Best Preemie Products

Premature babies need pretty much the same things that full-term babies need. They just tend to be smaller, and require a little more padding sometimes. And they need to be warmer. Preemies are born with very little subcutaneous fat. Add to this the fact that they often have difficulty keeping their temperature up! I don’t list any hats here among these “Best Preemie Products”, but don’t forget them! Babies in general lose a lot of heat from their heads, and this goes double for premature babies!

Best Preemie Products

Swaddling Blankets

Such a simple product, so much good! I’m still astonished by how quickly even the fussiest, most sensitive baby calms almost instantly when she’s swaddled. Swaddling (at least partially) reproduces conditions inside the uterus, where the baby feels most secure and warm. It’s not a difficult skill to learn. Done right, you can help your baby settle down to sleep in practically no time.

The key is to achieve a balance between snugness and constriction. Most new parents, fearing that the baby is too fragile, err on the side of keeping the swaddling too loose. This seldom works. With a little practice and good feedback from baby, you’ll gain confidence and swaddle like a pro in a few days.

There are dozens of videos on YouTube that teach good swaddling methods I like this one from Raeanne Brazee. Practice makes perfect.

Best Preemie Products: Sleep Sacks!

For sleep wear, there are two important things to keep in mind. The first is that preemie sizes are always too big… at first.

It’s just a fact of life and product sales that parents of preemies must deal with. Happily, the very little one grows into her clothes remarkably quickly. The second point is probably more important: Your baby doesn’t need to walk around in pajamas so why struggle to get her legs into pajama bottoms? One of the things I like most about the Carters One Pieces is the zipper. I’ll be forever astonished at the number of baby clothes with as many as 15 snaps. Speaking as a Dad, I protest: there is no way to do up all those snaps correctly! Same goes for buttons, only more so.

Best Preemie Products: Hug Me Joey Car Seat Insert

The hug me Joey is just the insert that goes in your existing car seat. It is a wedge and a bumper.Why is this important? Existing car seats must sit the baby more or less upright. But the best, safest position for a premature baby is laying on her back on a flat surface! The wedge and padding provides a compromise. It is to be used only when the baby is in the car. It’s not a good idea to leave a preemie in the seat and bring her inside, as tempting as that might be, especially if she falls asleep. For her safety, and to help prevent “flat head“, the car seat and Joey wedge should only be used when you take baby for a ride.
Another oddity about the Joey wedge I’ve observed is that parents of preemies get so used to using them that they continue to place the wedge in the car seat long after the baby is too big for it! Here’s a good index: when the baby gets to full-term, corrected gestational age, you can put the wedge away (or lend it to a friend!)

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Best Preemie Gear: Dr. Brown’s Bottles and Nipples

Premature babies have particular feeding issues that full-term babies do not. If your preemie is not able to latch onto your own nipples at first, Dr. Brown is here to the rescue!
They often have difficulty coordinating sucking and swallowing. They also have smaller mouths and stomachs (obviously!) so they often cannot handle the rate of flow that comes out of “regular” nipples.

Eating consumes a lot of energy for a little baby, as paradoxical as that sounds. The smaller the preemie, the more energy relatively they spend trying to eat! Feeding and growing is her #1 job of the preemie. Anything we can do to help her grow without taxing her system too much in the process, is a good thing. The “ultra preemie” nipple is smaller yet. The rate of flow is only 35% that of the original Dr. Brown’s preemie nipples. The “younger” preemies need to rest a lot and breathe more often. This nipple helps the baby avoid becoming exhausted during feeding.

Premature Baby Sleep Training: When and How

Premature baby sleep training is a special kind of sleep training.

The basic principles of sleep training apply, with a twist. We have to pay attention to a couple key questions. “What is your baby’s corrected gestational age?” and “Does your baby have any special difficulties related to her prematurity?”

I will review some basics about preemies and sleep training. Then I’ll talk about which sleep training methods are best for premature babies and why.

Premature Baby Sleep Training

The most important thing to know about premature babies is the most obvious. They were born early! But it might be better to say that they were born before they were ready. Harvey Karp would argue that even full-term babies are born before they are ready to be here on earth, but that is another subject!

Sometimes a premature baby will be born before her lungs are ready to breathe air on earth. These babies obviously need to stay in the Neonatal ICU (NICU) until they can breathe on their own. Still other preemies are born before they are able to eat on their own. They too need to stay in at least a special care nursery until they can “remember to eat”.

But the most important difference for our purposes is premature baby sleep. Premature babies sleep differently from full-term babies because, just like their lungs and stomachs are immature, so are their brains.

Turn Down the Noise!

