Camryn is a 6-week old baby girl who was born at 26 5/7 weeks gestation. She is now 32 5/7 weeks post conception. Camryn weighs 3 lbs. 4 oz. (148Ogms: 25th %ile). Her head circumference is 10 3/4 inches (27cm: 10th %ile). Camryn is on nasal CPAP with an oxygen level of 68-95% (room air is 21%). Her most recent apnea/bradycardic spells were on April 4 and she has not had any since that time. She is currently receiving iron drops to help increase her red blood cell count, Ampicillin (to help prevent any possible infection), Dexamethasone (to help decrease the inflammation in her lungs) and Ranitadine (to help decrease the acid in her stomach). Camryn is fed breast mild with added fortifiers and calories via an OG tube. She receives milk on a demand scheme every 2 to 4 hours as she wakes up and wants to eat. Camryn had an eye exam yesterday that was normal and has had 3 head ultrasounds, all of which have been normal.

On the basis of this observation, Camryn is a competent, appealing little girl. She is stirring and waking for her feedings. Camryn displayed her protest to the prongs in her nose and some caregiving activities by actively extending her arms and legs, grimacing and crying. She was successful in her own efforts to comfort herself by bracing her feet against each other and the lower boundary of her bedding. She was also successful in her own efforts to grasp and bring her hands to her face and needed further support from her caregiver with this. She made a few successful efforts to suck on her pacifier when it was offered. Camryn showed the costs of caregiving interaction by her dusky and webbed color and increased work of breathing. She was unable to maintain a flexed position without support and kept her back arched uncomfortably. Camryn was able to maintain a low level of quiet, alertness for several minutes before getting stuck on looking at a light next to her bed space. Camryn was able to transition fairly easily into alight sleep after caregiving interaction and had frequent twitches and tremors of her arms and legs.

1. Continue to care for and support Camryn including providing skin-to-skin contact with her on their chests.

On the basis of this observation, Camryn appears to be working towards:

1. More relaxed wakefulness when touched or moved with caregiving interaction.
2. Relaxed, pleasurable interaction with her caregiver during quiet alert times. More even breathing and less frequent pauses
3. Quiet, more restful sleep after caregiving interaction
4. Being successful in her OWN efforts to grasp and bring her hands to her face to keep herself calm during care with good support
5. Keeping her back rounded with her chin in a more neutral position

1. Consider all light sources when lifting the incubator cover and protect Camryn's eyes from bright lights.
2. Continue to support Camryn in a quiet sound environment so she can focus on the soft voice of her parents or caregivers during quiet, awake time.

1. Support Camryn in a side-lying position with boundaries close enough and high enough to help keep her in a tucked position where her own efforts to grasp her hands and brace her feet can be most effective.
2. Consider placing the rolled cloth midline for her arms only to allow something for Camryn to grasp and keep her feet available to brace against each other.
3. Continue to provide skin to skin contact with Camryn's mother and father for extended periods of time on their chests.
4. Pay attention to Camryn's CPAP tubing, making sure it's long enough to help keep her chin in a neutral position
5. Position Camryn's bedding with enough support that "I allow her back to be rounded and slightly forward.

1. Continue to time the caregiving interactions when Camryn is stirring and showing signs of wakefulness.
2. Provide continual and careful support during caregiving, especially with position changes. Help Camryn keep her body rounded, not arched, her hands by her face and legs tucked and feet braced against each other and offer support not restrainment.
3. Consider positioning Camryn on her side during caregiving so she can use her arms and legs to bean active participant.
4. Consider holding Camryn during her OG feedings and offering her pacifier is she's calm and settled.
5. Consider talking softly to Camryn or making eye contact with her when she shows signs of awake and alertness to provide meaningful interaction for her, being careful to pay attention to her threshold.
6. Consider Camryn's feeding interaction a time of pleasurable, nurturing experience in which every interaction counts!