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Caring for Your Preemie After the Hospital

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Having a baby is always an emotional experience, but when your child arrives earlier than expected, the joy of finally meeting him is coupled with worries over his health and future. Whether you were prepared for the possibility that your child might be born before your due date or you gave birth prematurely without warning, the feelings of uncertainty are probably the same. And it's far from an uncommon experience: More than half a million babies born each year (that's one out of eight) in the United States arrive prior to the 37th week of pregnancy. To quell your concerns, keep these considerations in mind.

Prepare to Pump
You'll likely be asked to begin pumping as soon as possible after birth. Long before a newborn is able to drink by himself, a nurse can rub a few drops of colostrum on the gums and tongue to get breast milk's immune-boosting benefits started. When your baby is ready to take a bottle, his stomach is still so small that he needs only a little. "One ounce of breast milk can last for two days at the beginning," says Christine H. Sajous, M.D., professor of pediatrics and neonatology at Loyola University Medical Center, in Chicago. If you're pumping regularly, your milk supply should increase with your baby's growing needs. Once you begin nursing, keep in mind that premature babies will feed more slowly than full-term infants, so be patient and allow adequate time for each session.

You may be wondering why there's such a focus on nursing. "It's incredibly beneficial for a premature newborn's immune system, especially the initial colostrum," says Dr. Sajous. Studies show that premature babies who are fed breast milk have fewer readmissions to the hospital following their discharge from the neonatal intensive care unit (NICU) and show greater gains in cognitive development than formula-fed preemies.

Protect Your Passenger
Before your baby is discharged, check the labels on the side of your car seat to make sure the minimum weight is appropriate for your preemie; not all seats can be used for babies who weigh less than 5 pounds. At one time NICUs wouldn't let a baby leave until he reached the 5-pound mark, but now many babies achieve stable health before reaching 5 pounds. "Before being discharged, premature babies typically have to meet the medical parameters set by their physician for temperature, breathing, and feeding," says Marilyn Bull, M.D., co-medical director of the automotive safety program at the National Center for the Safe Transportation of Children With Special Healthcare Needs at the James Whitcomb Riley Hospital for Children, in Indianapolis. "Your baby should also be evaluated when properly positioned in a car seat to ensure that she remains medically stable when positioned upright."

Clear the Air
Several studies have shown that exposure to secondhand smoke can lead to numerous health problems, including decreased lung growth and function and an increased risk of respiratory infections--especially in preemies. Avoid letting smokers visit your house, even if they don't light up when they're there, and keep your baby away from cigarette-friendly areas.

Keep Things Calm
Bright lights and loud noises are more likely to upset premature babies, who have been agitated by constant commotion in the NICU, says Dr. Sajous. Make sure your child spends time in a dim, quiet room at various times of the day, especially when she's fussy or crying and you think she may be overstimulated.

Guidelines Help Save Babies Born Extremely Early
Guidelines Help Save Babies Born Extremely Early

New guidelines for preemies. Courtesy of Nationwide Children's Hospital.

Remember Tummy Time
Since a preemie spends most of his time on his back in the NICU, he needs several belly sessions a day at home. This will help him strengthen his neck, abs, back, and shoulder muscles so that he can learn to push up and eventually crawl, and it will reduce the odds that he'll develop flat-head syndrome. "Putting your baby on your chest, skin to skin, while he's awake is great for tummy time as well as bonding," says Dr. Sajous.

Adjust Your Expectations
Don't worry if your child doesn't sit up at the same time as your friends' babies: They had a head start. When figuring out when your preemie might hit her milestones, use her adjusted age--how old she would have been if born full-term--until turning 2. "If your child arrived two months early, she'd still be considered a newborn at 8 weeks," says Dr. Sajous. Your child's adjusted age is also important when making feeding decisions, such as when to start solids or finger foods.

Try to Relax
Granted, parenting a preemie can be more demanding than caring for a full-term infant. But even though he may need more frequent weight checks and feedings, don't get so caught up in the challenges that you forget to have fun with him. You can still hold and talk to him just like any other baby.

Baby Care Basics: Concerns for Premature Babies
Baby Care Basics: Concerns for Premature Babies

Originally published in the October 2012 issue of Parents magazine.

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