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Interacting With Your Premature Infant: Identifying Overstimulation

Rose Mary, an Occupational Therapist since 1987, is experienced with pre-term infants, early intervention, school therapy, and home health.

Signs of overstimulation in premature babies and how to comfort an overstimulated baby.

Signs of overstimulation in premature babies and how to comfort an overstimulated baby.

Special Considerations for Premature Infants

Premature infants must fight to survive in a world that they are not yet scheduled to enter for weeks or months. Inside the mother, the infant is shielded from the full intensity of stimulation such as sights, sounds, and movements. The premature infant's central nervous system is not yet equipped to handle the environment and easily becomes overstimulated. This can cause the infant to feel stressed. The Developmental Care Model seeks to minimize environmental stress in the Neonatal Intensive Care Unit (NICU) and improve developmental outcomes.

What is Overstimulation?

Have you ever felt hopped up from too much caffeine? Or had a cold medicine that didn't agree with you? Remember that jittery feeling, like you could crawl out of your skin? Maybe you've felt overstimulated by sounds, and could not tune out routine noises, like the sound of machinery or air conditioning. Perhaps you became more aware of the clothes on your body. You may have wished you didn't have to talk to anyone, and that no one would talk to you. Maybe you wished you could escape to a quiet place. Do you get the idea of what it feels like to be overstimulated?

How Will I Know If My Baby Is Overstimulated?

Premature babies tell us they are overstimulated in many ways. Signs and signals of stress are grouped into three areas: autonomic, state-related, and motor stress signals. I have indeed seen virtually all of these stress signals exhibited by premies while working with infants and families in the NICU.

Autonomic or Visceral Stress Signals

  • Significant increase or decrease in breathing rate
  • Pauses in respiration
  • Changes in breathing patterns
  • Decrease in blood oxygen level
  • Changes in skin color, such as turning red, pale blue, ashy gray or mottled
  • Startling, tremoring or twitching
  • Gagging, gasping, spitting up, straining with or without a bowel movement
  • Coughing, sneezing, hiccuping
  • Yawning, sighing

State-Related Stress Signals

  • Whimpering sounds, facial twitches, or appearance of smiling
  • Eyes staring or floating, avoiding gaze, panicked look, glassy-eyed
  • Irritability, fussing, crying
  • Fluctuations of state systems, such as drowsy to sleep state, and back to drowsy
  • Increased motor activity while asleep
  • When awake and alert, the infant may not be able to handle focusing, and may look away (gaze avert)

Motor Stress Signals

  • Limpness of body, arms, legs or face
  • Tenseness of body, arms or legs
  • Splaying (spreading) of fingers
  • Grimacing
  • Hands in front of face, with hands open or fisted
  • Frantic flailing of arms and legs

Identifying Stress Signals

Your baby communicates in many ways. The fact that s/he becomes easily overstimulated is not anyone's fault. S/he becomes easily overstimulated due to her/his premature birth.

Ask members of your infant's team to help you identify stress signals. Don't be too timid to ask. Don't think that you should already know, or that if you don't that you are a bad parent. Stress signals indicating overstimulation have been identified and researched through years of study by healthcare professionals who take care of premature infants. This information has to be learned. It does not come automatically to anyone!

But how can I interact with my baby without causing overstimulation?

You can learn to interact with your infant in a way that is comforting to the infant. You can also learn to help comfort your infant when s/he is stressed by noises and activity in the NICU.

I like the sound of that! Tell me more about what I can do to comfort my baby.

To avoid overstimulation, try offering only one input at a time:

  • Offer a pinky finger to grasp.
  • Place your hand gently but firmly on her/his back or bottom.
  • Speak slowly in a soft, soothing voice.
  • Use your hand to tuck your infant's feet and legs near her/his bottom.
  • Gently swaddle, reposition “snuggly” or “bendy bumper”, or place rolled blankets to help your infant feel contained.

Anything Else?

Most NICUs routinely do things to insure the comfort of premature infants. You could review your child's NICU environment with her/his team for changes and improvements.

  • Does your child have a “snuggly” and “bendy bumper” or other containment?
  • Is the lighting low in the NICU, with additional protection to block out the light to your infant's isolette or crib?
  • Are there additional measures the NICU staff can pursue to reduce stimulation for your infant?
  • Is noise minimal? No radio? Quiet voices? Doors, hamper lids, drawers closed quietly, or padded to minimize noise?
  • Are more sensitive babies placed in low traffic, low noise areas?

How does my infant show s/he is not overstimulated?

Signals of an optimal state, indicating low stress, are the opposite of the stress signals.

Autonomic or Visceral Signals

  • Smooth breathing at a good rate
  • Good color
  • Good digestion

Motor Signals

  • Smooth movement and good muscle tone
  • Hand and foot clasping, grasping, hand to mouth movement, and sucking

State-Related Signals

  • Good sleep state
  • Good self quieting
  • Relatively easy to calm
  • Robust and rhythmic crying
  • Focused, alert attention to face of caregiver
  • Animated expressions

A Word About Feeding

Most babies are unable to feed by sucking on a bottle before 34 weeks gestation. Readiness for nipple feeding of course varies from baby to baby. If I observed 3 to 4 stress signals in the infant, I would gently attempt to feed. If I observed 8 to 12 or more stress signals, I would defer bottle feeding and recommend the infant be continued on tube feeds. Feeding readiness also depends on medical conditions, if any, such as motor or breathing problems.

