Developmental supportive care in the Neonatal Unit

Parents are encouraged to be actively involved in their baby’s care. You will be supported by nursing staff to learn and recognise your baby’s cues and to carry out routine cares such as nappy changes and feeds. Your presence and input has a very positive impact on your baby’s development and allows you to develop the skills and confidence to look after your baby, helping you prepare for discharge home.

Sleep is essential for normal growth and development and plays an important part in your baby’s brain development. Where possible we try to allow your baby to have long periods of uninterrupted sleep and will aim to plan any needed procedures or cares around this.

We know that it is very important to reduce the impact of pain and stress which may be caused by some of the necessary procedures involved with caring for your baby at this time. We will assess the likelihood of a procedure to cause pain or stress and use a range of measures such as swaddling or using a comforting hold throughout the procedure or sucking on a dummy to help baby to calm. If needed we will give some milk or sucrose before a procedure as this provides a pain relieving effect. We can also use medication for pain relief if required.

Depending on your baby's age, they may be positioned using specialised equipment to provide them with a close, firm boundary which will support them in a flexed, midline posture, bringing their arms and legs in towards their middle and their hands towards their face. This mimics the position they would have been in the womb, allowing them to push out against some resistance and return to a curled up or flexed position. This supported positioning is essential in the development of their muscle control, posture and normal movement patterns.

We know that the best place for your baby to develop is inside the womb therefore if your baby has been born early or if they experience a period of illness following delivery we need to adapt the hospital environment to reduce the impact of loud noise, bright lights and strong smells on the development of their senses.

Noise levels

Noise levels should be kept as low as possible to protect sleep and also to allow babies to recognise their parent’s voices. Try not to tap or put anything on top of the incubator. Try to close incubator doors gently.

Lighting

We will use incubator covers to protect your baby’s eyes from bright light sources. Covers should be used until your baby is 32 weeks corrected gestational age (CGA). After this time covers can still be used to provide a period of rest and should be used at night to promote cycled day/ night light levels.

Strong or noxious smells

Your baby can recognise your scent and the scent of your milk and this is very calming and reassuring for them. Strong smells such as perfumes, aftershave or alcohol hand gel can be too strong for them and create a stressful response.

Try not to use strong perfumes or aftershaves and let alcohol gel fully dry before opening incubator doors.

You will be provided with a set of MiniBoos in order to share your scent with your baby.

MiniBoos are small pieces of cloth which are swapped between mum and baby. One will be placed in the incubator with your baby and Mum should place the other one in her bra. These are then swapped to share the scent. The baby will experience the calming scent from mum and Baby’s scent can also help mum with expressing breast milk.

Kangaroo care is also known as skin to skin and is the time baby spends in direct skin to skin contact lying on parent’s chest.

Kangaroo care is extremely beneficial to both baby and parent. It soothes baby as they can hear the sound of your heartbeat and your voice. They can smell your comforting scent. This provides a wonderful opportunity for parent and infant bonding and helps to reduce the stress caused by separation when in hospital. Kangaroo care can also help with establishing breast feeding as the closeness to your baby will help with your milk production.

Kangaroo care is most beneficial when done for prolonged periods as this gives your baby the time to adapt to changes in position.

Try to choose a time when you can spend an hour or more if possible.

Go to the loo beforehand to make yourself comfortable!

Wear comfortable clothes. A button down shirt can be helpful.

Nursing staff will support you at all times with transfers in and out of the incubator and will monitor your baby throughout.

As your baby develops they will be fed in different ways, initially this may be through IV fluids and then through the introduction of small amounts of milk which will be given through a tube from their mouth into their tummy (OG) or their nose into their tummy (NG).

You will be shown how to check the tube is in the right place and how to give OG or NG feeds.

As your baby develops they will also begin to show readiness to start suck feeding. This will be done through a process called Cue Based Feeding. Suck feeding whether breast or bottle is a skill that will develop gradually and your baby will dictate the pace in order to ensure that feeding is a pleasurable experience.

You will be shown how to recognise your baby’s feeding readiness cues, when to offer a suck feed and when to stop.

Our specialist Breast Feeding Support Team will be on hand to offer advice and support to establish breastfeeding.

While in the unit your baby may be provided with a developmental care plan by the therapy team. This will indicate the appropriate level of developmental support for your baby, ifrequired. Your baby may be referred for assessment by the physiotherapist or speech and language therapist if there are any specific issues particularly in relation to positioning or feeding.

Before you are discharged home, the therapy team will speak to you about activities you can do to promote your baby’s development at home. They will also give you information regarding the developmental follow-up clinic which is explained below.