Why is my NICU baby sleeping on her belly?
Updated: May 11
See that picture? That gold ring is not a medical device, that is the wedding ring of a NICU parent on the foot of a very premature baby. Having worked in a neonatal intensive care unit for 13 years, I've seen parents do this in real life. And it never fails, every time I see this it induces awe, inspiration, a gigantic reality check, and a few tears.
The tiniest of babies taken care of in a NICU often weigh approximately 1 pound and spend well over 100 days there. They have a tube for everything, stickers everywhere, and wires galore. I often wonder how we could possibly fit one more thing in or on these tiny humans, but we do.
The challenges that come with a NICU stay are both physical and mental for the entire family. Often times, parents aren't able to hold their baby for weeks, and feeding their baby is just something they hope to do someday. These babies without a doubt have some extremely unique needs. Therefore, we have to make exceptions to the rules - the biggest one being sleeping on their belly.
In recent years many neonatal units have had cameras installed above the cribs and isolettes so parents can maintain a connection with their baby while they are at home. These cameras have been an amazing tool for offering parents peace of mind. Although, at the same time they can cause some anxiety as well. In the unit where I work, while nurses are providing care, the camera is off. This can make parents anxious and lead them to think something is possibly wrong. It also allows more opportunity for questions like, "Why is my baby sleeping on her belly? I thought this was a big no no."
As a sleep consultant it makes me extremely happy that safe sleep is so prominent and widely taught that parents know to question it when they see it done wrong. So why are premature babies the exception to the rule? I'll explain.
One of the main goals of the NICU team is to maintain an environment that is as close to the womb as possible. This includes a warm, humid environment and therapeutic positioning. Most babies have the advantage of finishing growing inside mom's gravity free zone. But, when a baby is born prematurely they suddenly face the challenge of trying to grow in the outside world. To facilitate growth we place neonates in the ideal position - one which resembles the position they would be in if they were still inside mama's belly.
This may include positioning a baby on their belly, side or back. Arms will be flexed and near the face and hips and knees will be tucked towards the belly. Many units even have tools specifically designed to help maintain the neonate's position. Once they are in this ideal position a roll of linens will be used to contain the neonate, allowing the baby to press against the sides to facilitate muscle growth while keeping the optimal position. Therapeutic positioning not only helps with muscle growth but also promotes proper skeletal alignment, decreases incidents of plagiocephaly (flattening of the head), decreases skin injuries, and, my favorite perk, promotes sleep.
It's no wonder that when parents see an isolette that is full of blankets, positioning tools, wires, and even pillows, that they would start to worry. Unlike the sleep environment at home, this type of positioning is done safely in a NICU. With continuous monitors that measure oxygen levels, heart rate, and blood pressure along with one to one nursing care you can rest easy knowing that baby is safe even if she's on her belly.
So is your NICU baby always an exception to the rule? Absolutely not! Once the hardest days of your NICU journey are over and your baby has shed most of the tubes, stickers, and wires and is gaining weight, your baby will graduate to the safe sleep club and stay there. At least until she starts rolling over. And hopefully, with all the work that your NICU team put in to maintain a developmentally friendly environment, your baby will hit this milestone right on time.
Before graduating from the NICU, education on safe sleep will be provided, and any questions you may have will be answered. Remember, once baby is home to follow the ABC's of safe sleep - Alone on the Back in the Crib. I also urge you to check out the websites below.
Cheers to happy and safe sleeping.
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