Questions After Discharge
When do I take my baby to the doctor?
You should see your baby's doctor within 2 weeks after you take your baby home
unless your doctor has stated otherwise.
Who can I call if I have a question
once my baby is home from the NICU (Neonatal Intensive Care Unit)?
Your baby's doctor will want you
to call if you have any questions.
You can also contact the NICU where
your baby was the past weeks or months.
Home Temperature and Dressing Your
How warm should I keep the temperature
in my house?
A low to mid-70's temperature is warm enough as long as the baby is dressed
How warm should I dress my baby?
One rule of thumb is to dress your
baby like you are dressed for that kind of day and a similar amount of activity
(usually sleeping or quiet). The best way to tell if your baby is dressed warm
enough is to look and touch his skin.
- If your baby's hands are cold,
blue or blotchy, add socks, hat, sweater or another blanket.
- If your baby seems restless or
fussy and his skin is flushed or reddened, remove a piece of clothing or blanket.
- When your baby is sleeping, add
If these things do not make a difference
and your baby continues to be uncomfortable, take your baby's temperature; your
baby could be sick.
Illness and Taking Temperature
How can I tell if my baby is sick?
Parents are the best at knowing when
their baby just doesn't seem to be acting the same. Some premature infants are
more susceptible to colds or respiratory infections. Babies can become dehydrated
(lose of fluid and nutrients) quickly. A change in your baby's response or behavior
could be a sign that your baby is sick. These include:
- Change in your baby's breathing
- Excessive crying or irritability
- Change in eating pattern
- Difficult to wake up or not as
active as usual
- Coughing, not associated with
- Vomiting all or most of his/her
- Frequent liquid stools within
a short period of time (6-8 hours)
- Not as many wet diapers as usual
and urine is a darker color
- Blue or pale colored skin
Don't hesitate to call your pediatrician.
No question is foolish or unimportant. Your doctor is there to answer all your
How do I take my baby's temperature?
Axillary (underarm) temperatures
- If you are using a glass thermometer,
shake the mercury down by snapping the wrist sharply while holding the thermometer.
Check to make sure the mercury is below 96 degrees F.
- Place the tip of the thermometer
under the arm pit making sure that it is in contact with both the skin on
the arm and the skin of the chest.
- Hold the arm down next to the
side of the chest keeping the thermometer under the arm.
- Keep in place for at least 3-4
- Axillary temperatures are slightly
lower than rectal temperatures.
Rectal (in the bottom) temperatures:
- If using a glass thermometer,
shake the mercury down by snapping the wrist sharply while holding the thermometer.
Check to make sure the mercury is below 96 degrees F.
- Place water based lubricant on
silver end of thermometer.
- Hold your baby either on his/her
abdomen across your lap or place on the changing table as if you are going
to change the diaper.
- Place the tip or the silver end
of the thermometer into your baby's rectum, no more than 1/2 inch.
- Hold the thermometer in place
for at least 2-3 minutes.
- Wipe thermometer with a tissue.
Oral temperatures should not be done
It is a good practice to have already
taken the temperature when you call your doctor or go to an appointment for
It is always best to take the temperature
rather than feel your baby's skin.
How do I know if my baby has a fever?
A fever is a temperature over 99 degrees Fahrenheit axillary or 100.5 degrees
Your doctor should be called if :
- Your preemie is under 2 months
of age and the temperature is over 99 degrees F axillary or 100.5 degrees
- Your preemie has a temperature
over 99 degrees F axillary or 100.5 degrees F rectally and other signs of
- Fever is present more than 3 days.
- The temperature is less than 97
Vomiting, Bowel Movement, and Diaper
How can I tell the difference between
spitting up and vomiting?
Spitting with a feeding is a common
occurrence in prematures. It can also occur with a burp or soon after a feeding
and may be called a "wet burp". It is usually only a small amount.
Vomiting is a continuous throwing
up of large quantities of food or liquid, and occurs other than at feedings.
What is a normal bowel movement?
By the time your baby is ready to
go home, his/her bowel movement will probably be yellow or light brown in color.
Normal consistency is soft with some form or mushy. Some babies may have a bowel
movement with every feeding and others may have one once every day or two.
If your baby has not had a bowel
movement for 2-3 days and seems uncomfortable, or after that time has one in
the form of hard pebbles, s/he may be constipated. Call your doctor. There may
be well meaning friends who have home remedies to use for constipation but it
is always best to check with your doctor instead.
Honey is NOT recommended for infants
under 1 year of age.
If your baby does not seem uncomfortable
and is eating well your baby may just be a baby who has infrequent bowel movements.
Breast fed babies may not have bowel movements every day.
If your baby has frequent watery
liquid stools in 6-8 hours time or seems to have looser stools more often than
regular, your doctor should be called.
What should I do about diaper rash?
At one time or another all babies
will have a rash in their diaper area. Some things to remember when this happens
to your baby are:
- Keep the area clean. Use a wash
cloth with soap and warm water after each diaper change, making sure to rinse
off the soap. Allow the area to air dry before replacing the diaper. Diaper
wipes may irritate the baby's skin.
- Leave the diaper off and let the
rash be open to the air as much as possible. This can be done when the baby
- Change the diaper often .
- Use a diaper ointment containing
zinc oxide, which can be found at any pharmacy. After washing off your baby's
diaper area rub a thin layer of this ointment on your baby's reddened skin.
If there is no improvement after 3 days, call your doctor.
How do I know if my baby is sleeping
the right amount of time?
Premature babies may seem to sleep
a great deal initially. They should be waking on a regular basis for feeding.
By the time of discharge your baby has developed a routine of sleeping.
If your baby has its days and nights
mixed up, it is best to minimize the stimulation during the night feeding time.
Some ways you can do this are:
- Use only a night light when getting
up to feed the baby.
- Change the baby before the feeding.
- Talk very minimally and softly
during the time you are up with him/her.
- If you normally rock the baby
after the feeding, do so for only a very short time. The baby will begin to
learn to settle him/her self.
The adjustment to the home environment
from the noisy nursery is difficult for some babies. Some suggestions to help
your baby make this transition are:
- Keep the lights dimmed.
- If your baby is fussy, swaddle
your baby by wrapping his/her arms and legs snugly in a blanket. Play soft
low music, or keep the television on during the day.
How often should I bathe my baby?
You do not have to bathe your baby every day if you are keeping the diaper
area clean with each diaper change. Baby's skin can dryout very quickly if bathed
too often. A complete bath 1 or 2 times a week is sufficient.
Should I wash my baby's face?
Your babies face should be washed every day with a wash cloth and warm water.
Pay attention to the folds under his chin where milk may collect. Most babies
do not like to have their face washed and will wiggle and squirm. It helps to
do one side of his face at a time, trying not to completely cover the face all
How do I clean my baby's nose?
Wiping your baby's nose with a soft tissue will usually help remove extra secretions.
If you have a bulb syringe be sure to push the air out of the bulb before gently
inserting the very tip of the syringe into the nose. You do not want to use
any force or squeeze the air into your baby's nose.
Stuffy Nose and Hiccups
What if my baby has a stuffy nose?
By adding humidity to the house, (turning on the shower, washing clothes or
having a humidifier) it may help your baby to breath easier. If the stuffiness
continues and your baby doesn't seem to be getting any better, it is wise to
call the doctor to have it checked out. It could be a cold.
