My Baby’s Discharge Day

Congratulations!

When the discharge day finally arrives, your baby will be ready to go home. Her or his short-term health problems will be resolved and possible longer-term problems will have been identified. Your baby’s doctor will have considered her or him to be healthy and stable enough to leave the hospital with you.

• Make sure you have an appointment booked with the baby’s doctor
• If your baby is going to be followed in the developmental/neonatal clinic, make sure you have an appointment
• If your baby is going to benefit from an infant development program make sure you have the information
• Make sure that you know about any other appointments that your baby may have, for example an eye test and hearing test
• Make sure your doctor has explained how to spot signs of any sicknesses or other problems your baby may encounter after leaving the hospital.
• Ask for a copy of your baby’s discharge summary, for both your baby’s doctor and yourself
• Ask who you can call after discharge if you have a question about your baby

Preparing My Older Children for Baby’s Homecoming
Tips to Help Your Other Children During the Homecoming Months
When Should I Call my Baby's Doctor
What is my Baby’s “Corrected” (Adjusted) Age?
How Do Premature Babies Act?
Shaken Baby Syndrome
Feeding my Premature Baby
Gastroesophageal Reflux Disease (GERD)
Vaccinations for my Growing Baby

Preparing My Older Children for Baby’s Homecoming

Bringing a new baby home can upset older brothers and sisters. Chances are, you have spent large amounts of time away from your other children while being with your preemie in the NICU. This loss of attention can make your other children worry, and feel angry or jealous. They may also feel your stress and become upset.

Children younger than six years old are more likely to find it hard to accept the new baby. They may act up because they want more attention from you. Here are some tips to help your other children get used to having a new baby in their home:

• Help your other children to talk about their feelings. They may be afraid that because the new baby requires so much attention no one will take care of them. Keep telling them that you are there for them, as well as for the new baby
• Bring your other children to the NICU to visit the new baby. This will help them understand what is going on. Be sure to supervise your children and do not let them run around in the NICU or touch any of the equipment
• If your other children are worried about how things will change when the new baby comes home, explain that it will be better because you won’t have to go to the hospital and leave them with baby-sitters anymore
• Bring pictures home of your newborn and put them where your other children can look at them often. Take pictures of your other children to the NICU and place them on the outside of your baby’s isolette (incubator) so that your other children can see them when they visit and realize that your new baby is part of their family.
• Talk with your other children about how they can help make the baby to become a part of the family; “We can sing to her (or him)” or “You can share your toys with her (or him)”
• Talking to your other children about all of the things that they can do that the baby cannot do (for example, dress themselves and drink from a cup) will help them feel grown up and special
• Buy small gifts for your other children and say they are presents from the new baby
• Keep telling your other children how important they are to you

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Tips to Help Your Other Children During the Homecoming Months

• If it is hard for you to give all the attention your other children need, ask a close friend, relative or favourite baby-sitter to spend some time with them
• Young brothers and sisters may start acting up or acting like babies when the new baby comes home

They might have more “accidents” if recently potty-trained, or they may go back to sucking their thumbs. Try not to get upset and don’t punish them, because your children are just trying to tell you they need your attention and love. Before long, your children will feel safe again and they will get back to normal.

• Remind siblings that you love them just as much as before the baby came home and try to provide them with special one-on-one time (for instance, during breakfast or when the baby is sleeping)
• Talk to your children about how your family loves their new baby, but do not expect them to show love right away. Tell them it is okay to feel anger toward the new baby, but it is not okay to hurt the baby
• Be careful about what you say in front of your children. They often hear more than you think they do
• Try to keep the day-to-day family life the way it was before the baby came home (naps, bedtime, meals, and other activities)
• Let their teachers know what is going on at home so they will understand
• Let your children care for the baby as much as possible. Let them hold their brother or sister and help with things like changing the baby’s diapers and clothes

Keeping your preemie’s brothers and sisters involved takes a lot of patience, but it will soon begin to pay off.

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When Should I Call my Baby's Doctor

Many parents of premature infants worry about what is normal and what may be an emergency for their baby. It is important to understand what is and isn’t normal so that you will know when to call your doctor.

The information below is only a suggestion. Be sure to talk to your doctor about when you should or should not call.

At first, you should call your baby's doctor or nurse about any concerns. In time, you will begin to understand your baby’s signs and know when there is a problem.

