Positioning of a premature infant

Positioning a premature child within the framework of individualized family-oriented developmental care aims to provide your child with comfort, support the position and movements important for development and self-regulation, as well as to adapt the environment to your immature child and reduce stress (noise, light, pain) to which he is exposed. All members of the health team and parents participate in this.

Why positioning matters 

Unlike a child born at term who lies with its head in the midline and with limbs bent, a premature child, due to immaturity, reduced tone and the force of gravity, lies completely stretched out on the bed. With uncontrolled movements it loses energy that it needs for basic physiological activities, growth and recovery. As its stay in the intensive care unit is often long, maintaining such an unfavourable position can lead to various deformities, contractures and slowed motor development. This is why healthcare providers in a neonatal intensive care unit carry out positioning by placing your baby in positions that mimic the position in the womb, with the aim of: 

  • Enabling your baby to sleep longer and better, which prevents the loss of energy needed for growth and development. 
  • Having a favourable effect on its respiratory, digestive and autonomic systems. 
  • Preventing deformities of its head, torso and limbs. 
  • Preventing the occurrence of neurodevelopmental disorders.

Positions of premature infants in intensive care units

Your infant can be placed on its back, side or stomach. Healthcare professionals change the position every 2-4 hours and each position is adapted according to the health condition of your child and any accompanying medical procedures. In individualized developmental care, observing your child and understanding its behaviour are very important. Healthcare professionals evaluate the general condition of your baby, the position of its head and trunk, arms and hands, legs and feet, and alertness. The basic principles of correct positioning are that your baby is comfortable, that its head is in the middle line, its large joints are bent, shoulders are forward, hands are placed towards its face and mouth, its feet are touching and that the movement of its feet is restricted. Allowing your baby free movement of its hands and to bring its hands closer to its face and mouth are important self-soothing strategies that help your baby remain calm. Health professionals may use nests, supports, rolls and soft toys to make your child feel tucked in and protected, and its movements limited as they would be in the womb. 

Positioning of twins in an intensive care unit

Twins and triplets are often born prematurely and are developmentally more vulnerable than singletons. In intensive care, twins are not only separated from the protective environment of the mother's womb, but they are also separated from their sibling. If there are no special medical problems, health professionals place the twins in the same crib, facing each other, without barriers between them. The benefits of such an approach are multiple: they are calmer, they show mutual comforting reactions, and they tolerate difficult procedures more easily. In addition, they maintain heat better, and research has shown that there is a lower incidence of sleep apnoea (pauses in breathing) and bradycardia (slow heart rate). 

How long should positioning be practised?

Premature babies are usually positioned until the 34th week of gestation. Before discharging your baby to home, health professionals gradually remove all supports until only a blanket remains. Healthcare providers will put your baby to sleep on its back (a recommendation to prevent sudden infant death syndrome), though during the first months your baby increasingly spends time awake and on its stomach.