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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
Flat spots, tight necks, and delayed motor milestones are more common in NICU graduates than most people realize. But they don't have to be scary. With the right information and support, families can help their babies thrive through simple, intentional movement. My guest today, Dr. Jessica Smith, is a pediatric physical therapist and founder of Rocketship PT. She's here to help us understand why these issues happen and what to look for and how parents and professionals can make everyday movement feel empowering and not overwhelming.
Mary Farrelly (01:05)
Hi everybody and welcome back to this week's episode of the NICU Translated Podcast. I'm so excited to have Dr. Jessica Smith here today and she is going to, we're gonna dive into all things head and neck in baby development and really like what does this look like in the NICU and how can families help support their baby's development at home too. So welcome to the show.
Dr. Jessica Smith PT, DPT (01:18)
you
Thank you so much for having me. I am so glad to be here. I was so glad when I found you and what you are doing for families. And I just think that if we all just work together, it's just that much better. So thank you so much for having me.
Mary Farrelly (01:44)
I love the, I always say like the social media gets a bad rap, but the connections that I've found are just incredible. And there's so many, it used to be, I feel like everyone's so siloed and everyone was doing their thing and their own little bubbles. And we're like, what if we just did it all together? Like how much better that would be. So I'm so excited to have you together. So let's just start kind of a little bit introduction, who you are, the work that you do, and maybe even a little bit about like why you're called to serve.
these unique patients because I know as a PT you can kind of choose so many different directions similar to nursing to specialize in. So I'd love to hear your story.
Dr. Jessica Smith PT, DPT (02:21)
thank you. I'm in Michigan now and I grew up outside of Detroit in West Bloomfield Farmington Hills area. I went to Michigan State University, so if there's any Spartans out there, still a big Spartan fan. Although, you know, football season isn't our best at the moment.
And then when you go to grad school, you do just like any other medical profession, you have to learn all of the things. So pediatrics and adult and ortho and all of the pieces. I really cared about bringing more community, being a part of the community and having like
a way for people to work together and a way for kids and families to be functional. And I felt like I was drawn to PEDs because there's just this way of making
kids be with their peers and making their families be with everyone else and having people feel included and ⁓ wanting to be a part of this. And I didn't get those good feelings when I was teaching someone how to swing a golf club or something else. It just didn't feel purposeful and also enjoyable to me. So working with kids is enjoyable. I like to solve those functional puzzles.
Mary Farrelly (03:34)
you
Mm-hmm.
Dr. Jessica Smith PT, DPT (03:48)
of how to help this specific kid and how to help this specific family. And not really like the protocol that orthopedics, I guess, kind of goes through.
Then if we continue down my, like everyone's road of work and life and how things change, I became a mom in 2020, which was an interesting time in the world. A pretty isolating time to be a new mom, I think, and to go through that postpartum.
by yourself or isolated. You couldn't really, my husband couldn't even come to a doctor's appointments. It just was all a really tough time. And I think that it gave me a lot of empathy for other moms and families who are feeling isolated in different reasons. And I know the NICU is one of those reasons. You feel like you are just...
in a bubble or you're the only one going through it or kids with disabilities, the parents feel like they're kind of the only ones going through it. And I agree with you that social media gets a bad rap, but this is like what it's for.
Mary Farrelly (05:04)
Mm-hmm.
Dr. Jessica Smith PT, DPT (05:05)
is
to like show people that they're not alone and to give people these this community and this space and to meet other parents who are going through it and to ask those questions openly. So that drove me from like a corporate clinic space to then my own business. And then
I had another baby and then I just was like, this is just where I'm going to be. I just love it. And I feel like new moms need as much support as possible. And over time, my...
work, I just started getting a lot of preemie, a lot of premature babies, babies who were in the NICU, and it kind of just snowballed from there, where I think if you have this level of empathy as a medical professional, you
I don't know, you get pulled in different ways. I guess you understand. It's hard to explain that pull, but I just wanted parents to feel like they weren't alone doing these things and like we were going to find a way for their kid together. There's a very long answer for that one.
Mary Farrelly (05:53)
Mm-hmm.
No, I love that and there's so many
instances of what you were saying. I was like, oh, I resonate with that and that and that and that. I also feel very called to pediatrics in specifically working with babies because they are such, I guess, a clean slate to a certain extent. There's so much possibility, there's so much hope, and there's so much relationships that you can form that are.
Dr. Jessica Smith PT, DPT (06:14)
Bye.
Mary Farrelly (06:32)
It's just different than working with adults. So I saying that you can't form relationship with an adult patient and you're not making an impact, but it does feel different. It's a different type of connection. And you get the whole family, right? You're serving a child, but by doing so, you are changing that whole family's trajectory in their whole next chapter of their life. So it's really, really special work that we're doing. And I love... ⁓
Dr. Jessica Smith PT, DPT (06:45)
Yeah.
