NICU parent handbook
Contents
1. I am a registered nurse I work with your NICU team and insurance company e I m the person who can help you find out what equipment and services your insurance company pays for while in NICU and at home e I also help arrange for your baby s special needs such as eye exams car seat tests developmental follow up etc I am a trained and certified infant massage instructor Infant massage is a great way to bond with your baby It also helps with your baby s development I teach infant massage classes to out NICU parents and caregivers I look forward to meeting you For parents of a baby in the NICU life can become a whirlwind of emotions Please know that we are here 24 hours a day to help you and your family We can provide spiritual and emotional support or just be there with you if the going gets rough Please let us know how we can help We work with patients families and siblings to normalize the hospital environment and decrease stress and anxiety We are trained to facilitate play activities provide education about procedures teach coping skills and offer emotional and developmental support We also lead a weekly support group for NICU families called the Cradle Club This is a social time where you can meet some of our other parents or work on fun activities such as scrapbooking At times your neonatologist may need to consult with other doctors about your baby I am a pediatric doctor specializing in a c2. Freezer in 5 F or 15 C 2 weeks Store milk toward back of freezer where refrigerator temperature is most constant Insulated cooler bag Milk stored for longer durations in the Freezer with O F or 18 C 3 to 6 ranges listed is safe but some of the lipids separate months in the milk undergo degradation resulting in doors lower quality Chest or upright deep freezer 4 F or 20 C 6 to 12 months Reference Academy of Breastfeeding Medicine 2004 Clinical Protocol Number 8 Human Milk Storage Information for Home Use for Healthy Full Term Infants ps PDF 125k Princeton Junction New Jersey Academy of Breastfeeding Medicine Available Page 34 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center Pediatrician amp Appointments Doctor amp Appointments Your pediatrician is the doctor who coordinates your baby s care Consulting doctors specialize in a certain area of your baby s care A follow up appointment and continued care with all your doctors will help your baby stay healthy 1 Please select a pediatrician and schedule yout appointment for three to five days after discharge 2 Know who your specialists are and schedule appointments as needed 3 We will send a copy of your baby s discharge summary to your pediatrician and specialists Insurance amp Your Doctors Private Insurance Please call your insurance company for a list of pediatricians
3. babies born with special health care needs and those that have experienced a loss to these or other complications Domestic Violence 1 877 701 SAFE 7233 www safehaventc org If you are currently experiencing abuse and are seeking emergency shelter please call the hotline above PLEASE NOTE Ifyou are in need of immediate help contact 1 800 SUICIDE Text 4 Baby www text4baby org Text Baby to 511411 and get free messages on your cell phone to help you through your pregnancy and your baby s first year Page 41 of 45 Dec 2012 Copyright Cook Children s www Caring Bridge org Make it easy to stay connected during any type of health event This is an online space where you can connect share news and receive support FNS Supplemental Nutrition Assistance Program SNAP Call 2 1 1 toll free to find out how to apply for food stamps www fns usda gov snap Medical Transportation Program Clients in most of Texas can call MTP at 1 877 MED TRIP 1 877 633 8747 Clients in the Dallas Fort Worth Service Delivery Area call LogistiCare at 1 855 687 3255 to atrange setvices Counties in this area include Collin Dallas Denton Ellis Erath Hood Hunt Johnson Kaufman Navarro Palo Pinto Parker Rockwall Somervell Tarrant and Wise Medicaid recipients can use this program to request transportation getting to the doctor or hospital in another city including the hospital to visit your baby It can help pay for travel
4. 1 The visitation policy is enforced during rooming in 2 If the mom is under 18 years old the father cannot spend the night with unless they are legally married Please talk to social worker if you have questions about this 3 One parent will be expected to stay with the baby at all times 4 Do not have sex 5 On the day of discharge plan to leave in the afternoon after the doctors round Page 29 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center Baby Care at Home Everyone you family and visitors must wash hands before touching baby Bath Time When do I give a bath 1 When baby is awake Keep your hand on your baby at all times 2 Not After feedings All the movement can make your baby spit up 3 Iwo to three times a week or Start with the face Clean eyes from the nose side when dirty to the ear side 4 When the room is warm Babies get cold Give bath as fast as can to keep warm 5 Do not put in water until cord healed This can cause an infection Cord Care 1 Keep cord stump dry No tub baths until the cord has healed 2 Only clean with warm soapy water until the cord has healed 3 Call the doctor if there is redness odor or drainage Taking a Temperature normal range 97 5 F 99 3 F 1 Rectal Call doctor if higher than 100 4 F 2 Axillary under arm Call doctor if higher than 100 4 F Check baby s diaper when fussy amp before feedings 1 Clean dia
5. Occupational therapy e Speech language therapy e Nutrition consults 1 Screening for developmental delays 2 Weight and measurements What you can do to help 4 Vision screening Talk to the NICU team about your baby s 4 Hearing evaluation developmental milestones Learn about S e Your baby s strengths and weaknesses e Exercises you can do at home with your baby e Know what therapy your baby needs e Attend all appointments Page 40 of 45 Dec 2012 Copyright Cook Children s Social Services Helpful Websites The National Hopeline Network 1 800 442 HOPE http www hopeline com Serves as a wonderful springboard for finding help in your area By calling their toll free number you will be routed to live support The website also aids you in finding services in your area in non crisis times 2 1 1 Help in Texas Call 211 Toll free from any phone www 211 texas org Free and Confidential Community Information and Referral Service for the state of Texas Tarrant Cares About You www TarrantCares org This one resource will provide you with countless solutions for issues your family may be facing Post Partum Depression Hotline 1 800 PPD MOMS Postpartum Support International 1 800 944 4PPD 4773 www postpartum net Post Partum Support Group online www ppdsupportpage com Hand To Hold Toll Free 855 H2H NICU www handtohold org Comprehensive resources and support programs to parents of preemies
6. accepting new patients Medicaid If you have Medicaid and you need help finding a doctor you can call Texas Health Steps at 1 877 847 8377 Monday Friday 8 00am 8 00 pm Medicaid STAR Program You will need to call Medicaid STAR Link to add the pediatrician added to your plan Call 1 866 566 8989 At the time of Rooming In you need to write down 1 Pediatrician e Name address and telephone number of pediatrician e Date and time of first pediatrician appointment 2 Specialists e Name address and telephone numbers of all specialists e Date and time of all follow up appointments 3 Clinics Tests etc e Name address and telephone number of all clinics e Date and time of all follow up appointments 4 Insurance e Name and telephone number of insurance e You may need to call the insurance company and tell them your pediatrician s name Please start working on the above items as soon as possible If you are having problems ask for a social worker to help Page 35 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center BACK TO SLEEP amp TUMMY TO PLAY Sleeping Safe on Back The American Academy of Pediatrics recommends we place all babies on their back to sleep This reduces the risk of SIDS Sudden Infant Death Syndrome 1 Always place your baby on their back when sleeping 2 Babies breathe easier during sleep when on their back 3 Babies who hav
