Getting ready for your premature baby’s hospital discharge is very exciting. But it can also be really scary. Especially if you are a first time mom and have no idea what to expect! Sounds familiar?
As preemie parents know, a baby’s prematurity doesn’t end with her hospital discharge. We deal with preemie-related stuff for years and years. So, if you’re feeling a bit anxious about taking care of your preemie at home, you’re not alone.
When Oliver came home we had to rush to the hospital many times, and he was hospitalized within a week for a lump in his groin. I felt like a failure, not even one full week and we were back in the hospital.
It turned out to be a hydrocele that reabsorbed itself. So, no biggie, but it felt terrible at the time.
Our baby sneezed, hiccuped, coughed, like any newborn. But he was also on oxygen, desaturating here and there. He went purple when breastfeeding, he was pooping too much or too little, and crying all around the place. And so extremely fragile to germs.
Oh, the germs!
So, if you’re like me, and you’re stressing all over the place after your premature baby’s NICU discharge, here’s a list of the answers to the top questions we had during our first month home.
1. How to take care of a baby on oxygen?
Most premature babies come home on oxygen support, and some of them don’t like it at all.
Our son hated it.
He pulled his oxygen tubes day and night, and we were just worried about him desaturating.
Babies are sent on oxygen with at least two cylinders. A big one for home, and a portable one for the doctors’ appointments or the casual stroll.
Usually, the smaller tank doesn’t require any humidification, but the bigger one does if you’re not using an oxygen concentrator. This means that once a day you should replace the small water recipient for a new one, it’ll prevent your baby’s airways to become dry and irritated.
The duration of the tank depends on your child’s oxygen needs and the size of the cylinder. But don’t worry, you’ll receive training as a first time mom to a preemie, and you’ll know when to replace it.
The nasal prongs get filled with water, and they crystallize easily. So, we changed them twice a week to avoid oxygen obstructions.
A baby who is on oxygen will desaturate if they aren’t attached to it. But this doesn’t usually mean that it’s instantaneous (of course, it depends on your baby’s needs).
At first, we were so afraid of our baby desaturating that we didn’t take proper care of his skin. We just did the minimum amount of tape replacement and sorts before putting the oxygen back on.
We soon regretted it.
Your baby’s cheeks can get irritated because of the contact with the tape, so it’s a good idea to have baby oil at hand to remove the tapes constantly before the baby pulls them off. I found a great idea of knitting oxygen-holder hats in this blog! You may want to consider it since they protect your baby’s skin!
Since we didn’t know about this fantastic idea, we cleaned the area daily, aired his cheeks for about 10 minutes while we held him asleep with his oxygen on, and then put new tapes on. During the night, we put an extra tape on his nose to prevent the oxygen from popping out.
We also used the small tank sparingly at home, for tummy time, or quality time with mommy and daddy, and to give our son a different sight than his parent’s bedroom.
Having a baby on oxygen is not an impairment for having fun and going out and about (if your baby is old enough, of course). It’s just a matter of organization and information.
2. Should I receive visit?
No. Not at first.
You’ll feel a bit lonely. And maybe some social pressure from friends and family who want to meet your baby.
But stand your ground.
We waited until our baby had at least three Synagis shots (and I had got used to being a first time mom breastfeeding a baby) until we started accepting visits. He was about 5 months old, 3 months adjusted.
We also started with a few people and gradually allowed more people to visit. It was always under a strict protocol, but we were taking care of our babies.
What our friends and family couldn’t see was that, for instance, if the had been with a co-worker who had the flu, it was dangerous. Small things like this can make a difference, and we did develop germ-vision.
I know that you must hear this a lot, but there will be time for visits later. The first month of your preemie home is usually not safe to have people over.
We even made a case of it at my husband’s office and he worked from home for the first 3 months after the baby arrived.
There are, of course, additional risk factors to consider. If it’s RSV season, then definitely keep as many people at bay as possible. And this not only during your baby’s first month home but also during your baby’s first year home.
If you have a family who has weak lungs, then it’s best that they don’t meet the baby until later.
And, of course, always consult your pediatrician to check on your baby’s readiness to receive visits. Make sure you build a support system as a first time mom, and everyone understands.
3. When can I take my baby outside?
Well, there are many definitions of outside.
If you’re planning to take the baby to the mall, then the criteria are similar to the “allowing visits” criteria.
But, if you want to take her to the park, or to an open space, that could happen sooner.
We waited a month before taking our son on strolls, and our pediatrician approved it. We went 30 minutes to the park when there was nobody around. Oliver had had two shots of Synagis by then and felt comfortable about doing it.
We also started taking him to do the groceries with us, but only because we could go during the least busy hour, so the supermarket was empty.
