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If Your Baby is Born PretermPostpartum

Introduction

Sometimes babies are born early (preterm) and need to be cared for in a neonatal intensive care unit (NICU) at the birth centre or another hospital. On this page, you’ll learn about your preterm baby and your role in providing care during their stay in the NICU. You will also learn about what you can do to keep your baby safe and healthy at home after they leave the NICU.

Not all babies staying in the NICU are born preterm – some babies are born full term (between 37 and 41 weeks of pregnancy) and have medical conditions that need special care. If your baby is staying in the NICU and was not born preterm, talk with your health care provider about their unique needs and special considerations for care.

Getting to Know the Neonatal Intensive Care Unit (NICU)

Corrected age

Your baby’s chronological age (or actual age) is the measure of time that has passed since they were born. However, if your baby was born preterm, your health care provider will use the term corrected age (or adjusted or gestational age). Corrected age is your baby’s chronological age minus the number of weeks or months they were born early. For example, if your 6-week-old baby was born 5 weeks early, your baby’s corrected age is 1 week old.

Your health care providers will use chronologic and corrected age to monitor your baby’s growth and your baby’s corrected age to monitor their development.

Calculating your baby's corrected age formula
Calculating your baby's corrected age

Your health care providers

The NICU is a very busy unit! Your baby will receive care 24 hours a day from a specialized health care team.

Your health care providers may include:

  • Charge Nurses: nurses who manage the care of many babies in the NICU and help the unit run smoothly.
  • Neonatal Nurse Practitioners (NNP): neonatal registered nurses with extra training in caring for babies born preterm or sick.
  • Nurses: registered nurses or licensed practical nurses make up a large portion of the NICU team. You will work very closely with the nurses to care for your baby.
  • Dietitians: registered dietitians help your baby with their nutrition needs.
  • Discharge Coordinators: nurses who help ensure that everything is ready for when you take your baby home and arrange for transfers.
  • Lactation Consultants: breastfeeding specialists who help you and your baby with breastfeeding.
  • Neonatologists: medical doctors with special training in caring for preterm and sick babies.
  • Neonatal Fellows: medical doctors who are working in the NICU to become a doctor specializing in neonatal intensive care.
  • Clinical Associates: medical doctors with special training caring for children (pediatrician) as well as preterm and sick babies.
  • NICU Residents: medical doctors who are training to become pediatricians.
  • Pediatricians: medical doctors who specialize in caring for children.
  • Pharmacists: health care providers who help your baby with their medications.
  • Social Workers: professionals who provide you support for the emotional, social, and financial stresses of being in the NICU.
  • Registered Respiratory Therapists (RRT or RT): health care providers who help your baby with their breathing.
  • Speech Language Pathologists (SLP) or Occupational Therapists (OT): health care providers who help your baby with feeding and swallowing.
  • Unit Clerks: staff in the NICU who greet you on the phone or at the door when you come to be with your baby. They also help your health care team by booking special appointments and tests.
  • You: you are an important partner in your baby’s care when they are staying in the NICU!

Alberta Family Integrated Care (FICare™)

Alberta Family Integrated Care (FICare™) is a model of care used in all NICUs across Alberta. It means as a parent, you are not a visitor to the NICU – you are an important member of the health care team! Your team of health care providers will help you learn about your baby’s needs and make sure you have the knowledge and skills to care for your baby while staying in the NICU and when you go home.

To learn more, visit Alberta Health Services – Alberta Family Integrated Care (FICare)

Your role in your baby's care

Your health care providers will help you understand how your baby is doing and how you are an important part of your baby’s care. Your baby might be too sick or small to hold at first. Talk with your health care provider about how you can be close to your baby as soon as possible. Being close will help comfort them and help you bond and build attachment, even if you are not able to hold them.

Being involved as a member of your baby’s care team will help you feel more comfortable caring for your baby once you go home. Ask your health care provider how and when you can take part in your baby’s care – for example, you can change your baby’s diaper, take their temperature, and possibly hold your baby. You can also give your baby skin-to-skin care. This will help you bond with your baby and help your baby be calm.

As time goes on, you will become comfortable doing more with your baby. Each time you come to see your baby, talk to your health care provider about what you can do or would like to do for your baby.

