Lancashire Teaching Hospital | NICU

Your baby has come from a darkend, contained, warm environment where sounds are muffled

To a very different environment here on the Neonatal Intensive Care Unit

A digital graphic depicting a baby inside womb

It is imperative that we consider all these changes to your baby's environment, their physical condition, and emotional wellbeing so that with your help, we can create the most appropriate environment to support your baby's development.

We call this Developmental Supportive Care and it involves the following:

Family Integrated Care
Protected sleep
Minimise pain and stress
Supportive positioning
Environmental adaptations to reduce noise, bright light and noxious smells
Kangaroo Care
Cue Based Feeding and Breast Feeding support

Click below to learn more about each stage of growth and development

How babies grow

22 weeks

At 22 weeks your baby is still in the very early stages of development. They might not be able to see or hear very well yet, and their bodies are still learning how to move and respond to the world around them. Their organs, especially their lungs are not fully developed, making it hard for them to breathe on their own. They’re also very tiny and fragile, with delicate skin and not much fat to keep them warm.

23 weeks

At 23 weeks gestation, your baby’s lungs are still immature, making breathing difficult. They are also very small and fragile, with underdeveloped skin and limited fat stores, which can lead to difficulty regulating body temperature. At this stage, your little one’s sense of touch is developing. However their sensory abilities may not be fully developed. Their vision is limited and they may not be able to hear or respond to sounds as effectively as full-term babies. Their nervous system is also still developing, so they may have difficulty coordinating movements and responding to stimuli.

24 weeks

At 24 weeks your baby might start to open their eyes and respond to light and sound. They may move more and even grasp onto things. However, they are still very fragile and need specialist care to help them breathe and stay healthy. As they grow, your baby might face challenges like feeding difficulties and developmental delays. But with medical support and time, they may overcome these obstacles and grow up to be a healthy child.

25 weeks

At 25 weeks your baby’s lungs are continuing to mature, but they still need a lot of help to grow and stay healthy. Your baby might start to open their eyes more often and respond to light and sound. They may also move more and try to grasp things. They are still very fragile and require support to breathe and grow.

26 weeks

At this gestation, your baby’s organs, including their lungs are still developing, but they are getting stronger every day. Developmentally, your baby might start to open their eyes more often and respond to light and sound. They may also move more, like kicking their legs and waving their arms. However, they remain quite fragile and continue to need specialist support to help them breathe and grow.

27 weeks

At 27 weeks gestation your baby is still early in development. Their organs are continuing to grow and mature, gradually becoming stronger. Developmentally, your little one may start to become more aware of their surroundings, occasionally opening their eyes and responding to stimuli like light and sound. They may also begin to move more, demonstrating tiny movements and reflexes.

28 weeks

At 28 weeks your baby’s organs are developing steadily and they’re becoming more active and aware. Developmentally, your little one may begin to open their eyes more frequently, taking in the world around them. They might also start moving more, giving you glimpes of their growing strength. While they may still need support with breathing and feeding, they’re making strides forward.

29 weeks

At 29 weeks, your baby is still on their early journey but showing promising signs of growth. Their organs are continuing to develop and they’re becoming more active and responsive to sound and light. They may open their eyes more and begin moving more, demonstrating their increasing strength with gentle movements. While they may still require assistance with breathing and feeding, they’re steadily progressing.

30 weeks

If your baby is born at 30 weeks gestation, they’re still premature but getting closer to being fully developed. At this stage, their organs are continuing to mature and they’re gaining strength day by day. Your little one may become more alert, opening their eyes more frequently and responding to stimuli like light and sound. They might also start moving more, displaying their increased vigor with subtle movement. While they may still require support with breathing and feeding, they’re moving forward.

31 weeks

At 31 weeks your baby’s sensory development and movement are starting to blossom. Their senses are becoming more acute, and they may begin to respond to light and sound by opening their eyes more often and turning towards familiar voices. In terms of movement, your little one may show more purposeful movements, such as reaching out to touch objects or bringing their hands to their face. They might also start kicking and stretching their legs more actively, exploring their new found mobility.

