Positioning in the NICU

Preterm infants have less muscle tone and are referred to as hypotonic compared with term infants. They tend to allow their arms and lefts to fall outward from the mid-line and their heads roll to one side.  In addition they encounter difficulties in maintaining or holding positions and their movements tend to be jerky and disorganized. Positioning and handling are important for development of movement.

Positioning preterm infants in supported positions (ones that encourage curling up) help:

  • Promote normal muscle development.
  • Promote balanced muscle development.
  • Minimise plagiocephaly (flat head syndrome).
  • Promote calmness and wellbeing.
  • Minimise stress.
  • Promote more settled breathing and circulation.
  • Preserve energy.
  • Promote the infants awareness of his/her hands (important for fine motor skill development).
  • Encourages the infant to bring their hands to the midline.
  • Promotes development of crawling, standing and walking


A nest provides the preterm infant with boundaries (similar to that in the womb) so that the infant has a surface to touch and brace against. Your infant’s nurse will make the bedding into a nest for your infant. The nest needs to be deep enough to keep the legs inside as the infant stretches, pressing feet against the walls and helping the infant to tuck his legs up again as he relaxes. The sides of the nest need to be close enough around the legs to prevent them spreading out at the knees or hips and to make it possible for the baby to rest one foot against the other leg or foot. Nests can be easily customized by folding bedding into a wide, thick, band long enough to surround the infant.

Photo of adult hands positioning a premature baby in an incubator.


Supine Position – Lying on their back

This position suits infants who are well and in a cot. The shoulders are rounded and supported , and hands can easily come forward to the face and mouth; legs are bent, the feet have boundaries.


Shoulders are rounded and relaxed, legs are bent with boundaries for foot support and hands are in the middle and can reach the mouth and face.

Prone – Lying on their tummy

This position can ONLY be used when the infant is in the NICU and should never be used at home due to the risk of Sudden Infant Death Syndrome (SIDS).

Cuski Nests

Designed, inspired and created by Claire (Neonatal Sister) & Cuski Baby Ltd this nest has been specifically designed by Sister Claire Ellerby and the neonatal team at the RVI, Newcastle and created by Cuski (www.cuski.co.uk).

The nests provide the security and boundaries for premature babies that are missing when they are born early. Being born so early leaves the babies vulnerable to external stimuli that can impact on their development The nests help to prevent flailing and they are used to mimic the safety of the womb and to support development. They provide the optimum environment to contain and support the position of the baby, helping to facilitate normal physical development.
The nests are designed and constructed with safe boundaries and comfort to aid physiological stability and support positive neurodevelopmental outcomes.
The baby is comfortably contained within the nest design by two soft but firm boundaries, positioned around the body and head of the baby. Two wide straps on either side of the nest are used to provide security and help support the normal flexed posture experienced while in the womb. Neonates can be supportively nursed Prone, Supine or Lateral within the nest.
Regular position changes in neonates can help reduce head moulding, and provides pressure care relief to support good skin integrity.
Lateral and Prone positioning has shown to improve digestion and respiratory effort in some neonates.