One way you can help your baby to grow healthy and strong is to gently touch or talk to them in a quiet voice. Your voice can help calm and soothe your baby. Watch your baby’s response to these actions. If your baby is calm or looking at you, they are enjoying what you are doing. If your baby becomes upset, ease back or change your actions to see if that helps them relax. Sometimes, quietly holding your baby against your body without any movement or noise is the best thing for your baby.

A parent cuddling their baby skin-to-skin
A parent cuddling their baby skin-to-skin

You can also help your baby’s developing brain through positive serve-and-return interactions like talking, reading, and singing. Other ideas for serve-and-return interactions you can try with your baby will depend on their specific medical needs. There will be more options for serve-and-return interactions as your baby grows stronger. Talk with your health care provider about ideas for serve-and-return interactions you can try with your baby.

To learn more about the NICU environment and your role in your baby’s care, watch MyHealth.Alberta.ca – Learning about the NICU.

A parent reading to their baby in the NICU
A parent reading to their baby in the NICU; Reproduced with permission from © www.kristywolfephotography.com

Parental Leave

As a parent caring for their baby in the NICU, you may be eligible for the Government of Canada Employment Insurance (EI) program’s Family Caregiver Benefit for Children. This benefit provides financial assistance to caregivers who provide care or support to a critically ill or injured child under the age of 18. To learn more, visit Government of Canada – EI Caregiving Benefits.

Learn more about other parental leave benefits.

 

Travel Expenses

If you need to travel to care for your baby during their stay in the NICU, you may be eligible to claim your travel expenses as medical expenses. To learn more, visit Government of Canada – Travel Expenses.

Daily rounds

Daily rounds are when you and other members of your baby’s health care team get together to discuss how to provide care for your baby. Your input is important during daily rounds. You may notice changes in your baby before other members of the health care team. You can share updates about your baby, ask questions, and take part in discussing their care plan. You decide if, when, and how you can take part in daily rounds. You can join daily rounds in-person or virtually. To learn more, watch MyHealth.Alberta.ca – NICU Bedside Rounds: How Parents can Participate.

Common equipment

Your health care providers will use different equipment to help take care of your baby. This includes:

  • incubator (Isolette): helps keep your baby warm and the surroundings quieter
  • warmer: an open bed that uses overhead heaters to keep your baby warm before being moved to an Isolette
  • temperature probe: measures your baby’s body temperature
  • heart monitor: keeps track of your baby’s breathing and heart rate
  • pulse oximeter: measures the oxygen level in your baby’s blood
  • intravenous (IV) pump: a machine that gives your baby fluids and medicine
  • feeding pump: a machine that controls the pace of breastmilk or formula during tube feeds
  • continuous positive airway pressure (CPAP): a machine that helps your baby breathe
A parent touching their baby inside an incubator; Reproduced with permission from © www.kristywolfephotography.comA baby wearing a continuous positive airway pressure (CPAP) machine
Top: a parent touching their baby inside an Isolette, reproduced with permission from © www.kristywolfephotography.com; Bottom: a baby wearing a continuous positive airway pressure (CPAP) machine

Your baby may need other equipment, too. Talk with your health care providers if you have any questions about the equipment used to care for your baby.

Common tests

Your baby may need to have tests done while they are in the NICU. These tests help your baby’s health care team understand their unique medical needs. Your health care provider will talk with you about these tests and answer your questions.

  • Blood test: checks your baby’s blood for infection, oxygen levels, nutrition and electrolytes. Your baby will also have a newborn blood spot screen to test for treatable conditions.
  • X-ray: takes pictures of your baby’s lungs and bones.
  • Ultrasound: uses sound waves to look at your baby’s head, abdomen and hips.
  • Echocardiogram: a special ultrasound used to look at your baby’s heart.
  • Hearing test: checks your baby for hearing loss. Learn more about newborn hearing screening.
  • Eye examination: checks your baby’s eye health and vision.

Your baby may need other tests. To learn more, talk with your health care provider or visit MyHealthAlberta.ca – Getting to Know the Neonatal Intensive Care Unit

Immunization

Your baby may be eligible to receive routine immunizations during their stay in the NICU, depending on their chronological age.  

Hand hygiene

Everyone must wash their hands before entering the NICU. Frequent hand washing with soap and water or an alcohol-based hand rub (hand sanitizer) is the most important thing you can do to protect your baby from germs. Clean your hands for at least 20 seconds before touching your baby. You should also clean your hands after changing your baby’s diaper. Learn more about controlling the spread of germs.

