Caring for Your Premature Baby Notes

Caring for Your Premature Baby Notes:

2 Home Journey

ike most parents of premature babies, you’re probably both excited and L anxious about taking your baby home. The time you spent at the hospital watching her† progress may have been a challenge. Your transition from hospital to home, and settling into a comfortable routine, will take time as well.

In the first days after your baby was healthy development. You’ll learn born, you adjusted to the fact that she more about each other with each was born earlier than expected. Many passing day. You probably already parents blame themselves for their know much more than you think baby’s premature birth. Or, they feel you do. guilty because they don’t feel like they did enough to avoid the premature The first few weeks that your baby birth. These reactions are normal. is home will be wonderful as well as challenging. You’ll have an entirely During the days in the hospital, you new routine. In addition to being and your baby developed bonds physically tired from meeting the that will grow even stronger now that demands of your new baby, you may you’re home. This is a lifelong process find yourself worrying about many of of attachment that is important to the things she does.

†† This booklet alternates between “she/her/hers” and “he/him/his” when referring to babies.

3 his booklet will give you guidance as to what to expect during the early Tmonths your premature baby is at home. You’ll learn how to use this information to help her grow and develop.

You’ll also learn some ways to help you relax and enjoy your new baby. Remember, you are an expert when it comes to your child.

• Trust what you see as a guide in deciding what to do for her. • Simply watching her actions closely will help you understand her needs and feelings. • If you have any questions or concerns, call your baby’s doctor or nurse.

4 Development

ou may be concerned about your baby’s development. As a parent, you Ymay have certain ideas about when your baby should smile, roll over, sit, walk and talk.

It’s important for you to know that A 5-month-old baby who was born the progress of premature infants 3 months early should be considered is somewhat different from that of a 2-month-old from a developmental full-term babies. While premature point of view. babies follow a similar order of development, their time schedule If your baby was very sick, he may is different. lag behind his adjusted age during his early months of life in physical A baby who developed in his or motor skill development. If you mother’s womb for only 6 to 8 are concerned about your baby’s months shouldn’t be compared with development, call your healthcare a baby who had a full 9 months to professional or the early intervention develop and grow. service in your community. The more you know, the better able you will be When considering your baby’s to help your baby grow and develop development, think in terms of his to his full potential. “adjusted age.” You can find it by subtracting the number of months Adjusted Age your baby was born early from his actual age. Your baby’s actual age _____ months Adjusted age gives parents and healthcare professionals a realistic Number of months premature _____ months view of a premature baby’s progress.

Adjusted age _____ months

5 How Premature Babies Act

ost premature babies come home within 2 weeks of their actual due Mdate. Even a baby who has finally reached her expected birth date still has some catching up to do. She may: • Not give you clear signs that she’s hungry or tired • Still be weak and hard to feed • Spend her day either sound asleep or crying, and may go from one stage to the other within seconds

Your baby’s behaviour patterns may Your baby will get better at making be difficult to understand at first. her needs known to others, and This can be frustrating and stressful. you’ll learn what certain cues mean However, as the weeks and months (see pages 19-20). As with all babies, go by, her nervous system will your premature baby will have stages continue to develop and her of rapid development followed by actions and responses will become long periods when nothing much more predictable. seems to happen.

6 Don’t be discouraged. This is normal. in his environment, or even • You can’t motivate or push to his own physical needs. your baby to develop before • He may suddenly stiffen she’s ready. his arms and legs or draw • D on’t try to force her into them inward. activities when she’s • At times, he may go limp and tired or actively resisting. then quickly become tense. Pushing will just leave both of you frustrated. As he grows, these reflex actions • Offer her your companionship, will gradually disappear. You your time and plenty can help your baby control his of encouragement. movements by: • Maintain a calm, accepting • Holding his arms and legs close attitude toward her to his body development. • Making slow, gradual changes • Focus on her progress. when you move him Whether she began walking at 12 or 20 months won’t In premature infants, the matter years from now. development of the senses is • A s you watch her for signs of often faster than the development behavioural development, of muscle coordination. always use your baby’s adjusted age to judge her abilities. Your baby may seem to be slow to gain control of the movement of his head or to grasp objects. However, Movement he may show an increasing ability to Premature babies often have very respond to sights and sounds—an uncoordinated movements. It’s indicator of healthy development. hard to predict how your baby will respond to you and the world around him. • His reactions may have a jerky, startled quality, because he is still trying to adjust to changes

