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Wirral University Hospital NHS Foundation Trust

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Going Home Advice

We are all sad to see you go, but that has been our aim from the moment you entered the Neonatal unit, to support you and your baby to go home.

We have been preparing you for home from the time your baby came to us, so you should now be becoming familiar with bathing, feeding etc. We ask you to take part in resuscitation training and to learn how to give medicines to baby if they are necessary.

We will make a date with you for going home. Providing your baby progresses well and you, the doctors, the staff on the unit and the community staff are happy, your baby will be discharged on this day.

A follow up visit is made for your baby to come and see the doctor 4-6 weeks after discharge in our children’s outpatients clinic.

The first night home can be a bit daunting so the Community Neonatal Midwives will visit you the next day to check everything has gone well and answer any of your questions.

Your GP and health visitor are sent a letter from the doctor about your baby’s diagnosis and care. The nurses also forward a letter to your health visitor regarding blood tests (PKU) and immunisations.

Congratulations

A few more tips!!

Your baby will take a few days to get used to different sounds, lighting and activities. This may mean that your baby is more fussy than usual, may change sleeping, waking or eating patterns.

  • Don't panic, you may ring us over the next few days on the Neonatal unit and we will offer our advice.
  • The community Neonatal staff will visit and liaise with you for future visits as you need them.
  • Try to keep the family schedule simple at this time e.g. not too many visitors to entertain.
  • Write out medications and times and check them off as you give them.
  • Write down all follow up appointments on your calendar/diary.
  • Make notes of questions as they arise, so you can ask your community Neonatal Midwife/GP/Health Visitor.
  • Accept all offers of help regarding washing ironing and shopping so you can spend time with your baby.
  • When you feel ready prepare for a simple trip out with baby to build your confidence.

Enjoy your parenthood...its a long road!

Temperature

There should be no need to try to imitate the extremely high temperatures of the Unit, as you are aware your baby has progressed from the Intensive nursery, which is kept a consistently high temperature, to the more acceptable levels of the outside nurseries. An ideal room temperature for your baby is about 19 C.

Do not be deceived by baby’s cool hands and feet, the ideal places to check for warmth are the back of the neck or the tummy with your warm hand. A baby’s normal temperature is 36.7 C or 37 C.

This is the most accurate way of finding out if the room temperature is right for your baby, if you find they are hot and sweaty and otherwise well, they may have been overdressed or over wrapped.

Alternatively if they feel cool then they may need more layers of clothing . If the room is too cold, make sure their cot or pram is kept out of draughts.

A baby that is too hot will feel hot and will sweat, especially from the face and head, will be irritable and may breathe faster than usual. In this case remove one or two layers of clothing or blankets.

If very hot, undress and cover with one sheet, call your Health Visitor for advice or your GP .

A baby that is too cold will be lethargic, their arms and legs may appear very pink but will be cool to the touch and they may not want to feed. Dress them more warmly and heat the room. Cover them with an extra blanket and check that they are starting to warm in about 15 to 30 minutes. If they do not seem to be warming up quickly, call your GP for advice.

Following the guide-lines from the Department of Health we do not recommend sheepskin blankets for babies to sleep on, or the use of duvets or baby nests for a baby to sleep in, all three can lead to overheating which has been linked to cot death

We recommend that babies be nursed on their back, this is to lower the risk of overheating (the baby can lose heat from their face more easily  and also if they are sick the baby will usually turn their head, the milk will soak into the sheet with no risk of them breathing it in.

To try to avoid the risk of cot death we also recommend, not smoking in the same room as your baby, not overheating them, not allowing them to become too cool, also to breastfeed if possible, should you require further information please ask for a leaflet from your Midwife or Health Visitor.

As a general guide a three month old baby (regardless of whether they are full term or premature). will feel as hot or as cold as an adult does. Therefore if you feel cool in a room your baby will, but if you feel hot make sure your baby is not overheating by being over wrapped or having too many clothes on. 

Clothing

Indoors 

During the day you should keep baby warm by putting a vest, babygro and cardigan on, a few layers trap air between them and this helps to keep your baby warm, with two blankets and perhaps a flannelette sheet to cover them.

In summer months a cardigan may not be necessary, or alternatively leave their vests off. Loose cotton clothing is a suitable alternative

Outdoors -Winter 

A further cardigan or woollen suit can be added, plus bonnet. Wrap baby (not too tightly) in a blanket with a further two blankets over them. (A blanket folded double counts as two blankets.) Remember to unwrap your baby and remove waterproof covers when you get indoors otherwise they will overheat.

