PREMATURE CHILD PARENTING

Hitherto the pediatricians and the nurses at the nursery have been observing your baby, planned his/her care and tried to provide the best possible care. Although your baby needed to be in the hospital nursery, it is not always a very comfortable or restful place to be. We make the best efforts possible to make nurseries and neonatal care more "baby friendly." We have implemented changes in the ways nurseries operate to help lesson the negative effects hospital care and minimize the stress babies’ experience. In addition, we ensure that the care each baby receives be adjusted to best fit that child's needs and coping abilities.  It has been our effort to involve you in the care of the baby all the way. Now that the traumatic period is over and we are handing over the baby under your responsibility we have a few tips and messages. We are providing a structured program for such babies providing intensive screening, special immunizations, growth monitoring and comprehensive developmental assessment called “Individualized Developmental Care and Early Intervention Program (IDCEP)”.

Providing Comfort and Developmentally Supportive Care for Your Premature Baby

As a parent, you can provide comfort and support to your growing baby in a number of ways. These may include making modifications to your baby's surrounding to minimize stress from noise and lights, as well as learning how best to hold and interact with your baby as he grows and matures.

Observe your baby's environment and try to minimize unnecessary noise, people and light. There are a number of simple adjustments you can make in your baby's surroundings to help reduce the amount of disruptive stimulation that he receives.

• Make sure your baby is shielded from light either by adjusting the amount of light shining directly on him or by putting a sheet or other covering over his bassinet.

• Always close the doors to his room quietly instead of snapping them shut.

• If the room seems particularly noisy because of a radio or television playing or phones ringing, try to remove or turn off these things or move your baby to a quieter location.

• Keep voices low around your baby, particularly when he is sleeping, or move away form his bedside for conversations.

• If your baby's bed is located in an area where there is a great deal of activity or foot traffic or traffic noises see if it can be relocated to a quieter spot.

Restrict the handling of the bay and follow the following rules regarding keeping the bay warm:

• Try to ensure that the handling of the baby is restricted to one or two people only after strict hand wash up to elbow as explained in the nursery. These people should include the mother and should go through all the instructions carefully

• Maintenance of body temperature is particularly vital in babies with prematurity or LBW. In summer cotton mittens, socks and caps and in winters the same made out of wool are mandatory. Ensure that the baby is properly wrapped or swaddled and no part is exposed. A rule of thumb is to ensure that the baby is wearing one cloth more than yourself in an environment where you are feeling perfectly comfortable.

Fig 2: TECHNIQUE OF SWADDLING (See Attachment) 

Fig 3: A properly swaddled baby (See Attachment) 

• Temperature of the AC should be set at 30 C

• Periodically check whether the hands and feet of the bay are colder than the rest of the body, If so wrap up more. If persisting call up your pediatrician

• Whenever you give bath to the baby ensure that the scalp of the baby is dried first with priority and that the temp of the water is as close to the body temperature as possible.

Hold your baby in a flexed position and provide boundaries around him while he sleeps.

 Preemies, like all newborn babies, feel more secure when they are swaddled securely in a blanket with their legs tucked up, arms bent, and hands brought together in front of them. When they sleep, they prefer to be touching or lying up against something, and will often move in the incubator until they are up against the wall or the bottom of the enclosure. By positioning your baby in a  curled position and providing boundaries for him when he sleeps, you not only help him feel calm and comfortable , but you also encourage the development of the curled position known as flexion that babies naturally assume in the womb. Preemies, with their lack of muscle strength, have a hard time maintaining this position by themselves, and, if left alone will lie spread-eagled with straight arms and legs on the relatively hard, flat surfaces but this are not seen in babies more than 34 weeks of gestation.

To provide comfort to your baby and support his physical development, try the following measures.

• When you hold your baby, keep him in a slightly curled position, with his legs tucked up and his hands brought forward in front of him.

• Create a nest for your baby to sleep in wool blankets or cloth diapers and place them around your baby to help keep his legs tucked or put them against his back and around the top of his head.

• A folded cloth diaper placed under your baby's chest when he is on his stomach can help him to feel secure and be in a flexed position.

• If your baby must sleep on his back, provide rolls along his sides to keep his arms bent and hands brought together in front of him, and another roll under his knees to keep his legs tucked up.

• Very soft pillows or mattresses and placing the baby in prone position should be avoided as this can predispose the baby to “ Sudden Infant death Syndrome”

• Do not wait for the baby to cry for feed as preemies sometimes lack the energy to do so and even when they do so at night the cry may not be strong enough. Try to follow the 2 hourly schedule at least till the baby reaches a post-conceptional age of 36 weeks or as advised by your pediatrician.

