Supporting Premature Infants and their Families

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Supporting Premature Infants and their Families

• Transition from Hospital to Home

Cindy Redd, M.Ed Ann Marie Elmore, P.T
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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
• wordnet.princeton.edu

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Transitions are 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.

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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 whats left behind

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Supporting Transition from Hospital to Home

• Needs of Premature Infants
• Needs of Families
• Services Needed

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Needs of Premature Infants

• Feeding
• Sleep
• Self-Regulation
• Social Interactions
• Motor Development
• Infection Control

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Feeding

• 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

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Common Feeding Concerns

• Chokes
• Wants to Eat all the Time
• Takes a Long Time to Eat
• Sucks Frantically
• Frequently Spits Up

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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

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Wants To Eat All The Time

• Babies sucking to feed and to self-regulate

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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 its age
  appropriate.

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Sleeps Only When Held

• Holding provides the supports babies need to
  sleep
• containment
• incline
• ventral support
• warmth
• Mothers body is home to baby
• Rhythms of breathing heart beat familiar
• Mothers smell is comforting

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Sleeps all Day, Awake at Night

• Its 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 babys efforts to stay
  awake or asleep at the appropriate times.

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Activities to Support Sleep

• Place light and/or radio near the babys bassinet
  at night
• Avoid social interactions and invitation to play

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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
  babys face
• Minimize noise and social activity
• Communicate invitation to play when baby wakes
  up during the day

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Social Interaction Self-Regulation Concerns

• My baby does no want to look at me
• Fussy
• Maybe self-regulation or reflux related

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Self-Regulation Concerns

• Baby does not want to look at parents
• Fussiness

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Activities to Support Social Interaction

• Decrease environmental stimulation
• Read and respond to subtilities of infant cues

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Activities to Decrease Irritability

• Dispel myth baby just wants to be held
• Support infants 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

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Activities to Decrease Irritability

• Decrease stimulation
• Understand how different environments and fatigue
  effects self-regulation

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Motor

• Premature infants have strong extensor muscles
• If extension activities are encouraged then baby
  will develop extensor dominance
• Encourage flexion

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Extensor Dominance Influences

• Hyper-extended Neck
• Retracted Shoulders
• Decreased Trunk/Pelvic Mobility
• Frog Legged
• Toe Walking

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Activities to Prevent or Decrease Extensor
Dominance

• Facilitate
• Flexion
• Trunk/Pelvic Mobility
• Weight Shifting

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Carrying

• Shoulders Forward
• Hips Tucked and Together

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Awake Stomach Time

• Activates Neck Flexors
• Facilitates Shoulder Forward

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Trunk Pelvic Mobility

• Hand to Feet Play
• Pivoting on Stomach

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Limit Leg Extension Activities

• Lap Standing
• Exersaucers
• Johnny Jump Ups
• Be sure heel cords are not tight

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Plageocephaly

• 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

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• Babys heads are very moldable
• Increase in abnormal head shapes

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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

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Torticollis

• Head tilted to the side and rotated to the
  opposite side
• Torticollis can be obvious or subtle
• Head position can lead to flat head

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Infection Control

• Immature immune system
• BPD and Cardiac conditions
• RSV
• Child care

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Needs of Families

• Emotional responses and support networks
• Shift of trust from hospital to community
  providers
• Compensatory Parenting

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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

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Shift of trust from hospital to community

• Neonatologist Pediatrician
• NICU specialists EI/CSC providers
• NICU nurse daily caregivers

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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

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Services Needed

• Consultation Anticipatory Guidance
• Observation Monitoring
• Initial Home Visits
• Coordination of Services

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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

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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.

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Initial Home Visits

• May need to be more frequent due to babys rapid
  growth development
• May take longer due to amount of concerns and
  mothers 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.

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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