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OB/GYN

Developmental Care

Helping Your Baby Grow and Develop

You play an important role in the care of your baby from the time he or she is admitted to our nursery until the time he or she goes home. You may help your baby by providing experiences that will support a baby’s developmental progress. That means treating your baby in the ways that are correct for his or her age, medical condition, and state of alertness. It also means recognizing when your baby is tired so that you can help him or her rest. Premature babies have muscle tone that is different from other babies. There are ways you can move and position your premature baby that will help your baby feel calm and secure. The knowledge you possess of your baby will help to individualize the care to best meet his or her developmental needs.

In this section, we will provide examples of typical behaviors seen in the very young premature baby, the older premature baby and the baby approaching term. Remember that your baby’s nurses, doctors, and developmental specialist will be ready to help you discover the individual needs of your baby.

Corrected age
If your baby was born prematurely, it is sometimes better to use his or her corrected age (the age of the baby if he or she had been born at the expected time) than the chronological age (how long it has been since the baby was actually born). When thinking about developmental progress, we expect a premature baby to act appropriately for his or her corrected age. However, if your baby was born at the expected time or near your due date, then you do not need to correct the age.

The corrected age of an infant is based on the expected date of birth. An infant, as a rule, develops in the mother’s uterus for 40 weeks before being born. This 40-week time is referred to as the term date or due date.

To determine the corrected age if your baby was born prematurely, add the number of weeks since he or she was born to his or her age at delivery. For example, if a baby was delivered at 28 weeks gestation and is now four weeks old, the corrected age is 4 + 28, or 32 weeks. The baby is still 8 weeks younger than a term age of 40 weeks. In other words, the baby is still 2 months premature.

After a premature baby reaches the term age of 40 weeks, it is easier to determine the corrected age by subtracting the amount of time the baby was born early (before the term date) from the chronological age. For example, if a baby was born 5 months ago and was 2 months premature, the corrected age is 5 - 2, or 3 months. We would expect the baby to act like a typical 3-month-old baby. Corrected age should be used even after your baby is discharged to continue to monitor growth and development.

Medical condition
No matter the age, if a baby is very sick, he or she will act like a premature baby. This means the baby will spend most of the time being drowsy or asleep. Noise, lights, and touch may cause the baby to cry or fuss. You can help calm your baby by keeping your baby still, talking quietly or giving your baby a pacifier.

Alertness
Alertness means being awake and paying attention to sounds, people or objects. Your baby is most likely to respond to you when awake, with eyes open. When you find your baby in this type of quiet state, the time is right for you to talk in a soothing voice, with gentle touch. You may place your face 9 to 18 inches away from your baby’s. Do not try to do everything at once. Although it is easy for an adult to talk, listen, see, and move all at the same time, those actions can overwhelm a baby. If it is all right with your baby’s nurse, you can also swaddle or wrap your baby snugly in a blanket. Swaddling is soothing to the baby and often helps babies become more alert.

Fatigue
Fatigue means becoming tired or losing energy. When babies are over-stimulated, they become fatigued. Some signs that your baby has had “enough” are:

  • sudden extreme changes in skin color (blue or too pale) while you handle your baby
  • marked increase or decrease in your baby’s breathing pattern, or yawning
  • sudden limpness
  • sudden change in heart rate
  • whitish areas around the mouth and bluish splotching of the body, especially on the hands and feet
  • sudden fussiness
  • closing eyes and making faces

When you see any of these signs, it is time to give your baby a rest. Sometimes all a baby needs is a short break, and the baby will become alert again and ready for more interaction with you. You will be able to handle your baby for longer periods of time as your baby becomes older or feels better.

Muscle tone
Babies born at the expected time, or near their due date, spend several months being crowded in the limited space of the uterus. During this time they develop a great deal of flexor muscle tone – the muscles that keep them folded are stronger than those that help them straighten out. This means they tend to hold their arms and legs bent or tucked.

Premature babies are not born with flexor muscle tone because their muscles have not had as much time to mature. Premature babies are smaller than babies born at term and have not spent a lot of time being tightly flexed or tucked inside the uterus. The muscles of premature babies tend to straighten out or extend, rather than flex. Premature babies often arch their backs and stiffen their legs and arms. It is actually hard for them to bring their arms and legs close to their bodies by flexing or tucking them.

Premature babies seem to miss being tightly folded or “contained” inside their mothers. One of the best ways to help a premature baby remain calm and content is to tuck the legs up next to the tummy and tuck the arms toward the middle of the body so that the baby’s hands are near his or her face. It also helps if the baby’s head, shoulders and back are all slightly bent forward. The staff of the NICU does this by building “nests” or using blankets and soft objects to keep the baby flexed. Our nurses will show you how you can help keep your baby in these flexed positions by building a nest or by holding your baby the correct way.

Kangaroo care
Baby kangaroos, called “Joeys,” are always born very small and immature. They must spend many weeks nestled next to their mother’s skin to stay warm and protected. Mother kangaroos have a special pouch of skin where the Joeys stay safe and snuggled.

