#257 - Premature Babies + The Sensory System: Activities to Promote Integration

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC May 24, 2023

#257 - Premature Babies + The Sensory System: Activities to Promote Integration

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Premature Babies + The Sensory System: Activities to Promote Integration

Today’s episode is diving into a question that we received from a listener.

“I have a preemie (32 weeks) and would love to see content on preemies as I know their sensory experience for the first few months of life are quite different and their development is likely going to be off as well.”

Get ready for some tips and tricks that you can implement in infancy, such as support for primitive reflexes, ideas for different sensory experiences, and feeding strategies. We also dive into tips for toddlers as well.

Make sure to check out all of our links below!

Infant and Toddler Sensory Development

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Article: Sensory Processing Disorders in Premature Infants

Article: Moro Reflex

Article: Development of Sensory Processing in Premature Infants and Implications for Evidence-Based Music Therapy in the NICU

Article: Premature Infant Oral Motor Intervention

Article: Assessment of Primitive Reflexes in High-risk Newborns

Article: Retention of Primitive Reflexes and Delayed Motor Development in Very Low Birth Weight Infants

Sensational Brain - The Role of OT in the NICU


Premature Babies And The Sensory System: Activities To Promote Integration

Sensory processing disorders impact between 39% to 52% of preterm infants, with research indicating that those born before 32 weeks have the highest risk.According to an article by Praxis Medica, premature birth disrupts neurosensory development in utero and exposes children to intense stimulation in the neonatal unit or NICU, potentially leading to further changes in the sensory system's development and function.

The sensory experiences of premature babies during the first few months of life are distinct from those of full-term babies, and as a result, their development may also differ. It's worth noting that premature infants are more likely to have underdeveloped primitive reflexes and an immature sensory system.

Underdeveloped Primitive Reflexes

Although primitive reflexes typically develop in utero, if this process is interrupted, infants may be born without functioning primitive reflexes, potentially impacting their proper development. It's crucial to evaluate the primitive reflexes, especially the Moro Reflex and the Babinski Reflex, in premature babies.

The Moro Reflex serves as a protective mechanism against sudden environmental changes, and can be tested by placing the infant on their back and gently jostling them to simulate a startle. If they respond with an arm jerk, then the reflex is present.

The Babinski Reflex helps infants with posture control. It is is tested when the dorsum of the foot is stroked from heel to toe and if you see an infant's toes curl up or they fan out, then their babinski reflex is present.

Absence of these reflexes can indicate brain damage, injury, or an underdeveloped central nervous system due to interrupted development. So if you have a child who was born prematurely, we want to look at their primitive reflexes first.

Integrating Primitive Reflexes & The Sensory System

Preterm infants' development depends on the integration of primitive reflexes and their sensory system, which can be facilitated through various activities. However, the NICU environment is often not sensory-friendly, with bright lights, beeping machines, and frequent medical interventions that can disturb the infant's sensory experience.

Various activities are incorporated to provide calming input and facilitate emotional regulation of premature babies. For example, gentle rocking and rocking baskets help to integrate the Moro Reflex, while balance boards aid in developing core stability and integrating Babinski reflexes.

Additionally, massage therapy can help develop tactile awareness, deepen body connection, and improve self-regulation. These activities also promote physical development by targeting underdeveloped areas resulting from early birth.

Activities Tactile And Proprioceptive Integration

When it comes to sensory activities that support your child's tactile and proprioceptive system, varying clothing textures, blankets, and gentle vibrations can be beneficial. It's also crucial to ensure sufficient tummy time and modify it based on the infant's needs.

Tummy time can be done in various ways, such as on the parent's chest, with the parent reclined or lying on the floor, or with the baby placed on the parent's tummy. This position helps build strength and endurance, while also calming the infant and facilitating primitive reflex integration through sensory input.

In the NICU, the prone position can have a calming effect. If your baby is in the NICU, try to advocate for the prone position as much as possible (when safe) while they're in the incubator, as it has an organizing effect on the nervous system and can keep them calm.

Finally, it's vital not to skip the crawling phase of development for babies. Failing to develop primitive reflexes properly can cause infants to miss this critical stage. Crawling is crucial for not only gross motor development but also visual and fine motor development.

Activities For Vestibular Input Integration

To regulate your baby's sensory system after bringing them home, you can use gentle swinging motions, either by holding them in your arms or wrapping them in a blanket. Following up with a hug can also provide additional comfort for the child.

Walking while holding your baby close to your chest and facing outward is an effective sensory activity for co-regulating and keeping the infant calm. This position also allows for the baby to be in the flexion position, which is beneficial, and provides natural movement.

Incorporating basic visual activities that feature pictures with contrasting colors can help engage your child in slow visual tracking, promoting the development of their visual system. This activity can be a delightful way to interact during tummy time or when your baby is lying on their back (supine).

Activities For Auditory Input Integration

Classical music or a listening program can be beneficial for babies, as can using the metronome at a consistent 60 beats per minute or playing the mother's heart rate in the background. Rhythms are essential for infants, as they are used to the heartbeat and blood flow rhythm from inside the womb.

In addition to playing music, patting your baby's back in time with the rhythm can be a simple way to soothe and calm them. This activity can also be incorporated during bonding time in the NICU, along with talking and singing to your baby.

Activities To Overcome Feeding Issues

According to the Indian Journal of Occupational Therapy, preemie babies who underwent oral motor intervention, combined with infant massage (IM) therapy, demonstrated improved self-regulation and interaction. This was attributed to the graded tactile stimulation received during therapy, which also facilitated better interaction with caregivers.s.

Stimulating your child's cheek, rooting reflex, and suck reflex prior to feeding is crucial to initiate the feeding pattern. To provide additional stimulation that supports primitive reflex integration and helps your baby learn how to feed, you can try introducing a pacifier, slow flow bottle, dropper, cup, finger feeding method, or spoon.

While it's necessary for infants to go through these reflexes and integrate them into their system, it's also crucial for these reflexes to fade away over time. This is essential to prevent potential issues from arising later in life.

Progression Of Primitive Reflexes And Sensory Integration In Premie Babies

It's important for primitive reflexes to integrate or disappear in toddlerhood, and we should prioritize activities that support this process. These may include crawling, various gross motor activities, visual tracking exercises, and movements in different planes.

Providing various kinds of vestibular input, such as somersaults, rolling, or going upside down over a therapy ball, is crucial in achieving developmental milestones that are closely linked to primitive reflexes. You may also begin to observe your child's sensory preferences during toddlerhood, such as avoiding swings or enjoying them greatly.

It's important to be mindful of this and not allow them to completely refrain from movement or activities that involve getting off the ground. Avoiding sensory input that they find uncomfortable can impede their ability to process and regulate it; striking a balance is therefore essential.

To sum up, premature babies may face challenges with primitive reflexes and sensory integration, but there are activities that can promote their development. These include providing vestibular, auditory, and tactile input while engaging in exercises like crawling and visual tracking.

Preemies can achieve all their developmental milestones with proper care and attention. If you have any concerns, it's essential to discuss them with your pediatrician and occupational therapist.





While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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