Developmental Care in the Nursery. June Bridgford Garber, PT. Emory Hospital - Midtown Grady Memorial Hospital Emory University - Professor Emerita. Why should you care about developmentally appropriate infant care?.
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June Bridgford Garber, PT.
Emory Hospital - Midtown
Grady Memorial Hospital
Emory University - Professor Emerita
In addition to physiologic instability, recovery periods are needed in response to floppiness, stiffness & jerky or tremulous movement patterns.
Infants communicate a need for recovery periods by facial expressions & behavior.Signs of tolerance, well-being or state organization include charming behaviors that help parents fall in love with their infants.
Neck & trunk arching
Frantic or jerky extremity movement
‘sitting on air’
Salutes with finger splaying
Gapping facial expression
Grimaces or Frowns
Frequent jerks or movement during sleep
Persistent gaze aversion
Hyper-alertness or panic expression
Light & deep sleep differentiation & plays a role in CNS maturation.
Some studies report increased weight gain from consistent day-night cycles of lighting & care giving levels.Management of the environment to fit the capabilities of maturing infants
Most infants have their own ideas about positioning to consider! Sometimes infants move out of our ‘fine’ positioning because they are uncomfortable, hungry, experiencing reflux and/or working too hard to breath.
Pinelli, Symington (2005)Non-nutritive Sucking during Alert Periods
Prior to initiation of nipple feeding, NNS and/or perioral stimulation help some infants alert but may also consume limited energy reserve and/or over-stimulate many others .Transition from Non-nutritive Sucking to Nutritive Sucking
Soft, high flow rate nipples do not generally help infants with inconsistent sucking pressure.
Soft, slow flow rate nipples are now available!!
Higher flow rate of warmed milk/formula presents a problem for some infants with inconsistent sucking pressure.
Slightly cool milk/formula helps some infants coordinate suck & swallow timing better.
Tilting the bottle downward to empty the nipple or complete removal of the nipple from the infant’s mouth my be needed before an infant will swallow & breath.Paced Feeding
After 32 weeks PCA, daily administration of auditory, tactile, visual & vestibular stimulation for 15 minute periods facilitated increased alertness, faster transition to complete PO feeding & decreased length of hospitalization.
Graded handling OOB including:
Parental participation in periods of graded infant stimulation facilitates bonding & competence. It may provide the infant’s CNS with input important for CNS maturation & development.
Although these studies have numerous shortcomings, benefits include the following:
Charpak N, Ruiz-Pelaez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versis traditional care for newborn infants less than or equal to 2000 grams: A randomized, controlled trial. Pediatr, 1997, 100(4): 682-688.
Kleberg A, Westrup B, Stjernqvist K, et al. Indication of improved cognitive development at one year of age among infants born very prematurely who received care based on the Newborn Individualized Developmental Care and Assessment Program. Early Hum Dev. 2002: 68(2): 83-91.
Pickler R, Best A, Reyna B, etal. Prediction of feeding performance in preterm infants. Newborn Infant Nurs Rev 2005; 5: 116-123.