Outdoors - Summer 

At first you may still need to cover baby’s head with a bonnet, however you should be guided by the outdoor temperature before putting too many layers over your baby. It is as well to remember that chilly breezes can be around on certain summer days, keep the hood of the pram up if this is the case, otherwise leave the hood down but protect your baby from the sun with a canopy or shade.

When to go out?

Give your baby time to adjust to your home temperature, we recommend waiting about four to seven days depending on your baby’s weight and the time of the year, e.g. summer or winter, this will depend on their weight as well, please ask your Community Neonatal Nurse or Health Visitor for advice.

Obviously in the summertime you may only need to wait a few days.

Make the first few outings short, try not to visit many crowded areas where your baby could be exposed to a lot of smoke or infections form others. e.g. Baby clinics, GP waiting rooms, crowded shopping areas etc.

Avoid damp, foggy or bitterly cold frosty days if you can, journeys in the car from one warm environment to another are ideal.

Make sure your car is safe, there are many car safety seats on the market suitable for small babies, a folded blanket under your baby’s bottom is often all that is needed to ensure the snug fitting of the safety straps (you should only be able to put one finger under the safety strap for a safe fit.) Also a rolled blanket around your baby’s head and sides will keep their head upright and prevent rolling.

When to bath?

In the first few weeks there is no need to bath your baby more frequently than once or twice a week, especially in the winter months, topping and tailing is acceptable and keeps your baby warmer.

When you do bath them make sure the room is warm, approximately 22 °C (room temperature) and free from draughts, that the water is at the right temperature 30 °C (tested with your elbow), and all the essentials you need are at hand, the clothing ready (if necessary warming too). Ignore the 'phone' and front door bell once you have started to bath your baby, the risk of them getting cold far outweigh the importance of the person at the door on the 'phone'

Vitamins and Medication

Most babies gain their vitamin and iron stores in the last twelve weeks or so of pregnancy, therefore a baby born before 32 weeks needs supplements until he/she is established onto mixed feeding.

Vitamins are essential for normal growth and nutrition, the iron and folic acid are needed to help make red blood cells and help to prevent your baby becoming anaemic. A full term baby who has been ill may also need iron and folic acid. These supplements usually continue until your baby is 6 months of age, once mixed feeding has been established, or when your Consultant or GP recommends.

You will have been shown how to give your baby's medication. Mix it with a little milk (breast milk or formula) and give this via bottle prior to the feed. Keep a bib or tissue handy as the medication can stain clothing.

If it seems to cause any vomiting try dividing the dose over a few feeds, giving it in the middle of a feed or mixing it with more milk. Iron drops will usually turn the baby’s stools green or grey but do not cause constipation.

Immunisations

Our consultants usually recommend a full course of vaccinations from 8 weeks of age, if for any reason they feel your baby should not receive a certain vaccine they will usually let your GP and Health Visitor know. If you have any doubts please ask.

Development

As the Consultant has probably told you, we correct premature babies ages to allow them to catch up with their developmental milestones. This means that if your baby was 10 weeks early he will be expected to do what a 6 week old baby can at 16 weeks. Try not to compare your baby with a full term new born, he will take a little longer to do things.

You can look for what a week old baby should be able to do and follow your baby’s progress.

  • Baby will stop crying when picked up
  • Turn to look at the person who is talking
  • Be startled by a sudden noise
  • Respond, by quieting, to a soothing voice
  • Turn towards the light
  • Stares at your face
  • Begins to smile
  • Begins to be able to control his head

They may be followed up by their Paediatric Consultant until they are 2 years of age, approximately, they will have developmental assessments at your local clinic to make sure they are catching up.

By the time they are 2 years old they will have caught up, but some children who are born prematurely do remain smaller than average. It is not unusual to be followed up by the Community Physiotherapist and/or Occupational Therapist.

Back to sleep

'Back to sleep' 'Feet to Foot' - Why is this so important?

Over the past twenty years there has been a gradual reduction in the numbers of babies suddenly dying in their cots and this has been explained by investigations into babies sleeping patterns and identified risk factors eg. baby sleeping on their front, parents sleeping with baby, smoking in baby's room.

These are the recommendations to lessen the risk of sudden infant death syndrome (when a baby dies with no cause found, SIDS).