An important difference between us grown-ups and babies is that we have a filter. We can filter out sounds, feelings, smells, tastes, and sights that interfere with our ability to focus. Babies can’t do this. They have to pay attention to everything. And so it’s easier for babies to become overwhelmed by too much sensation. This is what we mean by “overstimulation”. When babies get overstimulated they get fussy, they cry more, they eat poorly, and they don’t sleep! Premature Baby Sleep Training 2

How ever you decide to sleep train your preemie, you have to keep this in mind, particularly if she is still younger than her due date. The risk of overstimulation can be too high with babies with a corrected gestational age less than 40 weeks. For these babies it may be best to put off sleep training.

So You Say You’re Ready for Premature Baby Sleep Training?

Maybe so, but is the baby ready? There are a couple of ways to tell. First, does the baby weigh around what a full-term baby weighs? If she weighs less than 5 lbs 8 oz, it may be difficult. She’ll need to do a lot a feeding for catch-up growth. I recommend discussing with the pediatrician if you want to start at a smaller weight.

Does the baby have any problems related to her prematurity? For example, many preemies have reflux. A premature baby with reflux may be fussy and have trouble settling. Other premature babies go home from the hospital needing oxygen. These are babies I might not recommend sleep training until they are breathing room air. Again, this is something to discuss with the pediatrician.

Premature Baby Sleep Training MethodsPremature Baby Sleep Training 3

All the various sleep training methods fit into two broad groups: baby-led and parent-led. Briefly, baby-led methods lean heavily on paying attention to the premature baby sleep cues. These are eye-rubbing, yawning, and beginnings of fussiness. Parent-led methods lean heavily on providing structure for baby sleep. This includes starting meals at the same time every day, and encouraging naps at the same time every day.

The reality of premature baby sleep training is much simpler: it’s a combination of baby-led and parent-led methods. This is sometimes referred to as “combination” sleep training. That is to say that the most successful baby sleep training that I know of involves a combination of following baby’s cues and providing structure. This is the method I recommend in my practice.

I do make a slight exception for premature babies. Because feeding and growing is so important, I lean more toward following her feeding cues. Your pediatrician may have given you target for the number of calories she should have every day. If so, it’s best to do what you can to make sure she gets enough formula or breast milk to do catch-up growth.

The Ideal Age for Premature Baby Sleep Training

So what is the ideal age to sleep train a premature baby? The key is corrected gestational age. If the baby were full term, the ideal age for sleep training would be four months of age. Prior to that age, you have laid most of the groundwork already. You’ve learned baby sleep cues, and you’ve started providing structure to the baby’s day. You might not even need to sleep train at this point! If you’re doing premature baby sleep training, you want to aim for four months corrected. For example, if your preemie were born at 36 weeks (4 weeks early), your goal should be five months of age. At this point the baby can be expected, reasonably, to achieve the sleep patterns of a four month old full term baby.
Premature Baby Sleep Training 4
I say “ideal age” for premature baby sleep training, because this is the age at which I believe you’ll have the most success. Four months corrected is about the age when a girl baby can soothe herself to sleep. You can put these girls down in the crib fully awake. And they can learn to fall asleep without assistance. For boys, the age is somewhat later. Certainly by six months (corrected) a boy can master the self-soothing skills needed to settle himself… and to sleep through the night (if he’s well-fed!)

Summary

  • Premature baby sleep training is just like full-term sleep training, with some exceptions. You need to pay attention to any health issues related to prematurity. And you should lean more towards following her cues.
  • Providing structure is still important. Whichever method you choose to sleep train your preemie, she’ll do better if her day is as regular and as predictable as possible.
  • Expect a girl preemie to sleep through the night at around 4 months (corrected), and a boy by 6 months (corrected)
  • If there are any health concerns at all, please contact your pediatrician.
  • If the baby’s health checks out, you still are having sleep difficulties, I can help!

Where Should a Premature Baby Sleep?

It’s scary to come home from the hospital with a premature baby. I should know. I did it. Twice. We had tons of questions. Some of them didn’t even occur to us until we got home! One of these was “where should a premature baby sleep?” You may have/had this question yourself. Even if you ask the nurses before you leave, you may not get a satisfactory answer. Here are some of the issues you may want to consider.

Where Should a Premature Baby Sleep?

Like so many answers in the world of babies, the answer is “it depends”.

For premature infants, it depends on a couple of very important factors: your preemie’s corrected gestational age, and any particular health problems she might have.

Before dealing with health and gestational age, though, let’s re-phrase the original question: “where are you and your baby going to sleep?” I do this re-phrasing because you and the baby are going to sleep very close to one another for at least the first few weeks, possibly until the baby is 4 months old, corrected. Why so long? Because the baby will probably be feeding fairly often, especially if she needs to do “catch-up growth“. It will put a lot less stress on you to be near her during these critical weeks.

