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Your NICU baby -Supporting Motor Skills

Updated: Jul 19, 2018


The third trimester of pregnancy encourages infant flexion patterns as a baby nearly triples in size in the restricted uterine environment. Flexion supports development of midline skills, allowing for hands to come together and to the mouth for regulation, as well as the development of strong muscles and bones from pushing against the uterine walls in very small quarters. If your baby was born early or sick and spent time in the Neonatal Intensive Care Unit (NICU), their sensory and movement experiences have been different.


All babies have an innate desire move, though babies born prematurely or needing the medical support of a NICU environment often move differently than those born healthy and full-term. There are a variety of reasons for this, including immature body systems (ex: low muscle tone), medication requirements, illness or medical conditions, or need for life-supporting equipment. Babies in the NICU are often positioned to allow for easy medical access. Spending time on their backs for extended periods of time can lead to frequent extension patterns, changes to the shape of the head (flattening in one or more spots) and potential adverse impacts on the curves of the spine. Babies in the NICU may not have developed the strength or muscle tone to move against the forces of gravity, which contribute to these extension patterns. They may have also developed atypical movement patterns as a way to compensate for any limitations. Many babies in the NICU need additional support to balance extension patterns with flexion as well as opportunities for symmetrical and unrestricted movement, which are important for the foundation of motor development.


What can I do to support my baby's Skeletal and Motor Systems?

  • When your baby is awake and you are watching, LOTS and LOTS of Tummy Time (TT)! There are many ways to do TT and if your baby does not tolerate being flat on their belly your can try different strategies to improve their tolerance. Pathways has some great FREE visuals for different ways to incorporate TT many times throughout the day. If your baby is having trouble tolerating position changes, including tummy time, reach out for help.

  • Lots of popular baby equipment, such as bouncy seats, swings and car seats place baby in a semi-reclined and confined position, limiting their freedom of movement and placing forces on their skull that can cause flattening. Car seats should be used for travel only, and other equipment sparingly, if at all. A blanket on the floor (or activity mat) is the best piece of “equipment” for supporting development. When your baby is on the floor they have the opportunity for freedom of movement*, which is essential for early brain mapping to develop body awareness and increase strength. The body is not just two-sided so be sure to allow for time on the sides in addition to tummy and back.

  • If your baby is not yet rolling, continue to use a flexible swaddle for sleep, being mindful to not wrap too tightly, nor so loose that your baby breaks free. The top of the blanket or swaddle sack should be at the line of the shoulders, making sure to allow for hands to be positioned together in the middle of your baby’s chest so they can bring hands to mouth for oral exploration and self-soothing.

*Sometimes babies who have graduated from NICU are not used to this unrestricted movement, in part due to the practice of “nesting” while in the NICU to support their position and improve their state control. Free time on the floor might require some additional strategies (ex: using a flexible swaddle blanket around part of baby’s body, such as their arms or legs to allow for movement while limiting an over-active startle reflex). Babies sent home with special medical equipment such as feeding tubes, monitors, breathing equipment or with other special considerations may need positions to be modified. Consult with your physician regarding potential precautions as well as a therapist to learn ways to work on motor skills in an adaptive way.


When to Seek Help

Here are some potential indicators your baby may need some extra support for their motor development. This is not a comprehensive list and many babies will demonstrate one or more of these characteristics over the course of their development. Trust your instincts and if any of the below indicators persist or if you have concerns based on behavior not listed, reach out for support.

  • Your baby spent an extended time in the NICU

  • Your child has been diagnosed with developmental disabilities, such as Down Syndrome, Spina Bifida, Cerebral Palsy brain injury, genetic syndromes or other conditions impacting development

  • Baby is slow to meet developmental milestones (after adjusting for prematurity) or skips certain motor milestones, such as crawling

  • Your baby has a noticeable one-sided head turning preference or visible head flattening

  • Your baby has a hard time bringing their hands together or to their mouth

  • Your baby uses one side of their body more than the other (arm, leg or both)

  • Your baby dislikes "tummy time”

  • Your baby seems to have low muscle tone or tires easily with physical activity, like feeding

Click here for more resources or guidance for seeking additional support


Learn More about Sarah Reppenhagen, OTR/L


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