Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 1998;57(10):2400-2402

See related article on premature infants.

If your baby was born prematurely (before the due date), he or she may need special care, especially during the first two years. Special care is often needed in babies who weigh less than 3 pounds at birth. Here are some ways you can give your baby this special care when he or she comes home from the hospital.

Your Baby's Growth and Development

It's important to take your baby to your doctor's office soon after the baby leaves the hospital. Your doctor will check your baby's weight gain and find out how your baby is doing at home.

Talk with your doctor about feeding your baby. Your doctor may recommend a special formula if the baby is bottle-fed, and vitamins or iron. Vitamins are often given to premature babies to help them grow and stay healthy. Your baby also may need extra iron. After about four months of taking iron drops, your baby will have about the same amount of iron as a full-term baby. Your doctor may want your baby to take iron drops for a year or longer.

Your baby may not grow at the same rate as a full-term baby for the first two years. Premature babies are usually smaller during this time. Sometimes they grow in bursts. They usually catch up with “term” babies after a while. To keep a record of your baby's growth, your doctor can use special growth charts for premature babies. Your doctor will also want to know things like how active your baby is, when your baby sits up for the first time and when your baby crawls for the first time. These are things doctors want to know about all babies.

Your Baby's Feeding Schedule

At first, most premature babies need eight to 10 feedings a day. Don't wait longer than four hours between feedings, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to eight wet diapers a day show that your baby is getting enough breast milk or formula. Premature babies often spit up after a feeding. If your baby spits up too much, he or she may not gain enough weight. Be sure to talk to your doctor if you think your baby is spitting up too much.

Putting Your Baby on Solid Food

Most doctors advise giving a premature baby solid food at four to six months past the baby's original due date (not the birth date). Premature babies may choke if solid food is given earlier. They have to develop their swallowing ability. Cow's milk isn't usually given to a premature baby until the baby is about one year old. If your baby has medical problems, a special diet may be helpful.

How Your Baby Sleeps

Although premature babies sleep more hours each day than full-term babies, they sleep for shorter periods of time. They wake up more often, and they may wake you up more often.

When you put your baby to bed, place your baby on the back, not on the stomach. Use a firm mattress and no pillow. Sleeping on the stomach and sleeping on soft mattresses may increase your baby's risk of sudden infant death syndrome (SIDS).

Your Baby's Vision and Hearing

Crossed eyes are more common in premature babies than in full-term babies. The medical word for this is strabismus (say this: straw-biz-mas). Often, this problem goes away on its own as your baby grows up. Your doctor may want you to take your baby to an eye doctor if your baby has this problem.

Some premature babies have an eye disease called retinopathy of prematurity (called ROP, for short). ROP usually only occurs in babies who are born very early, at 32 weeks of pregnancy or earlier. If there's a chance your baby has ROP, your doctor will advise you to get regular check-ups by an eye doctor. ROP can be treated to help prevent vision loss.

Premature babies are also more likely than full-term babies to have hearing problems. If you notice that your baby doesn't seem to hear you, tell your doctor so your baby can be checked for hearing problems. You can check your baby's hearing by making noises behind or to the side of the baby. If your baby doesn't turn his or her head, or jump at a loud noise, you should tell your doctor.

Your Baby's Immunizations

Immunizations (shots) are given to premature babies at the same ages they are given to full-term babies. It may be helpful for you and your family members to get flu shots in the fall. This can help protect your baby from catching the flu from someone in the family. Your baby might be helped by getting a flu shot when she or he reaches six months of age. Flu shots aren't given to babies younger than six months. Premature babies might get sicker with the flu than full-term babies. Talk with your doctor about flu shots for your family.

Traveling in a Car with Your Baby

When traveling with your baby in a car, use an infant car seat (or another kind of infant carrier, if your doctor advises). Be sure that your baby's head and body don't slump over when he or she is in the car seat. No straps should be around your baby's head or stomach. You can use rolled-up towels or diapers to give your baby support in the car seat.

The safest thing for all babies is to ride in the back seat. It's especially important that your baby doesn't ride in the front seat if your car has an air bag on the passenger's side. When you're driving in the car with your baby, keep an eye on your baby by looking at him or her in your rear-view mirror. Or you can have a friend or family member ride in the back seat with your baby. If you're using an apnea monitor for your baby, it should be used even while your baby is riding in the car. Your baby shouldn't be left alone in the car, not even for a few minutes.

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