Some common signs that your baby may be getting sick include:

• Refuses to eat or eats very little
• Falling asleep or feeling tired after small feeds
• Cries often or for a long time
• Sleeps more than usual and is less active (lethargic) and more difficult to wake up
• Cannot sleep and is fussy
• Coughs often or for a long time
• Vomits (not a spit up or reflux)
• Frequent breaks in feeding to catch her or his breath
• Has wet stools (poops) or many bowel movements
• Has difficulty breathing, or a change in breathing (breathes faster or harder, with chest rising and falling)
• Has a bluish colour around the lips, is paler than usual, more irritable and refusing to eat

The Following Are Normal for Most Babies and Should Not Usually Cause Concern:

• Hiccups
• Sneezes
• Yawns
• Occasional spitting up
• Forcing or strain when having a bowel movement (if the stool is soft)
• Chin or lip quivering
• Passing gas
• Trembling or shaking arms and legs when crying
• Startled by noises with brief body stiffening (called the Moro reflex)
• Stuffy nose in dry weather

Call Your Doctor or an Ambulance Right Away if Your Baby:

• Has a significant change in breathing, i.e., difficulty breathing, nostrils open wide (flaring), chest moving far up and down, bluish lips, or coughing often
• Cannot be woken up from a sleep
• Has a seizure (sudden rhythmic moving and jerking of the body)

Call Your Baby's Doctor if Your Baby:

• Has only half as many wet diapers as usual
• Shows signs of not enough fluids: less urine (pee) or dark urine, sunken eyes, little movement, dry mouth
• Is acting unusual and you are concerned
• Has a fever over 37.5°C (99.5°F) and is under six months corrected age
• Has a fever over 38.9°C (102°F) without seeming sick
• Is sleeping poorly for two nights in a row
• Keeps crying for one hour when you are trying to help him stop
• Has not had a bowel movement for over three days
• Has purple spots on the skin that may look like blood blisters
• Has a fever with joint swelling (or does not move one or more limbs)

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What is my Baby’s “Corrected” (Adjusted) Age?

When a baby is born early it is important to correct their age.

What Does Corrected Age Mean?

Corrected age means that your premature baby has two ages, one counted from the day she or he was born, (chronological age, or birth date) and the other from the day he or she should have been born, (corrected or adjusted age, due date).

The corrected age (the original expected due date) is the age that is used to monitor your baby's expected development and growth. So everything that your baby should be doing, the amount of sleeping, eating, when to give solid and textured foods and when to be reaching development milestones, should be looked at from the day she or he should have been born (corrected or adjusted age, due date). Usually the premature baby's age is corrected until 2 years of age.

A premature baby or “preemie” may still have a pattern of milestones that is different from a full-term baby. The early delivery of your baby may affect the way she or he develops for at the first year of life or more.

Children who are born very early (ELBW and VLBW), who needed more medical support, or who have other medical problems are more likely to have longer delays, specifically gross motor, fine motor and speech development. Some delays, such as thinking ability (cognition) may not be easy to spot until school age.

All premature babies should have their development monitored for the first two years from their original due date.

The only thing that is not corrected because of being born early is immunizations. They will be given to your baby according to when your baby was born (birth date).

To measure your baby’s corrected age, take the number of months since birth (age) and subtract the number of months that the baby was born early (premature).

See information on Developmental Milestones for more information about your baby’s development.

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How Do Premature Babies Act?

Most premature babies come home around the time of their normal due date. Even a baby who has finally reached the expected birth date may still have some catching up to do. The baby may:

• Not give you clear signs that she or he is hungry or tired
• Still be weak and hard to feed
• Spend her or his day either sound asleep or crying, and go from sleeping to crying within seconds

You may find your baby’s behaviour difficult to understand at first. This can cause worry and upset you, but as the weeks go by, you will begin to understand and your baby will get better at making her or his needs known. As with all babies, your premature baby will seem to have bursts of fast development and other times when nothing much seems to change. If this is a worry, ask your doctor about it.

• You can’t push your baby to develop before she or he is ready
• Don’t try to force her or him into activities when she or he is tired or not in the mood. Pushing her or him will just upset both of you
• Give her or him your time and support
• Focus on her or his progress. Unless there is a problem which may need intervention, years from now it may not matter whether she or he began walking at 12 or 20 months of age. Always use your baby’s corrected age (adjusted age) to judge her or his abilities. See your doctor or development specialist if you are really worried.

Movement

Premature babies often have very uncoordinated movements. It’s hard to predict how your baby will respond to you and the world around her or him.

