Neurodevelopmental Supportive Care (NDSC) for infants
(Information adapted from Little Steps - www.littlesteps.co.za)
Having a little one is such a joy and a blessing but it can be difficult to know whether you are doing the right thing for them. Many parents ask if they are stimulating their premature or newborn baby enough or too much, they wonder why their baby is crying and what they can do to calm him/her down, and some parents of toddlers or slightly older children may contemplate why their child has sensory processing difficulties. Let us take a look at the development of the sensory systems in utero, overstimulation of newborns and what parents can do to bring their distressed babies back to the calm and alert state.
1. Overview of sensory development in utero
The sensory systems start to develop in utero. This happens in a specific order although they do overlap.
In the first trimester (0-12 weeks), the nervous system starts to develop as well as the tactile and gustatory system (taste). In the second trimester (13-27 weeks), the auditory and olfactory (smell) systems start to develop as well as eye movement. In the third and final trimester (28-40 weeks) auditory discrimination develops; and although the visual system starts to develop in the first trimester, it is only mature by the third as iris constriction occurs at week 36. Iris constriction is imperative for a baby to protect their eyes from being damaged by direct natural or unnatural light.
2. Overstimulation of newborn babies
As soon as a baby is born their environment changes. They go from the womb which is dark and warm where they are fully flexed in a foetal position and can only hear muffled sounds, to a bright and cool hospital room that smells like sterilization and where their first direct contact from human hands is being poked and prodded. It is important to be aware of this drastic change and how new sensory stimuli might affect your little one.
Premature babies are most subject to overstimulation as their sensory systems are not be fully developed yet, however every newborn baby can become overstimulated. This can happen relatively quickly in babies as their sensory systems are still developing and they have to adjust to their new environment- the outside world.
Babies can become overstimulated by specific intensities and durations of sensory input such as light, sound, smell, touch and movement. This happens when they have been given so much sensory input that they are not able to cope anymore and they start to become agitated. As a parent or adult it can sometimes difficult to tell where the line is between sensory stimulation that is doing good and sensory stimulation that is doing harm (over-stimulating your baby). So how do you know when to stop stimulating and to let your baby rest and process the new information that you have just given them? Let’s take a look…
Although we do not think so, babies are able to communicate. They use ‘stress cues’ to tell us when they are feeling distressed and need some help to be brought back to the calm and alert state. Their warning signs are: hiccups, yawning, showing the ‘stop sign’ (stretching their hand out as if to say stop), splaying of fingers or toes, arching their backs and crying. If your baby is in the distressed state and is not brought back down to the calm and alert state, they may enter into a ‘sensory shutdown’ mode where they stop crying and stare with a panicked look on their face, which we want to avoid.
3. How to support your babies’ neurodevelopment
When your baby is in the distressed state there are a few things that you can do in order to sooth them. These are handling and positioning methods that facilitate self-soothing. The following can be done in order to prevent your baby from becoming over stimulated:
- Only present one sensory stimulus at a time as your newborn baby is not ready to handle and process more than one at a time.
- Keep your baby’s body in a flexed, foetal position. Their arms and legs should be flexed with their hands and feet in the midline. It is often helpful to position them in side-lying in order to assist with bringing their little arms and legs into the midline.
- Use skin-to-skin as often as possible.
- ‘Nest' your little one in the flexed position using rolled up blankets to provide a boundary for them, imitating the womb. Remember to position them in different ways in order to avoid unwanted cranial moulding.
It is a natural instinct for a parent to want to stroke their baby gently but this is often painful and too much for a baby to tolerate (especially a premature baby) as they are not used to being touched directly and have only ever known deep pressure in the womb. It is thus better to use still touch in a containment hold or skin-to-skin in order to sooth your baby. Another natural instinct is to “shh-shh” a baby and bounce them up and down while swaying. This movement is actually stimulating and thus counteracts the desire to sooth.
The following things can be done in order to calm your distressed baby:
- Slowly sway your baby side to side in a rhythmical manner.
- Containment hold: cup your babies’ head with one hand and their feet with the other hand, giving them gentle pressure as they would have felt in the womb.
- Keep your baby’s body in a flexed, foetal position. Their arms and legs should be flexed with their hands and feet in the midline.
- If a newborn baby stares, gently touch the nose in the middle between the eyes to encourage the baby to blink. This will help ”reset” the system.
I hope that this information helps you to understand your babies more by picking up their ‘stress cues’ when they communicate to you. I also hope that you feel more confident with implementing the correct strategies to help them remain calm and alert, in order for them to learn all of the new and exciting things that the world has to share with them!