What your premature baby might look like

Premature babies look different from full-term babies. Premature babies might also look different from each other, depending on how early they were born.

A baby born at 36-37 weeks will probably look like a small full-term baby.

But an extremely premature baby – for example, a baby born at 24 weeks – will be quite small and might fit snugly into your hand. This baby might have fragile, translucent skin, and his eyelids might still be fused shut.

The NICU team carefully monitor your premature baby’s weight, length and head size to make sure he’s growing as expected.

Your premature baby’s bones

A premature baby’s bones aren’t always fully developed.

In the last months of pregnancy, lots of minerals – including calcium and phosphorus – are transferred from mother to baby. In a full-term baby, this helps bones grow and get strong. But premature babies don’t get these important minerals in the womb.

Premature babies also often lose more minerals through their wee than full-term babies.

And full-term babies spend their last few months in the womb stretching and flexing their muscles, which also helps their bones to develop. Premature babies miss out on this too.

It can take quite a while for your premature baby’s bones to grow and get strong.

Helping your premature baby’s bones to grow

Staff in the neonatal intensive care unit (NICU) might recommend a powder containing supplementary calcium and phosphorus that can be added to expressed breastmilk for premature babies. This helps their bones grow and strengthen. Sometimes a specially formulated and fortified formula milk can be used.

Gentle exercises specially designed for premature babies – for example, bending and straightening their arms and legs – can help your baby gain weight and build stronger bones and larger muscles. These exercises can also make it less likely that your baby’s motor development will be delayed.

These exercises need to fit into your premature baby’s overall medical plan, so speak to your doctor before you try them. Your baby’s doctor will know when your baby is ready to start exercises. A hospital physiotherapist will probably do these special exercises with your baby to start with, while you learn how to do them.

When you take your premature baby home, you can play games that encourage her to move her arms and legs. For example, let your baby kick while lying on the floor, or play ‘Row, row, row your boat’ while gently moving your baby’s arms.

Your premature baby’s skin

When a premature baby is born, his skin might not be fully developed. It develops quickly, though.

Skin has two very important functions. It lets your baby sense the world through touch and temperature. It also protects all the vulnerable tissues and organs inside your baby’s body.

Sensation
Touch is the first of the senses to mature. Your premature baby learns about the world mainly through touch, and touch is a key way for you to bond with your premature baby.

It can be soothing for your premature baby if you warm your hands and place them gently on her back or head. Just keep them still. Too much pressure or the wrong kind of touch can be stressful for your baby. Your baby’s nurse will show you how to touch your baby to soothe and comfort her.

Protection
In a full-term baby, the skin acts as a barrier against bacteria and viruses that can infect the body. The fat under the skin also insulates the baby by keeping in heat and fluid. It prevents dehydration too.

Sometimes, the skin of very small premature babies – those born at around 26 weeks – hasn’t fully developed. It might look smooth and shiny or translucent, and it’s very fragile. It doesn’t yet act as an efficient barrier. So if anything gets on the baby’s skin, the hair follicles and glands might let it through – for example, any lotions or creams put onto the skin.

Later – at 30-32 weeks – your baby’s skin might look wrinkly and loose, because the skin surface has increased, but your baby doesn’t have much fat underneath the skin.

Because premature babies sometimes have very little fat, they can’t keep a steady body temperature. Your baby’s incubator will be warmed and might be humidified until his skin strengthens 2-3 weeks after birth.

It’s also normal for premature babies’ skin to get dry and flaky.

Skin is a live organ that forms new layers and sheds old ones all the time. It has sweat pores, glands, blood vessels and sensory nerves. It stores water, sugar and calcium, and it helps produce vitamin D.

Taking care of your premature baby’s skin

Each NICU will have its own procedures for looking after premature babies’ fragile skin. For example, your NICU might use oil or cream for premature babies with very dry skin, and staff will take care handling premature babies with very fragile skin.

You can also help to care for your premature baby’s skin by:

• using soft cotton baby clothes rather than synthetics that don’t breathe or wool that can be scratchy
• not putting anything onto your baby’s skin without first checking with the nurse or doctor
• learning how best to touch your baby – your baby’s nurse or doctor will be able to help you.

Without much body fat or muscle, premature babies tend not to move very much. Some of their first movements can be jerky. But as their muscles develop and their nerves start connecting to the brain, their movements become more smooth and controlled.