Infant clinic: services
Parents may present with these kinds of questions or issues:
- “I don’t know why my baby cries – what should I do?”
- “Why does my baby seem fussy and overly sensitive?"
- “Why is my baby hard to settle or to put down to sleep?”
- “My baby’s head seems an odd shape—what should I do?”
- “My baby mainly looks or faces to just the one side”
- “My baby doesn’t seem to behave like other babies”
- “Is my baby’s development normal?”
- “My baby doesn’t want to look at me”
- “Why doesn’t my baby like tummy-time?”
- “My baby arches or pulls away when I try to feed him”
- “I can’t get enough sleep—my baby is hard to work out”
- “Bath time (or dressing / nappy-changes) is stressful for my baby and/or me”
- “My baby seems uncomfortable (e.g. from a food intolerance or reflux / GORD) and I don’t know how to help”
Occupational therapists traditionally assist people with their everyday occupations and daily living skills. For babies, this includes all their day-to-day activities, such as, playing (including interacting with you, moving their bodies and ongoing learning), feeding, sleeping, and care activities (such as bathing, dressing and nappy changes). Self-regulating their behaviour throughout all of these tasks is difficult for many babies; additional information and simple therapeutic strategies can help parents to provide developmentally sensitive support for their baby, on a daily basis, from the very beginning of life.
Assessment of Babies
Nisha uses a combination of comprehensive, standardised developmental assessments, clinical observations and history, and, importantly, parental observations, to determine with you the best plan forward for your baby and family.
Standardised developmental assessments may include:
- Neonatal neurobehavioural assessments (from birth), such as the NNNS – NICU Network Neurobehavioural Scale, and the HNNE – Hammersmith Neonatal Neurologic Examination
- Paediatric neurodevelopmental assessments (for older infants), such as the AIMS – Alberta infant Motor Scales, and the NSMDA - The Neuro-sensory Motor Developmental Assessment
- Observational assessments, such as the assessment of General Movements (Prechtl’s GMs – assessment of neurological integrity)
Outcomes from developmental assessments, combined with knowledge from parents and referrers, provide a comprehensive understanding of an infant’s developmental status, their strengths and current challenges; this information enables the planning of individualised strategies to promote optimal early development (see details below for examples).
Therapeutic strategies to support early development and parent-infant relationships: bridging the gap between infant neurobehavioural research and everyday care of babies
What does this mean in terms of practical help for parents & babies?
Babies’ behaviours are often viewed in very general terms, and thus parental advice is often generalised too. Whilst there’s a core group of behaviours that tend to be common across most babies, infants themselves, just like children and adults, are individual little beings, with unique qualities and personalities, and different thresholds for coping with our handling of them, play activities (interaction/chat time) and everyday tasks such as feeding, bathing and dressing. Understanding where an individual baby is up to in terms of their behavioural, physical and neurological development enables us to plan strategies within everyday care to promote optimal developmental progress and to ease daily stress for both babies and parents.
Here are some examples of ways I can help you to support your baby's development:
Identifying and understanding babies’ behavioural cues; reading early signs of tiredness, signs of stress, signs of coping, signs of wanting to play, signs of being overwhelmed or needing a change of activity
Providing the right level of sensory stimulation (activity/noise/light/touch etc.) for your baby’s individual sensory thresholds will enable you to create an optimal environment for learning and development (and help your baby to avoid becoming overwhelmed and unable to cope, which can affect your coping too).
Self-regulation (emotional and physical)
Babies will make their own attempts to ‘self-regulate’ their behaviour so that they can cope better. This can include trying to calm their jerky movements by holding something (like their clothing or part of their body), or limiting the amount of visual stimulation around them by looking away or closing their eyes, or getting their hand up to their mouth or face to self-comfort. Recognising these attempts at self-regulation enables you to support their actions and will help your baby to succeed.
Bathing & Dressing Strategies
Bathing and dressing strategies (nappy changes etc.) can be helpful for any baby or parent, but particularly for sensitive, upset, or stressed babies (or parents). Research shows that bathing can be a very stressful activity for babies. Understanding what causes your baby's stress enables us to modify the way we carry out an activity; for example, by providing extra physical support during the bath if your baby is having difficulty self-regulating their movements.
Optimising Head Shape
Promoting optimal head shape (avoiding ‘flattened’ areas): some babies develop a flattened spot on the side or back of their head from lying in the same position for long periods of time, which can lead to varying degrees of ‘positional plagiocephaly’, that is, a misshapen or asymmetrical head. Early identification and counter positioning strategies are often adequate to improve head shape (babies with more advanced plagiocephaly will be referred to a specialist plagiocephaly clinic)
Promoting cognitive and physical development for all infants (which includes early intervention for infants at developmental risk). For example, supported positioning and play activities; making tummy-time manageable and fun; supportive postures for babies with different muscle-tone or developmental diagnoses. Supportive postures during everyday activities for babies with GOR (reflux) can help with managing discomfort.
Supporting your relationship with your baby through a greater understanding of your infant’s development and their amazing skills (as well as their subtle behavioural cues and need for support) so that you can ‘gauge where they are at’ and identify the most rewarding times for play, interaction, quiet times etc.
Comforting, Settling, Sleeping & much more...
Research has much to offer effective soothing and settling strategies. Tuning in to your baby’s behavioural cues and emotional regulation is an essential component to these strategies, and may help both you and your baby have more energy for other activities in the day.
Nisha has a special interest in:
- infant development from birth
- infant interactions
- the recognition of subtle infant ‘behavioural cues'
- settling and sleep patterns
- infant self-regulation (self-calming)
- babies with discomfort (e.g. food intolerances, reflux, GOR)
- preterm infant development (monitoring and intervention)
- babies with movement difficulties or developmental delay
- babies at developmental risk (movement, play and interactions, including sensory and emotional regulation)