7. and meals in some cases if you must stay away from home overnight or longer for medical reasons Social Security Benefits for Children with Disabilities 1 800 772 1213 www socialsecurity gov Parents that have a baby with a birth weight under 1200 grams or less OR have been in the hospital for 30 days should apply Children s Medicaid amp Children s Health Insurance Program CHIP www chipmedicaid org Children with Special Health Care Needs CSHCN http wwdshs state tx us cshcn Temporary Assistance for Needy Families TANF www hbhs gov recovery programs tanf index html Texas Department of Assistive amp Rehabilitative Services www dats state txus Texas Department of Aging amp Disability Services www dads state tx us Page 42 of 45 Dec 2012 Copyright Cook Children s Lactation Resources Breastfeeding Educator Lactation Department 682 885 7144 Cook Children s Dietician 682 885 7188 or 682 885 7390 Breastfeeding Apps Express Yourself free Mommy Milk Milk Maids Breastmilk Counts free Pump Work Breastfeeding Resources Online Cook Children s Medical Center www cookchildrens org Center for Disease Control www cdc gov WIC Women s Infants amp Children www breastmilkcounts com Academy of Breastfeeding Medicine www bfmed org American Academy of Family Physicians 972 669 5714 www daafp org afp xml American Academy of Pediatrics WWW aap org International Lactation Consultant As
8. down 2 Isuck on my hand fingers or a pacifier 3 I take a nap to shut out sights and sounds Page 13 of 45 Dec 2012 Copyright Cook Children s Ways to help your baby calm down Sounds I Hear 1 Talk to me before you touch me 2 Decrease the noise in the room Touching Me 1 Hold me quietly and firmly with still hands Tuck my arms close to my chest and bring my hands together Let me hold your finger Place your hand on my feet firmly to help bend my legs so I can stay tucked Help me bring my hands to my face or mouth WN OF A W N Place pacifier to my lips and see if I will suck on it Lights in the Room 1 Limit bright lights in my face 2 Shade my eyes from the light Taking Care of Me 1 Remember I may get stressed when you change my diaper or care for me 2 Please give me a break Help me calm down and then finish my cares Dear Family Please pay close attention to what I am doing or saying Understanding how I feel will help me grow bigger and stronger and that s what we all want Page 14 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center PAIN Pain is a feeling that hurts Some pain cannot be stopped but at Cook Children s we believe almost all pain can be eased Taking care of your baby s pain is the concern of our entire health care team e Pain can be steady throbbing stabbing burning aching or pinching e It can last
9. e Always wash your hands before feedings and before preparing bottles e Sterilize all bottles and supplies 2 Formula baby does not drink Throw out formula that your baby does not drink within 1 hour 3 Formula Water e Although most tap water is safe boil all water used for mixing formula e Boil 1 minute at a rolling boil and let cool 4 Refrigerate e Always place prepared formula in refrigerator after you open or mix it e You may store formula up to 24 hours if refrigerated immediately Do NOT freeze formula Page 33 of 45 Dec 2012 Copyright Cook Children s Feeding Your Baby 5 Warming Formula or Breast Milk You may use a bottle warmer or set the bottle in a pan or bowl of warm not boiling water for 5 10 minutes Never warm in the microwave 6 Breast Milk Storage Freshly pumped breast milk is good for e 5 days in the refrigerator e 3 months in a standard home freezer e 6 to 12 months in a deep freezer Thawed breast milk amp fortified breast milk e Good for 24 hours in the refrigerator e Do NOT freeze thawed breast milk or fortified breast milk Fortifying Expressed Breast Milk 1 Measure 90 ml or 3 ounces of expressed breast milk 2 Add ___ teaspoon powder 3 Mix well to equal calories per ounce Be sure to take your expressed breast milk home from the unit My Dietitian Phone Number a a fr CookChildren s Medical Center Breast Milk at Home Safe handl
10. seat Infants and children up to 2 years old should ride or restraint rear facing until they outgrow their car seat 2 Read and follow both your safety seat manual l l and your car owner s manual e Check car seat manual for height amp weight limits l l 3 Never place a rear facing safety seat in front of e Young children have weak necks and spinal cords a passenger side airbag Read your cat ownet s Rear facing car seats keep the head and neck manual to learn mote about air bags from jerking oy ard This prevents serious head 4 Children younger than 13 years should ride in and spinal cord injuries the back seat with the correct safety Don t worry if your child s feet touch the back of It is the law 4 3 Texas Child Occupant Protection Law states your vehicle s seat pi Every child must ride in an approved safety seat for Children can bend their their weight and height until they are 8 years old or legs and there is no taller than 4 feet 9 inches All passengers in the car increase risk for leg injury must be secured with a seat belt if not restrained in a safety seat P 1 of 1 eee age 10 9 REVISION DATE June 2011 CookChildren s Family Copy Copyright Cook Children s Medical Center Child Passenger Safety Guidelines Car crashes kill or seriously hurt more children than any other injury or illness Keeping your child safe and protected is important to everyone at Cook Children s Medical C
11. storage container or syringe Dropping Milk Off Drop off most milk during Milk Bank hours at the window to the Milk Tech e When dropping milk off at the Milk Bank remember to pick up storage supplies if needed e If Milk Bank is closed and you need supplies you ask your baby s nurse Page 8 of 45 Dec 2012 Copyright Cook Children s NICU Milk Bank storing transporting amp labeling A Milk Tech will pick up your overnight milk in the morning Your baby s milk will be prepared for 24 hours then delivered to your baby s unit daily Milk Bank Hours of operation 9 am 9 pm If you arrive to the NICU unit outside of Milk Bank hours give your milk to your baby s nurse to refrigerate Keep Breast Milk Healthy amp Safe Storing Breast Milk At Home Refrigerate fresh milk immediately e Returning to NICU within 24 hours of pumping Store this milk in refrigerator e Returning to NICU afer 24 hours of pumping Store this milk in freezer Refrigerator amp Freezer 1 Refrigerator Fresh milk keeps 24 to 48 hours 2 Refrigerator Freezer Keeps breast milk for 3 months A freezer that keeps ice cream hard is cold enough to store your milk 3 Deep Freezer Keeps breast milk for 3 to 6 months Bringing Breast Milk from home to NICU Fresh Milk Transport in packed ice Frozen Milk Transport in insulated container with a frozen gel pack As soon as you arrive to Cook you can check i
12. who have grown out of the rear safety belts The best protection to give your child is facing seat usually 2 years old Held a Sac teal aap way never nce e Be sure to check your car seat manual for height and weight limits Best safety restraint e This seat should have a 5 point harness Use the restraint that fits your child s height weight Vourcuie shoultera aes ccaeualae age and type of car or truck Choose the safety outgrow it hopefully at least 4 years old and restraint that you will use the right way every time longer if possible Different types of Safety Restraints Booster seat for growing children This is the next important step for children who have 1 Rear facing 3 Booster seat outgrown their car safety seats Using a seat belt that 2 Porward facing 4 Seat belt restraint does not fit the right way can injure your child in a crash Stay in each type as long as possible e Boosters MUST be used with Do not be in a hurry to move into the next seat or lap and shoulder belt stage A child may fit into rear facing seats until they e Children should stay in a weigh 30 45 pounds booster seat until they are 9 Your child s safety decreases with each change 57 inches and fit into an adult to the next safety seat or restraint seatbelt usually between 8 12 years old Safest Protection Rear facing Safety Seats are 5 times safer What do I need to do 1 Always put your child in the correct safety
13. your nurse if you need a pump in your room ot need help setting up your pump to use 2 Save any milk you pump The hospital where you delivered will give you containers for storing your milk 3 When you leave the delivery hospital remember to take all your pump parts These are yours to keep At Cook Children s NICU Please bring your pump kits 1 If you have either the Medela or the Ameda brand pumping kit you may use it with one of the pumps in your baby s room 2 If you have a WIC pump please bring yout pump and pump kit when you come to NICU Getting a Pump for Home Use Please call your obstetrician if you need a prescription for an electric breast pump 1 You cannot buy hospital grade pumps at any store 2 You can rent hospital grade breast pumps Insurance If you have insurance call your insurance company to see if they will cover the cost If so they may tell you where to get your pump Page 5 of 45 Dec 2012 Copyright Cook Children s No Insurance If you do not have insurance or if your insurance company will not pay for a pump rental cost is about 55 80 per month WIC If you are qualified for WIC call WIC for a breast pump to use when your baby is in the hospital WIC Tarrant County Warm Line 817 321 5416 Notes My pump brand Place rented Date la La La CookChildren s Medical Center Breast Milk is the Best Medicine Providing yo