Corrected Gestational Age

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You’re going to have to find another place for the laptop

If the baby comes home at or around 36 weeks corrected, you may want to consider sleeping in a place where you can spend the majority of the day, and take care of your own needs as well as those of the baby (or babies!). For many parents, the bedroom works great, particularly if access to a bathroom is convenient.

The Quietest Room

For these preemies, and especially for babies with even earlier gestational ages, the answer to “where should a premature baby sleep?” is ” A very quiet place!”  You may have noticed that the neonatal ICU (NICU) was relatively quiet, with subdued lighting. The nurses there make sure the environment is as sensory-depriving as possible. The bells and alarms in NICUs have even been specially designed to be the least disturbing to sensitive little preemies as possible.

You should pick a space in your home that you reasonably can keep as free of sensory stimulation as possible, just like the NICU. This could be your living room, or it could be the den. You can experiment with this as well. Choose the room where she sleeps best!

Back to Sleep!

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Is your living room now the nursery?

Many preemie parents know that the baby has under-developed motor skills. These parents worry about back sleeping because they are afraid the baby will spit up and choke. However, the American Academy of Pediatrics advises that when a baby is discharged from the NICU, it means she should be able to turn her head to avoid choking if she spits up. The baby should always sleep on her back, on a firm surface. It turns out that premature babies are more at risk of SIDS than full-term babies. That is why it is even more important for your preemie to sleep on her back.

Where should a premature baby sleep who is particularly “spitty”? The ones who have reflux? Your pediatrician may recommend that you have the baby sleep inclined up at an angle of 30 degrees or so. This is not done with pillows or any other soft object! The object is to tilt the whole bassinet up, the way you may have seen in the NICU. This “anti-gravity” technique works for pregnant women with reflux as well! The important point to remember here is that even though the baby’s body is angled up, she is still on her back!

Take Home Messages

  • Find a place in your home that is the most quiet and otherwise free from sensory stimulation.
  • Find a place where you can sleep close by her for several weeks at least.
  • Make sure she sleeps on her back on a firm surface.
  • Her goal is to feed well and grow well. This is most important until she reaches her “due date”.
  • Ask your pediatrician about about any concerns you have along the way.

Any sleep questions? Ask ME?


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When Will My Preemie Sleep Through the Night?

Many parents want to know when, at long last, will their preemie sleep through the night?

It’s a good question.

First Things First

Perspective is an easy thing to lose. So is patience, especially when you are massively sleep-deprived and stressed out. I know. I’ve been there.

My second child was born at 35 weeks. He spent the first 13 days of his life in the NICU. We were lucky. Every day I walked past the ventilators and isolettes of babies who would be living in the NICU for weeks, possibly months. I couldn’t imagine what kind of stress these parents were feeling.

And yet, life was stressful. We already had an energetic pre-schooler at home. Now we were caring for a tiny little guy who ate well, but he was so… small!

I saw a picture of myself taken when the baby was 4 months old. I gasped out loud. I had lost a ton of weight without realizing it. I’m quite sure I did not lift a finger of exercise. And the majority of my diet probably consisted of eating stuff that my 2 1/2 year old dropped on the floor.

I don’t remember a whole lot from that first year, but I do remember asking when will our preemie sleep through the night.

And I remember stopping myself. “What am I saying?”

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Would that it were so simple!

We were lucky we had a healthy, growing boy. We had avoided a much worse fate. Was I asking too much by wondering when would our preemie sleep through the night?

With the passage of time and the acquisition of some perspective, I can answer ‘yes’, I was asking too much. He’s in high school now. The time went by so quickly. In the big picture, the sleep-deprived part of my life was very short!

When WILL My Preemie Sleep Through the Night?

There’s an answer to this question. But when parents ask me, I always begin by telling them my story. I want to help them gain some perspective on their situation. Most of them had endured extreme stress, as I had. I want them to know that there is a light at the end of the tunnel. I want them to know that with the passage of time, they too will see that the sleep-deprived part of their lives was relatively short.

The due date is a big event. I counsel parents to celebrate this day. Take stock of what they’ve gone through, and pretend to start the clock again.

Full term babies start to sleep through the night between 4-6 months of age. By “through the night” I mean 5-6 hours. I give a range of 4-6 months because girls tend to reach the milestone closer to 4 months, boys closer to 6 months.

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Night-night!

For babies born early, you can predict when they will sleep through the night using “corrected gestational age“. When they reach 4-6 months, corrected, you can expect that they should be ready to stretch those hours of blissful sleep together.

