Recognising the baby’s signs

Developmental support consists of a variety of intervention strategies in addition to medical care, to protect and promote the growth and development of a baby.  Developmental care includes among others the control of external stimuli, specific supportive behavioural techniques such as the positioning of the baby, skin-to-skin care, or the integration of parents in care activities and in the decision-making regarding the baby’s treatment and care.

Developmentally supportive care creates a neonatal unit environment that minimises stress for the baby, the parents and healthcare professionals.

It reduces pain and provides a developmentally appropriate sensory experience for the individual baby.

Individualised approaches to family-centred care, where every baby and every family is cared for according to the individual needs, may be more suitable for the child and the family and are based on observation.

Studies suggest that babies who receive developmentally supportive care may stay in hospital for less time and gain weight better. Parents can learn quickly how to recognise when their baby is upset or uncomfortable and how to react. They should be involved in the care for their baby from the early beginning.


Signs that suggest that the baby feels comfortable include among others:

  • Normal and regular heart rate
  • Gentle, regular breathing
  • Normal oxygen saturation
  • Digesting food without discomfort
  • Gentle movements
  • Firm muscle tone (but not too tight)
  • Arms and legs folded towards body
  • Hands resting on face or head
  • Hands and feet brought together
  • Relaxed face
  • Sucking
  • Shiny alert eyes or eyes closed


Signs that suggest that a baby may not feel comfortable include among others:

  • Changes in skin colour
  • Low or high heart rate
  • Rapid breathing; unregular breathing with pauses
  • Lower oxygen saturation
  • Vomiting (throwing up) or gagging
  • Hiccups
  • Sounds of regurgitation
  • Choking, burping,
  • Frantic movements, tremors
  • Low muscle tone; loss of energy
  • Appears sunk into the bedding
  • Fingers or toes stretched wide; tight fists
  • Arching
  • Stiffness
  • Straining
  • Grimacing
  • Yawning
  • Looking away
  • Crying

When a baby shows any of these signs, the caregiver needs to adjust the care of the baby. This can include diaper changes, comfortable positioning, feeding or regulation of temperature, noise, and light. 


The healthcare team and the parents can promote and support the development of the baby in many different ways, for example by:

  • Practicing skin-to-skin care
  • Breastfeeding or providing mother’s milk
  • Placing the hands on the baby’s head and lower back or feet
  • Placing the baby in a nest (rolled-up sheets to form boundaries around the baby)
  • Comfortable positioning
  • Monitoring environmental noise and adapt sound levels
  • Avoiding direct light exposure
  • Maintaining low levels of ambient light
  • Adapting the medical and care procedures to the sleep-wake-cycles of the baby
  • Optimising the pain management