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1. To advance to the next slide, please press the arrow ( ) button on the keyboard This PowerPoint program was created by Alisa Dent, RN, BSN.

2. Going Home What do I need to learn?

3. Discharge Requirements for your baby • Your baby must be at least 1800gm. • Must be able to keep his/her body temperature normal in an open crib. • Be on complete breast or bottle feeds, taking in an adequate amount of calories. • Gaining weight. • Not having many apneas or bradycardias. • Most will be off oxygen.

4. Discharge requirements for the parents • Get to know your baby and feel comfortable caring for him/her. • Identify a Pediatrician who will be caring for your baby after discharge. • If your baby is a boy, decide if you want him circumcised. • Inquire about immunizations have been given and when next are due.

5. Discharge requirements for the parents • Take CPR offered by the hospital. • If your baby is going home on a monitor, you will need to have monitor training. • Learn to properly position baby in car seat. • Get results of hearing test, eye exam, and head ultrasound. • Ask for a copy of your baby’s discharge summary.

6. Once all of these requirements are met: Pack your bags!! You are going home!!

7. Caring for your baby at home

8. Home temperature & dressing your baby • A low to mid-70’s room temperature is warm enough as long as baby is dressed appropriately. • Rule of thumb- dress your baby like you are dressed for that kind of day & a similar amount of activity. Just Right!

9. How do I know if my baby is warm enough? • The best way to tell is to look at and touch his skin. • If hands & feet are cold, blue or blotchy, add socks, hat, sweater, or another blanket. • If baby seems restless or fussy and his skin is flushed or reddened, remove a piece of clothing or blanket. • When baby is sleeping, add an extra blanket.

10. Illnesses & taking temperature • How can I tell if my baby is sick? • Parents are the best at knowing when their baby just does not seem to be acting the same. • A change in your baby’s response or behavior can signal that your baby is sick. • Don’t hesitate to call your pediatrician. No question is foolish or unimportant.

11. Change in breathing pattern Excessive crying Change in eating pattern Difficult to wake Not as active as normal Fever Coughing, not associated with feeds. Vomiting all or most of feeds. Frequent liquid stools Not as many wet diapers and urine is dark color. Blue or pale color Signs that your baby may be sick

12. How do I take my baby’s temperature? • Place the tip of the thermometer under the arm pit making sure that it is in contact with both the skin on the arm and the skin on the chest. • Hold the arm next to the side of the chest keeping thermometer under arm. • Keep in place for 3-4 minutes.

13. How do I know if my baby has a fever? • A fever is a temperature above 99° F axillary. • Your doctor should be called if: • Your preemie is under 2mos. of age and the temperature is >99°F. • Your preemie has a temperature >99°F and other signs of illness. • Fever is present more than 3 days. • The temperature is < 97°F.

14. Vomiting, Bowel movements, & Diaper rash

15. How can I tell the difference between spitting up and vomiting? • Spitting up with a feeding is a common occurrence in preemies. It can also occur with a burp or soon after a feeding and may be called a “wet burp”. It is usually only a small amount. • Vomiting is a continuous throwing up of large quantities of food or liquid, & occurs at times other than feedings.

16. What is a normal bowel movement? • By the time your baby goes home, his/her bowel movements should be light yellow or light brown in color. Normal consistency is soft with some form or mushy. • Some babies may have a bowel movement with every feeding, other may have one once a day or two. • Breast fed babies may not have a stool every day.

17. What if my baby has not stooled for 2-3- days • If your baby has not had a bowel movement for 2-3 days and seems uncomfortable, or has a stool in the form of hard pebbles, s/he may be constipated. • Call your doctor for recommendations. • If your baby does not seem uncomfortable and is eating well, s/he may just have infrequent bowel movements. • If baby has frequent, watery stools in 6-8 hours time, call your doctor.

18. What should I do about diaper rash? • At one time or another, all babies will have some form of diaper rash.

19. Points to remember about diaper rash • Keep area clean. Use washcloth with soap & warm water after each diaper change, making sure to rinse off soap. Allow area to dry before replacing diaper. Diaper wipes may irritate baby’s skin. • Leave diaper off and allow rash to be open to air as much as possible.

20. Points to remember about diaper rash • Change diaper often. • Use diaper ointment containing zinc oxide. After washing diaper area, rub thin layer of ointment on reddened skin. • If there is no improvement in 3 days, contact your pediatrician.

21. SLEEPING

22. How do I know if my baby is sleeping enough? • Premature babies seem to sleep a great deal initially. • They should be waking on a regular basis for feeding. • By discharge, your baby has developed a routine for sleeping.

23. What if baby has days & nights nixed up? • It is best to minimize stimulation during night feedings by: • Using only a night light when getting up to feed baby. • Change baby before feed. • Talk minimally & softly during feed. • If you rock baby after feed, rock for a short time.

24. Bathing Baby

25. How often should I wash my baby? • You do not have to bathe your baby everyday if you are keeping the diaper area clean with each diaper change. • Baby’s skin can dry out very quickly if bathed too often. • A complete bath 1 or 2 times a week is sufficient.

26. Should I wash my baby’s face? • Your baby’s face should be washed everyday with a wash cloth & warm water. • Pay close attention to the fold under the chin where milk may collect. • Most babies do not like to have their face washed and will wiggle & squirm. • It may help to do 1 side of the face at a time.

