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Supporting Premature Infants and their Families. Transition from Hospital to Home. Cindy Redd, M.Ed Ann Marie Elmore, P.T . What is a transition?. Passage: the act of passing from one state or place to the next Conversion: an event that results in a transformation

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supporting premature infants and their families

Supporting Premature Infants and their Families

Transition from Hospital to Home

Cindy Redd, M.Ed

Ann Marie Elmore, P.T

what is a transition
What is a transition?
  • Passage: the act of passing from one state or place to the next
  • Conversion: an event that results in a transformation
  • Change from one place or state or subject or stage to another
  • Cause to convert or undergo a transition

transitions are tricky
“Transitionsare Tricky”
  • Needs, priorities, concerns, strengths, resources etc. are changing
  • Strategies for support and intervention must be assessed and adjusted frequently
  • Stress and anxiety may increase due to change even when change is positive.
  • Beginning and end of transition can be unclear.
tricks for supporting transitions
“Tricks” for Supporting Transitions
  • View transition as “bridge” from one place/state to the next.
  • Reflect and recognize progress and movement
  • Celebrate the baby steps of progress
  • Expect and support grief for what’s left behind
supporting transition from hospital to home
Supporting Transition from Hospital to Home
  • Needs of Premature Infants
  • Needs of Families
  • Services Needed
needs of premature infants
Needs of Premature Infants
  • Feeding
  • Sleep
  • Self-Regulation
  • Social Interactions
  • Motor Development
  • Infection Control
  • Taking everything by mouth (full po feeds) is a newly acquired skill, two or three days, therefore feeding is not well established and can be stressful for parents
common feeding concerns
Common Feeding Concerns
  • Chokes
  • Wants to Eat all the Time
  • Takes a Long Time to Eat
  • Sucks Frantically
  • Frequently Spits Up
chokes when feeding
Chokes When Feeding
  • Difficulty coordinating suck, swallow, breathing.
      • Slow flow nipple
      • Side lying to feed
      • Assist baby with pacing and timing by tilting the bottle
wants to eat all the time
Wants To Eat All The Time
  • Babies sucking to feed and to self-regulate
common sleep concerns
Common Sleep Concerns
    • Only sleeps if being held
    • Sleeps all day, stays awake during the night
  • Catnaps throughout the day
  • Does not sleep thought the night when it’s age appropriate.
sleeps only when held
Sleeps Only When Held
  • Holding provides the supports babies need to sleep
    • containment
    • incline
    • ventral support
    • warmth
  • Mother’s body is “home” to baby
    • Rhythms of breathing & heart beat familiar
    • Mother’s smell is comforting
sleeps all day awake at night
Sleeps all Day, Awake at Night
  • It’s easier for premature baby to be awake when it is dark and quiet.
  • The “stress” of daytime activities can cause premature baby to “shut down.”
  • Strategies should support baby’s efforts to stay awake or asleep at the appropriate times.
activities to support sleep
Activities to Support Sleep
  • Place light and/or radio near the baby’s bassinet at night
  • Avoid social interactions and “invitation to play”
activities to support alertness
Activities to Support Alertness
  • Dark quiet environment is optimal environment for being awake/alert
  • Even dim natural light and buffered sounds can cause stress reaction.
  • Dim lights and close blinds, especially those in baby’s face
  • Minimize noise and social activity
  • Communicate “invitation to play” when baby wakes up during the day
social interaction self regulation concerns
Social Interaction & Self-Regulation Concerns
  • “My baby does no want to look at me”
  • Fussy
    • Maybe self-regulation or reflux related
self regulation concerns
Self-Regulation Concerns
  • Baby does not want to look at parents
  • Fussiness
activities to support social interaction
Activities to Support Social Interaction
  • Decrease environmental stimulation
  • Read and respond to subtilities of infant cues
activities to decrease irritability
Activities to Decrease Irritability
  • Dispel myth – “baby just wants to be held”
  • Support infant’s effort to self-regulate
    • Suck
    • Hands together
    • Hands to mouth
    • Feet together
  • Give infant time to respond to support
  • Avoid constant repositioning
  • Vestibular Movement with containment
activities to decrease irritability20
Activities to Decrease Irritability
  • Decrease stimulation
  • Understand how different environments and fatigue effects self-regulation
  • Premature infants have strong extensor muscles
    • If extension activities are encouraged then baby will develop extensor dominance
    • Encourage flexion
extensor dominance influences
Extensor Dominance Influences
  • Hyper-extended Neck
  • Retracted Shoulders
  • Decreased Trunk/Pelvic Mobility
  • Frog Legged
  • Toe Walking
activities to prevent or decrease extensor dominance
Activities to Prevent or Decrease Extensor Dominance