Yeah.
Mary Farrelly (07:01)
to find other people that are called to help families that are on the same way. My eldest daughter was born in mid 2019, so I didn't give birth in the middle of COVID, but I did do early parenting in COVID. I did it, and it's a different, it was incredibly humbling. feel like I truly, this business and this world would not, the experience that I had both as a parent and as a patient also inside the healthcare system totally changed how I practice my own.
Dr. Jessica Smith PT, DPT (07:12)
But you did it, yeah.
Mary Farrelly (07:29)
healthcare skills and provider skills. Sometimes you don't always know why, but it makes sense.
Dr. Jessica Smith PT, DPT (07:30)
Hmm. Yeah, that makes sense. Plus, babies are just cute. They are
so cute. Even when they're mad, they're cute. Even when, like, I will take a two-year-old tantrum over, like, a 65-year-old tantrum. honey guy. it's cute. Everything... It's so true.
Mary Farrelly (07:45)
Even their poop is cute. It's on
They're
just so special and they're so funny too and ever evolving and quirky and their own little people and it's pure magic. So I'd love also that you are doing your own work and finding your own voice in this space and filling in the gaps. I feel like a lot of times people that are in online, especially this type of work, are called because we see a gap and we're like, no, that needs to be closed. Families deserve a different type of model of care. so...
Dr. Jessica Smith PT, DPT (07:58)
Yeah.
Yeah, that's such
a good way to put it. I'm gonna have to use that more. Cause it's true, you do, you are filling in the gaps. Especially when it's a whole family. It's not just one person.
Mary Farrelly (08:29)
Go ahead.
No, it's not
isolated. It's the little ripple effects. Like each little moment that we have with these families and babies, it just ripples outward and outward and outward into so many different parts of their lives. it's very, sometimes I pause and I think I'm like, gosh, it's like very humbling to be like, I, the work that we do is so potentially impactful, but I'm excited to share a little bit with the NICU Translated community about the work that you do and things in ways that families can step into that role as.
as an advocate and different lens of taking care of their babies, especially with life after NICU. So one of the topics that comes up a lot during the NICU stay and families who are in the NICU may see this happening is there is a subtle focus on head shape and developmental positioning specifically. Because especially with preemutes, right, they're designed to be developing in...
bubble of both water essentially. Their body still is craving both boundaries and all those different sensory experiences that the uterus and amniotic fluid provides. But when a baby's born prematurely and or if they're born term and needing longer extended medical care, it impacts how sometimes their bones muscles can develop. So we do a lot of things in the NICU stay to help mitigate or decrease different things happening. But
Dr. Jessica Smith PT, DPT (09:25)
Yeah.
Mary Farrelly (09:52)
Two of the things that can come up and are like those words, buzzwords in the NICU are totocollis and plageocephaly. So let's just start with just simple definitions. What are each of those two things and why might they happen more frequently in the NICU community?
Dr. Jessica Smith PT, DPT (10:08)
Okay, so first a definition. So torticollis is specifically just tightening of one muscle, your SCM muscle right here. So this...
muscle has you rotating to one side and then pulls it so that you tip technically to the opposite side, which I know can be confusing. But it gives that muscle asymmetry so that they have tightness on one side and they're looking the opposite direction, whether the rotation or the tilt is more prevalent, depends on the kid. And then plagiocephaly is a asymmetrical flat spot.
So a flat spot on one side. So I should use this hand, it doesn't matter. So if you're always looking one way, you'll probably get a flat spot on the opposite side of your head just from gravity and the malleability of the baby's head. The bones are still so malleable and they're not fully...
sutured or full-armed or anything yet or hardened. So those two pieces are definitely, know, big buzzwords. One of the things that I
tell families to try to make them feel a little bit more at ease I guess when it comes to that is that in the NICU the primary goal is to
be alive and be healthy and deal with any medical complications that they're dealing with. And those things, like, they come first and they have to come first. And if a side effect of that is that they were facing one way for a little bit longer, we can address that later. And I think that that's a...
Mary Farrelly (11:39)
Anymore.
Dr. Jessica Smith PT, DPT (11:52)
I don't know, not that those buzzwords make anyone feel at fault, but I know this is a tangent, but it just feels like it's such a, I want people to know that these things are, we can help them later. We can bridge that gap and help them later. It doesn't have to be in panic for in the NICU. It can be just a conversation for
Mary Farrelly (11:57)
No, I think it's an important...
I love that.
Sometimes I see in the NICU,
or people after NICU, because I work with families after two, are like, well, why didn't we, why wasn't this picked up in the NICU? Why wasn't this addressed in the NICU? And we sometimes have to rewind back to those moments. And there's the idea, you know, nursing school or of Maslow's hierarchy of needs and the most fundamental thing in anyone's care before we can get to everything else, you know, head shape and all the other things is, is those basic needs of.