14. 5 3243 The National Women s Health Information Center National Website for Spanish Speaking Lactation Specialist by zip code WIC National phone number 800 WIC FOR U 800 942 3678 International Board of Lactation Consultant Examiner lists registered lactation consultants alphabetically by state Choosing a Breastfeeding support Specialist International Board Certified Lactation Consultant IBCLC RLC To earn these titles a person must have extensive lactation education and clinical training and have passed an international 817 433 6300 888 442 7747 817 641 2551 817 556 4254 972 747 1000 972 747 6377 214 345 6789 214 345 2595 214 345 2557 214 345 8098 972 932 7200 972 932 7361 972 981 8454 972 981 3788 www lalecheleague org www 4women gov www fns usda gov wic www iblce org Certification exam Continuing education is also required to remain certified They may also be called a Registered Lactation Consultant RLC Breastfeeding Educator A person using this title has attended a short course on basic breastfeeding assessment and management but may not be certified Other certifications you may see are CLE Certified Lactation Educator and CLC Certified Lactation Consultant These are earned in training coursed that are part of the preparation for the certification exam by the International Board of Lactation Consultant Examiners Page 44 of 45 Dec 2012 Copyright Cook Children s Drugs to Avoid d
15. CU team A social worker will call or meet with you within the first few days of admission to NICU What we do Social workers make sure that you and your family s experience in the hospital will be as comfortable as possible We work with your NICU doctors nurses and other staff and can help you with many different problems or concerns including e Stresses of NICU We are here to help you and your family deal with the many stresses of having a baby in NICU We can provide emotional support for you and your family help you find lodging or help arrange for transportation e Education amp NICU Staff We help arrange meetings with your different staff members We can help you find answers and understand choices e Financial Worries We can arrange for you to talk to financial counselors here at Cook Children s to help you see if you qualify for financial assistance e Community Programs Your family may be facing many issues during this time We can help you find a solution and arrange for community programs and services in your area Page 27 of 45 Dec 2012 Copyright Cook Children s Social Workers e Discharge Planning We can coordinate with the NICU team to ensure a safe and effective discharge home How to find a social worker NICU social workers are available in the unit Monday through Friday from 8 30 am 8 30 pm Social workers are available for emergencies 24 hours a day 7 days a wee
16. Place photo of your baby here NICU parent handbook This handbook belongs to CookChildren s Medical Center Ma A fr CookChildren s Medical Center Dear Parents This is a handbook about learning how to care for your new baby while in the NICU and then at home Learning about some of this care may seem scary This is normal However with a little practice taking care of your baby can become routine and easy to do At Cook Children s we have a special way of explaining information We call it Teach Back Learning new health information is not easy You are not alone if you find things confusing at times Sometimes we may explain information using words or sentences that are not clear Teach Back helps us make sure we explained information in a clear way This is how it works 1 We explain your baby s care by telling you e What you need to know about the care e What you need to do e Why doing this is important 2 During our discussion please tell us if the information is not clear 3 Always ask questions about anything that is not clear 4 We will then ask you to share with us what you heard us say or do e What do you know about this care e What do you need to do e Why is doing this important 5 Listening to you helps us make sure that we used clear words and explained all of the important health information Discharge amp General Instructions These instructions are only gen
17. a short time or seem to never go away e A treatment illness disease injury or surgery can cause pain e Pain means that a part of your body needs rest to heal Measuring pain We check all babies for pain e We check for pain at least every 12 hours e We also check as often as needed to make sure all pain is controlled N PASS Pain Assessment Scale N PASS stands for Neonatal Pain Agitation and Sedation Scale NICU uses a pain tool that is just for premature or newborn babies 1 We check e Your baby s heart rate breathing rate blood pressure e Your baby s oxygen needs 2 We watch e How often your baby cries and how easy they calm down e How your baby reacts to touch and sound e How stiff your baby s muscles are 3 We look for e Facial expressions e Tightly closed eyes or furrowed eye brows can mean your baby is in pain Parents Parents are a big part of our pain management team You are learning about your baby e You know your baby better than anyone else e You can tell us about even the slightest change in your baby s behavior Page 15 of 45 Dec 2012 Copyright Cook Children s To help us better understand and learn about your baby s pain history we may ask e How do you know when your baby is hurting e What does your baby do when hurting e How pain has been treated in the past e Did this way work e What didn t work Easing Pain 1 Needle Sticks Starting Vs or d
18. aby get ready for feedings 2 Your baby needs to learn how to safely take these feedings without choking The Infant Driven Feeding Program is not based on how much milk your baby takes Your baby may feed once a day or several times a day A successful feeding is about 1 Recognizing your baby s hunger cues These cues may be different each time and can occur at different times each day e Wakes up before feeding times e Wakes up when you change the diaper and take temperature e Brings hands to mouth e Sucks on a pacifier e Handles diaper change temperature change kangaroo care and non nutritive breastfeeding without stress cues 2 Recognizing signs your baby needs to stop e Goes to sleep e Stops sucking e Won t open his mouth e Turns away from the bottle or breast e Seems upset or not interested in feeding e Coughs chokes e Breathes faster than when not feeding 3 Preparing your baby s room A quiet room helps your baby focus better 4 Helping your baby suck and swallow during feeds The way you hold your baby the way you position the bottle and even the way you place the nipple can provide safer and easier feedings Please understand a successful feeding is not based on much your milk your baby is taking The number one goal of our program is to turn each feeding into a calm safe and nurturing experience shared by both you and your baby Page 23 of 45 Dec 2012 Copyright Cook Chi
19. ay Then gradually add or increase time each day so at 2 months your baby is doing a total of 2 hours of tummy time throughout the day Doing Tummy Time Try tummy time in a variety of ways e Over your shoulder e On your chest e Over Boppy pillow e On your lap e Over a rolled towel under the arms e On the floor Page 37 of 45 Dec 2012 Copyright Cook Children s 1 If your baby falls asleep during tummy time position them on their back following the BACK TO SLEEP guidelines 2 If your baby cries help to calm them give them breaks and try again 3 If your baby has reflux try to work on tummy time before a feeding Your baby may not like tummy time and start crying This is normal Remember always watch your baby when they do tummy time Child Passenger Safety Guidelines Car crashes kill or seriously hurt more children than any other injury or illness Keeping your child safe and protected is important to everyone at Cook Children s Medical Center Your questions are very important to us Please call Trauma Services 682 885 3954 if we can help Child passenger safety guidelines are supported by Safe Kids Worldwide www safekids org the American Academy of Pediatrics www aap org and the National Highway Traffic Safety Administration www nhtsa dot gov Car crashes kill Protect your child Forward facing safety seat Safety restraints are car safety seats booster seats or Use for children
