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Stay Calm and Confident: NICU Splinting Made Easier
Let’s face it—splinting in the NICU is not for the faint of heart. Between the constant alarms, tiny anatomy, and moving targets, things can get chaotic fast. But with a little preparation and some tried-and-true systems, you can make the process smoother for both you and your patients. Here are three of my go-to hacks that help me fabricate effectively and efficiently in the NICU.
1. Prep Before You Step
Before you even approach the isolette, set yourself up for success. Pre-cut your patterns, strapping, Velcro, liners, and padding if using. Have any exercise or caregiver instruction handouts ready to go—you’ll thank yourself later. We only have 30min or less to get a lot done!
Then, make sure your tiny client is ready, too: have the extremity you’re splinting exposed and supported, with the rest of the infant contained and comfortable. Positioning is key—be sure gravity is on your side! A fully prepped workstation saves precious time and frustration—keeps your focus where it belongs: on that fragile little extremity in front of you.
TheraTools Tip: Keep a small “NICU Splinting Kit” stocked with essentials—scissors, thermoplastic material (pre-cut rectangles), pre-cut strapping/velcro & lining, sharpie, and printed instructions—so you’re always ready!
2. Choose the Right Materials—Soft, Low-Heat, and Forgiving
When it comes to neonatal splinting, material choice makes all the difference. Skip the rigid thermoplastics you’d use for older children or adults and reach for options like Orficast or Orfit Colors. These materials are low-heat, soft, and easily remolded—perfect for fragile, preterm skin and the inevitable adjustments that come with growth.
Soft materials minimize skin irritation while still providing gentle, consistent support for positioning, alignment, and function. They also make re-fabrication quick and safe if wear schedules or tolerance change (and they often do!).
3. Timing, Tolerance, and Teamwork
A calm baby equals a better splint (custom orthosis!). Coordinate with nursing staff to plan your fabrication during or around care times when the infant is already being handled or repositioned. A few minutes of communication with the bedside nurse can mean the difference between a stressful session and a seamless one.
Equally important: establish a wear schedule and monitoring plan that works for the infant’s needs and the team’s workflow. Typical NICU orthotic wear schedules might include 3 hours on/3 hours off, 3 hours on/6 hours off, or even one 3-hour wear for an isometric stretch. Skin should always be assessed after each wear period—any redness should disappear within 20 minutes, ideally 10. If there are concerns, remove the splint and reassess before continuing.
TheraTools Tip: Document wear schedules, caregiver instructions, and skin check guidelines clearly. Consistent communication between therapist, nursing, and family ensures safe, effective, and comfortable splint use.
Final Thought
NICU splinting is equal parts precision, artistry, and heart. With the right preparation, materials, and teamwork, even the tiniest splints can make a tremendous difference in comfort, alignment, and long-term function.
Last chance to join our Custom Orthotic Fabrication for Infants & Children CEU course this year!
Only a few spots left!
“This course was organized, informational and applicable to my daily practice in acute care. Rachael is an engaging presenter and the course consisted of thoughtful discussions and knowledge sharing with other students. I highly recommend this course!”
-Tina J, OT