Your infant's team feeding specialist could be a Speech Therapist (Speech Language Pathologist) or Occupational Therapist. Occupational Therapists often assist in individualizing your infant's needs for feeding readiness. Strategies suggested by Occupational Therapists for feeding your infant might include:

  • Swaddling to contain your child, holding firmly
  • Minimizing movement during feeding
  • Placing the nipple in the baby's mouth and holding it still
  • Stroking the cheek once or twice gently if needed to encourage sucking
  • Maintaining a quiet environment with minimal talking to your infant during the feeding


Developmental Care Model provides a framework for examining and responding to stress in premature infants. By minimizing stress, the infant's chances to thrive are enhanced. This model has been studied with good evidence in terms of measures such as decreased duration of NICU stays and improved developmental outcomes.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.


Melis Ann from Mom On A Health Hunt on March 31, 2012:

Critical information for parents to know about their NICU babies. I'm posting a link to your hub within my hub for pregnant women to educate themselves on the importance of finding a well qualified NICU.

rmcrayne (author) from San Antonio Texas on June 27, 2011:

Thanks for visiting ClaireH. Sounds like you got good advice. I hope your baby is healthy and well.

ClaireHaley from UK on May 23, 2011:

Interesting Hub. My baby was born at 24 weeks and spent a long time in an incubator. To sooth him i was advised to gently place one hand on the top of his head and the other holding his feet. Apparently this helps them to feel secure and that there are boundaries to their alien environment. When i first held him at 3 months old it was awesome.

rmcrayne (author) from San Antonio Texas on September 06, 2010:

Thanks so much for your comment Eiddwen.

Eiddwen from Wales on September 04, 2010:

This hub was really interesting. Well written and very informative. Well done!

rmcrayne (author) from San Antonio Texas on October 09, 2009:

Cari Jean from the Melissa Gilbert book review! Thanks for reading and commenting. Coming from a premie graduate mom, it means a lot. This information was from a handout I developed a few years ago to use in educating parents. Thanks also for sharing about your daughter Faith in your recent hub.

Cari Jean from Bismarck, ND on October 09, 2009:

What a great, informational hub about preemies. My daughter was born at 29 weeks and we spent 2 months in the NICU. Everything you wrote sounds so familiar. I don't think most people understand just how different a preemie is from a full-term baby. This would be a great hub to send to someone for that kind of information.

rmcrayne (author) from San Antonio Texas on October 07, 2009:

Thanks OT mommy! Looks like your website is a good match. I'll include it in my links here. Take a look at my Children's Behavior- Sensory Regulation hub. It is about sensory processing.

Keep doing what you're doing. Although your area hospitals may offer excellent care, don’t give them too much credit. For whatever reason, even nurses and other staff that know about Developmental Care, don’t necessarily practice it or teach it to parents.

OTmommy from Southern USA on October 06, 2009:

Very thorough information. I, too, am an OT. I work in early intervention with children under the age of 3 years, and frequently help infants who recently graduated from the NICU to the home. I often am teaching the parents the sleep/wake states and how to calm their infant. Although hospitals in my area probably do a great job of training the families, I find that the parents need more education in this area. That is what motivated me to create my website I provide information on how to calm & "perk up" babies with sensory input as well as suggest ways to promote sensory processing during daily routines and playtime.

rmcrayne (author) from San Antonio Texas on October 01, 2009:

Thanks atoms. These angels are often so fragile.

atomswifey from Michigan on October 01, 2009:

great hub! Very informative and just wook at dos babies, awww how cute

rmcrayne (author) from San Antonio Texas on September 26, 2009:

Thanks Specialk. I am an Occupational Therapist and worked in the NICU at Wilford Hall Medical Center, Lackland Air Force Base, San Antonio TX. I trained at Franklin Square Hosp in Baltimore. Sometimes I was asked by the docs to consult, and wound up telling them exactly what their nurses had been trying to.

Karen Metz from Michigan on September 26, 2009:

Good information rmcrayne! Did you work in a NICU or have a premie? I had a premie back in 1994 and the NICU nurses were great! I learned so much from my 4 months spent there. I was amazed at the skill level of those nurses.

rmcrayne (author) from San Antonio Texas on September 19, 2009:

Thanks Veronica. Coming from a mom, that's high praise. Your Kangaroo Care hub is a perfect companion to mine.

Veronica Allen from Georgia on September 18, 2009:

I really appreciate the detail you put to this hub. Having a baby is scary in-of-itself, but when your baby is premature, it adds to the fear. I think this hub will put a lot of parents at ease and will educate them in just how to take care of their precious little ones.

rmcrayne (author) from San Antonio Texas on September 17, 2009:

Thanks so much Irohner! You're so right. We didn't see many full term babies or full sized babies in our NICU compared to the oodles and oodles of premies and micropremies. Overstimulation occurs in all ages, the stress signals just change!

lrohner from USA on September 16, 2009:

Great hub, and great detailed info! I think there are a lot of tips in here that will help new moms understand their newborns more -- whether they're preemie or not.