20. care while in NICU I am the doctor who will coordinate the care your baby needs Please know there is a neonatologist present in the hospital at all times I am an RN I have had special training in caring for critically ill newborns in the NICU I am the team member who will be caring for your baby most of the time I work a 12 hour shift so each day you will have 2 different nurses caring for your baby I am an RN with an advanced educational background in neonatology including a master s degree in nursing and additional certification I check on your baby every day and work closely with the doctors and nurses to help coordinate your baby s care We check on your baby s developmental skills We look at your baby s movement strength and muscle tone We evaluate how well you baby sees postures and responses to touch and sound Based on our assessment we develop a plan of care to meet your baby s developmental needs I am a new employee in training for a position at Cook Children s I work with an experienced staff member I help take care of your baby s medicines and IV nutrition I work closely with your doctors and nurses to make sure each medicine is safe and helpful for your baby I take care of your baby s breathing needs I set up breathing equipment and give treatments Before your baby goes home I will help you plan and prepare for any breathing treatments or equipment that you may need You will see me at the n
21. cossssecerssseecessseecessseccoseseeressseeressse 27 Going Home PRO Bh STH e Gone HoN eoero arr iner Oor EE oniosiesns etemean ses oceoneatiaen sous 28 Pa Care O aea oa a e aE a R aA a aE a E R a 30 E NOU BA O a E E E AEEA A E E N 33 e RTE A ONS E E N E E T E E seeesshoncsesnstiens 34 Pediatrician amp wave oco hulsvalcialacmmmere nn er eenrtre rere te err eia eina tre terre ts 35 PD ck to Sleep saad Tunny To Play oreiro roaa rore Trene o EEE TEE 36 Car Passenger Safety Guidelines sssessesesesesesessssssssesesssesesesesesestacsesessesesesesesesesenenesesesenes 38 Developmental POlOwW Up mere ere e eee eee en ene EEA TE 40 UG TOTEM FRO SOU COS oai terete ere eee 41 Page 2 of 45 Dec 2012 Copyright Cook Children s a La Lr CookChildren s Medical Center Patient Registration Please register your baby at patient registration as soon as possible On Admission We need updated information for your baby s record that includes 1 oe et SS oe Home address Insurance info Place of Employment Telephone number Emergency contact info Transferring hospital information 1 Information Go to Patient Registration located on the first floor next to Starbuck s Complete the above paperwork 2 Change your baby s first name Most babies admitted to NICU have the first name Baby Boy or Baby Girl on the paperwork Please give us your baby s official first name 3 Your baby s las
22. e Changes in dirty or wet diapers e Take notes of what baby is doing e What you did and when e How baby responded e Calling nurse when rooming in amp baby s doctor when home e What can happen if my baby has these problems Medicines What to know about this medicine What to do Why this is important Follow up appointments What to know about follow up appointments What to do Why this is important Feeding type What need to Know about my baby s feedings What need to do Why this is important Why your baby needs this medicine Side effects Getting refills Storing it Missing a dose Giving medicine in a dropper or special syringe Times for giving medicine How this medicine is helping my baby Names of each doctor or clinic Addresses and telephone numbers Dates amp times of each appointment Make all your baby s needed appointments When to call for an appointment Where to keep track of follow up appointments Change or cancel appointments Take a copy of your discharge paper work with you Why my baby needs this follow up appointment Doctors will check on your baby after discharge Name of formula Additives to my breast milk or formula and why How much and how often should my baby eat Getting more formula Mixing the formula storing my breast milk or formula Labeling Transporting How do know my baby is eating enough Helpful information to know about rooming in
23. e been in the hospital are at a higher risk of SIDS Do not swaddle when sleeping Your baby should never be swaddled when placed back to sleep 1 Baby s arms should be free to move around when they are asleep 2 Babies can over heat when swaddled This increases the risk of SIDS 3 Ifyou hold and swaddle your baby to help them fall asleep be sure to remove the blanket when you put them in the crib Blanket If your baby needs a blanket tuck the blanket around the bottom and sides of the mattress 1 Line the blanket up with the baby s armpits their arms should be over the blanket 2 Itis safer to use a sleep sack instead of a blanket 3 Put the infant on their back with their feet at the bottom of the crib bassinet Page 36 of 45 Dec 2012 Copyright Cook Children s At home a Tummy to Play Tummy Time helps your baby e Learn how to lift the head e Become stronger e Learn to roll e Have normal sensory input e Improve head shape e Explore their world How long each day Plan 1 hour of tummy time per day for each month home from the hospital Example 1 month home from hospital 1 hour of tummy time 2 months home from hospital 2 hours of tummy time How often during the day Work on tummy time spread throughout the day as tolerated For example when your baby has been home one month work up to a total of 1 hour of tummy time spread out throughout the day every d
24. e in a hurry to move into next seat or stage shoulder belt A child may fit into rear facing seats until they weigh e Children should stay in a booster seat 30 45 pounds until they are 49 57 inches and fit into Your child s safety decreases with each change to an adult seatbelt usually between 8 12 the next safety seat or restraint years old Safest Protection What do need to do Rear facing Safety Seats are 5 times safer 1 Always put your child in correct safety seat or restraint Infants and children up to 2 years old should ride rear 2 Read and follow your safety seat manual and your car facing until they outgrow their car seat aaner s manni e Check car seat manual for height amp weight limits 3 Never place a rear facing safety seat in front of a passenger side airbag Read your car owner s manual e Young children have weak necks and spinal cords to learn more about air bags Rear facing car seats keep their head and neck from 4 Children younger than 13 years should ride in the jerking forward This prevents serious head and spinal back seat with the correct safety restraint cord injuries Don t worry if your child s feet It is the law touch the back of your vehicle s Texas Child Occupant Protection Law states seat Children can bend their legs Every child must ride in an approved safety seat for and there is no increase risk for leg their weight and height until they are 8 years old or injury taller than 4 fe
25. enter Your questions are very important to us Please call Trauma Services 682 885 3954 if we can help Child passenger safety guidelines are supported by Safe Kids Worldwide www safekids org the American Academy of Pediatrics www aap org and the National Highway Traffic Safety Administration www nhtsa dot qov Car crashes kill Protect your child Forward facing safety seat Safety restraints are car safety seats booster seats or safety Use for children who have grown out of the rear facing seat belts The best protection to give your child is using a safety usually 2 years old restraint the right way on every ride e Be sure to check your car seat manual for height and weight limits Best safety restraint e This seat should have a 5 point harness h int that fi hild s heigh igh l Peano te a a wont ase ane e Your child should stay in this seat until they outgrow it type of car or truck Choose the safety restraint that you will inepetuliy avlenct 4 G ats old and onpa portio use the right way every time Booster seats This is the next important step for children who Different types of Safety Restraints for growing children have outgrown their car safety seats Using a 1 Rear facing 3 Booster seat seat belt that does not fit the right way can 2 Forward facing 4 Seat belt restraint injure your child in a crash Stay in each type as long as possible e Boosters MUST be used with lap and Do not b
26. eral guidelines Your doctor may give you specific instructions If you have any questions or concerns please call your doctor Page 1 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center NICU Parent Handbook Table of Contents Getting Started A E S 871 O e E ttre ee eer ee eee ee ne E eee ee E 3 Benefits of Breastfeeding amp Human Milk eemergere eeererr Trt teere ere terrsermet tr T hrs rer reer Terr tT 4 Breast Milkisthe Bost MediCinE etc crccesic sues cpscaip encoun aunenuseausenveruenesscertacpsrsesteracerosesstonseens 6 PSEC AN Ait D a E aa E EEE EEEE E E EAE E EE 8 DVS Nie NU i E E E E E A E E 10 Getting Involved Comforting Your Baby Readiae Your Baby s C UC senatne nanai iiia 13 haa OO Te A E E TE E EE E E E T 15 Touching amp Holding Your Baby seseseseesesessessseserereresesrsesesrsesrsrresrereseeesrsrsrsrsesess 17 Your Baby s Development Be e a a A A E A E A Tete ere tere 18 our Baby s Bye celle oine as al sisisi ni 20 Feeding Your Baby Non nutrtitive Breastfeeding eeeeseeeesisesesesrrrrrrererssrsrsrsesrstsrnesrsreererersrsrsrsess 22 inant Daven Peedina ProdtaNi sesmonatan Eia i o 23 Bottle Feedine Your 67 10 garererrn Cnetere Tee mere rer Tce cn Ter ere rr reer eT mer rer 24 Helping Brothers amp Sisters Understand ceeeeceeceeceeceecsecsessesseeesseeneens La Help for Parents SEDC D ia E E N A E E E 26 Social WorkefsS eeeeesseseeenseseecessssecesessscessssesesssse
