Occupational Therapy in the NICU and Beyond

April 4, 2022

Occupational Therapy in the NICU

by Eliana Cutler, Hand to Hold’s Occupational Therapy Intern, occupational therapy student and doctoral candidate at Midwestern University’s College of Health Sciences.

What is occupational therapy?

According to the American Occupational Therapy Association (2021), “Occupational therapy promotes physical and mental health and well-being by supporting occupational performance in people with, or at risk of experiencing, a range of developmental, physical, and mental health disorders.” Occupational therapists help people of all ages participate in the things they want and need to do through the therapeutic use of everyday activities or occupations.

Occupational therapy interventions mainly focus on promoting performance in nine areas:

  1. activities of daily living like eating, bathing, or dressing,
  2. instrumental activities of daily living (meal preparation, driving, or managing medication)
  3. health management
  4. rest and sleep
  5. education
  6. work
  7. play
  8. leisure
  9. social participation

What is the role of occupational therapy in the NICU?

Occupational therapists bring a unique perspective into the NICU through their scientific background, knowledge of development, and anatomical knowledge of the sensory and neurological systems. They also possess an understanding of mental health and wellbeing, an understanding of medicine, and an understanding of the importance of an individual’s environment.

In the NICU, the goal of occupational therapy is to work with families to help foster the infant’s physiological and cognitive development through evidence-based practice. Occupational therapists do this by providing the infant with a physical environment that helps their bodies grow, facilitating developmentally-appropriate activities, and educating parents on how to best take care of their child once they are discharged from the NICU. Occupational therapists work together with the NICU families to create an individualized intervention plan that incorporates the family’s priorities and the individual needs of the infant to help improve the infant’s participation in daily life activities.

What does occupational therapy in the NICU look like?

In the NICU, occupational therapists may work on a variety of skills with you and your child. Occupational therapists often have short-term and long-term goals they are working towards with your child. Feel free to ask your child’s occupational therapist to explain what they are working on with your child to get a better understanding of how this plays into their treatment.

Goals are usually broken down into the following six areas (adapted from Craig, et al., 2018)

  1. Environment: Create a healing sensory environment and physical environment for premature infants to grow and heal. Occupational Therapists make sure that the NICU has the correct temperature, lighting and is free of harmful sounds to affect brain development and minimize pain.
  2. Neurological development: Use age-appropriate activities to support brain development. Occupational therapists incorporate activities that help infants’ self-regulation and attention. Occupational therapists may position infants in certain ways to make them feel comfortable and help them learn to control how their bodies move.
  3. Muscle development: Use age-appropriate activities that help their posture and prevent deformities. An occupational therapist  also helps move and strengthen muscles to make sure that infants can eventually reach their feet to put on socks, or bring their hands together to hold a toy.
  4. Sensory system: The sensory system encompasses how the infant interprets the information provided around them through touch, smell, taste, hear, and see. Occupational therapists use age-appropriate activities to assess, facilitate, and protect the development of the sensory system.
  5. Family education and support: Occupational therapists not only work with NICU babies, but they also educate, support, and guide families. By teaching caregiving skills (like changing diapers, feeding, and bathing), providing psychological support and helping families bond with their infants, occupational therapists can help with the transition home from the NICU and improve overall confidence with early parenting skills.
  6. Activities of daily living: Activities of daily living (ADLs) are caregiving activities that each person needs to do each day. While in the NICU these caretaking activities are mainly done by NICU professionals. Occupational therapists help teach parents how to master these skills before they are discharged.
    • Feeding: Occupational therapists use activities that help support development of mouth muscles and other skills that are necessary for oral feeding.
    • Sleep: Occupational therapists help protect sleep, by incorporating activities that can help NICU babies fall asleep, and stay safe while they are asleep.
    • Bathing: Occupational therapists help teach parents how to calm NICU babies during bathing and help parents feel confident in their ability to bathe their child after discharge from the NICU.
    • Play and interaction: Occupational therapists help facilitate age-appropriate developmental skills by helping them explore and interact with their surroundings.


What do occupational therapy services look like after my child is discharged from the NICU?

After the NICU your child may be eligible to receive occupational therapy services. If you have any concerns regarding your child’s development, make sure to contact your child’s pediatrician as soon as possible.

Early Intervention Services: Occupational therapy services through Early Intervention are available as a part of the Individuals with Disabilities Education Act (IDEA) Part C for children ages 0 – 3 years. A child must be evaluated in order to qualify for Early Intervention Services, and if eligible, services can include occupational therapy, physical therapy, speech language pathology, and developmental therapy. Early Intervention Services are unique in that they take place in the child’s home environment.

NICU Follow-up Clinics: After your child’s NICU stay, you may be referred to a NICU follow-up program or specialized NICU follow-up clinic. This clinic provides specialized care for the growth and development of NICU graduates. Just like in the NICU, your child may see a team of specialists including occupational therapists, physical therapists, speech language pathologists, and neonatologists.

Other occupational therapy services for children:

As your child gets older, their pediatrician may refer your child to a pediatric occupational therapy clinic to help work on different areas of development. These services may be covered by your health insurance. School-aged children may also be eligible to receive school-based occupational therapy services during their school day to help them succeed as a student.

Helpful Links:

“What is Occupational Therapy? Answering the six Qs— what, who, why, when, where, and how—about occupational therapy.” – American Occupational Therapy Association

“What is ‘Early Intervention’?” – Centers for Disease Control and Prevention