Updated April 2014, next review April 2017

Your premature baby's time in hospital

Positioning your premature baby

Positioning your premature baby correctly can make her feel secure, improve her breathing ability, strengthen her muscles and reduce her risk of cot death.

Once your baby is stabilised there is much you can do to make sure that their positioning helps their short and long term recovery.

Supporting your baby

The way your baby lies in the incubator, cot, or in your arms can have an effect on their development. Premature babies do not have strong muscles. When they lie on a mattress the effect of gravity tends to pull them flat against the surface and it is hard for them to fight this. This means that their arms can end up in a prone 'W' position, and their legs in a 'frog' shape. This has several effects on the health of your baby

Babies on their backs with 'W' arms may find it difficult to:

  • bring their shoulders and hands forward and together
  • get their fingers and hands to their mouth for sucking and hand clasping, or to touch their mouth and head
  • when they are older, they may find it difficult to lie prone on their elbows, crawl, sit and balance.

Babies with 'frog legs' have hips that are not positioned well and they fall out to the side. These babies may:

  • have dislocated hips
  • find it difficult to crawl, stand and walk later on.

Because the baby is weak the head tends to fall to the left or right. This can cause shortening of neck muscles and your baby may want to turn his/her head to the same side. A poorly positioned neck can also affect breathing, swallowing and feeding.

Premature babies' limbs tend to flail around, instead of curling up as in older babies, so they need some help to lie in a position that is comfortable, helps their muscle development and may help them feel more secure.

A good position for your premature baby 

The healthcare team should try to help your baby into a good position through 'containment'. This means limiting her movement and giving her something to push against so she can practise flexing her muscles,  similar to the position that she would naturally have in the womb at this stage of development . This is often done using rolled-up bedding, but make sure any fabric cannot get close to her face and impede her breathing.

Another option is to 'nest' your baby: building a nest of rolled-up blankets around her so she is contained. She may need some cushioning under bony parts of her body such as her hips and knees.

The team will put your baby in a variety of positions to help her development whilst caring for her. Sometimes she will be on her front, sometimes on her side, sometimes on her back. The team will use supports for different parts of her body. 

Putting your baby on his front can increase the risk of sudden infant death syndrome (SIDs), so only put your baby in this position whilst he is being monitored on the unit and not at home.

Changing your premature baby's sleeping position

Premature babies are more prone to positional plagiocephaly (flat head) and dolichocephaly (long narrow head). To avoid this, it's important to change your baby's position regularly, including the position of her head, to help prevent a flat patch developing.

Avoiding cot death and breathing problems: front, back or side?

Lying on her front is fine in the baby unit

In hospital, it's safe for your baby to lie on her front, as she is being constantly monitored - and, in fact, this position can aid breathing problems in babies with respiratory problems. However, you will need to get her gradually used to lying on her back before taking her home.

Putting your baby on her back at home

Once you take your baby home you will be told to lie her on her back, because sleeping on the front is associated with cot death, also known as sudden infant death syndrome.

Baby on the move? Put her on her side

To prepare your baby for crawling, sitting and standing, it is important that she spends some time on her tummy and side. However, she should be awake at the time and you should never leave her unattended. Ask the staff on the unit for more information about this.


In this section


Your baby's time in hospital:

You can also read about

The following organisations can give you more information about the topics covered in this section.


Sources

Jane K Sweeney and Teresa Gutierrez (2002) Musculoskeletal Implications of Preterm Infant Positioning in the NICU, 'The Journal of Perinatal & Neonatal Nursing 16', no 1 58–70.

Jarus T et al (2011) Effects of Prone and Supine Positions on Sleep State and Stress Responses in Preterm Infants, 'Infant Behavior & Development 34', no 2

Cambridge University Hospitals NHS Foundation Trust (accessed March 2014) Supporting and Comforting Your Baby’, http://www.cuh.org.uk/rosie/services/neonatal/nicu/developmental_care/support_comforting_baby.html#positioning.

Macdonald S and Magill-Cuerden J (2012) Mayes’ Midwifery, Fourteenth Edition, Edinburgh: Bailliere Tindall Elsevier

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Ask the team to show you how the position your baby, so you can learn to adjust her yourself.

'As time went on, I came to know how to work around this box he was in. It was massively daunting at the start, but it got easier. By the end ot his time in the neonatal unit I could take him out of the CPAP and put him back in myself. I was very hands-on. They did encourage you - you learn by watching, and I liked to try to do as much as I could. This was partly because I didn't want everyone's hands on him - I wanted him to know my smell - so the more I could do the better.'

EMILY