Occupational Therapy in the NICU: ‘We’re Your Developmental Team’

Nicole S. and Courtney M. of South Shore Health pose for separate photos outside of South Shore Hospital's NICU
Occupational therapists Nicole (left) and Courtney care for infants throughout South Shore Hospital, with a particular focus in our Neonatal Intensive Care Unit (NICU).

Modern hospitals are busy, often noisy places. From beeping medical equipment to patients and caregivers coming and going, there’s a lot of commotion.

When you enter South Shore Hospital’s Messina Family Neonatal Intensive Care Unit (NICU), however, you’ll find a drastically different environment.

The unit has dim lighting, a controlled temperature, and minimal noise (unless a baby is finding its voice, of course).

This controlled environment is by design: it’s a protective measure put in place to aid each baby’s development, overseen by neonatal occupational therapists (OTs).

At South Shore Hospital, we have two neonatal OTs on our team: Nicole Swanekamp, OTR/L and Courtney McCarthy, OTR/L.

Nicole and Courtney care for infants throughout the Hospital but have a particularly strong presence in the NICU and the Andrade Family Special Care Nursery.

In the adult world, OTs focus on helping patients get back to their “occupations,” or the everyday activities that are a key part of their daily lives.

This includes things like dressing, bathing, and toileting – activities that may seem like second nature but can be very difficult after injury or illness.

In a neonatal setting, occupational therapy is very different.

“These are babies,” Nicole said. “Their occupation is basically sleeping, feeding, and growing.”

Instead of everyday activities, neonatal OTs focus on helping babies develop safely and appropriately.

“We’re your developmental team,” Nicole said. “We do an assessment on nearly all babies that come through. We’ll guide you, as parents, to make sure your baby is hitting the appropriate milestones for their age.”

“It’s very different from the adult world, but it’s very fulfilling,” she added.

Light, sound, and the importance of sensory regulation

Nicole and Courtney care for babies born as early as 24 weeks gestation. 

At that early stage, they work with babies and their parents on neuroprotection – which Nicole describes as protecting the brain from the outside in.

“The brain grows so much, even just in the last month of pregnancy,” Nicole explained. “For premature babies, the whole nervous system is underdeveloped.”

With that in mind, Nicole and Courtney work with parents and other NICU caregivers to introduce babies to different sensations and experiences gradually, ensuring that their young nervous systems aren’t overwhelmed – hence the tightly controlled environment.

“When you walk into the NICU, you’ll see the big isolettes with the covers over them,” Nicole said. “What we want to do, especially when they’re really little, is to limit too many senses at once, because we want the babies to continue developing, almost like they’re still inside their mom. As they get older, we slowly reintroduce those senses at a developmentally appropriate age.”

This sensory regulation is a key component of each baby’s time in the NICU.

“Their sensory system is so underdeveloped and we help protect that on the outside,” said Nicole. “We work on brain-body connections, getting them used to all of the different sensations that are out there.”

“Every little touch that they get at that tiny little level is going affect how their development plays out later on.”

Neonatal OTs also work on proper positioning and assisting babies with movements that have major developmental implications.

“I always try to explain these little movements to parents, like bringing their right arm to their left leg, crossing midline,” explained Nicole. “It seems like nothing right now, but that’s going to help when a baby starts to roll, reach for a toy, or crawl – all of these things will impact development later on.”

Caring for babies with genetic, neurological, and orthopedic conditions

In addition to sensory regulation, neonatal OTs also care for infants born with a variety of medical diagnoses.

Common conditions that require neonatal OT intervention include genetic or orthopedic conditions like trisomy 21, clubfoot, positional limb abnormalities, low or high tone, and feeding difficulties related to neonatal abstinence syndrome (NAS), which is a condition that can occur due to exposure to maternal medication in utero.

In these cases, Nicole and Courtney focus on age-appropriate activities designed to help each baby develop. 

Depending on the condition, these activities can include stretches and movements to strengthen muscles, exercises to improve posture or positioning, and activities to support each baby’s developing brain.


Occupational therapists serve as a key resource for parents

While the primary focus of our neonatal OTs is to help newborns develop and grow, they also play an important role in educating parents on how to care for a premature baby.

While in the NICU, this includes things like properly positioning their baby in their isolette and demonstrating when and how to pick up and hold their baby.

This education extends beyond the NICU, as our OTs teach skills that parents will be using in the weeks and months to come.

“We teach parents how to do things they’ll be doing at home,” Nicole said. “We teach them how to do swaddle baths, how to play with them to foster development, and how to do tummy time.”

Education and participation are key parts of our NICU’s Family Integrated Care Model, more commonly known as FICare.

FICare is a hands-on approach that makes NICU parents equal members of their child’s neonatal care team, encouraging them to weigh their baby, take vital signs, and more.

The FICare model sees Nicole and Courtney work with parents in a number of ways, including showing them how to perform a task that will be a big part of their lives for the next few years: changing diapers.

“There are ways to do that to protect a baby’s joints, for example,” Nicole said. “There are different movements that can help. You don’t want to be pulling legs up over baby’s head – full-term babies are so different than these little preemies.”

Our neonatal OTs play a vital role in each baby’s development – so it’s no surprise to hear that Nicole and Courtney often develop meaningful connections with NICU parents.

“At the beginning, we see these babies that weigh a pound and a half, two pounds,” Nicole said. “They’re the size of your hand. They can’t open their eyes yet, can’t tolerate a single touch.”

“Over time, they start doing typical things: we’re doing tummy time, we’re getting them in the bath,” she continued. “Seeing how far they come is so rewarding. There’s nothing like it, and that relationship we develop with the families is incredible.”

Understanding and encouragement through the NICU Support Group

At the beginning of her career, Nicole was an inpatient OT, caring for admitted patients at South Shore Hospital.

However, a major milestone in Nicole’s family life changed her career plans.

“I had my own preemie twins who were in the NICU,” she said. “I saw what the therapists did there and I immediately fell in love with it.”

Nicole decided to pursue neonatal therapy, completing a program offered by the National Association of Neonatal Therapists (NANT) that helps practicing OTs transition to the NICU setting.

As a former NICU mom, Nicole knows first-hand just how overwhelming a NICU stay can be for parents.

With that in mind, she helped develop a NICU Support Group, which meets bi-weekly and provides a safe space for NICU parents and family members to ask questions and share experiences.

Parents of NICU “graduates” often join the group as well to share their perspective and offer support to parents of current NICU babies.

“We just talk in a non-clinical space and parents are able to ask those questions that they didn’t think of before or didn’t want to ask at the bedside,” Nicole said. “It’s nice to get parents together and help facilitate some of those conversations.”

A ‘family’ caring for our most vulnerable patients

Nicole and Courtney are part of each baby’s larger NICU care team – which also includes nurses, physicians, specialists, and other therapists.

Nicole says the NICU Team is one that works well together, a group of like-minded caregivers dedicated to providing top-notch care to babies and compassionate support to parents.

“It’s like a family down here,” she said. “There’s such an interdisciplinary focus. Everybody has a role and everybody is just so appreciative of everybody else. It’s such a great team.”

Learn more about Neonatal Intensive Care and Maternity Services at South Shore Health.