Parents Corner
Information that gives the support you need in the NICU

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Promoting your baby's development after the NICU


To understand your preterm baby’s development, you need to understand the idea of corrected age. The corrected age (c.a.) is calculated from the date your baby should have been born. The chronological age is from the actual birth date.

Especially in the first year, your baby will be developing according to his corrected age, not his chronological (actual) age. His growth, feeding schedule, and overall development, gross motor skill (movements with his arms and legs) and fine motor skill (movements with his hands and fingers), will follow his corrected age. The same applies to his social skills (eye contacts, smiling), and his speech (making sounds-vowels, and the consonants). 

Understanding Motor Development

Muscle tone is a major factor in how a premature baby’s motor skills develop. A full-term baby usually has normal muscle tone. He’s able to keep himself in a nicely flexed position with arms and legs tucked into the body.

Muscle tone in the preterm infant

A premature baby often has less muscle bulk and is usually “hypotonic”. This means her muscles are loose and floppy. It will often be hard for her to stay in a flexed position. Instead, she may end up with a more “frog-like” posture. Her trunk may look flat when she’s lying down, rather than rounded.  

At first, the baby’s legs may seem stronger because he can pull them up into a flexed position more easily. The arms are weaker. Usually, the baby will hold his arms out at the side. There will only be short moments when he can bring his hands to midline (towards the middle of his body). It’s hard for these babies to keep their hands in their mouths and to stay in a nicely flexed position. 

When babies are weak and hypotonic

... especially through the trunk, they attempt to gain some control by fixing or stiffening their muscles. They may arch their head, neck and trunk. They may lift their shoulders, make fists with their hands, and/or stiffen their legs and point their toes. As they grow stronger and get more control through the trunk, these other areas will start to relax. 

Often babies with weak abdominal muscles will have an umbilical hernia. Usually the hernia goes away when the abdominal muscles become stronger. Your doctor will monitor this.

Premature babies may appear to be constipated and to strain when they have bowel movements. However, their stools are often not hard. The problem has to do with the weak abdominal muscles. The abdominal muscles have to be strong to move the stool out. 

Watch for these Cues

There are a number of cues or signs that your baby may give you to tell you whether she is ready for play or other interactions, or whether she is being stimulated too much and she needs a break. 

 These may be signs your baby is ready to interact:

  • Quiet, alert state. Eyes are opened and focused.
  • Relaxed; not too stiff or limp.
  • Arms and legs are tucked in. Hands are at mouth.
  • Some smiling (by about six weeks corrected age), and eventually cooing.

These signs say “time out”; your baby needs a break: 

  • Looking away, glassy-eyed, stressed look.
  • Limp body.
  • Stiffening (pushing body out straight).
  • Yawning, falling asleep.
  • Hiccups, spitting up.

3 Important Points to Remember to Help your Baby with Motor Development

Flexion

Keep your baby flexed or curled up. 

  • Try not to let your baby arch, stiffen, or keep herself out straight. Encourage her to be in flexion when you position, lift, or carry her. This puts the abdominal muscles in a good position to work efficiently and get stronger.
  • Provide Support:
    • Behind the head - keep chin tucked toward chest.
    • Behind the shoulders - bring arms forward and hands to mouth.
    • Along the hips - bring legs together.
    • Under knees - to keep knees flexed (bent).
Midline
  • You want to encourage your baby to keep his head in the middle, facing forward, and to bring his hands toward the middle of the body (hands into the mouth).
  • Keeping the head in the midline, hands to mouth, and legs up into flexion helps the baby strengthen his muscles and learn about himself and his surroundings. This promotes ongoing development.
Support

At first, provide as much support as you can. Then, as your baby is more able to control his own body, you can take away some of the support.

Touch

There are many ways to get close to your baby. Touch is the most useful when the baby is stable and showing you signs that he wants to be touched. 

Babies love to be carried. Once your baby is stable enough to come out of the incubator, feel free to pick him up and soothe him. Throughout the world, lots of parents carry their babies around with them often. You can carry your baby in your arms, in a sling, or in a front baby carrier. Just make sure that your baby’s head is always well supported. 

Reasons to carry your baby often:
  • Many parents believe that when babies are carried a lot their first few months they cry and fuss less.
  • Some researchers agree that the more you carry your baby, the more he feels you nearby, so he doesn’t need to cry as much. 
  • Carrying helps parent and baby form a close bond.
  • Babies are more awake and content when they are held.
  • Being carried puts babies in a position where they explore more with their eyes. It is also easier for them to make good social contact with other people. 
Infant Massage

Many studies show that when parents give their premature babies regular touching, stroking, and loving contact, the babies benefit. They show better growth and development; they take in oxygen better; and their heart rates slow down during and after the massage. While your baby is in the NICU, the staff might encourage you to massage him with oils and creams.

Massage involves things like eye contact, skin-to-skin contact, cuddling, soothing sounds, and smiles, and the smells of the oils or creams. All these things will help you and your baby feel a special closeness. Even when your baby is home, giving him regular massage will help him. You can also use message to help your baby calm down if he is stressed. 

To get help or training to massage your baby, please ask the nursing staff for more information and resources.

Printed from:

“The Next Steps? Caring for your Preemie at Home” with permission from the Canadian Institute of Child Health.