Getting to Know Your Newborn

What Do Preterm Babies Look Like?

Preterm babies can look a little different from babies born at term. Late preterm babies will often just look a little smaller than babies born after 37 weeks. Babies born very preterm or extremely preterm (less than 32 weeks) can be very tiny and frail looking. These babies usually look quite thin because they have not developed layers of body fat yet.

Preterm babies are often born covered with thick, white, greasy cream called vernix. This protects their skin in the watery environment of the uterus and is slowly absorbed into their skin over the first couple of days following birth. Since the skin is not fully developed, you may be able to see the blood vessels beneath. This gives premature babies a reddish-purple skin color. Their skin may feel "sticky" and can bruise easily.

Most very premature babies also have very soft hair, called lanugo, which may cover most of the body. It disappears as the baby grows.

The head of a preterm baby may look unusually large for the size of the body, and the arms and legs might look quite long. Very preterm babies have very little fat covering their bones. However, as they grow and develop more fat, their head, arms and legs should begin to look more "normal" for their size.

It is not unusual for a very preterm baby's eyelids to be stuck shut at the time of birth. Do not worry about this, as they will open in time.

The ears are also still developing and may be very close to the head and have little cartilage, the material that gives the ears their final shape. If the ears are folded or bent, they may stay in a folded position for a while. Do not worry. With time, the ears will develop cartilage that will make them spring back into place when touched.

How Do Preterm Babies Act?

It is common for very preterm babies to move very little, and when they do, it is usually in a "jerky" or "startled" fashion. This is because their reflexes are not fully developed and they have little control over their muscles. Since they also have weak muscles, you will have to look closely to see signs of increasing strength and ability. For instance, you may see the baby moving or bending an arm or a leg.

You may also see a suckling response if you put your finger near the baby's mouth. As he or she sleeps, eats and gains weight, the body shape and skin will begin to look more like that of older babies.

How Can I Interact with My Preterm Baby?

Following birth, the baby may not be awake or alert enough to focus on you, but your touch and voice are important. Babies usually respond better to a gentle but firm touch. At first, frequent touches may be too stimulating. Placing your hand over the chest using firm, gentle pressure may be very calming. Or you can hold the baby's arms and legs by tucking them in towards the body. During pregnancy, the baby was used to hearing the mothers voice, so speaking softly and repeating the baby's name can be soothing.

Positioning is important, and you will see the nurses change your baby's position often. Placing the baby on the stomach, back or sides nestled in a blanket can help him or her feel snug and secure as if back inside the womb. Keeping your baby's hands and legs tucked in close to his or her body may also be soothing and calming. Being able to get his or her hands up to the face and mouth can be especially soothing for the baby. You can also help keep your baby's eyes covered to protect against bright lights.

When your baby is stable enough to hold, the nurses will help to hand you the baby, along with whatever tubes and wires there may be. They will also stay close by in case you or the baby needs help. You may be a little nervous at first, and it may even be a little stressful for the baby. You can help by cuddling the baby with a gentle, firm hold, talking softly and keeping him or her warm and wrapped in a blanket.

There is another special way to hold your baby, called skin-to-skin or kangaroo care. This is when the nurse places the baby upright on a parents chest while wearing only a diaper, then wrapping the baby in your clothing, with a blanket placed on top. Your baby will be soothed by your warmth, smell, heartbeat and breathing.

At first, any kind of holding or interaction may be tiring or stressful for the baby. However, the baby will give you clues that let you know when he or she is calm, happy and able to handle interaction. Babies also let you know when they are tired or need to be left alone.

Signs that indicate the baby feels good are:

  • Placing his or her hands on the face or ears or clasping them together
  • Relaxing the arms and legs
  • Suckling or attempting to suckle
  • Cooing
  • Looking at and listening to you
  • Dozing off to sleep

Signs that say I need a rest include:

  • Hiccups and spitting up
  • Frowning
  • Arching
  • Stiffening the arms and legs
  • Spreading out the fingers and toes
  • Avoiding eye contact

The latter signs do not always mean that your baby wants to be left alone. Sometimes a brief rest or position change is all he or she needs to calm down. By learning your baby's signals, you will be able to determine his or her needs, likes and dislikes. This will be something you will continue to work on even after you leave the hospital.