Learn How Your NICU Baby Communicates: The NICU Parent’s Guide

August 22, 2020

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

Guess who has the greatest influence on a baby's NICU stay? It's YOU! Let's get you the tools, info, and resources needed to create positive NICU experiences, one interaction at a time.

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Want to understand the special way your NICU baby communicates with you? Learn how your NICU baby’s movements, facial expressions, body responses, and arousal level tell you what they need. By understanding your baby’s behaviors (“cues”) you are supporting their brain development and providing the most developmentally supportive care possible. Read on for information on how your NICU baby shows you they are stressed and overwhelmed, or content and ready for interaction.

Your 25 week old baby is communicating with you.

Your 30 week old baby is telling you what they need. 

As a neonatal occupational therapist, I am trained to evaluate the individual behaviors of infants. 

I’m trained to support bonding and development in appropriate ways based on a baby’s age, medical status, and tolerance to their environment.

When working with babies in the NICU and encouraging early interactions between a baby and their caregivers, one of the first things I like to talk about together is how their NICU baby is communicating with them. 

Today, I want to talk about—

  1. How NICU babies communicate.
  2. Why learning your NICU baby’s cues is so important.
  3. Signs your NICU baby is content, comfortable, and ready for interaction.
  4. Signs your NICU baby is overwhelmed, stressed, and needs support from you.


Premature babies in the NICU don’t communicate in the same way their full-term friends do.

And full-term babies who spend time in the NICU may also communicate in a different way.

We (NICU professionals) typically call signs of communication shown by NICU babies their “cues”. 

Cues can be…

  • behaviors
  • motor movements
  • facial expressions
  • postures, and
  • physical or medical changes.

They tell us (the caregivers!) what that sweet baby needs. 

Babies born prematurely have immature nervous systems (underdeveloped brains and spinal cords) and less energy or lung capacity for crying. 

If your baby was born prematurely, they may be communicating through less obvious body language and expressions.

The earlier your baby was born, the less able they are to regulate themselves as they learn to interact with their environment and survive in the world. 

As your baby gets older and stronger, their body language and responses will change and become more obvious.


Focusing on your baby’s cues can clue you into whether you can approach your baby for gentle interaction, or whether your baby needs some help coping with their environment.

Understanding and responding to your baby’s cues creates a foundation of trust between you and your little one.

  • It makes your baby feel safe and secure while they’re in an ever-changing and overwhelming environment. 
  • It decreases the release of cortisol (a stress hormone) during your baby’s care and interaction.
  • You’re supporting your baby’s ability to interact successfully with their environment—even if they are a 25 week old preemie and on a ventilator.
  • You’re teaching your baby self-regulation
  • It creates an environment that allows for positive interactions as your baby learns to breathe, grow, and interact.


NICU baby cues (4) (1)

Ready to learn the specifics?

Let’s jump into all the ways your sweet baby is communicating with you, so you can take what you learn to your baby’s bedside and start observing.

It’s kind of like learning the different cries of a newborn. 

One cry or whine may mean “I’m tired”, another, “I’m hungry”, or maybe “I need to be changed”.

Let’s get to decoding those baby behaviors!


Let’s talk about the behaviors and signs that show your baby is content, comfortable, and ready for appropriate interaction. 

These are cues that tell me (and you!) that your babe is coping well in their environment, and they’re ready for appropriate handling or interaction.

  • Your baby isn’t having “episodes” (signs of medical instability like breathing fast, dropping their oxygen, or dropping their heart rate)
  • They are resting with a relaxed body position and minimal jerky movements.
  • Your baby may transition to being awake with a calm face.
  • Their hands are coming to their face.
  • They are smiling.
  • Your baby is mouthing or sucking their hands.
  • If they are older, your babe may be cooing.
  • They have a relaxed facial expression.

If your baby is showing you these cues, they are content and interested.

Now’s a good time to show your babe some of that appropriate interaction. You can hold them, read a book quietly, give a massage if you’ve been shown how, or offer some eye contact. 

You can also provide a hand hug, let your baby hold onto your finger, or sing quietly to them.


It’s not easy to acknowledge that your precious baby is experiencing stress or pain.

