Tips on Sensory Stimulation of Your Premature Infant in the NICU

by Terry Shelton

30 week preemieYour baby has arrived and even though things may not be exactly as you imagined with a full term birth, there are things that you can do as a parent for your preemie.

Your infant is in need of specialized care that only a NICU and specially trained staff can deliver. The environment that you entered into may be confusing, scary and overwhelming for all concerned. All you want to do is hold your child and not let go.

Becoming a part of the team effort is necessary to the well being and health of your child. Many healthcare providers are involved in the care of your child and new research has come up with changes in what we know and how we care for premature infants.

An example of this research can be found in the NIDCAP program which stands for Newborn Individualized Developmental Care and Developmental Care of Premature Infant Assessment Program. This means that the care they receive is adjusted to the needs that best fit that particular child to allow them to grow and develop in a normal way.

During the first few weeks of life, your infant will be undergoing many changes and challenges as they grow and adapt to their surroundings. So how can you, the parent, help? By knowing the cues that your baby gives and understanding the development of your baby's senses you can become a bigger part of what is going on and take an active role in their care, provide support and comfort to your newborn.

Here's what you can do and watch for:

Touch: The infant's skin is very delicate and fragile. Light stroking or feathering may be too much for your infant. Remember their nerve endings are "raw" and underdeveloped. A gentle but firm handling in a slow manner is recommended.

kangaroo careThere are also massage techniques using firm gentle pressure that provide a feeling of security. Ask your nurse or physical therapist about "skin-to-skin" or "Kangaroo Care" techniques in handling and appropriate positioning of your infant. Discussion with your health care provider regarding these methods should be done first.

Gauge your interactions based your newborns physical signs, oxygen levels, heart rate, breathing rate, skin color, etc. Keep in mind that these techniques may not be able to happen due to the status/stability of the infant.

  • Swaddling: the infant is wrapped up in a blanket; legs are tucked up, arms bent and hands brought together in front of him.
  • While holding your infant help keep them in a curled position. This helps the premature infant to feel secure as if in the womb. Their muscles are weak and unable to hold this position naturally.
  • Create a cocoon for them in which they can feel something supporting them. Place rolled blankets around them to keep this flexed, curled fetal position by placing one behind their back, top of head or to help keep legs tucked in.
  • If your baby must sleep on his back, use these rolled blankets to keep arms bent and hands close to face and under legs to keep them tucked up.
  • Using boundaries to position your infant gives them a sense of comfort, security and helps keep them to block out disruptive stimulus that causes discomfort and allows them to regroup and calm down when agitated.
  • With the "Kangaroo Care" (skin-to-skin) technique holding the infant in a curled, flexed manner on the caregivers chest helps to provide this environment of the uterus.

Sight: Dimming the lights is the best thing you can do, or provide a protective light barrier across the incubator. The premature infant's eyes are very sensitive to light. Too much light may lead to other medical problems with their eyesight. If the hospital doesn't have special covers, blankets can be used over the isolettes.

mommy snuggling little oneSound: There is so much noise and activity going on in a NICU, helping to keep voices hushed and high pitched noises down will provide a soothing environment. Never place anything on top of the incubator in a loud, heavy manner, do it softly. Remember the incubator acts as an echo chamber and that can frazzle the baby's nerves. Close doors to incubator softly as well. Sometimes soft music or tape recordings of a heart beat can be used. Hearing is one of the first senses that develop in the fetus. The sound of their mothers heart beat is soothing.

Taste: Most infants at this age are unable to suckle due to weak muscles and poorly developed reflexes. These babies are usually fed through what is called a feeding tube that is inserted past the baby's throat and into their stomach. Using a very soft pacifier made specifically for newborns may help in the development of the sucking reflex.

Smell: Usually develops after a birth in a full term infant but within a week the infant can distinguish his mother. This sense of smell helps to contribute to the maternal-infant bonding.

Do not over stimulate. Use one stimulus at a time. For example, when holding/touching, or rocking do not sing or make eye contact at the same time. Or when making eye contact do not talk or sing. Remember use or engage one sense at a time. Overtime, and as the infant develops and grows, increasing stimuli to say rocking and singing may be better tolerated.

Cluster periods of care/procedures together. This allows for longer resting periods.

Periods of "negative" touch episodes may occur. Your infant may go through periods of not wanting to be touched, talked to, sung to, or held. This is normal.

Follow the cues your infant may display and let them be your guide in helping your infant.

"I'm agitated or overwhelmed and I need a break"

  • Increase or decrease in breathing
  • Increase or decrease in heart rate
  • Skin turning red or getting pale
  • Yawning
  • Hiccupping
  • Jerky movements, or easily startled
  • Arching of back or over extending legs/arms
  • Getting fussy
  • Not engaging in eye contact

"I'm ready; I feel calm and want to interact. I can handle sensory information."

  • Steady breathing rate, stable oxygen level, steady heart rate
  • Stable skin color
  • Alert, keeping steady eye contact
  • Steady sleep/wake cycles so that they have energy to interact

"I want to do it for myself, I need to learn and experience things"

  • Grasping objects and holding onto to them, like blankets
  • Putting fingers and hands in mouth
  • Sucking on fingers, hand or pacifier
  • Bending arms and legs and/or bracing against bedding and walls of isolette

By watching these cues, and engaging in appropriate stimulation you can begin to help your baby develop their senses in a way that will aid in their physical and emotional growth as well as creating parent-child bonds. Interacting with your child during this period also gives you, the parents, a sense of belonging and accomplishment in tending to the needs and care of their child. Your child needs sleep, rest, and peace to help him heal and grow.

Terry Shelton graduated Columbia University School of Nursing with a BSN, RN and joined the Navy in 1987. She is now a retired navy nurse and mother of a 14-year-old daughter who was a 30 week preemie. Terry's specialty is critical care nursing and she is certified in her field.

Copyright © Terry Shelton. Permission to republish granted to, LLC.
Photo credits: Hannah Taylor.