Premature Babies and Sensory
Issues
Fiona O’Farrell
Paediatric Occupational Therapist
Specialising in Premature Babies – Feeding,
Development and Sleep Difficulties
www.fionaofarrell.ie
Tel. 087 9144323
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Introduction
30 – 40 % babies born premature have subtle
discrete difficulties which may not become
evident until later
 Dev. Delays
 Attention Deficits
 Co-ordination difficulties
 Learning difficulties
 Emotional/Behavioural problems
 ( Autism at disproportionate rate )
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Associated with these Difficulties and
struggling with school curriculum
comes:
 Lowered Self Esteem
 Social Isolation
 Obesity
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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About 50% ELBW children require help
at school
Problems become increasingly apparent
with age
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Difficulties not picked up - really struggling in
preschool/school
Closer examination
Developmental Histories and research Studies
- Difficulties there since birth - More Subtle
form
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Long Term:

Poorer educational outcomes and drop
out from school
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Becoming aware of your senses!
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
What are the Senses?
Touch/Tactile
 Receptors in our skin respond to touch. Gives
us detailed info about our body
Proprioception
 Receptors in our muscles and joints
 Info about our body parts and how they are
moving
 E.g.. Touch your nose, eyes closed
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Vestibular
 Sense of Balance
 Change in movement
 Change in head position and gravity
 Develop and maintain normal muscle tone
 Co ordinate eye movements with our head
movements e.g. copy from blackboard
 Keep head up and maintain upright posture
important for sitting at table
 Ride a bicycle
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Auditory
 Screen out background noises
Visual
 Find objects in a background
Smell
Taste
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist

All the Information which is received via the
Senses has to be processed in the brain
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Sensory Processing is the term used.
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Brain responds to the Sensory Information
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Either Appropriate response or Inappropriate
response
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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The Sensory Systems develops In Utero
The Womb provides the ideal Sensory
Environment for our Babies
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
What does Womb Provide

Warm, Dim, Supportive, Soothing and
Confined
Enables:
 Build up muscle Tone, Sense of
movement, Sense of Touch to develop
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
What Does NICU Environment Provide

Noisy, Busy, Bright, Painful procedures
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Studies suggest:
 Premature Infants are not deprived of adequate
amounts of Stimulation
 Rather: - Receive Inappropriate patterns of
Stimulation detrimental to processing of Information
Brain of Preterm:
 Rather than being too immature to register and
process information appears to be
 Over Sensitive and unable to Buffer its intake of
Information!”
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
In mature Full term:
 These Sensory Subsystems support and
enhance one another and function smoothly
However:
 In Preterm These Sensory Subsystems
generally do not develop simultaneously
And are characterised by:
 Disorganised Behaviours and signs of Stress!
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Babies born Premature Do Not have
luxury calming, contained environment
Early exposure to extra uterine
influences results:
Different Adaptive responses Detrimental to Development
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Despite Major advances in Perinatal Care
 Preterm Birth increases risk of Neuro Sensory
impairments which greatly affect Daily Functioning!
Preterm birth
 Critical stages of Central Nervous System
development
Result:
 mismatch between intensity of Sensory Stimuli and
Infants Sensory System Maturation
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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These experiences increase Stress for
Preterm Infants
Associated with Regional Alterations in
Brain Structure and Function
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Sensory Experiences form basis for
learning in Infancy
Sensory problems that affect preterm
Infants contribute - higher incidence of
Later Developmental Disorders
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
How Senses impact on Premature
Infant and Long Term
Development
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Touch
Premature Infant
 Perceive soothing and painful interactions
 Feel changes of temperature, very sensitive
to light touch
 Lack of physical boundaries (womb),
containment
 Light touch, nappy change
 Lack of skin to skin sensations, own hands,
lack of opportunity contact with own body
 Pain
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Result Long Term
 Tactile Defensiveness.
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Feeding
Sleeping patterns
Tummy Time
Early perceptual concepts
Messy Play
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Vestibular ( movement & Gravity)
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Premature Infant can feel effect of gravity and
movement
Last trimester, baby inverts self, head down
preparation for birth. Provides intense input to
movement system
Experiences rocking movements
Moves weightlessly.
Meets resistance of Womb wall develops muscle tone
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Premature Infant
 Experiences Stillness
 No protection from gravity
 If lying on back, extremities fall
outwards
 Does not have muscle Tone to resist
Gravity
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Result
 Sensitivity to Movement
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Picked up
Different positions
Delayed Motor Milestones
Feeding ( Breastfeeding) Positions
Sleeping
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Long Term:
 Playground
 Fidgeting
 Coordination of movements
 Fatigue
 PE activities
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Smell and Taste
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Premature Infant can smell and taste scents and
flavours
In Womb responds favourably to sweet flavours
Premature Infant very Sensitive to
 Alcohol swabs
 Strong smelling cleaning agents
 Antiseptic soap, alcohol spray for cleaning hands
 Lack of sweet flavours & no soothing taste of breast
milk until able to feed orally
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Result Long Term
 Bonding
 Feeding
 Crying when exposed to strong smells
 Solids
 Oral Motor development for Speech
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Prolonged Sensory Input
Overwhelming Input from all Senses at once
Results
 Over stimulated State - Causes Stress &
Delayed Healing
 Crying. Uses all energy
 Difficulty Soothing self & Regulating State
 Delayed Development Sleep & Awake Cycles
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Constant Stressors from Environment means
all Sensory Systems constantly in Over Load
Parents ability to understand and respond to
baby’s needs
Parental anxiety
Self Regulation
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Difficulties with Sensory Processing
affecting ability to Feed

