Your Preemie’s Special Language

preemielanguage

Understanding Your Baby in the Neonatal Intensive Care

The womb is a warm, dark, and cozy home where the baby spends their days and nights curled up with arms and legs tucked in and flexed. Sounds of the mother’s heartbeat are rhythmic and soothing while the outside world sounds are muffled and muted. Boundaries are formed by the uterine walls, and the baby can float, kick, and test these boundaries with great success. This environment is ideally perfect and so crucial for the baby’s growing and developing brain.

All of this is interrupted when a baby is born prematurely. Preemies suddenly face a new and chaotic NICU world polluted with loud noises, strong voices, bright lights, painful procedures, beeping machines, and stressful handling. All these things are often way too much for the underdeveloped neurological system to handle. It’s very difficult for their immature brain to process all these bombarding sensory message that this new NICU environment provides. Even though measures are taken to help control and reduce the negative effects that all this new and artificial stimulation can have on a baby, it’s impossible to eliminate all of the stressors. It is important to understand and recognize what causes overstimulation in your baby, what can be done to minimize the effects, and what you, as a parent can do to help your baby grow and thrive in the best way possible.

Premature babies speak to us in the only language they know, through their behavior. Paying close attention to your baby's body language will help you not only learn what your preemie is trying to tell you, but how to react to it to give your baby the very best start possible. All babies are unique, and based on their gestational age as well as their personality, will have different ways in which they react to their environment. As you spend more and more time with your infant, you will begin to lean their specific  behavior cues, their likes and dislikes, and what your baby can and cannot handle.

The following is a list, based on gestational age, of stress or STOP signs as well as stability or GO cues. It’s important to recognize and respond appropriately to these signals when caring for your preemie.

 

23 to 25 Weeks Gestation

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Your baby’s language- Stress or STOP signs

Minimal stimulation is best at this gestational age. Babies born this early are not ready for social contact and need time to rest and recover from their very early arrival. These behaviors may let you know when your baby is stressed and may need some space or quite time:

 

  • A change in breathing pattern. Your baby may begin to breathe faster or have periods where they stop breathing. (apnea- absent breathing)
  • A change in heart rate. Your baby’s heart rate may start to speed up, (tachycardia) or slow down. (bradycardia)
  • A change in color. (may become blue, gray, pale, or mottled)
  • Increased oxygen requirements.

 

 

26 to 27 Weeks Gestation

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Your baby’s language- Stress or STOP signs

Minimal stimulation is best at this gestational age. Babies born at this stage are not developmentally ready for social contact and may get stressed very easily. The following behaviors may mean your baby is ready for some quite time and rest:

 

  • Change in breathing pattern, heart rate, and or color.
  • An increase in oxygen needs.
  • Frowning or grimacing.
  • Flailing arms or legs, or spreading fingers out wide in a waving motion.
  • Hiccupping.
  • Yawning.
  • Frantic, uncontrolled movements.

 

 

28 to 30 Weeks Gestation

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Your baby’s language- Stable or GO signals

 

 

These behaviors may mean your baby is ready to interact with you:

 

  • Relaxed arms, legs, and facial expressions.
  • Sucking on fingers or hands.
  • Awake and quiet. (may be very brief)
  • Focused gaze. (attention may be very brief)
  • Regular respirations.
  • Regular heart rate.

 

stop

 

Your baby’s language- Stress or STOP signs

Babies at this gestational age need a lot of rest and may get overstimulated easily. These behaviors may mean your baby is stressed or upset and needs some time to recover:

 

  • Change in breathing patterns, heart rate or color.
  • A worried facial expression.
  • Frowning or grimacing.
  • Limp posture.
  • Looking away from you.
  • Flailing arms or legs.
  • Tremors or startles.
  • Spreading fingers apart in a waving motion.
  • Yawning.
  • Hiccuping.
  • Arching back and neck.
  • Crying may be a late stress sign.
  • Falling asleep and unable to wake up. (checked out behavior)

 

31 to 33 Weeks Gestation

go

 

Your baby’s language- Stable or GO signals

 

Babies born at this age are capable of brief periods of socialization. These behaviors may mean your baby is ready to interact with you:

 

  • Awake and quiet.
  • Focused attention.
  • Open eyes.
  • Hands near mouth.
  • Face, arms, and legs relaxed.
  • Sucking on hands or fingers.
  • Fingers curled.
  • Turning toward sound.
  • Regular respirations.
  • Regular heart rate.

 

stop

 

Your baby’s language- Stress or STOP signs

These behaviors may mean your baby has had enough interaction and needs some time to rest:

 

  • Change in breathing pattern, heart rate or color.
  • Frowning or grimacing.
  • Arching posture.
  • Limp posture.
  • Looking away.
  • Frantic or uncontrolled movements.
  • Widening of fingers in a waving motion.
  • Spitting.
  • Hiccups.
  • Yawning.
  • Crying may be a late sign of stress.
  • Falling asleep and unable to wake up. (checked out behavior)

 

34 to 36 Weeks Gestation

 

Your baby’s language- Stable or GO signals

These behaviors may mean your baby is ready for social interaction with you:

 

 

  • Quiet, awake, and alert.
  • Bright open eyes.
  • Focused attention.
  • Sucking on hands or fingers.
  • Face, arms, and legs relaxed.
  • Turning toward sound.
  • Fingers curled.
  • Rooting or sticking out tongue.
  • Can be consoled easily.
  • Rhythmic sucking on pacifier.
  • Regular respirations.
  • Regular heart rate.

 

stop

 

Your baby’s language- Stress or STOP signs

These behaviors may mean your baby is stressed, upset, or may need some time to rest:

 

 

  • Change in breathing pattern.
  • Change in heart rate.
  • Change in color.
  • A worried face or brow.
  • Frowning.
  • Limp posture.
  • Looking away.
  • Frantic or uncontrolled movements.
  • Tremors or startles.
  • Widening of fingers.
  • Arching posture.
  • Closing eyes and falling asleep.
  • Yawning.
  • Hiccups.
  • Spitting up.

 

 

Retrieved from http://opensiuc.lib.siu.edu/cgi/viewcontent.cgi?article=1266&context=gs_rp

The Early Feeding Skills Assessment for Preterm Infants. (n.d.). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828611/

Journal of Perinatology - Recognizing the Potential Effect of Stress and Trauma on Premature Infants in the NICU: How are Outcomes Affected? (n.d.). Retrieved from http://www.nature.com/jp/journal/v23/n8/full/7211010a.html

Neurodevelopmental, Health, and Family Outcomes for Infants Born Preterm - Preterm Birth - NCBI Bookshelf. (n.d.). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK11356/

Understanding Preterm Infant Behavior in the NICU. (n.d.). Retrieved from http://www.pediatrics.emory.edu/divisions/neonatology/dpc/nicubeh.html