Developmental Care Guidelines for use in the NICU
The Developmental Care Guidelines for Use in the Newborn Intensive Care Unit (NICU) were developed in support of caregiving staff at the bedside. They are intended to support and train the caregiver in strengthening self-awareness in interaction with each infant and family. The Guidelines are derived from the literature1-3 and address two areas of caregiving which are under the direction of the individual caregiver at the bedside, namely the organization of the immediate physical environment of the infant’s bed space and bedding; and the organization of care involving the caregiver’s interaction with infant and family. The guidelines are modeled in their detail on the Profile of the Nursery Environment and of Care Components (OSA).
The Developmental Care Guidelines for Use in the Newborn Intensive Care Unit (NICU) are based on general principles for infant care which recognize the importance of emotional development in infancy and its significance for the physical well-being and growth of the child as well as for the child’s cognitive, motor and social affective interactive development.4-13 Characteristics common to appropriate infant care include the reliable experience of being known, cherished and loved; the reliable experience of emotional intimacy, comfort, and closeness; and the reliable experience of joy and a sense of effectance.
Safeguarding and assuring these experiences requires consistent trustworthiness of emotionally available, familiar, and affectively invested caregivers, who are few enough in number so that the infant may develop familiarity with them and therewith trust. This is foremost the role of the parents. Therefore the parent infant relationship is an essential priority. Parents are an infant’s most important lifelong nurturers and the appropriate care requires predictability and supportive timing and quality of all events and circumstances experienced by the infant. It requires safeguarding a predictable rhythm for each day; safeguarding a quiet, calm, physically and affectively warm and soothing environment; reliability in assuring consistently supportive positions and comfortable and soothing bedding; calmness in timing and delivery of all caregiving events; nurturing and satisfying feeding; protection and assurance of restful sleep; and assurance of supportive and collaborative implementation of all hygiene care and medical procedures. The infant’s sense of self, initiative and sense of competence, as well as the opportunity to experience pleasure and joy is developmentally essential.
Complexity, timing, duration and intensity of all aspects of care need to be specifically guided by each infant’s individual and changing thresholds from well organized to poorly organized functioning. Well organized functioning refers to the balanced modulation and mutually supportive regulation of autonomic, motoric and state organizational functioning. Poorly organized functioning refers to the transgression of thresholds from smooth and balanced to disorganized functioning in either one or all of the behaviorally observable systems. Supportive organization of care requires the caregiver’s understanding of the infant’s thresholds and of the progression of development towards increasingly well-differentiated and well-modulated robust neurodevelopmental organization in the context of continued transaction with the environment. Supportive organization of care furthermore requires the caregiver’s skill in ongoing
interpretation of the infant’s neuro-organizational thresholds and neurodevelopmental goals while simultaneously engaging in interaction with the infant. Foremost it requires the caregiver’s self-awareness and reflection while in action, the caregiver’s openness to each individual infant and family as well as the caregiver’s supportive and affectively engaged availability and emotional presence for infant and family. The parent looks to and depends on the professional caregivers to be the parents’ and infant’s best advocate and champion. The unconditional emotional allegiance to the parent in support of their best infant’s care fosters the parents’ confidence, competence and trust, which are key to developmental care.