Preemie vs. Normal Baby

Although Kate is now close to the age of a typical normal newborn baby, she is still different in many ways.  We took a class in the NICU so that we would know the differences and how best to take care of her.  Preemies still have a lot of developing to do with their bodies that they missed out on in the womb.  She can't be assessed for developmental skills according to her age.  She is just over three months old, but is nowhere near what a three month is.  She is assessed according to what is called her "adjusted age".  Right now she is considered a newborn.  The first week of January she will be 1 month old adjusted age instead of 4 months old and so on.  She will hit milestones like rolling over, sitting, crawling and eating when she's the appropriate adjusted age. 

Preemies brains aren't developed like they need to be.  They are still smooth and not like the typical curved and wrinkled brains.  Because of the lack of development they can not handle multi sensory input such as talking, touching, and looking at you until their brain develops further.

Preemies are very sensitive to touch!  Their neurological system is not quiet developed.  Usually the womb provides firm boundaries for a baby.  Swaddling and bumpers help provide boundaries similar to the womb.  Instead of stroking a preemie, containment touch should be used.  This is a firm pressure touch like placing a hand on their head or stomach.  Light stroking is very irritating to preemies. 

A preemies skull is very moldable, so their head needs to be positioned in different ways to help it grow into a round appealing shape. 

When bathing a preemie it is best to wrap them in a fleece blanket to keep them contained and also help keep their body temperature.  One section of the blanket is removed at a time to clean that area and then the blanket is returned to cover and keep the baby warm. 

Preemies are at a greater risk for infections.  RSV is a huge concern during the winter months.  Preemies should not be taken in public and should be isolated as much as possible. Kate will be receiving a shot each month starting in December called Synergist (sp?).  It is around $1000, but will help protect her from getting RSV. 

Sleep is critically important to preemies.  It is so important because during the REM cycle the growth hormone is released that helps the baby gain weight and brain growth.  They need to get as much uninterrupted sleep as possible.  Imagine trying to keep a house quiet with 5 kids (3 of them being very loud, rambunctious boys and the 2 others are whiny, crying girls!)

Preemies are very sensitive to smells.  Strong perfumes, lotions, laundry detergents, candles, and cooking smells (like onions) can be distressing.  Babies can smell their breastfeeding mom up to 50 feet away.   This has been hard for me to avoid because one of my favorite parts of the holidays is all the Scentsy and candle smells. We also cook a lot of onions- Josh believes all meat should be cooked with onions. 

Preemies sight is very underdeveloped.  This can cause problems, if there nerves don't develop appropriately.  Kate's eyes have been passed off as being completely developed at this point. Sometimes when a preemie is overstimulated their eyes become locked open in a stare.  This is a cue to get rid of all the extra stimulants around.

Feeding a preemie is also different.  Usually a baby has practice time in the womb to drink and swallow amniotic fluid.  Preemies miss out on this, so eating comes as a real feat for them to figure out.  Breathing, sucking, and swallowing are things they have to figure out and coordinate to eat.  It is best to lay the baby on it's side on a pillow and tilt the bottle so the nipple is only half filled with milk.  There are several feeding cues that the baby will show if it is too much for them to handle. 


It is important to understand the stress cues that a preemie may show when they are over stimulated.  Some cues are abnormal heart or respiratory rate, change in skin color, yawning, sneezing, hiccupping, crying, spreading out fingers (splay), straightening arms or legs, or hyper alert- eyes big and arms and legs are frozen.    Kate still shows a lot of these signs.  She most often gets the hiccups.  Almost every feeding time she gets the hiccups either before or after she eats.  If I un-swaddle her to quickly, when I change her diaper, change her clothes, if I move her too much, if the kids are around and it's too noisy or they are moving too much, swaying or rocking, or if I leave her un-swaddled too long- she starts hiccupping.  If she hiccups before I feed her- I have to wait until she stops to get her to eat.  Often times it only takes a minute to shut off the stimulation enough to get her to stop.  If I hold her head up underneath my chin, swaddle her, and hold her tight, she stops the quickest.  She also shows other signs frequently like yawning, tremors, and finger splays or straightening her arms and legs.  Just yesterday I gave Kate the hiccups just by starting to hum a song while holding her.  The best way to stop stress cues is to get rid of all stimulation and do containment touch.  

At first Kate needed to be swaddled when she ate, but now she is more relaxed and can handle having her arms or legs out.