Are hiccups and sneezes normal?
Yes, hiccups and sneezes are normal.
Normally the hiccups will just go away by letting them run their course. You
can offer a little water and if you are breast feeding let him/her suckle at
the breast for a minute or two.
Hiccups may also be a sign that your
baby is feeling a little stressed and needs to have some quiet time.
Sneezes will help to clear the passages
of your baby's nose. It is nature's way of helping the infant get rid of dust
or other irritants. Persistent sneezing may be a signal that the nose needs
to be cleared with the bulb syringe. Sneezing also occurs when your baby has
Growth and Development
Will my baby have any long term
Try to discuss any concerns you may have with your doctor. Your doctor can
tell you if there is reason to suspect that there is concern about your baby's
health in the future.
Will my babies growth be affected
It is impossible to tell how your
child will grow in the future. Your baby's doctor will be following your baby's
height, weight, and head measurement at each visit. Most children who were born
prematurely attain their "genetic potential" for growth; that is, their adult
height and weight are similar to their brothers and sisters. However, some preemies
continue to grow slowly and are small adults. Preemies whose chances are greatest
for remaining small are:
- those who were <2 1/2 pounds
- those who, at birth, were small
for their number of weeks' of gestation
- those who were very sick for a
long period of time
- those with consistently poor weight
gain while in the nursery
Will my baby's development be appropriate?
Your baby's doctor will assess if
your baby is developing appropriately.
It is important that you follow the
schedule for all follow up appointments. Some nurseries have developmental follow
up clinics to assess development.
Keep in mind that if your baby was
born early that it is normal to see slower growth and development. Remember
do not compare your 3-month old with your neighbor's 3-month old who was full-term
at birth. For more information, see Fostering Development After Discharge and
the section on Later Problems of Former Preemies.
How often should I feed my baby?
Feeding patterns differ between babies
and vary from day to day. Before discharge from your NICU (Neonatal Intensive
Care Unit), the nurses can give you an idea of your baby's feeding pattern.
Most preemies feed every 2 1/2 - 4 hours.
Look for cues that your baby is hungry.
Premature babies do not always cry, but may move around and become restless
if it has been 2-3 hours since they last ate.
Often the doctor will want you to
awaken your baby if it has been longer than 4 or 5 hours since the last feed.
Discuss this with your doctor.
How much should I feed my baby?
A baby who weighs about 4 1/2 lbs.
usually needs 12-15 ounces of formula or milk per day. A good way to see if
your baby is getting enough to eat is to observe how many wet diapers he/she
has in a 24 hour period. Your baby should have 6-8 wet diapers every day.
Most formula fed baby's will be taking
2-3 ounces every 3-4 hours when discharged from the hospital. If your baby is
finishing the feeding in a shorter time and still acting hungry offer an extra
ounce or two.
A breast feeding baby will usually
increase its feeding time by sucking longer or wanting to eat more often. This
builds up the mothers milk supply. Sometimes this means that your baby will
want to eat every 2 hours until your supply will meet his/her demands.
Your doctor will check your baby's
weight at each visit and let you know if the weight gain is appropriate.
Will my baby be able to nurse even
though he/she has been taking the bottle at the hospital?
Most nurseries encourage the mothers
to pump their breasts while their baby is in the hospital. The nurses will work
with you and your baby once your baby is able to begin the process of sucking,
swallowing and breathing.
Premature babies may take days or
weeks to learn how to nurse. It is important to remember to be patient and try
not to become discouraged if you have chosen to breast feed. There are times
when this transition is not entirely successful; it is important to not feel
Our baby will be getting formula,
what should we know about it?
There are three forms of formula:
powdered, concentrate, and ready to feed.
The nutritional content of the three
preparations of formula are the same.
Most formula found in stores has
20 calories per ounce. Your doctor will want you to use 20 calorie, unless she/he
has specifically told you to use a higher calorie. It is very important to use
only what the doctor has ordered.
Higher calorie formulas containing
24 or 27 calories per ounce, need to be ordered and can be very expensive. Here
are recipes for mixing formula from powder or concentrate.
- least expensive to buy.
- try using warm water and mixing
it in a blender to help dissolve formula.
- with measuring scoop in the can:
to make 20-calorie-per-ounce
formula: 1 scoop powder + 2 ounces of water.
to make 24-calorie-per-ounce
formula: 3 scoops powder + 5 ounces of water
- once the can is opened the powder
must be used within 1 month.
to make 20-calorie-per-ounce
formula: 1 ounce concentrate + 1 ounce water.
to make 24-calorie-per-ounce
formula: 3 ounces concentrate + 2 ounces water.
to make 27-calorie-per-ounce
formula: 13 1/2 ounces concentrate + 6 1/2 ounces of water.
- should be sealed and kept in the
refrigerator, once the can is opened.
- should be used within 48 hours.
Never add more water than what is
called for in the preparation. Follow the directions correctly.
How do I take care of the bottles
and other equipment when using formula?
Bottles, nipples, measuring cups, containers, brushes and any other equipment
used for feeding should be washed in hot, soapy water and then rinsed in hot,
running water. Glass or metal pieces can be washed in the dishwasher.
Why do babies cry?
Crying is a form of communication.
Your baby has different cries for different needs.
Frequent causes of crying are:
- Hunger, especially if it has been
over 2 hours since the last feed
- Discomfort, such as wet or dirty
diapers, too tight clothing, too hot or too cold
- Need for position change
- Stuffy nose preventing easy breathing
- A form of tension release
- Over stimulation. Some premature
babies are highly irritable. They may have a low tolerance for activity around
them or frequent contact with the caregiver.
- Illness. If your baby's cry suddenly
changes in intensity or seems abnormal for him/her, talk to your doctor.
Your baby will develop a trust that
you will be there when he cries if you respond to all crying. This sense of
trust will be a necessary foundation in his development.
What can I do if my baby cries frequently?
Many premature babies will have days
of frequent crying. They can be more sensitive to stimulation and they can be
more sensitive to gas pains.
- Be sure your baby is not wet,
hungry or uncomfortable.
- Burp your baby every five minutes
- Be sure your infant is not ill
(fever, diarrhea, poor color).
- Swaddle your baby by wrapping
his arms and legs snugly in a blanket.
- Rock your baby or place baby securely
in an infant swing.
- Hold your baby skin to skin on
- Walk with your baby or take your
baby for a ride in the car securely fastened in a car seat.
- Keep your baby's head higher than
the rest of the body while feeding.
- Place a warmed rolled towel under
your baby's stomach when lying down or give your baby a warm bath.
Many parents find that it is very
difficult to keep in control during a frantic crying episode. Try to remain
calm. Call for help especially if you feel so stressed that you fear that you
might hurt the baby. It is always okay to check with your doctor, with any concern
you may have.
What if my baby stops breathing
during a feeding?
It is a common occurrence for a premature
baby to have some breathing difficulty when they are eating. The baby is so
busy sucking that he/she may forget to take a breath or to swallow. You might
notice your baby becoming a little pale or "bluish" around their mouth, and
not sucking. If this happens:
- STOP THE FEEDING
- Sit your baby up on your lap.
Often times by patting him/her on their back it will be enough to remind them
to take a breath. You may have to take "breaks" during the feedings, allowing
time to burp more often.
- If your baby sometimes has this
problem, it is a good idea to always feed with a light on.
