#257 - Premature Babies + The Sensory System: Activities to Promote Integration

Today’s episode is diving into a question that we received from a listener.

“I have a preemie (32 weeks) and would love to see content on preemies as I know their sensory experience for the first few months of life are quite different and their development is likely going to be off as well.”

Get ready for some tips and tricks that you can implement in infancy, such as support for primitive reflexes, ideas for different sensory experiences, and feeding strategies. We also dive into tips for toddlers as well.

Make sure to check out all of our links below!

Infant and Toddler Sensory Development

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Links
All Things Sensory Podcast Instagram
Harkla YouTube Channel
Harkla Website - Shop Sensory Products!
Harkla Instagram
Article: Sensory Processing Disorders in Premature Infants
Article: Moro Reflex
Article: Development of Sensory Processing in Premature Infants and Implications for Evidence-Based Music Therapy in the NICU
Article: Premature Infant Oral Motor Intervention
Article: Assessment of Primitive Reflexes in High-risk Newborns
Article: Retention of Primitive Reflexes and Delayed Motor Development in Very Low Birth Weight Infants
Sensational Brain - The Role of OT in the NICU

Transcript

Rachel Harrington: 0:00

We're gonna talk about premies and sensory processing today,

Jessica Hill: 0:03

it's important to know that a child who is born premature is more likely to have underdeveloped primitive reflexes and an underdeveloped sensory system. Which, if you've been listening to us for any amount of time, you know that those two things, primitive reflexes and sensory processing affect every thing we do.

Rachel Harrington: 0:31

I'm Rachel.

Jessica Hill: 0:32

And I'm Jessica and this is All Things Sensory by Harkla.

Rachel Harrington: 0:36

We are both certified occupational therapy assistants and together with Harkla. We are on a mission to empower parents, therapists and educators to help raise confident and strong children of all abilities.

Jessica Hill: 0:47

On this podcast, we chat about all things sensory diving into special needs occupational therapy, parenting, self care, overall health and wellness, and so much more.

Rachel Harrington: 0:57

We're here to provide raw, honest and fun strategies, ideas and information for parents, therapists, and educators as well as other professionals to implement into daily life.

Jessica Hill: 1:08

Thank you so much for joining us.

Rachel Harrington: 1:10

Hey, everyone, welcome back to all things sensory, we're so happy to have you. We have a good episode coming your way. We got a question from Instagram. And it was about preemies. So the question was, I have a preemie who was 32 weeks and would love to see some content on preemies. As I know, their sensory experience for the first few months of life are quite different, and their development is likely going to be different as well. So we're going to talk about preemies and sensory processing today,

Jessica Hill: 1:47

It's important to know that a child who is born premature, is more likely to have underdeveloped primitive reflexes and an underdeveloped sensory system. Which, if you've been listening to us for any amount of time, you know that those two things, primitive reflexes and sensory processing, affects everything we do. So if you have a child who was born premature, the chances that these two things have been affected are higher, not guaranteed, there's no guarantee. But the chances are high that their challenges come from this.

Rachel Harrington: 2:28

I also want to say that we're focusing on the sensory system here. We're not focusing on medical procedures or anything...

Jessica Hill: 2:38

Medical complications.

Rachel Harrington: 2:39

Exactly, exactly. So that is something to keep in mind. As we're discussing these strategies and activities, always chat with your child's doctor before implementing these just to make sure that they're safe and everything's okay to do this, especially with seizures. Like that's always something I want to be extra cautious of. So just know that we trust you to be safe.

Jessica Hill: 3:07

Use your best judgment.

Rachel Harrington: 3:09

Okay, there's this quote that we want to share. It is from an article that we will link but it says,"Not only is neurosensory development in utero, interrupted by premature birth, but these children may also experience intense stimulation in the neonatal unit or the NICU, which can further alter the development and function of the sensory system. Sensory processing disorders affect 39% to 52% of infants born prematurely, with some evidence suggesting that infants born before 32 weeks are most at risk."

Jessica Hill: 3:42

With that being said, let's talk about some recommendations. Some strategies, things you want to focus on if your child was born premature. The first one is primitive reflexes. If a child is born premature, they may not have developed their primitive reflexes. So most primitive reflexes develop in utero. But if that is interrupted by birth, then the child can be born and not have functioning, primitive reflexes, which affects their ability to develop properly. And so if those primitive reflexes are not active, that's what we want to focus on first.

Rachel Harrington: 4:27

Yes, like if there are no primitive reflexes. So if you're testing for a Moro reflex, or a rooting reflex or a Babinski reflex, and they're not present, that is the first concern to look at, because that can tell us that there maybe is some some sort of brain damage or a brain injury.

