Preparing to go home

Siblings

Your home life after discharge must adapt to your new situation. It is not uncommon for siblings to react to the parents after the period of separation due to hospitalisation, and they may also react with jealousy towards the baby.

Therefore, be extra careful to involve siblings in the care of the little one so that they do not feel neglected. That they need extra attention when the family is back together is natural.

Relationships

It is common knowledge that it is a demanding period in a relationship when you have to both make room for a baby and have new roles as parents. After hospitalisation, there may be a need to find each other again. As a couple, it can be challenging to get everyday life established and it is important to give each other space and talk about things along the way. If your baby is particularly restless and demands a lot from you, your relationship can become strained because there is little room for adult contact.

For many new parents, it can be difficult to decide how best things can be done with the rest of the family and friends. There may be expectations of you where it can be difficult to say no. Talk to your family and friends about how they can best help you and invite them into your life to the extent in which you have the energy for. It can be a good thing to make a point of spending time with family and friends, even if your time and energy is short. Having a new baby is a wonderful event to share with those you care about, and it is also good to have the opportunity to share the joy of the baby and any worries.

Fatigue

Tiredness is quite common in the first months with a small baby, and it is often necessary to support each other as parents. Take advantage of any offers of help from others and see this as a strength in being able to accept help, so that you can use your energy on spending time with your baby and on the transition to your new home life.

The baby's immune system

Your baby may have a weakened immune system, and you must be mindful that your baby is not exposed to infections by avoiding being around people who are sick or have a cold. If you or any siblings get sick or have a cold, it is important to supplement good hand hygiene with the use of hand sanitiser.

In the months after discharge, many parents find that they gradually gain the energy to react to the entire experience. The baby may have calmed down more, are usually thriving and developing, and this allows room to appreciate how the whole ordeal of a premature birth may have left some impressions. Even though your own baby may not have been at a direct risk of death, the encounter with the reality that there are sometimes extremely sick babies as well as scared and upset parents has had a great impact on many.

Talk to each other

It can be difficult to have to process things when the desire is to just put it all behind you. But it is still important to talk things through with each other and maybe with others who have had a similar experience. If you need to, there is an opportunity for you to talk to professionals about the process. You can be referred to a psychologist via your own doctor, among other things. Perhaps you still have contact with other parents from your time in the Neonatal Unit that you can talk to.

There is also inspiration to be found online, such as from the patient associations Prematures Vilkår and the Dansk Præmatur Forening (in Danish) (See links to websites at the end).

Try to think about the first days at home as being a delayed maternity leave, where you are constantly getting to know your baby's reactions and signals better. As a parent, you are very attentive and perhaps concerned about your baby's development, which is normal with all parents and babies. The early birth, however, may have increased both your attention and concern.

Some parents find it easy to come home with a premature baby because their baby is thriving, while other parents experience the opposite. The ability to process impressions – also called sensory integration – develops later in premature babies, therefore, they may be sensitive to different sounds and sensory impressions in the first period after discharge.

Notice your baby’s reactions

Pay attention to how your baby reacts. For example, whether they can handle being passed from arm to arm and being in large gatherings, as well as how they react to noise. Among other things, let your baby sleep and avoid waking them in order for visitors to hold them.

Your baby has the ability to communicate in different ways. Because the baby's brain function matures later than in a baby born at term, premature babies may have a less obvious reaction towards interactions and need more time to process the impressions they receive. Your baby needs more time to react when you talk to them and also has difficulty processing numerous impressions simultaneously. This can impact how you think about stimulation and activities in everyday life.

Seeking the right level of stimulation

All babies need stimulation to develop. For the premature baby, it is particularly important that this stimulation takes place in a way that is adapted to their capacity and readiness for interaction and play. It may therefore be an idea to wrap the baby in a blanket in the beginning so that their body is supported and there is energy for interaction. On the changing table, towels can also be placed around the baby in the early days, creating a barrier to help them feel supported.

Initially, take advantage of the natural opportunities around changing and feeding time, and pay attention to your baby's reactions: facial expressions, breathing, alertness, fatigue. Make sure to wait for the baby so that you take turns "saying" something. Limit the number of simultaneous stimuli to give the baby enough calm to concentrate their attention to the activity occurring.

