Do you ever feel like the song “A Whole New World” from Aladdin should start playing as your theme song whenever you’re trying to explain what life was (or is!) like in the NICU? Just take out the “dazzling place…” part.

To help bridge the gap a little bit, I thought I would go ahead and share some frequently asked questions I get as a neonatal occupational therapist who works in the neonatal intensive care unit (NICU).

These are all common questions I get asked about development. 

Just remember, every country around the world and state in the U.S. has different policies and access to NICU therapy services after discharge. Talk with your baby’s medical team, neonatal therapist, or social worker if you have questions about what’s available in your area.

Now, let’s jump into some popular questions.

Will my baby need therapy after discharge?

It depends. 

One of the most popular questions I get asked around discharge is “What toys do I need to support development?” 

I shared some of my favorite toys in this post. But mostly, your baby just needs YOU.

7 PERFECT TOYS TO STIMULATE DEVELOPMENT AFTER DISCHARGE

If your region provides automatic enrollment in therapy services for your child after discharge, do it! Even if you don’t have any major concerns.

I think it’s incredibly important to get therapy services (like occupational therapy, physical therapy or speech language pathology) involved BEFORE there are major developmental concerns. 

Especially if they have a history of a NICU stay.

Also, there are certain diagnoses and medical circumstances that place babies at a higher risk for developmental delay. I would (generally) recommend seeking out therapy services, if your baby falls into one of these categories. 

• Prematurity
• Intrauterine growth restriction (IUGR)
• History of sepsis
• History of necrotizing enterocolitis (NEC)
• Neurologic involvement 
  • Hypoxic ischemic encephalopathy (HIE)
  • Neonatal stroke
  • Brachial plexus injury
  • History of seizures 
  • Intraventricular hemorrhage (IVH)
  • Periventricular leukomalacia (PVL)
• Hypertonia or hypotonia 
• Poor feeding or feeding concerns
• Body asymmetries 
• Congenital or genetic conditions

Is my baby going to have developmental delay?

This question piggybacks a little bit on the first one.

It can be hard to predict which babies will have developmental delay or other impairments after discharge, months, or years later.

What we can do is look at the research that has helped us understand more about which diagnoses and medical circumstances may place babies at a higher risk for delay or impairment.

Here’s the thing, research is not cause and effect.

If your baby has A, it does not ALWAYS result in B.

It doesn’t mean that all babies born at 24 weeks will have a neurologic impairment.

Instead, it means…if your baby was born extremely premature at 24 weeks that they have a higher likelihood of having developmental delay or developmental needs following discharge and later on in life.

Here are some diagnoses and categories that may be at a higher risk for developmental delay:

• Babies born < 32 weeks
• Babies with intrauterine growth restriction (IUGR)
• Babies with a history of sepsis 
• Grade 3 or 4 IVH
• Babies with history of NEC
• Certain genetic conditions
• Poor feeding and sucking strength

My baby is three months old, but her due date is next week, what does that mean?

All the “NICU ages” are confusing (can you say “AMEN!”??)

In this situation, your baby has a chronological age of 3 months. BUT, when looking at the appropriate development of infants, you want to use what we call “corrected age”.

Your baby should NOT be behaving like a 3-month-old.

If your baby’s due date is a week away, then they are technically -1 week old and should be showing similar behaviors to a 39 week newborn.

What is “corrected age”?

Corrected age is one way to account for the prematurity of babies. Essentially, we don’t want to count those months they were early against them.

There are a couple of ways you can calculate your baby’s corrected age.

This is ONLY used for babies who were born less than 37 weeks gestation.

1. Count out from your baby’s due date instead of their birthday (it’s kind of like your baby gets 2 birthdays!)
2. Subtract the number of weeks your baby was born early from your baby’s chronological age

For example, if your baby was born at 28 weeks estimated gestational age and they are currently 4 months old (16 weeks), then they are around 1 month corrected age.

16 weeks old (chronological age) — 12 weeks premature = 4 weeks corrected age

How long do I use my baby’s corrected age?

Typically, developmental therapists use the corrected age for premature babies until 2 years old.

This doesn’t mean your baby will need that extra time to catch up on milestones, but there may be some areas of development that match their corrected age and others that match their chronological age. 

Every baby grows and develops at their own pace!

How will I know if my baby is on track with their milestones?

My favorite website to track milestones and watch for developmental red flags is Pathways.org.

It’s a highly educational website that accounts for your baby’s prematurity, shares developmental videos, and has multiple charts and pamphlets you can use to “track” skills. 

Plus, the information is shared in several languages.

Your pediatrician and NICU follow-up team will also be monitoring your baby’s overall development after discharge as well.

VISIT PATHWAYS.ORG

Why does my baby need an occupational or physical therapist while they’re in the NICU?

As a neonatal occupational therapist myself, I would like to take three pages to talk about the benefits of our profession within the NICU environment (hehehe!).

Just kidding.

But seriously, why DOES your baby need a neonatal therapist while they’re so young and fragile?

• Neonatal therapists bridge the gap between your baby’s unique medical needs and the world around them.
• We have specialized training in skills that support infant development within the context of a medically-fragile environment. 
• We understand how your baby’s body position impacts their breathing, feeding, stooling, current and future developmental skills.
• We have the underlying knowledge of your baby’s sensory systems and sensory development to create positive interactions during care.
• We prioritize decreasing your baby’s pain and stress during handling, care, and bedside procedures, and understand how that impacts brain development.
• Our unique lens focuses on preventing developmental delay or other concerns BEFORE they happen.

Plus a million more reasons.

There are SO many reasons why your baby would benefit from the involvement of a neonatal therapist.

Neonatal therapists bring a unique, holistic, and family-centered voice to the medical team that places your baby’s current and future development at the forefront.

If you have concerns about your baby’s development, please voice those with your medical team and/or pediatrician.

There’s no concern too big or too small, if it’s occupying your thoughts.

You are your baby’s greatest advocate, and I’m so proud of you!