7 Breathing Keep in mind the kind of sleeping Breathing patterns and the skin environment your baby is used to. colour of premature babies can While some babies just out of the change rapidly and without nursery adapt easily to sleeping in warning. Observe your baby and a dark, quiet room, others miss the get to know his usual breathing noise and lights. If your baby has pattern and “normal” colouring. trouble sleeping: • W atch his chest as he breathes. • Turn on a night light. Provide • Count his normal number of background sounds, like a softly breaths per minute. playing radio. • Listen to the noises he makes • Gradually turn down the extra when breathing comfortably. noise and light to help your baby adapt to your home. By being familiar with these • Resist the urge to play with “normal” behaviours, you’ll be her during nighttime feedings. better able to detect problems. Keep her attention focused on eating during this time. Any time you’re concerned about your baby’s breathing or colour, call When your baby reaches an your healthcare professional. adjusted age of 6 to 8 months, she’ll most likely be sleeping Sleeping through the night. Your baby will do more sleeping than anything else during her first Experts recommend that most weeks at home. babies be placed on a firm mattress on their backs for sleeping. Check At first, your baby may sleep 15 to with your baby’s doctor or nurse for 22 hours a day. Premature babies advice on sleep positions for your tend to have long sleep sessions and baby. short wakeful periods. Your baby may come home from the hospital with her days and nights mixed up.

8 Crying Your premature baby may not Crying can alert you that your baby cry much at first. His crying may may be hungry, uncomfortable then seem to “turn on” as your or tired. Responding to his cries original due date (adjusted age helps your baby develop a feeling of 0 months) nears. of trust and a sense that he can communicate with others. Your baby’s first periods of crying may be short. He may be easily Don’t worry about spoiling your comforted by a soothing touch or baby. Give him lots of attention. something to suck on. As your baby In these early months, your baby grows, he may cry more often. In a needs to be held as often as you way, crying is a good sign of your can make time to do it. baby’s normal development.

9 Sometimes comforting a crying As premature babies develop, they baby is hard. Long periods of crying become easier to comfort. With may be a sign that a baby is sick time, they learn to calm themselves. or in pain. If your baby cries for an Fussing and crying generally reach unusually long time, you should call a peak at 3 to 4 months’ adjusted your doctor or nurse. age. As your baby gets older, he’ll probably cry less, and his periods of Usually nothing is wrong, but it’s sleep will become more regular. always wise to check. • F ull-term newborns may cry 2 to 3 hours a day during the early months of life. • Some premature babies, especially the smallest ones, are very fussy and may cry 6 hours a day or more.

10 Calming a Crying Baby irst of all, make sure your baby isn’t hungry and doesn’t need a F diaper change.

• Position your baby so that he can He may have a low tolerance see you. Talk softly to him. for stimulation. Instead, • Bring his hand to his mouth, or offer calmness. give him a pacifier. • Give your baby a warm bath • Hold your baby’s arms close to (unless he dislikes water). his chest. • When all else fails, put him down • Swaddle him. His shoulders and let him cry it out. This is should be forward and his body sometimes just what is needed to wrapped gently but firmly in a calm a crying baby. baby blanket. • Never shake your baby to try to • Pick him up. Motion usually helps, make him stop crying. Shaking so try rhythmic rocking or walking. your baby can result in brain • Resist the urge to entertain him. damage, or even death.

11 Feeding Your Premature Baby remature babies may not cry to be fed as full-term babies do. Because Pof the immaturity of her nervous system, your baby may not know when she’s hungry. And because her stomach is small, her feedings need to be smaller and offered more often (about every 3 hours, sometimes sooner).

