HYPERACTIVITY

One of the symptoms of Neonatal Abstinence from many substances is hyperactivity or excessive movement. This is seen when infants continuously moving or are abnormally active. Often what is seen is thrashing of arms and legs. This hyperactivity can interfere with sleep and feeding your baby. The constant need for movement can make them more easily upset (dysregulated) and fussy.

NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.

NAS: Early Interventions

NAS Babies & Movement

The SOOTHE Technique

Sucking & Feeding Devices

STRATEGIES BY DISCIPLINE

NEURODEVELOPMENT

  • Swaddling is a very important and helpful tool in gently restricting all this movement and hence calming the baby (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking, and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.

  • Swaddling during feeds will be important to gently restrict movement so baby can put motor energy into the suck/swallow/breathe patterns.

  • Infant massage will be very important to help the baby with movement and stiffness.

  • Tummy time is important and will help the baby to have smoother movements and coordination of their muscles. It is important to make sure that the baby is safe in tummy time and to make sure that breathing passages are always clear.

  • Movement with pattern or rhythm will help modulate your baby’s need for movement. Exercises like playing ‘bicycle’ with the baby’s legs and pat-a-cake with the baby’s arms will help with excess movement. It will help to make it a part of the daily routine. For example, for 5 minutes after every day-time diaper change.

  • Provide what we call a low threshold environment – low lighting, warm/swaddled, no noise/calming music (see music offered here in the kit that were developed specifically to not be overwhelming), limited movement or rhythmic rocking.

  • MAKE sure to read and respond to the baby’s cues to inform your intervention or interventions. Remember that sometimes you may need to help your baby learn to calm with step by step calming techniques…

MEDICAL

  • It is important to determine the root cause of hyperactivity. If you are unsure you need to call your baby’s doctor.

  • Check to see if your baby is in pain. If you think that the baby is in pain you should call your baby’s doctor for assistance.

  • Recommended interventions:

    • Reduce the stimulation in the environment; lower lights, lessen noise, and use soft materials, make sure the room in a comfortable temperature (70- 72 degrees Fahrenheit).

    • Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.

NURSING

  • It is important to determine the root cause of hyperactivity. If you are unsure or symptoms do not go away you need to call your baby’s doctor office.

  • Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.

  • Change the infants position to make them more comfortable

  • Reduce the stimulation in the environment. Limit noise. Lower lights. Make sure the baby is comfortable (temperature and fabric).

  • Give the baby a warm bath.

OCCUPATIONAL THERAPY

  • Movement, especially if it is jerky and unwanted, can cause hyperactivity.

    • Swaddle (helps to limit the movement and provide calming) Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.

    • Change the position – some positions may actually feel painful while the infant is going through abstinence. Be aware of what positions are more calming.

    • Look at all the senses – are they overwhelmed? They may need you to decrease artificial lighting, background noise and eye contact in order to calm. Think about hearing (noise – even background noise might be increasing more irritation), touch (is your touch stimulating or is gentle but firm, fabric of clothing (soft textures) etc), movement (do they seek movement or does it make them more irritable) vision (is the light too bright or in their eyes, are you trying to make eye contact and they need a break right now). *note: eye contact is important but may be too much for an infant when they are moving, during calmer moments reengage with eye contact.

    • Rhythmic rocking as in Dr Kiti’s Soothe Technique will be very helpful to the baby.

SPEECH PATHOLOGY

  • It will help to teach them to use a pacifier. Sucking is very calming to the nervous system. You will need to teach them to use a pacifier when they are calmer so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.

  • They can be overwhelmed by what is going on in the environment. Hearing background noise, talking, TV, radio, even the sound of lights – this, especially, when they are all happening at once can cause the baby to be fussy and cry.

  • Most importantly, read your babies cues to inform your strategy.

  • Use swaddling especially during feeds to limit movement so baby can focus on suck, swallow, breathe pattern (SSB). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.