Self-Regulation: What Is It and Why Is It So Important For Your NICU Baby?

July 24, 2020

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

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Self-regulation is one of the most important things your sweet NICU baby is trying to learn as they take on the world. We’re diving into the importance behind the development of your NICU baby’s self-regulation skills, so you can learn how to support them. Hint: Self-regulation is one thing that helps your baby cope with the stress, pain, and interactive input surrounding them. Plus, it buffers the effects of negative exposures and experiences. 

I know you want your baby to have excellent coping skills and sensory processing abilities when they’re a toddler, teenager, and adult…it starts now!

Today goes beyond the medical needs of your little, but it’s something equally important. 

A skill your little one will carry with them for the rest of their lives. 


Self-regulation is the ability to cope and interact successfully with the environment, even when it is stressful or painful. 

Self-regulation is the capacity we have to self calm or re-organize when we are met with overwhelming, interactive, or stressful input.

To put it simply, it’s our coping mechanisms.

As adults and moms, we each have unique habits that we use to help regulate our own systems, even if we don’t realize that’s what’s happening! 

There are so many ways we can regulate our own systems and bodies when we are coping with everything the world throws at us. Things like…

  • Riding home from work in silence, because having music playing is too much after a long day.
  • Dimming the lights at home.
  • Sipping on some warm tea when anxiety kicks in.
  • Running or getting in a good work out
  • Listening to your favorite playlist 
  • Or if you are a lucky mama, getting a massage!

We have a much more mature self-regulation system than our little babes!


The earlier your baby was born, the more difficult it is for them to learn to regulate themselves as they interact with their environment and learn to survive in the world. 

Premature babies need our help to achieve self-regulation. 

The life of a premature babe is tough!

Premature babies are fighters! They are overcoming more than most of the adults caring for them have overcome.

As a NICU occupational therapist, a major goal I have for all of the premature and medically fragile babies that I work with, is for them to learn how to regulate their behaviors and interactions on their own. 

When a healthy, full-term baby is born, their self-regulation skills kick into gear. 

Soon after birth, they already have the ability to regulate their own body processes, the environment, and their own behaviors.

They had time learning to regulate all of those things while they were still in their mama’s belly. For those sweet premature babies, their time in that cozy, safe environment was cut short. 

Research shows us that even when premature babies reach their due date, they have a lower capacity for regulation when compared to healthy, full-term babies.

Self-regulation is the hardest thing for your baby to achieve.

All of their body systems have to work together in just the right way for your little one to balance all of the things that their body is processing. 

Before your baby can be successful with regulating their environment, there are several other body systems that they have to master first. 

Below is a pyramid so you can see the progress of things your little has to master before they can tackle self-regulation.

(Source: Als Synactive Theory)

If your little struggles in stability in more basic areas of function like breathing, keeping their heart rate up, or learning to transition from being asleep to awake, then they won’t be able to merge all of those skills together to achieve self-regulation and interact with you at their care times.

Your baby isn’t ready to be social or focus their attention on you (top levels on the pyramid) when their body is prioritizing keeping their oxygen or heart rate where it’s supposed to be, or when they are just learning how to go from being asleep to awake (lower levels of the pyramid).

We have to help (and let!) NICU babies focus on the basics for survival…even if that means being patient and changing the ways you interact with your new babe.

Want to know what you CAN do to support your baby’s self-regulation skills, no matter how little or fragile they are?

I share 5 pretty great things you can do here! 


Your baby has a LOT of things to learn to coordinate while they are in the NICU. 

We have to marvel at all the hard work they’re doing. 

  • Breathing
  • Maintaining their temperature
  • Moving their arms and legs
  • Digesting food
  • Learning to take a bottle or breast-feed
  • Interacting with all of the lights, sounds, touch, and smells surrounding them
  • Being touched and interacted with frequently
  • Changing positions 
  • Getting their diaper changed or blood pressure taken 

Whew! That is a lot for a tiny babe who’s just entered the world! Thankfully your baby has YOU as a mama, so you can help them learn such an advanced skill.


How do you know if your baby is coping successfully with everything going on around them? 

You can become the expert on your baby’s cues (their behaviors)!

Examples of a premature baby who is successfully learning self-regulation:

  • A baby in a bright room may cover his face to cope with the visual input
  • A baby who is too overstimulated by eye contact may shift from being awake to drowsy, or may look away during attempts at eye contact
  • A baby feeling overwhelmed by a diaper change may bring their hands to their face to help them cope

Good functioning of your baby’s systems (all those things listed in the pyramid above— basic life functions, movement, alertness, attention) means your baby now has the foundation needed to learn how to self-regulate.

