Home from the NICU - Everything You Need to Know to Get Ready
When is my preemie coming home from the NICU?
This is, bar none, the #1 question every NICU nurse and doctor is asked. And I get it - that's exactly what I'd want to know, too! Because the day you get to leave the NICU is a beautiful day, indeed.
Unfortunately, I can't tell you when your baby will be ready to go home, but I can tell you a whole bunch of great ideas for making that day as stress-free and fantastic as possible.
The day you go home will be smoother and less stressful if you are as prepared as possible. I find it easier to prepare when I have a list I can check off as I go along with my preparation. So, to help you out, I'm dividing all the preparations into these 3 categories:
- Prepare yourself
- Prepare your home
- Prepare your tribe
Over the past 20 years as a NICU nurse, I've heard a plethora of fantastic ideas to make going home easier. I've been jotting down all that great advice and I wanna share all the best with you here today. It makes for a pretty large list, I know, but don't let that overwhelm you. Much of it is stuff you're doing and buying anyway, but I believe you'll learn a few great tips that you might not have otherwise heard about. Give it a read, and then bookmark the page so you can come back to it. Better yet, I've put together a checklist that includes everything you read here - you'll find it at the bottom of the page.
So, are you ready to get ready for the most awesome day ever?
The first thing you'll start doing to get ready for taking your baby home will be getting yourself ready. This means practicing as much of the hands-on cares for your baby as possible, and asking tons of questions.
Learn & Practice How to:
Change your baby's diaper. This one's usually easy-peasy and most preemie parents are diaper experts way before it's time to head home. If you're not there yet, let the nurses know that you want to do as many diaper changes as you can when you're there. They definitely should let you do that.
Feed your baby. Feeding preemies can be challenging. Whether you're breast-feeding, bottle feeding or both, you should be at the NICU practicing all of the different types of feeding you'll do. You should ask to practice as much as possible, and get all of the help you can while you're there. Ask to work with lactation consultants if you're breastfeeding or ask to meet with occupational therapists or speech language pathologists if your baby has complicated feedings.
Take your baby's temperature, and know what is normal for your baby.
Swaddle your baby. Again, nurses have different styles, so try learning from lots of different people and you're sure to find a few ways that work well for you. Again, the only way to get good at it is to practice.
Calm your baby. Sometimes it's hard to have other people telling you what your baby likes when she's upset because you'd probably rather be figuring that out on your own, in the comfort of your own home. But NICU nurses have tons of experience helping upset babies, and some of them are sure to have figured out some things that work well with your sweet little one. Take the suggestions and use them as needed.
Give your baby a bath. Let your nurses know that you want to do baths, and ask them to save bath time for you so that you can get the practice you need. You'll learn lots of different styles of bathing (who knew there were so many different ways to give a baby a bath?) from all the different nurses.
Mix your baby's formula or fortified milk. Many preemies need to have extra calories in their diet, and that means parents have to know how to mix up the milk that they'll be feeding their baby. Don't wait until the last day to learn how to do this. Ask to help out with mixing up your baby's milk early on, and you'll soon become comfortable with the job.
Give medicine to your baby. If your baby will need any medications, such as multi-vitamins or reflux meds, be sure you have the nurses show you a few different ways to give them to your baby and then practice it yourself.
Use any special home equipment (if needed). Some babies need oxygen or feeding tubes or more complex medical care at homes. If so, start practicing with them as soon as possible. If at all possible, do not wait until the last day or two to get used to it. Without a doubt, there will be complications with any kind of home equipment and it's better to work through those while you still have the NICU staff there to help.
Massage your baby and do tummy time. Ask if your NICU staff can teach you ways to massage your preemie and have your preemie do tummy time. They're both super easy and fun ways that you can continue to help your preemie thrive at home.
Do Infant CPR. Fortunately most parents will never need to use CPR skills, but it's good to know what to do in the event of an emergency. If your NICU does not have any CPR training available, ask them where you can take a class.
Room In. What's rooming in? It's when parents parents stay at the hospital overnight for one or more nights, providing care for their baby independently with staff nearby to assist as needed. It's a fantastic way to practice and get comfortable while surrounded by the security of the NICU staff. If your hospital offers it, it's a great thing to do.
Ask, ask, ask! Now's your chance - you have free access to the experts who know preemies better than just about anyone, so ask your questions! There's nothing more frustrating than getting home and then realizing you have a million questions you could have asked when you had that chance.
prepare Your Home
While you're busy learning everything you can about your baby, you'll also be getting your home ready. It's really not all that different than getting a home ready for a full-term baby.
These are the items that every baby should have at home, and your preemie is no different. Just be sure they're the appropriate size.
stock up on:
Diapers and wipes. No brainer here.
Car Seat. Most preemies are fine in regular newborn car seats, but if you have any doubts about the one you've selected, ask your nurses. If you haven't bought one yet, and if there's a chance your little one will be less than 5 pounds when going home, then you might consider carseats like these which are rated for 4+ pounds (most are 5+ pounds).
