From NICU to Nursery: 5 Must-Know Tips for a Smooth Transition Home

Guest Post by: Jennifer Bonilla, RN

It’s been a bazillion days, and you are finally ready to go from NICU to nursery; here’s 5 must-know tips for a smooth transition home from a NICU nurse. 

Above all, know that this day may be bringing you a very mixed bag of emotions. Everything from excitement and relief to anxiety and grief. These are all valid feelings. Don’t for one second feel bad or guilty about any of them. Nobody ever plans for their baby to need NICU care so it can seem like the transition home is the first step to the path you were ‘supposed to’ be on. Finally stepping out of the hospital with your baby may release a ton of emotions that were just waiting for a safe moment to be expressed. 

As a NICU nurse, I have a very specific list of things to teach you so I can send you on your way. The truth is no checklist could ever encompass all the minor details of life with a premature baby. So, here’s what I really want you to know: 

NICU graduate tips:

#1 - Feeding a NICU baby at home can be tricky. 

Most of our NICU babes are “feeders & growers” in their last few days to weeks in the NICU. This means they’ve mastered life- ing and just have to be bigger and eat to go home. 

Things to know: 

• Your baby should be feeding on demand now instead of the rigid 3hr NICU schedule. This means your day may not be predictable

• You may need to change your pumping schedule. While your baby was admitted, the team was asking you to supply the milk for us to feed your baby. Now your baby is with you! Remember you aren’t feeding a freezer and may be able to wean how much you pump. Do this slowly so you and baby are both comfortable

• Be cautious about changing too many things at once. Talk to your health care providers about things like changing nipple speeds/ levels and decreasing supplements. 

• Check out my feeding packages if you need help working through the sticky spots. 

#2 - There are some day-to-day precautions & checks for newborn care after the NICU.

Everything in NICU can feel very numbers driven. Heart rate, bottle volume, weight gain, oxygen flow... But here’s a couple day to day numbers to keep in mind:

• Be sure you have a car seat with a minimum weight that is appropriate for your little peanut. Follow the manufacturer guidelines on strap placement. In most cases, the straps should be in the smallest setting. 

• If you feel your baby needs something to support their head, use rolled up blankets or towels.

• While we’re at it, more expensive does not equal safer. All car seats have to pass a certain Canadian standard. Honestly sometimes the fancy- pantsy car seats are really awkward to put the baby into and carry.

  
  

  (Check out transport Canada here for the guidelines)

#3 - Your NICU to home transition needs to include tummy time to protect head shape.

Tummy time is important. Your baby should be spending at least 30 mins doing tummy time a day. It's a super easy way to help with head shape. Keep in mind: 

• Laying your baby upright on your chest, tummy to tummy with you counts as tummy time! 

• Don’t try to do 30 mins all together. Do 5 min intervals throughout the day. 

• Rotate where you lay the baby's head in the cradle. At my hospital, the windows are to the left side of the baby’s head and our babies tend to go home with a preference for turning their head to the left. 

• Use rolled up towels at home to help your baby turn and keep their head to the non-preferred side when doing awake floor time. 

#4 - Milestones for your premature baby may vary. 

Talk to your primary care doctor about your baby’s age. Should you be expecting milestones based on their current days of life? Or should you be considering corrected gestational age? 

Depending on how premature your baby was, health care providers may refer to their age as corrected gestational age or CGA. This means that we’re viewing what a baby at 40 weeks should be doing as opposed to what your 3-week-old baby should be doing. 

For example, while your baby might be 6 months old in days of life, we may be expecting them to behave like a baby x weeks younger depending on how early your preemie was. 

P.S. This includes sleep milestones! Let Melody know if you need a hand!

#5 - Life after the NICU does not just start where you would have been without the NICU.

Believe it or not you have been living in survival mode. You just need to get through this next step (enter NICU goal here) in order to be closer to going home. This has been your reality for however long your baby has been admitted. Now that you are going home or have arrived home, expect that emotions will run high. 

You may have become habituated to checking your baby’s monitors to see how they are coping, and you no longer have monitors. It’s okay to be scared. 

You may feel like you don’t have easy access to medical care the way the nurses were available in the hospital. It’s okay to reach out to the support numbers we provided to you like the “early start line”. 

You may feel like things just aren’t right if you’re bringing home a medically complex child. It’s okay to grieve the birth, delivery, path, baby that you thought you’d have and don't. 

You may feel jealous of friends or family members that bring their new baby's home without any bumps in the road. It’s okay to be angry. 

There’s so many more.

Life is incredibly nuanced and society has tricked us into believing that birth and new babies are safe and healthy and without risk.

The truth is that isn’t always the case.

Let yourself feel the feelings and reach out if you need help working through them. You have been through a crisis, allow yourself time to recover without guilt. 

You are your baby’s constant. You know them best. Trust your instincts. 

I’m here if you need help.

Jennifer Bonilla