Hyper Sensitive to Touch

Oral Tactile Hypersensitivity
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Vestibular
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Behaviours
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist

Low Tone
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Positioning and energy exerted
Result – Fatigue
External Stimuli
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Lights, Sounds, Human Face – Too
Stimulating – Overload, Shut Down
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Feeding experience overwhelming
Often mums abandon breastfeeding
Sensory Hypersensitivity and Motor Planning
Problems
Result
Feeding process becoming more mechanical
- process of feeding more successful when baby
upright looking away from mum
Negative - baby learns to detach affecting social
development

May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Mothers Anxiety
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Negative reaction from baby to feeding
Result:

May 2017
Anxiety, Depression
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
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Difficulties with Sensory Processing very
Negative impact on Parent – baby
Dynamics
Early Feeding experience very important
aspect of building attachment bond
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Difficulties with Sensory Processing
affecting Sleep Patterns

Hyper Sensitive to Touch

Vestibular System
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Auditory

Visual

Self Regulation
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Babies Struggling:
 Regulation
 Sleep, Awake times, Feeding, Constant
irritability
 Dislike Tummy Time
 Difficulty with weaning onto solids
 Constant flitting one play object to
another
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Toddler Years:
 Feeding issues
 Sleep issues
 Behaviour issues emerging (hyperactivity,
Meltdowns)
 Difficulty with academic skills
 Fear of playground activities
 Can’t sit to attend
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
School Years:
 Clumsiness
 Constantly on the Go
 Difficulty with school related tasks
 Behaviours
 Emotional
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Role of Public Health Nurses
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Very Critical Role
Early identification of Sensory
Processing difficulties in Preterm Infant
Facilitate parental Education
Empowering parents
Involvement in Developmental
Programmes
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
Next Step for Public Health Nurses
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Further training. Evaluation of Sensory
Defensiveness in Premature Infants
Further training - Developmental
Programme for use with parents and
premature babies
Dates to be confirmed - Autumn/Winter
2017
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist
BIO
Fiona O’Farrell BSc Occupational Therapy from University of Ulster 1995
Specialised in the area of Paediatrics since 1997, particularly area of Early
Intervention, with special interest in babies born premature.
Have worked for both NHS and HSE and also private practice.
Have undertaken extensive postgraduate training including areas of
Sensory Integration, Baby Assessment and Treatment Training, Early
Assessment and Intervention for Babies born Premature ( NICU )
Privately I provide one to one Paediatric Occupational Therapy
assessments and intervention, Training for Health Care Staff, Parenting
Workshops ( promoting healthy sleep patterns) Corporate Training and
contribute to the Media on baby development and sleep.
Validated by Department of Health.
Board of Directors Irish Neonatal Health Alliance www.inha.ie
For further information see www.fionaofarrell.ie
Contact [email protected]
Mobile: 0879144323
May 2017
Fiona O'Farrell Specialist
Paediatric Occupational Therapist