If you are unsure if you need to wash your hands – wash your hands!

Transfers

As your baby’s care needs change, they may be transferred between hospitals (for things like surgery or other treatments not available at their current hospital) or between Levels I, II, and III NICUs.

Level I

Provides basic care for babies who need short term or minimal support.

Level II

Provides care for babies who may be at risk for developing health problems that require special monitoring or treatment, such as oxygen, IV fluids, or feeding support.

Level III

Provides care for babies who are at a high risk for serious health problems and need specialized monitoring and treatment. Since there are few Level III NICUs in Alberta, you may need to travel to care for your baby. Call Health Link at 811 or talk with your health care provider to find out about travel support options.

Remember – you are a member of your baby’s health care team. Talk with your health care team about your baby’s transfers. Ask them any questions you may have about what transfers mean for your baby, like:

  • where is your baby being transferred to and why?
  • how will your baby be transferred? Are you able to stay with your baby during the transfer?
  • how will your baby’s care change before, during, and after the transfer?
  • what kind of supports are available for you to help you get to know the new hospital, new NICU, or the new health care team?
  • are there any risks to your baby being transferred?

Taking care of yourselves

You may have many different feelings about your baby’s stay in the NICU. You may be feeling sad, guilty, scared, or worried about your baby and what is going to happen.

Pay attention to your feelings. If you are parenting with a partner or support person, talk with them about how you feel. Remember to be patient with each other. They may also have mixed feelings and show those feelings differently – that’s okay!

Whether you’re parenting with a partner or on your own, talk to someone you trust about your feelings.

You can also talk with your health care provider about your feelings and ask questions – they are there to give you information and support.

It may not be easy, but taking care of yourself, both mentally and physically, is one of the most important things you can do to help take care of your baby. Learn more about caring for yourself after birth and postpartum mental health.

Sources of support

When your baby is born preterm, it can be hard to relate to the needs and experiences of parents with babies born full-term. Sometimes the best support comes from people who are going through or have gone through the same things that you have. Call Health Link at 811 or talk with your health care provider about options for parenting classes and support groups for NICU parents.

“It is easy to let your mental health deteriorate while you have a child in the NICU. It is hard to see your baby in the NICU and deal with the rollercoaster of emotions that inevitably follow. It is important that you lean on those around you – like your partner, family and friends. Seek professional help if you need and recognize that you are a human being, in a tough spot. Eat healthy, get sleep, and try to engage in the hobbies and interests you enjoy. A mom that is well-taken care of is the best thing for her baby.”

~ Omar, parent of a preterm baby

Getting to know your baby

How your baby looks

If your baby was born preterm, they will be smaller than babies born full term. Your baby’s appearance will depend on how early they were born.

If your baby was born 1-2 months preterm, they will look small with less fat and muscle. If your baby was born 2-4 months early, they will appear very small with thin, red and shiny skin.  Without layers of fat to control their temperature, your baby may need special equipment to keep warm.

Your baby’s movements may be limp or jerky at first. They may lie flat, quiet and still on their mattress. Your baby’s movements will become smoother as their muscles, nerves, and bones get stronger.

A baby holding their parent's finger while sleeping in an incubator
A baby holding their parent's finger while sleeping in an Isolette; Reproduced with permission from © www.kristywolfephotography.com

Skin care

Your baby’s skin may be very thin and fragile. They can get cold easily and their skin may become very dry. You may see your health care provider use special techniques to protect your baby’s skin, like placing special pads underneath your baby or placing clear coverings on their knees or elbows. Talk with your health care provider about how you can help protect your baby’s skin.

Water loss

Depending on how early your baby was born, they may be in a plastic bag from the shoulders down right after birth to keep them warm and to keep their skin moist. Your health care provider may use a warmer or an Isolette to keep track of your baby’s temperature while keeping them warm. Moisture can be added into Isolettes to prevent water loss from the skin and keep your baby’s skin from becoming too dry.

Infection prevention

To protect your baby’s skin and prevent them from getting infections, special cleansers, cleaning wipes or tape may be used. Special cleansers may be used before having a test or procedure. Talk with your health care provider if you have questions about cleansers and tape and how to use them.

Diaper rash

Change your baby’s diaper often to prevent diaper rash, especially after a stool. Your health care provider may have you gently put a special cream around the buttocks to help protect your baby’s skin and help it heal.

