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Your baby's development by gestation

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The Early Preterm Baby: 22-27 weeks

General Condition

Babies born before 28 weeks of pregnancy are delicate. Weighing between 400-800g, your baby will probably be covered in fine hair – this helps keep them warm. Their eyes may still be closed, but you will be able to see their eyelashes. During this stage, your baby is able to hear - hearing your voice is very important to them. We try to minimise loud noises, which may be overstimulating to your new baby. You will be able to touch your baby, but try not to rub their skin as this may be too much stimulation for them. Your baby may be able to hold onto your finger.

Your baby will have support for their breathing, which may be given through a breathing machine – or ventilator. As they develop, their breathing support will change to a mask or prongs over their nose.

Your baby is going to spend several months in the neonatal unit. At this time, they need support with their breathing, feeding and keeping warm while they continue to grow and develop. They are at risk of infection, because their immune system – the body’s defences – are very under developed.

Caring for your baby

Your baby will be in the Intensive Care department. Your baby will be looked after in a plastic cot called an incubator. This will make sure they are always warm enough. This makes sure that they have warm, peaceful and quiet time to promote their development – as they would have had in the womb. For this reason, we group together times of handling your baby – such as changes, measuring weights or doing tests. 

You will be able to do kangaroo care, or cuddle your baby, as soon as your baby is stable enough. To start with, you will be able to touch your baby inside the incubator. Then, you will be able to hold them within the incubator. The best way to do this, is by cupping your hands around their head and feet. This mimics their position in the womb and makes them feel secure and comforted. When your baby is stable enough, you will be able to share skin-to-skin cuddles, also called kangaroo care, with them. Handle your baby slowly and gently, they like it when you get them ready for being touched using a soft and gentle voice. You will see us change your baby’s position regularly. This is to support their muscles and make them comfortable.

Feeding

Your baby will get all their nutrition from TPN - balanced nutrition that is given through a drip. They will also have a tube going to their tummy from their nose or mouth, and your babies’ nurse will teach you how to use this to feed your baby milk. Breast milk is the very best medicine you can provide for your baby – helping them grow, develop, and helping to reduce their risk of infections. We will help support you in expressing milk for your baby.

The Developing Preterm Baby: 28-32 weeks

General Condition

Your baby is small and fragile, and can still require quite a lot of support. They are looked after in an incubator, which keeps them warm. They are likely to need breathing support, with a breathing machine or prongs in their nose or mouth. They will have feeding support, with a drip in their arm/leg or belly button, as well as a tube to their tummy through their nose or mouth for breast milk.

Caring for your baby

Your baby may still be in the Intensive Care department but will soon move to the High Dependency department. Your baby loves to spend time with you. They can hear your voice, smell your scent, and start to see your outline. Reading books, singing gentle songs and gently holding or touching them will help them grow and develop, as well as comfort them and help your bonding experience. They are quite sensitive, so avoid bright lights – turn off camera flashes – strong smells – minimise perfume/aftershave and loud noises – use gentle voices around your baby. You will get to know your baby, and get to know the signs they display when they are looking for contact and stimulation, and when they are looking for rest. We will help you recognise these signs.

It is really important that your baby gets plenty of sleep. This is their time to focus on growing and developing. We will group together cares and interactions with your baby.

Feeding

Your baby is too small to suck and swallow milk by themselves at the moment. They will get their nutrition from a drip and breast milk. As they take more milk into their tummies, we will reduce the drip nutrition. Your breast milk is the most important thing your baby can receive, it is full of everything they need to grow and protect them from infection. Using a dummy while giving your baby milk through their nose/mouth tube will help them learn to suck and swallow at the same time.

As well as helping to feed, touch and hold your baby, you may be able to start helping with their cares by changing their nappies. We will help you learn to do this when you and your baby are ready.

The Growing Preterm Baby: 32-36 weeks

General Condition

Your baby may still be in the High Dependency Department but will soon be in the Special Care department. Your baby may now be growing quite quickly, and their development is easier to see. They are getting bigger and stronger, which means they may require less help from us with their breathing, feeding and staying warm. Your baby will probably need less breathing support during this stage, and may only need prongs supplying them with a bit more oxygen. Some babies may be ready to breathe for themselves without any support. Your baby will let us know the level of support that is right for them.

Your baby is growing quickly now, and this means sleep is still really important to them. They will start to have longer and deeper sleeping times, and it is important to try not to disturb them then. Your voice and presence will be a comfort to your baby, and they love to have regular skin-to-skin cuddles. You will be able to take part in more of your baby’s cares, changes and feeds during this time, and you will be able to bathe them together with the nurses.

Feeding

Your baby may be able to have all their feeds of milk by now and may start to suck some of these feeds. Some babies may be able to suck all their feeds, but it is common to still need some support with a tube into their tummy from their nose/mouth. Your baby will show signs of looking for feeds, and we will help you get to know these. When cuddling your baby, they may show signs of being ready to try breast feeding. We will support you and your baby to try this when they are ready. Learning to suck, swallow and breathe takes a lot of energy, so you will notice your baby getting tired and needing rest between feeds.

The Older Preterm Baby: 36 + weeks

General Condition

Your baby will now be in the Special Care department. Your baby is getting as big and strong as other babies born at full term at this stage. They may not need much, if any, support from us by this stage, and you may be getting ready to take them home.

If your baby has been with us a while, it will take a bit of time to prepare you & your baby to go home together. This may include a stay in one of our family rooms to give you an opportunity to stay together with support before leaving the unit.

Commonly, babies of this age will be looked after in a cot. Skin-to-skin time, reading and singing to your baby are so important in helping their brain development and bonding with them.

Your baby will be developing their own sleeping patterns, and these patterns are very important for growth and development. You will be getting to know them, how they show you they are ready to eat, sleep and interact with you.

Many babies by this stage do not need breathing support, but it is not unusual for some to need extra oxygen. Some babies, especially those that have been born very early and had a long stay with us, may need to go home while still requiring extra oxygen – we will support you through this if your baby needs it.

Feeding & Development

Your baby will be learning to breast, or bottle, feed now. Your baby may be waking up for their feeds now. They may be taking all of their feeds themselves, although some may need tube feeding support while they learn. Your baby is now getting big enough to be held during a feed, and they like to be swaddled for comfort and warmth in between feeds.

You will be able to start thinking about tummy time for your baby now. To start with, they can do this on your knees, or on a padded clean floor mat. Your baby will be able to see things about a quarter of a meter away now, and really enjoy looking at your face and seeing your smile. They will be able to recognise and turn to sounds, especially your voice as they have grown to recognise it. You & your baby will enjoy learning new activities together, such as baby massage and playing with soft toys.

Resources
This booklet is about parents and staff working together in supporting the physical and psychological development of your baby. It will help you to understand your individual baby’s responses to care, and preferences too.