- Call your baby's doctor about
any change or problem your baby may have.
Should I take a CPR (Cardiopulminary
Resuscitation) course before my baby comes home?
Learning CPR is appropriate for all
parents whether or not their baby was born prematurely.
If your nursery offers CPR for children,
it is a good idea to take the course. The Red Cross offers classes in adult
and infant CPR also.
CPR prepares parents for an emergency
if one should occur.
Going Out, Visitors, and Relatives
When can I take my baby out in public?
It is best not to take your baby
out in public for the first three months after bringing your baby home from
When you do take him/her out, try
to avoid crowds of people who might have colds and other illnesses. Some of
these places may be:
- Older children's school.
- Malls or grocery stores.
- Your baby's doctors office. When
arriving for your appointment, you could ask if you could be put in an examining
room to wait.
Should I allow visitors when my
baby gets home?
When your baby gets home there will
be many well meaning people who want to come and visit. Some things to keep
in mind are:
- People with colds or the flu will
have to visit at a later date.
- Your premature will be more sensitive
to stimulation and may do better if not held or only held for a limited time
by one person.
- You can limit the number of people
who visit at one time and limit the amount of time they visit.
- Don't let people drink hot liquids
or smoke and hold the baby at the same time.
- Remember you are your baby's best
advocate. It is okay to say that your doctor said it is not good to have visitors
until your baby is a little older.
How do I deal with people's reactions
to my premature infant?
People may respond with surprise
or concern about your premature baby's size.
They may be afraid to hold for fear
of "breaking" your little one. This is a common response and they will need
your reassurance that they will not harm your baby.
How can grandparents and other relatives
help after discharge?
Grandparents can help with the care
of siblings once you are home. Maybe an outing or an overnight at their house
will help you and give the siblings a special time with their grandparents.
Often there is very little energy left to handle regular day time living with
other children. If possible having a grandparent come to stay for a short time
can be a big help.
If there is a special relative whom
you trust to stay with your little one, begin to take time with your spouse.
Going for a walk or for a cup of coffee can help you keep in touch with each
Meals for the freezer or grocery
shopping is another way for others to help.
While most relatives are well-meaning,
there are those who give advice you do not want to hear or advice that is incorrect
for your baby. Parents need to decide what is best for their family and whether
visits or phone calls from others will help or hinder. You have come home equipped
with the best knowledge to care for your baby and, as the parent, know what
is best for your little one.
It is a stressful time for everyone.
If you find just one person who will be there to listen and be your advocate,
they can help you explain your needs to the others in your family.
What can grandparents/family/friends
do to help?
The birth of a premature baby is an emotional time for everyone. As a grandparent
you probably joyfully anticipated the birth of a healthy baby. It is natural
to want to take your child's fears, pain and anxiety away, but that is not what
s/he needs right now. The parent(s) of the new baby need to be supported. They
are going through a life crisis.
Things to do that are helpful include:
- Offer a hug, a tear, or other
signs of love and concern.
- Offer to be the family communicator.
Find out exactly whom to notify and what the baby's parent(s) want others
to know. Communicate that information--no more.
- Try to alleviate guilt. It is
natural for a mother of a preemie to feel guilty for not carrying the baby
to term and feel responsible for the condition and problems of the baby. With
rare exceptions, there was nothing the mother did to cause the baby to be
premature or have problems. She needs to hear this over and over again. Sometimes
having her talk to her obstetrician is reassuring.
- If there are other children and
they know you well, offer to care for them; spend extra time interacting with
them, help them to feel as important as the baby.
- Help with household chores: going
on errands, getting groceries, cooking, picking up the house, caring for pets,
providing transportation for their other children or for the parents. When
others call or offer to help, let them know exactly what they too can do to
help; don't turn them down.
- Acknowledge the baby's birth like
your would if the baby had been born on time, such as send flowers to the
mother, buy something for the baby, take pictures. Gift suggestions: film
for the camera; baby book, diary or calendar to record important events.
- Become involved with the new baby
only to the extent that the parent(s) desire. Let the parents have time alone
with the baby. If they wish you to be present in discussions they have with
doctors and nurses, be a good listener, write down important points, suggest
questions to the parents if they do not ask them; ask questions yourself if
the parents do not. You are likely to remember more than they, so review the
session with them later to help fill in important information. If they don't
invite you to become involved, accept their need for privacy.
- Be empathetic regarding their
concern for their child. Let them know how worried you were when your children
- Help the parents keep their focus
in the right place, on the baby. Decrease additional stresses in their lives.
This means putting aside any personal problems, such as disagreements, conflicts
with other grandparents or children, or feelings of being "left out". This,
too, may mean excusing them from family duties such as reunions, birthday
parties, or gatherings.
- Find something about the baby
to complement at each visit, be it hair color, eyes, willingness to fight,
cute feet, long fingers, a loving staff of nurses, etc.
- Praise your son/daughter/friend
for his/her strength and fortitude through this stress; it provides encouragement.
- Help your son/daughter/friend
keep up with his/her health. They tend to focus only on the baby, excluding
and sometimes risking their own health and well-being.
- Suggest talking to a professional
or seeking out medical help if the pressures grow too great.
- When setbacks occur, go back over
all the successes the baby has had to date; help them to acknowledge the battles
the baby has already won. Even when setbacks seem minor, do not minimize how
difficult they are for parents.
- Offer to stay with them during
NICU visits. Often a parent is alone. It can be a lonely time and just being
there may help. If this is refused, though, don't see it as a sign of exclusion;
respect the space that your child or friend needs.
- Be there for them when they need
you. This might be during surgery or a sad moment, when dinners are needed,
when they need a hand with the camera or merely a funny card. It may seem
like your son/daughter/friend calls only in times of dire need, but that is
when they need your help the most.
- Keep in touch often, even if it's
only leaving a messge on an answering machine telling them you care. Often
evenings are a good time to see how the baby's day went. Keep the conversation
going only as long as your son/daughter/friend wishes. Remember, they are
physically and emotionally exhausted and may just need to know you are thinking
of them and their baby. Keep questions general, such as "how was the baby's
day today?". Try not to ask if everything is "all right"; there is always
something that is not right -- often it's just the mere fact that the baby
is still hospitalized. They will provide information when they are ready to
share it. Often, parents will only tell you that it's been a bad day. Respect
the fact that they do not wish to rehash the painful event again.
What shouldn't I do as a grandparent,
family, or friend?
Things which are NOT helpful
- Creating guilt by suggesting that
the mother contributed to her baby's problems; for example saying, "You shouldn't
have ___ while you were pregnant" (smoked, worked, gone swimming, etc.) or,
"If only you ______".
- Trying to take over decision making
for the baby's parents. It is their baby and they need to be the ones making
the decisions. Provide your opinions only if asked.
- Frequently verbalizing your concerns
about the baby's outcome, whether s/he will live or die, or focusing on the
possibility of future problems or disabilities. Usually preemies do much better
than grandparents or friends anticipate.
- Saying, "You can always have another
baby" if the baby is very sick or dying. It does not make the situation any
better or easier to handle. Instead, it implies rejection of the baby and
lack of sympathetic understanding. Also, no one knows for sure if they can
have another baby.
- Comparing your son/daughter's
circumstance or tiny baby to that of someone else.