• Burping after each feed for 15-20 min including at night helps to minimize chances of regurgitation of feeds.

Fig 4 and 5 showing techniques of burping (See Attachment) 

Ways to Stimulate Your Child's Normal Development

The methods used to stimulate the development of a baby vary with the age of the child but follow certain general principles. The objective of the exercise in the first year is to repeatedly stimulate all five sensations –touch, hearing, vision, smell and taste to help the child integrate the information and utilize it for motor activities. Also the skills which form the next step in development need to be repeatedly practiced

1. Hold your baby as much as possible. Touching and cuddling is good for your baby. Give him or her lots of eye contact, smiles, and affection. Use feedings as a special opportunity for these warm personal interactions.

2. Talk to your baby. Babies of all ages enjoy being talked and sung to. Babies must first hear language before they can use it themselves. You don't need a script--just put into words whatever you are thinking and feeling.

3. Have colorful objects with musical sounds close to the baby to facilitate interaction.

Fig 6 and 7: Ideal environments keep stimulating the senses and promote motor activity(See Attachment) 

1. Play with your baby. If this doesn't come easy for you, try to loosen up and rediscover your free spirit. Respond to your baby's attempts to initiate play. Provide your baby with various objects of interest. Toys need not be expensive; for example, homemade mobiles, rattles, spools, pots and pans, and boxes. Encourage your baby's efforts at discovering how to use his or her hands and mind.

Fig  8 and 9: Playing and interacting with your baby are vital

1. Read to your baby. Even 4-month-olds enjoy looking at pictures in a book. Cut out interesting pictures from magazines and put them in a scrapbook for your baby. Look at the family photo album. By 8 months of age, begin reading stories to your child.

2. Show your baby the world. Enrich his or her experience. Point out leaves, clouds, stars, and rainbows. Help your toddler describe what she sees or experiences. Everything we see or do has a name.

3. Provide your child with social experiences with other children by age 2 years. If he or she is not in day care, consider starting or joining a play group. Young children can learn important lessons from each other, especially how to get along with other people.

4. Avoid formal teaching until age 4 or 5. Some groups have recently overemphasized academic (cognitive) development of young children. The effort to create "superkids" through special lessons, drills, computer programs, and classes can put undue pressure on young children and may result in an early loss of interest in learning. Old-fashioned creative play and spontaneous learning provide a foundation for later academic efforts and are much more beneficial during the early years.

Call Your Pediatrician If Your Child Does Not Meet the Following Developmental Milestones:

Speech and hearing

• Makes gurgling, cooing, or babbling sounds by age 3 months.

• Turns head to quiet sounds or whispers by age 9 months.

• Makes "ma-ma" and "da-da" sounds by age 12 months.

• Uses at least 3 specific words by age 2 years.

Fine motor skills

• Plays with hands by touching them together by age 6 months.

• Uses fingers to put pieces of food in mouth by age 12 months.

• Uses a cup without spilling by age 18 months.

Gross motor skills

• Rolls over by age 6 months.

• Sits without support by age 9 months.

• Supports own weight on legs when held under the arms by a parent by age 9 months.

• Walks across a large room without help by age 18 months.

Learn to read your baby's cues and pace your activities with him accordingly. As discussed earlier, premature babies tend to express themselves through physical changes and behavior. As you spend more time with your baby and as he matures, you will begin to recognize how he signals that he is getting tired or upset, and the things he does to calm himself. The following technique may help your child stay calm or regain his equilibrium if he has become upset.

• Provide one form of stimulation at a time: if you rock him, don't talk; if you are feeding him, try not to look him in the eye; while you are holding him, shield his eyes from strong light. Add more types of stimulation slowly, watching your baby for signs of stress.

• When your baby signals that he is getting tired and needs some time out, give him a rest period by cutting back on some of the stimulation he is receiving. For example, if you are rocking and looking at him, look away and just hold him quietly, perhaps shading his eyes from light until he relaxes again. Or decrease the intensity of the stimulation by talking more softly, or rocking more slowly. If these approaches don't work, your baby may simply need to be paced back in his incubator or bassinet to rest and sleep.

• Help your child bring his hands to his face or mouth, or offer him your little finger or a pacifier to suck on.

• Handle and move him slowly and gently.

• If your baby must be unwrapped from his blankets during certain procedures, use your hands to keep his arms and legs tucked and to create boundaries around him. This will comfort him and help him feel more secure.

Frequently asked questions

Do premature babies need special care?