• Your baby’s reactions may have a jerky, startled quality, because she or he is still trying to adjust to changes in her or his environment, or even to physical needs
• She or he may suddenly stiffen her or his arms and legs or draw them inward. At times, she or he may go limp and then quickly become tense
• As she or he matures, these reflex actions will gradually disappear
• You can help your baby control her or his movements by:
  • Holding arms and legs close to her or his body
  • Moving her or him slowly and gently
  • Being quiet and calm with her or him

In premature infants, the senses (hearing, touching, seeing) often develop faster than the baby’s ability to control her or his muscles (coordination). Your baby may seem slow at gaining control of the movement of the head or to hold objects, but learn quickly to react to sights and sounds—signs of healthy development.

Breathing

Breathing patterns and the skin colour of premature babies can change quickly and without warning. Watch your baby and get to know you baby's usual breathing pattern and “normal” colouring.

• Observe how your baby breathes
• Observe skin colour

Knowing usual behaviour will help you spot any problems. Anytime you’re concerned about your baby’s breathing or colour, call your baby’s doctor or nurse.

Sleeping

Your baby will mostly want to sleep and eat during her or his first weeks at home. At first, your baby may sleep about 18 hours a day. Premature babies tend to have long sleep sessions and short wakeful periods. Your baby may come home from the hospital with her or his days and nights mixed up. Think about how different the baby’s sleeping area is at home from what it was like in the hospital. If your baby has trouble sleeping:

• Try using a night light and play the radio softly
• Turn down the extra noise and light slowly to help your baby get used to the new sleeping area
• When feeding your baby during the night, keep her or his attention on eating and don’t play

Generally, when your baby reaches an (adjusted) corrected age of 6 to 8 months, she or he should be able to sleep through the night. Unless there is a medical problem and you have been told otherwise, ALWAYS put your baby to sleep on her or his back to decrease the risk of SIDS.

Typical Hours of Nighttime and Daytime Sleep Required in Early Childhood*

Crying

Regardless of how much crying your baby does, it can wear on your nerves, especially when you are tired. Here are a few tips to help you deal with crying:

• Try your best to keep calm and you will read your baby’s signals better.
• Try to talk to your baby in a soft, soothing voice when she or he cries
• Touch your baby softly. When babies are distressed, they often relax and calm down with soft touch. Try carrying your baby more. This can help to reduce normal bouts of crying. Consider using a baby carrier or sling so that you can go about your routines as your newborn snuggles close to you, but make sure that your baby is safely positioned; her or his face is not pressed into sling or carrier, your body or your clothing, and ensure that the chin is not pushed down into the baby's chest, when using a sling or a carrier.
• Try not to schedule activities during the time of day when your baby seems to cry on a regular basis
• Take breaks from your baby. If possible, find a neighbour or friend who can watch your baby for a few minutes and get away. If you are alone and you feel like you are becoming too frustrated or agitated, try placing your baby in a safe place such as her or his crib, and go outside for a few minutes
• Make sure you get as much sleep as possible. Try to grab a nap when your baby sleeps during the day, especially if your baby fusses and cries at night. If you have a friend who will watch the baby, ask her or him to come over for an hour or two while you catch up on your sleep
• Weather permitting, take your baby outdoors for a walk in a carriage or stroller or for a drive in the car
• You likely have older, well-meaning relatives who think you are spoiling your baby by responding to her or his every cry. Rest assured that you cannot spoil a newborn baby. When you respond quickly to your newborn

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Shaken Baby Syndrome

It takes only a few seconds to do serious damage to a baby’s brain when they are shaken. Shaking a baby can result in permanent brain damage or even death. Some of the damage that can result from shaking your baby can include blindness, hearing loss, seizures, developmental delays, learning difficulties, paralysis or mental retardation.

It is easy to become frustrated when your baby doesn’t stop crying, especially if you are exhausted. So it is important to understand that if you are frustrated and nothing has worked to calm your baby, either put your baby back to her or his own crib and leave the room or ask someone to help you.

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Feeding my Premature Baby

Premature Babies' Diet:

• Breast milk
• Premature baby formula
• Vitamin and mineral supplements
• Combination of the above

Ways Premature Babies Can Get Nutrition

• By breast or bottle-feeding
• Gavage or tube-feeding through the nose or mouth to the stomach
• Intravenous (IV) feeding through the bloodstream by passing the gastrointestinal (GI) tract
• Combination of the above

Premature babies grow by feeding. The larger a baby is, the healthier she or he will usually be. In most cases, a growing premature baby thrives and gets stronger and healthier day by day.

