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Tips of the Week for November, 2016

Caring for a Premature Baby: What Parents Need to Know

Fast Facts

  • Premature birth occurs in about 11 to 13 percent of pregnancies in the US.
  • Almost 60 percent of twins, triplets, and other multiple deliveries result in preterm births.
  • A birth is considered "preterm" when a child is born before 37 weeks of pregnancy have been completed. Other categories of preterm birth include late preterm (34–36 weeks), moderately preterm (32–36 weeks), and very preterm (less than 32 weeks).

It is important to recognize that preterm deliveries, even if late preterm, should never be done for the convenience of the mother or obstetrician. Research has shown that late preterm babies have significantly greater risk for negative outcomes, and all efforts should be made to have babies reach full term. See Let Baby Set the Delivery Date: Wait until 39 Weeks if You Can.

Characteristics of Babies Born Premature

If your baby is born prematurely, she may neither look nor behave like a full-term infant. While the average full-term baby weighs about 7 pounds (3.17 kg) at birth, a premature newborn might weigh 5 pounds (2.26 kg) or even considerably less. But thanks to medical advances, children born after twenty-eight weeks of pregnancy, and weighing more than 2 pounds 3 ounces (1 kg), have almost a full chance of survival; eight out of ten of those born after the thirtieth week have minimal long-term health or developmental problems, while those preterm babies born before twenty-eight weeks have more complications, and require intensive treatment and support in a neonatal intensive care unit (NICU).

How Your Premature Baby Looks

  • The earlier your baby arrives, the smaller she will be, the larger her head will seem in relation to the rest of her body, and the less fat she will have.
  • With so little fat, her skin will seem thinner and more transparent, allowing you actually to see the blood vessels beneath it. She also may have fine hair, called lanugo, on her back and shoulders.
  • Her features will appear sharper and less rounded than they would at term, and she probably won't have any of the white, cheesy vernix protecting her at birth, because it isn't produced until late in pregnancy. Don't worry, however; in time she'll begin to look like a typical newborn.
  • Because she has no protective fat, your premature baby will get cold in normal room temperatures. For that reason, she'll be placed immediately after birth in an incubator (often called an isolette) or under a special heating device called a radiant warmer. Here the temperature can be adjusted to keep her warm.
  • After a quick examination in the delivery room, she'll probably be moved to the NICU.

How Your Premature Baby Acts

  • You also may notice that your premature baby will cry only softly, if at all, and may have trouble breathing. This is because her respiratory system is still immature.
  • If she's more than two months early, her breathing difficulties can cause serious health problems, because the other immature organs in her body may not get enough oxygen. To make sure this doesn't happen, doctors will keep her under close observation, watching her breathing and heart rate with equipment called a cardio-respiratory monitor.
  • If she needs help breathing, she may be given extra oxygen, or special equipment such as a ventilator; or another breathing assistance technique called CPAP (continued positive airway pressure) may be used temporarily to support her breathing.

Preemie Parents: How to Cope with the Stress

As important as this care is for your baby's survival, her move to the special-care nursery may be wrenching for you. On top of all the worry about her health, you may miss the experience of holding, breastfeeding, and bonding with her right after delivery. You won't be able to hold or touch her whenever you want, and you can't have her with you in your room.

To deal with the stress of this experience, ask to see your baby as soon as possible after delivery, and become as active as you can in caring for her. See How You Can Participate in the Care of Your Baby in the NICU.