Your baby may also take longer • If you’re breastfeeding, you may to feed until she grows stronger need to give extra support to and better able to coordinate her your baby’s head and shoulders. sucking, swallowing and breathing. • If you’re bottle feeding, you may need to use a special soft nipple A premature baby needs a lot of designed for premature infants, energy for sucking. Her mouth is which makes sucking less tiring. small, and the muscles used for Your baby will eat best when sucking may be weak. she’s wide awake. Help her

12 concentrate on eating. Until your suddenly develops frequent, watery baby gets skilled at eating: stools, you should call your doctor • Feed her in a quiet room without or nurse. bright lights • Keep distractions, even talking Also notice how often your baby or rocking, to a minimum wets her diaper. She should have a wet diaper at least as often as Be sure you make eye contact with she takes a feeding. If she wets her and support her head and neck fewer diapers, it may be a sign with your hand or arm. Keep her that she’s not getting enough comfortable—not too stretched out breast milk or formula. and not too hunched over. Breastfeeding Try to make feeding a comfortable, The experience of breastfeeding relaxed time for you and your baby. and of feeding your baby your own Nutrition is important to your baby’s milk offers many special benefits. growth and development; so, too, is Certain components of breast milk a pleasant feeding experience. help protect babies from infection. Breast milk is an excellent source of Your baby may have a bowel nutrients for premature infants. movement after every feeding, or only every 1 or 2 days. If you At discharge, your premature baby breastfeed, your baby’s stools will may still tire easily while eating be yellowish and soft—like cottage and not completely empty your cheese. If your baby is fed formula, breasts. To ensure adequate milk stools may be soft and yellow to production in the early weeks, it brown/green. may be necessary for you to pump your breasts and feed or store the Notice the normal frequency and expressed milk. consistency of your baby’s stools so that you can recognize constipation In addition to the feedings at the and diarrhea. breasts, some premature babies may need a supplement to help them If your baby passes hard stools or grow—either a breast milk fortifier,

13 a vitamin-mineral preparation or a Experts recognize the benefits of special formula. Your doctor will tell special preterm discharge formulas you if your baby needs one of these. containing higher levels of nutrients than standard infant formula. • Before you leave the hospital, make sure you’re comfortable with all aspects of breastfeeding The American Academy of your baby. Pediatrics‡ has recognized that • Make a plan with your nurse, continued feeding of a preterm doctor or lactation specialist discharge formula to premature as to how often you’ll need infants to age 9 months may to feed, and if you’ll need to improve length and weight gain offer supplements. compared to feeding a standard term formula. • Early weight checks, at home or at the doctor’s office, will It’s possible that before being give you the information and discharged from the hospital, your reassurance you need to be baby was started on Similac® Advance® sure your baby is getting the Neosure® Infant Formula with Iron, nourishment he needs for proper a nutrient-enriched postdischarge growth and development. infant formula for conditions such as prematurity. Remember to get plenty of rest. Most of all, enjoy the good feeling you get To meet your baby’s increased from breastfeeding your baby. nutritional needs, Similac Advance Neosure has higher levels of Bottle Feeding calories, protein, vitamins and If you’re not breastfeeding or minerals than standard Similac expressing milk for your baby, your Advance and should be used only as doctor may prescribe a special infant directed by your doctor. formula.

‡ Kleinmen RE, editor Pediatric Nutrition Handbook 5 ed ELK Grouve(III): American Academy of Pediatrics 2004.

14 Similac Advance Neosure Because your premature baby is contains DHA and ARA, special at risk of developing iron deficiency, nutrients found in breast milk that he’ll need added iron in his diet— are important for an infant’s mental either through his feedings or as and visual development. iron drops. Without it, he’s likely to use up the iron stores in his Before you take your baby body by 2 months of age and home, learn any special feeding could become anemic. techniques, and find out how much formula he should be taking in a Check with your baby’s healthcare 24-hour period. professional to find out if a vitamin supplement is needed.

15 Your Baby’s Developing Senses Seeing At an adjusted age of 0 months, All babies notice dark-light contrasts. premature babies can best see • Early on, they like simple black- objects 8 to 12 inches away—almost and-white patterns, such as a exactly the distance from their eyes bull’s-eye or diagonal stripes. to the face of the person who is • As they get older, babies like to feeding or holding them. look at more detailed or complex patterns and bright colors. By the adjusted age of approximately • Like adults, babies get bored 6 months, premature babies can see looking at one object for a almost as far as adults can. long time.