Dr. Jessica Smith PT, DPT (12:33)
Yeah.
Mary Farrelly (12:45)
eating, breathing, digesting food, heart-speeding, all the things have to happen first and sometimes other needs have to be deprioritized. It's always about like that triage, like what do we need to work on today versus what can we address tomorrow, next week, next month. So I think that's super important because lot of people may be listening to this in the NICU and be like, gosh, I need to think about this today. And there are so many things that you can do after the NICU to help support families.
Dr. Jessica Smith PT, DPT (13:01)
Mm-hmm. Ugh.
Mary Farrelly (13:13)
babies in their development too. So thank you for bringing that up.
Dr. Jessica Smith PT, DPT (13:16)
Yeah, exactly. the side preference in the NICU, it can happen for a number of reasons depending on why the baby was there. So as you know, if they're, and you know more than me, if they're hooked up to a certain number of things and lines and tubes and oxygen, depending on how much oxygen they need, they're hooked up to different things and feeding tubes.
their positioning for that is important. It takes priority. because of that, they might be turned to one side more. And that is just a result of it. But then what we can do afterwards, after we get home and address that, is to...
take a look outside of the hospital at home in their normal environment and first just see where the preference is and where it isn't and then we can go from there. We can address it in like well now I'm moving on more and more and more. Yes.
Mary Farrelly (14:19)
I always like NICU is chapter one and we have get through
chapter one before we can go to chapter two and it doesn't mean that the NICU just ends at discharge, right? Like a lot of the same things are continuing at home. There may still be feeding difficulties. Babies are oftentimes going home with a lot of medical equipment and gear and all the different things. So chapter two can evolve into chapter three, but chapter one has to kind of...
end to a certain extent or flip to the next page before we can go into these next few things. And there are, a lot of times at least in my own clinical experience as a NICU provider is really, depends, a lot of later on preferences and head shaping things often are linked to a much more complicated early start. Like if they have a harder beginning, they're on a lot more equipment and medical gear, there's some types of ventilators that make it really hard to reposition. Those babies are much more likely to have.
more, I guess, complex versions of her shaping and preferences, but it's not a forever problem. It's why we have...
Dr. Jessica Smith PT, DPT (15:16)
For sure.
For sure. And then
babies who have surgical sutures on their front are going to have a harder time with tummy time. But these are just things that we address in PT and we try to address them as early on as possible to bridge that gap as soon as possible. would love to. I saw that you're you do that life after NICU now and that is just it.
Mary Farrelly (15:28)
Mm-hmm.
Dr. Jessica Smith PT, DPT (15:42)
in this country, unfortunately, the gap between getting discharged from the hospital and then getting outpatient appointments is sometimes a big gap. So we like to give them a few things in between there so they're not just sent home. Like, what do I do now with this thing?
Mary Farrelly (15:52)
Mm-hmm.
Right. That is, that's
usually people are like, here's my baby. Okay. There's what you used to see inpatient PT two or three times a week. And we were seeing OT and I had a doctor by me and a nurse. And now I'm just supposed to like figure this out.
Dr. Jessica Smith PT, DPT (16:10)
Yeah. And now I'm
just like sitting here with Google and two at two in the morning. Like what, what do I do with this? ⁓ yeah. Amazon.
Mary Farrelly (16:13)
Yeah.
Google and Amazon. That's our village, right?
It's Millennial parents and Gen Z parents. Their village is our home. But let's go there. Let's say you are that NICU parent whose early discharge you have maybe a preemie or even a term infant that had a longer stay and you have a gap between your...
You might be seeing your pediatrician, but you have a gap between you're seeing maybe Nicky follow up or other specialists. So what are some things that families maybe should be looking for or some really simple things that they can be doing with their baby kind of on this topic?
Dr. Jessica Smith PT, DPT (16:50)
Okay, so ⁓ my biggest, if you haven't seen anyone and you haven't talked to anyone and a medical professional or a PT and you haven't gotten any evaluation, I would first think about symmetry.
trying to notice if they're looking both ways equally, if they're turning both ways equally, if you're holding them on both sides, feeding them on both sides. I know even as parents, know, we hold them, if you're right-handed, you hold them in your left and you stir the something with your right. So we all have preferences too. And just trying to do things as symmetrical as possible in the beginning.
specifically with premature babies, I will say most babies who are in the NICU, but I don't want to say all because there's just such a variety. I have found that
premature babies and most babies in the NICU, they are missing those end of gestational reflexes that help them find midline. They have the hardest time finding midline and therefore they have the hardest time crossing midline later. one of, or a few of my favorite things are when you're singing and playing and just cuddling with them to bring their
Mary Farrelly (17:53)
Mm-hmm.
