When infants spend extended time in the hospital, it can be difficult to keep them to a normal developmental schedule.
To make the most of these stays, therapists across multiple disciplines at Monroe Carell Jr. Children’s Hospital at Vanderbilt collaborated to launch a new tool called Ready, Set, Go, which empowers families of patients in the pediatric cardiac intensive care unit (PCICU) to actively support their child’s neurodevelopment.
To use the Ready, Set, Go tool, families scan a QR code attached to a stoplight image posted in the patient room and find suggestions for healing-focused activities that are appropriate for the patient’s level of acuity. The child’s status is denoted on the stoplight, which is set to red, yellow or green depending on the nurse’s assessment of the patient.
“The whole idea behind Ready, Set, Go really started when we were noticing a lot of variability with how families were interacting with their kids, especially in the ICU, where it can be really overwhelming,” said Jenna Luther Beach, MOT, OTR/L, occupational therapist in Pediatric Rehabilitation Services at Monroe Carell. “We just wanted to create some sort of uniform solution that would help to empower families to be hands-on, even in the times that it can be the scariest.”
Even if a patient is in the red and unable to move around, parents and caregivers can still support healing through more hands-off activities such as reading aloud or decorating the room. The closer the patient is to green, the activities become increasingly hands-on and might involve movement or play. If a patient’s status allows, being active is a great way to support optimal neurodevelopment while in the hospital, according to physical therapist Hope Goudiss, PT, DPT.
“In this population, we’re looking at gross motor skills,” Goudiss said. “Giving these kids more opportunities to move is going to help them make progress, whether that’s working on their head control with sitting up or transitional movements like rolling. If they’re constantly being swaddled and kept quiet all day, or we’re scared to touch them, they’re not really getting those opportunities.”
For an infant, working on strength and balance means practicing movement from a variety of positions, including sitting and moving on their backs, sides and stomachs, she said.
Just as integral to an infant’s development is communication. Speech language pathologists (SLPs) play a critical role in helping infants develop that skill, beginning with nonverbal communication such as smiling, eye-tracking or babbling, eventually progressing to first words. In addition to supporting communication development, SLPs are there to help with feeding, said Nan Bumpus, MS, CCC-SLP.
“Particularly in the acute care setting, SLPs often provide feeding therapy as well,” explained Bumpus. “We assess the safety and efficiency of feeding and swallowing, and we can provide strategies to improve bottle feeding, such as positioning, type of bottle and flow rates. We also work alongside our wonderful lactation consultants to support breastfeeding.”
Between lactation consultants, nurses, physicians and others in the cardiac unit, it was important to get support from multiple disciplines to ensure Ready, Set, Go would be successful, said Luther Beach.
“It’s been a long-term thing that we’ve been working on behind the scenes … to make sure we have buy-in from everybody,” she said. “The first step was meeting with all of the physicians and making sure the criteria to determine these light statuses were appropriate.”
Above all, according to occupational therapist Morgan Njoroge, OT, using the tool is about empowering families to engage in the healing process at every step.
“It can also help empower families to be comfortable before they get home,” said Njoroge. “Rather than waiting until they’re right about to discharge to start doing those things, now they do them sooner. By the time they go home, they’re way more comfortable and doing way more with their children.”
When families take their children home, they don’t go empty-handed — they return to the nest with toys.
Through the Brett Boyer Foundation, a local nonprofit that raises awareness for congenital heart disease (CHD) and funds research to advance treatment options, families with children in the PCICU receive age-appropriate toys for infants to enjoy both during their time in the hospital and once they return home.
“We are thrilled to be able to supply the Ready, Set, Go kits for families in the pediatric cardiac unit,” said Jennifer Peyser, executive director of the Brett Boyer Foundation. “Our goal is to help families in as many ways as possible during their CHD journey, including neurodevelopmental services. The team at Monroe Carell Jr. Children’s Hospital at Vanderbilt does a great job in trying to find ways to support families, and it’s an honor to be a part of their hard work.”
The Brett Boyer Foundation went above and beyond, Goudiss said, to help design the kits by involving the therapists in choosing age-appropriate toys.
According to Njoroge, it’s crucial to make the healing environment as typical as possible for patients spending extended time in the hospital — and ready-made toy kits go a long way toward that goal.
“I’ve seen so many kids that I have never seen smile … that are now smiling at themselves in the mirror,” said Njoroge. “It’s such a big thing that I had not seen until those [toy kits] started coming out, and now I see it from so many more of them.”
The Ready, Set, Go tool launched in March, and the therapists who helped create it are eager to see how it helps move the needle for patients in the PCICU.
“This is considered a tool under what will hopefully be a larger push to focus on neurodevelopment in this population,” said Bumpus. “We’re providing better medical care now for these kids to live and thrive, so now we need to focus on not just surviving, but thriving. This will be a tool in that toolbox.”
