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University Hospitals Dorset NHS Foundation Trust

Neonatal Therapy Service

What is a Neonatal Therapist?

The Neonatal Therapy Service is made up of Developmental Physiotherapists and Occupational Therapists, based in the Child Development Centre.

A Neonatal Therapist aims to support the development of babies who may be at risk of having movement or developmental difficulties due to:

  • Low birth weight
  • Problems before, during or after birth
  • Problems or conditions affecting joints or muscles
  • Other problems that may affect how they move

Most babies develop well in spite of being born early or being ill in their early life. We have a Physiotherapy led developmental follow-up programme to monitor your baby’s progress on the neonatal unit and after they go home, to reassure you when all is going well, to offer suggestions for appropriate developmental play activities, and to make sure your baby gets the earliest possible help if they need it.

Who is referred to the Neonatal Service?

Premature babies born earlier than 33 weeks gestation are routinely referred to the Physiotherapist for developmental monitoring and input as required. Other babies at risk of movement or developmental difficulties because they are small or sick, had a bumpy start to life or have a known condition which may affect development are also referred by medical staff.

Developmental Assessment

The Therapist may observe your baby and watch their active movements when they are awake. They may ask you if they can video your baby moving so they can look at their movements in more detail, and keep a record (Prechtl Assessment of General Movements). This assessment of a baby’s spontaneous movement gives a good insight into how they are doing developmentally. The Therapist may also place your baby in different positions (on their back, side and tummy), and move their arms and legs to assess their muscle tone (how stiff or floppy they are) and how well they respond to being handled.

Other Assessments

These may include looking more specifically at your baby’s range of movement and muscle strength.

Therapy on the Neonatal Unit

After an assessment the Therapist will be able to advise you how your baby’s movements and skills are developing. If your baby would benefit from support with their development the Therapist will advise you and the nursing staff on ways you can support and encourage their movement and other skills. This may include ways to position, handle and carry your baby, developmental play ideas, and stretches. This advice is not usually a list of exercises, but ways to handle and position your baby through the day and night to help their development.

Developmental Care

In our Neonatal Unit we endeavour to practice family-centred developmental care for all babies. Developmental care encompasses a range of interventions that aim to reduce stress on babies, conserve their energy and promote growth, optimise and promote neurological development by mimicking the conditions of the womb as best as we are able to. These interventions include environmental adaptations such as dimming lights and reducing noise to protect your baby’s developing eyes and ears, developmentally supportive positioning and positive touch programmes (comfort holding, kangaroo cuddles etc).

Developmental Care also aims to encourage and support parents to allow them to play as full a role as possible in their babies care. Your Therapist will be happy to discuss aspects of developmental care with you.

Physiotherapy and Occupational Therapy Follow-up after discharge home

Once discharged home babies born under 33 weeks gestation and other babies at risk of having movement or developmental difficulties will continue to be followed up by a developmental Physiotherapist or Occupational Therapist. This is usually to monitor their sensory development, their ‘gross motor’ movement development (such as learning to roll, sit, crawl, stand etc) and their ‘fine motor’ skills which are skills involving the hands (grasping, reaching, pointing etc).

Frequency of appointments is dependent on each baby’s needs, but appointments are usually at 3 to 6 month intervals until your baby is walking or until there are no further concerns surrounding their motor development.

We assess gross motor development using the Alberta Infant Motor Scale (AIMS), which involves observing what your baby can do on their back, tummy, in sitting and in standing.

Correcting for age

Motor development is measured from your baby’s corrected age, that is from the date they were due, not from the day they were born. It is important to correct for your baby’s prematurity to give an accurate assessment of their developmental abilities. We do this because babies’ brains grow and develop according to a preprogrammed biological sequence and also in response to their experiences. When a baby is born early, their brain and the rest of their neurological system have not developed or matured to the same degree as a baby born at term.

If your baby had a gestational age of 28 weeks at birth, their brain and the rest of their neurological system would need a full 12 weeks of growth before we would even expect them to function as a term newborn. Therefore, the developmental expectations of a premature baby are based on corrected age, rather than chronological (actual) age. We generally make this correction for age until children are 2 years corrected age because by this time most premature babies have ‘caught up’ and there is little or no difference noted from a baby born at term.

Locality Physiotherapy or Occupational Therapy

Some babies will require longer-term input from the therapy team, because they need extra help to develop their movement skills or sensory skills. These children will be transferred to a locality Physiotherapist or Occupational Therapist who will be able to provide therapy input and ongoing monitoring.

Developmental Therapy follow-up appointments are held at the Child Development Centre, Poole Hospital which is a separate building on Parkstone Road, behind the main hospital and multi-storey car park.

If you have any questions or worries about your baby’s movements or development please talk to the Neonatal Physiotherapist or ward staff on the neonatal unit.

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