That’s why I want to tell you about the cues your baby gives when they may be getting overwhelmed with input, experiencing pain, or feeling stressed. 

If your baby is in the NICU, they have a lot of input coming at them that was unanticipated like heel sticks, breathing tubes, blood pressure checks, and even diaper changes. 

By learning your baby’s stress cues, you can know when your little one needs positive, feel good, support!

Some of these signs of stress or overstimulation may surprise you, like hiccups or yawning!

NICU babies communicate very differently (with WAY less obvious signs), because they are focused on basic life functions like breathing, keeping their heart rate up, maintaining their temperature, or learning how to move their arms and legs in space.

I have grouped these stress cues/signs of overstimulation into four categories.

You’re going to build a lot of confidence and mama knowledge by KNOWING the special ways your babe communicates with you.

Body Movements

  • Frantic, disorganized movement of arms and legs
  • Stiffening of arms and legs 
  • “Stop” hand
  • Arching their back
  • Floppy arms and legs (aka: hypotonia)
  • Flailing movements

Alertness Signs

  • Your baby shifts from alert to drowsy suddenly
  • Irritability
  • Crying
  • Difficulty calming down
  • Your baby may look like they’re “shutting down”—eyes close and they may appear zoned out.

Face/Body Responses

  • Looking away from you
  • Furrowed brows (looks like a wrinkly forehead)
  • Face grimace
  • Yawning
  • Gagging 
  • Sneezing
  • Hiccuping 
  • Spitting up

Medical Responses

  • Dropping their oxygen (aka:“desat” or “desaturation)
  • Dropping their heart rate (aka: “brady” or “bradycardia”)
  • Faster breathing rate (respiration rate)
  • Faster heart rate 
  • Having a skin color change (the face turns blue, pale, red, pink)

If there are signs of medical instability (like those listed above), your nurse may need to intervene by providing your baby with stimulation or breathing support.

Medical responses happen when your sweet one is still learning to process their environment.

You know what’s amazing though??

YOU have the power to decrease your baby’s pain and stress responses.

YES—you actually do!!

Your baby needs you to provide support if you see them do any of those stress cues listed above.

I’m SO glad you’re here learning how to comfort and support your sweet one.

You’re amazing!


Your NICU baby has to learn coping skills, and it takes some practice—they’ve got a whole lot to manage right now.

Want to get started teaching your babe coping skills, no matter what their age is or how medically fragile they are?

Check out:


There are things you can do IN THE MOMENT to provide your baby with positive touch and comfort after you notice stress cues.

Things like:

  • Give your baby a hand hug
  • Provide a pause—stop any stimulation like talking, movement, tickly touch.
  • Cover your baby’s eyes—sometimes visual stimulation and light can be overpowering for your baby. Covering their eyes takes that input away.
  • Provide your baby with a pacifier for sucking—but only if they want it!
  • Guide your baby’s hands to their face and support them there.

Here’s a Tip!

Spend some time watching your baby while you’re at their bedside.

Watch for 5-10 minutes just to observe your baby’s movements, facial expressions, medical responses and body responses.


If you have a neonatal therapist in your unit, please use them. They have SO much to offer you and your baby. 

Discuss these cues with them and observe your baby together. They can help show you all the individual things your sweet baby does to communicate with you in their own unique way.

If you haven’t been educated on these cues by your NICU staff, take this information to the unit and start applying it yourself.

Would you like to see your sweet babe featured in this post?

Send me a picture or video of your baby communicating with you through the cues above.

I would love to integrate them into this post, and better educate future mamas.

I would also love to hear about your experience.

Is your babe telling you they are content and ready to be cuddled? OR are they saying, “I’m a little overwhelmed…can I have a hand hug?”

Proud of you, Mama!


Coughlin, M. E. (2014). Transformative nursing in the NICU: Trauma-informed age-appropriate care. Springer Publishing Co.

Coughlin, Mary. (2016). Trauma-Informed Care in the NICU: Evidenced-Based Practice Guidelines for Neonatal Clinicians. 10.1891/9780826131973. 

Vergara, E., & Bigsby, R. (2004). Developmental and therapeutic interventions in the NICU. Baltimore: Paul H. Brookes.

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