Dr. Jessica Smith PT, DPT (18:08)
hands together and with your hands over them and bring their feet together and try to give them what that midline is. You can lay them on their side on either side and that'll help give them a little bit of that midline. Premature babies just kind of missed that in development and we in early PT spend a lot of time focusing on that and gaining that before we can do any
thing past it that kind of ends up being our first step. I think that those would be the pieces that I would really, if you could just start with anything I guess out of it, I would focus on playing in midline with them and singing songs and connecting and trying to do things as symmetrically as possible.
Mary Farrelly (18:56)
That's doable,
right? It's not, it doesn't have to be, I know you're rocket petite, but it doesn't have to be rocket science, right? Like sometimes we, as parents are like, okay, we have to get all the, we have to buy the toys and we have to get the gear and we have to do all the things and buy a course and do all the, we have to do, do, do, do, do all day long. And no, that's not sustainable. We're very tired at baseline. The babies are tired too, but it's just like.
Dr. Jessica Smith PT, DPT (18:58)
That seems doable!
⁓ yeah! Yeah!
⁓ by the things.
Yeah.
The peeps are tired.
Mary Farrelly (19:25)
building in tiny little tweaks to normal bonding play development and not making it feel like a chore or a task we have to check off the list. But that's sometimes something mindful. I love that idea of symmetry because I even am like thinking back to my own littles and thinking like, yeah, like my preference is definitely guiding their preference to a certain extent.
Dr. Jessica Smith PT, DPT (19:36)
Yeah, that's what.
Mary Farrelly (19:48)
And even in the NICU, you can, if you're listening to this in the NICU, you can start doing this, especially as your baby's getting closer to discharge. Hold them the opposite way when you're doing skin to skin, turn their head one way one day and turn their head the other way the next day. When you're doing their diaper change, start doing little developmentally appropriate midline play then too, because a lot of times these babies are getting, especially preemies that have been there for a while, they're getting to the point where they...
want more interactive time, they're out of that critical window, rest, rest, rest, low stim. They're craving developmental interaction. This actually, I see this sometimes, is hard for families who especially have gone through a really intense NICU stay of flipping out of that mindset of we need to keep things calm and cool and quiet with our babies and knowing that when they're bigger, it's time to start.
playing and the baby you had yesterday is a different version than the baby you have tomorrow or next week. So I love that you mentioned those things.
Dr. Jessica Smith PT, DPT (20:49)
yeah, I didn't think about like as you get closer to discharge and that they can do more. That makes sense. In my brain, I'm always thinking about the like very acute, but you're right. There is that period of time where you can start doing those things in the NICU actually. That's really great.
Mary Farrelly (21:04)
Yeah, and it starts to bring
those parenting moments in drip by drip into that space. So it's just like it's a special way to do it. And a lot of times, PTs in the NICU, especially if you're in like a level three, level four, will start hopefully talking about these things and having conversations, but they're only sometimes there for 15, 20 minutes. And if it's not when the families are there, sometimes there's missing gaps in education. So I love just kind of closing the loop there too.
Dr. Jessica Smith PT, DPT (21:27)
sure.
Mary Farrelly (21:30)
Another like hot topic and this isn't exactly related but kind of is that people everybody today but especially NICU families kind of get hyper fixated on is the concept of tummy time. So how does this play into your experience and also maybe specifically with preemies how does tummy time work maybe even
Dr. Jessica Smith PT, DPT (21:50)
Tummy Time, I
feel like is a triggering topic for a lot of new parents and probably a lot of NICU parents because it's just this like big huge thing that if you don't do it.
you're one step away from messing them up for the rest of their lives. We're always just one bad decision away. Yeah, which is just not true. Like, let's just give them a little bit of grace for a minute. Like, they just worked on living for a while, and like, that's important, and we can adjust as needed. But my biggest thing is to...
Mary Farrelly (22:13)
That is definitely how it feels.
Dr. Jessica Smith PT, DPT (22:32)
try to meet babies where they are and meet families where they are. the mom who has one baby is gonna, their household's gonna look different than the mom who has three kids and is trying to fit in a newborn tummy time after the NICU. And all of these pieces I think are not gonna be one size fits all. So I do try to give just like simple, doable actions that you can do through
your day, I found that those instances of tummy time, if you can just do a few seconds here and a few seconds here and then in the evening and then at night and not one big huge, I don't know how many minutes session that there's no way an infant can do. Also too, especially preemies, I think that people
unknowingly just kind of put them on the floor and then watch them like suffer with their face in the floor and then wonder why on earth am I doing this? And a lot of...
NICU families, even I'm sure they do this in the hospital with skin to skin too, but propping them on you counts, propping them on a pillow or a wedge counts. It also takes some of that pressure off from, you know, the gravity force angles that, you know, we all probably learned back in the day at some point.
