YOUR PREMATURE BABY A MESSAGE TO THE FAMILY ARKANSAS STATE BOARD OF HEALTH T. T. ROSS, M. D. State Health Officer DIVISION OF MATERNAL AND CHILD HEALTH 19Jf7 YOUR PREMATURE BABY A MESSAGE TO THE FAMILY ARKANSAS STATE BOARD OF HEALTH T. T. ROSS, M. D. State Health Officer DIVISION OF MATERNAL AND CHILD HEALTH 191fi BIRTH RECORD I was bom at (Date) (Home — Hospital) My name is My Parents are (Mother) and (Father) I was horn .... ... weeks too soon. I weighed I —.at birth. Here Is How I Gained My First Three Months: One Week Seven Weeks ..... Two Weeks Eight Weeks ..... Three Weeks Nine Weeks Four Weeks Ten Weeks Five Weeks ... Eleven Weeks ... Six Weeks Three Months .. DEAR FAMILY OF A PREMATURE BABY: You have been given a little baby to care for, a tiny boy or girl who weighs less than five and a half pounds and who is therefore called a premature baby. However, just because it is small does not mean that your baby will not grow up well and strong. It will take time for the pre- mature baby to catch up, and the smaller the baby is at birth, the longer that time will be. But if you keep him warm, guard him against illness, feed him carefully, love and want him, you will be helping him along the way. The doctor and the public health nurse have given you directions for taking care of your premature baby in the best possible way. This book is to help you to follow these directions. Some of them may seem unnecessary, but they are all planned according to the baby’s needs. Perhaps if we tell you some of the difficulties that the baby has because he was born before he was ready to live in the world, you will understand why it is important to take such good care of him. In the first place it is difficult for the premature baby to keep his body at a normal temperature. The part of the baby’s brain that regulates his temperature is not fully de- veloped; also the baby has little fat on his body to act as insulation to keep his body heat in. So, if the air surround- ing the baby is too cool or too hot, his body tissue will be- come cooler or warmer than it should be. Therefore, it is best if the baby is kept in an incubator so that the temper- ature of the air surrounding him can be kept at the proper temperature at all times. Also, we must be careful not to chill the baby by removing him from the incubator into a cool room or by putting cold clothes on him. In the second place the premature baby has more trouble breathing than does the full term baby. Due to the fact that the muscles which are used in breathing are weak, the baby does not breathe in very much air at a time. Then, too, until he becomes strong enough to breathe deeply, his lungs will not be completely opened. Because of these dif- -5- ficulties the baby is able to breathe better if we handle him as little as possible and if we make sure that the baby’s clothes and blankets are not put over the baby too tightly. This also is why some premature babies need oxygen at times and need to be in the hospital to get it. In the third place the baby has difficulty in eating and digesting his food. This is due both to the fact that he is weak, and therefore cannot suck well, and to the fact that his digestive system is not developed enough for him to be able to make full use of the food. Also, because his stomach is small, ff he is fed too much, he is apt to vomit. Therefore, we want to give him his food in such a way that he can take it without using too much strength, and we want to feed him the food that he can best digest. Finally, since he is so weak and so small, he is more apt to become ill, so we must try to keep him from getting any sickness such as colds and diarrhea. We carry the germs of these diseases on our hands and in our nose and throat. Therefore, we do not want to get our faces near the baby, and we never want to handle the baby until we have washed our hands. Keeping the baby in the incubator will also help to keep other people from getting too close to him. With best wishes for success in rearing your prema- ture baby, we are, Sincerely yours, DIVISION OF MATERNAL AND CHILD HEALTH, Arkansas State Board of Health. INDEX IMPORTANT THINGS TO KEEP IN MIND IN CARING FOR THE BABY Page Signs of Illness 9 If the Baby Becomes “Blue” 9 Have Breast Milk If Possible 9 Weighing the Premature Baby 10 He Is All Right When 10 PROTECTION OF THE BABY FROM HARM Washing Your Hands 11 Keeping People Away from the Baby 11 Working from the Baby’s Head Down 11 Covering the Baby 11 When Removing Pins 12 USING THE INCUBATOR Heating the Incubator 13 To Add Moisture to the Air 13 About the Glass Tops 13 Cleaning the Incubator 14 FEEDING THE BABY Boiling the Feeding Things 15 Feeding with the Medicine Dropper 15 Feeding with the Small Bottle 15 Feeding with the Large Bottle 15 Breast Feeding 15 Expressing the Mother’s Milk 16 Boiling the Breast Milk 16 Some Premature Babies Do Not Want to Eat 16 Warm the Baby’s Food 16 INDEX—Continued Feed In the Incubator 16 Hold the Nursing Bottle 16 Belching the Baby 17 Giving the Baby Water 17 If Your Baby is Vomiting 17 DIAPERING THE BABY When to Diaper 18 Getting Ready 18 Diapering 18 Bowel Movements 18 Taking the Temperature 19 Have Warm Diapers Ready 19 BATHING THE BABY When to Bathe 20 Before Taking the Baby Out of the