Overstimulation

A small baby who becomes overstimulated and needs a break will typically:

• look down
• turn their head away or close their eyes
• fall asleep
• raise their arms defensively
• become agitated or cry
• maybe display a change in skin colour and regurgitate or have the hiccups.

There are parents who find that their baby only cries, is restless or has difficulty in falling asleep after they have been overstimulated – i.e. a delayed reaction. Therefore, think about how the day has been, if for example, your baby is very restless in the evening, night and sometimes also the day after. Perhaps you can find a way to organise your daily life by looking for any connections between your activities and the baby's difficulty sleeping and restlessness.

Use of sling

All babies need close body contact and can benefit from being carried close to the body by their parents. Using a baby sling can help with this, the sling is tied around your body so you can walk about with your baby secured to your chest and have your hands free. The sling is good for:

• restless, fidgety babies
• babies who cry a lot
• babies who have a special need for close contact

The sling can also be used skin-to-skin. Pay attention to whether the baby sits well with support for the head and back. Ask us if we can help you practice with a sling before you are discharged.

Play

You can stimulate your baby’s motor skills through small games, where the baby cycles with their legs, changes position, does walking exercises or roll over gently. You can strengthen the neck and back muscles by letting the baby lie on its stomach when they are awake and supervised. You can find inspiration in the book “Leg med din baby” from Politikens Forlag (in Danish). Let your baby feel your enjoyment of the game and notice their reactions during the interaction.

Baby swimming

Baby swimming can be started once your baby weighs around 5 kg. You need to bear in mind whether your baby has been susceptible to infections or is sensitive to noise.

Development and corrected age

Babies who are born prematurely may have a slightly delayed development in relation to their age, we call this corrected age. Corrected age means the age the baby would have had if it had been born at the due date.

However, the most important thing is that your baby develops continuously and that you focus on what your baby can do, instead of what they are not capable of yet. You can ask the health visitor for advice on the baby’s development and stimulation.

Anxiety and crying

When a small child cries, it can be for a number of reasons. It can be deeply frustrating to be the parent of a child who cries and is restless for no obvious reason, causing uncertainty for you as parents. All children cry, and crying cannot be avoided. Common explanations for crying are:

• hunger
• fatigue
• boredom
• malaise
• pain
• overstimulation.

Your baby's personality and temperament also play a role in relation to crying. Try to find out what works for your baby and continuously adjust the "toolbox" with tips and tricks as your baby grows and develops. Fortunately, you will gradually get to know your baby well, and over time, the baby’s signals become clearer, and it becomes easier to deal with crying and restlessness in general.

When your baby sits in a baby bouncer, they are held in place and do not have as many opportunities to move. A baby bouncer should therefore be used with care or as little as possible for the first few months. The baby must be able to keep their head in the middle position before they can sit in the chair. When the baby is 6-8 weeks old (after its due date), they can start sitting in the baby bouncer for short periods, around 10-15 minutes at most, 2-3 times a day. The baby must never sleep in the baby bouncer.

Before discharge, your baby must learn to feed at the breast or by bottle and be healthy and thriving. Indications of this are:

• that your baby "demands" that they need feeding
• that your baby is generally awake, alert, calm and seems full and comfortable after they have fed.
• that your baby is gaining weight.

Vitamins and iron supplements

Give your baby vitamins and iron supplements according to the recommendations of the Danish Health Authority (Sundhedsstyrelsen).

Weaning

When the baby is ready to switch to eating solid food, we recommend that you consult your health visitor.

Your baby should have 6-8 wet nappies a day, and the urine should be totally pale yellow or clear.

If the baby is breastfed, they may have a bowel movement several times a day, but it can also take 1-2 weeks in between. Both are completely normal. A baby who is given infant formula should have a bowel movement 1 time a day.

Some premature babies tend to be constipated for a while. Contact your own doctor and also talk to the health visitor about it.

We recommend maintaining regular room temperature. The bedroom should be cooler. However, avoid drafts and place the cot or bed away from external walls and windows. Air out daily. Have a good temperature at the bathing and changing area.

