Providing Comfort and Developmentally Supportive Care for Your Premature Baby

How to provide comfort for your pre-term baby in the NICU.

By Susan L. Madden

You can comfort your premature baby in the NICU by minimizing noise, providing positioning support, and reading your baby's clues. Although your baby needs to be in the hospital nursery, it is not always a very comfortable or restful place to be. Lights are on 24 hours a a day; machinery, alarms, people, telephones, and radios can create a lot of noise; and necessary medical procedures are often painful. Even routine caretaking activities can be tiring and disruptive.

In the last ten years, Boston psychologist Heidelise Als and others have researched and developed ways of making nurseries and neonatal care more "baby friendly." They have recommended changes in the ways nurseries operate to help lesson the negative effects hospital care and minimize the stress babies experience. In addition, they recommend that the care each baby receives be adjusted to best fit that child's needs and coping abilities. This approach, known as individualized developmental care (or formally, NIDCAP - Neonatal Individualized Developmental care and Assessment Program), is designed to provide an environment in which a preemie's development can continue as normally as possible despite his early birth. Research into its effects has shown that babies who are cared for using the individualized developmental care approach have fewer medical complications, shorter stays in the hospital, better weight gain, and fewer days on respirators. There may be long-term effects of this approach, as well. Some of the early research has indicated that babies cared for with the NIDCAP approach may show more organized behavior and better development in their first year of life.

As a result of this work, many nurseries have made modifications o the nursery environment and to the way in which they provide care. For example, medical and caregiving procedures are often clustered so that babies can sleep undisturbed for several ours at a time. In addition, during invasive or uncomfortable procedures, various comforting methods may be used to help babies stay calm. These include holding a baby in a curled position with hands or swaddling, giving the baby something to grasp, or a pacifier to such on. Our nursery may have a staff member - usually a nurse - who has been rained in the NIDCAP method. She will observe your baby, help plan his care, and advise you and the staff on the best ways of handling him.

As a parent, you can provide comfort and support to your growing baby in a a number of ways. These may include making modifications to your baby's surrounding to minimize stress from noise and lights, as well as learning how best to hold and interact with your baby as he grows and matures.

Observe your baby's environment and try to minimize unnecessary noise and light. There are a number of simple adjustments you can make in your baby's surroundings to help reduce the amount of disruptive stimulation that he receives.

Hold your baby in a flexed position and provide boundaries around him while he sleeps. Preemies, like all newborn babies, feel more secure when they are swaddled securely in a blanket with their legs tucked up, arms bent, and hands brought together in front of them. When they sleep, they prefer to be touching or lying up against something, and will often move in the incubator until they are up against the wall or the bottom of the enclosure. By positioning your baby in a a curled position and providing boundaries for him when he sleeps, you not only help him feel calm and comfortable , but you also encourage the development of the curled position known as flexion that babies naturally assume in the womb. Preemies, with their lack of muscle strength, have a hard time maintaining this position by themselves, and, if left alone, will lie spread-eagled with straight arms and legs on the relatively hard, flat surfaces of their nursery beds.

Learn to read your baby's cues and pace your activities with him accordingly. As discussed earlier in this chapter, premature babies tend to express themselves through physical changes and behavior. As you spend more time with your baby and as he matures, you will begin to recognize how he signals that he is getting tired or upset, and the things he does to calm himself. The following technique may help your child stay calm or regain his equilibrium if he has become upset.

Susan L. Madden is the author of The Preemie Parents' Companion : The Essential Guide to Caring for Your Premature Baby in the Hospital, at Home, and Through the First Years. The parent of a child born 12 weeks premature, Susan Madden has written about health and health care policy for more than 15 years. Copyright 2000 Susan L. Madden, from 'The Preemie Parents' Companion.' Reprinted by permission of the publisher, The Harvard Common Press. All rights reserved