Common medical conditions

Your baby may be more likely to develop certain medical conditions because they are not yet fully developed. They may also be more likely than others to get sick or get an infection. Talk with your health care provider if you have any questions about your baby’s medical conditions.

It may help to learn about the medical conditions that are common for babies in the NICU:

Preterm baby cues

Preterm babies have a different body language from full term newborns. Your baby will show cues to help you understand their needs as they interact with you and their surroundings. Crying is one way your baby communicates with you and tells you that they need your help. Here are other cues to watch for:

Quiet Alert

Your baby is awake. Their eyes are bright and wide. If your baby was born preterm, they may have difficulty maintaining a quiet alert state for long. They may look away to cope with too much stimulation.

A baby in an incubator with their eyes open

Attentiveness

Your baby shows attentiveness by focusing on what they can see and hear. They appear comfortable and relaxed with regular breathing and little physical movement. When your baby is in an attentive state, this is a good time to interact with you and other caregivers.

A parent holding their baby in the hospital

Overstimulation

If your baby is overstimulated, they may show signs of stress and being tired. They might not cope as well with overstimulation compared to babies born full term. They may need to take more breaks so they can learn to adapt to their surroundings. As your baby grows, they will learn how to self-regulate from you.

A parent holding up their yawning baby in the hospital

Active alert

Your baby is awake. They are moving around and responding to sights, sound, and touch.

A parent looking into their bay's eyes while holding their baby on their bare chest

Disorganized

Your baby may be feeling stressed and have a hard time self-regulating. They may show stress by stretching their arms and fingers out or moving in repetitive and jerky movements. Your baby may squirm, turn or push themselves away while being held. You can help calm your baby by comforting them until their breathing is steady.

An awake baby laying down with their arms in the arms in the air in a hospital

Overwhelmed

If your baby is feeling overwhelmed, they may spread their fingers wide and signal “stop!” or make a T shape with their hands. They are not strong enough to do this for long.

A parent changing their baby's clothing and the baby has their eyes closed and hands in the air with fingers spread

Talk with your health care provider how you can recognize and respond to baby’s needs.

TAKE A BREAK, DON’T SHAKE

Frustration when dealing with a crying baby is the number one reason for shaking. Never shake your baby or child for any reason.

Babies and young toddlers have heavy heads and weak neck muscles. Even a few seconds of shaking can cause blindness, hearing loss, inability to walk, learning problems, and in some cases may even cause death.

Plan ahead so you’re ready for the times when your baby’s crying becomes too much. The Crying Plan – Take a break, don’t shake printable is your own plan to help you cope when you are feeling overwhelmed.

Feeding your baby in the NICU

Feeding takes lots of practice – for you and your baby. You play an important role in helping your baby learn how to suck, swallow, and breathe when feeding, while you learn how to follow and respond to their feeding cues. Your experience of feeding your preterm baby may be different, depending on how early your baby was born.

You can feed your baby with your own breastmilk and colostrum in the NICU. Most babies born preterm need extra nutrients to help them grow. In some cases, a human milk fortifier may be added to your breastmilk to provide extra nutrients for your baby. Your health care provider may recommend pasteurized donor human milk or special formula if your baby needs it.

Sometimes babies who are born preterm may not have the strength or skills they need to feed by mouth (oral feeding). Your baby may need to get your breastmilk from a feeding tube until they are able to feed by mouth. Feeding tubes are soft, flexible tubes that go into your baby’s mouth or nose and into their stomach. Feeding tubes help your baby get the nutrition they need to grow strong while they develop their oral feeding skills.

Every baby is unique. Some may develop feeding skills quickly, while others may continue to need support once they leave the NICU. Talk with your health care provider about creating a feeding plan for your baby — to help them develop their feeding skills while in the NICU as well as a plan for their transition to feeding at home.

However you feed your baby, information and support is available

Whether you’re feeding your baby by tube, by bottle, or by breast, information and support is available from your health care provider.

Storing expressed breastmilk

Your breastmilk needs to be handled safely. This is also important when your baby is in the NICU. Learn more about storing breastmilk at the birth center or hospital.

Sometimes you may need to express your breastmilk at home while your baby is in the NICU. Follow these guidelines for preparing and storing breastmilk at home. After expression, put your breastmilk in your refrigerator right away. Use a cooler bag with ice or freezer packs to take your breastmilk to the birth centre or hospital.

