Updated October 2013

Your premature baby's time in hospital

Positioning your premature baby

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

Initially if your baby is very sick, positioning will come secondary to medical treatment. But 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

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. If they are critically ill, they may be sedated and thus unable to move. The upshot is that their arms can end up in a prone 'W' position, and their legs in a 'frog' shape.

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
  • lie prone on their elbows, crawl, sit and balance when they get older.

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

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

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.

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

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Containment or 'nesting'

The healthcare team should try to help your baby into a good position through 'containment': limiting her movement and giving her something to push against so she can practise flexing her muscles. 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.

If she is on her back, make sure that:

  • shoulders are rounded forward and supported off the mattress
  • legs are bent and together with strong boundaries for foot support
  • head is in line with body
  • encourage your baby's hands to his/her face/mouth.

If she is on her front, make sure that:

  • shoulders are rounded and fall forward often with the help of a bean bag and baby nest (or similar positioning aid)
  • hands to face/mouth if possible
  • legs are tucked together under the body and supported with boundaries. Do not over extend or bend, (flex) the head/neck. Change the direction of your baby's head.
  • avoid letting the hips fall into a 'W' shape, outwards
  • a small roll is under your baby's hips to help tilting of the hips. Ensure his/her hips are positioned below the level of the head.

NOTE: This position can only used whilst your baby is monitored on the unit and is not for when you have your baby at home, due to increased risk of cot death.

If she is on her front, make sure that:

  • the shoulders rounding forward, not 'sticking out'
  • legs are flexed with boundaries for foot support
  • hands are central and near the face/mouth
  • the back and neck are supported in a 'C' shape
  • sides are changed regularly.

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Adjusting 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.

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


Sources

Balaguer A, Escribano J and Roque M (2003) Infant position in neonates receiving mechanical ventilation, The Cochrane Database of Systematic Reviews 2003, Issue 2, Art No:-CD003668.DOI:10.1002/14651858.CD003668.

Ferrari F, Bertoncelli N, Gallo C et al (2007) Posture and movement in healthy preterm infants in supine position in and outside the nest, Archives of disease in childhood, fetal and neonatal edition, Vol 92, F386-F390, doi:10.1136/adc.2006.101154

Hummel P, Fortado D (2005) Impacting Infant Head Shapes: Preventing Positional Plagiocephaly and Dolichocephaly in the NICU, Advances in Neonatal Care, Vol 5, No 6, p329-340

Rennie JM (2005) 'Roberton's Textbook of Neonatology', England, Churchill Livingstone, p389

North Devonshire NHS Trust (accessed Feb 2012) Patient Information Leaflet: Parental Information on Positioning For Premature Babies, North Devon District Hospital

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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