16 Hearing Most of all, babies like to look Babies seem to like sounds at faces. that change, such as a voice or • The ever-changing expressions music, more than sounds that of the human face are stay the same. continually interesting to them. • Your baby will especially be • Your face-to-face contact with “tuned” to and enjoy the sound your baby, while brief at first, of your voice. will become an important • Babies enjoy soft music, source of learning in the early especially people singing, even weeks and months at home. if it’s off-key! • At an adjusted age of 0 months, your baby may be able to Although premature infants are imitate smiles, frowns and other generally screened for hearing loss facial movements. He may even prior to discharge, you should note copy you if you stick your tongue how your baby responds to sounds. out at him! Often a baby with normal hearing You’ll become the main focus of will ignore some loud noises. A your baby’s interest and attention. consistent lack of response, however, Your smile, the sound of your voice should be brought to the attention and the comfort you give are critical of your healthcare provider. to his development. Look for your baby’s increasing responsiveness to you as an important marker of progress.

17 Touching Tasting and Smelling You naturally touch and stroke Your baby can taste and smell. your baby. Touching is a calming Newborns seem to prefer the force that keeps him feeling safe taste and aroma of their own and secure. Babies who like being mother’s milk. And they will cuddled—and most do—will usually often wrinkle their noses when relax and snuggle up to the person offered a sour substance. holding them. Enjoy these times.

Babies like to feel many textures. Help yours to feel the many things he comes in contact with every day—towels, diapers, water, clothes and your skin.

18 Communicating

ne of your baby’s first Talking to your baby is extremely Oaccomplishments is social important. smiling, which begins around an • It helps her learn language adjusted age of 2 to 3 months. and serves as a basis for many other skills. To encourage your baby to smile, • Don’t be shy about talking to smile at her. Respond to your baby your baby about everything by smiling, talking to her or picking you’re doing. her up whenever she smiles at you. • Never hesitate to express your love in words. Although your baby can’t By an adjusted age of 7 months, understand words in the early your premature baby should begin months of life, she’s learning the cooing and babbling—her first give-and-take of conversation. attempts at speech.

19 Comfort Signals As premature babies communicate, For example, you may be rocking they give “ready” signals that tell your baby while talking to him and others now is the time they want to making eye contact. If he tenses his socialize or play. When your baby is arms and legs, or sends other stress ready to interact, she may have: signals, you need to provide less • Good skin color stimulation. Some premature babies • A bright, alert expression can cope with only one activity at • Eye contact with wide-open eyes a time. So slow down the pace of • Hands that she can put together one activity and stop the others. You across her chest might rock more slowly, stop talking • Her fist to her mouth and briefly look away from your • Relaxed arms and legs baby’s eyes. This gives him a chance to relax and build coping skills. Stress Signals Babies also have a set of “stress” signals that indicate when they need a break. When too much is happening your baby may: • Look away • Fuss and cry • Hiccup • Spit up or vomit • Arch his back • Stiffen his arms and legs If you see a comfort signal, continue your activity with your baby. If you see a stress signal, slow down the activity or stop it. Give him time to relax.

20 Working With Your Baby’s Doctor hoosing your baby’s primary care doctor is very important. C• Be sure any doctor you interview knows that your baby was premature and received care in a neonatal intensive care unit (NICU). • The doctor should listen to you carefully, respect your judgment and be sensitive to you and your baby’s needs. • Select a doctor who understands your normal feelings of fear and frustration, as well as love, as you care for your baby.

21 First Visits Your baby should be seen by her Immunizations doctor according to your hospital Discuss your baby’s immunization discharge plan. Be sure that all schedule with your pediatrician, and necessary medical information don’t miss scheduled visits. about your baby’s stay in the NICU is conveyed to your pediatrician Cosmetic Concerns by the time of discharge. If you’re Premature babies commonly breastfeeding, this visit needs to be are born with birthmarks called early in the first week. At that time, hemangiomas. These “strawberry the doctor will discuss with you how marks” are soft, red, raised areas often your baby should be seen. composed of swollen blood vessels (capillaries). Toward the end of the Be sure you know how to reach first year, they will start to slowly your doctor at all times. Use office disappear and usually are gone by visits to ask questions, discuss your age 4. baby’s progress and talk about your concerns. Write down your Other cosmetic concerns include questions ahead of time, using the scars from surgeries or procedures, space provided on page 25. which can seem large and unsightly on some tiny babies. Most of these What you tell the doctor or nurse become much less noticeable with about your baby is very important. time and growth. Be sure to discuss issues relating to activities, attention level, sleeping and feeding patterns, and personality.

