preemie

Exercies for Preemies:  Post 2 – Legs and Trunk

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In honor of the March of Dimes’ March for Babies walks, I am providing some exercises that families can do with their former premature infant upon discharge.

The posture of a premature infant is often characterized by the baby having trouble holding themselves tucked in like a full term infant.   Instead former preemies tend to have a straighter posture.  This posture often over-activates the muscles of the back of the body and under activates the muscles of the front of the body.  This may result in difficulties with activities that require flexion like sitting, rolling and crawling.  It is for this reason that we it is beneficial to do stretches to prommote elongating of the muslces in the back of the body and exercise to activate muscles in the front of the body.   

Exercises for Legs and Trunk 

1. Elongation of the lower body

leg to ankle

  • Purpose:  Premature infants often have stiffness in the outside of their hips from laying with their legs too wide. When the hips are tight it limits the ability to shift weight (move side to side) effectively in all positions.  This exercise will stretch the outside muscles of the hips.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your hand on baby’s back by the tailbone.  Bring your hand with gentle but firm pressure down the leg to the ankle. Follow with the opposite hand so that the baby has continuous pressure.
  • Repetition: Do this 2-3 minutes as your baby tolerates.

2. Gentle Pelvic Rocking

pelvic rocking

  • Purpose: Premature infants often have difficulties rotating their body and pelvis.  Effective pelvic rotation helps with bowel function (pooping) which can be a problem for former premature infants.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your right hand around baby’s thigh and left hand on baby’s ankle.  Rock leg front and back so that you are rocking the pelvis as well.
  • Repetition: Do this 2-3 minutes as your baby tolerates.

3. Gentle Bicycles

real bicycles

  • Purpose: Premature infants often have difficulties rotating their body and pelvis.  Effective pelvic rotation helps with bowel function (pooping) which can be a problem for former premature infants.
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his back with bottom at your belly and legs bent.
  • Exercise: Place your hands hand around baby’s thighs and bring right leg to belly and then left.  Be sure to make the pelvis rotate a bit when doing this.
  • Repetition: Do this 2-3 minutes as your baby tolerates

4.  Massage Baby’s Feet

  • Purpose: Premature infants are exposed to painful procedures to their feet with frequent blood draws. This can make his feet more sensitive.  Gentle massage to the bottom of the feet helps to provide positive sensory input to the feet.  
  • General tips:  Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a daily activty like ffeeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby on her back or side with her bottom at your belly and legs bent.  
  • Exercise: Provide firm but gentle pressure to the bottom of his feet paying special attention to the heels with positive pressure.  If you have a great blanket or stuffed animal with a nice texture feel free to rub this on baby’s feet too.

Do exercises 1-2 on one side, followed by 3 and 4 then repeat 1-2 on the other side.  Add the arm and shoulder recommendations from a previous post

Disclaimer: If you are uncomfortable performing an exercise please consult with your pediatrician or physical therapist.

Exercises for Preemies: Post 1 Shoulders and Arms

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In honor of the March of Dimes’ March for Babies walks, I am providing some exercises that families can do with their former premature infant upon discharge.

The posture of a premature infant is often characterized by the baby having trouble holding themselves tucked in like a full term infant.  Instead former preemies tend to have a straighter posture.  This posture often over-activates the muscles of the back of the body and under activates muscles of the front of the body.  This may result in difficulties with activities that require flexion like sitting, rolling and crawling.  It is for this reason that preemies would benefit from  stretches to promote elongating of the muscles in the back of the body and exercises to activate muscles in the front of the body.

Exercises for Arms and Shoulders 

1.  Gentle shoulder stretch

shoulder down

  • Purpose:  Premature infants often have trouble with breathing,so they use their shoulders (specifically their upper trapezius) to help them pull in air.  This causes the shoulders to be tighter than we would like.  Try this exercise to help your baby relax his or her shoulders
  • General tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on her side with bottom at your belly and legs bent.
  • Exercise: Place your hand on shoulder and gently pull down, hold for 3 seconds, then stroke your hand down the baby’s arm to their hands bringing hands together.
  • Repetition: Do this 5-10 times as your baby tolerates

2.  Hands to Mouth and Hands Together

hand to mouth  hand to hand

  • Purpose: Former premature infants need help to activate the muscles in the front of their body.  Practicing self calming skills (hand to hand and hand to mouth) reinforces the flexor muscles in the front of the body to activate.
  • General Tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his side with bottom at your belly and legs bent.
  • Exercise: Bring the top hand toward baby’s mouth and stroke the side of the mouth with his hand.  The baby will want to suck on their hand.  Let him!  When he is done, bring hands together with gentle pressure,, this is very calming.
  • Repetition: Do 5-10 times as your baby tolerates.

3.  Upper Back Stretch

shoulder to hand

  • Purpose: Former premature infants can pull their arms back and have trouble bringing ands together.  This exercise will elongate the muscles of the upper back making it easier for baby to bring arms forward.
  • General Tips: Take time during the day to exercise your baby.  Try to do exercises one time per day.  Pairing the exercise with a dialy activity like feeding or playtime is helpful.  
  • Pressure: Babies in general prefer firm but gentle pressure versus light touch.
  • Position: Place your baby in your lap on his side with bottom at your belly and legs bent.
  • Exercise: Place your right hand on them middle of her upper back, right at the shoulder blades.  With gentle, but firm pressure, bring your hand from shoulder blade to wrist, following the arm.  Do the same with your left hand.  Think of this as a waterfall with continuous massages from shoulder to wrist alternating hands.
  • Repetition: Do 2-3 minutes as your baby tolerates.

Do 1-3 on the left side and repeat on the right side.

Disclaimer: If you are uncomfortable performing an exercise please consult with your pediatrician or physical therapist. If you are concerned that your child is delayed, please consult your pediatrician or a physical therapist in your area.

Honoring March for Babies Walks . . . Dedicated to Families and Children affected by Prematurity

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My tired boys and I at March for Babies 2013

My tired boys and I at March for Babies 2013

The months of April and May are filled with March of Dimes’ March for Babies Events.  These events raise funds to research and prevent prematurity, assist families who have premature infants and assist women in achieving healthy pregnancies with full term deliveries.  The next few posts this week are dedicated to my friends and families I have worked with that have endured the NICU with their little ones. Thank you for allowing me to be a part of your family’s life and allowing me to learn more from you than you have learned from me!

One of the most treasured aspects of my career so far has been my time spent as the Lead Physical Therapist in a level 3 NICU.  Seeing beautiful miracles weeks before they are supposed to be born is truly a blessing.  More importantly, being able to shape their development so intimately by providing positive and beneficial touch while they are in the NICU is extremely rewarding.  Instructing families on positive touch and instructing activities that they can do with their babies provides families with a sense of confidence that they can participate in some of the care for their babies during a time feels perhaps overwhelming.

My role as a physical therapist in the NICU was to provide care for the premature and medically involved babies that assists in preventing unnecessary delays.  Further, I provided education for parents on the importance of early therapeutic intervention which can maximize the abilities of their child.  One cannot be an effective pediatric NICU therapist if they are not aware of the possible structural concerns, sensory concerns and motor concerns that can result from being in the NICU. I have followed hundreds of premature infants through direct treatment and NICU follow up clinic throughout their development, allowing me to continue to learn how I can better care for the babies while they  are in the NICU.

Over the next few days, I will provide some suggestions for common problems seen in NICU graduates and some exercises you can do with your former premature infant.  Please remember if you have any concerns about the suggestions posted, please ask your doctor or therapist for the appropriateness of the exercise for your baby.

If you are interested in finding a March for Babies in your area, please go to http://marchforbabies.org.