32 weeks

At 32 weeks gestation, your baby’s sensory development and movement are really starting to take shape. They’re becoming more aware of their surroundings and may respond to light and sound by blinking, squinting, or turning their head towards familiar voices. Your little one may start to show more purposeful movements such as reaching out to touch objects or bringing their hands together. They might also begin to kick their legs and move their arms with more coordination.

33 weeks

At 33 weeks gestation your baby will show some awareness of their environment by responding to light and sound. They may show more deliberate actions like reaching out to touch or bringing hands together. They may also kick their legs and move their arms with growing coordination. At this stage their sensory development and movement are really starting to blossom.

34 weeks

At 34 weeks gestation your baby may initially have difficulties feeding. They might have trouble coordinating sucking, swallowing, breathing, so they may need to be fed through a tube at first. At this gestation, their sensory development and movement are still in progress, but they’re getting there! Your baby may start to blink at bright lights and turn their head toward familiar sounds, like your voice. They’re starting to take in the world around them, even if it is a bit fuzzy. Your little one might make more deliberate movements, like reaching for objects or kicking their legs. They’re exploring their tiny worls and starting to flex those muscles. While they’re still growing and developing, these early signs of sensory awareness and movement are positive steps forward.

35 weeks

At 35 weeks gestation, your baby is becoming increasingly aware of their environment and starting to explore the world through their senses. They may be able to blink in response to bright lights and turn towards familiar sounds, like your voice. You are likely to see your little one making more deliberate movements. They may reach for objects and may start to show a grasp reflex, meaning that they’ll curl their fingers around objects that touch their palms. This reflex helps them explore and interact with their environment. They may also bring their hands to their face more often, which is a way for them to self-soothe and explore their own body. They may also kick their legs with greater coordination. They’re becoming stronger and more mobile, showing off their growing capabilities.

36 weeks

At 36 weeks old your baby is getting stronger, making more deliberate movements, showing more coordination. They may begin to grasp onto objects with more intention, exploring them with their hands and fingers. You might notice them bringing their hands to mouth more often, showing off their growing coordination and dexterity. Your baby continues to become more aware of their surroundings, exploring the world through their senses, taking in new sights, sounds and textures. Their eyesight is still developing, but they are beginning to see more clearly. Your baby can now focus on objects that are close to their face, usually within 8 to 12 inches. They may enjoy looking at faces, especially yours, and may track moving objects with their eyes. Your baby’s eyes are becoming more sensitive to light. They may blink or squint in response to bright lights and prefer dimly lit environments.

37 weeks

At 37 weeks gestation, your baby’s posture is still developing, but they’re gradually gaining more control over their movements. Your baby will likely maintain a flexed position, with their arms and legs curled towards their body. Your baby’s neck muscles are getting stronger, allowing them to lift and turn their head slightly. This helps them explore their surroundings and interact with their environment. They may respond to external stimuli, such as your voice or gently touch, by shifting their position or becoming more active. They’re beginning to show signs of awareness and responsiveness to their surroundings.

38 weeks

If your baby is born at 38 weeks gestation, they’re considered full-term, and their development is progressing well. They are starting to explore the world through their senses, becoming more alert and responsive to their surroundings. They may turn their head towards familiar sounds and blink in response to bright lights. They are gaining more control over their movements. They may kick their legs with more coordination and reach out to touch objects within their reach. You might notice them moving their arms and legs more purposefully as they explore their environment.
Benefits of developmental supportive care
- Decreased respiratory support
- Decreased incidence of moderate / severe chronic lung disease
- Decreased length of stay
- Improved neurodevelopment outcomes to 24 months corrected age
- Increased breastfeeding rates of discharge
- Decreased cost of hospital
- Improved short-term growth outcomes

Here’s how you can support your baby

Emotional bonding: spend quality time cuddling, talking and singing to your baby. Your comforting presence helps them feel secure and loved and reduces stress and pain.

Skin-to-skin contact (Kangaroo Care): Practice kangaroo care by holding your undressed baby against your bare chest. This promotes bonding, regulates their temperature, and stabilises their heart rate and breathing. Practice for a minimum of 1 hour at a time for best results.

Feeding support: If your baby is able to breastfeed or bottle feed, offer them nourishment and support during feed times. This bonding experience strengthens your connection and provides essential nutrients for their growth.

