Working in a neonatal intensive care unit (NICU) is an advanced area of practice. Insufficient experience and training can increase risks to medically fragile infants. These infants' occupations are not play and self-care. They respond to their environments, take in nourishment, maintain homeostasis, and begin social interactions with their parents. Occupational therapists working in the NICU must have expertise in the medical conditions, procedures and social-emotional developmental abilities of pre-term and full-term infants. Other advanced practice knowledge areas include pain, stress, mental health, and a strong understanding of family systems theory. Parents with an infant in the NICU often experience complex physical and emotional challenges and may need support from an occupational therapist or other medical health professional. Occupational therapists play an essential role in supporting parents' engagement with their infant. Therapists must be sensitive to the family's circumstances and support the parents as decision-makers and caregivers of their child. Parents want to learn how to support and care for their children in the NICU, and occupational therapists are well equipped to support this role. Therapists provide a balance of medical knowledge, psychosocial support, and hands-on skills for parents. Adapting the environment is an important factor to caring for infants in the NICU. When stress and overstimulation are reduced, such as modifying the amount of exposure to light and sound, infants demonstrate improvements in health outcomes. Occupational therapists are experts in assessing and modifying environments and may play a role in adjusting an infant's environments to promote treatment outcomes. Neonatal practice requires advanced education and training. Occupational therapists are encouraged to seek additional knowledge and skills through continued education and mentorship experiences. Reference: Hong, Chia, and Lynne Howard. Occupational Therapy in Childhood. Wiley, 2002.