- Suggesting that a small baby implies
an easy labor, or talking about how "lucky" the baby's mother is that she
did not go through the final months of pregnancy. Parents would have loved
nothing better than to have a big full-term baby.
- Telling parents that this is a
good time to catch up ahead of time for all those sleepless nights when the
baby comes home. It is difficult for parents to sleep with all the worry,
stress, being apart from their baby, and often pumping breastmilk every few
- Questioning the skill of the nurses
or doctors and/or the completeness of the information they provide. The parents
need to form a bond of trust with their medical team; this undermines that
- Pitying the baby. ("I just can't
bear to see him this way", "he's in so much pain",etc.) It makes the parents
feel even more helpless and guilty.
- Remarking repeatedly about the
tiny size of the baby. Parents interpret this as a form of criticism or blame.
It may also be equated with the unspoken, "he's too tiny to make it".
- Ascribing the mother's reaction
to "hormones". While hormones are indeed out of kilter now, they are not the
primary reason that the baby's mother is upset. The parents, and their baby,
probably are facing the biggest challenge in their lives. They are afraid;
the situation is completely new and unfamiliar.
- Asking when the baby will come
home. Usually parents do not know until shortly before the day comes and there
are often unforeseen setbacks that interfere with homecoming. Remember, parents
keep this question in their minds always.
Interacting with Your Baby
How do I interact with my baby?
By visiting your baby in the hospital
you have been getting to know your baby and your baby has been getting to know
Things that parents can do once you
- Talk, read a book, or sing to
your baby in a soft voice.
- Draw a picture with a black marker
on a white piece of paper. Place it near your baby's crib or infant seat while
your baby is awake. Babies like to look at the contrasting colors.
- Touch and hold your baby closely
- Carry your baby in a sling or
pack in the front of you.
- Lay on your side on the bed and
place your baby down next to you so he/she can see your face. Babies love
to look at faces and eyes.
Premature babies are much more sensitive
to stimulation. Some signals to watch for that would show that your baby might
be getting tired are:
- Turning away from you, or squirming
- Grimaces, yawning, sneezing or
sticking tongue out
- Faster breathing
- Crying or becoming irritable,
maybe spitting up
- Skin color changes
- Straining as if to have a bowel
- Arching of the neck and back
Remember to keep in mind that your
baby needs to have short times of stimulation because he/she tires quickly.
How will I know if my baby needs
Premature babies may not always cry
when they need something.
Ways to tell if your baby may need
- Squirming or moving their arms
or legs, becoming more active in their crib
- Facial grimaces
When should I get my baby immunized?
Immunizations may begin at the hospital
before you leave to go home. Premature babies are usually immunized at the same
age after birth as term babies.
- If there is any question whether
to immunize your baby at the hospital, your baby's doctor will make that decision.
- It is very important to follow
your baby's schedule for immunizations. They will be given when you see your
Is cigarette smoking bad for my
Exposing infants and children to
any smoke is not good. No one should be allowed to smoke cigarettes in your
- If people have a need to smoke,
have them smoke outside.
- If a parent smokes, remember to
not smoke in a closed car with the windows up.
- Never smoke while holding your
Can I lay my baby down on his stomach?
Even though preemies may be positioned
for sleep on their stomachs in the nursery while they are on monitors, your
baby should not be positioned on his/her stomach or side for sleeping
at home unless specifically requested by your baby's doctor. You should put
your baby lying down on his/her back for sleep.
While awake your baby can be either
on his/her stomach or side lying. Tummy time is important for infants because
it helps babies develop strength in their neck, legs and upper body. To help
a baby with side lying, place your baby on either side with his bottom arm pulled
slightly in front of him. This will prevent him from turning over to his stomach.
It is also helpful to put a small blanket roll behind and next to his back to
help support the side position. As babies get older they will roll to their
FOSTERING DEVELOPMENT AFTER DISCHARGE
What activities can
I do to foster normal development of muscle and muscle control in my preemie?
The following are age-specific activities that you and your baby can try. In
all examples, age is determined by correcting for the weeks of prematurity;
for example if your baby was two months early, activities listed at two months
would be expected at four months. Another way is to use your baby's due date,
not the actual date of birth.
Age 0-2 months
- To help develop head control,
when held at your shoulder:
- Hold your baby high enough that
s/he can look around
- Let your baby raise his/her
head, but keep a hand near to support if necessary
- Turn your back to a mirror so
the baby can see him/herself
- Have someone stand behind you
and talk to your baby
- Walk around so there are new
things to see
- Tummy time, when awake only.
This helps strengthen neck and shoulder muscles. This should be done on a
flat surface like a matress or a covered floor.
- Place baby on tummy with the
arms forward and elbows in line with the shoulders.
- Place a toy 6-8 inches in front
of your baby or place your baby in front of a mirror.
- Gradually increase tummy time.
At first your baby will tire easily.
- Hold your baby on his or her
tummy while on your lap.
- Bring hands together near the
face and chest. This helps prepare your baby for reaching and exploring his/her
- Position your baby with the
arms forward when cradled or when in an infant seat.
- Place a finger in each of his/her
hands when playing.
- Play pat-a-cake.
- Encourage your baby to bring
hands together to explore a toy, bottle or your face.
- Put a toy with texture on your
- Provide some side-lying time
with your baby's hands together.
- Encourage your baby to grasp toys
and other objects. At first your baby will have an automatic grasp. As this
reflex goes away, your baby will develop a more purposeful grasp.
- Provide opportunities for you
baby to grasp things: fingers, rattles, teething type toys.
- Provide a toy during diaper
- Help your baby practice holding
on to things one hand at a time. At first your baby will drop toys frequently
even if s/he is still interested in them.
- If your baby has trouble letting
go, gently stroke the back of the hand from wrist to fingers or bend the
wrist forward a little to encourage letting go
- Learning to roll from tummy to
back: With you baby lying on its stomach, get your baby's attention by holding
a toy in front of him/her. Then slowly move the toy toward the side and back.
As your baby stretches to see the toy, s/he will start to roll.
- Help your baby explore his/her
- Play with your baby's feet,
kiss them, move them and play games with them.
- Encourage your baby to find
his/her feet with his hands.
- Help your baby explore his/her
toes with his lips and mouth
What things should I avoid during
- Walkers. They are unsafe and do
not foster good development.
- Doing activities too long or when
your baby is tired. If your baby arches or fusses, it is time to stop.
- Standing on his/her legs before
s/he is ready.
How can I foster mental development?
Mental development is fostered by:
- Providing an interesting environment
and toys. Let your baby explore them safely.
- Talking to your baby often. Use
a lot of facial expressions.
- Singing to your child.
- Reading to your child. Start this
habit at a few months of age and continue it daily until your child reads
What do babies of different ages
like to do?
