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Rule #1: Give your baby plenty of stimulation.
When full-term babies are born, they're ready to be in the world. Parents are eager to talk and play with them, keeping them up for longer stretches during the day, reading to them, giving them opportunities for exercise and tummy time.
Preemies, though, are here before they're ready. And doctors recommend treating preemies as if they're still in utero. Mostly that means letting them sleep as much as possible, keeping the lights low and voices hushed. It also means limiting interactions that demand anything of the baby and burn precious calories she cannot spare.
This can be disappointing – like any new parent, you want to get to know your new baby. But the more you let your preemie rest, the better she'll grow. Think of the early weeks as time your baby would have been in the womb and adjust your expectations to the connection you'd have had in that situation – an intimate bond, for sure, but not one in which you'd be playing patty-cake.
By Emily Bloch
Rule #2: Babies love to be stroked and massaged.
Not preemies. They just aren't neurologically ready to be stroked. Their nervous system is still wired to have a cushion of amniotic fluid around them.
"Instead, preemies like to be contained, just like they were in the womb,” says Tenielle Langevin, a NICU nurse in Springfield, Massachusetts. She tells parents to hold their babies firmly, with one hand cupped on the head and one on the bottom.
Once babies are stable enough for kangaroo care, parents can hold them skin-to-skin while they sleep. Babies find this very soothing, because being held this way is as close to being in utero as they can get.
Rule #3: Always put your baby to sleep on his back.
Parents are taught this as a simple truth – the best way to protect your baby from SIDS is to always put her down on her back. So parents are often alarmed to see their tiny preemie sleeping on her belly in the NICU.
There are two reasons preemies break this rule. "It can improve oxygen delivery to their lungs," says Jennifer Gunter, ob-gyn and author of The Preemie Primer. "Also, preemies seem to respond better to sleeping on their belly. They're tucked in, with their hands resting under their body. When they do lie on their back, it's hard to give them that contained feeling. They flail around." Preemies in the NICU are constantly monitored, so letting your baby sleep on her belly is safe there.
The American Academy of Pediatrics recommends that preterm babies be put to sleep on their back as soon as they're medically stable – by 32 weeks at the latest. Once your baby is home, you should always put her to sleep on her back.
Rule #4: Never wake a sleeping baby.
Normally, parents are told that a hungry newborn will wake up and demand food, so he can sleep as long as he likes. And preemies need sleep, right?
But parents of preemies are often told to feed the baby at least every three hours, sometimes every two, even if that means waking the baby from a deep sleep. So, in what everyone admits is a contradiction of the advice to let preemies sleep as much as possible, parents are on feeding duty night and day, with no breaks.
Rule #5: Don't give a breastfeeding baby a bottle.
Moms who want to breastfeed are usually told to avoid giving their baby a bottle for at least the first few weeks. Once a baby gets a bottle, which can deliver milk faster and more easily than the breast, she sometimes doesn't want to switch back.
But with preemies, getting a lot of food without spending a lot of energy is a good thing. So preemies are often fed breast milk from a bottle, to spare them the effort of breastfeeding. Moms who have heard that bottles are the enemy of breastfeeding will have to adjust to this new reality until their baby is strong enough to breastfeed.
In some cases, doctors also prefer to feed preemies special enriched formula to help them gain weight more quickly than they would on breast milk. This 180-degree turn in strategy should last until the baby is gaining weight well and is strong enough to breastfeed effectively.
That doesn't mean you shouldn't also nurse your baby, if your doctor advises it. Even if she's getting most of her nutrition from a bottle, she'll still benefit from the contact (and practice) of breastfeeding.