If you have spent time in the neonatal intensive care unit (NICU), you may have walked the halls and noticed some babies have toy mobiles over their cribs. Getting a mobile at your baby’s bedside can feel like a major developmental accomplishment! But, there are some questions we should ask, and developmental cues we want to follow before giving any NICU baby something to gaze at over their head. Let’s talk about 7 questions we should ask.
A toy mobile is a developmental tool often used to “help” babies develop visual skills.
I’ll be honest before I dive into this, I couldn’t find any research looking specifically at the use of visual mobiles in the NICU (and how they relate to medical or developmental outcomes), so I’m sharing based on what we know about visual development, self-regulation, and my own clinical experience.
Plus, what I’ve learned from some really amazing mentors in the field of neonatal therapy.
I’m going to let you in on a little secret…
If your baby is younger than 37 weeks old, they don’t actually need visual stimulation to develop good visual focus or tracking skills.
Crazy, right??
Before a NICU baby has reached their due date (or even for a while after), they don’t need “extra stuff” in their visual field.
No black and white cards, and no mobiles hanging in their face.
And here’s why…
- Vision is the last of all the senses to develop, and it continues to develop for several years before your baby gets real good at it.
- Gradually introducing a preemie to light over time (we call this “cycled lighting”) is all they need for visual development as they’re growing.
- The best way to support visual development is by supporting good sleep.
Crazy huh!
A mobile can be a popular (and exciting!) developmental toy to introduce at some point— especially if you have a baby who’s experiencing a longer NICU stay.
Before introducing a mobile let’s walk through a couple of questions to ask first.
1. IS THE BABY OLDER THAN 37 WEEKS GESTATION?
Let’s start with age.
Age is one of the first things to consider when assessing whether a baby would benefit from a mobile or not.
If a baby is less than 37 weeks old, wait to introduce a mobile until they’re older.
If a baby is older than 37 weeks and approaching their due date, or has passed their due date…then we can decide whether a mobile is a supportive thing to add to their life.
Please know, there are TONS of term babies in the NICU where a mobile would not be appropriate.
Depending on the circumstances that led to a NICU stay, term babies may be a “touch-me-not” and need a lower stimulation environment to promote healing,
2. CAN THEY BE AWAKE IN THEIR CRIB WITHOUT FEELING STRESSED?
A baby needs to feel comfortable hanging out awake without any input before we add in something for them to look at.
Everything in the environment…all the demands we place on their sweet body, build on each other.
Watch the babe to see if they’re showing any signs they’re stressed without the mobile FIRST.
If your baby looks uncomfortable or unsettled while they’re laying in their crib in a low stimulation environment, it’s not time (usually!) to add anything else.
3. HAVE THEY DEVELOPED GOOD SLEEP CYCLES?
Remember what I mentioned at the beginning?
Visual skills develop during sleep.
Protecting sleep in the NICU is a MAJOR focus…maybe even frustratingly so.
“Don’t wake them up.”
“Let’s wait until their next assessment.”
“Try not to wake them up.”
Sleep is when brain growth and healing occur.
Sooo, if your baby is having trouble going to sleep or staying asleep…a mobile may interfere and make that even harder for them.
Again, this isn’t true for every single baby. It’s ALWAYS important to read your baby’s cues and make a decision based on their unique strengths and circumstances.
4. CAN THE BABY LOOK AWAY FROM THE MOBILE IF THEY WANTED TO?
Here are two ways a baby may tell us they’re stressed out by visual input:
- They just CAN’T look away from it. OR…..
- They look away from the mobile and AVOID focusing on it (we call that “gaze aversion”).
If you see either of those, your babe may just not be ready yet.
Just for now, not forever!
Babies should look comfortable while they gaze up at their mobile.
If you’re looking for other ways to help your baby as they learn to cope with all the things around them, check out….5 WAYS TO HELP YOUR BABY LEARN COPING SKILLS IN THE NICU.
5. CAN THE MOBILE BE HUNG AT LEAST 8 TO 12 INCHES FROM THE BABY’S FACE?
All right, it’s time to start looking at the types of mobiles your unit offers, or figuring out which one you may want to buy your baby. Eeek! The fun part!
First, look at whether or not the mobile will hang 8 to 12 inches away from your baby’s face at the shortest point.
Term babies can only see around 12 inches away.
6. DOES THE MOBILE PLAY MUSIC OR MOVE?
With sweet babes in the NICU, I love it when a product has options.
Some mobiles will have a movement feature + music feature that can be turned on and off.
Babies are definitely NOT one size fits all.
If there is a volume control, option to pause the movement, or ability to turn off all the “extra” stuff, then I can modify the mobile to support the baby at whatever stage they’re in (#winwin!).
Maybe they’re ready for it to be above them, but they’re not ready for it to move.
Maybe they would enjoy some music during a diaper change?
If the baby
- looks comfortable,
- has a relaxed face
- is moving their arms and legs in a smooth, calm way,
- and is able to transition to sleep…
it may be a good developmental fit.
7. ARE THERE ANY SIGNS OF OVERSTIMULATION WHEN YOU PUT A MOBILE ON THEIR CRIB?
It’s time! Give it a try.
Put a mobile on their crib (I usually connect it to the end of the crib, so it’s not directly above their head!) and just watch that babe’s reaction.
Look out for any signs they may be stressed or overstimulated.
Things like…
- Wide eyes
- Unable to look away
- Increase in frantic movements
- Facial grimace
- Crying or fussing
Any time we choose to introduce something new to a baby in the NICU world, we are giving them something else to manage and process.
Actually, this is true for ALL babies, NICU or not.
Friends, it’s okay to introduce new things!
If that sweet baby…
- Has the sensory skills needed to tolerate it successfully,
- Becomes more calm, medically stable, or organized because of the mobile.
- OR, is developmentally prepared for it…give it a try.
HERE ARE A COUPLE I RECOMMEND
I really love these “mobiles” for babies who are term, or have passed their due date.
They are a great option for term babies who:
- are on a warmer bed,
- may still be intubated and on the ventilator, but are awake and eager for some input at times,
- or who have surgical/medical interventions that limit their ability to get out of bed.
As with everything we talk about on Blooming Littles, please discuss ALL developmental decisions with your baby’s neonatal therapist, bedside nurse and/or medical team. Babies are VERY different from one another, and what’s appropriate for one may be completely inappropriate for another. This is all for information purposes only.
It can be propped up on the side of the crib or warmer bed, and is a really relaxing way to give a baby something to look at when they are on their side.
I find it can also help a lot of babies transition to sleep when they’re uncomfortable, or even in pain and need a distraction.
Plus, I love to use it as a way to encourage a baby to lift up their head while they’re on their belly!
I also love this Nurture Smart Mobile, and it’s a VERY popular choice for hospitals across the country.
As I write this, it seems like a lot to think about for ONE question, “Can my baby have a mobile?”.
And it is! But, many NICUs follow similar policies related to the introduction of a mobile.
I wanted to share some of the background into our thought process.
It’s an exciting thing to see a mobile on your baby’s bed, especially if you have been in the NICU for a while.
It’s a symbol of hope, of moving forward, of growing and developing.
If you’re wondering whether or not a baby in the NICU would benefit from a mobile on their crib, just ask some questions first.
- Is this baby older than 37 weeks gestation?
- Can they be in a comfortable, awake state without being overstimulated by what’s happening around them?
- Are they interested in looking at faces?
- Does the mobile I’m using offer an appropriate amount of input.
How do you feel about using mobiles in the NICU?
You’re amazing!
