Developmental care

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INTRODUCTION

Developmental needs are an integral part of care planning; these differ according to gestational age, postnatal age and health status. Assess developmental needs and plan care responsive to baby’s stress threshold and sleep/wake pattern

Key concepts

Promoting organised neurobehavioural and physiological function
Altering the physical environment to protect vulnerable developing sensory systems
Family-centred care

Goals

Improved physiological stability
Reduced stress and pain
Appropriate sensory experience
Protection of postural development
Improved sleep patterns
Improved feeding
Confident parenting and attachment
Staff satisfaction
Improved neurodevelopmental outcomes

OBSERVATION AND RECOGNISING BEHAVIOURAL CUES

Recognition of signs that baby may be experiencing stress is vital. Babies will display different cues at different stages of development according to their behavioural state (wake/sleep state)

Defensive/avoidance behaviour

Coping/approach behaviour

Any of the following indicate baby may need help or some time-out:
- respiratory pauses, tachypnoea, gasping
- yawning, sighing
- gagging, posseting
- hiccoughing
- sneezing
- coughing
- straining
- flaccidity (limp posture) trunk, limbs, face, mouth
- hypertonicity with hyperextension (stiff posture)
- arching
- finger splays, ‘high guard hands’, ‘saluting’
- hand-on-face, fisting
- facial grimace
Frantic diffuse motor activity:
- squirming
- disorganised transition between and rapid changes of behavioural state
- fussing or irritability
- staring or gaze averting
- hyper alertness
- crying/whimpering

The following may indicate how well baby is able to settle itself, cope with interventions and to interact:
- able to regulate colour and breathing pattern
- reduction of tremors, twitches and autonomic stress cues
- smooth well-modulated posture and normal tone
- smooth movements
- hand and foot clasping
- grasping
- hand-to-mouth activity
- hand holding
- hands to midline
- rooting/sucking
- defined sleep states
- focused, shiny-eyed alertness or animated facial expression
- ‘ooh’ face
- cooing
- attentional smiling
- easily consoled

CARE-GIVING AND INTERVENTIONS

Handling and invasive procedures may cause:
- destabilisation of blood flow, cardiac regulation, oxygenation and digestive functions
- discomfort, pain and iatrogenic injury
- poor thermoregulation
- disrupted growth
- altered sleep patterns with disordered transition between states
- delay in development of normal movement and posture
- diminished parental confidence and competence

Whenever possible all care-giving and intervention should be carried out by 2 people, 1 person performs the intervention; the other provides the baby with comfort and support

Aim

Method

Plan and deliver individualised care and interventions (nursing and medical), in accordance with baby’s cues, promoting physiological stability and self-calming behaviours
Protect baby’s sleep and ability to self-regulate
Avoid pain, distress and iatrogenic injury
Protect developing musculoskeletal systems by promoting midline postures and symmetry
Increase parents’ confidence and competence

Closely observe baby’s physiological, motor and behavioural cues. Plan, adapt and pace care-giving and interventions in response
Have all necessary equipment ready before starting
Approach baby carefully, using soft voice and gentle touch, allowing time to adjust before beginning
Keep lighting and noise levels low
Support and comfort baby throughout:
- administer appropriate analgesia including sucrose and MEBM
- avoid totally exposing baby
- facilitate baby’s self-calming strategies according to behavioural cues e.g. non-nutritive sucking, grasping, hand-to-mouth and foot bracing
- use swaddling and containment (hands/nest/soft blanket or clothing) to provide support during care or procedure
- allow baby ‘time-out’ to recover if cues indicate stress. Recommence when baby is calm
Use side-lying position for cares, including nappy changes. Promote a flexed position with limbs tucked in. Do not lift baby’s legs, place soles of feet together and roll side-to-side instead
Use containment and swaddling for transfers into/out of incubator/cot, weighing, and bathing. Move baby slowly, in flexed, side-lying position, close to carer’s body
Promote positive touch and active parental role
Promote kangaroo care as soon as possible (see Kangaroo care guideline)
Ensure baby settled, comfortable and stable before leaving bedside

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Date updated: 2024-01-10