10 Tips on Caring for Your Premature Baby

If your baby arrives before 37 weeks of pregnancy, then your infant is considered premature, or a “preemie.” Babies born early have special health needs because their bodies and brains need time to finish growing and developing to match babies who are born full term.

Taking care of a premature baby can seem overwhelming, especially if you’ve had to spend extra time in the hospital. Here are 10 things to know that will help ease your family’s transition from the hospital to your own home.    

1) Premature infants have extra growing to do

Preemies have special dietary needs. They need extra calories, vitamins, and iron to meet the demands of their growing bodies and developing brains. Although premature babies are smaller than term babies at first, they “catch up” with the right nutrition.

Special formula and extra calories

Your baby might need a special formula that’s made for premature babies. These formulas have extra calories and vitamins like calcium and phosphorus. If you’re using breast milk, you might need to mix a fortifier into breast milk to add these extra nutrients. Make sure that everyone who prepares your baby’s feeds knows how to make it.

Vitamins and supplements

Preemies are born with low iron stores, and all babies need extra vitamin D. Your baby will need iron and vitamin D supplements — and maybe other vitamins, too. Vitamins are usually given once a day, and you can mix them right into the bottle. 

2) Mastering feeding will take practice and patience

Sometimes preemies can have trouble eating enough because their mouth and throat muscles are still maturing. Your healthcare team might recommend special “preemie nipples” so it’s easier for your baby to eat from a bottle. They might also recommend working with a feeding team. This group can help your baby continue to work on feeding skills over the first few weeks at home. 

3) Their lungs are still catching up

Depending on how early your baby arrived, their lungs may still have some catching up to do. Some babies need extra oxygen and medication called “diuretics” until their lungs mature. Some need special monitors to keep an eye on their oxygen levels. If your baby needs this equipment, you’ll have a visiting nurse to help you learn to use it.

Most babies don’t need any support for their breathing. But even so, you can help your baby’s lungs stay safe by keeping your home smoke free. 

4) They might not be able to use a regular car seat (at first)

Before your baby goes home, they’ll have a “car seat test.” This test makes sure your baby can use a regular infant car seat. If your baby’s neck isn’t strong enough to keep their head up and airway open, your healthcare team will help you adjust your car seat. Sometimes, special padding or supports around your baby’s head are enough to make the car seat safe. But some babies may need a special “car seat bed.”

Often, healthcare teams ask someone to ride next to the baby in the back seat. This way someone is always watching to make sure your baby is breathing properly while in the car seat.

Experts recommend limiting travel time in the car to about an hour.    

5) It takes them longer to sleep through the night

Preemies may sleep for shorter periods and take longer to start sleeping through the night. Babies who were born full term start to sleep up to 8 hours at night by 4 months of age. But your baby may not sleep through the night until they’re 6 to 8 months old, or even later — and that’s OK. 

Make sure you place your baby on their back anytime you put them down to sleep, even for naps. Create a safe sleep space by keeping stuffed animals, blankets, pillows, comforters, and baby bumpers out of their sleep environment.  

6) They have sensitive skin 

Many premature babies have sensitive skin. There are several things you can do to help prevent rashes. 

Sensitive skin care products

Use hypoallergenic baby wash, soap, and shampoo. The products shouldn’t have any scent and should be either white or clear — this means the product is free of dye. Most babies don’t need lotion. But if you want to use lotion or oil, pick something without scents or dyes. 

Also, you can skip daily baths for the first few months. Your baby only needs a bath about three times a week!

Diaper creams and wipes

Because you’ll be changing lots of diapers, your baby may get red, irritated skin in their diaper area. Here’s a tip to help their skin: Skip the baby wipes when possible. Modern diapers absorb a lot of pee, so your baby’s skin is less likely to get irritated by urine. For cleaning poop, use scent-free wipes or a wet washcloth.   

If your baby’s bottom gets irritated, use a scent-free, zinc oxide-based diaper cream. Apply a thick layer (think cake frosting thick) to their diaper area. Don’t wipe off the cream with each diaper change! This can irritate their skin. Just keep adding more if you need to. At the end of the day, you can give them a bath or wipe it all off with a wet washcloth and apply a new layer. Keep using this barrier until the rash goes away. 

7) They might need an extra layer of clothing

Your baby might have needed an isolette to help them maintain their body temperature when you were in the hospital. But your baby will be able to maintain a normal body temperature when they come home. You won’t need heavy blankets or comforters to keep them warm. 

But they might still need an extra, thin layer of clothing. If you’re comfortable in a T-shirt, your baby might need a short-sleeve bodysuit plus a long-sleeve bodysuit or pajamas. 

8) It’s a good idea to be extra careful about germs

Your premature baby has an immature immune system, so they can get sick more easily. A virus that may cause a bad cold in an adult might get to your baby’s lungs and lead to serious illness.

Tips for visitors and outings include:

• Ask anyone who is sick or not feeling well to postpone their visit.

• Everyone should wash their hands before touching or picking up your baby. 

• Limit trips outside the house, and avoid crowded public places — especially in the fall and winter months.

• Schedule healthcare provider visits early in the morning so you can avoid sick kids in the waiting room. 

9) There are great resources available to support their development

Just like the rest of their body, a premature baby’s brain has extra growing to do. So similar to how you're supporting their growth with vitamins, you want to support their brain development. Most premature babies qualify for early intervention services, which are free in many states. Specialists come to your home to provide services like physical, occupational, speech, and developmental therapies. If your baby spends any time in the neonatal intensive care unit (NICU), the NICU team will also follow your baby in a special developmental clinic to make sure their development is on track. 

Premature infants usually need a repeat hearing test by the time they’re 30 months old, even if they passed their newborn hearing screen. This is because their hearing is still developing. Because their eyes are also still developing, premature infants are at higher risk of developing strabismus (cross-eye). Your healthcare provider will recommend that you see an ophthalmologist when your child is about 2 years old — or sooner if you have concerns. 

10) Taking care of yourself is just as important as taking care of your baby

Taking care of a baby can be stressful, even more so when your baby is born prematurely. Let family and friends run errands, make meals, or watch your other kids so you can take care of your baby and rest. Seek help from your healthcare provider, family, clergy, or community support groups if you need it. 

Parents can also develop postpartum depression. Contact your healthcare provider if you think you could have postpartum depression. Postpartum depression is treatable — you’ll feel better with treatment, and you don’t have to go through it alone.      

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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