Premature Babies Inspire –
First Annual NANT Conference

Observation: The Most Important Skill You’ll Ever Develop

by Sue Ludwig

In our everyday haste in the NICU, we sometimes pick up a new eval, review the chart, and walk right into that assessment without a lot of forethought or observation. If we’re in a hurry or haven’t been taught otherwise, we might just begin doing a thorough neuro exam, recording what is occurring for this infant.

But if you get into a habit of doing this, you’re losing valuable information about that infant’s system.

So take a breath – the kind we all need to take to begin scheduling our day in the NICU – and do this instead:

Go to the bedside. (And I’m assuming you get the whole developmental scheduling part first. If not, we’ll talk more about that soon!)

Once at the bedside simply observe the infant for longer than feels natural at first.

Watch her breathing. Watch her movement. Observe her overall stability. Then once you gently place her supine, unswaddled or out of her positioning aids, repeat you observations. Again, for longer than feels natural.

It also helps to stand at the foot of the bed if possible, or look at the infant from that angle.

You’ll learn so much about asymmetry, movement patterns, stress and self-regulation during this observation. You’ll notice if this infant is still just trying to maintain autonomic stability or if her physiologic, motor and state systems are maturing and/or stable. You’ll notice things no one else does.

And make sure you know her first name.

That way you know you’re thinking of her as an individual, not the ’34 week new eval’ on your schedule. You’ll ‘see’ and treat her differently when you know her name.

This seems simple, and some people blow it off as unnecessary. The really great neonatal therapists I know observe these infants religiously.

It’s how I pick up the subtle things. The mild brachial plexus injury, the intermittent stridor in supine that wasn’t present in prone, the head preference that sometimes goes unnoticed. It goes on and on.

Become a master at observation. It will become your most valuable skill.