Jessica Hill: 4:46

Or the central nervous system isn't fully developed because it didn't have a chance to exactly one article stated that the Moro reflex is particularly weak in preterm newborns because of low muscle tone, inadequate resistance to passive movements, and slow arm recoil compared with those of full term newborns. So if you have a child who was born prematurely, we want to look at their primitive reflexes first. This is where occupational therapy can come in clutch. And there are other professions like physical therapy, that can also work on primitive reflexes. But this would be something, if you have an infant and you're going to early intervention, chat with your therapist and say, hey, I want to know about my child's primitive reflexes, are they fully developed? What do we need to do to get these primitive reflexes going?

Rachel Harrington: 5:45

So once we've identified that, we know that there's a potential for these reflexes to not integrate, we know there's a potential for them just to not be there at all, we want to move on to incorporating different sensory experiences. So remember that the sensory system develops in utero. And oftentimes, when a baby is born prematurely, the sensory system hasn't had a chance to fully develop. So with the premature baby who's born, their sensory system might not be completely developed. So it's important that we provide it with a lot of these experiences. And it's also important to note that the experience in the NICU in the hospital is also not one that is very sensory friendly, there's beeping, there's people poking and prodding, bright lights, there's sounds, it's as much as it is supposed to be a safe environment.

Jessica Hill: 6:45

And it can be life saving

Rachel Harrington: 6:46

Medically it is neccessary, but their focus isn't on the sensory system, their focus is on saving the baby and keeping the Baby Alive, which obviously is necessary. We're not saying that we don't think that that's important. We're saying that our focus as occupational therapy assistants is on the sensory system and those experiences. So with that being said, the first thing we're going to think about is tactile and proprioceptive activities. So thinking along the lines of textures of clothing of blankets, and vibration, and so we want to be cautious with vibration, but we also want to incorporate it so like the Z vibe would be the perfect amount of vibration for a young baby.

Jessica Hill: 7:30

We want to make sure that the child is getting lots of tummy time and modify it as needed. So tummy time on the parents chest, when the parent is reclined or laying on the floor, having baby on their tummy laying on their parent. So they're getting that really good tummy time, but it feels safe and controlled, where sometimes on the floor might be a little more scary for a premature baby. But lots of tummy time. This really focuses on that strength and endurance prone, that prone position is very calming as well, but also it directly impacts their primitive reflexes while providing that great sensory input.

Rachel Harrington: 8:12

Yeah, and one side note here, about Jessica mentioning that the prone position is calming in the NICU. If your babies in the NICU, try to advocate for that prone position as much as possible when safe when they're in their little incubator, because that prone position is so organizing to the nervous system. And that's one way to keep them calm. The next one is vestibular input, followed by deep pressure that proprioceptive input. So when you've got your baby home, they're doing well. They're growing, swinging in your arms, followed by hugs, doing slow blanket swinging. That vestibular input can be really helpful for the sensory system as well as the primitive reflexes.

Jessica Hill: 8:59

We want to incorporate some very simple visual activities using contrast color pictures. So black and white pictures, slow visual tracking where you are, you know, you and your baby are making eye contact and you're slowly moving side to side. So they're slowly visually tracking you while you're moving in front of them. Just very simple visual activities while they're in these different positions, while they're in tummy time, while they are in supine, which is laying on their back.

Rachel Harrington: 9:31

Another one is calming auditory input. So thinking music, classical music, listening program, music for babies is a good one. Even the metronome at 60 beats per minute or the heart rate of mom can be on in the background because if you think about how important that rhythm is, babies constantly have that heartbeat, the blood flowing, that rhythm inside while they are in the womb and so that can be really organizing to have that rhythm can tap their bum. You know when you're like patting their bum, pat to the beat of the metronome Pat to the beat of whatever your heart rate is as the mom.

Jessica Hill: 10:16

Yes, that's our new catchphrase.

Rachel Harrington: 10:20

Yes, that can be really helpful.

Jessica Hill: 10:21

There is an article that we found that said,"Evidence based NICU music therapy can be combined with nursing care to reduce the risks of sensory processing disorder for the developing premature infant." So that was really interesting. We're going to link that article in the show notes, so you can check it out. But just knowing that when your baby is in the NICU, incorporating music therapy, can be so beneficial.

Rachel Harrington: 10:48

Even talking and singing to them, too, because they hear your voice all the time when they're in your womb and your tummy. But they hear your voice. So my point is to talk to them and sing to them so that way they can hear your voice.

Jessica Hill: 11:02

We also advocate for as much floor time as possible and as little container time as possible. So during most waking hours, we want you to put your baby on the floor and engage them in these simple activities, these visual activities, music activities, and less time in containers is going to help them fully develop those primitive reflexes so that then the reflexes can do what they need to do before they integrate. It helps them to get so much sensory input when they're on the floor, and learning how their body can move without being in a container. We understand that containers are a part of life, you know, the stroller or car seat, but we're just advocating for less.