But it takes some of the pressure off of their abdomen and their head. If you can put them on a wedge or put them on a pillow, tip them on you, give them a little bit of a head start and just meet them where they are. You also, any exercise or thing that you give to a kid or a baby, you want them to like it. You want them to want to do it and to want to play and to want
Mary Farrelly (24:16)
Mm-hmm.
Dr. Jessica Smith PT, DPT (24:22)
So
don't just live in the torture and just count the seconds while they're screaming. You want to try to adjust it so that they can enjoy it. And then we'll slowly make it harder. Or we'll slowly add a different element to them. But I think, especially in the NICU, just meeting.
parents and babies where their actual baby is in development is going to give us the most developmental success that we can.
Mary Farrelly (24:51)
I love
that there is no one size fits all in anything and in anything we do with parenting you take you know you you bring in all this education you bring in your own resources and your own you know you learn from this person this person and then you meld it all together in whatever recipe works for you and your kid on that day and then on today.
Dr. Jessica Smith PT, DPT (25:10)
Yeah, on that day, that's on that day because you
don't know the night that they just had. It might have been terrible. And so they're not going to do 7 a.m. tummy time after a terrible night. So on that day and just giving that grace that it's not going to be a definite uphill the whole time and that you're going to have days that are good and days that are not good. And it'll just keep going and we'll keep working on it.
Mary Farrelly (25:17)
Yeah.
Dr. Jessica Smith PT, DPT (25:39)
on.
Mary Farrelly (25:41)
It can be really hard, especially for NICU families who come from the NICU, which is a very rigid scheduled place. We do things on the hour. You're at eight, 11, two, and five, baby. You have PT at 11 a.m. It's hard sometimes when you go home for many families to reprogram more fluidity and cue-based care into their life because the schedule can sometimes feel...
It might have been the only way, especially if you're a new parent, that you've ever been exposed to baby rhythms and parenting. Or if not, it can feel very safe and comforting because it's like, we'll keep the NICU schedule. But sometimes the NICU schedule and documenting things down to the milliliter and timing tummy time and all the things, you kind of lose the joy of having this tiny human and this baby. tummy time can be beautiful. Like it can be your baby on your chest looking, pushing up and looking at you in the eyes. It doesn't have to be like,
working on the floor kid and check out the shiny light. Babies are like, no, thank you. I want to snuggle. And even in the Nakey, sometimes people like ask me about tummy time. I'm like, girl, we just did it. You just held her skin to skin and she was trying to pull her CPAP off and looking up right at you. Like we were doing it. It counts. You're not even thinking about it. So I love that that kind of reframe of like it should feel good for you and for your baby. it doesn't mean ⁓
Dr. Jessica Smith PT, DPT (26:39)
Yeah. Yeah.
It counts! That's it! Yeah!
Mary Farrelly (27:06)
you're not challenging your child. Sometimes, you know, babies have one language and it's sometimes crying and every once in a while, sometimes you might do things that feel weird for them and it doesn't mean they're like suffering always. It just can be like, oh, we're trying something new and they might have this new voice and you'd be like, okay, cool, we tried it. Maybe we'll try again tomorrow. That's our training. That's all.
Dr. Jessica Smith PT, DPT (27:25)
Yeah, yeah, and
what works today.
might or what doesn't work today, it might work tomorrow. You could try. They're always growing and adapting and changing. I'm glad you told me about the schedules in the NICU. I tend to be I'm very flexible. I am a very fluid and flexible and play based person. So that will give me a little bit more insight when I talk to my own NICU families in my practice that they did come from a rigid schedule.
Mary Farrelly (27:33)
Mm-hmm, exactly.
And one thing that isn't often shared in the NICU is the why behind care times because we don't always fully understand it ourselves sometimes as care providers, but the one reason like the
The holistic reason for care times in the NICU is clustering care so that especially those smaller babies we don't have to constantly be interrupting their sleep and overstimulating them all the time. But the rigidity of the 8, 11, 2, and 5 or 8, whatever it is, is for the nurses because we have 1, 2, 3, sometimes 4 patients and if you you can't do cue-based play-based feed on and no schedule while maintaining any sense of safety in that type of an environment. So
Dr. Jessica Smith PT, DPT (28:35)
No, no way.
Mary Farrelly (28:39)
Sometimes families don't, we're never told that like eight o'clock is for the nurses. It's not specifically for your baby. Yes, feeding generally every three hours is appropriate. So you need to have a rhythm, but we don't need to be as minute by the minute rigid at home. And in fact, you're potentially causing more psychological harm to yourself, but.
Dr. Jessica Smith PT, DPT (28:54)
again.
Yeah!