Your baby should have a reasonable temperature when you feel it in the neck, warm but not wet. When the baby sleeps in cool rooms, it is acceptable to have slightly cold hands but not to feel cold up their arms.

Sleeping outdoors

The baby may sleep outside when they weigh over 3 kg, as they then have a sufficient layer of fat to be able to keep warm. If your baby weighs less than 3 kg, you can go for shorter walks of around 30 minutes in the pram. The baby must not sleep outside in damp, foggy weather, or if it is colder than -10 degrees. Put a hat, socks and mittens on your baby, do not place them in direct sunlight and also remember sunscreen.

The safest place for your baby to sleep is in their own bed in the same room as the parents. If you choose to let your baby sleep in your bed, they must not lie inbetween you, and there must be as much free space for the baby as if they were in its own bed.

Older siblings and pets should not sleep in the same bed as the baby and parents.

See also the Danish Health Authority's (Sundhedsstyrelsens) website on the prevention of cot death. (Link at the back of the booklet).

We advise against babies being exposed to smoke because tobacco smoke is harmful to the baby 's health. The baby is a passive smoker and cannot say no to it. The baby’s trachea is very thin, meaning they become irritated by smoke faster than adults.

Babies who are exposed to smoke are at greater risk of getting respiratory diseases because the mucous membrane of the airways becomes irritated, making it easier for viruses and bacteria to penetrate through the mucous membrane. Therefore, they are more likely to suffer from asthma, asthmatic bronchitis, colds and otitis media.

The Danish Health Authority recommends that smoking takes place immediately after breastfeeding and expressing to reduce nicotine transfer to the baby. Nicotine is transferred via the milk to the baby in a concentration that is up to three times higher than in the mother. In addition, there are 4000 chemicals in tobacco.

The Danish Health Authority recommends 6 precautions for passive smoking:

• Never smoke indoors.
• Never smoke near your baby.
• Don't let your baby see you smoking.
• Ask friends and family not to smoke indoors.
• Leave the car smoke-free.
• Remember that it is for the baby's sake.

For more information, see the Danish Health Authority's recommendations. (Link at the end).

Carrycot

A flat or fully reclined car seat (Boxette) or a pram carrycot (lift net) is recommended for premature babies in the beginning, when they are so small that they cannot be properly secured in a car seat. In the case of the carrycot, the included foam rubber/polystyrene cushions must be placed inside the lift. The baby's head should be facing the centre of the car.

Car seat

When your baby reaches the recommended size, a regular car seat can be used. It is important to test a car seat to ensure the baby and seat fit together and that the baby can be fastened in securely. A rear-facing car seat is the safest.

Neither flat seats, carrycots nor rear-facing car seats must be placed next to an airbag.

Other information can be found at the "Rådet for Sikker Trafik” (Council for Road Safety). (Link at the end).

Be aware of changes in your baby’s behaviour, eating less, has a temperature, has vomiting or diarrhoea. If you are unsure, contact the health visitor or your own doctor and tell them your concerns about your baby. Only contact the emergency medical service in case of acute illness.

The health visitor's job is to examine your baby and give advice and guidance about your baby 's health and development, as well as how you can handle everyday life. Please note that the health visitor can help you apply for a double place in daycare or nursery if the baby needs it (this allows the carers to have more time with your baby)

Book an appointment with your own doctor for the routine examinations of your baby

Health examinations are at:

• 5 weeks
• 5 months
• 12 months

Vaccinations (follows the baby's birthday)

• At 3, 5 and 12 months old, the baby should be vaccinated for diphtheria, tetanus, whooping cough, polio, haemophilus influenza and pneumococcal disease. The vaccine is repeated when the baby is 5 years old.
• At 15 months and at 4 years old, the baby should be vaccinated against measles, mumps and rubella. If the baby has not received the vaccine when they were 4, it must be given when the baby is 12 years old.

The paediatrician routinely follows babies born before week 32 in relation to their corrected age. This happens when your baby is 5 months old and 13 months old, respectively.

The paediatric physiotherapist will examine the baby after 9 months and after 18 months (corrected age), after which your baby is offered a thorough examination by a paediatric physiotherapist and an occupational therapist at the age of 3 years and 5 years. You will be sent an appointment for these.

If you have any questions, please don’t hesitate to contact us.