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Stress Cues

Since your baby cannot talk to you, her only way of communication is through non-verbal (body) language.  When someone, either you or the nurse, is handling your baby, your little one will tell you through her body language whether she is ready for the activity or not.  Your baby may show either readiness or avoidance (or stress) cues.

Readiness cues, also known as self-regulatory behaviour is the techniques a baby use to interact with her environment and if the environment is unsupportive, these techniques help her to cope.  Some of this self-regulatory behaviour includes non-nutritive sucking, foot bracing, hands to chin, grasping and hands to face.  You can help your premmie to reach self-regulation by supporting her with lots of skin-to-skin contact, positive touch techniques, positioning and protection from the harsh NICU environment
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Swaddling

Hands-to-Mouth

Nesting

Frequent handling and even routine procedures disturbs sleep, which leads to decreased weight gain, decreased state regulation and low oxygen levels in the blood.  Even noise and bright light can cause stress in the preterm infant.  The premmie will show her inability to cope with her environment through stress cues.  This will be her way of communication to you that something is bothering her.  Some stress cues you may see in your premmie are:

Physiologic/ autonomic (Automatic Functions)

  • Colour changes - pallor or flushing
  • Changes in vital signs (e.g. Heart rate, breathing)
  • Hiccups
  • Spitting up
  • Sneezing
  • Yawning

State subsystem (States of consciousness)


Yawning

  • Irritability
  • Diffuse sleep states - grimacing, twitching
  • Glassy eyes
  • Gaze aversion (looking away)
  • Staring
  • Panicked look
  • Looking Away

Gaze aversion

Frowning

Looking away

Crying

Motor subsystem (Muscle Movements)

  • Hyperextension of extremities - saluting, arching, airplane, sitting on air, "stop" sign
  • Frantic movements
  • Finger splaying
  • Generalised hypotonia - low muscle tone

Extension of Extremities

Arching

Toe Splaying

Finger Splaying

Fatigue


Sitting on Air

Attention/interaction (Awake stages, ability to interact)


Yawning

Avoid interaction

"Stop sign"

A baby that is tired or over stimulated will send out a signal that says, "I need a break!" These time-out signals tell us to stop what we are doing and give the baby a rest.  You saw examples of these time-out signals or stress cues.  Look for these signals whenever you do an activity with your baby.  Ask your baby's nurse to help you identify these signals.  Remember that it takes practice to learn to identify them, but it will help you understand your baby better.

Read more on stress cues and understanding your baby in Chapter 4 of Prematurity - Adjusting your Dream.

 

Know your premmie

Since your baby cannot talk to you, her only way of communication is through non-verbal (body) language. When someone, either you or the nurse, is handling your baby, your little one will tell you through her body language whether she is ready for the activity or not. Your baby may show either readiness or avoidance (or stress) cues.

Readiness cues, also known as self-regulatory behaviour is the techniques a baby use to interact with her environment and if the environment is unsupportive, these techniques help her to cope. Some of this self-regulatory behaviour includes non-nutritive sucking, foot bracing, hands to chin, grasping and hands to face. You can help your premmie to reach self-regulation by supporting her with lots of skin-to-skin contact, positive touch techniques, positioning and protection from the harsh NICU environment.

SwaddlingSwaddling

Hands-to-MouthHands-to-Mouth

NestingNesting

 

Stress cues

Frequent handling and even routine procedures disturbs sleep, which leads to decreased weight gain, decreased state regulation and low oxygen levels in the blood. Even noise and bright light can cause stress in the preterm infant. The premmie will show her inability to cope with her environment through stress cues. This will be her way of communication to you that something is bothering her. Some stress cues you may see in your premmie are:

Physiologic/ autonomic (Automatic Functions)

· Colour changes - pallor or flushing

· Changes in vital signs (e.g. Heart rate, breathing)

· Hiccups

· Spitting up

· Sneezing

· Yawning

Yawning Yawning

State subsystem (States of consciousness)

· Irritability

· Diffuse sleep states - grimacing, twitching

· Glassy eyes

· Gaze aversion / looking away

· Staring

· Panicked look

Gaze aversion Gaze Version

Frowning Frowning

Looking Away Looking Away

Crying Crying

     

Motor subsystem (Muscle Movements)

· Hyperextension of extremities - saluting, arching, airplane, sitting on air, "stop" sign

· Frantic movements

· Finger splaying

· Generalised hypotonia - low muscle tone

Extension of Extremities Extention of Extremities

Arching Arching

Toe Splaying Toe Splaying

Finger Splaying Finger Splaying

Fatigue Fatigue

Sitting on Air Sitting on Air

     

Attention/interaction (Awake stages, ability to interact)

Yawning Yawning

Avoid interaction Looking Away

"Stop sign" Stop Sign

A baby that is tired or over stimulated will send out a signal that says, "I need a break!" These time-out signals tell us to stop what we are doing and give the baby a rest. You saw examples of these time-out signals or stress cues. Look for these signals whenever you do an activity with your baby. Ask your baby's nurse to help you identify these signals. Remember that it takes practice to learn to identify them, but it will help you understand your baby better.

Read more on stress cues and understanding your baby in Chapter 4 of Prematurity - Adjusting your Dream.

 

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