Mary Farrelly (28:59)
being so
strict, but that is, that's the baggage that a lot of times NICU families are bringing into their outpatient life. So it always is good to like have that, that understanding as you said, that like extra layer of empathy for like, you can't just be like, just don't do this anymore. If that's the only way anyone's ever done it or ever, that's the only thing their baby's experienced too. So it is, it's a different world to be raised in as a parent than, than not. But there's, there's,
Dr. Jessica Smith PT, DPT (29:14)
Yeah.
Yeah.
Mary Farrelly (29:28)
There's an evolution usually that I of families regaining their own rhythm and their own voice and their own flow. But it is definitely a process
Dr. Jessica Smith PT, DPT (29:36)
Yeah, I had,
after I had my first son and I was having a hard time and it was all of the things and I was postpartum, she reminded me and it was so kind and she said, you know, your baby is going to fit into your life.
Mary Farrelly (29:53)
Mm-hmm.
Dr. Jessica Smith PT, DPT (29:54)
However, that looks so like just bring him with you and do all the things if you're gonna do this bring them with you and fit into that rhythm and I can imagine even though I haven't been there myself that NICU Mom is trying to recreate the Nick you at home in the structure because it gives her that sense of Understanding and then you know that you're gonna do something good But there is probably that transition of finding your own rhythm again
and your baby's gonna join your life and what you do in your home and your wonderfulness and what time you wake up and eat and what time you want to play and what time they actually want to play because it might not be what time the nurse wanted to do it in the NICU.
Mary Farrelly (30:25)
you
with you.
Yeah, and
we see that even in care times as a nurse I'm like This is not your time of day kiddo like 11 a.m.. Kind of friend, but here we are, but you know they're like try me at 11 p.m.. And I'm ready to go What I also wanted to ask a lot of times NICU parents especially are navigating a lot of different appointments and
Dr. Jessica Smith PT, DPT (30:43)
Yeah, yeah.
Yeah, yeah, that definitely happens.
Mary Farrelly (31:03)
people and voices and things to do. So I guess what things can families do to advocate for their babies in each of these settings and or like kind of I guess work through the multiple different voices and and advice and things that are being shared.
Dr. Jessica Smith PT, DPT (31:21)
that's a big one. I feel like with social media too there's a lot of noise to sift through and a lot of, I can imagine, different appointments also to sift through. I think what we talked about earlier with the hierarchy is important to remember and also to remember that it's going to shift at different times.
Mary Farrelly (31:26)
Mmhmm
Dr. Jessica Smith PT, DPT (31:42)
Developmental milestones sometimes need to take a back seat so that other health concerns or other health things take a front seat.
I think the flexibility that they will wax and wane and shift over time also is something I tend to remind families too Like right now we're gonna work on this developmental milestone, but then something happened and we now need to focus on feeding or focus on something else and then that's going to take a front seat. My hope is that...
By having a hierarchy like that in your brain, you can be addressing what my baby needs now. And then that's the professional that I might put to the top of the list right now.
and my hope as medical professionals is that we understand when things need to take different front seats and then we step back and we're like okay let's reconvene at a different time when this is important but here are the things you can do in the meantime. From a specific PT standpoint one of my pet peeves is that
Mary Farrelly (32:46)
love that.
Dr. Jessica Smith PT, DPT (32:55)
which I think this happens in not only Peds, but everywhere in PT. As a person progresses, we are adding new activities and exercises and things for the baby to do without eliminating the previous ones that they have mastered. And then the parent ends up with a binder that they have created of a million exercises and things to do.
So my hope is that PTs and other professionals will move that with the kid and say, okay, you don't have to do that anymore. And now we can work on these next five steps. We don't have to do tummy time anymore if we're going to work on crawling and other stuff. So I think that just addressing that hierarchy in both medical, but then also specifically in PT will give people a little bit of
Mary Farrelly (33:38)
Thank ⁓
Dr. Jessica Smith PT, DPT (33:49)
less on their plate, hopefully.
Mary Farrelly (33:51)
I
love that binder. feel like what I was thinking of is I'm trying to like declutter in my my personal life and the idea is like bring a toy in a bring a toy goes out. You open have this like equilibrium of things in your house is almost that like once you add a new exercise or add a new skill like we can stop thinking about and doing this skill too. So I love I feel like the binder stays the same size. We're just.
Dr. Jessica Smith PT, DPT (34:02)
Yes.
Yeah.
you
Mary Farrelly (34:19)
moving
the context of what's changing up that route too. And I did, as we kind of started talking today about torticollis and managing those kind of developmental differences at home, what is the typical timeline for families who are just fresh out of the NICU and thinking about, like how my baby has this weird flat spot on the side and they'll only look to the right. What does that look like in terms of transitioning?
Dr. Jessica Smith PT, DPT (34:23)
Yeah.
Mary Farrelly (34:49)
out of that NICU phase and going to the next, I guess, chapter.
