Developmental Care in the NICU

Premature baby sleeping

Welcome to the Neonatal Intensive Care Unit (NICU). Having your baby in the NICU is like walking into a new and strange world. We are trying to change this high-tech world to make it more comfortable for you and your baby.

How we care for your baby is based on your baby’s specific needs and personality. This approach is called “developmental care.”

What is developmental care?

Developmental care means that:

  • Your baby’s room in the NICU is quiet and dimly lit.
  • How we care for your baby is based on your baby’s behaviour.

The environment of the NICU affects a baby’s health. Most NICUs try to keep the lights dim, avoid loud noises, and disturb babies as little as possible. This can help premature and sick babies get better faster.

Babies can tell us things, even though they cannot talk. This is true even when a baby is very small or sick. We can learn a lot from how a baby looks and acts, such as his body and face movements, skin colour, breathing patterns, and cry. If we pay attention, we can learn to see what your baby is telling us. This will help us give the best possible care to your baby.

You can learn to tell if your baby is not comfortable

The NICU staff know how babies often act when they are upset and the best way to respond. You can learn to understand and respond to your baby’s behaviour as well. Not all babies are alike. What works to comfort one baby may not work for another baby.

Signs that suggest your baby may not be comfortable include:

  • changes in skin colour
  • lower heart rate
  • lower oxygen saturation
  • vomiting (throwing up) or gagging
  • wide open mouth
  • arching
  • frantic movement
  • flaccid (very floppy) muscle tone

When your baby shows any of these signs, the person who is looking after him needs to adjust his care. This includes diaper changes and bathing.

You can help with developmental care

You are the most important person in your baby’s life. To help your baby, be in the NICU with your baby as often as possible. Your baby knows the sound of your voice. You also need to gain skills, abilities, and confidence to help care for your baby. If you are not sure of something, ask the NICU staff.

You and your baby’s nurse can help your baby in the following ways:

  • Give your baby a pacifier to suck (non-nutritive sucking).
  • Place your baby next to your bare skin (kangaroo care).
  • Place your hands on your baby’s head and lower back (facilitated tucking).
  • Place rolled-up sheets to form boundaries around your baby so that he can feel something protective around him (containment).
  • Place a flannel sheet into your bra or shirt to take on your smell and then place the sheet next to your baby (“snoedels”).
  • Breastfeed your baby or provide breast milk so that your baby can have the best food possible.

Developmental care can help your baby grow and get better

Premature and sick babies have to work hard to grow and get better. They need our help. Developmental care will help your baby to focus his energy on growing and getting better. Studies have shown that babies who receive developmental care stay in hospital for less time and gain weight better.

Key points

  • Developmental care involves keeping a baby’s surroundings quiet and dim and giving care that responds to the baby’s behaviour.
  • Developmental care can help sick or premature babies grow and get better.
  • Parents can learn to tell when their baby is upset or uncomfortable.
  • Parents can help care for their baby in the NICU.

Jonathan Hellmann, MBBCh, FCP, FRCPC


Room 3 in the NICU at SickKids

In Room 3, we care for babies who were born before 28 weeks of pregnancy (28 weeks gestation). It is darker than the other rooms, because babies at this age have very thin eyelids and their pupils do not yet react quickly to light. The room also has special floors and ceilings to keep the room quiet.

When your baby reaches 30 weeks gestation, he no longer needs a quiet and dark room. As babies mature, they need a place with more light and activity. This will help them develop all of their senses. Transfer out of Room 3 is a sign of maturity. It is a time when you can become even more active in the care of your baby.

Sometimes we will not be able to admit your premature baby into Room 3, because the room is full. If this happens, please remember that developmental care is practiced in every NICU room. Although the room may look different, your baby will still be getting the best care possible. We will always work with you to make your baby’s time in the NICU easier.