Incubator, Remember 20 When Getting the Baby Ready to Take Out of the Incubator, Remember 20 When Bathing the Baby, Remember 21 Conditions to Look For 21 Making the Bed 21 Dressing the Baby 22 IMPORTANT THINGS TO KEEP IN MIND IN CARING FOR THE BABY Signs of Illness The following signs of illness may be serious and should be reported to the doctor as soon as possible: Vomiting. Loose or many stools. Constipation. Blueness. Bleeding of any kind. Difficulty in breathing. High or very low temperature. Pustules or rash on the skin. If the Baby Becomes “Blue” If the baby becomes “blue,” try to improve his breath- ing by doing the following things while the doctor is coming: Gently thump the bottom of his feet with your finger in order to make him cry. See if he has mucus in his mouth. If so, turn his head to the side, raise his body a little higher than his head, and suck out the mucus with a medicine dropper. Be careful not to hurt his throat or tongue. Put a few drops of aromatic spirits of ammonia on a piece of cotton (as the nurse has shown you), and give the baby a few whiffs of it. Have Breast Milk If Possible The best feeding for the baby is breast milk. Breast milk is the ideal food for all babies, and especially for prema- ture babies. Even a little bit is better than none at all, so everything possible should be done to try to have breast milk for the baby. Weighing the Premature Baby The weight of the baby is not as important as his con- dition. If the baby’s condition seems good when he is born, he should be weighed sometime during the first day; other- wise, he should not be weighed until his condition is good. Weighing him once or twice a week after his condition be- comes satisfactory is enough. He Is All Right When— If the baby is getting along all right, he takes his feed- ings well and does not vomit. He gains weight steadily. He sleeps quietly and sleeps most of the time. He has good color, sucks eagerly, and is active when awake. PROTECTION OF THE BABY FROM HARM Washing Your Hands We have said that we want to prevent the baby from becoming sick and that many of the germs which would make the baby sick are on our hands. The best way to get rid of these germs is to wash our hands well with soap and water at all times when we may have got some germs on them. Wash your hands every time before you handle the baby and before touching anything that will be put on or near him. Wash your hands before diapering the baby. Wash your hands before feeding the baby and before touching any of the things with which you feed him- Dry your hands on a clean diaper or other clean cloth which you alone use. Use this cloth only when taking care of the baby. Hang it on a nail be- tween two newspapers as the nurse has shown you. Keeping People Away From the Baby Do not let anyone other than the person taking care of the baby handle him or come near him. Especially keep all children, including his brothers and sisters, away from him. Work From the Baby's Head Down In caring for the baby handle his head first, and then care for the lower part of him. For example, you should never change his diapers and then feed him without wash- ing your hands. Covering the Baby DO NOT WRAP THE BABY IN BLANKETS. PUT THEM OVER HIM. OTHERWISE HE MIGHT BE SMOTHERED. In handling the blankets over the baby, never touch the part of the covers which goes next to the baby’s face. Han- dle the blankets at the outer edge. When uncovering the baby to diaper him, ROLL the blankets down to the foot of the incubator. Be sure you roll them so that the part that goes next to the baby’s face does not touch the foot of the incubator. When Removing Pins When removing pins from his shirt or diaper, put the pins in the lower sheet, making sure to close them so that there will be no danger of his being scratched. Never leave any pins, opened or closed, lying around loose near the baby. USING THE INCUBATOR Leave your baby in the incubator at all times except when you are bathing him—if he is able to have a bath. Heating the Incubator When the incubator is being heated by the use of hot water in jars, watch the thermometer inside the incubator so as to keep the temperature of the incubator as warm as the nurse has told you to. As it becomes necessary to re- heat the water, change one jar at a time. To Add Moisture to the Air Add water in the tray at the foot of the incubator as needed. This gives moisture to the air that the baby breathes. About the Glass Tops In cool weather do not remove the glass tops from his incubator. In hot summer the glass tops may be left off, but keep the open incubator covered with the mosquito netting so that flies and mosquitos cannot bite your baby. There are some things to remember about handling the glass top. Wash your hands, every time, before you touch the glass. To work with the upper part of the baby, as for feed- ing, slide both glass tops to the foot of the incubator. To work with the lower part of the baby, as for diaper- ing, separate the glass tops. To work at the foot of the incubator, as when removing the warm diapers from the foot, slide the glass tops to the head of the incubator. NEVER REMOVE THE GLASS TOPS ENTIRELY FROM THE INCUBATOR SINCE YOU WILL THEN EXPOSE YOUR BABY TO AIR THAT IS COLDER THAN THAT IN HIS