What is Developmental Care?

Where did it come from?

-Development Care began in the 1980s with Dr. Heloise Als as Newborn Idividualized Developmental Care and Assessment Program (NIDCAP).

What organizations support Developmental Care?

- Several formalized programs exist for Developmental Care: NIDCAP, NAPI, Brazelton, APIB.

- There is little formalized research on developmental care as most now recognize it as best practice and there is no research to validate the efficacy of one method versus another.

So what exactly is Developmental Care?

-Supports and infant’s natural posture.
-Provides the least disruption to an infant’s inborn mechanisms for self-stabilization.
-Maximizes the role of the parents in an ainfant’s care while hospitalized.
- Reduces the risk of known sequelae associated with the care provided for at risk infants.
- Enhances the neuro development of infants by recognizing the needs and cues they exhibit.
- Is individual to each infant and family.

Potential Problems with ELBW

Positioning of ELBW infants is extremely imporant. If they are improperly positioned then a variety of problems can occur.

For Example:


-Plagiocephaly or a Rhombus Shaped Head

-Brachycephaly or Flattened Head


- Scaphocephaly or an Elongated and Narrowed Head.

-Torticollis or Tightening of the Neck Muscle.


-Hip Dysplasia

-Winging Scapula

Correct and Incorrect Positioning

Good Positioning is NOT...

Allowing the baby to lay transverse 

Trendelenburg.

Letting the hips remain abducted and the baby having no boundaries.

Using a Nasal Cannula as a "securement device"

Flat scapula are not meant to touch!

Good Positioning IS...



Comfortable… Think...would you want to lay like that for 3 hours?

Supportive of the natural 

curvature of  the shoulders and rotated to support a more mid-line orientation.

Contained! Not only is it cozy, but it reduces metabolic demands and lowers oxygen consumption

Aids an Infant’s Self-Soothing.

Self Stabilization

How do Babies Self-Stabilize?
- Every baby, like every nurse, is different!
-Some common methods of regulation are:
    * Movement of hand to mouth
    * Grasping
    * Tucking
    * Hand Clasping (Yes, babies do love to hold hands.)
    * Sucking
-When providing care, note what the baby does when agitated. This will provide a clue to their preferred method of stabilization.
-While each baby has a "favorite" way, the mechanisms they use may vary from day to day and may dramatically differ as they mature.

Using the Stabilization Method

Now that you know your patient...
-Take time to support this behavior when they begin to decompensate.
-Signs of decompensation may include:
    * Hiccoughs
    * Agitated or fantic movements
    * Hyperextensions or Arching
    * Duskiness and Respiratory Pauses
    * Finger Splaying
    * Gaze Aversion
- With your expert attention, you will note fewer episodes during (and after) cares!
What else can you do?
- Take your time!
- Whenever possible, allow the baby to wake up before beginning care.  Look for these cues:
    *Attempted Eye Opening
    * Increased, Irregular Respiratory Pattern
    * Increased Activity
    * Fussiness
    * Increased Heart Rate
-  If you need to do cares and the baby is still sleeping,w hat can you do to rouse them?

Research shows that babies who are awake are more prepared to self-regulate and may be better able to tolerate care.
Even though it seems counter-intuitive, supporting self-stabilization will allow for fewer swings in sats/pressure.  By going slowly enough to follow the baby's cues, you will actually help them.  Just be sure to provide for adequate thermoregulation!
Turn the lights on for a few minutes, provide quiet containment, etc.

Family Centered Care

Family-centered care meants that we are acknowledging that the family  is a key piece in our care.  Just as every baby is different, so is each family!

ASK! Use specific questions to get the best understanding of the family needs.  Meeting the family where they are will provide for the best outcomes for our patients by allowing us to support the vital bond between parents and babies.

Including the baby's family can be difficult at times but they are essential to recovery.
* They see the infant on a daily basis and may know a tell-tale sign that we don't.  Even if you know what they are going to say, asking makes them feel included.  Having parents on our team is not just better for the baby, it's better for us too!
*noting irregularity in sats or breathing patterns not only reaches parents to be attuned, it reduces the anxiety of each little drop in numbers.
*Research shows that parents who bond in the hospital have an easier transition at home and better neurodevelopmental outcomes at two years of age.
*Explaining why we do what we do removes the mystique which promotes trust. 
For Example:
- "Your baby seems to really like it when you touch her like that.  See how she is all snuggled in and calm?  She's telling you that she feels safe." or "Did you notice that little desat? He's saying that he thinks we're too loud.  He seems to like it much better when we're quiet."

How do you include the family?

- Ask the family if there are cues that they have noticed.
- Teach them ways to "read" their baby.
- Allow them to be involved as much as possible...diapers and temperatures should be a parent's job!
- Provide positive reinforcement for their parents ability.
- Explaining things in terms of the baby's viewpoint when providing teaching.
- Whenever you can, give a rationale.

References

Als, H.(1994). Individualized developmental care for the very low-birth-weight preterm. The Journal of the American Medical Association, 272(11), 853-858.

Maguire, C. (2008). Effects of basic developmental care on neonatal morbidity, neuromotor development, and growth at term age of infants who were born at <32 weeks. Pediatrics, 121(1), 239-245.

Treyvaud, K. (2009). Parenting behavior is associated with the early neurobehavioral development of very preterm children. Pediatrics, 123(1), 555-561.

VandenBerg, K. (2007). State systems development in high-risk newborns in the neonatal intensive care unit: identification and management of sleep, alertness, and crying. J Perinat Neonat Nurs, 21(2), 130–139.