27. ertain area of medicine such as the lungs the eyes surgery etc I am a member of your NICU healthcare team and will work very close with your doctors and nurses Page 10 of 45 Dec 2012 Copyright Cook Children s Dietician Lactation Consultant Milk Tech Neonatologist Nurse Neonatal Nurse Practitioner NNP Occupational amp Physical Therapist Orientee Pharmacist Respiratory Therapist Secretary Social Worker Speech Therapist I have been trained in nutrition This includes human milk vitamin and mineral supplements and infant formulas I monitor what your baby is fed and how your baby grows At the time of discharge I will explain your baby s nutritional needs and show you how to prepare and store any special formulas It s a fact that breast milk provides the best nutrition for growth and development of all full term or premature babies I have been specially trained to provide you with support and information for breastfeeding your baby I am specially trained to protect your breast milk I help you store your milk while your baby is in the hospital I also provide you with needed supplies mix your milk for the nurses and deliver your milk to your baby I am the main doctor responsible for your baby s care I have received advanced training in caring for premature and newborn babies who require intensive care after birth Although there are many different people involved in your baby s
28. et 9 inches All passengers in the car must be secured with a seat belt if not restrained in a safety seat have a copy of these home instructions know what I need to do understand why this is important Parent Legal Guardian s Signature Date Nurse s Signature PTEOUC Page 1 of 1 an tn tr REVISION DATE June 2011 8 3 Copyright Cook Children s CookC hildren S Medical Center Chart Copy Ma La fr CookChildren s Medical Center Developmental Follow Up Developmental Follow up Types of Developmental Follow up Most babies who have been in the NICU will Early Childhood Intervention ECI need a developmental follow up Specially trained staff come to your home for A developmental follow up checks on your baby s routine appointments to developmental skills such as rolling reaching for objects and making sounds 1 Provide occupational therapy physical therapy and or speech language When your baby has follow up appointments you therapy as needed will learn about activities that you can do to help your baby with these skills 2 Provide case management and social Services 3 Teach you activities to help you Therapy for your baby develop your baby s skills Your NICU team will decide what type of follow up is best for your baby This may include NI Grad ee Appointments are scheduled when your baby is 6 months old from the baby s due date Services provided include e
29. ey often need a slow flow nipple 3 Sidelying Holding your baby on their side on a pillow or your lap is often easier for babies first learning to bottle feed Feeding Specialist Speech Therapist If your baby is having trouble feeding we may need to consult with a feeding specialist My La fr CookChildren s Medical Center What About Me Helping Brothers amp Sisters Understand Acting Out All big brothers and sisters know when something in the family is not right Change can be very scary especially for younger children How much children understand will depend on their age Many children feel lost out of control or insecure Acting out is a common way for expressing these feelings Big Brothers amp Sisters may e Become quiet and withdrawn e Have trouble eating or sleeping e Start thumb sucking e Cry or become angry for no reason e Regain an attachment to a toy or blanket e Regress with toilet training or have night time accidents e Act out at school e Be clingy and want undivided attention Learning about the different tubes Child Life in NICU Children feel the safest when they know what to expect NICU Child Life Specialists can help big brothers and sisters understand the changes taking place in their family and with their new baby If you have concerns about an older brother or sister ask to speak with our child life specialist Brothers amp Sisters Visiting NICU Man
30. f Notes milk or after 2 minutes whichever comes first move the cycle knob to halfway between Min and Max 5 Set the pump on a low vacuum setting Gradually increase it to your comfott 6 Pump both breasts for at least 10 15 minutes Gradually over time as milk volume increases increase pumping time to 15 20 minutes 7 Ifyou are planning to freeze your milk only fill the containers 4 full 8 After pumping you may want to hand express your milk Hand expression can help you to make more milk If you need help learning how to hand express you may ask for a Lactation ry Consultant Page 7 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center The Milk Bank does 3 things 1 Stores your milk at the correct temperature 2 Provides you with barcode labels storage containers yellow dots 3 Adds extra calories or nutrients to your breast milk if necessary Labeling Labeling your milk with your baby s label is the safest way to store milk for your baby 1 Place expressed breast milk in a storage container or syringe 2 Place one of your baby s name identification barcode labels on the storage container 3 Place a date time medicine milk label on the storage container 4 Write the date amp time pumped and any medicine taken by mom on the label 5 If your baby is less than 3 weeks old and born before 36 weeks place a yellow dot on the
31. helps identify decreasing production Talk to your Lactation Consultant 1 Keep the Pumping Log during your infant s hospital stay If you see that the amount of milk you remove from your breast is starting to decrease talk with your baby s nurse or a Lactation Consultant 2 You may want to speak to a Lactation Consultant if you have tender or painful areas in your breasts Cook Lactation Department Office 682 885 7144 www medelabreastfeedingus com Pumping Cleaning Your Breast Pump Before pumping wash your hands with soap and water for at least 20 seconds Wash both sides of your hands amp under your nails Shower ot bathe daily 1 Rinse your equipment in cold water followed with hot soapy water using liquid soap in the hospital or liquid dishwashing soap at home 2 Let equipment air dry on paper towels in a clean dry place Ameda Breast Pump Instructions 3 You may want to sterilize your pump kit once a day by either boiling for 15 1 Always pump into a clean container ee minutes or washing in a dishwasher on 2 Massage both breasts and hand express to the sanitation cycle start the milk flowing before pumping hhe micie 4 Keep your tubing clean and dry Do not run any liquids through the tubing 3 When your flow slows down massage of your pump kit your breast to help you empty your breast completely 4 Start each pumping session with the cycle on Max As you start to see drops o
32. ing amp storage Breast Milk Storage amp Thawing Safely Thawing Breast Milk Bad bacteria can grow in your milk and make You can thaw frozen breast milk by either yout baby very sick The following guidelines for will keep your baby healthy 1 Placing bottle from freezer in refrigerator 2 Swirling bottle in bowl of warm water 1 Wash your hands before expressing or Do not use the microwave oven to thaw handling milk or heat bottles of breast milk 2 Do not add fresh milk to already frozen 1 Microwaves do not heat liquids evenly milk in the same storage container It is 2 Bottles may explode if left in microwave best not to mix the two too long 3 Do not save milk from a used bottle for 3 Excess heat can destroy the nutrient quality of the expressed milk use at another feeding 4 If delivering breast milk to a childcare provider always clearly label the container with your child s name and date Do not re freeze breast milk if it has been thawed Where Temperature How Long Comments Room temperature up to 77 F or 25 C e Keep containers covered e Keep as cool as possible e Covering container with a cool towel may keep milk cooler Countertop or Table 5 to 39 F or 15 to 4 C 24 hours Keep ice packs in contact with milk containers at all times e Limit opening cooler bag Refri 39 F or 4 C 5 days Store milk in the back of the refrigerator efrigerator not in the doors Freezer