Dr. Jessica Smith PT, DPT (34:53)
Yeah, so I'm gonna speak on this with a typically developing baby in months. So if the baby's premature and having an adjusted age, we'll have to adjust kind of accordingly. A typically developing baby, we won't start...
even considering or talking about a cranial reshaping helmet until that five to six month mark of a typical developing baby. Because we want their head to grow, they're gonna go through a big growth spurt before that, and also we want them to be strong enough to carry a cranial reshaping helmet.
So that gives a really big span of time to where we can work on positioning before then, before we even have that big fear-based conversation of like, do I need a helmet or not a helmet? Because what their head looks like right at discharge is not what their head is going to look like at five or six months later. It's just, they're gonna grow so much between now and then.
The other, if you see a big flat spot and you're really worried about it, you can of course get it measured wherever locally, but also the two pieces that are needed to reshape a head is time off of that flat spot and then counter pressure on the opposite side, kind of like that.
to make a circle. What is, I'm trying to think of that, like a donut, like a something, something that you would shape. That doesn't make sense. Something. Yeah, play dough, I don't know. Something you need time off the flat spot. You can't make it worse. And then you do need counter pressure on the opposite side to kind of round it out again.
Mary Farrelly (36:24)
Like what's the deal? Like you're trying to mold?
Okay.
Dr. Jessica Smith PT, DPT (36:35)
And so something that you can do at home if you don't know how to do the counter pressure or no one's taught you and you don't have the appointment yet is to at least just get the time off of the flat spot as much as you can. That is whether it's trying to carry them in a carrier versus putting them down in a stroller for a walk, having them lay on their side on the opposite side. So we can definitely do the time off of the flat spot.
before anything else. And that's something that I think we can safely start with at home.
the bones in your skull start to harden between like nine months is when it starts. So not to be scary about the nine months, it's just when it starts. But then they don't fully solidify until like 12 to 18 months. So you do have a big span of time to correct it. There is that piece where time is of the essence because at some point that will be it.
But I don't want anyone to just panic at a two month old or an immediate, you know, right after NICU discharge because you do have quite a lot of growth and grace period for that. Up to relatively a year. That's a good marker. If you really, it's going to be very hard to reshape a head after a year.
Mary Farrelly (37:42)
Mm-hmm.
And let's quickly go down the helmet kind of talk. One of the things I always encourage families to do is use the brain model when making a decision. So what are the benefits? What are the risks? Are there alternatives? What other information do I need? And what would happen if we did nothing? So I would love you to do like a, I know each baby's different and each scenario is gonna be totally different. But if someone is at that point.
and they have this, they're at nine months, they've done some work and they're at this point of like kind of thinking it through. Or maybe they're at two months and knowing that this is a conversation we might have. What is like kind of your take on general brain for helmets and reshaping and that kind of pathway?
Dr. Jessica Smith PT, DPT (38:40)
Yeah, that is a good question. There is a social stigma, I suppose, about anything your baby has to go through or wear or do. My first piece is I will say I have rarely had a baby care about wearing a helmet. They don't care.
They just want to play. I had a couple babies who loved wearing their helmets because they got to roll out of the flat spot and they got to move easier. It gave them a round surface. So they were very excited about it. They loved their helmets. So what are, wait, what are the pieces of brain?
Mary Farrelly (39:17)
So it's what
are the benefits and what are the risks are the top two like.
Dr. Jessica Smith PT, DPT (39:20)
the top two.
The benefits are it gives the counter pressure on the opposite side consistently and it will also keep
the pressure off of the flat side when they're sleeping. Now that we are back to sleep, sleeping on our backs is the safest, that is a higher likelihood of laying in the flat spot for so long. So the benefits are pretty high. The risks are pretty minimal.
heat rash, think, cradle cap. That's very baby dependent. There's not like a, they do a skin check all the time with them. The risks are so minimal. What are the other letters of brain? No, alternate. Yeah.
Mary Farrelly (40:04)
and the A is alternate, like is there other alternate pathways?
Dr. Jessica Smith PT, DPT (40:11)
So alternate pathways. I of course feel that PT is an alternate pathway for this. have had, I recently had, this was a fun assessment, but
I had a pair of twins and they had opposite flat spots, but one was a little, one was more severe than the other one. So the baby with the more severe difference, the more severe flat spot was put in a helmet.
And the other one was not, and we did PT with both, and the family was so lovely, and they did all of their home program. And they both had remarkable outcomes. And the baby that wore a helmet only wore it for two months. And...
They both had PT and they both ended up with wonderful shaped heads. They graduated from both things. And it was a really great scenario where it just showed how much PT also was an alternative. I do think that there's a range like with anything. So if it's a very severe plagiocephaly, it's gonna be a harder time to do PT only.
If it's mild to moderate, I've had great results with only PT, depending on how much the parents do at home. But, okay, now I'm lost in my tangent. Okay.
