Problem-Solving with Catherine: Considerations with Positioning in the NICU


What age would you typically start trialing an NICU babe in a more upright seat (e.g., Tumble forms feeder seat)? Thanks!

Catherine’s Answer:

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.

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