SENSORY RELAXATION SENSORY STIMULATION AND PLAY.

1. SENSORY RELAXATIONSENSORY STIMULATIONAND PLAY. Anne Aspin Nurse Consultant – Neonatal Surgery Yorkshire Neonatal Network. 2010

2. Snoezelen. • Developed in Netherlands as a ‘sniff and doze’ method of relaxation for handicapped children and adults. Hulsegge and Verheul 1987. • Their technique involved relaxing aromatic smells, listening to soft music and watching a variety of light sources and coloured baubles. • Today, we have lava lamps, alternating bubble tubes, fibre optic shower threads and projected pictorial images.

3. BACKGROUND. • It was from the notion of pain management that an idea was generated to create a sensory and relaxation room for infants and their parents within the ward area. • There are many sick infants who require a number of surgical procedures and need to stay in hospital for months and experience many painful procedures.

4. In the short term: Apnoea Bradycardia Hiccoughing Vomiting (Pinnelli and Symington 2001) In the long term: Clumsiness Decreased motor skills Sensitivity to stressful events later in life. (Winberg 1998) Effects of pain, discomfort or distress.

5. Sensory stimulation • In order for neuro developmental pathways to develop and mature, an experience of the senses taste, smell, hearing and vision is necessary first (Schultz 1992) • A well, term infant cared for by a loving, stable family and environment, and their first encounters to stimulate their senses ex utero are pleasant, the potential for their development can be optimal. • However, this is a different story for those sick and/or preterm babies who are exposed to multiple detrimental stimuli.

6. Sensory relaxation • Sensory relaxation • Effective to relax if fretful or fussing • Relax after sensory stimulation • Promote quiet sleep into deep sleep • Rocking • Kangaroo cuddling- encourages breast milk • Bathing • Soft music • Soft lighting • Create an air of calm

7. Tactile sensitivity • Stroking the head • Massaging hands and feet • Limb exercises • Lying prone over a wedge • Re educate not all touch is painful

8. Parents Parents are encouraged to spend some quality time with their infants in the sensory room, to minimise stress for both the infant and their parents. • Breast feeding • Expressing their milk • Bathing • Cuddling • Floor exercises • Stimulating hand held toys.

9. Quiet time The period spent in the snoezelen room is a special quiet time for parents so they may build a loving relationship out of an extremely stressful roller- coaster experience in an acute hospital environment.

10. Growth and development • Young(1994) identifies developmental care as specific interventions to facilitate and promote infant growth and development by optimising potential outcomes and minimising developmental impairments. • Neonatal surgical infants who have undergone extensive bowel surgery (NEC) and need long term TPN. Growth is interrupted on numerous occasions due to milk intolerence.

11. Hungry infants expend vital energy reserves needed for growth • by 200% through increased basal metabolic rate from • crying (Pineyard 1994). • Klaus et al (1982) • Early interactions between parent and child are needed for • emotional security and cognitive, social and educational • development. • Lupton and Fenwick (2002) • New mothers feel overwhelming despair, grief, alienation • and a sense of needing to ask permission to touch or care • for their baby on a neonatal unit.

12. Sensory stimulation • In order for neuro developmental pathways to develop and mature, an experience of the senses taste, smell, hearing and vision is necessary first (Schultz 1992) • A well, term infant cared for by a loving, stable family and environment, and their first encounters to stimulate their senses ex utero are pleasant, the potential for their development can be optimal. • However, this is a different story for those sick and/or preterm babies who are exposed to multiple detrimental stimuli.

13. Nurses encourage, teach and support parents how to interact with their infant and interpret behavioural cues such as distress, discomfort, hunger or quiet, alert and relaxed states. Although there are parents who sit by the bedside for hours and learn cues themselves (Sparshott 1989). Parent support

14. Cerebral irritation Convulsions Neurological problems Drug exposed infant Hypersensitive infant -post surgery. Sepsis, injury or anaemia Swaddle/contain infant, reduce environmental stimulation. Avoid any stimulation. Use holding techniques Swaddle, rock or warm bath to relax Holding techniques, use of boundaries. Containment holds if distressed. Nursing responsibilities

15. Planning • Teaching parents how to recognise infant behaviour and provide some strategies to give comfort and reassurance. • Develop a plan of care together with the parents and build a positive relationship. • Between the family and baby this promotes parental confidence, increased eye contact, increased weight gain, shorter hospital stay and longer duration of breast feeding.

16. Six weeks post term tactile stimulation Different textures Large shapes By four months, hold and move small hand toys

17. Auditory stimulation Auditory stimulation. Auditory pathway functional by 20 weeks gestation Rattles, bells and chimes hold attention for 10 -15 seconds before concentration is affected.

18. Sessions • Initial session of five minutes. • Increase as tolerated to a maximum of ten minutes • Extensive literature searching revealed no evidence based guideline • Positive touch by parents is a relaxing experience, no time limit is set, whilst it is pleasurable and induces a quiet sleep into periods of deep sleep. • Personal experience has shown by giving the parents information they need, it provides some control and privacy to go into the snoezelen room on their own.

19. preferences • Distinguish mother from stranger by two weeks of age • Fix and follow a small object by six weeks • Babies show a preference for human faces • Track a moving object by four weeks

20. Behavioural cues • Behavioural cues in infants are a type of body language portraying how an infant is feeling • There are many different cues that if misinterpreted can cause detrimental outcomes by over stimulation, particularly if the infant did not want to be disturbed. Do not disturb

21. Neonatal and nursery nurses. Enabling nurses to remember behavioural cues byAls(1986) Assessment of Preterm Infants Behaviour Framework. • Physiological – pattern of resp, gagging, hiccoughing, sneezing, yawning. • Motor – posture, pattern of moving, arching, saluting. • State of sleep – refers to type of sleep and wakefulness • Attentiveness – response to stimuli • Self regulation – the ability to respond to stimuli and maintain a stable state.

22. responsibilities • No clinical procedures in snoezelen room –safe haven. • Find out medical history –plan programme with parents • Aim for balance of stimulation and relaxation • The length of time will be different for each occasion depending upon baby responses • Give praise, encouragement and support to parents to promote self confidence in an environment that can be intimidating.

23. continued • Inform parents how to • recognise baby behaviour. • Nurse be aware of trigger • factors, teach parents how • to alleviate distress. • Quick response to crying.

24. Diary • A developmental diary is a useful aid to plan developmental care and improve communications between parents and professionals.

25. Adverse behaviour is highlighted so it can be avoided in the future and alternative techniques can be tried!!!!

26. THE END WHAT A SENSE OF ACHIEVEMENT WHEN PARENTS FIND THE CONFIDENCE TO FINALLY TAKE THEIR BABY HOME.

27. Audit • Parental questionnaire. • Parent satisfaction • Safety • Supervision

28. Research • Seek the evidence • Clinical governance • To do no harm • Optimise potential.