From Scattered to Strategic
May 18, 2025
Custom Splinting in the NICU: Why It’s Time to Rethink What’s Possible
I don’t know about you all, but I’ve been deep in the work of demystifying neonatal therapy lately. From orienting new staff to presenting to administrators and refining our program, I’ve found myself immersed in research—always searching for clearer ways to explain our why.
And lately, one topic keeps surfacing: custom splinting in the NICU.
👀 “Wait… You Can Splint in the NICU?”
In the past two weeks alone, I’ve had several conversations with staff who are surprised—sometimes even amazed—when they see our tiniest patients wearing the most adorable and, more importantly, effective custom orthotics.
I get curious questions like:
🗨 “Where did you get that?”
🗨 “How did you make that?”
And I hear excited observations:
🗨 “Wow, their fingers are really moving a lot more.”
🗨 “The baby is holding their thumbs out of their fist now!
These reactions are exactly why this conversation matters. Because custom splinting in the NICU isn’t just possible—it’s essential.
🚫 Myth: There’s No Place for Splinting in the NICU
✅ Reality: It’s Safer and More Purposeful Than You Think
We’ve all seen IV boards or prefabricated splints fall short—slipping out of place, causing pressure spots, or simply not serving their intended function. In contrast, custom orthotics fabricated by trained therapists are shaped to fit the infant’s unique anatomy. They maintain purposeful positioning while minimizing risk.
🔧 What Makes Custom Splinting Safe & Effective?
With the right tools and training, splinting can be done safely—even at the bedside. Materials like Orficast make it easier than ever:
- ✅ Lightweight and breathable
- ✅ Low-temperature and moldable
- ✅ Radiolucent (X-ray compatible)
- ✅ Gentle on fragile skin
With these tools, we can confidently fabricate:
- Wrist cock-up splints
- Thumb spica splints
- Ankle-foot orthoses (AFOs)
- Resting hand orthoses
- Web spacers
- Custom Sarmientos
- Muensters
- …and more
🧒 How Infants Benefit
Custom orthoses do more than just hold limbs in place—they support development in powerful ways. No more watching and waiting.
🟢 Protect joint integrity and prevent deformity
🟢 Prevent overstretching of tendons and ligaments
🟢 Support emerging motor patterns and musculoskeletal development
🟢 Promote long-term functional outcomes
👩⚕️ Benefits for Therapists
- Professional credibility: Elevate your role on the NICU team
- Advocacy: Replace outdated devices like IV boards with safe, developmentally appropriate orthoses.
🧠 Splinting Is Just One Tool—But It’s a Powerful One
It’s important to remember: splinting is not our only intervention. We continue to integrate neurosensory strategies and functional, goal-directed activities—like encouraging hand-to-mouth movement—to help build vital neural connections in the developing brain.
And we splint with care:
- We monitor each orthosis closely
- We alternate on/off times
- We use splints as targeted interventions
- And we’re humble enough to reassess and adapt when a splint isn’t serving its purpose
Because at the heart of neonatal therapy isn’t just what we do—it’s how intentionally, responsively, and compassionately we do it.
🔚 Final Thoughts: Splinting Deserves a Place in the NICU with Careful Consideration
Custom splinting isn’t a “bonus skill” or a luxury. When done well, it’s a critical intervention that supports both the short-term and long-term needs of medically fragile infants.
To help you being to move from inspiration to implementation, I’ve created a free download just for you: the Neonatal Orthotic Quick-Start Guide.
This easy-to-use chart breaks down common neonatal diagnoses that benefit from custom orthotics, outlines their musculoskeletal risks, and provides suggestions for a custom splint— all in one clear, practical reference.
Download the Neonatal Orthotic Quick-Start Guide here.
📝 References
Anderson, L. J., & Anderson, J. M. (1988). Hand splinting for infants in the intensive care and special care nurseries. The American Journal of Occupational Therapy, 42(4), 222–226. https://doi.org/10.5014/ajot.42.4.222
Jackman, M., et al. (2014). Functional outcomes of custom orthoses in pediatric rehabilitation. Pediatric Occupational Therapy Journal.
American Occupational Therapy Association. (2023). 3D-printed orthoses in NICU care: Feasibility and safety. OT Practice.
