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For Lynne Buscaino, RN, staff nurse at All Children's Hospital in St. Petersburg, Fla., providing developmental care to her tiny infant patients is natural. Buscaino says, "it is merely a kinder, gentler way to provide nursing care."

Using the Newborn Individual Developmental Care and Assessment Program (NIDCAP) approach to care, Buscaino follows a baby's cues carefully. If a baby is distressed, Buscaino stops care until the baby has calmed down. She talks to the baby in a quiet, soothing voice. She swaddles the baby gently with both hands to comfort him or her. She never raises the baby's feet and legs over its head to change a diaper. And before she leaves the room, she tucks the baby's tiny limbs close to its body and face.

"It has changed the way I practice nursing," says Buscaino. "As a NICU nurse, sometimes we can be very task-oriented and we forget to tend to feelings. NIDCAP is based on determining the individual needs of each child and how they respond to their environment. Every baby is different."

For instance, a stressed baby may experience a darkening of the skin, labored breathing, and increase or decrease in other vital signs. The baby may stretch out his or her arms and legs or spread fingers in a stop-like gesture. If a baby shows signs of distress, the nurse will stop and nurture the baby until vital signs return to normal and the infant shows other positive cues.

The NIDCAP movement

According to research conducted in the early 1980s by the NIDCAP Federation International founder and president, Heidelise Als, PhD, and her colleagues, babies who receive individualized developmental care have improved growth and weight gain, decreased days on ventilators, decreased severity of lung disease, and fewer medical complications, as well as shorter lengths of stay. Additional research on long-term outcomes has shown these babies also have better intellectual processing and improved neuropsychological functioning at later ages.

Developmental care was adopted as a standard of care by the National Association of Neonatal Nurses in the early 2000s.

"Nearly every NICU or special care nursery in the country today practices some form of developmental care, although it may not include the full NIDCAP methodology," says Gretchen Lawhon, RN, PhD, co-founder and vice president of the NIDCAP Federation and director of the Mid Atlantic NIDCAP Center at Children's Regional Hospital at Cooper University Hospital, Camden, N.J. "While it has not yet spread into the fiber of learning and education, that is one of our major goals."

Using detailed observational tools, certified NIDCAP observers evaluate an infant's behavior and note when the baby is steady and relaxed or is experiencing stress or discomfort. By observing and then interpreting behavior of infants within their environment and in response to care they receive, the NIDCAP observer creates a developmental care plan with the caregiving team that best supports the infant's overall goals and efforts at self regulation. This is shared with the parents and all clinicians providing care.

"Babies are very competent and capable of communicating with us," says Betsy Vaught, MA, LMT, developmental specialist at All Children's. "They attempt to tell us how they are dealing with a situation at every moment. The problem is, we don't always understand how to interpret their cues. But when we learn these cues and pay attention to them, they thrive. They get better faster, they are calmer, and they respond with smiles and other positive cues."

Mom and Dad get involved

Six-month-old Lela Gray, who was born at 28 weeks, is doing everything a 6-month-old infant should be doing. Her mother, Jayde Gray, believes the special care Lela received while in the NICU at All Children's has a lot to do with Lela's remarkable progress.

"The way our nurse dealt with our baby and listened to her cues was very gentle and soothing," says Gray. "She taught us how to learn Lela's cues and how to interact with her without overstimulating her. She involved us in her care from the beginning so that we felt like parents instead of bystanders."

NIDCAP encourages parents to perform tasks such as diaper changes, bottle-feeding, kangaroo care, and comfort measures when the baby is in distress. "We're there to help families take care of their babies," says Buscaino.

A newly designed NICU is scheduled to open in 2009 and will include single-patient rooms, providing more privacy for families at their baby's bedside.

All Children's also incorporated environmental changes that support a baby's growth and development. Sound level is kept to a minimum, and indirect lighting and dimmers are used to promote a calm, quiet, soothing atmosphere. Parents are invited to bring in personal items from home, including clothing and baby blankets, for their child. Everyone is encouraged to limit interruptions to protect the baby's sleep state, since sleep is when most brain growth occurs.

NIDCAP is more rewarding for nurses, too. "What are you going to remember as nurses?" asks Vaught. "The IV that you placed perfectly or the parents that were so grateful or the baby that smiled at you? Nurses that practice developmental care seem to enjoy what they're doing more. They are holding babies more, talking to them and nurturing them. It's these kinds of relationships that make the job so rewarding."

Vaught says All Children's is working to provide training based on the NIDCAP approach to all clinicians and consultants in the NICU, from doctors and nurses to respiratory therapists and housekeeping staff. "It's a whole culture change," she says. "Everyone who comes into the NICU affects the environment and also has the opportunity to positively support each baby's growth and development through their interactions."

Susan Meyers is a freelance writer.

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