Don’t let your baby’s weight or bowel movements be the only thing you talk about. Ask the doctor or nurse to explain anything you don’t understand. Ask them to write down the information or repeat it until you understand it.

22 Home Monitors There is a growing trend toward Another word of caution: It’s very sending premature babies home while important that no one smoke still on apnea monitors or oxygen. around an infant, especially when oxygen is being used. This allows babies to go home with their families a little sooner CPR than expected. If your baby comes home with • The home environment can help oxygen or a monitor, infant CPR your baby’s development. (cardiopulmonary resuscitation) • It’s a much less expensive may be part of the overall training way to give your baby the you receive before leaving the care she needs. nursery. This training will give you the skills to get your baby’s heart If your baby comes home with and lungs working again in case oxygen, you’ll be carefully of an emergency. instructed and trained how to use it. It’s also important for family CPR is a skill every parent and members and potential baby sitters caregiver should know. to be trained and comfortable using this equipment.

23 Does Your Baby Need Testing? Newborn Metabolic Screen should have examinations by an All newborn babies are tested for ophthalmologist. certain rare inherited diseases. These diseases, if untreated, can seriously If your baby received a hospital eye interfere with a baby’s development. checkup, you should ask for the For testing, a few drops of blood results. And you should find out if or are taken from your baby’s heel. when your baby will need to see an Although all babies are tested in the ophthalmologist after discharge. hospital, sometimes a baby will have to be retested after going home. Follow-Up Check with your baby’s doctor at Hearing Exam the time of discharge or at an early Your baby most likely had a hearing visit to be sure that your baby has screen prior to leaving the hospital. been tested for these rare but Follow-up evaluations are often serious diseases. recommended. Check with your doctor or nurse to see if further Follow-Up Eye Exam testing is needed. All premature babies, born weighing less than 1500 grams (3 lbs. 5 oz.), If you have concerns about any of and those who have medical these tests, check with your baby’s complications while in the hospital, doctor or nurse.

24 Questions to Ask the Doctors and Nurses

25 Practical Tips Car Safety Seat A premature baby in a car seat will Always place your baby in a need extra support to keep her body government-approved, rear-facing straight so she can breathe easily. safety seat in the back seat of your Rolled-up blankets and cloth diapers car before driving anywhere. Even can provide padding to keep her the tiniest baby needs to ride in a from slumping over and will help safety seat. prevent excessive movement.

All provinces by law require infant car Have the NICU team show you how seats. Transport Canada states that to position your baby properly. They you should: may monitor your baby’s oxygen level and general condition while sitting • Always put a rear-facing infant seat in the back seat of the in the car seat before going home. vehicle. Monitoring your baby’s oxygen levels • Never put a rear-facing infant while sitting in the seat can indicate if seat in the front passenger seat. there is a problem. • If your vehicle has side air bags, see the Transport Canada fact sheet on How to Read the instructions that came with your baby’s car seat.

26 Diapers and Clothes Room Temperature You may want to buy diapers that Keep your baby’s room at a are designed to fit premature comfortable temperature. A baby infants. Your baby’s nurse should under 3.63 kg doesn’t have much be able to tell you where you can insulating baby fat and has trouble purchase these smaller diapers. coping with temperature changes.

You may decide to make or have Keep your house at a low-to-mid- clothes made for your baby. Since 21°C temperature. Dress him your baby will soon outgrow these comfortably. Check the temperature clothes, you shouldn’t need many of of his skin as a precaution. them. Most large department stores • If his hands and feet are cool, and many Internet sites sell ready-to- pale or blue, warm him up. wear clothes for premature babies. • If he feels warm and looks Make sure clothing meets the safety flushed, he may be overdressed. standards necessary for infant wear. Because the skin of a premature Crib baby is sensitive, keep your baby Never use bumper pads in your out of direct sunlight. Also, try to baby’s crib and be sure that the slats avoid cold drafts and extremely on the crib are less than 6 cm low humidity. apart. If the spaces are wider, his head could get caught.

