Sensory systems are unique. Sure, they have the same basic wiring. But each infant may respond differently to the same stimulus. When responding to a brief loud noise, one baby may display some mild motoric stress signs such as widened eyes and raised eyebrows. But he may also be able to demonstrate self-regulatory behavior by bringing his hands together in midline.
Another infant, perhaps even his twin, may demonstrate more marked motoric stress signs with full arm extension and finger splays, mouth agape, and mild arching of the trunk. This may last much longer than just a startle reflex and likely indicates stress. As neonatal therapists we must note and support each individual response.
Take home thoughts and resources:
1. We must support the infant's individual responses to sensory stimuli on a continuous basis during care. Providing this type of developmental care is not extra or secondary. It is humane and necessary. The whole is greater than the sum of its parts. And we must support the whole as we proficiently provide all medical care and therapeutic intervention.
2. It's also important to consider noise as a stressful stimulus in the NICU. A great resource for all NICU design and environmental standards is listed here. The link posted below will bring you right to the section dedicated to the acoustic environment. (Source: http://www.nd.edu/~nicudes/stan%2023.html)
3. Is your NICU monitoring noise? Monitoring noise is not a punitive measure for the staff, but rather a step toward a more healing environment for the fragile babies in our care.
4. You can buy a simple hand held decibel meter at Radio Shack or Amazon.com to begin monitoring your noise levels (search for 'decibel meter'). Your unit may already have a system installed that continuously monitors noise, or may wish to investigate this type of monitoring.
5. Regardless of how involved your unit is in addressing issues related to sound, what matters immediately is supporting the infant in the moment. Many of the design issues take significant time and financial investment to remedy. While you address those long-term goals, you can still provide great care to your patients. Awareness alone is the most vital component.
Sue Ludwig OTR/L
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