Now, I’m hesitant to dangle promises. I hate to write checks that your preemie cannot cash. But I should say that often a preemie will sleep through the night prior 4-6 months corrected. This is because of a phenomenon I call “catch up development”. What I mean is that by being here on earth, a baby learns some things that she might not otherwise know if she were “inside”. Sometimes the experience of being here helps accelerate certain developmental milestones. Sleep is one.

For example, there is the the development of circadian rhythm, the daily cycle of her body’s systems. It goes without saying that there is no day and night inside the uterus! Once she is out here in the world, the relative brightness of day and the relative darkness of night helps train her brain to adopt a day-night sleep cycle. Sometimes, despite premature birth, a baby can be “nudged” into sleep habits that are more mature than her corrected gestational age.

Summary:

  • Feed the baby! If your pediatrician suggests that the baby needs to eat every 3-4 hours, you may need to wake her up, even if she’s sleeping! If she’s gaining good weight (an ounce per day), waking her may not be necessary.
  • Back to sleep saves lives! She should always sleep on her back, on a firm surface.
  • SHHHHH! Premies can be more sensitive to sensations than full-term babies. Try to keep her environment as calm and quiet as possible. This will help her sleep better.
  • Consistency, consistency, consistency.  Try to keep the baby’s day as regular and as predictable as possible. Falling into a routine will help her eat and sleep!

If you need any help getting your preemie to sleep, I can help!

How Long Does a Premature Baby Sleep?

How long is my preemie supposed to sleep?

There are two reasons why I get this question.

The first is that the parents are worried the baby is sleeping too much. The second is that they are concerned the baby is sleeping too little. In either case, they’re worried!

How Long? It Depends

The answer to the question depends on a number of things, not least being “corrected gestational age”. This is simply the age of the premature baby corrected for the baby’s actual due date. Take, for example, a baby born at 36 weeks gestation. She was born four weeks early. So when she is 8 weeks old (her “chronological age”), we say her corrected gestational age is 4 weeks.

The corrected gestational age is a way of “cutting slack” for a baby who may not achieve the developmental milestones you’d expect at a certain age. Those milestones include sleep. With premature infants, I assume their sleeping habits approximate what they should do at their corrected gestational age, not their chronological age. I don’t expect a baby to sleep like a full-term infant until she reaches her due date!

How Long Do You Cut Slack?

Now the question becomes “how old does a baby have to be before you can stop calculating corrected gestational age?” Doesn’t it get silly at some point?

Both my children were born prematurely. The younger was born at 35 weeks, or 5 weeks early. At this writing he is now a Freshman in high school. And I tell people he is still 5 weeks behind. It’s a joke of course. To his enduring credit, my former preemie laughs politely when I tell that joke in his presence.

The serious answer to the question is: stop correcting for prematurity some time between 6-12 months.

Premature Sleep

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How long?

Premature babies sleep a lot. They can spend between 20-22 hours per day asleep. This tends to be a lighter sleep, meaning that it does not take much for these babies to be aroused. And in fact, preemies do wake more often than full-term babies, but never for very long, and they do not often reach a very alert state.

This is why it’s especially important for a premature baby to sleep in a place that is as free from stimulation as possible: low noise, low light, and as little handling as possible.

The exception of course is feeding. A premature baby’s number one priority is feeding and growing. Your pediatrician may advise you to wake the baby every two to three hours to feed, at least in the early stages. This is one of two instances in which I recommend violating the “never wake a sleeping baby” rule! (The other instance is twins.)

Back to the Parent’s Question

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How long indeed?

Precisely because feeding and growing is the number one job, the answer to the question “how long should my preemie sleep?” is “how ever much time allows the baby to feed and grow well”. You will probably discuss “how much is enough” with your pediatrician. In general, a premature infant will eat and sleep, and do very little else for the first 2 months or so. It’s much tougher and more labor-intensive than it sounds!

It will be several months before your preemie will be able to sleep through the night. If a full-term baby can sleep through the night (meaning 5-6 hours) between 4-6 months, you can expect your premature baby will be able to accomplish the feat at 4-6 months corrected gestational age. That may mean more weeks of sleep deprivation than you might otherwise get!

Here are the important take-home messages.

  • Premature infants can sleep 22 hours per day, never very deeply, with frequent drowsy but awake periods
  • Have the baby sleep on her back, swaddled, on a firm surface.
  • You may have to violate the “never wake a sleeping baby” rule in order to get her to make “catch-up growth”
  • Expect she’ll adopt more “normal” baby sleeping habits when she reaches her due date.

Any issues getting your premie to sleep?  I can help you!

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