We started taking our baby to crowded places when he was around 6 months chronologically. And, we kept clear out of nursery school until our son was 21 months old.
Eventually, our son did get the RSV when he was 12 months old. Even after we took every precaution we could. It landed him on the hospital for two weeks, and it delayed his lung development even more. But, strong as a preemie, he got over it.
4. Should I wake her up for feeds?
This was a question I didn’t expect to ask, even as a first time mom.
What my doctor recommended was not to, unless my boy hadn’t eaten for the last 5 hours.
When it comes to a preemie, putting on weight is critical.
It’s so important that we do a lot of things around allowing the baby to gain weight. So, we were initially desperate to wake him up, but he’d wake up fussy, wouldn’t eat well, and then sleep again.
It was later that we learned that babies do most of the growth during their sleep.
So waking him up wasn’t the best idea. First time mom mistake!
When we started allowing him a couple of more hours of sleep, he started gaining more weight than when we were on a strict schedule. We rarely had to wake him up, since he rarely slept 5 straight hours without feeding anyways.
You can learn more about your baby’s month-by-month sleeping and feeding patterns by signing up to my mailing list and receiving my Free Milestone Printable here.
5. How often should my baby poop?
It’s common that premature babies are discharged close to their due date. So, during their first month home, we can consider the corrected age close to a newborn.
The frequency of your baby’s bowel movement depends on her corrected age, and on her medical history.
Assuming that your baby is less than 1 month-old adjusted, and with no significant medical history that would affect her digestions, the frequency of soiled diapers can range widely.
It’s considered normal for a baby to poop once a week, or once every feed.
Our son usually got 5 days without any number 2 in his diaper. And then. on the 6th day, we got 5 soiled diapers! Crazy, right? Turns out, it’s totally normal.
6. Where should my baby sleep?
As a first time mom, I had no idea that this was even an issue! I thought babies went to their room, and that was the end of it.
It turns out that it depends on your budget and space, and how comfortable you feel with your choice.
For us, Ollie slept in our room, where we could easily monitor that he had his oxygen on. And obsess on his breathing patterns.
It was also easier since he was waking up every 3 hours for feeds, so we didn’t move much. We had a set-up in our own bed, where he was safe in his space and close enough that I could hear him breathing.
Eventually, he transitioned to his own room, but he was almost 2 years old at the time.
7. When and how often should I give my baby a bath?
Ask your pediatrician if your preemie is ready to receive baths.
Since maintaining his body temperature is such a big deal for preemies, we couldn’t give him baths until he was at least 3000 grams (6.6 lbs). He needed those calories to grow!
During the first month, we just cleaned him with wipes.
If you can give your baby a bath, you don’t need to do it daily. Once every 3 to 7 days should be enough.
Newborns don’t get that dirty, and giving them daily baths (or even one every two days), can clean natural oil and greases in their skin, causing skin problems.
8. My baby won’t stop crying, what Should I Do?
If the crying persists and nothing seems to calm down your baby, you should consult your pediatrician as soon as possible.
It’s fairly common for preemies to suffer from colics.
As a first time mom, I had no idea what was going on, and I just assumed he was hungry. When I took him to the doctor, he told me that my son was having colics!
If your preemie is crying for long periods of time (up to 6 hours), always at the same time (normally in the evenings), and no matter what you do, she won’t stop crying your baby may have colics, there isn’t much that you can do to calm her and it will disappear with times.
Ollie suffered from this for the first 9 months of his life. He cried every day from 8 pm to 3 am. We tried reflux medicines, making his bottles with natural herbs, singing, TV, dancing, holding him upright, feeding him more often in less quantity, pressing him tight against us, putting him in his tummy, you name it. We tried it all.
It would sometimes get better but, sooner than later, he’d be crying in pain again. It was nerve-wracking.
What finally worked was a more developed digestive system. And that is something only time can achieve.
9. Do I need to do kangaroo care?
Unless your doctor says so, or your baby is less than 2500 grams (5.5 lbs), you don’t need to.
We had to do kangaroo care 24 / 7 for two weeks until our son reached 2500 grams.
But if you don’t need to do it, you should consider doing it anyway. Even for short periods of time. Kangaroo care has many benefits for all babies and parents.
I highly recommend it! It did wonders for us!
That’s a Wrap
If in doubt, always call your pediatrician. Being a first time mom is hard, but being a first time mom to a preemie is even harder. You’ll have to team with your doctor, and friends and family!
Our first month home was hard, to say the least. But, we were finally with our preemie baby at home, just like we dreamed so many times.
Trust your instincts, and keep your baby close by.
Do you have any tips on how to take care of your preemie during the first month home? I’d love to hear all about it, give us a shout in the comment section!