Talking and playing with babies are two of the most important things parents and caregivers can do to help them develop. There are many ways to encourage development. The recommendations provided are general and not all inclusive. The recommendations provide strategies to help promote gross motor skills, fine motor skills, early language development, and socialization.
- Gross motor skills include big movements such as rolling, crawling, standing or walking.
- Fine motor skills include hand movements such as reach and grasp.
- Early language development includes cooing, babbling, and a baby’s first words.
What is the Neonatal Neurodevelopmental Follow-Up Clinic?
The Neonatal Neurodevelopmental Follow-Up Clinic is a specialized clinic for children who had medical complications related to, or immediately after, their birth. This clinic assesses gross-motor skills, fine-motor skills, social development, language and learning ability at specific ages to determine if the child is developing normally.
The majority of patients seen in the Neonatal Neurodevelopmental Follow-Up Clinic are referred from a Neonatal Intensive Care Unit (NICU) or a Cardiac Critical Care Unit (CCCU). Babies who have been admitted to the NICU or CCCU may be at risk for developmental issues due to medical problems before delivery, during delivery or after birth. These recommendations may be used to encourage development in babies who have not spent time in the NICU or CCCU, but still require care in the Neonatal Neurodevelopmental Follow-Up Clinic. Talk to your child’s doctor to see if you should be following these guidelines with your baby.
Babies and toddlers are assessed at specific ages in the clinic and given recommendations that parents and caregivers can refer to at home to help their baby achieve their maximum potential. These recommendations are for eight months corrected age, as most of the babies followed in the clinic were premature at birth.
If you are concerned about your baby’s development, speak with your primary health-care provider.
Neonatal neurodevelopmental recommendations at eight months
Gross motor:
- Practice frequent tummy time and floor time to help promote overall strength and motor development.
- Encourage your baby to play in sitting position. Try to sit in front of them (not behind) to encourage flexion and core-strengthening.
- Place toys off to the side to encourage your baby to reach and transition out of sitting.
- Use crawling position for play by putting baby on their knees and then lower their hands down.
- Motivate your baby to crawl by practicing rocking them on all fours.
- Encourage them to reach for toys when on all fours.
- Practice transitions such as: sitting to 4-point (i.e., on hands and knees) and lying to sitting.
- Supervise your baby while they are standing at a supportive surface (e.g., couch, ottoman).
- Avoid standing devices (e.g., Jolly Jumpers and Exersaucers).
- Practice gross motor activities in both directions (i.e., transitions, rolling to the left and right).
Fine motor:
- Introduce finger feeding and cereal play to refine pincer grasp.
- Practice holding two objects and banging at the midline (middle of your baby’s body).
- Provide a variety of objects in different shapes, textures, sizes for exploration with hands.
- For babies with thumbs held across the palm, encourage holding thicker round rattles or squishy toys.
- Handedness (left or right) — encourage use of non-dominant hand by presenting toys, objects, stimulation to non-dominant side while restricting use of preferred hand, if necessary.
Communication/Social:
- Be face to face with your baby and be animated.
- Use single words, repeat what you say and do, and use lots of gestures.
- Watch what your child is doing, wait, listen and respond. Imitate actions and try to keep the interaction going.
- Play vocal turn-taking games (e.g., imitate sounds they make and keep the interaction going).
- Use simple picture books, with real life photos.
- Electronic media use by children younger than two years old is not recommended. This includes phones, television, computers, and tablet devices.
Play:
- Play social communication games (e.g., peek-a-boo, itsy bitsy spider) and encourage container play (putting objects in and taking out of containers).
- Introduce stacking and simple cause and effect toys and activities.
- Functional play — introduce playing with toys and objects as they were intended to be used.
- Provide opportunities for interaction with other children (e.g., Ontario Early-Years Drop-In Centres, library programs or community groups).
Feeding and Growth:
- Continue regular visits to your family doctor/paediatrician to monitor your child’s growth.
- Progress to thicker pureed consistencies and forked mashed solids with daily opportunities for soft dissolvable pieces. Include a variety of foods from all food groups (e.g., fruits, vegetables, meats, fish, dairies).
- Present a variety of cubed or chopped foods for finger feeding.
- Avoid juice and other sweetened beverages.
Sleep:
- Establish a regular sleep schedule and bedtime routine. Consider reading to your child as part of routine.
- Practice safe sleep habits: back to sleep on a separate firm flat surface in your room at least for the first six months.
For more information on neonatal neurodevelopmental recommendations at different ages, please see the links below:
Parental mental health and well-being
All caregivers are encouraged to have ongoing discussions about their mental health and well-being with their family doctor. There are free community services available to promote coping and resilience for caregivers. Consider learning more about the following supports and interventions.
- Healthy Babies Healthy Children Ontario: Free home visiting program that supports all pregnant mothers and families with young children up to age six.
- Connex Ontario: Provides service information for mental health supports by phone, online chat or email.
- AboutKidsHealth: Baby blues and postpartum depression
- Ontario 211: A useful tool to search for community and government services in the greater Toronto area.