33. itioning aid mattress or positioning aid Has a special mattress or positioning aid Has a special mattress or positioning aid May have special mattress amp positioning aids Temperature control improving May be able to wear clothes and sleep in a crib May have positioning aids Temperature control improving Can usually wear clothes and sleep in a crib Transitioning to back for safe sleeping at home No positioning aids when close to going home CookChildren s Medical Center Non Nutritive Breastfeeding Why Non nutritive Breastfeeding Non nutritive breastfeeding means your baby latches on to your breast and suckles after you have removed your milk from your breast using a breast pump Baby Benefits 1 Non nutritive breastfeeding or sucking at breast is a way your baby can learn to breastfeed 2 Practicing non nutritive sucking at breast will help your baby learn to suck swallow and breathe while feeding Mother Benefits 1 Non nutritive breastfeeding can help you to practice positioning and latching your infant to your breast 2 Non nutritive sucking at breast is a good way to increase the amount of milk you pump in a day Mother amp Baby Benefits 1 Non nutritive sucking at breast will help you and baby to get to know one another during feeding times 2 Youcan do Kangaroo Care skin to skin with your baby during non nutritive breastfeeding Getting Baby Ready You ca
34. k If you need to get in touch with a social worker Second floor call 682 885 3681 or 682 885 6982 Third floor call 682 885 6981 Or ask the NICU staff for help calling us Ma La fr CookChildren s Medical Center Discharge Instructions Rooming in x Going Home Rooming in is a time when you will provide all of the care for your baby while in the hospital This is a list of what you may need to do to take care of your baby during rooming in and at home We will review each item on this list with you before you room in Before Rooming in What need to Know What need to bring Why this is important e Things to watch for amp do What to watch for What to do Why this is important Page 28 of 45 Dec 2012 Copyright Cook Children s The name of your pediatrician address phone number Completed CPR and Car Seat Classes Watch Shaken Baby video Your baby s filled prescriptions from your pharmacy Your picture ID drivers license student ID Your baby s car seat Baby blankets and clothing Breast feeding supplies from home Modest night wear and footwear Personal hygiene products We will review each medicine with you Please remember you are still in the hospital and need to wear night clothes that are not revealing Floors can be slippery without shoes e High or low temperature e Cough e Throwing up e Sleepier or fussier than usual e Not eating or drinking
35. k environment Developmental needs will change As yout baby gets older these developmental needs will change Parents and families can help a baby s growth and development by understanding what these needs are and how to provide them Developing organs Brain Lungs Heart and blood vessels Intestines Bones and muscles Skin mo aa yro Your baby may need help with Breathing Blood pressure Body temperature Eating Sleeping Coping with pain Calming oS mo ts GA YD Page 20 of 45 Dec 2012 Copyright Cook Children s Your baby may need a Medical equipment Lines and tubes Special bed Positioning aids Minimal touch or movement Quiet dark environment mo Oe Oe Before going home your baby will need to develop the abilities to Breathe without help Maintain heart rate and blood pressure Maintain body temperature Wake up and take full feeds Gain weight oanp Page 21 of 45 Dec 2012 Copyright Cook Children s 36 to 44 weeks 32 to 36 weeks 28 to 30 weeks 30 to 32 weeks 26 to 28 weeks 26 weeks or less Benefits from touch amp Kangaroo Care Benefits from touch amp Benefits from touch amp Kangaroo Care Kangaroo Care Benefits from Kangaroo Care amp Infant Massage Does not tolerate May tolerate well Touch amp Movement Easily over stimulated by light and Light amp Does not tolerate Sound well
36. ldren s CookChildren s Medical Center Bottle Feeding Your Baby Feeding Time Should always be a nurturing calm time for both you and your baby Suck Swallow Breathe Smooth and coordinated sucking swallowing and breathing are all necessary for a safe feeding Your baby must learn this process 1 It takes lots of energy to suck swallow and breath Your baby can concentrate on sucking and feed better when awake At first your baby may e Cough or choke e Tire quickly e Refuse to suck or suck poorly But as you and your baby get more practice feedings will improve Prepare your baby s room It s ok to talk to your baby in a soft voice Limit noise in the room from the radio cell phone or talking loudly Try not to distract your baby with rocking Make eye contact Your Bottles When your baby is getting close to going home bring in the bottles and nipples that you plan to use at home Let your nurse know if you would like to try them Page 24 of 45 Dec 2012 Copyright Cook Children s Special Ways of Feeding We may teach you some special ways to help your baby with the feeding Some examples are 1 External Pacing Helps baby with breathing Take the bottle out of your baby s mouth ot tip it down This lets your baby take a breath 2 Controlling how fast milk flows There are many different types of nipples When babies are first learning to take a bottle th
37. n practice non nutritive breastfeeding if yout baby 1 Has stable vital signs 2 Can swallow saliva 3 Can suck on a pacifier Your baby does not need a doctor s order to practice Non nutritive Breastfeeding Page 22 of 45 Dec 2012 Copyright Cook Children s Getting Mother Ready 1 Pump your breast for at least 15 minutes just before putting your baby to your breast Your breast is never 100 empty your baby will get some milk 2 Use pillows to support you and your baby 3 Position baby s tummy to your tummy in a nursing position that is comfortable 4 Line baby s nose just across from your nipple 5 Tease baby using your nipple e Wait for baby s mouth to open wide as if yawning e Gently pull baby in close by pressing in on the upper back and shoulders using your finger tips to support his head neck Always let us know if you need help with positioning and latching your baby After non nutritive breastfeeding you will need to hand express or pump the remaining milk out of your breast to store see Hand Expression CookChildren s Medical Center Infant Driven Feeding Program For babies at least 32 weeks of age who can swallow saliva and have stable vital signs Beginning to feed to your baby is an exciting time but it can also be very challenging Both you and your baby will need to learn new skills that take time and lots of practice 1 You need to learn how to help your b
38. n your milk at our NICU Milk Bank see Milk Bank Process for Parents Page 9 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center Meet Your NICU Staff Your baby has special needs amp we have specially trained staff to take care of them Audiologist Baby Buddy Care Partner Case Manager Certified Infant Massage Instructor Chaplain Child Life Specialist Consulting Doctor I find out how well your baby is hearing I use special equipment to test your baby s response to different sounds Before you go home I do a Hearing Screen e ll send you a letter explaining what we find before you leave e Please call me if you have any questions We are a group of volunteers We help NICU staff take care of the babies We help wherever and whenever needed We can hold babies do laundry clean beds and put together mobiles e We are interviewed by the Cook Children s Volunteer program before we become a Baby Buddy e We also have a background check and receive special training on the importance of hand washing confidentiality and unit rules We are trained to help care for your baby and work with the nurses We can give baths do feedings change clothes etc e Some of us have been specially trained to help the staff draw your baby s labs e Weare also the group teaching the NICU CPR and Car Seat Class e This is a very important class so plan to attend before going home
39. number e Check to make sure your household plants are not poisonous Basic Safety e Keep one hand on your baby at all times when on a high surface or in water e Do not prop bottles e Do not leave your baby alone with a bottle e Do not take your baby around people who are sick e Do not smoke around your baby e Avoid day cares church child care and crowded areas until released by your doctor e Never leave your baby alone in the car e Never leave your baby alone with a stranger e Cover electrical outlets Emergency Procedures e Keep emergency numbers by the phone police ambulance fire department poison control pediatrician and neighbors BABY SITTERS e Check credentials of babysitters and child care providers e Have your babysitter learn CPR e Teach care providers to use the bulb syringe e Teach Period of PURPLE Crying e Show where emergency numbers ate Page 32 of 45 Dec 2012 Copyright Cook Children s Ma La fr CookChildren s Medical Center Babies have different nutrition needs at each stage of growth 1 We will give you feeding instructions for yout baby before you go home 2 Your baby may need a special formula 3 Your baby may need fortified breast milk This is adding extra nutrients to your expressed breast milk usually to give it more calories 4 Some babies may need to follow a feeding schedule General Safe Practices 1 Clean
