Mother & Child Care

Infant Positioning Assessment Tool (IPAT)

Background How to use the tool (A, B, Cs)
Developmentally supportive positioning in premature and A) Utilize the IPAT prior to engaging in caregiving interactions
critically-ill infants is one of the seven core measures for to identify infant movements that may benefit from
family-centered developmental care detailed in the Philip’s developmentally supportive positioning, as well as ensure
Neonatal Integrative Developmental Care (NIDC) Model.1,2 that the infant is repositioned appropriately to promote
(Philips HealthTech, Cambridge, MA). Positioning infants in self-regulation, musculoskeletal development, sleep,
the NICU is a neuromotor developmental intervention used comfort, sensory system development, and growth.
to minimize positional deformities and to improve muscle Spontaneous movement is a natural phenomenon for
tone, postural alignment, movement patterns, and ultimately infants; however, in the absence of therapeutic positioning
developmental milestones.3 Developmentally supportive supports, these spontaneous movements may leave the
positioning positively influences physiologic function and infant ‘stranded’ in a suboptimal position.
stability, sensory development, neurobehavioral organization,
skin integrity, thermoregulation, bone density, sleep B) Assess and score the infant utilizing the IPAT
facilitation, optimal growth, brain development, and neonatal in each of the six body-part areas.
developmental outcomes.1-9 The core measure ‘Positioning & 1. Score a 2 for an ideal therapeutic position
Handling’ incorporates the Infant Positioning Assessment Tool 2. Score a 1 for acceptable alternative positioning
(IPAT), which was developed with three goals for use: • Score any asymmetrical positioning
1. as a reference and educational tool for teaching, of the arms or legs
2. as an evaluation instrument, and 3. Score a 0 for unacceptable positioning.
3. as a method of standardizing best positioning practices of 4. Total the cumulative score.
premature infants in the neonatal intensive care unit.4 5. Once this baseline information/IPAT score is assimilated
by the clinician, s/he is ready to provide consistent
Introduction developmentally supportive positioning.
The IPAT is a validated and reliable easy-to-use pictorial tool
used to evaluate posture of premature infants in six areas
C) Positioning in the NICU simulates the flexed/contained/
of the body (head, neck, shoulders, hands, hips/pelvis, and
midline posture of the infant in utero; external supports
knees/ankles/feet), with cumulative scores ranging from
provide a temporary substitute for the immature infant’s
0 – 12. A two-point scoring system is used on each area of the
diminished internal motor control. Provide premature
body with a score of 2 for ideal therapeutic positioning, 1 for
infants with positioning aids and boundaries to help
acceptable positioning, and 0 for unacceptable positioning.
them maintain optimal tone and position, remain
Any asymmetrical positioning of the arms or legs is scored a 1
either in a quiet, restful sleep or a relaxed, comfortable
(a full score of 2 is never granted). According to the IPAT, a full
wakefulness. Consistency in positioning for the infant
score of 12 is indicative of ideal positioning, scores of 9 to 11 are
can promote strong neuronal connections. Positioning
acceptable as it accommodates for asymmetry of positioning
aids provide greater ease-of-use and consistency among
often needed when technology interfaces (infants with various
caregivers.
venous or arterial access needs, drains, surgical sites, etc.) are
present, and scores of 8 or lower indicate a need for positioning
support that offers containment, promotes flexion and ensures
proper body alignment.4,5,6 Routine utilization of a validated
& reliable positioning assessment tool provides appropriate
positioning and encourages accountability.

References
1. Altimier, L. & Phillips, R. (2016). The Neonatal Integrative Developmental Care Model: 5. Jeanson, E. (2013). One-to-One Bedside Nurse Education as a Means to Improve
Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Positioning Consistency. Newborn and Infant Nursing Reviews: NAINR.,13(1), 27-30.
Family-Centered Developmental Care. Newborn and Infant Nursing Reviews: http://dx.doi.org/10.1053/j.nainr.2012.12.004
NAINR., 16(4), 230 – 244. http://dx.doi.org/10.1053/j.nainr.2016.09.030 6. Spilker, A. & Hill, C. (2016). The effectiveness of a standardised positioning tool
2. Altimier, L. & Phillips, R. (2013). The Neonatal Integrative Developmental Care and bedside education on the developmental positioning proficiency of NICU
Model: Seven Neuroprotective Core Measures for Family Centered Developmental nurses. Intensive and Critical Care Nursing., 35, 10-5. http://dx.doi.org/10.1016/j.
Care. Newborn and Infant Nursing Reviews: NAINR., 13(1), 9 – 22. http://dx.doi. iccn.2016.01.004
org/10.1053/j.nainr.2012.12.002 7. Altimier, L. & Philips, R. (2018). Neuroprotective Care of Extremely Preterm Infants in
3. Hunter, J., Lee, A., & Altimier, L. (2015). Neonatal Intensive Care Unit. Occupational the First 72 Hours after Birth. Critical Care Nursing Clinics of North America.
Therapy for Children and Adolescents. St. Louis: Elsevier; 2015. p. 595-635.7. doi.10.1016/j.cnc.2018.07.010.
4. Coughlin, M., Lohman, MB., & Gibbins, S. (2010). Reliability and effectiveness of 8. Liu, W., Laudert, S., Perkins, B., MacMillan-York, E., Martin, S, Gravens, S. (2007). The
an infant positioning assessment tool to standardize developmentally supportive development of potentially better practices to support the neurodevelopment of
positioning practices in the neonatal intensive care unit. Newborn and Infant infants in the NICU. Journal of Perinatology. 2007;27(Suppl): S48-S74.
Nursing Reviews: NAINR., 10(2), 104-106. 9. Lockridge, T. (2017). Neonatal Neuroprotection: Bringing Best Practice to the Bedside
in the NICU. MCN, the American journal of maternal child nursing.
Infant Positioning Assessment Tool (IPAT)
Patient’s name: Birth gestational age/corrected gestational age:

Clinician’s name: Date/time of assessment:

Infant position: Supine Side-lying Prone

Indicator 0 1 2 Score

Head

Head rotated laterally (L or R) Head rotated laterally (L or R) Head aligned (L or R) 0 - 30° from
> 45° from midline 30 - 45° from midline midline

Neck

Neck in hyperextension Neck neutral Neck neutral, aligned, head slightly

or hyperflexion flexed forward 10°

Shoulders

Shoulders retracted Shoulders aligned, flat to surface Shoulders rounded forward

towards midline

Hands

Hands away from body Hands touching torso Hands touching face

Hips/pelvis

Hips/pelvis abducted, externally Hips/pelvis aligned but extended Hips/pelvis aligned and softly
rotated flexed

Knees/
ankles/feet

Knees extended, Knees, ankles, feet aligned but Knees, ankles, feet aligned and
ankles and feet externally rotated extended softly flexed

12 = ideal cumulative score. 9 – 11 = acceptable cumulative score. ) 8 = need for repositioning. Total cumulative score

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