Taking Care of a Preemie
At the hospital
At the hospital, once your baby’s state of health is stable, you can take part in caring for her in several ways.
Comforting
Premature babies are very sensitive to pain. Your baby may require several medical treatments, however, so you can provide comfort. If your baby’s condition allows, you can hold your baby skin to skin (kangaroo method) and murmur to her. Some babies also like to be swaddled or sung a lullaby. When a medical procedure is required, be sure to wake your baby gently. To reduce the pain, you can offer breast milk or sugary water to your baby, or breastfeed if she/he can suckle. A soother can also comfort.
Stimulating baby at her/his own pace
Preemies can quickly become overstimulated. Between watching her parents, and listening to their lullabies while being touched, she can feel overwhelmed, since her nervous system is still not fully developed. Moreover, the hospital itself is a source of unpleasant stimulation: needles, medical staff’s hands, smelly disinfectants, noisy equipment, etc. So it is important to give your preemie pleasant sensations, preferably by introducing them gradually. For example, you could begin with skin to skin contact with your baby. When she is comfortable with this, sing her a lullaby. Later, you can gently massage her back. Finally, once she can withstand more stimulation, you can rock her.
Feeding your baby
A baby born before the 34th week of pregnancy will probably need to be fed partly by intravenous. As baby matures, she can receive small amounts of milk by tube through her nostril or mouth to her stomach. At this time, mothers may pump their milk to feed to their baby, if they wish. In fact, breast milk is highly beneficial to preemies. Breastfeeding a premature baby can be challenging, however. It is important that the mother receive support and encouragement. When the baby reaches the equivalent of 30 to 34 weeks of pregnancy, she can successfully latch on to the breast. This capacity develops before the baby can drink from a bottle.
Breast milk bank
Québec has a public breast milk bank managed by Héma-Québec. The milk, donated by some 400 mothers, is analyzed, processed and pasteurized to eliminate viruses and bacteria. It is then sent to hospitals that care for very premature babies. The bank milk is reserved for babies born before the 32nd week of pregnancy who do not get enough of their mother’s milk. According to Héma-Québec, babies who are fed breast milk have three times less risk of developing a severe intestinal disease known as necrotizing enterocolitis.
Returning Home
The medical team will look at several factors to decide if your baby can go home.
- He must weigh between 1800 and 3000 g, depending on his state of health.
- He must have sufficient respiratory maturity.
- He must be able to nurse or bottle-feed and gain 15 to 30 g daily.
After hospitalization, premature babies often need special medical and paramedical follow-up, so that they can be screened for potential developmental problems and begin treatments if necessary. Some children require no treatments. Only a minority will need to be monitored for a longer period, which may range from several months to several years.
During baby’s first weeks at home, you may feel anxious, even if you’re happy to be home. You’ll certainly have an adjustment period to get through. If you are concerned, do not hesitate to contact your CLSC.
Don’t forget to plan breaks for yourself, to get some rest. Don’t worry about doing housework. Ask for help. Grandparents, family and friends can be of invaluable assistance. They can pitch in to get baby’s room ready, do certain household chores, accompany you to the hospital, or discuss what you’re going through. But limit the number of visitors if you feel the need for peace and quiet.
Resources and Useful Links
Check out our publications, fact sheets and reading suggestions. Also discover useful resources and links: CLSC, breasfeeding support, child health and development, etc.
Sleep
For the first few weeks, your baby will be able to sleep most of the time after arriving home.
Premature babies tend to have long periods of sleep and short periods of awareness. Premature babies sometimes don't cry for food like full-term babies do because they don't recognize when they're hungry.
Your baby may also confuse day and night just after leaving the hospital.
Realize how different his new room at home is from the neonatal unit. If you think your baby is having trouble sleeping, you can turn on a nightlight and play the radio at low volume; you can also slowly lower the noise and light to help your baby adjust to the atmosphere of your home.
When you feed your baby at night, don't play with him or her, and keep his or her attention focused on feeding. If your baby has trouble sleeping, and you are sleep-deprived, ask your family or a friend for help and, if possible, take a nap of two or three hours for a few consecutive days. You need to recover from your hospital stay too!
Usually, a baby between 6 and 8 months of age (corrected age) should be able to sleep through the night. Babies lie on their backs in bed to help prevent breathing difficulties during sleep. Ask your baby's doctor and nurse for advice on sleeping positions that can help restore a well-rounded head. To relieve the stress and exhaustion of the last few weeks/months, many parents set up a small bed in their bedroom for a few months to recover a little.
Fever
Fever is one of the ways the body fights infection. The body's "cleaning" cells (called macrophages) are on constant patrol. When they detect something (virus, bacteria, fungus), they work to eliminate it. They call for help by asking the brain to raise the body's temperature. Heat directly destroys certain types of bacteria. Fever also seems to accelerate the body's production of white blood cells and germ-killing chemicals.
Teething
Your baby's first teeth, the lower central incisors, don't emerge until between four and eight months. Don't worry if you see them coming earlier or later! The four upper incisors and two lower lateral incisors will follow, and after a few months, the first four molars will appear. The canines come out around sixteen/eighteen months, and the last molars around twenty/twenty-four months. In any case, the baby will have twenty milk teeth between the ages of two and three.
Premature children grow their teeth according to their "corrected age,” not their actual age.
Teething
Your baby's first teeth, the lower central incisors, don't emerge until between four and eight months. Don't worry if you see them coming earlier or later! The four upper incisors and two lower lateral incisors will follow, and after a few months, the first four molars will appear. The canines come out around sixteen/eighteen months, and the last molars around twenty/twenty-four months. In any case, the baby will have twenty milk teeth between the ages of two and three.
Premature children grow their teeth according to their "corrected age,” not their actual age.
Virus Prevention
The more premature a baby is born, the more vulnerable it is to infection. Its lungs are less developed, and unlike a full-term baby, its immune system has not benefited from the transfer of antibodies from the placenta during the third trimester of pregnancy. As a result, premature infants are more at risk of contracting certain viruses and common winter illnesses such as the cold, respiratory syncytial virus (RSV), influenza and so on. Fortunately, infections can be prevented by vaccination and small everyday gestures.
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