Stages of oral feeding

Most babies go through three stages when they are learning to oral feed (feeding by mouth). Your health care provider will determine the stage your baby is at. Your baby may need to go back and forth between stages while they are developing their skills and getting stronger. Understanding your baby’s cues and feeding skills will help you to help your baby with their oral feeding journey.

StageSkills your baby is working on

Pre-feeding

Your baby is learning to breathe smoothly, move their body, and wake on their own to show early hunger cues.

They are not ready to practice sucking or oral feeding but they are getting stronger each day.

You can help your baby at this stage by staying close, touching them, letting them hear your voice, and giving them breastmilk for their tube feedings.

Sucking and breathing practice without milk

Your baby is still tube feeding during this stage, but they are also practicing sucking on a soother or nipple without milk or nuzzling a pumped breast.

They are not yet ready to suck, swallow, and breathe. Once they are able to do all three, they will move to the next stage.

Introduction to oral feeding (three steps)

Step one: Your baby is learning to taste milk by sucking and swallowing very small amounts of milk from the breast or drops of milk on a soother while breathing.

Step two: Your baby is practicing drinking small amounts of milk gradually by breast or bottle.

Step three: Your baby is starting to take full breast or bottle feedings by mouth.

Breastmilk benefits

Breastmilk has many health benefits for babies who are sick, preterm or are born with low birth weight. Breastmilk helps to protect your baby from getting necrotizing enterocolitis, a serious disease that affects the intestines. Breastmilk also helps to protect your baby from some infections. This protection may lead to a shorter stay in the NICU. Talk with your health care provider about how you can build your breastmilk supply and provide breastmilk for your baby.

“I know that with myself, I tried to breastfeed and it didn’t work. It was too stressful and painful. I did however pump for a year so that my daughter was able to get breastmilk.”

~ Sudarshini, parent of a preterm baby

Feeding cues

Your baby uses feeding cues to let you know when they are hungry and ready to practice their oral feeding skills. They also use cues to let you know if they are having a positive feeding experience or if they are feeling stressed while feeding.

Your baby is having a positive oral feeding experience when they are:

  • sucking and swallowing
  • drinking in a smooth and regular pattern — starting with short, quick sucks that become slower and deeper as they feed
  • given breaks to let them breathe and swallow during the feed (paced feeding)
  • holding their hands near their face
  • awake and focused on feeding
  • showing a relaxed face and body

Your baby may show signs that they need to take a break from oral feeding (stress cues). Early stress cues are the first signs your baby will show to let you know they need to take a break. By responding to their early stress cues, you teach your baby they are safe and help them build trust. If early stress cues are missed, your baby may show late stress cues.

A sleeping preterm baby breastfeeding
Going to sleep can be a stress cue if it’s early in the feed.

Here are some early and late stress cues to watch for:

Your baby may be showing early signs of stress when they are:

  • moving around a lot (squirming) or arching their back
  • turning away from the tube, bottle, or breast
  • wide-eyed or look worried
  • taking in lots of milk with each suck (gulping)
  • spitting out milk or have milk leaking from the side of their mouth
  • looking sleepy
  • showing changes in their breathing pattern
  • widening their nostrils (openings of the nose)
  • spreading their fingers

Your baby may be showing late signs of stress when they are:

  • making a sign to stop with their hand
  • coughing or choking
  • closing their lips tightly together
  • closing their eyes
  • looking like they are asleep

Paced feeding

As your baby learns to feed by mouth, it is important to start feeding slowly and remember to follow and respond to your baby’s feeding cues and stress cues. Sometimes, babies may forget to breathe at the beginning of a feed when they are very hungry. Not breathing enough when feeding or feeding too quickly can cause your baby to feel stressed. Squirming, leaking milk from the mouth, or sucking too fast are some of the first signs that your baby may benefit from paced feeding.

Paced feeding is a way to help your baby have a safe and enjoyable feed while they develop their feeding skills. During paced feeding, you give your baby breaks to let them breathe and swallow during the feed. Paced feeding helps your baby have the energy they need to feed longer and finish their feeds.