40. ow ln gentle movements Sometimes just a a firm hand on your baby s head feet or chest can be very calming 2 Position your baby and perform gentle exercises This helps to develop better 2 Bed Buddy aligned joints and muscle tone This is a bead filled bag covered with soft fleece 3 Protect your baby from bright lights and loud noises This helps to protect your baby s immature and sensitive brain We gently shape it around your baby When your baby pushes against the bag they can feel the beads moving back This is similar to what a baby feels in your womb Special Positioning Premature babies feel more secure when they curl up with their legs tucked and arms bent When they sleep they like to be supported Because premature babies have poor muscle strength they cannot stay in this curled position by themselves a We use several different types of devices to pG se te ean PIY relieve pressure or position your baby toward SE ud midline and flexion curled slightly aes NER ITAN E Cas x gt Sy Page 18 of 45 Dec 2012 Copyright Cook Children s 3 FROGS This is a bean bag that we can use for suppott around your baby s head neck or hips We can use it to help position an arm ot leg or use it as extra set of hands during procedures 4 BOPPY PILLOW This is a pillow for our moms to use when breast feeding You can also use it for supporting and pos
41. per area Use baby wipe Clean from front to back 2 Do not use powder Babies can breathe in the powder Wet Diapers Should have 6 to 10 wet diapers a day 1 Color May be clear or yellow 2 Amount Change diaper when wet to avoid rash Page 30 of 45 Dec 2012 Copyright Cook Children s Dirty Diapers Have different amounts of dirty diapers 1 Color May be yellow green or brown 2 Consistency Soft mushy or grainy When to call doctor 1 Stool Baby has diarrhea for more than 1 day Stool is hard Baby has no dirty diapers for 3 days 2 Urine Has 2 dry diapers in a row at feeding times Dehydration Call your doctor if you think your baby may be dehydrated This may happen if your baby e Throws up most of 2 feedings in a row e Has watery bowels e Has two dry diapers in a row at feeding times e Soft spot is sunken in e Mouth or eyes look dry Clothing 1 Make sure your baby s clothes are safe This means e Flame resistant e Buttons not loose e Ribbons not long 2 Do not overdress your baby e Most babies only need one mote layer than you are comfortable in e For example if you are wearing one shirt then your baby will need one shirt plus a blanket 3 Cap e Keeps head warm e Check under hat often Page 31 of 45 Dec 2012 Copyright Cook Children s Poisons and Other Dangers e Keep dangerous things like cleaners soaps or medicines out of your baby s reach e Know your poison control phone
42. rawing blood can be almost painless We have special ways to help your baby feel less pain Please ask us if we do not tell you about it We will also warm your baby s foot with a warm pack before blood draws from their heels 2 Pacifier dipped in sugar water Sucrose This often comforts small babies before during or after a needle stick Parents can hold this pacifier 3 Relaxing Room A dark and quiet room can help your baby to relax You can help us keep a calm room by silencing your cell phone talking quietly and reminding visitors and staff to use quiet voices 4 Pain medicine Although all of these methods holding cuddling medical play etc help children feel better sometimes we also use pain medicine Your doctor or nurse will explain what medicine your child is on and how it works Please remember that treating pain is ongoing 1 We will regularly check your baby for pain throughout your stay at Cook Children s Your questions about your baby s pain and treatment are very important to us 2 3 Always let us know if our answers are not clear 4 Please feel free to discuss your questions or concerns with any member of our health care team CookChildren s Medical Center Page 16 of 45 Dec 2012 Copyright Cook Children s My La fr CookChildren s Touching and Holding Your Baby Touching and holding your baby is important to help 1 Comfort your baby 2 Get to know your baby 3 Bond
43. sociation lists Lactation Consultants by location www ilca org Texas Department of State Health Services 817 588 1006 www dshs state tx us Local Resources WIC Tarrant County Warm Line 817 321 5416 Baylor Main Number 1 800 422 9567 Baylor Simply Moms Dallas 214 820 3103 Fort Worth 817 698 8695 Garland 972 487 5154 Grapevine 817 424 4867 McKinney 469 764 6262 Texas Health Resources Hospitals Arlington Memorial Hospital 817 548 6100 Lactation Consultants 817 548 6561 Spanish speaking Lactation Consultant on Staff Harris Methodist Erath County 254 965 1500 Lactation Consultant 254 965 1585 Harris Methodist Fort Worth 817 882 2000 Breastfeeding Resource Center 817 250 2229 www breastfeedingresource com Harris Methodist HEB 817 283 0631 Breastfeeding Support Center 817 685 4773 817 433 5000 Page 43 of 45 Dec 2012 Copyright Cook Children s Harris Methodist Southwest Lactation Consultants Breastfeeding Brown bag support group Harris Methodist Walls Regional For breastfeeding help Labor amp Delivery dept Presbyterian Hospital of Allen Lactation Consultants Presbyterian Hospital of Dallas The Prescription Shop Lactation Consultant NICU Lactation Consultants Presbyterian Hospital of Kaufman For Breastfeeding help Postpartum floor Presbyterian Hospital of Plano A mother s Gift Lactation Consultants National Resources LeLeche League National Website National Phone Number 800 laleche 800 52
44. sound Breathing Needs help Needs help breathing May need help e Getting stronger Breathing amp regulating heart rate Breathing amp regulating heart breathing breathing e May need some help improving rate improving Nutrition through Nutrition through feeding tube or IV feeding tube or IV e Rapid brain erowth e Needs sleep to conserve energy firm but gentle touch Beginning to tolerate rocking May not like rocking Improved tolerance for May not like rocking rocking e Kangaroo Care Cannot tolerate rocking Does not tolerate well Improved tolerance to light amp sound e May not tolerate dim lighting amp quiet voices Begins tolerating dim lighting quiet voices May not tolerate well e Suck strong amp coordinated e Works on taking all feeds by breast or bottle e Gaining weight e Wakes up before feeds some of the time Nutrition through feeding tube or IV e Needs feeding tube for adequate nutrition May start to wake up before feed Suck getting stronger Gaining weight e Suck getting stronger e May need some nutrition via feeding tube Rapid brain growth Needs sleep to conserve energy Rapid brain growth e Rapid brain growth i 5 e Needs sleep to conserve energy e Needs sleep to conserve energy e Rapid brain growth e Needs sleep to conserve energy e Rapid brain growth e Needs sleep to conserve energy Has a special mattress Sleeping Has a special or pos
45. t name Your baby s last name while in the NICU will always be the Mother s last name This is a safety precaution You can change this on the day of discharge if you would like Page 3 of 45 Dec 2012 Copyright Cook Children s 4 Review your consent form At this time we need you to review each form you have signed We understand this is a lot of information to read Please let us know if something is not clear The forms you will need to sign are 1 CCHCS Acknowledgement of Privacy Practices Financial Disclosure Authorization for Consent to Treat Non Parental Authorization for Consent to Medical Surgical Care and Treatment CCPN Consent to Release Medical Information CCPN Consent to Obtain Medical Information Discharge We may need to get in touch with you when you go home Please make sure your account information is correct CookChildren s Medical Center Benefits of Breastfeeding amp Human Milk Importance of breast milk Mother s milk is the best food for babies Breast milk is easy for your baby to digest 1 Breastfeeding helps promote a special time for a mother and baby to bond 2 Breastfeeding makes comforting baby easier less crying 3 Breastfeeding helps protect a mother from some forms of female cancers First 6 months The American Academy of Pediatrics recommends feeding your baby only breast milk for the first 6 months of life Up to 1 year Con
46. tinue to feed breast milk up to one year of age as you introduce solid foods to your baby Breast milk protects your baby Breast milk 1 Contains anti bodies to protect your baby against infections 2 Helps protect your baby s stomach and intestines from harmful bacteria 3 Can make your baby smarter because it promotes healthy development of the brain and nervous system 4 Helps decrease the chances of your baby getting sick having allergies asthma and ear infections 5 Helps promote healthy mouth and facial growth It also decreases the number of dental problems and helps with speech development Page 4 of 45 Dec 2012 Copyright Cook Children s Colostrum This is the first milk you will produce for your baby This is the first milk you or your baby will get out of your breast Feeding colostrum gives your baby immune protection for life Making human milk for baby To make milk for your baby you need to stimulate your breasts by feeding or pumping If you have milk and want to keep your milk you must either 1 Feed your baby at the breast 2 Remove the milk from your breasts by pumping or hand expression If your infant is sick or unable to breastfeed you will need to remove the milk from your breasts by using a hospital grade pump Pumping after baby is born It is important to begin pumping within the first 6 hours after you have your baby In Delivery Hospital 1 Ask
