Parenting in the NICU - a quick look

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Learning about the NICU and ways of helping and bonding with your preemie can help you manage some of the stress and uncertainty associated with a preterm birth.


Finding special ways to connect & understand preterm birth

The joy of childbirth is often short-lived for parents of preterm babies. Isolation from your newborn, extended hospital stays, and the uncertainty associated with medical procedures, takes a massive emotional and physical toll. This section has been created to help you navigate your way through some tough times. It covers everything from family-centred care, tips on how to bond with your preemie, helping out in the NICU, what to bring, to learning to read your prem's body language


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Baby Watching: Understanding Preemie Baby's Body Language

As you spend more time bonding and watching your preemie baby in the NICU you will begin to understand little signs about how they are feeling.

It can be helpful to think about what certain reactions and behaviors might mean in particular situations. Remember you know the most about your preemie baby’s specific circumstances and spend the most time with them, so your judgments and opinions are very important.

Reading the Signs: Preemie Babies

Everyone has their own personality, likes and dislikes, this includes your tiny preemie baby. As a concerned parent who is probably spending the most amount of time with your baby you will likely notice more about what they like and dislike, what makes them feel comfortable and uncomfortable.

It will probably take you awhile to work out when your preemie baby is lying in a relaxed way or is completely exhausted. Just as it will take awhile for you to understand the positive signs and those that may indicate your preemie is distressed. However, once you start working it out the observations you make will be very valuable to everyone helping to care for your baby.

(Dick, 1993; Liaw, Yuh, & Chang, 2005; Maguire, Bruil, Wit, & Walther, 2007)

Watch your preemies reactions to;

  • Diaper changes
  • Blood tests
  • Breathing tubes
  • Touch in different situations

General Signs & Considerations: Preemie Babies

Parents often become concerned when their preemie baby drops suddenly off to sleep; this is common for preemies, and often means they have had enough. Keep note of whether they seem to prefer being put back in the crib or whether they prefer that you hold them.

Frowning doesn’t always mean that something is wrong or is bothering your preemie baby, they may just be concentrating or mimicking your expression. Grimacing on the other hand is more likely to mean he/she isn’t happy about something.

Some parents report feeling a sense of rejection when their preemie turns their head away while they are looking at, talking gently, or stroking them. However this is often a very good sign because it might mean they are mature and well enough to move away or may have been interested in looking at something that grabbed their attention.

(Dick, 1993; Liaw, Yuh, & Chang, 2005; Maguire, Bruil, Wit, & Walther, 2007)

Signs That Your Preemie Might Want Help

Take note of the following list of signs that might mean that something is either physically not right or that something is bothering your preemie baby. Keep in mind that it may have do to with whatever is happening at that moment and may not be a sign of a serious problem. If you are concerned though, ask your nurse or doctor.

Avoidance signs will often appear in groups or certain behavior may be repeated (e.g. 3 sneezes). If the stimulus causing the avoiding behavior is reduced or removed straight away, your preemie has more chance of maintaining balance and avoids over-stimulation resulting in stronger signs of distress.

preemie babies & behavioral cues of distress

Behavioral cues:

  • Yawning
  • Sneezing
  • Hiccups
  • Gagging
  • Straining
  • Coughing
  • Squirming
  • Arching
  • Grimacing, stressed or stiff look on their face
  • Tongue thrust
  • Twitching
  • Stiff or tense arms, legs or body
  • Limp posture
  • Sudden or jerky movements
  • Finger splay
  • Eyes floating
  • Looking away
  • Staring
  • Glazed look

Strong Signs of Distress:

  • Sudden state change, such as crying and fussing changing to drowsy or sleep
  • Is being frantically active and cannot seem to calm down
  • Blotchy, paler, dusky or very red skin color
  • Changes is breathing
  • Breathing fast and/or heartbeat has suddenly sped up
  • Changes in oxygen levels
(Dick, 1993; Liaw, Yuh, & Chang, 2005; Maguire, Bruil, Wit, & Walther, 2007)

Positive Signs

There are many positive signs you can look out for and you might notice others that are relevant for your preemie baby. Certain actions referred to as approach and/or coping behaviors show you that your baby is trying to settle themselves, keep themselves in balance, calm their movements, and to interact and look for contact.


Signs of feeling comfortable:

  • Lying with relaxed arms and legs
  • Has eyes open and shiny, looking alert
  • Face is relaxed and smooth rather than stiff, or with lines or furrows
  • Orientation to voice or sound
  • Smooth state change (sleep to wake)
  • Snuggling
  • Smooth movements
  • Concentrated frowning
  • Tries to curl over sideways
  • Has pink, even skin color

In more mature preemie babies:

  • Looks at you, or an object with interest, rather than staring blankly
  • Might try to smile
(Dick, 1993; Liaw, Yuh, & Chang, 2005; Maguire, Bruil, Wit, & Walther, 2007)

Signs of Self-Comfort

There are many signs that show that your preemie baby is trying to comfort themself.

preemie baby signs of self-comfort

When your baby tries or manages to:

  • Clasps hands together
  • Brings hands up to mouth or face
  • Sucks on fingers or hands
  • Holds onto the corner of their blanket
  • Has feet, one on top of the other
  • Tucks into a cosy & curled-up position
  • Turns gaze or head away


Technical References

Bradford, N. (2003). Your premature baby the first five years. Toronto: Firefly Books.
Dick, M. J. (1993). Preterm infants in pain: nurses' and physicians' perceptions. Clin Nurs Res, 2(2), 176-187.
Liaw, J.-J., Yuh, Y.-S., & Chang, L.-H. (2005). A preliminary study of the associations among preterm infant behaviors. J Nurs Res, 13(1), 1-10.
Maguire, C. M., Bruil, J., Wit, J. M., & Walther, F. J. (2007). Reading preterm infants' behavioral cues: an intervention study with parents of premature infants born <32 weeks. Early Hum Dev, 83(7), 419-424.



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 

Read More: Defining Preterm birth



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