Neonatal therapists care for the most fragile patients

Physical and occupational therapists are problem-solvers. They do everything from assisting patients recovering from hip surgery to helping people feed themselves after a stroke.

For neonatal therapists, who work with the smallest and sickest patients, the problem is more elemental; their job is to help medically fragile newborns negotiate the most basic parts of life.

“It’s almost like a different field,” said Martha Herbers-Sanger, an occupational therapist in the neonatal intensive care unit at Children’s Healthcare of Atlanta at Egleston. “We’re helping babies with things that most of us take for granted, like how to handle the state of being awake and how to tolerate being touched.”

Birth is a traumatic experience for all babies and new parents.

“But the babies and parents who come to CHOA’s Level III NICU are shell-shocked,” said Herbers-Sanger, BS, MOT-R/L. “Instead of going from womb to their mother’s arms, the babies find themselves in a box with lights and strange noises. Some have come from miles and miles away because they need surgery or medical intervention. All is pain and confusion.”

Parents must learn to bond with their children in circumstances that are anything but normal. At Children’s Healthcare of Atlanta, a multidisciplinary developmental care team of occupational therapists, physical therapists, speech therapists and child-life specialists help parents interact with their babies in safe, positive ways.

“We’re all working toward the same goal of helping families connect and babies get better,” Herbers-Sanger said.

The babies may be tiny and ill, but Herbers-Sanger knows her patients are communicating.

“They may spread out their hand to signal stop when they need a break, open their eyes when they’re interested, change color, look toward you, squirm or cry,” she said. “The signs are subtle and it would be easy to ignore them. I have to take a moment and be intentionally present with each child. Then I can help parents decode the messages and learn to read their babies.”

It takes special skills — many of which she has learned from mentors who have long worked in the field — as well as patience, compassion and the ability to work with each parent individually.
"You can't be judgmental. The mom may not be there as much as you think she should, but you have no idea what is going on in her life," Herbers-Sanger said.

In the hospital, it’s easy for a mother to feel like she’s not needed or to be intimidated and disengage from her child. Asking one mother to join her at her baby’s crib, Herbers-Sanger learned that the woman believed that her presence was causing the child to have more seizures.

“I was able to tell her that that seizures were going to happen regardless,” she said. “It wasn’t her fault, and she could help by staying connected. She was able to hold him that day.”

With doctors and technology saving premature babies earlier, there is a growing need for therapists in the NICU to help these babies develop. A growing body of evidence-based practice is showing their work to be effective.

Children’s Healthcare of Atlanta recently hired consultant Mary Coughlin, RN, MS, NNP, an expert in age-appropriate care for premature and hospitalized infants, whose guidelines have been accepted by the National Association of Neonatal Nurses. She will help the staff create a more developmentally focused culture in the health system’s NICUs.

“We want physicians, nurses, everyone to understand the importance of every single interaction with these babies,” Herbers-Sanger said. “It may sound touchy-feely, but we have evidence on our side.

We know that babies who are attended to and held by their mothers grow more, heal faster and go home quicker. It just makes sense that if a baby has lung or heart problems, he’s going to heal faster if he isn’t crying all the time.”

Her job is filled with highs and lows. Some babies go home with their families and others die.

“It’s an emotionally exhausting environment, which is why it’s important to work with a great team, like I do,” she said. “Some days you cry on your way home. But some days you get to see that moment when parents first connect with their child, when they get it. Those are the most rewarding moments.”