47. tioning your baby 5 Nurturing Item NICU LOVIES Research shows that premature babies born as early as 26 weeks may respond to different smells This is a cloth that you tuck close to your skin to absorb your scent You can then leave the scented lovie next to yout baby for comfort when you are not there Page 19 of 45 Dec 2012 Copyright Cook Children s 6 Safe Sleeping for Your Baby Lights amp Sounds SLEEP SACKS This generous sack design allows room for kicking but cannot be kicked off so baby stays warm Premature babies are more sensitive to their environment than full term babies and react to changes in light and sound Lighting e Natural light is better than electrical lights e Keep background lighting low e Use dimmer switch to prevent the sudden Sound Keep room quiet Use soft voice when talking to your baby change of brightness Close cabinets drawers and doors gently to avoid loud noises CookChildren s Medical Center Your Baby s Development Providing positioning warmth quiet and darkness For nine months babies live a protected life in their mother s womb This type of protection positioning warmth quiet and darkness is essential for their growth and development Premature babies must also have this same type of protection and care 1 Positioning to support infant s posture 2 Warm environment 3 Quiet environment 4 Dar
48. ur baby breast milk Your breast milk is more than a food Breast milk is a medicine that your baby needs In fact your breast milk may be the most important medicine anyone can give to your baby and only YOU can give it If you choose not to breast feed you can still pump breast milk It is important to start breast milk pumping within 6 hours of baby s birth 1 Consistent pumping the first 2 3 weeks helps to establish your milk supply 2 The first weeks of pumping determines your long term supply next 6 months to a year Establishing milk supply Using a hospital grade electric breast pump pump at least 8 times per 24 hours to establish or increase your milk supply 1 Pump every 2 3 hours around the clock until milk supply is well established not going past 3 hours without pumping 2 Pump after holding or providing Kangaroo Care to your infant 3 Pump after breastfeeding for 2 3 minutes after milk flow stops or slows down 4 Do not skip delay or decrease the number of times you pump 5 Pump both breasts at the same time this helps you produce more milk Page 6 of 45 Dec 2012 Copyright Cook Children s Keep a Pumping Log You may get different amounts of milk each time you pump This is normal You may also get different amounts from each breast 1 Itis important to detect decreases in milk production as soon as possible 2 Tracking the amount of milk you pump in 24 hours
49. uring Lactation Brand Name Blue cohosh Blue Cohosh Comfrey o G O Tegison KombuchaTea SS G O plead Lead SSS Mercury o G O Zonisamide Antipyrine Antipyrine a Page 45 of 45 Dec 2012 Copyright Cook Children s
50. ursing station I am responsible for answering the phones the call buttons and monitoring the visitation list I visit with all families in NICU I can help you deal with new concerns about your premature baby I can also help you adjust to the sometimes stressful NICU environment If necessary I can help you with lodging and transportation and will give you a list of community resources for when you go home I look for signs that your baby is ready to feed and then I help your baby learn how to do it I may suggest a special nipple thickening of feeds or use special techniques to help your baby suck swallow and breathe I work closely with your doctors and nurses to develop a plan of care for feeding your baby Page 11 of 45 Dec 2012 Copyright Cook Children s Student Our hospital is very proud to provide learning experiences for our future in healthcare You will see students with the nurses respiratory therapists and other staff caring for your baby I am a qualified interpreter for parents and families who do not speak English or can better Translator understand information in another language Please let your NICU nurse know if there is any Interpreter way I can help you or your family My NICU Staff Department Staff Member Name Page 12 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center Reading Your Baby s Cues Learning how your baby communicates Babies have needs just like
51. we do and are lam happy if happier when we can meet these needs Cues are all the things your baby tries to tell you using ways other than words I am alert and my eyes are open My face body arms and legs are relaxed I may try to smile amp suck calmly on my pacifier gt i oE i I look at objects or people Premature or Sick Baby s Brain i A premature baby s brain cannot handle the stress that a full term baby can e Premature babies try to tell us when lam not happy amp need some help if they are feeling stressed 1 Crying or fussy e We can avoid adding more stress and l i l i help calm by responding to their cues Yawning gagging sneezing or hiccups Arching or extending my neck By learning these cues you can help your baby 1 Be less stressed 2 Gain weight 3 Grow and develop 2 3 4 Outstretched hand stop sign 5 Closing my eyes or looking away 6 Opening my hand amp spreading my fingers Frown grimace or grunt Learn about your baby s cues 1 Holding and caring for your baby will help you learn your baby s cues Skin color changes in my face 2 Visiting as much as possible helps you learn how your baby communicates 3 Always ask your nurse or therapist if you have any questions You can tell when your baby is 1 Feeling happy O Potnesees Coping Skills am calming myself 3 Calming self down 1 I clasp my hands together 4 Needing help to calm
52. with your baby 4 Support your baby s growth and development Babies born prematurely or sick need different types of touch or holding Your baby may have 1 Medical lines 2 Special equipment 3 Feeding tubes There are several ways to touch and hold your baby Some common ways include 1 Encircled holding 2 Kangaroo care 3 Swaddled holding 4 Cradle holding 5 Infant massage A staff member will help you learn how to touch and hold your baby What you need to do 1 Always wash your hands before touching or holding your baby Learn about your baby s medical lines and equipment Get to know your baby s cues Learn different ways to touch and hold your baby Never be afraid to ask a staff member how to touch or hold your baby Visit your baby as often as you can Ou WN Page 17 of 45 Dec 2012 Copyright Cook Children s CookChildren s Medical Center DEVELOPMENTAL CARE What is developmental care 1 Z Flo Mattress We frequently use this phrase in the NICU a Babies born early need special attention to he _ This mattress is made of support their growth Developmental care i soft material We can mold means providing your baby with every ay A and shape it to your baby s opportunity for the best possible progress ga amp size condition and ar co A equipment It provides This includes teaching you how to R ke 2 comfort and support 1 Touch hold massage and use sl
53. y children are eager to meet their new brother or sister If possible we encourage our families to arrange for a sibling visit 1 Please call our NICU Child Life Specialist if you would like to schedule a visit 2 Child Life will meet with and you to discuss the guidelines we must follow NICU can be very scary for young children Preparing brothers and sisters for the sights and sounds of NICU is an important first step Page 25 of 45 Dec 2012 Copyright Cook Children s My La fr CookChildren s Medical Center Spiritual Care Chaplains are available at all times Chaplains care for the needs of persons of all faith backgrounds or of no faith backgrounds Talking to a chaplain is often helpful e Chaplains support you your child and your family in all situations e Chaplains are available to discuss spiritual and or ethical concerns e Chaplains provide information regarding faith resources outside the Medical Center e Chaplains are familiar with resources related to spiritual and ethical needs and concerns Talking to a chaplain 1 Tell your nurse you would like to talk with the chaplain for care and or support 2 Call the hospital operator and ask to have a chaplain paged 3 Access the Get Well Network and ask for a chaplain Page 26 of 45 Dec 2012 Copyright Cook Children s a La A CookChildren s Medical Center Social workers meet all NICU families Social workers are a part of your NI
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