To slow the pace of your baby’s feeding, remove the nipple (breast or bottle) from your baby’s mouth after about 3-4 sucks. This gives your baby time to breathe after they finish swallowing. Rest the nipple on your baby’s lip. Wait for your baby to open their mouth before offering them the breast or bottle again. Repeat these steps until your baby’s sucking slows down and they start taking short pauses during the feed.

You can also try:

  • using a slow flow nipple if you are bottle feeding
  • expressing by hand or with a breast pump before feeding to slow the flow of breastmilk
  • breastfeeding positions where the baby’s head is higher than the rest of their body (football or clutch position, laid-back position, or side lying position)
  • using a nipple shield with the help of a lactation consultant

As your baby’s oral feeding skills develop, they will learn how to pace themselves and feed safely. Talk with your health care provider about how to use paced feeding as part of your baby’s feeding plan.

To learn more about your baby’s feeding cues and their stages of oral feeding skill development, watch MyHealth.Alberta.ca – Oral Feeding Your Preterm Newborn or Infant with Challenges: Steps to Safe and Enjoyable Feeding

To learn more about feeding your baby, visit MyHealth.Alberta.ca – Feeding Your Premature Infant

“I always believed that breastfeeding was so natural and would come easily but it didn’t for us. With support, a few tools, and time to figure it out, we were able to find a routine that worked for us”

~ Olivia, parent of a preterm baby

Getting ready to go home

It is normal to feel many emotions when it is time to take your baby home. You may feel excitement and joy and also anxiety and worry. Your baby’s health care providers will help you learn about caring for your baby’s needs at home so you feel confident when it is time to leave the NICU.

Rooming in

You may be able to spend time caring for your baby on your own before your baby is discharged from the NICU. This is called rooming-in. Your health care providers will be close by for help and advice. Some hospitals may not have a private room for you to stay in, but you can spend time caring for your baby in the NICU – day or night.

Your baby may be ready to go home as early as 5 weeks before their actual due date, or they may be ready to go home later. Learn more about going home.

To learn more about the milestones your baby needs to meet before heading home and what you can do to prepare, visit MyHealth.Alberta.ca – Taking Your Baby Home and watch MyHealth.Alberta.ca –  NICU: Getting Ready to Take Your Baby Home.

Medications

Your health care provider may prescribe medications to give to your baby at home. Before you leave the NICU, they will teach you about the medications your baby needs, why they need them, and how to give them to your baby. You can purchase your baby’s medications before leaving the NICU.

Car Seat

Your baby needs to be in a safe, properly fitted, rear-facing car seat when you are ready to go home from the NICU. Visit MyHealth.Alberta.ca – Preterm or Low Birth Weight Babies and Rear-facing Car Seats to learn more about using your baby’s car seat properly.

To learn more about travelling safely with your baby, visit MyHealth.Alberta.ca – Premature Infant: Safe Travel With Your Baby (alberta.ca)

a baby properly strapped into their car seat

Feeding your baby at home

Your baby is on a feeding journey during and after their stay in the NICU or hospital. They may be feeding at the breast, by bottle, by tube, or a combination of these. They may also need fortified feeds for extra nutrients to support their growth and development.

Your baby’s feeding journey may be challenging and emotional for you as well. As you settle in at home, continue to follow the feeding plan that you and your health care provider created for your baby. Ask everyone who feeds your baby to feed them according to the feeding plan. This will help your baby’s transition to home.

Talk with your health care provider about:

  • adjusting your baby’s feeding plan as they grow and develop their feeding skills at home
  • services in your area if you need support feeding your baby.

To learn more about feeding your baby at home, visit Alberta Health Services – Feeding Your Preterm Baby at Home.

 

“After months of NICU living, finding the balance between pumping, fortifying milk for bottles and getting the hang of breastfeeding when we went home was daunting. It took a few weeks to find our groove but, with patience and determination, we were able to meet our feeding goals.”

~ Akna, parent of a preterm baby 

SUPPORT FOR FEEDING IS AVAILABLE

If you’re having a hard time with feeding your baby, you’re not alone. Call Health Link at 811 or talk with your health care provider for information and support.

Feeding frequency

Once at home, your baby should feed at least 8 times in 24 hours (about every 3 hours). Since your baby’s hunger cues may not be strong yet, you may need to help them wake up to feed. Setting an alarm at night can help you wake up when it is time to feed your baby. You can help your baby wake up by holding and talking to them, turning on lights or sounds, or undressing, or changing your baby’s clothes or diaper. As your baby grows, their feeding cues for hunger and fullness (satiety) will get stronger.

