Rosemarie Bigsby Clinical Professor of Pediatrics, Clinical Professor of Psychiatry and Human Behavior

I am a pediatric occupational therapist with a career-long interest in infant development. Current focus is on improving outcomes for infants in the NICU, through developmental assessment and interventions and developing an interdisciplinary approach to initiating and progressing breast and bottle feeding.

Brown Affiliations

Research Areas

scholarly work


  1. Single Family Room Neonatal Intensive Care Unit Improves Infant Medical and Neurobehavioral Outcome. Lester, B.M., Hawes, K. Abar, B., Sullivan, M., Miller, C., Bigsby, R., Laptook, A., Salisbury, A., Taub, B., Lagasse, L., Padbury, J. (2014). Pediatrics, 134, 4, 754-760.
  2. Lester, B.M., Andreozzi-Fontaine, L, Tronick, E., Bigsby, R. (2014). Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale.  Journal of Visualized Experiments, 25, 90, e3368, doi:10.3791/3368. 
  3. Bigsby, R., LaGasse, L., Lester, B.M., Shankaran, S., Bada, H. Bauer, C. & Liu, J. (2011). Prenatal cocaine exposure and motor performance at 4 months. American Journal of Occupational Therapy, 65, 5, 60-68.
  4. Lester, B. M., Miller, R. J., Hawes, K., Salisbury, A., Bigsby, R., Sullivan, M. C., Padbury, J. F.  (2011). Infant Neurobehavioral Development. Seminars in Perinatology, 35, 8-19.
  5. Hwang, Y., Vergara, E., Lin, C., Coster, W.J., Bigsby, R., Tsai, W. (2010). Effect of prefeeding oral stimulation on feeding performance of preterm infants. Indian Journal of Pediatrics, 77, 8, 869-873.
  6. Hwang, Y., Lin, C., Coster, W.J., Bigsby, R., Vergara, E. (2010). Effectiveness of cheek and jaw support to improve feeding performance of preterm infants. American Journal of Occupational Therapy, 64, 886-894.
  7. Vergara, E., Anzalone, M; Bigsby, R;, Gorga, D.; Holloway, E.; Hunter, J.; Laadt, G.; Strzyzewski, S. (2006). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. The American Journal of Occupational Therapy, 60, 6, 659-668.
  8. Miller-Loncar, C., Lester, B. M., Seifer, R., Lagasse, L. L., Bauer, C. R., Shankaran, S., Bada, H. S., Wright, L. L., Smeriglio, V. L., Bigsby, R., & Liu, J. (2005). Predictors of motor development in children prenatally exposed to cocaine. Neurotoxicology and Teratology, 27, (2), 213- 220.
  9. Miller-Loncar, C., Bigsby, R., High, P., Wallach, M, & Lester, B.M.  (2005). Infant colic and feeding difficulties. Archives of Disease in Childhood, 89, 908-912.
  10. DeSantis, A., Coster, W., Bigsby, R., & Lester, B.M.  (2004). Colic and fussing in infancy, and sensory processing at 3 to 8 years of age. Infant Mental Health Journal, 25, (6), 522-539.
  11. Boukydis CFZ, Bigsby R, Lester BM. (2004).  Clinical Use of the Neonatal Intensive Care Unit Network Neurobehavioral Scale. In: Lester, BM & Tronick, EZ (Eds), The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Pediatrics, 113. (3), 679-689.
  12. Grenier, I.R ., Bigsby, R., Vergara, E. R, & Lester, B. M.  (2003). Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions. The American Journal of Occupational Therapy, 57, (3) 289-297.
  13. Gorga, D., Anzalone, M., Holloway, E., Bigsby, R., Hunter, J., Strzyzewski, S., Vergara, E.  (2000). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit.The American Journal of Occupational Therapy, 54, (6), 641-648.
  14. Lester, B. M., LaGasse, L. L., & Bigsby, R.  (1998). Prenatal cocaine exposure and child development: What do we know and what do we do? Seminars in Speech and Language, 19 (2), 123-146.
  15. Case-Smith, J., Bigsby, R., & Clutter, J. (1998). Perceptual motor coupling in the development of grasp. American Journal of Occupational Therapy, 52 (2), 102-110.
  16. Meyer, E. C., Lester, B. M., Boukydis, C. F. Z., & Bigsby, R. (1998). Family-based intervention with high-risk infants and their families. Journal of Clinical Psychology in Medical Settings; 5 (1),49-69.
  17. Bigsby, R., Coster, W., Lester, B. M., Peucker, M. R. (1996). Motor behavioral cues of term and preterm infants at three months. Infant Behavior and Development, 19, 3, 295-307.
  18. Bigsby, R. (1983). Reaching and asymmetrical tonic neck reflex in preterm and full-term infants. Physical and Occupational Therapy in Pediatrics, 3, (4), 25-42.   