Bottles. Unless you are 100 percent exclusively breastfeeding, you'll want enough bottles to get through a day at home. Even most breastfeeding moms enjoy having a partner or friend feed the baby every once in a while, and most preemies take a combo of breast and bottle, at least in the beginning. Ask your NICU which types of bottles and nipples your baby will likely use.
Baby clothing that fits. So many cute baby clothes, but don't buy too many - they'll outgrow them soon!
Sleep sacks and swaddle blankets. Definitely practice using them with your preemie before the first day home. How? Wash 'em and take them to the NICU a few weeks ahead of time and ask the staff to help you & baby get used to them.
Somewhere to sleep. Where should your baby sleep? The million dollar question. These guidelines from the American Academy of Pediatrics are a good place to start. Make sure you and your partner have talked about this ahead of time, and you have whatever equipment you need.
Formula. Only buy formula if your doctors recommend it. Wait until just before going home to buy any, so you know exactly which formula your baby is using. (Amazon does offer many of the preemie formulas in bulk, so it's a pretty affordable way to get it if you need it.)
Baby thermometer. Be sure your home thermometer is appropriate for use on newborns. Personally, I like this non-contact thermometer because you can use it without even waking the baby. But even a regular old digital thermometer for under the armpit works well.
Medication syringe. If your preemie is taking any medications at all, you'll want the equipment used to get that medicine into your baby, such as a medication pacifier or syringe.
Bathtub. It's perfectly fine to bathe your baby in any basin that is safe, but parents tend to prefer a bathtub designed specifically for babies. If you'll be using one of these, go ahead and pick one before you're already home. My latest favorite is the tub from 4Moms, makers of the amazing MamaRoo swing, because of the way it keeps water fresh.
Nasal aspirator. You don't want to be unprepared when the first runny nose hits, which it most certainly will. Bulb syringes work fine, but parents who have used the Nose Frida snot sucker (don't you love that name?) swear by it. Or if that's too gross for you, try a battery powered nasal aspirator (Occobbay makes a great one for newborns!) Whatever you choose, you want to be sure to have something on hand to keep your little one's nose clear.
Hand sanitizer. Plan to have a bottle by the front door, in the main living area, and anywhere else you may be with your baby. This way, you and every visitor has a quick and easy way to keep germs away from your little one. You might consider face masks, too, just in case someone shows up with questionable "allergies." Better safe than sorry.
A few meals in the freezer. You can do this far in advance - stock your shelves with several super-easy-to-prepare meals for those times when you need it. You'll need it.
If you can, consider giving the house one good cleaning when it looks like your baby will be going home soon so you'll be set for a while.
In addition to these basic necessities, tons of preemie parents rave about the following items to help make the transition from NICU to home even smoother:
Owlet oxygen sensor. This incredible new device is delivering peace of mind that preemie parents have been craving for years. The technology of the pulse ox that is used in every NICU everywhere (the red glowing light on the baby's foot or wrist that reads oxygen levels) is now available for home use. It's a small sock worn on one of your baby's feet, and it will alarm if oxygen levels dip below safe levels. It's not for everyone, so talk to your preemie's doctor first. But I haven't yet met a parent who didn't feel great comfort from having this! Better yet, you can buy them on Amazon.
Baby monitor. These range from simple to complex, but most parents love having a way to see and hear their babies when they are in separate rooms. These are different from medical grade home monitors, which come only with your doctor's orders. These home monitors allow you to hear and see your little one, and they offer parents great peace of mind. And it shouldn't break the bank, either - for example, this one from Avin gets 5 stars on Amazon in the under $100 range.
Rock-n-play. So many preemie parents swear by these. They keep baby's head slightly elevated, which helps with reflux, and it offers a gentle rocking motion, which a regular crib can't do. (They even make a battery-operated one now that rocks itself!)
Baby swing. My favorite, by far, is the Mamaroo. Nothing really compares to it as far as being truly effective at comforting and consoling a baby. However, your baby may have gotten used to particular a swing at the NICU, so you may want to buy something similar.
Skin-to-skin shirt. Even though your baby is much bigger now, there are still tremendous benefits to spending time holding skin-to-skin. Shirts designed for this purpose are really wonderful ways to continue with your preemie at home. Pro tip - if at all possible, start using it while the baby is still in the NICU. That way, it's a familiar sensation to your baby, something he or she is already used to.
Hands-free pumping bra. Pumping is a reality for most preemie moms, and these bras are lifesavers. Don't waste all of your pumping time just holding those flanges - you can read, relax, write in your journal or anything else! I actually know a mom who pumped while she was driving to and from the NICU! The argument against them used to be that they're too expensive, but it's getting better - for example, this one gets 5 stars and is currently under $20 on Amazon, so you can't beat that! And don't forget the bags for storing milk—you won't have the freebies from the NICU anymore.