The following guidelines are from "Helping Baby Grow", WI Department of Health
and Social Services, Division of Health, with permission (POH 4022, 9/97). A
premature baby's age should be corrected for the weeks of prematurity; therefore,
consider your baby's age from his/her due date, not from the actual date of
DUE DATE TO 1 MONTH
Baby is able to:
- respond to sounds by blinking,
crying, or startling
- lift head momentarily when on
- be comforted most of the time
by being held or spoken to
- follow with eyes and sees best
at a distance of 8-12 inches
- move all extremities
- cry a lot; it's his or her only
way of telling you what s/he wants
Offer your baby:
- bright colors, contrast patterns
and shint objects
- lots of cuddling and holding
- a change of position so s/he can
look at different things
- talking and singing in a soft
- gentle motion, like rocking and
2- 3 MONTHS
Baby is able to:
- coo and vocalize
- hold on to other's fingers
- smile when spoken to
- show some head control in an upright
- open hands most of the time now
- may begin to sleep 5-6 hours during
the night and take 3 naps during the day
- show interest in seeing different
things and hearing different sounds
Offer your baby:
- a pacifier to help meet the need
- a massage after bath, s/he likes
- the feel of soft fabric and textures
on his/her skin
- repetition of sounds that he makes
- stimulation by opening and closing
your mouth or eyes
- musical toys
- time to
- play on his/her tummy
4, 5 and 6 MONTHS
Baby is able to:
- smile, laugh and squeal
- roll over from stomach to back
- reach for and bat at objects
- pass toy from hand to hand
- show signs of stranger anxiety
- recognize his/her own name
- stand up if held under arms
- bring toy to mouth
- make single sounds
- hold head erect, raise body on
hands, arch back and rock when on tummy
Offer your baby:
- your response when s/he "talks"
to you; s/he will answer back and smile
- safe squeaky toys and rattles
to grab or kick
- a game of pat-a-cake
- a mirror to look at self
- time to play on her tummy when
awake strengthen leg, back, and arm muscles
- different places to play during
the day; s/he likes to see new things
- toys to teethe on
7, 8 and 9 MONTHS
Baby is able to:
- sit up alone
- "babble" a lot
- roll around
- scoot around on his tummy or crawl
- put toes in his/her mouthlearning
to use fingers
- solve simple problems, such as
making a bell ring
- look at and study things for a
Offer your baby:
- the sounds of toys when they are
- a container to put things into
- the opportunity to explore; s/he
is very curious
- reading books and point out pictures
that s/he sees everyday
- hide a toy under a cup or cloth
for him/her to find
10 -12 MONTHS
Baby is able to:
- sit alone and turn body in a complete
- pull self up on furniture and
walk holding on
- walk if hands are held
- it down from a standing position
Offer your baby:
- animal sounds
- play hide and seek
- roll a ball back and forth
- teach him/her to pick up toys
by doing it with him/her
Child is able to:
- climb onto a low ledge or step
- stand alone and walk
- stoop and stand up again
- speak two or three word sentences
- wave "bye-bye"
- take off clothes, but can't put
them back on
- open and close doors
- look in the correct direction
when asked where something is
Offer your toddler:
- play "copy what I do"
- play music and dance with him/her
- practice naming body parts
- a large safe area to explore and
strengthen muscles needed for walking and running
Child is able to:
- climb on things and up stairs
on hands and knees
- carry things in each hand
- follow simple requests such as
"give me the ball"
- point to pictures you name, if
the things are familar
- say "no" a lot!
- recognize self in a mirror or
Offer your toddler:
- help to discover how things move
- gentle bouncing on your knee or
- clap with her in time to music
- the feel of different kinds of
- things to throw, push and pound
Child is able to:
- run without falling too often
- stand on either foot, holding
- kick a ball
- climb on everything!
- be very independent
- ask a lot of questions, mostly
"why?" or What's that?"
Offer your child:
- music and teach him/her to dance
and clap hands to the beat
- wooden spoons to beat on something
to make noise
- blocks of varying shapes and sizes
- show how to stack things and what
happens when they fall down
- encourage and priase each tiny
- be calm and patient
- read to your child often
- point to objects that are familiar
and ask him/her to name them
21 MONTHS TO 2 1/2 YEARS
Child is able to:
- express feelings of love and anger
- show right or left handedness
- use gestures when communicating
- understand "mine" and "yours"
- walk backwards
- pedal a small tricycle
- balance on one foot for about
- understand why some things happen
(a switch turns on a light)
- walk up stairs with both feet
on each step, holding a railing
- recognize and name people s/he
knows from a photograph
Offer your child:
- encouragement to wash and dry
his/her own hands
- help tp pick up and put away toys
- a puzzle with three to six pieces
- help to match colors and to learn
- talk to child about what you're
doing, without using baby talk
- communicate to child by talking
- help child develop an imagination
by encouraging and joining in with his/her pretend play
2 1/2 TO 3 YEARS
Child is able to:
- walk on tiptoes and hop
- walk up stairs taking turns with
- tell you where things are
- sort and put things away
- throw a ball overhead and catch
a large ball
- repeat simple rhymes
- dress and undress self
- match objects that have the same
function (cup and plate)
- brgin to control bladder and bowel
movements during the day
- walk down stairs, usually with
both feet on each step
Offer your toddler:
- routines that make him/her comfortable
- teach him to understand alike
- a form boerd to match shapes on
- draw an "X" on paper and have
child copy you
- establish simple rules, explain
them to child, and stack to them
- simple instructions (please throw
the napkin in the trash)
- give him reasonable, limited choices
(do you want peanut butter and jelly or grilled cheese for lunch?)
The following guidelines are from
"Helping Baby Grow", WI Department of Health and Social Services, Division of
Health, with permission (POH 4022, 9/97).
Miscellaneous Safety Checklist for
- Change him/her on a safe area
where s/he cannot roll off.
- NEVER let cords from window blinds
dangle; they can accidentally strangle him/her.
- Put gates at the top and bottom
of stairs and install window guards.
- Shut and lock or latch doors to
the bathroom, garage, basement and outside.
- Cover sharp edges and corners
of furniture and cabinets that s/he could run into.
- Don't let him/her stand up in
a high chair.
- Be aware of possible childhood
lead exposure; lead screening is recommended at 12 months.
- Keep a list of emergency numbers
by the phone.
- Learn CPR and the Heimlich Maneuver
so you are prepared in case of an emergency.
- Place safety plugs in electrical
- Use cord holders to take up slack
in loose cords.
- Turn pot handles toward the back
of the stove
- Install childproof safety latches
on drawers and cabinets.
- Put your baby to sleep on his/her
- NEVER hang anything across the
crib or from the crib ends or sides.
- Make sure crib is safe and the
slats are no more than 2-3/8" apart (or the width of a 16 ounce soda can).
- Make sure crib mattress is firm
and snug-fitting so s/he cannot get trapped between mattress and side of crib.
- Set the crib mattress to the lowest
position when s/he is able to pull to a standing position.
- Remove bumper pads and large toys
when s/he could use them as steps for climbing out.
- NEVER leave infants on adult or
youth beds, (s/he could suffocate, become wedged between mattress and frame
or wall, or roll off.
Car Seat/Motor Vehicle Safety
- ALWAYS use a rear facing infant
car seat, placed IN THE BACK SEAT.
- Switch him/her to a toddler car
seat when s/he is 20 pounds or 26 inches in length, and ALWAYS place in the
- Be sure that s/he is properly
belted in a car seat on every ride.
- Be sure the car seat is installed
- Check the car seat regularly to
be sure it has not been loosened or shifted its position.
- NEVER leave you child unattended
in a car for any length of time, especially on a hot day.
- Keep cigarette smoke and butts
away from your child and out of his/her reach.
- Keep matches and disposable lighters
away from him/her.
- Install and maintain smoke detectors
in your home.
- NEVER leave him/her unsupervised
near a fireplace or heater.
- Set hot water heater to 120 degrees
Fahrenheit to prevent hot water burns.
