What does a neonatal physiotherapist do?

Neonatal physiotherapists are specialists in assessing and supporting neuromusculoskeletal development, movement, muscle tone, positioning and postural control for all infants at risk on the NNU. Physiotherapists work closely with families to support the parent-infant dyad and empower caregivers to recognise and respond to infant cues, leading to improved infant and family outcomes.

Research shows that early intervention is essential within the first two years of a child’s life, to optimise the infant’s later function and abilities. Physiotherapists have specialist skills to identify any early signs of subtle neurodevelopmental difficulties, and they are trained to use specialist assessment tools, to ensure access to early intervention and support. Neonatal physiotherapists also have expert knowledge in respiratory and orthopaedic care. They can identify infants at risk of respiratory compromise, provide individualised airway clearance advice, and consider additional respiratory physiotherapy interventions, to optimise respiratory function and support neurodevelopment.

The Association of Paediatric Chartered Physiotherapists (APCP) have developed a “Guidance for Good Practice”  Guidance for Good Practice for Physiotherapists Working in Neonatal Care | Association of Paediatric Chartered Physiotherapists which provides guidance and capabilities for all neonatal physiotherapists, ranging from foundation to enhanced level.

Positioning posters

Here are some posters to help staff and families provide optimal positioning for infants in the neonatal unit.

Optimal positioning is a vital part of developmental care. It supports comfort, reduces stress, and promotes positive neurodevelopmental outcomes in both preterm and term infants. Wherever possible, infants should be positioned in flexed, midline, and well-supported postures that approximate the intrauterine environment. This helps to facilitate self-regulation, musculoskeletal development, and overall well-being.

Please remember that positioning must always be individualised, taking into account each infant’s gestational age, medical condition, and tolerance. The examples shown are intended as guidance and should be adapted in consultation with the wider healthcare team.

Produced in a collaborative effort, NCEL physiotherapists, regional care coordinators, and the ODN comms and engagement lead have developed physiotherapy positioning posters.

Respiratory Management and Airway Clearance Guideline

This guideline is designed to support neonatal staff who complete respiratory management and airway clearance techniques on the
neonatal unit to optimise respiratory function and ensure safe and appropriate practice. It also outlines how neonatal nursing staff can identify escalation strategies and management options.
Download the file here

We are in the process of developing an education package to go alongside the respiratory management and airway clearance guideline. This package will be available to all of the neonatal MDT, ensuring each unit have access to the same education and training to optimise airway clearance for all our infants. Please contact our ODN physiotherapy leads if you would like further information on this – Maria contact link.

Bliss webinar MDT spotlight on Neonatal Physiotherapy

This webinar, hosted by Bliss, is aimed at neonatal healthcare professionals and discusses the neonatal physiotherapy role, how we work with the wider neonatal MDT, and our role in supporting families and optimising infant and family outcomes. It features a Q&A and a discussion with 2 neonatal physiotherapists, featuring Anna Lukens, London ODN Joint Lead Physio.

Link – Bliss webinar MDT spotlight Physiotherapy Professionals

Other useful links

The Neonatal Physiotherapy staffing recommendations (2023) document provides physiotherapy staffing ratios for neonatal units across the country, as highlighted by the NHS England Neonatal Peer Review process. It was initially published in 2018 and reviewed in 2023.

Neonatal Staffing Recommendations | Association of Paediatric Chartered Physiotherapists (csp.org.uk)

The Guidance for Good Practice for Physiotherapists Working in Neonatal Care (2020) document provides guidance relating to the physiotherapy management of preterm and at risk infants on neonatal units. It is due to be updated in 2024.
Guidance for Good Practice for Physiotherapists Working in Neonatal Care | Association of Paediatric Chartered Physiotherapists (csp.org.uk)

Parent leaflets

May be useful to signpost parents to:

Awake Time Ideas
awake_time_ideas_2015.pdf (csp.org.uk)

Head turning preference and plagiocephaly
Head Turning Preference and Plagiocephaly 2020_0.pdf (csp.org.uk)

Positional Talipes Equino-Varus
Positional talipes (CTEV) 2023 (1).pdf (csp.org.uk)

Positional Talipes Calcaneo-Valgus
Positional talipes (CTCV) 2023 (1)_0.pdf (csp.org.uk)

Spina Bifida
Spina Bifida.pdf (csp.org.uk)

APCP

The Association of Paediatric Chartered Physiotherapists (APCP) have a neonatal committee page, which has links to various resources and leaflets for staff and parents, as well as training opportunities: Neonatal Committee | Association of Paediatric Chartered Physiotherapists (csp.org.uk)

Resources

Watch the Bliss Webinar 
Neonatal psychological professionals staffing