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In this episode, we sit down with Angela Fritz, a board-certified pediatric physical therapist with a passion for infant development. Angela brings her expertise working in the NICU and shares valuable insights on supporting babies from the very beginning—especially those who’ve spent time in the NICU.
We dive into:
The role of physical therapy in the NICU
Tummy time and developmental milestone tips for infants (including NICU grads)
The importance of positioning for development
Primitive reflexes and how they influence early movement
Practical advice for parents and caregivers
Whether you're a therapist, parent, or caregiver, you'll come away with actionable tips and a deeper understanding of the early building blocks of development.
Angela Fritz, PT, DPT, PCS is a board-certified pediatric physical therapist who specializes in infant development. She received her doctorate degree in physical therapy (DPT) from the University of Washington (Go Dawgs!) and has worked with infants and children ever since! Angela just recently moved to Boise, ID and works in the NICU and NICU follow up at St Luke’s Children’s Hospital, but was trained in neonatal therapy at Seattle Children’s Hospital. Though her passion lies with infants, Angela has experience working with children 0-18 years of age. She is passionate about celebrating the unique spark in each and every baby, and believes that empowering parents to advocate for, engage with, and support their baby is the best way to foster lifelong success. Angela was also born with hearing loss and is passionate about disability awareness, inclusion, and justice and making healthcare more accessible for all!
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All Things Sensory Podcast Instagram
When a baby is born prematurely or with complex medical needs, the NICU becomes their first home. But alongside lifesaving medical care, these tiny babies also need something just as vital: sensory-rich, developmentally appropriate interactions.
That’s where neonatal therapists like Angela come in. In this post, we explore how tummy time, skin-to-skin care, and positioning in the NICU set the foundation for healthy sensory and motor development—especially for babies with feeding tubes, medical fragility, or who are born prematurely.
The NICU is often seen as a sterile medical space, but for therapists, it’s also a place to begin neurodevelopmental care from day one. Angela explains it perfectly:“NICU therapy isn’t rehab—it’s habilitation. We’re setting babies up for success right from the start.”
This includes:
Safe, supportedtummy time.
Parent education around handling and sensory development.
Early intervention forfeeding readiness,muscle tone, andvestibular input.
Postural control and head shaping.
Oral motor and sensory development.
Visual exploration.
Overall motor milestones like rolling and crawling.
Angela describes using custom-made “surfboards” (foam positioners tailored to the baby’s size) to make prone play both safe and therapeutic. With the right modifications, even babies with G-tubes or recent surgeries can benefit from tummy time.
Start withchest-to-chest tummy time (parent holding baby).
Use soft foam or aZ-Flow pillow to offload pressure from sensitive areas.
Gradually build tolerance withshort, frequent sessions.
Partner withrespiratory and nursing teams for safe positioning.
A common myth? Babies with feeding tubes shouldn’t do tummy time.
In reality, with surgeon approval, most babies are cleared for tummy time 10–12 days post-surgery. Angela empowers parents and therapists with tools like:
Blanket rolls or Boppys for gentle incline support.
G-tube belts or pads to reduce friction.
Gradual reintroduction of prone play during parent holds or floor time.
OT Tip: Start small—do tummy time during diaper changes or just before a feed. Even a few minutes counts!
Traditionally, NICUs have focused on minimizing stimulation. But Angela shares that safe, developmentally appropriate sensory input is not only beneficial—it’s critical.
This includes:
Skin-to-skin contact (shown to reduce cortisol and improve sleep).
Vestibular input like rocking or movement in the arms.
Auditory and oral stimulation like binkies or facial massage.
Did you know? Even intubated babies can benefit from a pacifier for non-nutritive sucking—priming them for future oral feeding.
Babies, especially those born prematurely, can’t maintain a flexed, midline posture on their own. Angela’s team uses nests, splints, and positioning tools to mimic the protective fetal environment and support:
Symmetry to prevent torticollis and head flattening.
Movement variety to prevent sensory deprivation.
Muscle tone development through supported prone, side-lying, and upright play.
Angela’s role doesn’t stop at discharge. She ensures parents go home with:
Tummy time routines tailored to their baby’s needs.
Clear guidance for G-tube care and positioning.
Home exercises that blend seamlessly into daily routines.
Her mantra?“Back to sleep, tummy to play. An hour a day keeps the PT away!”
Angela emphasizes that discomfort is not danger. Crying during tummy time is common—and often means baby just needs some support and motivation.
Here’s how parents and therapists can help:
Get face-to-face on the floor.
Use mirrors, favorite toys, or bubbles to engage.
Try vestibular-rich movement (e.g., on a yoga ball or in arms).
Make tummy time routine and make it consistent.
Start where they’re comfortable: If flat floor time is a no-go, try tummy time on your chest or in a supported hold.
Angela encourages aspiring neonatal therapists to:
Build infant experience in outpatient or early intervention.
Take courses through NANT (National Association of Neonatal Therapists).
Seek mentorship and observe NICU teams whenever possible.
Above all, she reminds us that NICU therapy is about being both evidence-based and heart-centered.
Whether you're a parent navigating life in the NICU or a therapist supporting fragile infants, Angela’s insights remind us that tiny babies are capable of so much more than we give them credit for—especially when given the right environment and support.
Remember:
Tummy time is always possible, even with medical complexity.
Positioning matters for reflex development and motor skills.
Safe sensory input like skin-to-skin, movement, and oral play builds the foundation for feeding, mobility, and more.
Parent education is key—the NICU is only the beginning.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
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.
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