NICU Care Time After Discharge - What Can Stay and What Can Go
When your baby was in the NICU, one of the first things you learned about was likely your baby’s “Care Times”. This special time of day typically started with getting your baby’s vital signs such as blood pressure and temperature. Your nurse may have done a “Head-to-Toe” assessment and then helped to change their diaper. Then came the baby’s feed by bottle, breast or tube. Many NICUs have babies’ Care Times on a every three hour or every four hour schedule – you might have heard that your baby was a “8/11/2/5 baby” or a “9/1/5 baby” or something in between.
But now your baby is finally discharged and you might be wondering how much of the NICU schedule should you keep at home?
Here is my list of what part of Care Times you can leave behind in the NICU and the things you might want to keep:
Keep: Basic Vitals
You are almost definitely not going to need to check your baby’s blood pressure at home, but it can be helpful in the first days home to take your baby’s axillary (armpit) temperature once or twice a day. The temperature of the NICU environment that your baby was used to might be quite different than yours at home. By taking a temperature, you can understand what type of clothes the baby will need to wear to stay warm without overheating. The general rule of thumb is that a baby’s temperature should be between 36.5-37.3 C (97.7- 99.1F). If colder, be sure to add a layer of clothing and then recheck in 30 minutes. If warmer, remove a layer and recheck. If the baby remains warmer or colder than the recommended temperature despite changing their clothes, you should notify your pediatrician. NICU babies are at a much higher risk for infection and one of the earlier signs can be a temperature outside of the normal range.
If you check a few times and your baby’s temperature is normal, then you can stop regularly checking. But note how your baby’s skin temperature feels at the normal temperature (checking their upper back under their clothes using the palm of your hand is the most accurate place to feel a skin temperature). That way you can understand their normal, so if it feels different to you in the future you can consider checking their axillary (armpit) temperature.
You should also take a moment each day to observe your baby’s level of activity and breathing pattern. Are they awake and active or difficult to wake up? Are they breathing quickly? Does it look like they are using extra muscles to breathe? It can be helpful to start this practice while in the NICU so you can understand how the vitals signs on your baby’s monitor match to how they look when you observe them. Once you understand your baby's unique normal, you can feel more confident about when to check in with your pediatrician.
Keep (mostly…): Start with a diaper change before a feed
Many NICU babies (especially preemies) tend to be quite sleepy throughout the day. It can be helpful to start with a diaper change to begin the arousal process so the baby is nice and alert before starting a feed. That way if they fall asleep at the end of their feed, you can tuck them in for a nap without worrying about waking them up again with a diaper change. Sometimes a diaper change with a full belly can also cause the baby to spit up.
However, if your baby is already awake and hangry you can absolutely start with a feed! Some babies may also fall asleep halfway through a feed. That’s okay! They might just need a power nap to regain their energy. Lay them down on a safe surface and let them snooze for 5-10 minutes. Then you can try to wake them up again with a diaper change. If they are still sleeping after a change, don’t worry about forcing them to eat the rest of the feed. Baby might just need some extra sleep and then wake up hungry and ready to eat in another hour or so.
With that in mind…
Leave: Rigid care times and a strict schedule
The every 3 hour care time schedule in the NICU was created to help structure the day for a NICU nurse that might be caring for three babies or more throughout their shift. Rather than having all three babies hungry and crying at the same time, the thought is to stagger their feeds at half hour intervals so the nurse can devote time to each baby while the others are sleeping (this works most of the time, but some babies just don’t get the memo).
At home, the best plan is to follow your baby’s lead. This might mean your baby still wants to eat every three hours exactly and that’s okay. But it also might mean that your baby wants to eat every two hours in the evening and then sleep for a four hour stretch and then eat and then sleep for another three hours and then sleep and then eat on and off every hour. That’s okay too! It can be quite frustrating (and exhausting) for families to lose the structure of the every three hour schedule. But you will likely find that your NICU baby eats better and sleeps more soundly when you follow their lead. It is helpful to understand generally how much formula or breastmilk your baby should be eating in a 24 hour period. That way even if they don’t take a “full feed” at one feeding time, you can still know that they are getting enough throughout the day.
Reminder: unless recommended otherwise by your baby’s care team, most NICU babies should not go any longer than 4 hours between feeds. If your baby is still sleeping after four hours, you will need to wake them up to eat.
Keep: the same feeding techniques your baby used in the NICU
During the first days home, it is important to keep using similar techniques that the nurses and therapists used while feeding your baby in the NICU. This way your baby can feel safe and secure in the feeding process and not feel overwhelmed by too many changes in their environment. For many babies this will likely mean feeding in a semi-upright/side-lying position with a slow flow nipple and using a paced feeding technique. Once your baby grows and with approval from your pediatrician, you may be able to introduce new bottles and methods of feeding.
Keep: charting the basics
NICU nurses spend much of our days charting in the electronic medical record. While that level of detail is not necessary at home, it can be helpful to keep a basic record of your baby’s day including the number of wet/dirty diapers, the frequency of feedings and how much your baby ate at each feeding. This way you can easily answer any questions your care team may have without having to rack your brain.
Tracking can be as simple as a notebook you keep in your room or notes on your phone. But there are also many different apps that can be used to track details that are fun and easy to use. My favorite with my girls is the Huckleberry app. It grows well with them and can be shared with others, so your partner or other caregiver can also log details in their phone.
Keep: protected sleep in a safe environment
After each care time, your NICU nurse likely swaddled your baby and laid them to sleep on their back in a flat bassinet with a firm mattress and no other items in the bed with them. It also may have been encouraged to let the baby sleep undisturbed until the next care time.
At home, your baby should continue to sleep in this type of Safe Sleep environment when sleeping unobserved. NICU babies and preemies especially are at a higher risk of SIDS (Sudden Infant Death Syndrome), so being mindful of removing risks from your baby’s environment is extremely important. You can learn more about safe sleep here.
Protecting windows throughout the day for undisturbed sleep is also very important. NICU babies can sleep for more than 18 hours a day and it is during this time their bodies are doing the important work of growing and developing.
That being said…
Leave: the idea that your home environment should look the same as the NICU
In the NICU, you likely were confined to your baby’s room or bedspace and were limited by all the cords, tubes and wires. At home, even if your baby still has medical equipment, there is much more flexibility on where your baby can go! Hold your baby as much as you (and they) want, babywear in a carrier if medically cleared, take them on walks in a stroller, do tummy time and play on the floor. It is these rich and wonderful experiences that make being home so much more beneficial for you and your baby than the more sterile NICU environment.
Take a moment each day to celebrate the little wins and look back to see truly how far you and your sweet baby have come.
You’ve got this.
And if you want a safe space to connect with other NICU families and get your questions answered by people who get it, we’ve got you covered.
Learn more about 1:1 post-NICU support services or join our Life After NICU online community here.
Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.