  • Flexion
  • Trunk/Pelvic Mobility
  • Weight Shifting
  • Shoulders Forward
  • Hips Tucked and Together
awake stomach time
Awake Stomach Time
  • Activates Neck Flexors
  • Facilitates Shoulder Forward
trunk pelvic mobility
Trunk &Pelvic Mobility
  • Hand to Feet Play
  • Pivoting on Stomach
limit leg extension activities
Limit Leg Extension Activities
  • Lap Standing
  • Exersaucers
  • Johnny Jump Ups
  • Be sure heel cords are not tight
  • With “back to sleep” infants spend more time on their backs, in infant carriers, car seats & swings and much less awake/play tummy time
  • Prior to 2 months (corrected age), babies will turn their head to the side when lying on their back
  • 85% of newborns have right head preference
Baby’s heads are very moldable
  • Increase in abnormal head shapes
what to do
What To Do
  • Monitor head position
  • Alter sleep, carrying, and play positions
  • Head in midline in carriers, car seats, swings
  • Range of motion exercises- preferably active
  • Increase awake stomach time and sitting play
  • Head tilted to the side and rotated to the opposite side
  • Torticollis can be obvious or subtle
  • Head position can lead to flat head
infection control
Infection Control
  • Immature immune system
  • BPD and Cardiac conditions
  • RSV
  • Child care
needs of families
Needs of Families
  • Emotional responses and support networks
  • Shift of trust from hospital to community providers
  • Compensatory Parenting
emotional responses and support networks
Emotional responses and support networks
  • Parent may “fall apart” after discharge even though baby is okay
  • Post-traumatic reactions to smells & sounds in the community that may trigger memory of NICU
  • FSN, March of Dimes, Hospital Reunions
shift of trust from hospital to community
Shift of trust from hospital to community
  • Neonatologist Pediatrician
  • NICU specialists EI/CSC providers
  • NICU nurse daily caregivers
compensatory parenting
Compensatory Parenting
  • Tend to try to compensate for perceived loss
  • Parenting should be based on developmental info & family values
  • Parenting should not be based on fear and guilt
services needed
Services Needed
  • Consultation & Anticipatory Guidance
  • Observation & Monitoring
  • Initial Home Visits
  • Coordination of Services
consultation anticipatory guidance
Consultation & Anticipatory Guidance
  • Relationship begins with parent/caregiver and evolves toward infant
  • Parent brings expertise from NICU experience
  • Routine assessment of “how things are going?”
  • Partners in problem solving not solutions
  • Prepare family for “what to expect next”
observation monitoring
Observation & Monitoring
  • Looking for subtle qualitative differences not measurable delays
  • Should monitor over time since some differences may appear at various developmental stages.
  • Encourage families to stay enrolled in services at least until18 mos. when motor & language can be assessed.
initial home visits
Initial Home Visits
  • May need to be more frequent due to baby’s rapid growth & development
  • May take longer due to amount of concerns and mother’s need to “tell her story”
  • May be difficult to schedule due to other appointments, stress of having visitor and desire to “lay claim” on their baby.
coordination of services
Coordination of Services
  • Services may include medical, developmental, legal, social and support.
  • Important to be sensitive to # of service providers involved with family
  • Communication& collaboration between providers is critical and challenging