  • Spend as much time with her in the special-care nursery as your condition—and hers—permit. Even if you can't hold her yet (until she's stable), touch her often. Many intensive care units allow parents to do "kangaroo care"—or skin-to-skin care—for their babies once the infants don't require major support to their organ systems.
  • You can also feed her as soon as your doctor says it's OK. The nurses will instruct you on either breast-or bottle-feeding techniques, whichever is appropriate for the baby's needs and your desires.
    • Some premature babies may initially require fluids given intravenously or through a feeding tube that passes through the mouth or nose into the stomach. But your breast milk is the best possible nutrition, and provides antibodies and other substances which enhance her immune response and help her resist infection.
    • In some cases, if it's too difficult for your premature baby to nurse at the breast, you can pump breast milk for feeding through a tube or bottle. Once you are able to start breastfeeding directly, your baby should nurse frequently to increase your milk supply. Even so, mothers of premature babies sometimes find it necessary to continue using a breast pump in addition to feeding frequently to maintain a good milk supply. See Providing Breastmilk for Premature and Ill Newborns.
  • You may be ready to return home before your newborn is, which can be very difficult, but remember that your baby is in good hands, and you can visit her as often as you'd like. You can use your time away from the hospital to get some needed rest and prepare your home and family for your baby's homecoming, and read a book for parents on caring for preterm babies. Even after you've returned home, if you participate in your infant's recovery and have plenty of contact with her during this time, the better you'll feel about the situation and the easier it will be for you to care for her when she leaves the special care nursery.
  • As soon as your doctor says it's OK, gently touch, hold, and cradle your newborn.
  • Your own pediatrician may participate in, or at least will be informed about, your infant's immediate care. Because of this, he will be able to answer most of your questions.

Your baby will be ready to come home once she's breathing on her own, able to maintain her body temperature, able to be fed by breast or bottle, and gaining weight steadily.

Additional Information on


Last Updated



Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition (Copyright © 2015 American Academy of Pediatrics)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information, including links and audio, please go to the following website:


Childhood Looks Better When Dad is in It: AAP Report Explained

​By: David L. Hill, MD, FAAP

In the weeks after my first child, Abby, was born I spent a lot of time doing "kangaroo care" with her—keeping her warm on my bare chest while her mom caught some rest between feeds. As she grew hungry, Abby would inchworm towards my chin, pecking and nuzzling in a vain search for a food source that was in fact on the other side of the room. When she grew frustrated she would raise her head and look up at my face with an expression that seemed to say, "Dad, what are you for?" There were times I wasn't sure I knew the answer.

Dad's Many Roles

Now that Abby is 16, she can ask me such questions aloud (and does). In the intervening years I have been a stay-at-home dad, a working dad, a married dad, a single dad, and a stepdad. In each of these roles, I've tried to figure out what I was for and hoped that my involvement made a difference in my kids' lives.

In the meantime, the volume of science on fatherhood has exploded, and it tells us that dads are for a lot, in both traditional and nontraditional roles. See the American Academy of Pediatrics (AAP) updated clinical report, Fathers' Role in the Care and Development of Their Children: The Role of Pediatricians, for more information.

Involved Dads = Positive Effects on Kids

The positive effects of paternal involvement start before birth. Mothers with involved fathers are more likely to receive early prenatal care and are less likely to deliver prematurely, and their newborns are less likely to suffer infant mortality. Right after birth, fathers can help support breastfeeding, and their participation in kangaroo care helps newborns calm themselves and sleep soundly.

In childhood, dads' involvement contributes to language development, and children whose fathers are involved early on enjoy protection from mental health and behavioral problems. The good news continues through the teen years, when paternal involvement is associated with decreased high-risk behaviors, lower rates of teen pregnancy, protection from depression, and improved cognitive development. As a whole, the picture of childhood looks better when dad is in it.

Changing Times

Given all these positive effects, the even better news is that paternal involvement in child-rearing has increased dramatically since the days when I was the only dad sitting on the alphabet rug at the library's toddler reading time.

  • Between 2003 and 2012, the number of stay-at-home-dads skyrocketed from 98,000 to an 189,000.
  • Dads in 2011 had more than doubled the amount of time they spent on housework and childcare from 1965.

Let's face it: in the era of "Father Knows Best" a lot of fathers were just guessing.

Both Parents Bring Different Strengths

When we ask who's better, fathers or mothers, the answer is "yes." Both parents bring different strengths to the family. Fathers, for example, tend to play in more stimulating, vigorous, and arousing ways with their children. It's not that they don't also read, snuggle, and kiss boo-boos, but dads tend to be more rambunctious and exploratory during fun time. Fathers are important not because they are just like mothers, but because they are in some ways different.