Human babies also like to snuggle next to their mother’s skin. In our nursery, we encourage all mothers or fathers hold their babies against their chests, skin to skin, with warm blankets on top. We call this “kangaroo care.” Many studies have shown the benefits of this type of care. Babies receiving skin-to-skin care from their parents improve their oxygen levels, use less energy, lower their heart rates, grow faster and sleep better.

Feeding
Taking feedings by mouth, whether from a bottle or a breast, is really a rather complicated skill. It is often one of the very last things a baby is ready to do before going home. There are several reasons why feeding may be hard for your baby:

  • Your baby may not be mature enough to suck, swallow and breathe at the same time (this usually occurs between 32 and 34 weeks gestation).
  • Your baby’s medical condition may alter the pattern of swallowing or breathing.
  • Your baby may have a normal pattern of sucking, swallowing and breathing, but may fatigue quickly. This is normal for young or small premature infants.
  • Your baby may be able to suck well but is still fed through a tube so that he or she can save energy (calories). Sucking is hard work for small infants.

As with any area of development, your baby will give cues as to when he or she is ready to nipple feed and also signs of fatigue when they are done. It is important for all of us to learn these signs so that we can individualize the feedings to their needs. Share your observations about feedings with the staff so we can learn together.

The Very Young Premature Infant (less than 32 weeks gestation)

Typical Behavior
  • These babies rarely appear alert.
  • They spend most of their time sleeping.
  • They awaken for brief periods and tend to fuss.
Ways To Support Development
Optimal growth and healing occur during quiet sleep. That is why we protect your baby’s sleep as much as possible. A very young premature baby should not be handled unnecessarily. Talk softly to your baby for a few minutes. Place your hand on your baby using a gentle but firm touch. Avoid stroking too rapidly or too lightly (this can be irritating or feel like tickling). Ask your baby’s nurse to help you recognize if he or she can tolerate handling or needs to be left alone.

Sensory Response

  • To light: infants close their eyes.
  • To sound: infants are startled and change breathing patterns.
  • To touch: infants move slightly or awaken to touch; they cry and pull away from pain.

A plain blanket over the isolette can shield the baby’s bed from bright lighting and absorbs some of the room noise. Avoid the use of flash cameras.

Avoid loud noises when possible. Use a soft voice to talk to your baby.

Avoid overstimulating your infant with touching. Use a gentle, firm, even pressure to hold your baby in your hands. Offer your finger to grasp.

Feeding
The suck reflex is only beginning to develop. Your baby cannot breathe, suck, and swallow at the same time. Since premature babies tire rapidly when sucking, tubes are used to feed them.


Help your baby stay calm during tube feedings. Do not overstimulate your baby by touching or talking too much. Make sure your baby is comfortable in a flexed, contained position.

Breathing
Breathing is not even. Short pauses may occur between breaths.


Help your baby stay calm and comfortable.

Movement and Positioning
Infants have bursts of movement and stiffen their arms and legs or fling them away from their bodies. They often are not able to bring their arms and legs back into a folded or tucked position. Movements tire an infant very easily, and arms and legs may feel limp because of poor muscle tone.


Move your baby slowly when handling or when you change his or her position. Provide containment during and after position changes. Blankets, synthetic lamb’s wool or stuffed toys can be used to stabilize your baby’s position and provide security.

The Older Premature Infant (greater than 32 weeks gestation)

Typical Behavior
Babies at this age wake more easily than before. For only short periods, they may be quiet, alert and lying still with open eyes.
Ways To Support Development
To help your baby stay alert, hold him or her upright for short periods of time (a few minutes). When your infant’s eyes are open, position your face 9 to 18 inches away from his or hers so that your baby can look at you. Make brief eye contact for a few seconds or talk softly. Do not do too many things at once or your baby will become fatigued.

Sensory Response

  • To light: infants close their eyes in bright light.
  • To sound: infants are startled and close their eyes to sudden, loud sounds.
  • To touch: infants withdraw from a source of pain. They like gentle but firm touches. Touch that is too light feels like tickling or may be irritating.

Hold your baby so that his or her eyes do not face bright lights. This will encourage eye opening. Place a blanket or quilt over your baby’s isolette to reduce the level of bright lighting and absorb some of the room noise. Avoid bright colors and patterns. Avoid the use of flash cameras.

Avoid making sudden, loud noises.
Talk gently to your baby.

Use a gentle but firm touch and securely hold your baby’s trunk, arms and legs. Cuddle and gently rock your baby. Avoid quick or sudden movements that can cause a startle or jerk.

Feeding
Many infants still need nasogastric tube feedings. Others are just beginning to coordinate sucking with swallowing. Even these babies will often forget to breathe and need to be reminded. Even when infants suck well, they still tire easily.

