Table 3.

Developmentally supportive activities of daily living core measure

Attribute	Criteria
Positioning: Infant positioning is documented to provide comfort, safety, physiologic stability and support optimal neuromotor development (Sweeney & Gutierrez 2002, Vaivre-Douret et al. 2004, Chizawsky & Scott-Findlay 2005)	1.Each infant is positioned and handled in flexion, containment and alignment during all caregiving activities
	2.Infant position is evaluated with every infant interaction and modified to support symmetric development
	3.Positioning aides are gradually removed and Back to Sleep and Tummy to Play practices are implemented as the infant demonstrates physiologic flexion of the upper body in supine
Feeding: Feeding will be infant-driven, individualized, nurturing, functional and developmentally appropriate to ensure safety (McCain 2003, Pinelli & Symington 2005, Ludwig & Waitzman 2007)	1.Non-nutritive sucking is offered with each non-oral feeding contingent on the infant’s state
	2.Assessment of feeding readiness cues and the quality of the oral feeding is documented with each oral feeding encounter
	3.Education regarding the benefits of breastmilk is provided and family choice is supported
Skin-care: Infant skin integrity is assessed, protected and care is documented (Lund et al. 2001, Curley et al. 2003)	1.Infants are bathed no more frequently than every 3 days
	2.Skin integrity is assessed using a reliable assessment tool at least once per shift and documented. (Braden Q Scale or similar tool)
	3.The skin surface is protected during application, utilization and removal of adhesive products