Baby mobile. This is another item that can be great to have early because you can play the sounds while your baby is still in the NICU, and then those same sounds will be comforting and familiar for your baby when you are home together. (My pet peeve is a mobile you have to wind - it's so disruptive when the music stops and you wake the baby by cranking the winding mechanism. I highly recommend a battery operated one, and this one from Tiny Love, with a 40 minute music time and nice classical tunes to play, is a great choice.
Prepare Your Tribe
Preemie parents - you really shouldn't try to do this alone. It's easy to feel as if you've done it alone during these NICU days, so you have to continue doing it alone now. No way! A tribe of helpers is going to help make your life easier. And believe me when I say this - they desperately want to offer you love and support by helping you.
Some tips for getting them ready include:
Figure out who your tribe is. Who has offered to help? Who has said "let me know if there's anything I can do to help out"? This is your tribe and you really should let them help you! Will this be enough? Will you have enough support, or would it make sense to reach out to a close friend or relative to ask for a little help? If so, do it now rather than later when you may be too tired or overwhelmed to think to ask for help.
Ask your tribe to be fully vaccinated. Your NICU doctors can help you determine which vaccines your visitors should ideally have.
Give your friends & family a clear explanation about what visits will be like. Your tribe is all super pumped to finally get to meet your little one! They may not have any idea how traumatized you are/how much alone time you want/what to say, etc. I've crafted this simple letter you can print and share with them to help.
Think about the kind of help you want. Do you want someone to give you a break once a day so you can take a walk? Do you want help with groceries or babysitting for older siblings? Do you want someone to talk with, or would it be better for you to nap while they help with household chores? Friends and family members are usually desperate to help but they may not know what to do, so just tell them what you want. It'll help you and make them feel oh so useful!
It's okay to want to be alone for a while. Many parents feel bad about wanting no visitors, but it's very common. After so many months of having to share your baby with the hospital staff, many parents want time all to themselves. Don't let this mean you refuse help! Just let your tribe know that you need a few weeks together, and that if they can help without expecting a visit, that would be wonderful.
Choose a pediatrician who understands preemies, if possible. If you still haven't selected a pediatrician, try finding one who has some experience with babies similar to yours. It's great to meet potential doctors and ask them about their experience with preemies. They are going to be a major part of your baby's tribe, so you want one you feel comfortable with and trust.
Jot down the numbers you'll need to have handy. These include the number to your pediatrician, a lactation consultant you can talk to for breastfeeding help, poison control and your local emergency room. See the printable checklist below for a great place to write all these down.
Find a preemie support group. Prematurity is a truly traumatic experience, and it stresses parents out, a lot. When you take your baby home from the NICU it may seem like you're returning to "normal" life, but other parents of "normal" babies may leave you feeling depressed and lonely because those parents won't understand the traumatic world you've been living in. Try to connect with other preemie moms and dads to help you feel appreciated and understood. Research shows it is incredibly helpful.
Share this article with your partner. Help him or her understand what to expect and what they can do to help make this transition easier.
The day of discharge
So, by this day I hope you've got everything above already done. I know it's a lot to do, but it will help. Now that the big day is finally here, I have a few final tips to make the day even better.
Do everything possible to keep your schedule and your attitude open and flexible. Sometimes it takes way longer than expected. Sometimes baby is fussy and needs a feeding, then poops all over the going home outfit, and then needs to eat more, and then the family next door wants to take a photo and then... you get the picture. It might take a while, so plan for that.
Figure out who's driving. It may seem silly, but I've stood many times at the car with the baby in the carseat, ready to head home, when mom & dad discuss if someone should sit in back with the baby. Good to figure out ahead of time.
Be sure you have all prescription medications filled. If possible, go to the pharmacy a day or two ahead of time to pick up your baby's medicine. But if it's not possible, make sure you have the prescriptions (or they're filled electronically) before you leave.
Gather some NICU keepsakes. Be sure you take your baby's name card and hospital ID band, but you can also ask for things such as: a diaper that was the smallest size your preemie wore, the disposable blood pressure cuff. Just ask the nurses for the things they are able to send home for your keepsake box.
Hire a photographer to do a photo shoot of the day you go home. I learned this tip from a friend, and it's a great idea if you're a photography kind of parent. If it's something in your budget, you'll probably be very glad you did. If it's not in your budget, perhaps you can ask a friend or family to be your photographer? And then take great pictures - ask your favorite nurse or doctor for a pic, ask your new friends from the NICU for a pic, and definitely take a pic as you're walking out the door!
Credit: Sara Bollinger
So, there you go
Whew! That's a long list, right? There's even more we could discuss, but I think this helps you get the ball rolling. Hopefully you're able to have as much ready as possible before you take your preemie home. But nobody does it perfectly. Don't expect yourself to do it perfectly, either.
To make it easy for you, I've compiled a checklist you can print & check off everything as you get ready for the most awesome day ever!