- Bath water should not be hotter
than 100 degrees Fahrenheit
- NEVER leave him/her alone in the
- S/he can drown in less than 2
inches of water - keep toilet lid closed and avoid leaving buckets of water
unattended while cleaning or washing the car.
- Never leave him/her unsupervised
while in or near water (swimming pool, pond, lake, creek, etc.).
- Avoid heating his/her formula
bottle in the microwave; it can get scalding hot in center but feel cold on
- Never prop the bottle, s/he could
- Don't let him/her lie on his/her
back with food in the mouth.
- Never allow eating while actively
playing; choking on foods is a real danger.
- Until six months of age you should
keep your baby out of direct sunlight; move to the shade or under a tree,
umbrella or stroller canopy.
- Dress him/her in comfortable lightweight
clothing that covers the body and a hat with a brim that shades the face and
- Child-sized sunglasses with UV
protection are a good idea for protecting the eyes.
- After 6 months of age chose a
sunscreen made for children; test a small area on his/her skin for a reaction
before applying all over.
- The sun's rays are the strongest
between 10 a.m. and 4 p.m. and can come through the clouds even on cloudy
days; try to keep your child out of the sun during these hours.
- Keep toys with small parts or
sharp edges out of reach.
- Don't give him/her plastic bags,
balloons or small objects to play with; s/he could choke or suffocate.
- Avoid using baby walkers; they
can be dangerous and won't help your child learn to walk.
- Store and lock guns, unloaded
and uncocked in a securely locked container.
- Store ammunition in a locked place,
separate from the gun.
- Keep the poison control number
by the phone.
- Keep all medicines, tobacco and
household products away from children.
- Know the plants in and around
your house; many kinds of yard and house plants are poisonous if eaten.
- Don't let your child play near
- Always hold on to his/her hand
in a parking lot or when crossing the street.
- Practice stopping and looking
both ways with him/her before crossing the street.
- Always put a helmet on his/her
head when seated in a bike seat or when riding a tricycle or bike.
The Vulnerable Child
What is the Vulnerable Child Syndrome?
Sometimes parents continue to think of their former preemie as fragile and
susceptible to problems even though the child is physically and developmentally
healthy. They become overly protective, worry excessively, and unknowingly slow
or change their child's development. The former preemie may fail to develop
self confidence and/or a sense of independence.
How can I prevent the Vulnerable
First, try to interact with this child like you would if s/he had been born
at term. Encourage socialization and age-appropriate activities. When considering
expectations and when to introduce activities in the first two years of life,
use the child's "corrected age", his/her age corrected for the number of weeks
of prematurity. For example, if your baby is ten months old and was three months
premature, your expectations should be that for a seven month old. After age
two, you do not need to correct for prematurity.
Things you can do to prevent the
vulnerable child syndrome:
- Encourage interactions with other
children their age
- Let them do things by themselves
when they can
- Let them have opportunities to
make decisions; give them choices
- Find play experiences outside
your home, such as at parks, play groups
- Give words of praise when they
do things independently
- Don't be too quick to intervene
in trial and error learning
- Set appropriate limits and be
consistent with them
- Establish consistent routines
so they know what to expect and can develop independence in following the
- Don't speak for them if they are
capable of expressing themselves
- Talk to them in age-appropriate
language, (not baby talk to a 3 year old)
How common are learning problems
in former preemies?
Learning deficits or learning disabilities at school age occur in about 10%
of children born at term. They are more common in former preemies; the smaller
and sicker the preemie, the greater the risk. Up to 45% of infants weighing
<3 1/4 lbs. at birth have one or more abnormalities on testing at school
age. It is usually not possible to predict at the time of discharge or during
early development who might develop these problems. Sequential evaluation over
time is the best predictor. Knowing what problems might develop can make you
alert to signs of difficulty. Early diagnosis enables early evaluation and intervention.
On the other hand, being overly concerned and always questioning your child's
development may be detrimental in itself. Problems which are normal at a younger
age may be abnormal at a later time. If you have a question about your child's
development or performance, talk to your child's doctor or teacher or have your
What are the most common learning
problems at school age?
- Eye-hand coordination problems
- difficulty with copying pictures
or words, especially if there are many objects in the picture
- difficulty with puzzles
- difficulty learning handwriting
- Language problems
- difficulty following directions,
especially if there is more than one step
- difficulty putting things in
a logical order
- poor vocabulary for age
- difficulty learning to read
- not understanding the meaning
- inability to tell one sound
- avoiding classroom participation
- difficulty remembering words
- Thinking problems
- poor memory, difficulty memorizing
words, tables; forgetting assignments
- difficulty with spacial relationships
such as size, distance
- problems with sounds and their
- difficulty with abstract thinking
- difficulty making decisions
or making poor decisions
- poor common sense
- slow to grasp new concepts
Are behavior problems common?
Behavior is a complex interaction of a child's biologic vulnerabilities, innate
strengths, a nurturing environment and parenting styles. A problem in any single
area may lead to undesirable behaviors. A mismatch between these areas (for
example a very strong-will child with a parent who is unable to set limits)
can also emerge as behavior problems. Behavioral problems are not limited to
infants who were born prematurely, but they are more common in former preemies.
Children with other learning problems are at greater risk for behavioral problems,
and behavioral problems can interfere with learning.
What behaviors might be a sign of
Behavior problems usually start before
school age. They often are exaggerations of normal responses or behaviors, or
persistence of behaviors beyond the usual age where they are common. Some of
- Too aggressive at play, other
children won't play with him/her
- Temper tantrums- severe, long,
- Won't comply with requests
- Can't tolerate any change in routine
- Excessive fears
- Can't play quietly
- Can't stay seated for meals or
- Always moving
How will I know if my school age
child has behavior problems?
Almost all children have periods
of time when they misbehave or go through difficult stages. Your child's teacher
or school will probably alert you if your child's behavior is out of the usual
range. However, if you have concerns, discuss them with your child's teacher
or pediatrician. Common signs of behavioral problems include:
- Doing poorly in school
- Difficulty paying attention
- Not completing projects or tasks
- Not following directions
- Difficulty sitting still for even
short periods of time; always moving
- Impulsive behavior; acting before
thinking about it
- Fighting, bullying or stealing
The above listed behaviors usually
catch a teacher's attention quickly. Another behavior pattern is one characterized
by anxiety and withdrawal. Signs include the following:
- Extreme shyness
- Not wanting to play or be with
- Extreme fears or worry about the
unknown, such as new activities or places
- Being over-sensitive to touch
What can I do about behavior problems?
Children who have these problems are often in need of greater structure in
their environment and more defined limits. Sometimes parents of preemies are
reluctant to set limits, enforce rules or deny their child's requests because
the child had to go through so much in the early months or because they don't
want to dampen their child's strong will that made him/her a survivor. But,
consistency in rules and limits and more structure often lead to a more secure
environment in which to develop. If behavior problems persist or get worse,
discuss them with your child's doctor or pre-school teacher.
Eye and Vision Problems
What are some of the more common
eye problems of former preemies?
The most common eye problems to appear
after discharge are:
- Poor vision (either near sighted
or far sighted)
- Strabismus (inward or outward
turning of one or both eyes)
- Amblyopia (lazy eye due to unequal
- Nystagmus (constant or frequent
jerking movements of the eye)
- Decreased color vision (some colors
look alike, for example purple,blue,green)
- Smaller field of vision
Although the above listed
problems are more common in infants who have had ROP,
they can occur in other preemies as well.
