Positioning

The muscle tone is defined as the strength or tension of the muscle. Due to their immaturity, preterm babies usually have a lower muscle tone compared to term born babies. Maintaining a position can be quite challenging for a preterm baby. Movements are sometimes jerky and disorganised.Comfortable, supportive positioning and handling of the baby are important for the development of the skeletal and muscle system. Optimised positioning also helps to minimise stress, to promote breathing, digestion, and circulation, to preserve energy, and to promote the development of crawling, standing and walking.

So called nests can be built by folding rolled-up sheets or bedding into a wide, thick band long enough to surround the baby. A nest provides the baby with boundaries with a surface to touch and brace against. These boundaries are similar to the situation in the womb which makes the baby feel more secure. At the same time, the nest can help to keep legs and arms in a developmentally supportive position.

There are different comfortable lying positions for the baby: The supine position (i.e. lying on the back) is often used, if babies are unstable and need to be observed regularly. It facilitates access to the baby, for example to initiate procedures if necessary. This position is also recommended to use at home to ensure safe sleep. The caregivers usually support the baby’s head, shoulders and hips with additional pillows under the head and the shoulders.

The lateral position (lying on one side) supports a flexed position with bended arms and legs and allows the baby to adjust his or her own position. Usually, shoulders are rounded and relaxed, legs are bent with boundaries and hands can reach the mouth and face more easily. This position is often used to reduce stress during caregiving activities (e.g. mouth care, nappy change, or tube feeding), medical procedures, and lifting).

The prone position (lying on the tummy/breast) may improve oxygen saturation, respiratory function, digestion, and sleep. Babies may lose less heat and energy. However, this position should only be used when the baby is monitored continuously and should not be used at home due to the risk of Sudden Infant Death Syndrome (SIDS).