• The mattress should be firm and fit snugly into the frame. • There should be no more than a thin, tight-fitting sheet between the mattress and your baby. • Don’t put any soft, bulky items in the crib that could block your baby’s breathing.

27 Infection Control Bath Time The fall and winter months bring Keep bath time as short as colds and respiratory infections. A possible. Premature babies lose common and serious respiratory body heat quickly. infection in premature babies is • Check the temperature of the caused by RSV (Respiratory Syncytial water with your wrist or elbow Virus). Talk to your nurse or doctor before you place your baby in before leaving the hospital about the tub. Keep the room warm, how to keep your baby from and shield him from drafts. developing a severe respiratory • Use smooth, soothing motions illness from RSV. when washing and handling him. Swaddle him in a soft towel Once you get your baby home, give after the bath. yourself a few weeks of adjustment time before having company. Then, as long as your baby’s visitors are healthy, there’s no reason to keep them away from your premature baby. Insist that they wash their hands with warm water and soap before touching your baby. Be aware that kissing the baby can spread RSV infections. Hug her gently, or stroke her head instead.

When you do begin to take your baby out, stay away from people, places or situations where you can’t control her exposure to germs. And remember, never let anyone smoke around your baby. Infants and children exposed to smoke have a higher than normal incidence of respiratory illnesses.

28 Tips for Relieving Your Stress henever possible, sleep when your baby sleeps. This is not a one- Wperson job—don’t be afraid to ask for help when you need it. Take turns caring for him.

• Although family and friends can be asked to hold off visiting until you and your baby have time to get settled, gladly accept their help with cooking, cleaning and running errands if offered.

• Parents need time away from their baby. Take time-outs. Privacy and recreation for you are essential if you are to continue to meet the challenge of caring for your baby.

• Many parents find that talking with other parents of premature infants lowers their anxiety and stress. For the name and location of a parent support group in your area, check with the NICU staff.

29 Your Baby’s Future

ou may wonder if premature birth will affect your baby’s mental Ydevelopment. Most premature infants develop normally. Only a small percentage of babies born early have serious long-term problems.

Many famous people were you develop workable schedules. premature infants. They include Having a daily routine is essential to Mark Twain, Albert Einstein, Anna the healthy parent-child relationship Pavlova and Winston Churchill. that you both need.

One of the most important factors Abbott Nutrition joins your doctor, in the development of premature nurse, nutritionist and hospital in infants is their home environment. extending to you and your baby Your loving attention and caring best wishes for good health and will help your baby develop to his many happy years ahead. full potential.

It’s easy for parents to become overly protective of their premature baby—even when the doctor or nurse has assured them that all is well. In these families, the child may become dependent and demanding. As the parent of a premature infant, you need to help your child develop emotionally as well as physically. As your baby grows, you can help him adjust by setting schedules and limits.

Stay in touch with your baby’s doctor and nurses. They can reassure you about your baby’s progress and help

30 Similac® Advance® Neosure® Infant Formula Premature and low-birth-weight Good nutrition is very important babies usually leave the hospital during this first year of rapid when their health is stable and they growth. Similac Advance Neosure are growing. However, they still have helps meet the nutritional needs unique nutritional needs after they of premature babies throughout leave the hospital. the important first year of life. In a published scientific study, premature Similac Advance Neosure was infants fed Neosure for the first year developed to help meet the of life had improved growth when nutritional needs of premature and compared to premature infants fed low-birth-weight babies after they term formula.†† are discharged from the hospital. Similac Advance Neosure provides Ask your doctor about your more protein, vitamins and minerals premature baby’s special nutritional than formulas designed for full-term needs and the extra nutrition infants and helps support the rapid Similac Advance Neosure offers for growth of a premature baby. conditions such as prematurity.

Similac Advance Neosure contains DHA and ARA, special nutrients found in breast milk that are important for an infant’s brain and eye development.

31 The Right Nutrition at the Right Time Similac® Advance® Neosure® Babies grow and develop faster during the first year than at any other time. You’ll want to make the most of that important first year with the right nutrition. The American Academy of Pediatrics* has recognized the importance of post-discharge formula in the first 9 months in preterm infants.

Similac Advance Neosure contains DHA and ARA, special nutrients found in breast milk that are important for an infant’s brain and eye development.