Planning for Developmental Follow Up

Developmental Evaluation: What to Expect

Your baby’s neonatologist has requested that he or she be followed by San Antonio Pediatric Developmental Services. While your baby is in the NICU, we will conduct periodic examinations to evaluate posture, movements, reflexes, strength, sucking skill and the ability to respond to people and activities.

A developmental specialist will look at your baby’s strength and movements, reflexes, response to sounds, touch, use of vision, sucking and progress with feeding. After evaluating your baby, the developmental specialist will make recommendations to the baby’s NICU team about ways to support his or her development. Their recommendation may include suggestions about how to position the baby, interact with them and how to help the baby learn to feed from the breast or bottle. The developmental specialist may ask a NICU occupational, physical or speech therapist to work with your baby on a regular basis to help them achieve these goals.

Benefits to Your Baby

Being referred to developmental services does not mean that someone has identified a problem with your child’s development. Babies who are born prematurely or critically ill often have special developmental needs. The normal progress of their development may be interrupted by prematurity or illness. We will work with your NICU team to serve as an advocate to ensure your baby is given every opportunity to reach his or her full potential. Our goal is to identify infants who are at risk and assist in providing them with a developmentally appropriate environment.

Who We Treat

• Born at less than 37 weeks (premature)
• Have congenital anomalies (birth defects)
• Born with heart problems
• Exposed to illicit drugs or certain medications during pregnancy
• Low Apgar score (slow to recover after birth)
• Neurologic (brain) abnormalities
• GI (gastrointestinal) surgery
• Triplets or greater multiple births
• Noted to have slow development

What You Can Do

Parents often want to know how they can help support their baby’s development. The following are some ideas you may want to discuss with the developmental specialist:

• Visit your baby daily.
• Participate in kangaroo care (skin to skin holding).
• Help your baby learn how to feed. When your baby is feeding from the bottle or breast, try to be present to participate in at least one feeding per day.
• Learn about your baby’s positioning needs.
• Learn how to read your baby’s signals.

Reading Your Baby’s Signals

Babies have special behaviors that tell you when they are calm, happy and ready to pay attention to what is going on around them. Other behaviors will let you know when the baby is receiving too much stimulation and needs a break. You can help your baby by learning to read the signals and adjusting how you interact according to these cues. A developmental specialist will be happy to meet with you to discuss your baby’s individual signals.

Positioning Your Baby

Babies born early have soft skull bones, which can flatten from lying against the mattress. To help maintain a nice, round head shape:

• Rotate your baby’s position so that he or she is not always on his or her back
• Rotate the head of bed
• Hold your baby on different sides during feeding

Babies born early or critically ill need to be placed in special positions to help their muscles develop properly.

As the time approaches for your baby to go home, we will help you prepare for the baby to sleep on his or her back without positioning supports.

Helping Your Baby Learn to Feed

At first, babies may be fed through a tube placed in their nose or mouth that leads to their stomach. Feeding from breast or bottle is a lot of work for the baby and requires coordination of sucking, swallowing and breathing. You can help your baby, before feeding begins, by giving a pacifier to suck on while the baby is tube fed. If you are going to breastfeed, let the baby nuzzle at your emptied breast during tube feeding.

Planning for Developmental Follow-Up

Most parents of NICU babies worry, “Will my baby be normal?” The majority of babies in the NICU go on to develop normally. However, they are considered to be at a higher risk for developmental difficulties. It is hard to predict which babies will have difficulties. Therefore, the developmental specialist will probably recommend follow-up visits after your baby goes home. During these visits the developmental specialist will administer specific developmental tests to track and evaluate your baby’s progress to help identify any developmental difficulties early. Identifying these difficulties early is the best step you can take to help your baby reach their full potential. The specialist will also provide you with ideas for activities at home designed to promote your baby’s development. Typically, your baby will be seen in the follow-up clinic every four to six months. This schedule may be adjusted based on your baby’s specific needs.