A day in the life of a Neonatal Physiotherapist
Hi, my name is Emma Cave and I work clinically in the NICU at William Harvey hospital, Ashford and SCBU at Queen Elizabeth the Queen Mother, Margate. I am also Lead Physiotherapist for Kent, Surrey and Sussex ODN. I work clinically on the units and spend time in Neonatal Neurodevelopmental follow up clinics, assessing and treating our baby unit graduates until they are 2 years corrected age.
I can honestly say, I do not have a typical day and my working life is extremely varied. I do have an amazing team of unit physiotherapists, who work all around the network and together we have tried to create an example of a typical few days.
Our days start with handover and ward round, just one of our referral routes, where we may be asked to provide ad hoc assessment and treatment to individual babies, as well as advice and reassurance to parents and other members of the MDT. Our approach is very much ‘proactive, rather than reactive’ and by spending time in the nurseries, we are able to offer a universal approach to the benefit of all babies. A more targeted approach can be given to those babies at higher risk of developmental delay and it is this cohort that we would routinely screen for neurological or developmental concerns. We use standardised assessment tools offering longitudinal assessment and always try to involve the patient’s greatest therapists – their family! Our aim is to work collaboratively with parents as they know their child best.
On the ward, we work directly with families on positioning and handling to optimise experience of movement and therefore outcome for the baby. Providing appropriate support and motor opportunities is critical. We are actively involved in creation of Positioning Principles of Practice and teaching to all members of the MDT. This can be in the form of formal teaching sessions or take the route of more informal cotside discussions.
Timing of our intervention is largely determined by the individual baby and their parents. We try to limit our intervention if the baby has a number of procedures on any given day and definitely aim to avoid the unit’s quiet time, to protect the baby’s rest. Our sessions may be joint with the OTs, SALTs, developmental care nurses or play specialists. We are always aiming for collaborative, functional goals which are decided in partnership with the baby’s family. Assessment and treatment may involve orthopaedics, respiratory or neurodevelopment (or any combination of the above!).
When we are not directly assessing and treating babies in the nursery, we may act as a second pair of hands to assist medical/nursing staff during procedures. Containment holding helps to settle the babies and keep their heart rate and oxygen saturations within normal limits. We promote FICare and developmental care, always looking to optimise the outcome for each baby.
Away from the cotside, we may be asked to contribute to discharge planning, psychosocial meetings, developmental care team meetings, parent craft sessions and be actively involved in audit and research. We are constantly working in partnership with families, other members of the MDT team, community teams and the safeguarding team. Always striving to enhance the experience of the patient and thinking ‘bigger than the baby’.
On other days, we spend time in MDT follow up clinics. With the consultant neonatologists and paediatricians, we contribute to assessment of high risk infants carrying out multifaceted neurological and developmental assessments and providing advice, support and hands on therapy as required. Anticipatory guidance is given to all of our families to promote normal development. As needed, short blocks of timely intervention and therapy can be carried out, often preventing unnecessary referral to the community teams. Therapy may be carried out in clinics, at the patient’s home or in a nursery setting.
Being a neonatal physiotherapist is extremely rewarding. The variety in workload provides a constant challenge and there is always something new to learn. It is such a privilege to be part of the families’ lives and be able to make such a difference to their neonatal experience and ultimately their outcome.
