Occupational Therapy in the NICU

Tiki_Torch · Feb 23, 2004

In one hospital I worked, we had a decent sized Occupational Therapy Department and a couple of them had taken some special classes for working with neonates. They worked with other hospital patients as well and weren't specifically assigned only to the NICU. They were a great help though when we had babies who were having trouble learning to bottle feed. They'd come and assess the babies as they fed them figuring out what was most likely causing their feeding problem and would work with them each day to help resolve it. They met with the neonatologists and spoke with the nurses to help the baby resolve whatever issues were causing the problem. We all thought our OTs did a great job and we found them very helpful.

By the way, they only worked in the day time... I never saw one at night and I've always worked nights. I'd imagine most OTs work regular day hours and maybe take call on the weekends.... much different than most nurses.

Good luck on making your decision! I hope my input has been helpful in some way.

Tiki

lulu88 · Feb 23, 2004

Thanks Tiki! That was very helpful! One quick question- on an average day, how much time did the OT's spend working with the babies? How long were their sessions? Thanks again!!

dawngloves, BSN, RN · Feb 23, 2004

We have a PT/OT group that comes in about once a week. They evaluate high risk kids (micros, neuro) and leave us instructions on positioning and range of motion exercises. They mainly work out of our local children's hospital and specialize in peds, not neonatology.

Gompers, BSN, RN · Feb 24, 2004

One thing to consider is that there are thousands of jobs for NICU nurses across the country, but very few for pediatric/neonatal physical and occupational therapists. A typical unit might have 2 OT/PTs and 100 nurses. Your odds of getting to work in a NICU are much better if you go into nursing.

Of course, they are totally different jobs. Maybe you could shadow a nurse and an OT in a NICU for a few days, to see which job you'd enjoy more?

Good luck!

lulu88 · Feb 24, 2004

Thanks everyone for all of your helpful advice! Do they allow students to shadow a nurse in the NICU? I just assumed outsiders were not allowed for the good of the babies. Who should I contact about this? Also, one hospital near me has a level 3 NICU, and the other has a special care nursery. What is the difference, and would I be better off observing in one over the other? Thanks again!!!!!

Gompers, BSN, RN · Feb 24, 2004

Some NICUs are called special care nurseries, but for the most part:

Level I - normal newborn nursery

Level II - special care nursery

Level III - neonatal intensive care unit

The higher the level, the sicker the babies.

You'd want to go to the NICU, becuase here you will see therapists working with babies who have been sick for a while and need extensive therapy.

Tiki_Torch · Feb 24, 2004

Lulu,

To answer your question about how long the sessions were between the OT's and the babies...

Here is a typical scenario:

Baby not eating well... problems like weak suck; poor suck-swallow-breathe coordination; acts afraid to swallow; pulls away from any nipple feeding (aversion to bottle feeding for whatever reason); some type of deformity that causes difficulty eating, etc.

Neonatologist is aware of this from the NICU nurses telling him/her about the problem or from their physical assessment or other clinical tests that have been done.

Neonatologist decides to write an order for Occupational Therapy to work with and evaluate the baby.

OT comes and spends a good 30 minutes or so assessing the baby's reflexes and other things and then attempts to feed the baby as part of their assessment. From all their assessements (before and during feeding) they are able to formulate a plan for nurses to follow during the rest of the feedings. They write up their findings in the progress note part of the chart for the neonatologist and nurses to see. The OT then returns each day for one feeding to assess the baby for any other changes that need to be done and to assess the baby's progress. When the baby's problem is cured, the OT doesn't come any more.

Some things they'd suggest are certain ways to hold the baby or the bottle, certain nipples to use, certain ways to help the baby suck, behavior modification things to help babies with nipple aversion, etc., etc., etc.

So, to make a long answer short, our OT's would come once a day and spend a total of 30 minutes or so with the babies the Neonatologist asked for them to come see. They didn't visit each NICU baby... only the ones having problems that the Neonatologist felt could benefit from OT care. They didn't come to our unit all the time since most babies did just fine. I guess that's why they also worked with other patients all over the hospital too.

Sure hope this helps!

NicuGal, MSN, RN · Feb 25, 2004

We have 5 regular OTs for our unit. The positions are limited and most start out in the regular department then specialize in NICU and Peds.

Our kids all have a consult if they are less than 32 weeks. OT then decides if they will need complete following or just hit and miss. They also see the kids in the outpt clinic.

mrose22 · Jun 3, 2006

My NICU is in the process of changing to a blanket referral for OT orders, does anyone have any pros/cons/recommendations

lovemyjob · Jun 3, 2006

We have a PT for range of motion, massage therapy, etc. and speech therapy for feedings. We dont have a blanket order, but I could def see the benefit. Babies would be properly evaluated form the begining and would prevent wasting several days having nurses feed a baby who wont eat...I guess I see it as more efficient...the quicker we get successful po feeding means quicker to go home.

To the OP, I agree with Gompers...the job opportunities are a'plenty for nurses. But, at the same time, you do what will make you happy in your career. I think you can contact your local NICU and ask. We have volunteer baby cuddlers. That could be a way to observe from afar AND play with a baby! I think if you explain what you are trying to accomplish, they may be able to set you up to shadow a nurse and PT.

Best of Luck!!!

LMJ