  1. Bigsby, R. & Lee, YJ.  (2010).  Neonatal screening and supportive interventions to promote neurobehavioral development.  Medicine & Health/Rhode Island, 93, 5, 139-141.
  2. Bigsby, R.  (2007).  Book/media review:  Focus on the Brain:  A toolkit of evidence-based practices to support preterm development in the NICU.  Part 1:  The science of preterm infant development; Part 2:  Clinical practices for special care nurseries; No matter how small:  Parent’s guide to preterm infant behavior and development.  Vida Health Communications, Inc., Cambridge, MA, 2006.  Journal of Developmental & Behavioral Pediatrics, 28, 5, 429.
  3. Lester, B. M., Bigsby, R., & Miller-Loncar, C.  (2004).  Infant massage:  So where’s the rub?  Social Policy Report of the Society for Research in Child Development, 18, 1, 8.
  4. Bigsby, R.  (2002).  Book review:  The Preemie Parents' Companion, by Susan L. Madden, Boston, MA, The Harvard Common Press, 2000, 393 pp.  Journal of Developmental & Behavioral Pediatrics, 23, 1, 59-60. 
  5. Bigsby, R.  (1994).  Motor behaviors as cues to cardiorespiratory reactivity in full-term and preterm infants at three months corrected age.  Dissertation.  Boston University.
  6. Lester, B., Bigsby, R., High, P., & Wu, S.  (1995).  Principles of intervention for preterm infants in the NICU.  In Optimizing the Neonatal Intensive Care Environment:  Proceedings of the 10th Conference in Pediatrics, (pp. 59-72).  Canadian Paediatric Society.  Montreal:  Abbott Laboratories, Limited.
  7. Bigsby, R.  (1992).  Motor behaviors as cues to physiological state in preterm infants:  Application of sensory integration theory to occupational therapy practice with neonates.  Monograph.  In Proceedings of Symposium '92:Current Topics in Sensory Integration, Torrance, CA:  Sensory Integration International.



  1. Bigsby, R.  (2010).  Fueling development by enhancing infant-caregiver relationships: Transformation in the developmental therapies.  In B.M. Lester, & J.Sparrow (Eds.)  Nurturing Children and Families: Building on the Legacy of T.Berry Brazelton.  (pp. 219-280).  Oxford, UK:  Wiley-Blackwell.
  2. Bigsby, R., Boukydis CFZ, LaGasse, L.L., Lester BM.  (2004). Clinical Applications for the NNNS.  In: Lester, BM & Tronick, EZ (Eds), NICU Network Neurobehavioral Scale Manual. (pp. 85-182).  Baltimore:  Paul H. Brookes.
  3. Vergara, E., & Bigsby, R.  (2004). Developmental and Therapeutic Interventions in the NICU.  Baltimore:  Paul H. Brookes.  (Second Printing, January 2007).
  4. Bigsby, R.  (2003).  Overview of infant and child developmental models.  In, E. B. Crepeau, E. S. Cohn & B. A. B. Schell (Eds.) Willard and Spackman's Occupational Therapy (10th ed., pp. 243-245), Philadelphia: Lippincott Williams and Wilkins.
  5. Case-Smith, J., & Bigsby, R.  (2001).   Motor assessment.  In L. T. Singer & P. S. Zeskind (Eds.), Biobehavioral Assessment of the Infant (pp. 423-442).  NY:  The Guilford Press.
  6. Case-Smith, J., & Bigsby, R.  (2000).  Posture and Fine Motor Assessment of Infants.  San Antonio, TX:  Psychological Corporation/Harcourt Assessment Co..
  7. Vohr, B. R., Cashore, W. J., Bigsby, R.  (1999).  Stresses and interventions in the neonatal intensive care unit.  In M. D. Levine, W. B. Carey, & A. C. Crocker (Eds).  Developmental-Behavioral Pediatrics, 3rd Edition (pp. 263-275).  Philadelphia:  W. B. Saunders Co.
  8. Bigsby, R.  (1998).  Overview of infant and child developmental models.  In M. Neistadt, & E. Crepeau (Eds.)  Willard and Spackman’s Occupational Therapy, 9th Edition, (pp. 543-545).  Philadelphia:  J. B. Lippincott Co.