Yes, babies born prematurely (before the due date) may need special care during their first 2 years, especially if they were very small at birth (less than 1800 grams) or very preterm (<36 weeks). We would advise you to follow up at our “Individualized Developmental Care and Early Intervention Program” to enable close and comprehensive monitoring, follow up and early intervention (where necessary) so that your child achieves his/her full potential. The program provides a structured format for follow up with early and detailed screening procedures so that the earliest indications of any deviations form the normal are picked up and treated immediately.  Here's some advice on how to care for your baby when he or she comes home from the hospital.  

Your baby's growth and development

It's important to take your baby to your doctor's office soon after the baby leaves the hospital. Your doctor will check your baby's weight gain and find out how your baby is doing at home.

Talk with your doctor about feeding your baby. Your doctor may recommend vitamins, iron, and a special formula if the baby is bottle-fed. Vitamins are often given to premature babies to help them grow and stay healthy. Your baby also may need extra iron. After about 4 months of taking iron drops, your baby will have about the same amount of iron as a full-term baby. Your doctor may want your baby to take iron drops for a year or longer.

Your baby may not grow at the same rate as a full-term baby for the first 2 years. Premature babies are usually smaller during this time. Sometimes they grow in bursts. They usually catch up with "term" babies after a while. To keep a record of your baby's growth, your doctor will use “special growth charts for premature babies”. Your doctor will also want to know things like how active your baby is, when your baby sits up for the first time and when your baby crawls for the first time. These milestones are described in detail in the “normal development handout” and a close watch by the parents on these is very helpful to the doctors.

Your baby's feeding schedule

At first, most premature babies need 8 to 10 feedings a day. Don't wait longer than 3-4 hours between feedings, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to 8 wet diapers a day show that your baby is getting enough breast milk or formula. Always ensure burping after each feed. Premature babies often spit up after a feeding. If your baby spits up too much, he or she may not gain enough weight. Be sure to talk to your doctor if you think your baby is spitting up too much.

Putting your baby on solid food

Most doctors advise giving a premature baby solid food at 6 months after the baby's original due date (not the birth date). Premature babies may choke if solid food is given earlier. They have to develop their swallowing ability. If your baby has medical problems, a special diet may be helpful.

How your baby sleeps

Although premature babies sleep more hours each day than full-term babies, they sleep for shorter periods of time. They wake up more often (and they wake you up more often!).

All babies, including premature babies, should be put to bed on their backs, not on their stomachs. Use a firm mattress and no pillow. Sleeping on the stomach and sleeping on soft mattresses may increase your baby's risk of sudden infant death syndrome (SIDS).

Your baby's vision and hearing

Crossed eyes are more common in premature babies than in full-term babies. The medical word for this is strabismus (say this: "straw-biz-mas"). Often, this problem goes away on its own as your baby grows up. Your doctor may want you to take your baby to an eye doctor if your baby has this problem.

Some premature babies have an eye disease called retinopathy of prematurity (called ROP, for short). ROP usually only occurs in babies who are born very early, at 34 weeks of pregnancy or earlier. Your baby will be screened for ROP as a part of the “Individualized Developmental Care and Early Intervention Program” If there's a chance your baby has ROP, your doctor will advise you to take the baby for regular check-ups by an eye doctor. ROP can be treated to help prevent vision loss.

Premature babies are also more likely than full-term babies to have hearing problems. The child would be screened for these under the “Individualized Developmental Care and Early Intervention Program” and appropriate intervention initiated if required.  If you notice that your baby doesn't seem to hear you, tell your doctor so your baby can be checked for hearing problems.

Your baby's immunizations

Immunizations ("shots") are given to premature babies at the same ages they are given to full-term babies. Your baby might be helped by getting a flu shot when she or he reaches 6 months of age. Premature babies might get sicker with the flu than full-term babies. Talk with your doctor about flu shots for your family. This can help protect your baby from catching the flu from someone in the family.

Traveling in a car with your baby

When traveling with your baby in a car, use an infant car seat (or another kind of infant carrier, if your doctor advises). Be sure that your baby's head and body don't slump over when he or she is in the car seat. You can use rolled-up towels or diapers to give your baby support in the car seat.

The safest place for all babies is to ride in the back seat. It's especially important not to put your baby in the front seat if your car has an air bag on the passenger's side. When you're driving in the car with your baby, keep an eye on your baby by looking at him or her in your rear-view mirror (of course you still need to concentrate on your driving as well). Or you can have a friend or family member ride in the back seat with your baby. If you're using an apnea monitor for your baby, it should be used even while your baby is riding in the car. Your baby shouldn't be left alone in the car, not even for a few minutes.