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Behavioural Stages

While your preterm baby is in the NICU you may experience a lot of emotions such as loss, guilt, self-blame, anger, anxiety, depression and many more.  These are all normal emotions, since the birth of a preterm baby is similar to the loss of a baby.  As parents of a preterm baby, you’ve lost the opportunity to experience a normal pregnancy and birth, as well as the joy of taking a healthy, full term baby home.  One of the main challenges parents of preterm babies experience is that they do not know how to interact with their babies while they are still in the NICU.  Before even touching or interacting with your baby it is important to observe her and read the cues that she gives you.  Your baby has different behavioural stages and behavioural cues that will help you give her the appropriate care at the right time. A behavioural stage (turning-in, coming out or reciprocity) will tell you whether your baby is ready for interaction or whether you should rather not handle her at the time, since she is already experiencing stress.

Behaviour stages of the preterm baby

Your baby will react or behave differently depending on the age she was born.  Even though all babies are unique, research has shown that they can normally be categorised into certain stages of behaviour.  A baby born before 32 weeks gestation will not be able to communicate with the environment or her caretakers at all. This baby will need intensive care nursing, will be physiologically unstable and will be unable to come into and maintain the quiet alert state.  This is called the turning-in stage.  The baby's behaviour is similar to that of a porcupine, since she reacts on pain (or touch) by turning in to herself and trying to protect herself from possible harm.

Between 32 and 35 weeks gestation your baby will become physiologically stable, start to communicate and interact, breathe comfortably and absorb calories when fed by mouth.  This is the coming-out stage and the baby is similar to a tortoise, since she will shyly start to explore the environment, but as soon as it becomes too much she will withdraw to try to recover.

When your baby is 36 weeks or older she will be able to actively interact with the environment and her parents.  She will be able to recover from agitation by using self-quieting behaviours (which the staff and her parents taught her).  This stage is the reciprocity (interaction) stage and similar to a puppy.  During this stage she mainly sleeps and feed — just like a newborn full term baby does.

Keep these stages in mind when starting to interact with and getting to learn your baby.  It is important to remember that your baby may be outside the womb environment, but the development will be at the same level than that of her counterparts who are still in the womb, receiving the protection they need.  Preterm babies may also be compromised from over stimulation that is too must for her fragile system.

As mentioned earlier, all babies are unique and you might find that your 30 week old baby will be in the coming out stage.  It is more important to look at how your baby reacts to interaction than at the gestational age.  Chapter four of Prematurity – Adjusting your Dream explains the different stages and also provides you with activities that you can do during each stage to get to know your baby.

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