Preterm infants are exposed to numerous stressors during their NICU stay, including routine handling or cares by nursing staff. Previous research has determined the majority of touch in the NICU is procedural vs comforting. The absence of “good touch”, or positive tactile experiences, can alter an infant’s brain development, as they are developing circuitry and learning with each interaction.

Study: Observational study, using a cross-sectional design, to characterize and quantify touch experienced by preterm infants during nursing cares.

Subjects: 20 infants, born 27-32 weeks PMA, from level III-IV NICUs in a large Midwest city.

Methods:  Observation of two nursing cares per infant (one day shift, one night shift) within the first three weeks of life and within one week of infant enrollment in the study.


  • Score for Neonatal Acute Physiology-II (SNAP-II)
  • Care Observation Checklist (investigator developed-see Appendix of article)
    • 3 mutually exclusive categories: (1) Rest periods, no touch; (2) Indirect touch, touch to equipment or materials in contact with the infant; (3) Direct touch, physical contact between the caregiver and infant.
    • If indirect and direct touch occurred at the same time, direct touch was recorded.


  • The first direct touch of care was general handling (not comforting touch) in 75% of observations on day shift and 95% on night shift.
    • Infants on CPAP experienced more direct touch and handling related to respiratory equipment.
  • Caregivers wore gloves >89% of direct touch interactions.
  • Comforting touch findings:
    • Comprised 30% of direct touch on day shift, and 10.6% on night shift.
    • Exclusive comforting touch (touch not provided alongside other care), was found in 9.7% of direct touch during day shift and 3% during night shift.
    • Without the assistance of a second caregiver, comforting touch decreased to 1.3% (days) and 1.7% (nights).

Discussion: Most of the touch infants received during nursing cares was for clinical needs (general handling) instead of comfort. Comforting touch is essential to support infants’ neurological development and to mitigate stressors of daily, procedural touch. Targeted efforts to incorporate comforting touch into nursing cares is critical to optimize infant outcomes.

Recommendations: To increase the amount of comforting touch include:

  • Complete cares with a second caregiver who can provide comforting touch.
  • Provide intentional comforting touch and breaks if unable to have a second caregiver.
Dion Nist, M., Harrison, T. M. & Pickler, R. H. (2023). Touch experiences of preterm infants during essential nursing care. Neonatal network: NN, 43(1), 13-22.