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PROTOCOL ON NESTING AND POSITIONING

Purpose​

Making the baby feel safe and secure, and provide opportunity for optimum physical and neuro-behavioural development.
To imitate the foetal position and the womb, by nesting the baby. The nest prevents the arms and legs to fall out to the sides and limiting the baby`s movements. The nest gives the baby something to push against to practice flexing of the baby`s muscles. A nest can improve the baby`s sleep quality, temperature control, digestion, weight gain and strengthen the baby`s muscles. Babies who have not been nested can be faced with shorten neck muscles, problems with sucking on their hands, dislocated hips, and have problems with crawling, standing, sitting and walking later on.

Indications​

  • Babies below 1500 grams
  • Babies on ventilator or CPAP
  • Other sick newborns

Procedure​

  • Use linen to make an oval shaped nest and cotton for extra support. If linen is not available then cotton can be utilised. Tape can be used to secure the nest.
  • Make sure the baby`s airways are open and head not bent by using cotton under the neck.
  • The nest must be tight enough to provide the nesting effect, but not too tight making breathing difficult.
  • The baby’s arms are to be flexed and their hands are to be placed towards their face/mouth. Their feet are flexed and pulled towards the centre of the body. Avoid the frog position of the legs.
  • If baby is lying supine, make sure the baby is properly supported so that the arms and legs do not fall out to the sides. Placing the baby in the supine position makes it easy to monitor the baby and easier to do procedures. However, many believe it is not optimal for oxygenation.
  • When the baby is lying on the side, is it easier for the baby to curl-up and to suck on the hands, as gravity will help. Digestion is best when the baby is lying on the right side.
  • Many babies benefit from lying in the prone position with the head turn to the side, e.g. if the baby is in respiratory distress, digest poorly or if the baby is undergoing phototherapy. If the baby is lying in the prone position, it is recommended that the baby is on monitoring as lying prone are believed to increases the risk of sudden death. Put cotton or linen under the baby`s chest for comfort and to make breathing easier for the premature babies. A nest is still necessary when lying prone.
  • Most babies’ benefit form lying with a 30-degree headboard. This is especially important for preterm, babies with resperatory distress, have a lot of secretion, digest poorly or vomits.
  • The baby`s position is to be changed every 3 to 4 hours. This to prevent bed ulcers and edema, to better lung function, loosen secretion, increase motor development and improve head shape. Vary between left and right side, supine and prone position.
REMEMBER

NESTING IS SECONDARY TO MEDICAL TREATMENT

References:​

Practical Procedures for the Newborn Nursery, A Manual for Physicians & Nurses, by Deorari, Paul, Singhal, Scotland and McMillan and Neonatal Intensive Care by Merenstein & Gardner, 7 edition (2011).

Document Information​

Archived Version

Version: 1.0 (Archived)
Published: August 3, 2015
Contributors: Teaching Nurses from Norway and FBNCU Nursing Staff, JK Lone Hospital, SMS Medical College, Jaipur
View: Current Version