Rachel Harrington: 11:51

Also, babywearing is a great tool to co regulate and keep the infant warm, keep them calm. It provides that natural movement that vestibular input Yes, it's a container. Kind of I mean, technically by, by terminology,

Jessica Hill: 12:09

It contains them. specific definition.

Rachel Harrington: 12:11

Yes, but it isn't a negative container, I would say it's it gets them in the prone position, the flexion position, and they get movement as well. Yeah, natural movement.

Jessica Hill: 12:25

If you're going for a walk, try to wear your baby versus putting them in the stroller. Or when you're grocery shopping, try to wear your baby on your chest versus putting keeping them in the car seat or a little container in the shopping cart. Whatever people do nowadays, just so that when you are in those moments when they might be in a container, they're in a container with you where they're getting your body heat, they can hear your heartbeat, and they're getting that more natural movement

Rachel Harrington: 12:55

and think about the eyes as well. If they're awake, if their eyes are open, they have to be constantly processing what they're seeing their eyes are moving, they're getting that visual vestibular integration, versus if they're in a car seat in the shopping cart, they're only getting one plane of visual tracking, yeah, visual input.

Jessica Hill: 13:14

We also want to make sure that we don't let our babies skip crawling. Oftentimes, if those primitive reflexes haven't been developing the way they should be, those infants might skip crawling. And crawling is a very important part of development, not just gross motor development, but visual and fine motor development as well. So we want to promote that.

Rachel Harrington: 13:40

The next one is coregulation, like we've mentioned a little bit, your baby consents when you are stressed, which it's you can't not be stressed all the time because it's very, it's a scary time.

Jessica Hill: 13:52

It's stressful to have a baby, especially a premature baby.

Rachel Harrington: 13:55

Exactly. So as much as you can focus on staying calm, coregulating, just being present, you know, keep that heart rate low so that way they feel it and and just co regulate.

Jessica Hill: 14:11

You, Rachel, had a thought going back to primitive reflexes.

Rachel Harrington: 14:16

My thought was the birthing process. So we know that the vaginal birth process kickstarts primitive reflexes into integration specifically the spinal galana, the A TNR. And those are potentially not kickstarted into integration by different birthing experiences to like see sections and vacuum, release and forcep usage. So keep that in mind. And unfortunately, doctors aren't going to say hey, just so you know, we had a C section so be aware of your child's primitive reflexes. C-sections are obviously life saving, sometimes they're overused, I think it really depends on the situation. But regardless of how your baby is born, I think it's so important to just know that primitive reflex integration is something to be aware of, if there were interventions used, even if it was a traumatic birth, even if it wasn't a traumatic birth, because birth itself is traumatic, no matter how they come out very much. So it's a lot. And you have to think about too with the sections, how much force is being put on the child's neck and spine as they're being pulled out. That's a lot of trauma. So things like pediatric chiropractors can be really beneficial to look into as well. So that was my thought on primitive reflexes and the birthing process.

Jessica Hill: 15:45

Cool. Okay. Next one is feeding. Feeding is often effected in preterm infants. There was an article that we found that said preterm infants who received premature infant oral motor intervention, along with IM therapy showed better self regulation and interaction due to graded tactile stimulation received during therapy, which also enhanced interaction with caregivers. So this is talking about a specific intervention program or process that the article talks about. But just knowing that there are programs and protocols out there specifically designed for preterm infants is important if you have a preterm infant or if you're a therapist working with preemies

Rachel Harrington: 16:32

definitely advocate for speech language therapy, feeding therapy, if needed, using a pacifier or sugar water prior to painful pokes and difficult procedures can help regulate the nervous system and kind of prevent that overwhelm even trauma and their responses to these medical events going forward, likely they will have trauma as it relates to medical procedures. And then the last thing here with feeding is to make sure that you're stimulating the cheek, you're stimulating the rooting reflex, the suck reflex to initiate that feeding pattern. So we want to make sure that we are providing that input prior to feeding them so that way they go through those reflexes to help integrate them. So they're necessary at an infant's and we need to see them but they also need to go away so they don't impact later life issues.

