Looking after your premature baby in the NICU -Stage 1

For parents of premature baby’s the usual evolution of parenting is disrupted, and parents are in many ways as premature as their baby’s. You are the most important person in your baby’s world and you CAN parent your baby in the NICU.

Family-centered and developmentally supportive care is an essential element of neonatal intensive care and touches the life of each family in the NICU in a positive and lasting way. It is of particular importance when your baby is vulnerable and at greater risk for poor outcomes complicated by a family unit that is easily challenged by the unique needs of your baby. Family-centered care sees the relationship between you and your baby as essential, assesses the needs of your family in addition to your baby’s and aims to provide a nurturing environment where your baby is part of your family. Family-centered and developmentally supportive care is now recognized as an essential attribute of high-quality neonatal and family care.  Baby’s and families who must traverse the neonatal intensive care unit deserve the quality of care that this caregiving philosophy demands by providing an environment for your family that is comfortable, safe and supportive of their individual needs.

Stage one (high level of intensive care)

Watch your baby

This is a wonderful stage for you to get to know your baby’s special characteristics and learn how they communicate, notice their changing facial expressions and take note of their hand and feet movements. Record your observations in a notebook and ask the staff to explain your observations in terms of your baby’s communication skills.

Watch your baby’s breathing and note changes in speed, depth and rhythm that tell you if your baby is feeling more settled or wakeful, or more tired or restless.

Notice variations in your baby’s skin tones. Dusky tinges around his/her eyes or mouth or blotchy patterns on the body can become more marked during care-giving. They can indicate that your baby needs to pause , requires comfort or a change in position. Premature baby’s often get hiccoughs, yawn, sneeze or posit (bring up some milk) or make squirming movements when they are tired or overwhelmed. If your baby’s cheeks look slack with the mouth open he/she is telling you that he/she has run out of energy for movement and requires a break. Baby’s use protective gestures by bracing their feet against something, raising their arms with the hands wide open, shielding the face, ears and eyes or turning away.

parenting in the nicu

Your baby may make little twitchy and tremulous movements which are very common and are signs of immaturity. Baby’s born prematurely find it difficult to co-ordinate movements and tend to lose energy quickly after bursts of activity. A limp looking baby is seeking additional support and comfort. Arching the back or stretching the limbs out stiffly or even lifting them off the bed are signs that your baby requires help to get comfortable.

Your baby may use self soothing gestures such as bringing his/her hands to his/her mouth, sucking, holding onto something, clasping his/her hands together or resting one foot against the other to get comfortable or ready to interact with you.

Touch your baby

In the early days your baby may not like being stroked or touched as it can be too stressful for him/her and he/she can only tolerate one form of interaction at a time.  Your baby will protect himself/herself against stressful overstimulation situations by engaging in frantic activity, stiffening their limbs, appearing drowsy, showing a panicked facial expression , gaze aversion, hand-to-mouth mandoeuvres or bracing his/her feet against the side of the incubator. If your baby shows signs of distress, give him/her time to recover or rest.

Ensure that your hands are clean and warm. Start by offering a finger for your baby to hold, or by cupping your baby’s feet, body and head in your hand. Gently open the incubator doors, talk softly to your baby and let him/her know that you are present.  Comfort Hold is a form of positive touch and helps your baby to feel secure and relaxed. It is often used after a medical procedure.

How To Do “Comfort Hold

  • Cup your warm still hand around your baby’s head and/or feet.
  • Gently rest the other hand around your baby’s shoulders or hold his/her arms across their chest.
  • Refrain from using light stroking.
  • Breathe slowly and deeply and keep your hands relaxed.
  • Comfort hold your baby until he/she feels settled.
  • To finish, slowly remove one hand and only remove the remaining hand if your baby continues to remain relaxed.

parenting in the nicu 2

Your Voice

Your voice will be the only familiar thing in your baby’s world. He/she may find it soothing to listen to your talking quietly, humming or singing. By observing your baby’s expression and gestures as you talk or sing you will learn what he/she likes best.


Shade your infant’s eyes if the light is bright in the unit. Ask for an incubator cover to be placed over your infant’s incubator with a corner folded back so that the infant can be observed while keeping his face in the shade.

Express Your Breast Milk

This is one of the special things that only you as a mother can do for your baby. Breast Milk helps protect baby’s and do not be surprised if you are asked to express breast milk within a few hours of the birth. Talk to the Lactation Consultant attached to the unit who will help you establish expressing. Starting early and expressing frequently helps to ensure that you can provide breast milk for as long as your baby requires it.

Looking after your premature baby will help your form a strong bond that will last a lifetime and will really help your baby get used to their new world.