What age would you typically start trialing an NICU babe in a more upright seat (e.g., Tumble forms feeder seat)? Thanks!
Elevated sidelying as you know has an increasing evidence base that consistently supports its benefits for our NICU infants during PO feeding and also for developmental support. Semi-upright can be supportive for motor learning during non-feeding experiences (and post-discharge as a feeding intervention) when the infant’s postural mechanism and motor learning are ready for that experience.
I don’t think of a particular age or weight as criterion. That would make the basis for this critical intervention too arbitrary, since we recognize that typically infant A and infant B can, while the same weight or size, have very different clinical feeding presentations, and different readiness for tolerance of semi-upright (specific to head/ neck/postural control, WOB, tidal volume and reserves, GI comfort, and swallow-breathe interface).
Whether for motor-learning and/or feeding, I always “ask the infant” by carefully considering that infant’s unique readiness – or lack thereof – specific to these factors, in the setting of their unique history and co-morbidities and developmental goals. That way the intervention – in this case, progression to supported semi -upright – is more likely a true match for our therapeutic goals. And best meets the risk-benefit ratio that underpins our clinical reasoning.
The more I understand about the postural mechanism, sensory motor learning, the effects of gravity on multiple systems, and the potential to recruit adaptive behaviors (and provoke maladaptive behaviors) – the more I’ve learned that positioning is too complex of an intervention to be based on arbitrary points in time.