Jessica Hill: 17:26

Yeah. Now moving on to toddlerhood, when we have toddlers and young children who are born prematurely we want to continue to focus on primitive reflexes and sensory integration. Primitive reflexes should integrate or go away in toddlerhood. So we want to make sure we're working on that. This includes crawling, different gross motor activities, visual tracking activities, moving in different planes of movement. So getting a lot of different types of vestibular input, going upside down over a therapy ball. somersaulting, rolling, we want to make sure we're hitting those developmental milestones, because those developmental milestones are directly connected to primitive reflexes,

Rachel Harrington: 18:17

you might also start to notice your child's sensory preferences and toddlerhood as well. So they might avoid swings, or they might love swings. And so being aware of that, not letting them completely avoid movement or getting their feet off the ground. If we continue to avoid sensory input that they're sensitive to, they'll never learn to process and modulate it. So there has to be a happy medium. That's where in person occupational therapy services can be really, really helpful. But going along with the primitive reflexes in toddlerhood, things like crawling things like visual tracking, noticing head position changes, yoga, supine over the therapy ball, just know that we are broken records about this information.

Jessica Hill: 19:06

We want to just make sure that we're giving our kids sensory experiences every single day. We all have eight different sensory systems, and we want to do something for each of those every single day. So start doing two step obstacle courses, work on body awareness, motor planning, strength, get your toddlers crawling, running, jumping, rolling, somersaulting, all the things we've already said, make sure they're doing those things on a daily basis because it's giving them the sensory integration that their body needs. And it's working on those primitive reflexes.

Rachel Harrington: 19:44

Start working on the emotional awareness, that self regulation by identifying those emotions of happy, sad, mad, and then incorporate simple sensory strategies during those big emotions and help them identify that, you know, a big hug makes me feel happy or swinging makes me feel calm when I'm sad. It's really important.

Jessica Hill: 20:04

Yes, everything we just got done talking about is geared towards preemies, premature babies, and toddlers. But these are also things that we want to do for all infants and toddlers, if possible, keeping in mind that preemies might be over or under responsive to sensory input. They have a higher chance of underdeveloped primitive reflexes and underdeveloped sensory systems. So just keeping that in mind when we're doing all of these activities. Now, a couple of more resources for you guys.

Rachel Harrington: 20:41

We've got a couple more, we will link all of the research articles in the show notes. If you are a therapist, and you're looking to learn more about just OT practice in the NICU, there is a course from Sensational Brain we will link there is zero to six months sensory guide from The Sensory Project from yours truly. That is just like a PDF guide that has lots of tummy time activities and just simple sensory activities for birth to six month olds. And then we also have our infant and toddler sensory development course. And there are primitive reflex integration activities and information in there as well. And that is for birth to three year olds.

Jessica Hill: 21:23

Even four year olds, sometimes I recommend it to people with four year olds.

Rachel Harrington: 21:27

I think so I think the goal here is just to get moving, get integrated. And that could be a t shirt, get moving, get integrated, get...

Jessica Hill: 21:39

...regulated? No. I like just get moving and get integrated. Just those two. Someone would make that shirt for us, please. I'm a size medium.

Rachel Harrington: 21:51

Send us your design, send us your mock up. All right, that is it for you. We hope this episode was helpful. We hope multiple people can benefit from this episode, not just the person who asked for it.

Jessica Hill: 22:03

If you did like this episode, share it with someone. Leave us a review. Tag us on social media

Rachel Harrington: 22:11

at All Things Sensory Podcast. We love hearing from you. We love hearing how helpful the podcast is if it makes a difference in your life at all. Thank you. Thank you. Thank you for spending time with us today and listening to us try to talk to you. It was really difficult for some reason.

Jessica Hill: 22:32

We'll see you next week.

Rachel Harrington: 22:33

Okay, bye. Thank you so much for listening to All Things Sensory by Harkla.

Jessica Hill: 22:38

If you want more information on anything mentioned in the show, head over to Harkla.co/podcast to get the show notes.

Rachel Harrington: 22:46

If you have any follow up questions, the best place to ask those is in the comments on the show notes or message us on our Instagram account which is @Harkla_family or at All Things Sensory Podcast. If you just search Harkla you'll find us there.

Jessica Hill: 23:02

Like we mentioned before our podcast listeners get 10% off their first order out hard glass, whether it's for one of our digital courses or one of our sensory swings, the discount code sensory will get you 10% off. That's s e n s o r y.

Rachel Harrington: 23:21

Head to Harkla.co/sensory to use that discount code right now.

Jessica Hill: 23:26

We are so excited to work together to help create competent kids all over the world. While we make every effort to share correct information we're still learning.

Rachel Harrington: 23:36

We will double check all of our facts but realize that medicine is a constantly changing science and art.

Jessica Hill: 23:41

One doctor or therapist may have a different way of doing things from another.

Rachel Harrington: 23:45

We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be as evidence based as possible.

Jessica Hill: 23:57

By listening to this podcast you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your child.

Rachel Harrington: 24:05

Consult your child's pediatrician or therapist for any medical issues that he or she may be having.

Jessica Hill: 24:11

This entire disclaimer also applies to any guests or contributors to the podcast.

Rachel Harrington: 24:16

Thanks so much for listening