 

 


If your baby has a nasogastric tube for feedings, have him or her suck on a pacifier during feedings or at other times. While learning to feed, it may be difficult for your baby to concentrate on feeding while being talked to, looked at, and rocked at the same time. Be aware of the amount of stimulation at any one time and allow your baby to use energy to work on successful feeding.

Breathing
When then head rests on the chest, the infant may have trouble breathing. Infants will try to straighten their heads to help with breathing.


Support your baby’s head, or position your baby in ways that help him or her breathe comfortably.

Movement and Positioning
Infants may bring their hands to their mouths and suck their fingers. Movements are often sudden and jerky, and infants may have difficulty bringing their arms and legs in to tuck against their bodies.


A small roll placed on the sides of the legs may help keep them closer together until your baby develops the strength to keep them together. Help your baby bend his or her arms and bring his or her hand to the mouth to suck. Provide containment to support your baby’s posture. Reduce startling and tremors by placing blankets around your baby. Provide changes in position such as lying on the side to align the baby’s head and trunk to promote midline movement patterns.

The Infant Approaching Term (expected due date)

Typical Behavior
At this age, infants are alert when awake. They seem to enjoy being touched, cuddled or moved gently.
Ways To Support Development
Your infant may need to be touched, talked to, and cuddled to stay alert. If your baby is taking bottles or breastfeeding, he or she is most often quiet and awake after feeding. When crying, cuddle and talk to your baby.

Sensory Response

  • To sound: newborns show a response to sound by changes in movement or breathing patterns; monotonous, low-pitched sounds may cause them to become drowsy; loud, sudden sounds will startle the newborn.
  • To touch: the newborn responds more to touch than to noise; the tactile (touch) system is one of the more mature regions of the central nervous system at term birth.
  • Vision: newborns appear to see objects best when they are placed 9 to 18 inches away from their face.

Avoid sudden loud noises. Soft music or voices will help quiet your baby.

Hold your baby while gently but firmly stroking his or her body, legs and arms.

Newborns open their eyes more when lighting is soft. They may look at points of contrast between colors or patterns, but still can become overwhelmed. Your baby does not need to be surrounded with brightly colored toys and pictures. Your face is actually the best toy you have available. It has just the right amount of contrast and babies prefer to look at faces more than toys. Smile and talk to your baby. When your baby is looking at you, move your face from side to side. This will encourage your baby to focus and follow your face.

Feeding
Sucking, swallowing, and breathing patterns should be working together. The suck-swallow reflex is rhythmic.


Cuddle and talk to your baby during feeding. If your baby stops sucking when you speak, do not talk during the feedings. Hold the baby in your arms or on your lap for feeding. Cradle your baby sometimes in your right arm and sometimes in your left arm. This will change the baby’s head posture and visual gaze.

Movement and Positioning
Infants will move their arms and legs often. They will try to calm themselves by bringing their hands to their mouths. Movements are usually smooth.


Keep changing the baby’s position during the day. When you are with your baby, have your baby spend time on his or her tummy to help strengthen muscles in the arms and shoulders. When sleeping, place your baby on his or her back. Reduce handling during the night to help your baby become accustomed to a daytime-nighttime schedule.

Choosing the Appropriate Toys for Infants

Stores today are filled with many wonderful toys designed to help children grow and develop. Your baby will be ready to explore and enjoy all types of toys after he or she is discharged from the hospital.

Keep the following tips in mind when you shop for toys. Check with your baby’s nurse for specific information regarding acceptable NICU toys.

Safety
Be sure that any toys you choose do not have small or loose parts. These parts can fall off and cause choking if an infant places them in the mouth. Follow the instructions that are provided with each toy. Use the toy only according to the manufacturer’s instructions. Only purchase toys that are recommended for your child’s age group.

Items strung across or hung from the crib or bassinet should be carefully positioned. Be sure that your baby can play with these toys without getting his or her arms and legs tangled and without having to pull the toys into the crib to play with them. To prevent strangulation or suffocation, toys should never be placed inside a crib or bassinet with an infant. Hanging items should be removed from the crib when your child begins to sit or stand.

Sanitation
Purchase toys that have washable, non-toxic (non-poisonous) surfaces. Stuffed toys should be kept clean from dust. A line of stuffed animals called “Allergy Free Toys for
Me” are designed and packed to leave the factory free from bacteria, molds and other respiratory irritants. To order toys from this company, call 1.219.741.9726.

Sight
Newborn infants find human faces more appealing than any other object. Looking at your baby and allowing your baby to look at you during playtime, feedings, or changings is a wonderful experience for both of you.

Sound
Toys that rattle, squeak, or crunch are fun for infants. You may have to squeeze squeaky toys for your baby until he or she is able to squeeze them. Babies often enjoy musical toys or chimes. Soft sounds like classical music are especially soothing to infants.

Touch
Toys that have different textures on their surface are also fun. Choose toys that are furry, velvety, bumpy, or rippled.

Development
Always keep your baby’s development in mind when you shop for toys. Babies master different tasks at different times. Your baby’s first toys should encourage swatting, grasping, holding, shaking, and banging.

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