Is my baby feeding enough?

You may find yourself worrying about if your baby is feeding enough. Their appetite and feeding cues may vary from day-to-day and from feeding to feeding. Keeping track of your baby’s weight and how many wet and dirty diapers they have can help you learn if your baby is getting enough breastmilk or getting enough formula.

Babies grow at different rates. Have your baby’s weight, length and head circumference measured regularly by your health care provider during your baby’s recommended checkups. You can also contact your community health or public health center and ask if they have a walk-in option for using their scales. Your baby’s growth pattern over time is more important than one single measurement.

You may need to give your baby’s bottle feedings of fortified breastmilk throughout the day. This will help support their growth as they continue to work on their feeding skills. You can also try giving your baby a small bottle first and then complete the feed by breast or start the feed by breast and complete with a small bottle. As your baby learns to feed more from the breast, they will need to be supplemented less from a bottle. You may notice that your baby is able to feed for longer amounts of time as they grow stronger.

If your baby is not feeding by breast at least six times a day, you may need to pump to maintain your breastmilk supply. You may also need to pump after breastfeeding to maintain your supply until your baby is feeding well. As your baby breastfeeds more often each day, you will need to pump less.

INFANT FORMULA MUST BE PREPARED AND STORED SAFELY

Your baby may need extra nutrition from infant formula fed separately or added to breastmilk. Your health care provider will recommend the type of formula your baby needs and how to safely prepare it. It is important to prepare and store all formula properly.

Feeding tips

Your baby’s feeding skills may change from feed to feed or gradually over time. If your baby is having a positive feeding experience, then keep up the good work! If your baby is showing stress cues, they may need to take a break and rest before trying to feed again.

You can help your baby have a positive feeding experience at home by:

  • gently waking your baby when it is time to feed or during a feed if they fall asleep
  • starting feeds when your baby shows early hunger cues
  • pacing feeds at breast and bottle
  • limiting oral feeds to approximately 30 minutes
  • burping your baby well and often
  • stopping the feed when your baby seems satisfied
  • holding your baby upright for 10-30 minutes after feeds if they are uncomfortable or spit up

The first few weeks at home

Transition to home

It’s normal to feel anxious, nervous, or overwhelmed about taking care of your preterm baby at home. They may still need special treatment or equipment, like medication, oxygen, or feeding tubes. You had regular support from your baby’s health care team during your stay in the NICU and you may be wondering if you’ll be able to do it all on your own. Yes, you can!

Your health care team will help you prepare to care for your baby at home. You can also contact Health Link at 811 or talk with your health care provider if you have questions or need support along the way.

You and your baby will transition to new routines during your first few weeks at home. Knowing some of the things to expect can help. To learn more, watch MyHealth.Alberta.ca – After the NICU: Caring for Your Baby at Home.

“Bringing my daughter home after 99 days in the NICU was bittersweet. I was so excited to have her home so that we could be a real family, but I was also terrified. It took several weeks before we developed a routine that worked for us. Overtime, after a few trials and tribulations, we were able to settle in and enjoy our beautiful baby girl.”

~ Ryan, parent of a preterm baby

Taking care of yourself

Caring for your baby in the NICU can be challenging, stressful, and tiring. Your experiences may affect your mental health even after you take your baby home. Don’t be afraid to ask for help – it’s important to talk with someone you trust about how you’re feeling. You can also call Health Link at 811 or talk with your health care provider to find out about mental health support programs in your area.

“Our daughter was born with little warning at 24 weeks gestation. We spent 4 months travelling to the NICU daily and kept busy with getting her home. When we did get home and settled in a routine, I took the time to process some of the emotions and traumatic experiences that we had been through. Therapy gave me the space and time to lay everything out and organize my thoughts and feelings about all that we had been through. It helped me to feel lighter and focus on the future.”

~ Claire, parent of a preterm baby

Safe infant sleep

The safest position for your baby to sleep is on their back, on their own sleep-surface, and in a smoke-free environment. This helps to lower their risk of sudden infant death syndrome (SIDS), which is more common among babies born preterm.

You may have noticed your baby’s health care provider placing them on their tummy or their side to sleep when they were in the NICU. This is done to support their medical needs, like monitoring their heart rate and breathing. Your health care provider will help you get your baby ready to sleep on their back before you leave the NICU. Unless your health care provider has told you otherwise, the safest position for your baby to sleep is on their back once you and your baby leave the NICU.

