The Pillars of a NeuroNICU: Neuro Development

I think we can all agree, there is not a one-size or one-time fits all strategy for babies in the NICU.  And this is especially true when we talk about providing “developmental care”.
Over the years, there have been a growing number of synonyms for neuro-developmental care.  We have used terms like: age-appropriate, individualized, infant-driven, cue-based, or clustered care.  Although these terms are a bit more descriptive of our aims, they all boil down to the same principle, which is this:
Another term that is often added to developmental care (and truly all of health care lately) is: family centered.  Implementation of family center care has been spotty at best in most NICU’s over the years.  However, the evidence for family integration and family support in the NICU has reached a tipping point where the must recognize our need to continue to improve in this area; and hopefully by doing so we can also prevent some of the long-term family distress and dysfunction that often follows a NICU stay.   I’ll save the discussion of this evidence for another blog series in the future 🙂

Let’s dive in to today’s topic – the 4th Pillar
of Neuro-Nurturing Care – Neuro-Development.

Although I love learning about complex brainy things, I always find myself breaking these complex concepts down in to simple patterns so that I can remember them and hopefully teach them to others so that they stick.
So, in this weeks’s blog, I’d like to share my simple framework of the 4 B’s of developmental care that I developed over a decade ago, and I hope you love this easy to remember and easy to use outline as much as me. .
The 4 B’s of developmental care are – Body, Brain, Bonding, and Breast (bottle) feeding.  
Although it is simplistic, I believe that it is comprehensive enough to cover most of our developmental care goals in the NICU 😃  In future blogs I will explore all of these concepts in more detail but for today, here is a quick run down:
  1. Body – Provide therapeutic positioning which is to say we use supportive aids to ensure proper body alignment which the hopes that we increase comfort, optimize neuronal organization, and promote physiologic stability (and ultimately prevent hypoxia).
  2. Brain – Optimize neuro-genesis and organization through the protection of sleep and minimizing pain, stress, and sensory system over-whelm
  3. Bonding – Minimize separation and stress to parent which can cause long-term psychological stress and family dysfunction which impact; we have to also include skin to skin time (which has been shown to increase brain maturation, and synaptogenesis too – so maybe this belongs under Brain more than Bonding – For me skin to skin is a non-negotiable activity in the NICU, it’s not fluff, it’s essential to healthy brains, the side benefit is enhanced family bonding and mother’s milk supply. Okay I’m exiting my soap box now!)
  4. Breast (bottle) feeding – This B encompasses optimizing nutrition from day 1 (even before oral/enteral feedings), but offering positive oral stim, assessing feeding readiness, and leaving the culture of “force feeding” behind us.
We have important work ahead of us, but I know that if you break down the complex in to simple, you can truly make changes that stick and truly impact your NICU, the babies, and their families for the better!!
I always love hearing from you!! Tell me, which of these B’s do you want me to focus on first in the blog series??  Which one of these challenges you (or your NICU) the most?
Interested in continuing to expand your knowledge on developmental care of newborns and infants? Check out my book club!

Missed the first three parts of the pillars series? Click here to check out part one, two and three!


  1. Sleep –
  2. Sleep –

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