27. How do I clean my baby’s nose? • Wiping your baby’s nose with a soft tissue will usually help remove extra secretions. • If you have a bulb syringe, be sure to push the air out of the bulb prior to gently inserting the tip into the nose. • You do not want to use any force or squeeze air into your baby’s nose.

28. What if my baby has a stuffy nose? • By adding humidity to the house, it may help your baby breathe. • You can add humidity to home by: • Turning on the shower • Washing clothes • Use a humidifier • If stuffiness continues and does not improve, call the doctor. It may be a cold.

29. Are hiccups & sneezes normal? • Yes, hiccups & sneezes are normal. • Normally hiccups will go away by letting them run their course. • Hiccups may also be a sign that your baby is stressed and needs quiet time. • Sneezes are to clear baby’s nose. • Persistent sneezing may mean the nose needs to be cleaned out with the bulb syringe or baby has a cold.

30. Feeding my Baby

31. How often should I feed my baby? • Feeding patterns differ between babies and vary from day to day. • Prior to discharge, the nurses can give you an idea of your baby’s feeding pattern. • Most preemies feed every 2 & 1/2 to 4 hours. • Look for cues that your baby is hungry. • Often the doctor may want you to awaken the baby if it has been longer than 4-5hours since last feed.

32. How much should I feed my baby? • A baby who weighs about 4 &1/2 pounds usually need 12-15 ounces of formula per day. • A good way to tell if baby is receiving enough is to count diapers. Baby should have 6-8 wet diapers per day. • Most formula fed babies will be taking 2-3 ounces every 3-4 hours when sent home.

33. What about breastfeeding? • A breast feeding baby will usually increase their feeding time by sucking longer or wanting to eat more often. • This builds up the mother’s milk supply. • Sometimes this means your baby will want to eat every 2 hours until your supply meets his/her demand.

34. Will my baby be able to nurse even though s/he has been taking a bottle? • We encourage mothers to pump while their baby is in the hospital. • The lactation consultants can work with you and your baby once your baby is able to begin process of sucking, swallowing, & breathing. • Premature babies may take days or weeks to learn, and may not succeed at all.

35. What do I need to know about formula? • There are 3 forms of formula • Powdered • Concentrate • Ready to feed • The nutritional content of the 3 are the same. • It is very important to use the formula your baby’s doctor has ordered.

36. How do I take care of the bottles & other equipment when using formula? • Bottles, nipples, measuring cups, containers, brushes and other equipment used for feeding should be washed in warm, soapy water and then rinsed in hot, running water. • Glass or metal pieces can be washed in the dishwasher.

37. What if my baby stops breathing during a feeding? • STOP THE FEEDING. • Sit your baby up on your lap. Often times patting him on the back will be enough to remind him to breathe. • You may have to take breaks during the feeds, allowing for frequent burps. • If baby sometimes has this problem, it is a good idea to feed with the lights on.

38. CRYING

39. Why do babies cry? • Crying is a form of communication. • Your baby cries for different needs. • Your baby will develop a trust that you will be there when s/he cries if you respond to all crying. • This sense of trust will be a necessary foundation in their development.

40. Frequent causes of crying FEED ME! • Hunger • Discomfort • Need for position change • Stuffy nose • Tension relief • Overstimulation • Illness

41. Premature babies & crying • Many premature babies will have days of frequent crying. • They can be more sensitive to stimulation and gas pains. • Many parents find it difficult to keep control during frantic crying episodes. • Try to remain calm and call for help if you are losing your cool.

42. Suggestions for dealing with crying baby • Be sure baby is not wet, hungry, or uncomfortable. • Burp baby every 5 minutes while feeding. • Be sure baby is not ill. • Swaddle baby by wrapping his arms & legs snugly in blanket. • Rock baby or place in infant swing.

43. Suggestions for dealing with crying baby • Hold baby skin to skin on chest. • Walk with your baby or take baby in car seat for a ride. • Keep baby’s head higher than the rest of the body when feeding. • Place a warm, rolled towel under baby’s stomach when lying down. • Give baby a warm bath.

44. Going Out, Visitors, & Relatives

45. When can I take my baby out in public? • It is best not to take your baby out in public for the first 3 months after bringing baby home from hospital. • When you do take him/her out, try to avoid crowds of people who may have colds or illnesses.

46. Should I allow visitors when my baby gets home? • Many well meaning people will want to come visit. Just keep in mind: • People who are sick will have to visit later. • Limit amount of people and visiting time. • Do not allow people to smoke around your baby. • You are your baby’s best advocate. It is ok to say your doctor said it is not good to have visitors until baby is a little older.

47. Other Information

48. When should I get my baby immunized? • Immunizations will begin in the hospital before baby goes home. • It is very important to follow your baby’s schedule for immunizations.

49. Is cigarette smoking bad for my baby? • Exposing infants & children to any smoke is not good. No one should be allowed to smoke in your house. • Have them smoke outside • If a parent smokes, remember not to smoke in a closed car with the windows up. • Never smoke while holding your baby.

50. Positioning • Even though preemies may have been placed on their bellies while in the hospital, your baby should NOT be positioned on his/her stomach or side for sleeping at home unless specifically requested by the doctor. • You should place your baby on their back to sleep.