Newsletter Spring 2008 Providing Support to Premature Babies and Their Families

Bringing Your Baby Home

Whether your baby comes home from the hospital right away, arrives later (perhaps after a stay in the neonatal intensive care unit), or comes through an adoption agency, the homecoming of your little one is a major event you've probably often imagined. Of course, it may or may not turn out to be what you'd expected. Read on to find out how to be prepared in any situation.

Leaving the Hospital

Moms-to-be sometimes pack clothes for the trip home before even going to the hospital - or they may wait to see what the weather brings and have their partner bring clothing for both themselves and the baby. Plan to bring loose-fitting clothing for yourself with a drawstring or elastic waste because you most likely won't yet fit into your pre-pregnancy outfits yet.

Babies are frequently overdressed for the first trip home. In warm weather, it's practical to dress your baby in a T-shirt and diaper and wrap him or her in a baby blanket. Hats aren't necessary, but they can be a cute finishing touch, especially for the first picture in the hospital. If it's cold, add a snowsuit and an extra blanket. Chances are much better that you'll bring home a calm, contented baby if you don't spend a lot of time at the hospital trying to dress your baby in a complicated outfit that may require pushing and pulling your baby's arms and legs to get him or her dressed.

If you haven’t already made the arrangements with your baby’s health care provider, make sure to ask when the baby's first checkup should be scheduled before you leave the hospital. Depending on the circumstances, some premature babies also go home with a special monitor for breathing and heart rate, and you may be taught infant cardiopulmonary resuscitation (CPR). But whether your baby is full-term or premature, don't feel rushed out the door - have your questions answered before leaving the hospital. And if you find yourself wondering about anything - from bathing to breastfeeding to burping - ask your nurse, lactation consultant, or your baby's doctor.

The Car Trip

The most important item for the trip home is a proper child safety seat (car seat). Every state requires parents to have one before leaving the hospital because it's one of the best ways to protect your baby.

Even for a short trip, it's never safe for one of you to hold your baby in your arms while the other drives. Your baby could be pulled from your arms and thrown against the dashboard by a quick stop.

It's a good idea to purchase, rent, or borrow a car seat before your baby's born, when you have time to choose carefully. There are two kinds of car seats for babies: infant-only seats (which must be replaced when your baby weighs 20 pounds) and convertible seats that accommodate both infants and older children.

Infant-only seats are designed for rear-facing use only and fit infants better than convertible seats. Infants must be in rear-facing car seats until they're 1 year old and weigh at least 20 pounds. (If your baby exceeds that weight before his or her first birthday, you'll need to use a convertible seat designed for bigger babies.) Some parents of newborns find that a "travel system," which includes a stroller and an infant-only car seat that can be attached to the stroller, make it much smoother to transition babies - especially sleeping ones - from the car to the stroller.

Convertible seats face toward the rear until your baby is 20 pounds and 1 year old, and can be turned to face forward after that. (Some convertible seats have higher rear-facing weight limits to accommodate larger babies younger than 1 year).

Never put a rear-facing infant or convertible seat in the front seat of your car - always use the rear seat. Passenger-side airbags in the front seat cabin are hazardous for both rear- and forward-facing car seats, and most accidents happen at the front passenger area of the car. When it's cold, strap your baby in snugly first, then put blankets over the baby.

If you borrow a car seat, make sure that it's not more than 10 years old and was never in a crash (even if it looks OK, it could be structurally unsound). Avoid seats that are missing parts or aren't labeled with the manufacture date and model number (you'll have no way to know about recalls). Also, check the seat for the manufacturer's recommended "expiration date." If you have any doubts about the seat's history, or if it's cracked or shows signs of wear and tear, don't use it.

Inquire at your prenatal classes, health care provider's office, hospital, and insurance company about rental or loan programs for car seats - they're quite common.

When buying a new seat, it's important to remember that there isn't one type of seat that's safest or best; get one that fits and can be correctly installed in your car. And higher price doesn't necessarily indicate a seat's quality - it may simply mean the seat has added features that you may or may not want. Also, be sure to register your new seats, so you can be notified of any problems or recalls.

The most common problem involving car seats is improper installation (according to the National Highway Traffic Safety Administration, the majority of all car seats are installed incorrectly). In recent years, new LATCH (Lower Anchors and Tethers for CHildren) car seats have become standard in the United States, but a large percentage of these seats are improperly installed too. Don't trust illustrations or store displays. Follow the manufacturer's instructions - and hang on to them. Ask your child's doctor or nurse about local resources where your car seat can be checked by someone specifically trained to evaluate car seat installations. Many hospitals, police and fire stations, and even car dealerships offer this type of service for free. Make sure that the evaluation is done by someone trained and experienced.

If you're bringing your baby home from the intensive care unit, bring the car seat to the hospital ahead of time, so the staff can see if it will work for your baby. If special health concerns rule out a standard restraint, ask your child's doctor to recommend car seats for children with special needs.