Positive touch: Provide positive touch experiences to your baby by holding them or touching their skin gently. Some babies prefer ‘still’ touch while others will enjoy stroking to soothe and comfort them. Baby massage can also be used- talk to your Occupational Therapist for more information about this. You can also provide reassurance and positive touch during hospital procedures such as heel pricks and ROP examinations.

Responsive care: Pay attention to your baby’s cues and respond to their needs promptly. Whether they’re hungry, tired, or in need of comfort, your attentive care helps build trust and security.

Encouragement: Celebrate your baby’s milestones, no matter how small. Offer praise and encouragement as they reach new achievements, such as lifting their head or grasping onto objects.

Advocate: Be your baby’s advocate by communicating with healthcare providers and voicing any concerns or questions you may have. Your active involvement ensures that your baby receives the best care possible.

Your love, care and support are invaluable for your baby’s well-being and development. By providing a nurturing environment and being actively involved in their care, you’re laying the foundation for a strong and loving bond that will last a lifetime.

Behavioural cues

As a parent, understanding your baby’s behavioural cues can help you to respond to their needs more effectively. When your baby is very young, their behaviour is their way of communicating. Subtle cues from your baby can provide important insights into their well-being and how they are coping with something eg. Facial expressions, turning head away, splayed hands, extending arms and legs, change in colour, raised heart rate etc

Speak to your Occupational Therapist for further information

Sleep states

Understanding your baby’s sleep states can help you determine the best times to interact with them or perform cares. Here are the typical sleep states and recommendations for interaction:

Active Sleep (REM Sleep): During active sleep your baby’s eyes may move rapidly beneath closed eyelids, and they may make twitching movements. This is deep sleep, and may be difficult to wake your baby. It’s best to avoid unnecessary interaction during this state unless necessary.

Quiet Sleep (Non-REM Sleep): In quiet sleep, your baby’s body is relaxed, and their breathing is regular. They may have occasional startles or brief movements. This state is lighter than active sleep and your baby may be more easily aroused. Try to keep any interactions gentle and avoid overstimulation.

Drowsiness: This is the transition state between wakefulness and sleep. Your baby may appear sleepy, with droopy eyelids and slower movements. This is an opportune time for cuddling, soothing, or quiet interactions to help your baby drift off to sleep.

Quiet Alertness: During this state, your baby is awake and calm, with bright eyes and minimal movement. This is an ideal time for bonding, engaging in activities like talking, singing or gentle play, and offering opportunities for skin-to-skin contact.

Active Alert: In active alertness, your baby is awake and alert, with increased movement and more frequent eye movements. This is a good time for interactive play, such as showing them toys or making facial expressions to encourage social interaction.

Crying: Crying is your baby’s way of communicating needs or discomfort. Respond promptly to your baby’s cries to address their needs for feeding, comfort or attention.

Observing your baby’s sleep cues and states can help you anticipate their needs and provide appropriate care and interaction. Remember that every baby is unique, so tune in to your baby’s individual cues and preferences to establish a nurturing and responsive caregiving routine.

Non-Intrusive Sucking

Non-nutritive sucking is the process of babies sucking without receiving any nutrition. Sucking is one of the earliest reflexes learnt (from 11 weeks) in the womb and is extremely soothing for babies especially during procedures and when not being able to be fed due to prematurity, sickness or awaiting a procedure that requires them to be nil by mouth.

We will always ask for consent from parents to provide their baby with a pacifier.

Benefits of Non Nutritive Sucking

Supports normal sucking patterns which promotes early oral feeds
Helps reduce ‘oral aversion’, where a baby dislikes having things in their mouth
Encourages the association between sucking and having a full tummy, when offered with a tube feed
Stimulates the stomach to help digest milk

Resources to look at your baby's development

BLISS: Look at me, I'm taking to you

Tommy's Your Baby's Development

'All Wrapped Up' videos have been created by Yorkshire & Humber Neonatal Families - NHS Networks to guide and support families to care for their babies during their stayon the Neonatal Unit

BLISS: Skin to Skin & Kangeroo Care

BLISS: The role of parents in comfort and pain relief

NWODN: Positioning and Handling on the Neonatal Unit

NHS South Tees Hospitals has an excellent page on Developmental Care

Sensory Beginnings