Most parents spend months imagining the moment they finally bring their baby home. It’s an exciting time.
But birth rarely follows a perfect plan. Sometimes babies arrive early and families find themselves stepping into a world they never expected: the neonatal intensive care unit.
In those moments, the hospital a family chooses suddenly matters in ways they may never have anticipated. For premature infants and their families, the NICU becomes both a medical lifeline and the first place parents learn how to care for their child.
Kate Castellano, an occupational therapist at Methodist Hospital | Stone Oak, says she is lucky enough to be part of the team that helps families navigate those first uncertain days -- helping the tiniest patients to begin developing the skills they will need for life outside the hospital.
But for Castellano, occupational therapy in the NICU is about far more than physical development.
“We focus on sensory information, neurodevelopmental care and bonding with the family,” she said. “We want the infant to understand good touch, a safe environment outside of their parents, and have the physiological stability to reach developmental goals and decrease delays that could occur from their prematurity.”
Helping tiny bodies learn how to move
Occupational therapy helps people throughout their lives regain or develop the ability to perform daily activities. In the NICU, that work begins almost immediately.
After a premature baby stabilizes -- typically around 24 hours of life -- therapists begin to evaluate the infant’s development and introduce gentle therapeutic interventions.
Sessions often begin with monitoring vital signs but quickly move into carefully designed sensory and movement exercises.
“We might do a massage with lotion or a two-point massage,” Castellano said. “It’s safe throughout the body and easy to teach families, which gives them something they can do with their infant. It gives them a sense of control, pride and love in helping their little one.”
Therapists also work on joint movement and motor development. Premature babies’ brains and muscles are still developing, which means they have not yet learned the fluid movement patterns most people take for granted.
“Their brains have to learn how to tell their bodies what to do,” Castellano said. “Everything we do to a baby from the minute they’re born sends a neural response back to their brain. Their brain learns from it.”
That learning happens through repetition. Each movement and sensory interaction helps the baby’s brain refine the connection between thought and motion -- a process known as motor learning.
Protecting growth and development
Because premature infants expend energy easily, therapy sessions are carefully timed.
NICU teams typically coordinate care so that babies receive treatment just before feeding time. After feeding, the infants are allowed to rest for extended periods so their bodies can focus energy on growth and development.
“When babies are resting and being fed, those calories go to growth and neurodevelopment,” Castellano said. “If we were bothering them throughout that time, they could be expending more calories instead of growing.”
For extremely premature babies, therapy may be delayed until the infant is stable enough to accept stimulation. In those cases, the focus remains on allowing the body time to recover and grow.
Feeding: A milestone that brings babies home
One of the most important milestones for any NICU baby is learning to eat independently.
While occupational therapists focus on movement and sensory development, speech therapists in the NICU serve as feeding specialists.
“People always think it’s funny because no babies leave the NICU talking,” Castellano said with a laugh. “But our speech therapists specialize in feeding and swallowing.”
Premature infants often need specialized bottle systems and slow-flow nipples because their suck-and-swallow reflexes are still developing.
The ultimate goal is for babies to take all their feedings by mouth and demonstrate consistent weight gain -- a key step toward being discharged from the NICU.
For mothers who want to breastfeed, the NICU team works together to support that goal. Lactation specialists help mothers begin pumping soon after delivery, and breast milk is prioritized whenever possible.
“As soon as moms can provide breast milk, that’s the first thing we give to the baby,” Castellano said.
Parents as partners in care
While medical technology and specialized training are essential in the NICU, Castellano says the most important part of care involves the baby’s parents.
From the moment an infant arrives, families are encouraged to be active participants in their child’s care.
“We want parents involved in all aspects of care from day one,” Castellano said.
Therapists teach families how to provide calming touch, change diapers, use pacifiers and safely hold their baby during skin-to-skin “kangaroo care.”
Parents also learn developmental activities that help premature babies grow stronger -- like tummy time, supported sitting and self-soothing techniques.
“We don’t want to send parents home without knowing what to do,” Castellano said. “Our job is to make them feel comfortable and confident when that day comes.”
That education continues throughout the baby’s stay. Many premature infants continue therapy after leaving the hospital through Early Childhood Intervention programs or home health services.
A team approach to care
NICU care involves a wide network of specialists who work together every day.
At Methodist Hospital | Stone Oak, daily rounds bring together physicians, neonatal practitioners, nurses, therapists and other specialists to review each baby’s progress and treatment plan.
Families are encouraged to participate in these discussions so they can understand not only what is happening, but why.
“Understanding the why behind every decision provides comfort for families,” Castellano said. “It helps them feel like they’re truly part of the process.”
That collaborative approach is central to the hospital’s philosophy of family-centered care.
“We are here for the infant, but more than that, we focus on the whole family,” she said. “They’ve given us their most precious gift, and we handle them with the care and love that we would give our own.”
Finding joy in the smallest victories
For Castellano, working with premature babies is not defined by difficulty, but by possibility.
“These tiny babies are the start of something so big,” she said. “I have the luck and the pleasure of helping families start out with their best foot forward during probably the hardest time of their lives.”
Over the years, she has stayed connected with many of the families she has helped.
Some return for annual NICU reunions, bringing children who once fit in the palm of a hand and are now running across the room.
“It gives us a sense of pride and reminds us why we get up every morning,” Castellano said.
For parents facing the uncertainty of a premature birth, those moments offer reassurance that even the most fragile beginnings can grow into strong futures -- with the right care, the right support and the right team by their side.
Click or tap here to learn more about Methodist Healthcare’s NICU locations and services.