For more information on the proper use of child safety seats, read our article on auto safety.

First-Time Feelings

Don't be surprised if you have a mixture of emotions as you bring your baby home, especially if this is your first child. You'll likely be nervous. In fact, you may actually feel terrified as you realize that you've given up a certain amount of control over your life.

If your baby wasn't with you much at the hospital, you may not know what sort of schedule your little bundle of joy will keep. But you'll know before long - although babies' schedules do change a lot during those early months. You'll be less stressed if you don't overschedule yourself and can go with the flow.

Depending upon your labor and delivery experience, you may feel physically drained and sore. Your hormones may be struggling to catch up, too. Meanwhile, your partner may feel a little left out if you're totally engrossed with the baby.

You also may have other children awaiting the arrival of this newest family member. Or you may be dealing with a pet who's wondering what's suddenly drawn everyone's attention. Frequently, the expectations of new grandparents, competitive siblings, or friends can also make the homecoming stressful.

Your baby's first extended crying period at home will be painful. Remember: young babies typically cry for 1 to 5 hours within a 24-hour period, and you can't always calm them. Crying usually decreases gradually after the first several weeks. Although it may seem impossible now, in a few months it will be difficult to recall your baby's seemingly endless crying episodes.

The Home Front

Introducing your baby to others at home can be challenging. If you have other children, be sure to spend some quality time with each of them. Some parents bring home gifts from the new baby for big brothers and sisters. At first, you can expect some jealousy, especially if the main focus of your attention for several years suddenly has new competition. Encourage siblings to "help" you care for this newest family member.

If you have a pet, bring home a blanket with the baby's scent on it and place it near the pet - even before leaving the hospital. Then, when you come home, the pet will already be somewhat familiar with the baby. But remember to never leave pets alone with newborns.

Family and Friends

It's a good idea to have your partner serve as the gatekeeper for visitors, and to limit the number of guests at first. You'll be glad later on if you take some time now to rest and become comfortable with your new situation. Although babies typically aren't shy around strangers for the first 3 months or so, they may become overstimulated and tired if there are too many people around.

If you have voice mail or a telephone answering machine, you should consider changing your message to give the vital statistics of your new arrival. You might want to say something like: "Our newest family member has arrived. Her name is Jill Michelle; she was born on the first of June, and weighed 6 pounds, 7 ounces. We're all fine and adjusting to our new life. If you'd like us to call you back when it's convenient, please leave your name and number."

Don't be shy about accepting visitors slowly. Ask anyone who's ill to wait until they're feeling well and no longer contagious before they visit. It's also a good idea to ask visitors to wash their hands before holding your baby because a newborn baby's immune system is weak.

When to Call Your Baby's Doctor

Your baby's health care provider expects calls from new parents on many topics, including breastfeeding and health concerns (for more on newborn care, visit the Pregnancy & Newborns section). They'd rather have you call than worry about something needlessly. It's important to remember that you are the best source of information for your child's health care provider.

If you wonder whether you should call the doctor's office, do it, especially if you see something unexpected or different that concerns you. Call if you see any of these signs:

• rectal temperature of 100.4 degrees Fahrenheit or higher (in babies younger than 2 months)
• symptoms of dehydration (crying without tears, sunken eyes, a depression in the soft spot on baby's head, no wet diapers in 6 to 8 hours)
• a soft spot that bulges when your baby's quiet and upright
• a lethargic or difficult-to-arouse baby
• rapid or labored breathing (call 911 if your baby has breathing difficulty and begins turning bluish around the lips or mouth)
• repeated forceful vomiting or an inability to keep fluids down
• bloody vomit or stool
• more than eight diarrhea stools in 8 hours

If your concern is urgent, call your doctor and take your child to the emergency room. Remember, with young infants, minor conditions can quickly become serious

Looking Ahead

In the majority of cases, premature babies grow to be normal, healthy children and eventually adults, indistinguishable from their peers. No amount of expertise on the subject can make it possible to walk down the street identifying all those who were born premature.

At the same time, some premature babies will have long lasting or lifelong problems. The chance that this will be the case for any individual premature baby depends on how premature the child was born, how low the baby’s weight was at birth, and if the baby experienced complications that are known to put them at risk for problems as children and adults.

During the last few decades of the 20th century, the survival rate of premature babies has seen an incredible increase. While we can celebrate these saved lives and the triumph of medical knowledge, skill, and technology, the success has come at a price for some. Many premature babies who would not have survived in the past now live with a disability of one kind or another.

Most commonly, these babies grow up with cerebral palsy, mental retardation, poor vision, chronic lung disease, and learning disabilities. While such conditions, and others, do not necessarily mean that these children will not be able to enjoy life and thrive in their own way, some premature babies will have severely restrictive lives that require constant care, even for the most basic necessities. These babies face a challenged quality of life that may not improve over time.

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