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• This PowerPoint program was created by Alisa
  Dent, RN, BSN.

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Going Home
What do I need to learn?
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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.

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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.

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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 babys discharge summary.

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Once all of these requirements are met
Pack your bags!! You are going home!!
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Caring for your baby at home
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Home temperature dressing your baby

• A low to mid-70s 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!
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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.

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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 babys response or behavior can
  signal that your baby is sick.
• Dont hesitate to call your pediatrician. No
  question is foolish or unimportant.

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Signs that your baby may be sick

• 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

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How do I take my babys 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.

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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 gt99F.
• Your preemie has a temperature gt99F and
  other signs of illness.
• Fever is present more than 3 days.
• The temperature is lt 97F.

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Vomiting, Bowel movements, Diaper rash
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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.

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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.

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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.

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What should I do about diaper rash?

• At one time or another, all babies will have some
  form of diaper rash.

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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
  babys skin.
• Leave diaper off and allow rash to be open to air
  as much as possible.

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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.

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SLEEPING
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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.

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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.

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Bathing Baby
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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.
• Babys skin can dry out very quickly if bathed
  too often.
• A complete bath 1 or 2 times a week is
  sufficient.

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Should I wash my babys face?

• Your babys 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.

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How do I clean my babys nose?

• Wiping your babys 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 babys nose.

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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.

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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 babys nose.
• Persistent sneezing may mean the nose needs to be
  cleaned out with the bulb syringe or baby has a
  cold.

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Feeding my Baby
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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 babys 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.

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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.

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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 mothers milk supply.
• Sometimes this means your baby will want to eat
  every 2 hours until your supply meets his/her
  demand.

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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.

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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
  babys doctor has ordered.

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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.

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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.

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CRYING
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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.

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Frequent causes of crying
FEED ME!

• Hunger
• Discomfort
• Need for position change
• Stuffy nose
• Tension relief
• Overstimulation
• Illness

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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.

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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.

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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 babys head higher than the rest of the body
  when feeding.
• Place a warm, rolled towel under babys stomach
  when lying down.
• Give baby a warm bath.

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Going Out, Visitors, Relatives
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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.

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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 babys best advocate. It is ok to
  say your doctor said it is not good to have
  visitors until baby is a little older.

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Other Information
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When should I get my baby immunized?

• Immunizations will begin in the hospital before
  baby goes home.
• It is very important to follow your babys
  schedule for immunizations.

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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.

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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.

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Growth Development
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Will my babys development be appropriate?

• Your babys doctor will assess if your baby is
  developing properly.
• It is important that you follow the schedule for
  appointments.
• Keep in mind that if your baby was born early
  that it is normal to see slower growth
  development.
• Do not compare your preemie baby with a term baby
  of the same age.

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Will my babys growth be affected by prematurity?

• It is impossible to tell how your baby will grow
  in the future.
• Your babys doctor will be following your babys
  growth carefully.
• Many children who were preemies reach their
  genetic potential for growth.
• Some preemies continue to grow slowly and are
  small adults.

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In conclusion

• We will not send your baby home until s/he is
  medically stable and ready to go home.
• On the contrary, we will not keep your baby here
  longer than s/he needs to.
• Prior to going home, some parents will have the
  opportunity to room in with their baby overnight
  to become comfortable with caring for their baby.

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