Learn more about safe sleep for your baby’s first year.

A parent in their bed next to their baby in a crib
A parent room-sharing with their baby

Your baby's sleep environment

Your baby may have gotten used to sleeping with all the lights and sounds of the NICU. This may affect their sleep at home, where their sleep environment may be darker and quieter than they are used to. Talk with your health care provider about ways you can help improve your baby’s sleep as they transition to home.

Body temperature

Babies that are born preterm are not able to control their body temperature as well as babies born full term. They are not able to cool down if they get hot or warm up if they get cold. You can help keep your baby stay comfortable by checking their body temperature.

Things to watch for

If you are concerned about your baby and wonder whether you should call your health care provider, call them.

Call your health care provider if your baby:

  • has rapid or slow breathing
  • shows symptoms of dehydration, constipation or diarrhea 
  • has a soft spot on their head (fontanelle) that bulges when they are quiet and upright
  • is vomiting and can’t keep fluids down
  • has bloody vomit or stool
  • has difficulties waking up or not waking up to feed
  • has not been eating well for more than two feedings in a row
  • has been spitting up more than usual
  • has signs of pain after feeds
  • is choking, coughing, or not breathing while feeding

Call 911 NOW if your child has any of the following:

  • skin that looks grey or blue
  • trouble breathing or is wheezing
  • breathing much faster or slower than usual or has stopped breathing
  • is sleepy and not responding when you’re trying to wake them

Go to the Emergency Department NOW if your preterm baby has an underarm temperature that is lower than 36.5 °C (97.8 °F) or higher than 37.5 °C (99.5 °F).

Immunizations

Immunization is safe for your baby. Your baby is at higher risk of getting a communicable disease as their immune system is not yet fully developed. Immunization helps your baby build their own natural protection (immunity) against communicable diseases before they’re exposed.

Follow the vaccination schedule based on your baby’s chronological age. For example, your baby is due for their first vaccinations 2 months from the day they were born, even if they were born preterm.

To learn more about immunization and your child’s immunization schedule, visit Alberta Health Services – Immunizations and vaccines.

Infection prevention

If your baby was born preterm, they are at a higher risk for infections. There are things you can do to lower these risks. The most important thing to remember is to wash your hands often.

Before you bring your baby home from the NICU, give their room a good cleaning – avoid the use of strong-smelling cleaners. Strong smells from cleaning products and second-hand smoke may irritate your baby because their lungs are still growing. Learn more about cleaning, sanitizing and air quality.

Try to limit trips outside the home with your baby to appointments only for the first several weeks after coming home from the NICU, especially during the winter months. If possible, try scheduling follow-up appointments as the first appointment of the day or request to wait in an exam room with your baby instead of the main waiting area. This can help lower your baby’s risk of being around someone who might be sick.

Follow-up appointments

After your baby leaves the NICU, your health care provider may recommend follow-up appointments. The types of appointments your baby needs and how often will depend on your baby’s needs. These appointments may include eye checkups, hearing checkups, and other specialist appointments. Talk with your health care provider about your baby’s follow-up appointments.

Visitors

It’s okay to ask friends and family not to visit right away. This gives you and your baby time to settle into your home life together.

Remember, your baby is at a higher risk for infections. Once friends and family start to visit:

  • Limit the number of visitors you have in your home.
  • Tell your visitors they should not visit if they are not feeling well.
  • Tell your visitors they should not visit if they are smoking or have been smoking and could expose your baby to third-hand smoke.
  • Teach everyone who touches your baby about good hand washing.

Learn more about having visitors.

Looking ahead to the early years

Every stage of development has specific markers (milestones) that tell you how babies and children will typically develop.   Use your baby’s corrected age when following your baby’s developmental milestones for the first 2-3 years after birth. During this time, your baby may appear to be developing behind other babies of the same age, but you can expect their overall development to follow the same pattern. Some babies may “catch up” to other babies their age around age 2 while some may require additional support as they grow. Learn more about how children grow and develop.

As your child grows and develops, you do, too! Adjusting to your new role as a parent can sometimes feel overwhelming. Remember to be kind to yourself as you build your parenting knowledge and skills. Learn more about how parents learn and grow and other parenting information.