fetal general movements consistent to those observed in the womb
When:
- From 24 weeks gestational age
- Baby is stable on or off ventilator
- No interventions are taking place
How:
- Nursing staff or parents will give the baby free movement without nappy in situ between nappy changes
How often:
- Starting at two minutes once a day at 24 weeks gestation increasing to every nappy change when at full term
- Therapy staff with guide for how long depending on age and condition
Precautions:
- Nursing staff follow hand washing protocol
- Wrists clear of clothing, jewellery and watches
- Baby is stable
- No urinary catheter in situ
Visual
Light cycling/darkness
Why?
- In the womb babies develop in darkness and exposure to light too soon can disrupt sensory systems and development
When:
- Darkness from 24 weeks until 32 weeks gestation
- Light cycling from 32 weeks
How:
- Babies younger than 32 weeks gestational age will be kept in darkness 24 hours of the day using an incubator cover unless a procedure that requires light is needed
- Babies older than 32 weeks gestational age will spend 12 hours of the day in dim light using a thin incubator cover and 12 hours at night in full darkness unless a procedure that requires light is needed
How often:
- 24 hours per day in darkness for pre-32 week gestational age
- 12 hours in dim light in the day and 12 hours in darkness at night for babies older than 32 weeks gestation
Precautions:
- Light will be needed at all ages on occasions when a baby requires a procedure or assessment
- Nursing staff will be responsible for ensuring the correct incubator cover is in situ for the baby when born
Auditory
Reading to baby/providing auditory stimulation
Why?
- From 25 weeks gestation babies form connections with familiar voices and other meaningful sounds that help with regulation. Continuing the appropriate auditory stimulation promotes brain activity for language development, increases bonding and reduces stress in preterm babies.
When:
- From 25 weeks gestation provide natural whisper voice input, reduce environmental NICU noises
- From 27 weeks gestation provide natural voice input more frequently
How:
- 26-27 weeks, quiet area, quiet conversations during diaper changes
- 30-33 weeks positive sounds, sing, read, speak using calm, soothing voice
- 35-40 weeks, reading, singing, speaking as often as possible
- Repetitive books, songs with bouncy rhythms and rhymes
- Allow family members to provide input, allowing for bonding
How often:
- 25-32 weeks – 1. 5 hours daily. Can be broken into 30-minute intervals throughout the day
- 32-40 weeks - As often as possible, during all interactions with baby, diaper change, feeding, or kangaroo care
Precautions:
- Ensure input is no louder than 45 dB
- Do not provide input if baby appears in distress or overwhelmed
A selection of books are available for use at NICU reception.
1. The Wonderful Things You Will Be - Emily Winfield-Martin
3. I Was a Preemie Just Like You - Ali Dunn
4. Guess How Much I Love You - Sam McBratney
5. Peanut: A Storybook for Mighty Preemies - Lindsay Nolan
6. The Gruffalo - Julia Donaldson
7. On The Night You Were Born - Nancy Tillman
8. Good Things Come in Small Packages - Candy Campbell
9. Each Peach Pear Plum - by Janet and Allan Ahlberg
10. The Monkey Puzzle - Julia Donaldson
You’re welcome to use your favourite books, or books you’ve started reading to baby while in utero.
Reading, speaking and singing in your home language is also encouraged.
Smell
Scented cloth/snoedel
Why?
- Babies can detect smell at 24 weeks gestation. Preterm birth can interfere with sensory development when exposed to unusual stimuli as experienced in the NICU unit. Pleasant smells sooth baby, stabilise heart rate and stimulate them to feed and improve their appetite. Scented cloths are helpful for bonding and regulation when baby is unstable for kangaroo care and cannot be removed from incubator.
When:
- 30-33 weeks place scent of parents near baby
- 35-40 weeks, hold baby as often as permitted, during kangaroo care/breastfeeding
How:
- Parents keep cloth on skin for 6-8 hours to absorb unique natural scent/breastmilk scent
- NICU nurse place a cloth near or under baby’s head for 12-24 hours
- Cloths can be swapped out and washed every 24 hours
How often:
- Change every 24 hours
Precautions:
- Avoid strong fragrances on skin
- Avoid scented/fragranced cleaning agents
- Be cautious of infection control measures, and remove immediately from baby if soiled
You will be provided with a scent cloth/snoedel to start your bonding journey.