In the beginning, the goal of feeding a premature baby is to help her or him grow and gain weight like he or she was in the womb during the third trimester of pregnancy. In general, premature babies should increase their length by 1 cm per week, should increase their head circumference by 0.7 cm per week and should gain about 15 g per day in overall weight.

There are several ways in which a premature baby can be fed. The type of food and the method used to deliver it will depend on the condition of your baby and your choice.

Your baby will be measured and weighed to assess how much she or he is growing (absorbing the nutrition).

Breastfeeding

The experience of breastfeeding and of feeding your baby your own milk offers many special benefits. Breast milk can help protect babies from infections. Breast milk is the best source of nutrients for premature infants. When your baby first comes home from the emptying hospital, she or he may still tire easily while eating and not completely empty your breasts. To keep up your milk production in the early weeks, it may be necessary for you to pump your breasts and bottle-feed or store the extra milk.

In the hospital, in addition to breast milk, some premature babies may need a supplement to help them grow: this might be in the form of a breast milk fortifier, a vitamin-mineral preparation, or a special formula. Your doctor will tell you if your baby needs one of these when she or he is discharged.

• Before you leave the hospital, make sure you understand how to breastfeed your baby
• Make a plan with your nurse, doctor, or lactation specialist as to how often you’ll need to feed, and if you’ll need to give the baby supplements
• In the beginning, checking the baby’s weight regularly at the doctor’s office will help you be sure your baby is getting the food she or he needs for proper growth and development

Remember to get plenty of rest. Most of all, enjoy the good feeling you get when breastfeeding your baby.

Bottle-Feeding

If you’re not breastfeeding or expressing milk, your baby (mostly ELBW and VLBW babies) will be given preterm formula in the hospital. Most babies can have the normal formula that you can buy in a store after you bring your baby home. Before bringing your baby home, ask the nurses how to mix your baby’s formula, learn any special ways to feed your baby and find out how much formula your baby should drink in a 24-hour period.

Check with your baby’s doctor or nurse to find out if a vitamin supplement is needed.

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Gastroesophageal Reflux Disease (GERD)

Babies born prematurely more commonly experience a condition called gastroesophageal reflux disease (GERD, or “reflux”). GERD occurs when the muscle at the opening of the stomach stays open, letting food and stomach acid to go back up the food pipe. It is important to watch for signs of GERD.

Call your doctor if your baby:

• Spits up frequently
• Has trouble breathing during or after feedings
• Is often fussy during or after feedings
• Arches her or his back during feedings
• Has poor growth
• Has difficulty breathing and/or breathes food into the lungs

There are several ways to check for GERD and to treat it. Your doctor will talk to you about this. Babies usually outgrow GERD within their first year of life.

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Vaccinations for my Growing Baby

Babies need different vaccinations at different ages to help protect them against serious diseases. It is important for children to be immunized on time according to the recommended schedule, which uses the baby’s date of birth (not corrected age or adjusted age). For more information, contact your doctor or public health nurse.

1. Haemophilus influenzae type b (Hib) requires a series of immunizations. The exact number and timing of each may vary with the type of vaccine used.
2. Two-dose programs for MMR are given in all territories and provinces. Second dose MMR is given either at 18 months or 4-6 years of age. If the child is past the age at which the second MMR is recommended, the second dose can be given 1-2 months after the first.
3. Hepatitis B requires a series of immunizations. In some jurisdictions, they may be administered at a younger age.
4. Given in 1 dose to children between 1 and 12 years old and in 2 doses, 1 month apart for older children. It is not recommended for children under 1 year old.
5. The specific age that your child will be offered the vaccine through the provincial or territorial immunization program depends on the provincial program. Children at higher risk for meningococcal infection should receive a conjugate meningococcal C vaccine as a baby and MCV4 when they reach 2 years of age. All adolescents should receive a booster dose with MCV4 or a conjugate meningococcal C vaccine at about 12 years of age.
6. For girls only. The second dose is given 2 months after the first, and the third dose after 6 months. Adapted from the Canadian Pediatric Society. Last updated: February 2009. Available at: http://www.caringforkids.cps.ca/immunization/VaccinationChild.htm#Table1. Accessed on Sept. 21, 2009.

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