Risk factors may include

Prematurity (immaturity of CNS system, hypoxia), environmental overstimulation, invasive/painful procedures and therapies, separationfrom parent(s)

Possibly Evidenced by




Physical regulation




(Refer to comprehensive assessment parameters.)


The neonate will

Exhibit organized behaviors that allow the achievement of optimal potential for growth and development asevidenced by modulation of physiological, motor, state, andattentional-interactive functioning.

The parents will

• Identify factors that place infant at risk for behavioral disturbance.

• Identify potential signs of behavioral disturbance in infant.

• Identify appropriate ways to interact with infant.

• Identify their reactions to infant (including ways of coping with

occasional frustration and anger).

• Express positive feelings about their ability to care for infant. Identify resources for help with infant.

Determine infant’s chronological and developmental age; note length of gestation. Assess individual behaviors using appropriate tool (e.g., assessment of Preterm Infant Behavior Scale).

Create womblike atmosphere whenever possible by putting incubator for extended periods, playing recorded placental or maternal heart sounds, and surrounding infant with rolled blankets or manufactured “nesting” device. **(It has provided as possible as yet it has no using of maternal sounds in our hospital.)

Reposition infant using rolled diapers placed at the back and front, if infant is in lateral position, or at sides, if infant can tolerate a prone position.

Change infant’s position periodically to provide kinesthetic stimulation. Neuromuscularly immature infant is unable to reposition self or move about in the incubator.

Use containment measures when handling/moving infant and avoid sudden postural changes.

Provide gentle stroking and caressing, especially at feeding time, introducing textures (tongue blade, washcloth), as appropriate. [Provides tactile stimulation, which is associated with weight gains and is especially critical when infant is 40 weeks after conception or more. Note: Slow, sure movements provide stimulation while reducing motor disorganization

Talk or quietly sing to infant, call infant by name play soft music in nursery, or play a tape of parent(s) voice.

Interact with infant at face level (en face interaction), allowing eye contact.

Encourage periodic skin-to-skin contact, as appropriate (i.e., mother holds diaper-clad infant upright between her bare breasts). [Research suggest kangaroo-care technique not only provides closeness, strengthening mother-infant attachment, but also reduces periodic breathing and promotes deep sleep].

Plan activities to allow periods of sleep. Prevent loud noises, limit conversation near bedside, respond to alarms quickly; and reduce light intermittently by covering incubator with towel shielding infant’s eyes, or lowering room lighting.

Weigh infant daily. Note feeding frequency and intake and frequency of stools. [Vagal stimulation produced by appropriate tactile and kinesthetic stimulation promotes weight gain increases peristalsis and expulsion of waste products reduces gastric retention, and increases feding activity].

Provide parents with information about infant’s behavioral cues and responses to stressors.

Baby T was able to exhibit organised behaviors, not observed any problem

Explained to parents that certain risk factors might interfere with the infant’s ability to achieve optimal development [Educating the parents would help them understand their role in interpreting the infant’s behavioral cues and providing appropriate stimulation].