  • Don't cover baby with extra blankets or cloths.
  • Place baby on their back with their feet at the bottom of the cot, covered by two blankets tucked in at the sides.
  • Always place baby on their back to sleep, for naps and at night.
  • Place baby on a firm mattress, safety approved and covered by a fitted sheet.
  • New baby, new mattress
  • Keep soft objects, toys and loose bedding out of your baby's sleep area.
  • Do not smoke or allow smoke around your baby.
  • Don't share your bed with your baby during sleep.
  • Keep your baby's sleep area close but separate from where you and others sleep. It is recommended for you to have your baby in a cot within your room for up to 6 months.
  • Don't allow your baby to get too hot during sleep. Have a thermometer within the room and set to 18-20'C. To check your baby's temperature feel his tummy which should be warm to touch, not hot.
  • Avoid too much time in car seats, bouncers and carriers.
  • Provide tummy time to avoid flattened areas on baby's head. This also promotes normal development and tone in the baby's shoulders and thighs.
  • Observe baby clearing his airway by turning his head and trying to crawl. Consider doing this at each nappy change.
  • Tummy time should only be when baby is awake and when someone is observing the baby.
  • Discuss use of baby monitors as these on their own will not reduce the risk of SIDS.

The Foundation for the Study of Infant Deaths (FSID) is the UK's leading baby charity working to prevent sudden deaths and promote health. www.sids.org.uk

Further information provided by the Department of Health on reducing the risk of cot death.

Common Feeding problems

Slow to Feed

This includes falling asleep before taking their required amount, taking more than half an hour to finish their feed, or taking part of a feed and waking a short time later ready to finish it.

Usually changing to a medium flow teat will solve the problem, these teats allow the baby to take the milk at a faster rate, they will be able to finish the feed without being too tired. Please ask your Midwife or Health Visitor for advice.

You may find your baby still likes to have a nap before finishing the feed, but do not reheat the milk or re-use an hour after starting the feed.

If your baby has taken a lot of air into their stomach whilst feeding, this will make them feel full so they may fall asleep. You may need to wind them, or change their nappy in the middle of the feed (being careful to wash your hands before feeding again) in order to let them finish their bottle.

If your baby is lethargic or reluctant to feed and has taken less than half the normal amount of feed in 24 hours, or more, you should immediately consult your GP to rule out illness.

Frequent Feeding

This may include waking early for a feed or not being satisfied after finishing a feed. Usually making up an extra 30mls (or one ounce) at the next feed will satisfy your baby, as if they are draining each bottle this is an indication that they need a little more milk.

Check that you are making up the feeds correctly, if you are making the feeds too weak by adding extra water this will make your baby hungry. On the other hand if you are making their feeds thicker by adding extra scoops of powder this is extremely dangerous as you are making them thirsty by dehydrating your baby and putting them at risk of kidney damage. If you are having a problem ask your Midwife or Health Visitor to advise you. 

Weaning Premature Infants

What is weaning?

Weaning is the change from milk to solid food. As babies grow their nutritional needs change and are no longer met by breast or bottle alone. At this time a mixed diet is required. Weaning also helps babies to progress from sucking to biting and chewing.

When to wean?

There are no clear guidelines about when to wean premature babies but generally the earlier the baby was born the later we recommend weaning. We suggest you start offering your baby solids between 4 and 7 months after birth. The reasons we recommend this are: -

  • Before 4 months your baby’s gut is unlikely to be ready to cope with different foods and textures
  • It seems that around 4—7 months, babies are quite receptive to new flavours. After this time they may become increasingly suspicious of new foods.
  • Milk alone is not sufficient after about 6 months. Please discuss when to start weaning with either your Health Visitor, Children’s Nurse or Dietician. However if you have a family history of allergy, or your baby has had gut surgery, please discuss weaning with your Dietician

Infant Resuscitiation

For First Aid advice for babies (1 year old and under) you will be provided on discharge with a dvd by the Bliss Charity.

Choking Infant

If at any stage the infant becomes unconscious, open the airway, check breathing and, if necessary, begin rescue breaths. If you cannot achieve effective breaths, you must immediately begin giving chest compressions to try to relieve the obstruction quickly:

  • Give up to five back slaps
  • Check the mouth and remove any obvious obstruction.

If the obstruction is still present:

  • Give up to five chest thrusts
  • Check the mouth; remove any obvious obstruction

If the obstruction does not clear after three cycles of back-slaps and chest thrusts dial 999 and request an ambulance, then continue until help arrives.