3 Positioning Concerns That Can Negatively Impact Development

March 1, 2022

I'm katie, OTD, OTR/L, NTMTC, CNT & founder of blooming littles

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Let’s talk about your baby’s body position. One of a neonatal therapist’s specialties.

There’s a lot to think about as a NICU parent. A lot of worries, concerns, anxieties, miracles, and milestones. 

I want to offer some insight into one of the most impactful things you can do for your baby’s overall development. There is something you can do NOW to prevent and decrease your baby’s risk for developmental delays. 

Ready? It’s positioning!

Positioning is one of the best things we can do for babies in the NICU! And, unlike so many things in the NICU world, we actually have a little control over how your sweet babe is positioned.

Not only does good positioning help align their muscles, bones and joints in a developmentally supportive way, but it also helps them learn self-regulation, or coping skills.

When your baby is in the NICU, you spend a lot of time watching your baby while you sit at their bedside. You may not be able to jump in and interact or get hands-on with care very frequently, but I want to give you something you can look at that can make a big impact.

In today’s post, I’m sharing 3 body positions we should look out for when positioning NICU babies.

If a baby spends too much time (like it’s difficult to position them somewhere else) in these positions, it can impact a baby’s ability to meet milestones down the road. 

1. Their shoulders are back, and their hands are away from their face.

As therapists, we call this position the “W” position, because the arms look like a “W” when they are up and away from the face.

Friends, this is a really common position for babies to end up moving into, especially premature babies. Premature babies commonly have hypotonia (low muscle tone), so they don’t have the strength to hold their arms and hands in towards their body all by themselves. 

When you don’t have strength, gravity kicks in….so their bodies may fall and flatten against the bed surface. That’s one reason why babies need the support of those extra positioning devices, whether it’s something fancy like a special gel mattress or whether it’s rolled towels and blankets. 

I’m a mom too, so hear my heart when you read this. Please don’t be upset or alarmed if you walk into the NICU and see your baby’s arms up above their head. Babies move! A lot sometimes. We can do our best, but positioning babies is ever-changing. We’re not working with something that stays where we put them. Give everyone grace and reposition them at their next touch time.

Some developmental reasons to avoid the “W” position:

  • Can lead to tightness in the upper back muscles
  • Makes it harder for your baby to bring their hands to their face
  • Is more difficult for your baby to show you cues like bringing their hands to their mouth for rooting and sucking.
  • Positions the shoulders in external rotation which is not developmentally supportive

2. Their legs are straight and extended.

I like to refer to these babies as babes “lounging by the pool”.

Let me explain, these babies are the ones where you peek in their isolette or crib and their legs are straight out. They have kicked out of their positioning equipment or swaddle and are relaxing with those legs extended, just like someone in a beach chair. 

Although soooo cute, this body position doesn’t help your baby meet those early milestones, like reaching for their toes or even rolling over. 

Our goal is something that looks more like the fetal position. We like to see a baby who is nice and tucked.

Tucking those legs up and towards their belly is actually a really hard thing to do. 

Similar to why babies fall into the “W” position with their arms, babies often rest with their legs extended, because they don’t have the ab muscles to keep them in a fetal position. Plus, if your baby was born early, they didn’t have extra time in the tight space of your belly pushing them into a cozy flexed position.

They’re stretching and moving as much as they want out in the world because they don’t have the tight quarters of the uterus.

Which leads me into the last positioning concern to keep a look out for.

3. There are no boundaries!

What are boundaries? Boundaries surround your baby, so they can feel a calming pressure all around their body. 

Your NICU may use rolled towels around your baby, or they may have a special piece of positioning equipment that looks like a tube surrounding your baby.

Boundaries also help keep those arms and legs in flexion, which we just learned is a major positioning goal for babies. 

See this little one above? She’s resting on positioning equipment without having any boundaries. Her arms are in the “W” position and her legs are out straight. She needs some support surrounding her body to help bring her into a position that more closely resembles the fetal position. 

There are several different ways that NICUs provide your baby with boundaries. You can use rolled up towels or swaddle blankets, special positioning equipment, or gel positioners that mold to the baby. Regardless of the type of positioning equipment available to you (if any!), we’re looking for the same kind of position. Boundaries at your baby’s head, feet, and surrounding their body.

Here’s a good example of a baby all tucked in and cozy.

As a mom or dad in the NICU, I’m sure you’ve watched your baby’s little fingers and toes move, and maybe even let them hold onto your finger.

While you sit by their bedside, you can now look for…

  1. Tucked arms
  2. Tucked legs
  3. Boundaries

There are so many incredible ways your baby’s body is developing and adapting to the world around them. As their body learns to breathe and regulate their body temperature, digest food, and learn to eat…positioning is one way we can support all of those body systems to work together. 

You’re doing an amazing job!

You’re parenting in a new and inspiring way, and I’m so grateful you’re here adding to your NICU parenting toolbox!

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