INCUBATOR. Every day clean the top glass of the incubator with a clean soapy cloth and then dry. Wipe the outside with a damp cloth. When the incubator bed is being made, wipe the inside of the incubator with a clean damp cloth also. Cleaning the Incubator The doctor or the nurse has left instructions with you as to what to feed the baby and how to give it to him. Fol- low these instructions carefully. DO NOT FOLLOW ANY OTHER PERSON’S ADVICE. FEEDING THE BABY Boiling the Feeding Things All the bottles, medicine glasses, nipples, medicine drop- pers, spoons, and dishes used in making or giving feedings to the baby should be boiled for ten minutes each time be- fore they are used. To keep these things clean, put them in the covered dish which also has been boiled for ten minutes. Feeding With the Medicine Dropper Use the medicine dropper for feeding until the baby is at least four days old, no matter what he weighs. Feeding With the Large Bottle If the baby sucks well and weighs over 2% pounds when he is four days old, feed him with the small bottle. Use the bulb from the medicine dropper for a small nipple. To make the hole use a red-hot sewing needle (No. 9), mak- ing a single hole in the center of the nipple. ONE HOLE IS ENOUGH. The hole should be large enough for the feeding to DROP out of the bottle but not so large that it runs out. Feeding With the Large Bottle When the baby weighs at least 4 pounds, is eating well, and is at least a week old, he may be fed with the large bottle and nipple. This nipple also needs only one hole. En- large one of the three holes already in the nipple with a red-hot sewing needle (No. 9). Breast Feeding The baby should weigh about pounds, be at least a week old, and should be taking his feedings well before he is put to breast. The first few days he nurses at breast, it is best to let him nurse only one or two times a day and for ten minutes only at each time. He should be offered his feeding from the bottle after he has nursed to see if he wants any more. Expressing the Mother's Milk While the baby is being fed from the medicine dropper and from the bottle, the mother’s milk should be expressed from both breasts 4 to 5 times a day. If any milk is left in the breast from which the baby has nursed, it should be expressed in order to prevent “caking” of the breast. Boiling the Breast Milk Unless the breast milk is used right away it should be boiled for 3 minutes and put in a bottle which has been boiled for 10 minutes. This is to prevent harmful germs from growing in the milk. It also makes the milk easier to digest. Some Premature Babies Do Not Want to Eat— Always remember that if he does not want to eat or if your baby is very tiny, it may be necessary to feed him with the medicine dropper for many days, and after that with the small bottle for many weeks. The way your baby acts when you feed him will help to tell you if he is strong enough to suck from either the small or the large bottle. Warm the Baby’s Food All feedings and all water should be warmed before being offered to the baby. Test the temperature of the feeding by letting a little of the milk or the water drop on the inside of your wrist. It should feel comfortably warm, not hot or cold. Feed IN the Incubator Leave the baby in the incubator. Support the back of his head and shoulders with one hand, lifting his head about 4 inches off the mattress. This will help him to swallow his feedings more easily. Hold the Nursing Bottle Never feed the baby with the nursing bottle propped because he may strangle. Always hold the bottle. Belching the Baby At first the baby will be getting such a small amount of feeding he will not need to be belched, but after a few days it may be necessary to do so. When he is small, do not remove him from the incubator, but raise him to a sit- ting position and gently pat him on his back until he belches. When he is being fed from the breast, or when he is getting more than an ounce and a half from the bottle, he may be picked up and put over your shoulder to help him belch. BE SURE TO COVER YOUR SHOULDER WITH A CLEAN DIAPER OR CLOTH AGAINST WHICH TO HOLD THE BABY. Give the Baby Water All premature babies require boiled water between feedings since they do not get very much to eat at first. They are also losing water from their bodies all the time. This should be replaced. If Your Baby Is Vomiting— Vomiting may be a sign of serious illness and should be reported to the doctor but most premature babies can be expected to vomit some the first few days. He will be less likely to vomit if you make sure: (1) that you are not giving him too cool a feeding, (2) that you are not giving him too much to eat, (3) that you are feeding him properly with the right kind of nipple and bottle, and (4) that you are not handling him too much. However, if the baby continues to vomit either fre- quenty or a lot, notify the doctor or the public health nurse at once. DIAPERING THE BABY When to Diaper The premature baby should not be handled much, so he is diapered only before each milk feeding. This means that he is diapered every three or four hours, according to the feeding schedule he is on. Getting Ready When you are going to diaper the baby, have every- thing ready that you need: pieces of newspaper on top of