When children are born prematurely, they’re at risk for complications ranging from changes in respiratory functions to cardiac issues. It’s not uncommon for a premature baby, averaging 30 weeks old, to spend 100 days in the Neonatal Intensive Care Unit (NICU). During that time, their care team considers more than their physical health. They’re also looking at major developmental milestones. That’s where pediatric physical and occupational therapy come in.
Therapists like Walter Farrell (OT) and Bette Anne Connaughton (PT) work with each baby’s doctor, nurse practitioner, nurse and others to come up with the best care plan to improve their quality of life. Therapists in the NICU focus on management of state control and the facilitation of motor and visual skills.
Developmental Focus: Three Major Areas
1. State control – How well do the infants tolerate stimulation like touch? Are they able to remain stable and calm? What can we do to help them?
The therapists have a very sensitive task of recognizing an infant’s stress and coping signals to see what he or she can handle. Connaughton describes this period as calm state support. “You need to read a baby’s signals, and when the baby can be touched,” she said.
There are therapeutic techniques that can be used to help infants accommodate stimulation like touch and position changes while maintaining a calm and alert state. If handling and interactions are performed improperly, babies can generate more stress, which can compromise their immediate health. Additionally this is a time when the therapists teach parents how to touch their baby without overstimulating them, mitigating any negative effects from the environment.
2. Motor skills – many times premature infants experience hypotonia, a state of low muscle tone where the baby displays a floppy appearance.
A newborn’s growth and development is closely monitored. Therapists check head positioning, ensure babies can perform hand-to-face movements and move both sides of the body at the same time. Therapeutic handling is introduced to help babies use their trunk muscles for stability and promote smooth motor skills.
What does a PT and OT do?
Occupational therapists identify and eliminate environmental barriers that can hinder infants from their independence in daily activities.
Physical therapists promote mobility and train an infant’s movements and developmental behaviors to facilitate normal function and prevent future problems.
Together they provide direct patient care and consultative services for premature and medically complex infants in the NICU.
3. Visual skills – most of the infants have their eyes shut a majority of the time. However, the therapists monitor each baby’s progress and help teach them to focus and track with their eyes when they are ready.
Farrell and Connaughton are also concerned with how efficiently the patient’s vision allows them to function. Teaching babies how to track and focus their eyes early on can be beneficial later in dealing with depth perception and their relation to objects around them. Emphasis on visual skills helps contribute to better eye-hand-body coordination, essential for everyday tasks.
The Gift that Keeps Giving
Although challenging, the fields of occupational and physical therapy are very rewarding. Critical thinking skills and teamwork are crucial to the successful, individualized development of each baby. Therapists strive to help patients as much as possible before they’re discharged, giving them a head start to continue improving at home.
To Farrell, his practice goes beyond physical intervention; he prepares the babies for the challenges ahead. Farrell states, “Therapists are the vanguards of hope. I don’t have a day where I feel like I haven’t helped someone.”
Likewise, Connaughton is motivated by the long-lasting relationships she forms with her patients and their families. She feels a special bond with the preemies as they graduate from the NICU. “I learn something new every day. It is a very personally rewarding experience,” she says.
NICU Services at UVA
Our 53-bed NICU is nationally ranked by U.S. News & World Report. Learn more about the care team and the UVA NICU.
