UNDERSTANDING YOUR PREEMIE

How Your Baby Communicates
It's true, babies communicate. From the first moment a parent looks into their child's eyes there is a communication established. It may not be words like you and I use but it is communication none the less. Under ideal circumstances parents have an immediate opportunity to start this process of understanding.

In the situation where your baby is premature or sick your baby is swooped away to the NICU after a very brief hello, that communication is interrupted. This is something that all would prefer to avoid but if your baby needs attention it becomes unavoidable. When a parent enters the NICU your baby may have breathing tubes in place, be sedated, sleeping, or a number of other potential situations preventing that communication to start. There then needs to be a more indepth understanding of the way a baby communicates to the parents as well as his/her caregivers.

In order to understand how a baby communicates you have to understand a bit about Stages of Sensory Development and when they accomplish certain goals. Please keep in mind that as with all things in life a baby's development is very individual and will vary from baby to baby.

Stages of Sensory Development
TOUCH	20 Weeks	Sense of touch is fully developed in fetus First developed sense that is foundational to any and early communication with baby
SMELL	Uncertain at age of development	Prefer sweet smells over bitter Can tell mother's breast milk from another woman's breast milk May have distress cues when smelling strong perfume
TASTE	28 weeks 32 weeks 34 weeks 35 weeks-term	Rooting, sucking and swallowing reflexes developed but response may be slow Gag reflex is present, protects them during feedings Coordination of sucking, swallowing, and breathing is possible due to mylenization (maturing of nerve endings) Prefers sweet taste over plain or bitter Taste preferences continue to develop post-natally
HEARING	20-30 Weeks 25 Weeks 30-32 Weeks	Ear is fully formed with adult shape Able to hear muffled sounds in-utero Fetus will react to sounds in-utero Will show positive reactions to sounds that they find interesting or familiar Will show distress at sounds which are unfamiliar or unpleasant Can tell parent's voice from other people Show a preference for rhythmic sounds (heartbeat, breathing)
SIGHT	25 Weeks 26-28 Weeks 27 Weeks 28-30 Weeks 30-32 Weeks 32-35 Weeks	Blink reflex Eyelids open Eyes open, but unable to focus Baby gets tired immediately when presented with visual stimulus Looks around more but may have low heart or breathing rates when trying to focus Bright lights cause eyes to close Can focus objects 6-10 inches away Can follow and track an object visually Has pattern preferences
	36 Weeks-Term	Eyes fully developed Demonstrates preferences for curved lines and shapes (likes your face!) rather than angles

- Relaxed brow
- Uplifted cheeks / chin
- Gently flexed fingers / hands
- Flexed arms and legs
- Smile
- Stable heart and breathing rates, pulse ox after first 20-30 minutes (of touching or holding)

Signs of Stress

- Fingers stretched out and open
- Baby looks away, no eye contact
- Baby's color changes (pale or blue)
- Change in breathing (too fast, labored, stops)
- Hands/feet pushing away

What to Do?

W - Wait, stop what you are doing and watch for recovery
H - Hand contain baby
A - Assess environment for source of stress (i.e. noise, smells, light, temp)
T - Time to re-group, then try again after recovery

Ranges of Infant Behavior

Quiet Sleep – breathing is rhythmic, eyelids are closed with no movement, overall muscle tone is limp or flaccid.

Quietly Awake – body is still, eyes are open, may make eye contact, and often cooing sounds (if appropriate for age).

The Quietly Awake State is the best time to massage or interact with an infant. This is typically when the infant is willing or ready for some type of activity.

Active Sleep – alternates between rapid and slow breathing, may twitch and cry, often there is rapid eye movement during sleep.

Actively Awake – can become easily overstimulated, has rhythmic cycles of activity, will avoid eye contact when tired or overstimulated.

Almost Awake – drowsy state that is between sleep and awake, more body movement seen, eyes may open.

Crying – vigorous movement, flush skin, crying noises.

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