Mary Farrelly (41:29)
So there, no, I love, I think that that ties
it together showing that there are so many different pathways, but it is so dependent on the baby's history and the story and what works for that family, right? Like some families simply are not going to have the time or resources to go to regular PT, but they might be able to have that helmet fitting and go in and have that path down. There was sometimes we also build up in our head, you we don't wanna,
Dr. Jessica Smith PT, DPT (41:45)
Yeah.
Mary Farrelly (41:59)
bother our babies or things are going to be too hard for them, but knowing that like the baby might not care about the helmet and that's new. Great. Feels different and then they're new and then it's another chapter. it's nice sometimes as parents are starting because you know, just as we said before, parents, we don't want to make the wrong choice. We feel like we're one choice away from ruining our kids' life, which we just know is simply not true. It just means what you decide today, we're allowed to change our minds.
Dr. Jessica Smith PT, DPT (42:05)
Yeah, they don't, it's like shoes. They don't care. You just, you change their clothes. Yep.
Mary Farrelly (42:25)
And our babies have so much grace for us, right? Like we have to say you have the same amount of grace that our sweet little humans give to us too. So it is all an evolution. I did also, while we're talking about helmets, wanted to get your take on, there are so many products on the market for head shaping that are not coming from a prescription. So what are your thoughts on any of those types of products that are out on the market?
Dr. Jessica Smith PT, DPT (42:33)
Yeah.
I don't like any of them.
I just don't really believe that we should be so product crazy. I think that there is not one thing that you can just buy without someone looking at your baby and actually assessing your actual baby. I don't think there's going to be a magic pillow or item or toy or container. They're not gonna be one size fits
fits
all and some of them, if you're doing it while your baby's sleeping, it's really not recommended. We have to put the priority more on PT and maybe a helmet if we need that and less on what's another thing I can just buy and we'll fix this.
Mary Farrelly (43:38)
Yeah, I feel
like the marketing that is done is so strategic because they know, they know that these are fears that we have. They know that these are concerns that we have and people are just, we're wired to want a quick fix. Amazon gets it something to do in the next 24 hours. Great. I'm the problem.
Dr. Jessica Smith PT, DPT (43:53)
Yeah, and then I'll solve that. Yeah.
I will say the N for if you do nothing, it's not going to fix itself. I don't, the wait and see is probably like triggering for PTs.
It's not just going to round out and fix itself by growing. So we do have to do something. You have to pick like an avenue to do something for it. You need the counter pressure on the opposite side and the time off the flat spot just scientifically to do it. So just growing is not is not going to fix itself. So that's where doing nothing.
isn't a choice to me.
Mary Farrelly (44:32)
Thank you for clarifying that too. And I think we all kind of want to do something as parents usually, but especially with the products and things like that, it is sometimes just those points of connection that you get in PT like skills and things that you can do together as a family, which also helps with bonding and connecting and all the magical things that you get to do, especially with life after NICU. So.
Dr. Jessica Smith PT, DPT (44:56)
Yeah.
Mary Farrelly (44:58)
How can families connect with you? What resources do you have for families? I'd love to hear more.
Dr. Jessica Smith PT, DPT (45:05)
⁓ thank you. Okay, I'm on all the social media things. My website is RocketshipPT.com. My Instagram is Rocketship UnderscorePT. ⁓
I started a YouTube channel to try to reach more people. I'll keep connecting with you. I also developed an at-home course. So if you are in this waiting period, especially between discharge and...
cannot get in with anyone. Hopefully this course will give you something at home to kind of help you with. It's called Just a Parent's Guide to Torticollis and Plagiocephaly.
videos and PDFs and the whole thing that all the other courses have, but hopefully it will help bridge that gap for people. You can also reach out to me and I do virtual appointments too, especially if you take that course and you just want to check in along the way, then hopefully we can do that.
Mary Farrelly (46:04)
I feel
like so much sometimes especially families just want to know more about different diagnoses and topics so that they can then step into that advocacy role and parent specifically to their child. So I love that you have that resource for them to help build their skills and give that those tangible to-do's in those two o'clock in the morning time when you're feeding your baby. Yeah, so you can to Amazon, you can learn about ⁓ how to help.
Dr. Jessica Smith PT, DPT (46:16)
Yeah.
Yeah, instead of being on Amazon, do something else.
Sure,
really you should just sleep. ⁓ you know, really. Yeah, well thank you so much for having me, but also for creating this space. Your Life After NICU whole program, think it's just, we're just gonna all hope to bridge that gap together. So thank you, thank you for having me on here. This has been really great.
Mary Farrelly (46:32)
Also sleep. Also sleep.
Thank you so much for coming and I can't wait to continue to stay connected.
Dr. Jessica Smith PT, DPT (46:56)
Yeah, perfect.