- Hemangiomas are small networks
of tiny blood vessels. They can appear anywhere on the skin and grow rapidly
for several months. If they are on the eyelid or skin surrounding the eye,
they may interfere with vision. Hemangiomas are more common in premature infants.
- Former preemies can have eye problems
common in all children, these include:
- Conjunctivitis - inflamation
or infection of the surface of the eye
- Blocked tear duct
How will I know if my child has
an eye problem?
If your child develops any of the
following, your infant needs to see an ophthalmologist (eye doctor) very soon;
s/he may have a serious vision problem.
- Infant frequently pokes at his/her
- Infant often waves hand in front
of his/her face
- Lazy eye, slow to move
- Constant movement of eyes, even
when trying to look at something
- Frequent crossing of eyes, beyond
three months of age correcting for prematurity
- One eye that stays out or in most
of the time
- Frequent or constant jerking of
eyes especially when looking straight ahead. A few jerks when looking to the
far left or far right is normal.
- The infant fails to blink to a
camera flash just in front of the face
- The surface of the eye or the
pupil (black circle in the center of the eye) appears cloudy or white
- In a photo, the center of one
eye appears red while the other eye does not
- Abnormal head turn or head tilt
- The infant (beyond 6 weeks of
age correcting for the weeks of prematurity) cannot fix his/her eyes on an
object or a face, or follow it as it moves
- The infant's eyelid droops so
much that it completely covers the pupil (black center) of the eye when he/she
- Normal lighting seems to hurt
the baby's eyes and make him/her cry or turn away
Common problems can often be handled
by your baby's regular doctor. These include:
- Frequent tearing (blocked tear
- Redness to the eyes with cloudy
or yellow drainage (may indicate a conjunctivitis or infection on the surface
of the eye)
If you have a question about your
baby's sight or think your child may not see well, call your baby's physician
or an eye doctor.
It is important to keep any eye appointment
that was arranged at your baby's discharge, even if you do not think there is
an eye problem.
How are eye problems treated?
Infants who have poor vision can be fitted with glasses. If the correction
of vision would require very heavy or thick lens, soft contact lens may be prescribed.
Other conditions, such as wondering eye and crossed eye, are treated with patching
of one eye to encourage the use of the other eye. Early treatment is important
for best visual outcome later on.
Why is early treatment so important?
When infants see much better out of one eye, or if using both eyes causes double
vision, they will gradually stop using (seeing out of) the weaker eye. Visual
pathways are still being established in the first few months and years of life.
Making and keeping these connections requires regular use of the eye. If a child
"blocks out" vision in one eye during this critical period in eye development,
these connections are not established and cannot be made at a later age. Sight
from two eyes is necessary for determining what is close and far away (depth
perception). Poor vision may slow mental development and physical progress in
many areas such as recognition of objects, learning symbols such as letters
or pictures, and motor activities such as walking or climbing.
How common are hearing problems
- At birth, moderate to severe hearing
impairment occurs in about three per 1000 infants born on time, but in about
three per 100 (3%) of high risk infants. High risk factors include:
- Birth weight under 1500 grams
(3lb 5oz), especially those with IVH or PVL
- Family history of childhood hearing
- Viral infection present at birth
- Any abnormality in the formation
of the face or the ear
- Very high bilirubin levels necessitating
exchange transfusion, see Bilirubin
- Infection of the fluid surrounding
the brain, called meningitis
- Severe lack of oxygen near the
time of birth
Children can also develop hearing loss after birth during childhood.
How will I know if my baby has a
Many nurseries screen babies for
hearing. Commonly used hearing tests are:
- Auditory Brainstem Response (example,
ALGO). Three electrodes are placed on the baby's head and a click sound is
delivered to the baby's ear by a small headphone. The baby's brainwave response
to the sound is recorded and compared to a normal baby pattern.
- Otoacustic Emissions. A small
rubber probe is placed in the ear canal. It delivers a sound which travels
to the inner ear. The inner ear sends back an echo which is picked up by a
microphone in the probe.
- The Crib-o-gram. A loud sound
is presented to the infant during light sleep. If the baby responds by arousing
from sleep or startling, s/he passes. This test only detects severe hearing
If my baby does not pass the screening
test, is s/he deaf?
Hearing tests are designed to not
miss a possible hearing problem. There are many "false positives" or abnormal
tests in babies who eventually turn out to have normal hearing. Things that
cause false positive tests include:
- Ear wax or other substance blocking
- Narrow ear canal
- Testing in a noisy setting
- Ear infection
- Restless, fussy baby
- Certain medications
Some medical problems of preemies
cause changes in hearing which go away when the problem resolves. For that reason,
babies are usually tested near the time of discharge, not when they are the
Any abnormal screening test must
be verified by another test at later point in time.
After discharge how will I know
if my child has a hearing problem?
The following is a check list for hearing.
All ages listed are based on the
child's age from his/her due date, not the date of birth.
- Due Date
- Does your baby awaken, startle
or cry to a loud sound?
- Does your baby seem to listen
to speech part of the time?
- At 3 Months
- Does your baby seem to recognize
- Does your baby appear to listen
to sounds or speech?
- Does your baby smile when spoken
- Does your baby turn toward the
- At 6 months
- Does your baby distinguish friendly
sounds from angry or warning sounds, such as NO! ?
- Does your baby notice and look
around for the source of new sound?
- Does your baby turn toward the
side a sound is coming from?
- Does your baby enjoy vocal play?
- Does your baby coo in more than
- At 9 months
- Does your child turn or look
when you call?
- Does your child look for the
source of a new sound?
- Does your child listen to sounds
or people talking?
- At 12 months
- Has your child begun to respond
to requests, such as Where is.....?
- Does your child babble?
- Does your child have 3 words?
- At 18 months
- Does your child understand and
respond to requests?
- Does your child have at least
- Does your child have a way of
indicating no, either verbal or gesture?
- Does your child respond to rhythm
- After 24 months hearing loss may
be suspected if:
- The child's speech sounds like
s/he has a cold even when s/he does not
- The child's speech is difficult
- The child has fewer words than
other children his/her age
- The child does not pay attention
when someone is speaking
- The child cannot follow simple
Hearing is often decreased during a cold or ear infection. When children are
young, their speech and communication may be noticeably poorer during a cold
or ear infection, but should return to the previous level after the illness.
What should I do if I suspect my
child has a hearing problem?
Notify your child's doctor of your concern and make arrangements to have his/her
hearing tested. This testing should be done at your earliest convenience and
when your child does not have a cold or ear infection. Do not delay several
months; early detection of hearing loss is very important!
Why is early detection of hearing
loss so important?
Hearing is essential for speech and language development. The sooner a hearing
loss is detected, the sooner the child can be treated and the better language
and speech s/he will develop.
How is hearing loss treated?
If there is some hearing, sounds can be amplified (increased) by a hearing
aids. If the loss is severe, children may also be taught other forms of communication
such as sign language or lip reading. Speech and hearing therapists can teach
you how to best communicate with your child. Specialists must determine the
location of the hearing problem (outer, middle or inner ear) before deciding
on the best treatment.
What are common dental problems
of former preemies?
