Interacting with Your Premature Baby

Prematurity is something that lies very close to my heart. We are three siblings, and all three of us were born premature. My baby photos are of a very skinny, very very tiny baby, attached to tubes. I can only imagine the fear and uncertainty that my mother must have felt when we were infants in the Neonatal Intensive Care Unit. There are so many barriers to interacting with your premature baby. In this blog post we’ll be taking a look at how you can still form an important bond with your premature baby.

Most of the information in this blog post comes from the wonderful book,  Prematurity: Adjusting Your Dream by Welma Lubbe. This book is a wonderful resource to have when learning to understand premature babies.

A very stressful environment

When a baby is born prematurely, they are not yet ready to handle all the sensory input of the outside world.  The outside world is filled with stimulation that can lead to extreme distress in your little one. It’s your privilege to help your baby to learn how to calm herself down when in distress (we call this self regulation).

Your premature baby will communicate when she is feeling overwhelmed in different ways than an older baby might.

You will know your baby is distressed when she:

  • has a high or low heartbeat
  • becomes pale/blue or blotchy
  • has a change in rate of breathing (either very fast, very slow)
  • yawns, hiccups or sneezes
  • frowns
  • stretches out arms, legs, fingers and toes
  • arches out her back
  • moves around frantically
  • looks away
  • cries/ makes whimpering noises
  • lies limply, poor muscle tone

What stage is your baby in?

It would be very unfair to expect a baby born at 28 weeks gestational age to respond and interact in the same way that a baby who is born at 32 weeks gestational age. When your baby is born prematurely, she needs to complete the foetal development that should would have taken place in the womb.

Turning in Stage:

Babies born less than 32 weeks gestational age are in the Turning In Stage. Your baby will need lots of medical suppport at this stage. She will also be very disorganised and easily distressed. Whilst touch is good for your baby, not just any touch is good. Light, feathery touches may be experienced as pain at this stage, so gentle, but firm touch is good. You can also let your baby grasp your finger. She may not like this at first, but it will help her lo learn how to calm herself down.

Babies in this stage benefit from being surrounded by boundaries that are similar to what they had in the womb. Soft, firm and non rigid boundaries will help.

During the turning in stage, your baby will sleep a lot. She needs to grow, and that is done best whilst in a deep sleep. Interaction can take place when she wakes up on her own. Allow her to sleep when she is sleeping.

What can you do in the Turning In Stage?

  • Learn how to clean your baby’s eyes, mouth and change the nappy.
  • Touch in a positive way. Keep all touches gentle, but firm. Rest your hand on your baby, rather than frequent little touches. You can hold your hands on her so as to ‘contain’ her, or cup her head. One of the most important forms of touch is Kangaroo Mother (or Father) Care. Your NICU nurses will help you with that.
  • Take photos, but don’t use the flash.
  • Journal about your baby. Record things like the faces she makes, her favourite position and her behaviour when you think she is distressed. This is alll part of your journey getting to now your little one.
  • Rather than having many people visiting and overwhelming your baby, show them a few special photos.

Coming Out Stage:

Between 32 weeks and 35 weeks gestational age, your baby is in the Coming Out Stage. She will start  breathing more comfortably, consuming more calories and start reacting and seeking social interaction.

What can you do in the Coming Out Stage?

  • Observe her different states. There are a number of states that she may be in.
    • Deep sleep.
    • Active sleep.
    • Quiet alert state.
    • Active alert state.
    • Crying
  • Talk to your baby softly. Observe her reaction to see if she becomes over stimulated.
  • Learn how to swaddle your baby.
  • Ask when youcan start holding your baby so that you can start Kangaroo Mother Care as soon as possible.
  • Meet with a breastfeeding and feeding specialist to discuss when it will be safe for your baby to start feeding orally.
  • Ask to help bathing your baby if she is stable enough.

Reciprocity Stage:

From 36 weeks and onwards, your baby is in the Reciprocity Stage. Your baby will start to actively interact at this stage, and depend more on your love and care than on machines.

What can you do in the Reciprocity Stage?

  • Start teaching your baby self regulatory behaviours.
    • Non-nutritive sucking – this can be with a dummy, or placing her own thumb in her mouth.
    • Hands to chin – place your baby’s hands tucked under her chin.
    • Hands on face – place your baby’s hands on her face.
    • Foot bracing – provide a boundary at the bottom of your baby’s feet that she can push against.
    • Finger grasping – let your baby grasp your finger.

Having a baby that is born prematurely can rock your world. Financially, emotionally, the toll is so much greater than what you expected it would be when you expected a full term baby. Make sure to reach out when you need help or rest, and never be afraid to ask the professionals around you for information or advice!

The Little Steps Website has so many valuable resources for both parents and professionals. Be sure to take a look for much more detailed information and guidance!

If your premature baby is a bit older, you can find some guidance for how you can help develop speech and language skills before she even starts to speak here: Before Words

The advice given in this blog is not medical advice and should never be taken in place of your doctor or healthcare team’s advice.

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