the lower half of the incubator and on the floor; the tray on which you have a jar of cotton balls; a bowl of warm water; and a newspaper bag. Wash your hands and put on your apron before touching the glass tops of the incubator or the baby. Diapering Lift the baby’s head and change his feeding diaper and the towel under his head before you roll down the covers to change his diapers. If the baby has had a bowel movement, clean him gently with cotton and warm water. Then take the soiled diapers out of the room. Wash your hands before putting the clean diapers on the baby. Put the diaper on high—just under his armpits—snug, and over his shirt. Pin the diaper with the pin pointing upward. Wrap the baby’s waist and feet in a “warming” diaper, folding a part of it under his feet and legs so that they are in an envelope. Bowel Movements The baby may have 4 to 6 bowel movements a day. If they are small, yellow, and pasty, it is normal. If the baby should have a watery or “runny,” bowel movement, the doc- tor or the nurse should be told about it at once, and the diaper with this bowel movement should be saved for them to see. Taking the Temperatures If you are taking the baby’s temperature, take it twice a day, once in the morning and once at night, and at a time when you are diapering the baby. The nurse will show you how to do this. The baby’s temperature should be between 97° and 99°. Have the Warm Diapers Ready It is important that you have warm diapers ready for the next diapering. Wash your hands when you have fin- ished putting the diapers on the baby. Then fold two clean diapers and put them and a clean pad into the paper bag which is next to the heating unit at the foot of the incubator. BATHING THE BABY When to Bathe The premature baby should not be bathed until he is strong enough to be handled that much. The nurse will tell you when the doctor thinks that it is all right to bathe the baby and will help you bathe him at first. Before Taking the Baby Out of the Incubator, Remember— Close all the doors and windows and have the room warm. Have everything ready that you need: newspapers pro- tecting the table; a newspaper on the floor by the incubator for the dirty diapers; the baby’s bath tray; the bathing pad; and the bath water. Be sure to wash your hands and put on your apron be- fore handling any of the clean things; that is, the bath tray, pad, and water. When Getting the Baby Ready to Take Out of the Incubator, Remember— Check the feeding diaper first of all, and if it is dry, you may use it for the baby’s bath towel. Unpin the baby’s diaper but take his temperature be- fore removing it. If the baby has a bowel movement, clean him with cotton and warm water before removing the soiled diapers. Wash your hands after removing the soiled diapers from the room. Next, come back to the baby and cover him first with the opened feeding diaper (now the bath towel) and then the cotton blanket. Then remove his shirt, pick him up, and place him on the bathing pad. When Bathing the Baby, Remember— The bath water should be comfortably warm but not hot. Always begin with his face and head and work down toward his feet. Keeping the baby’s body covered, wash his face and head, and, if necessary, clean his eyes, ears, and nose. Then uncover the baby by rolling the covers to the side. Soap the rest of his body well. Use a large piece of soapy cotton to clean his genitalia. Put the baby in the tub of water and rinse his body with the wash cloth. Take the baby out of the water and cover him with the drying diaper and white blanket. Dry his body gently and apply alcohol to each part as you dry. Last of all, cleanse the genitalia carefully with the wrung washcloth. In a baby girl be sure to clean in the folds. Conditions to Look for When bathing the baby, look to make sure that the baby’s eyes, ears, nose and mouth are clean and that he does not have any scaling (cradle cap) on his head, any rash or sores on his skin, or that his skin is not dry. If there is any scaling or any rash or sores, ask the public health nurse what to do. If the baby’s skin is dry, do not use alcohol but use* baby oil or mineral oil instead. Making the Bed If there is someone to help you, have her make the bed while you bathe the baby. Otherwise you will have to do this yourself. Put the baby in a safe place while you do it so that there will be no danger of his falling. In making the incubator bed use two clean sheets, one clean towel under his head, a clean quilted pad to cover the rubber pad, a clean cotton blanket, and two clean diapers. Dressing the Baby When the incubator is ready, put the baby back in it and dress him. In cool weather be sure that the shirts and diapers are warm before putting them on the baby. To dress the baby: first, put the woolen shirt, which has closed sleeves, inside the shirt with the open sleeves. Put both of them on the baby, leaving the opening in the back. Pin the small safety pin crosswise through all thick- nesses, a little down from the neck line. Then put the baby’s diaper on, and wrap the warming diaper around his feet. In warm weather the baby may need only the open- sleeved shirt. Wearing the woolen shirt will not only make him too warm, but he may get a heat rash from wearing wool next to his body. 22-