Once they’ve mastered self-regulation, they won’t always need our help to stay well organized or cope with mild stressors like a diaper change or transitioning out of their crib or isolette (also known as an incubator).

Pretty hefty stuff, y’all. 

Don’t be discouraged if it takes your baby some time to learn to self-regulate. It may take your premature baby well after they go home from the hospital to get the hang of it.

Luckily, you can know how to support their efforts and read their communication cues.

Wondering how your little babe shows you they have good functioning of their body systems with appropriate self-regulation?

  • There are no decreases in their heart rate or oxygen rates (also known as bradycardia or desaturation)
  • Breathing rate is stable
  • They’re smiling
  • They are bringing their hands to their face
  • They’re cooing
  • They have relaxed arms and legs
  • They have smooth body movements
  • Their eyes are open and calm
  • They have a relaxed facial expression
  • They are exploring bringing their hands to their mouth to explore sucking on them
  • They are tucking their legs into their belly


As I said before, for premature babies who entered the world too early, and have been bombarded with stressors and input…self-regulation is a REALLY hard skill to achieve. 

Remember, even by the time a premature baby reaches their due date, they aren’t able to cope or self-regulate as well as their healthy, full-term baby friends. 

Difficulty learning self-regulation doesn’t just apply to babies who are born early.

Any baby who has to spend time in the NICU may have difficulty learning self-regulation.

NICU‘s have made major progress in recent years, in changing the physical environment (like keeping light and sound to lower levels) and adapting care for your baby (like protecting their sleep) to support your little one’s coping skills and to lower their stress and pain experiences.

I know that I’m not alone in wishing (and hoping someday!) that every single touch experience your baby has while they’re staying in the NICU would be positive. 

Unfortunately, your baby is in the NICU for a reason and needs medical intervention. Some input and experiences your baby has during their stay, like heel sticks, IV placements, being woken up every three hours, diaper changes, surgeries or eye exams (to name only a few!) may not be as positive as we want. 

The good news is, your baby is giving you cues, so you can know and respond to what they need—even during procedures!

Become the expert on your NICU baby’s special communication style and check out a more detailed post all about it.


Here are some signs your baby is having a difficult time tolerating their environment or interactions.

  • Flailing or stiffening of arms and legs during their care or assessment
  • Looking away
  • A drop in their heart rate or oxygen rate (called bradycardia and desaturation)
  • An increase in their heart rate or breathing rate (called tachycardia or tachypnea)
  • Crying
  • Facial grimacing
  • Gagging, sneezing, yawning, or hiccups

They need us to bridge the gap between their ability to cope and maintain stability with the new, interactive world around them.

Hopefully, the NICU where your baby is staying has already implemented some supports that help your baby’s growth, self-regulation, and development.

Clustering care

Sometimes a baby is able to achieve self-regulation on their own, and sometimes they need some help. 

For premature babies, learning self-regulation relies a lot on external supports—you, me, medical caregivers, and the environment. 

As your baby learns self-regulation, they will be less dependent on you to provide them with supports. 

YAY! Your little is already growing up!

We are never looking for perfection—there are moments when every baby needs our support to help them cope. After all, we are their mama!

Even healthy, full-term babies need their mama’s support—it’s one of the best (and hardest!) parts about being a mama. 

I want to empower you to work toward providing an environment that is responsive to your baby’s cues and allows for as many positive interactions as possible.

Our ultimate goal is for your baby to have sufficient self-regulation skills, so they can do a variety of tasks and activities that newborns need to do like:

  • Feeding (bottle feeding or breastfeeding)
  • Interacting with their family
  • Living in a diverse environment
  • Being awake to explore their environment
  • Tolerating a diaper change or clothing change
  • Maintaining their temperature
  • Laying on the floor for free play
  • Taking a bath

By supporting your baby’s self-regulation, you have an important job in promoting their long-term developmental outcomes, helping them manage emotions and behaviors, supporting their sensory processing skills, protecting their sleep so their brains can grow, and optimizing their overall medical journey.

Your baby is one big puzzle.

Self-regulation is one piece of your baby’s HUGE, NICU puzzle, but it is woven into EVERY SINGLE ONE of your baby’s processes and interactions. 

I would love to hear about how your baby tolerates diaper changes, care times, feeding experiences, and/or skin-to-skin care. 

Where are they on their journey to self-regulation?

You’re doing it, Mama!


Als, H., & McAnulty, G.B. (2011). The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with Kangaroo Mother Care (KMC): Comprehensive Care for Preterm Infants. Current women’s health reviews, 7(3), 288-301. 

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