The most common dental problems are:
- Abnormal formation of enamel (white
outer covering of the tooth)
- Slow teething, especially of the
first baby teeth. As the child gets older, there is catch up to the normal
- High arch or groove to the palate
(roof of the mouth)
- Abnormal bite called cross-bite
Why do preemies have more dental
problems than term babies?
We do not know all of the reasons
for these problems, but some common factors are:
- Stress and severe illness delay
and alter normal tooth formation.
- Normally during the second half
of pregnancy the teeth are forming enamel from calcium and phosphorus. It
is not possible to deliver as much calcium and phosphorus to the preemie as
s/he would get if s/he were in the womb. This is true even though formulas,
breast milk and nutritional fluids by vein are fortified with added calcium
- If a baby needs to be on the breathing
machine, the breathing tube that is in the mouth rubs or presses against the
roof of the mouth and the gums. Over time this may make the palate high and
more arched than normal. The pressure of the tube or an instrument on the
gums may also change the development of the teeth under the gum.
How will I know if my child's teeth
have enamel problems?
Often small abnormalities in enamel
formation are not visible. More severe abnormalities are:
- The teeth may not appear as white
as other children's. They may have a gray or brownish color.
- The teeth may have an uneven surface.
- The teeth may have an abnormal
What problems should I expect if
my child's teeth have poor emamel?
When the emamel of the tooth is poorly formed, it is much easier for the tooth
to develop cavities.
What can I do to prevent tooth decay?
It is very important to do the following:
- Develop good toothbrushing habits
as soon as the teeth break through the gums. The teeth should be cleaned two
times a day, morning and before bedtime.
- Avoid the habit of letting your
child sleep at night or nap with a bottle. It can cause decay so severe that
it destroys the teeth. Dentists refer to this as Nursing Bottle Tooth Decay.
Which teeth are most likely to be
The baby teeth are most often affected with enamel problems. Sometimes the
first permanent teeth to come in are affected also, but usually to a lesser
degree. These include the front teeth (incisors) and the first permanent molars
What can be done for my baby's abnormal
Often problems look worse than they actually are. Good dental care and regular
teethbrushing may be all that is needed. Cavities can be filled just as for
any child with a dental cavity.
What can be done for my baby's high
The shape of the palate can effect many things, including speech and bite.
As your child gets older, the shape of the palate, along with other factors,
determine if your child needs braces or other orthodontics. Most children seem
to adapt to the shape of their palate and will compensate if their palate is
higher than normal.
Will my child need braces later
The need for braces is determined by many factors including the shape of the
palate and the presence of a cross-bite. The chances that your preemie will
need braces are probably a little higher than average.
When should my preemie first see
Pediatric dentists prefer to see
children at a very young age. The current recommendation of the American Academy
of Pediatric Dentistry is for any child to see the dentist by his/ her first
birthday. Since preemies are known to have more dental problems, this early
exam is often beneficial. At this visit your dentist may:
- Show you how to care for your
child's teeth; give tips on brushing
- Address diet concerns that relate
- Find any problems that need attention
No matter what the age, if you notice
any questionable areas in your child's teeth, make a dental appointment.
What do we know about the experience
of pain in the baby?
Many procedures and conditions experienced in the NICU involve some pain for
the baby. Yet, there are many different opinions on how much the newborn experiences
pain, how to tell whether a baby is experiencing pain, and what should be done
to relieve pain.
Do babies experience pain?
For adults and older children, we
know that there are two parts to a painful experience.
- The sensory experience. This happens
when the pain nerves are stimulated by some harmful event, such as a finger
prick or cut.
- The emotional experience. This
is what the sensory event seems or feels like to the individual person. Many
things affect this. They include what we remember from past experiences and
have learned from our family and friends, how well we are feeling otherwise
at the time, and whether it is a brief, one-time event or will last for an
unknown amount of time.
For babies, we know that:
- The sensory experience is well
developed as early as 24 weeks of gestation. Babies do feel pain.
- The emotional experience is not
well understood. There are questions about what the sensory event means to
the newborn, whether the baby remembers it, and whether it has any effect
on the baby after the pain has gone.
How will I know if my baby is experiencing
Unfortunately, there is no one behavior
or set of behaviors or physiological signs (heart rate, breathing rate, blood
pressure, oxygen levels), that we know for sure mean that a baby is in pain.
- If there is some obvious painful
event, and the baby responds with a change in either behavioral or physiological
signs, it seems fairly safe to assume the baby is in pain.
- However, if there is no obvious
event, it is not always easy to tell if a baby is experiencing pain.
A baby may show the following signs
that we interpret as indicating pain:
- crying, grimacing
- trouble sleeping
- an increase in motor activity,
jerky movements, or stiffness
- flushing -- turning red
- high breathing and heart rates,
or drops in oxygen levels.
Or, a baby may instead show:
- falling asleep or becoming drowsy
- a decrease in motor activity,
- turning pale, or no color change
- decreased breathing rate or slowing
of the heart rate.
Babies may show these same behaviors
when they are upset or agitated but there is no reason to suspect pain, such
as when they are being diapered or are having trouble breathing.
There are now several tools designed to help determine when a baby is in pain.
They usually rate how irritable the baby appears (crying, whimpering, grimacing),
change in activity level, change in sleep patterns, change from usual ways of
responding, and stability of physiological signs (heart rate, breathing, oxygen
levels). If a tool like this is used by the nurses in your nursery, becoming
familiar with it may help you as a parent to understand your baby's responses
when there is reason to suspect pain. These tools are only rough guides; there
is as yet no sure way to know when your baby actually is experiencing pain.
How can we relieve pain and discomfort
for the baby?
There are a number of drugs that
can be used for relieving the sensory experience of pain in babies. However,
all drugs have disadvantages as well as benefits. Different nurseries prefer
different drugs. To find out which drugs might be used for your baby, consult
the nurses and physicians in your nursery.
Sometimes, the physician or nurse
may decide that using a drug to reduce pain is more harmful to the baby than
the experience of pain. For example, drugs used for pain may cause the blood
pressure to fall, impair the baby's ability to breathe, or hide a fever.
There are a number of other ways
to help relieve the sensory experience of pain and help the baby cope with the
experience of pain or discomfort.
- Giving rhythmical, repetitive
stimulation may block out painful sensations. For example, rocking and music
often are soothing.
- Firm touch may block painful sensations.
(Light finger-tip touching usually is arousing, not soothing.) Gentle but
firm pressure with the hand, or swaddling the baby tightly, provide a constant
touch sensation that may block pain.
- Distraction can reduce the baby's
attention to painful sensations. Sucking on a pacifier can provide distraction.
Responding quickly to signs of pain
or discomfort gives the baby some control. A pacifier also gives some control
-- the baby can stop and start sucking or adjust the strength of sucking.
Do all babies respond the same to
No, babies will react in different
ways to these attempts to soothe them. For example, for some babies being touched
or rocked is not soothing, and for others, sounds or music also may not be calming.
It always is important to carefully watch how the baby responds when trying
any of the suggested ways to relieve pain or discomfort. Try something else
if what you are doing seems to be more stressful than helpful.
When we experience pain or discomfort,
each of us tries to deal with it or adapt to it in ways that work for us. Therefore,
rather than trying to identify a set of specific behaviors or signs that mean
your baby is in pain, it is more helpful to learn how each individual baby tries
to cope with being upset or uncomfortable, and what works best to help him or
her feel more comfortable.