research overview

Dr. Bigsby's research focuses on the actions and facial expressions used by infants to signal their wants and needs to caregivers, and the relation between these behaviors and regulation of physiologic functions such as heart-rate and oxygen saturation. Other research interests include developmental interventions and outcomes for preterm infants in the NICU, feeding issues of early infancy, and the relation between early motor development and maternal life style.

research statement

Research involvement and publications reflect a long-standing interest in motor behavior of premature and other high-risk infants, particularly with regard to development of self-regulatory and feeding competencies and positive interaction with caregivers. An initial study of the presence of the aymmetrical tonic neck reflex, the attributes of stimulus objects and related patterns of reaching among preterm and full-term infants formed the foundation for a dynamical systems approach to development which could be woven into her clinical approach to infants at risk. For her doctoral dissertation work, Dr. Bigsby further explored dynamical processes by investigating the relation between motor behaviors and physiologic regulation among previously sick preterm and healthy term infants at 3 months corrected age. This work was continued within the clinical context of the neonatal intensive care unit (NICU) as a pilot project studying these same motor behaviors in the sick preterm population, and their relation to physiologic stability and positioning practices, through coding of videotaped observations of the infants before, during and after nursing care. She has coauthored a textbook on NICU interventions (Developmental and Therapeutic Interventions in the NICU - Brookes Publishing). Currently, she is collaborating with other NICU professionals on a study of the impact of the NICU environment on infant and caregiver behavior and development.

She is the coauthor of a tool for assessment of fine and gross motor development of high risk infants during the first year of life (Posture and Fine Motor Assessment of Infants (PFMAI) – Psychological Corp/Pearson), which involved Rasch analysis for scaling of items and forming criterion for norm referencing. She has acted as a consultant and trainer for the infant motor assessments used in the multi-site NIH funded "Maternal Lifestyles Study", including the PFMAI and the Peabody Scales of Motor Development, to demonstrate subtle differences between infants who have been exposed to illegal substances in-utero and those who have not. She also has participated in the development of clinical applications for the Neonatal Network Neurobehavioral Scale (NNNS). Dr. Bigsby has mentored graduate students in their study of preterm infant behavior, and the relation between infant sensory and feeding issues, and is currently working with a multi-disciplinary group of professionals in the NICU to develop an approach to initiating and progressing breast and bottle feeding in the NICU.

funded research

Travel Award to attend Physical and Developmental Environment of the High-Risk Infant Conference, January 26-29, 2005; March of Dimes Birth Defects Foundation, Rhode Island Chapter.

Research Grant #399469, 1995-1996, $5000.00, Reliability and Validity of the Posture and Fine Motor Assessment of Infants, Parts I and II.  American Occupational Therapy Foundation, Co-Principal Investigator.

Research Grant #4680-105, 1992 - 1993, $1000.00;  Motor Behaviors as Cues to Cardiorespiratory Response in Preterm Infants.  American Occupational Therapy Foundation, Principal Investigator.