Challenges of Maintaining Dad's Involvement

With 40% of today's births being to unmarried couples, many families face the challenge of maintaining dads' involvement. The trend away from traditional marriage correlates to an increase in the number of nonresident fathers. But while 1 in 6 fathers do not live with their children, only a tiny fraction, 1% to 2%, never see their kids. In most cases finding some way for kids and fathers to interact helps both parties, leading to measurable improvements in children's academic achievement, emotional well-being, and behavioral adjustment.

Healthy Dads, Healthy Kids

It should not surprise us that a father's health affects his family's health. Paternal depression has significant negative impacts on moms' and children's mental health. Doctors are now recognizing that post-partum depression affects dads, too, and they are beginning to screen for it. On the positive side, dads who maintain a healthy weight can lead their children to healthy weights, as well, since fathers' weights correlate with childhood o​besity and overweight. And vaccinating dads against pertussis (Tdap) can prevent an estimated 16% of cases of whooping cough.

Paternal Leave: Dads Need Time, Too!

Corporations and governments are starting to recognize the critical role fathers play in their families' mental and physical health, and increasingly they are seeing how these benefits contribute to the success of a company or even a nation. Many developed countries mandate paternal leave policies that have led 90% of fathers to take at least some time off after a birth to bond with their children.

We Now Know What Dads Are For!

The more we encourage fathers to share their unique gifts with their families, the better off we all are likely to be.

Additional Information & Resources:


About Dr. Hill:

David Hill, MD, FAAP, practices at KidzCare Pediatrics in Wilmington, NC and serves as Adjunct Assistant Professor of Pediatrics at UNC Medical School. He chairs the American Academy of Pediatrics Council on Communications and Media (COCM) and serves on the board of the North Carolina Pediatric Society. Dr. Hill won the Independent Book Publishers Association Benjamin Franklin Award in 2013 for Dad To Dad: Parenting Like A Pro. He writes and broadcasts on child care issues for local and national radio, television, print, and internet-based media. Dr. Hill lives in Wilmington, North Carolina with his wife, three children, and two step children. ​ 


David L. Hill, MD, FAAP

Last Updated



American Academy of Pediatrics (Copyright © 2016)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information including links and audio, please go to the following website:

Antibiotic Prescriptions for Children: 10 Common Questions Answered

Parents need to know that using antibiotics when they are not the right medicine will not help and may even cause harm to children. 

Antibiotics are medicines used to treat infections and they target bacteria, not viruses. Before prescribing an antibiotic, your child's doctor will find out if it is the right medicine to treat your child's infection. 

Read on for answers from the American Academy of Pediatrics (AAP) to common questions about the use of antibiotics. Talk with your child's doctor if you have other questions. 

1.  My child has a really bad cold. Why won't the doctor prescribe an antibiotic?  

Colds are caused by viruses. Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines. 

2.  Don't some colds turn into bacterial infections? So why wait to start an antibiotic?  

In most cases, bacterial infections do not follow viral infections. Using antibiotics to treat viral infections may instead lead to an infection caused by resistant bacteria. Also, your child may develop diarrhea or other side effects. If your child develops watery diarrhea, diarrhea with blood in it, or other side effects while taking an antibiotic, call your child's doctor. 

3.  Isn't a nose draining yellow or green mucus a sign of a bacterial infection?  

During a common cold, it is normal for mucus from the nose to get thick and to change from clear to yellow or green. Symptoms often last for 10 days. 

Sinusitis is a term that means inflammation of the lining of the nose and sinuses. A virus or allergy can cause sinusitis and in some cases, bacteria can be the cause. 

There are certain signs that bacteria may be involved in your child's respiratory illness. If your child has a common cold with cough and green mucus that lasts longer than 10 days, or if your child has thick yellow or green mucus and a fever higher than 102°F (39°C) for at least 3 or 4 days, this may be a sign of bacterial sinusitis. 

If your child has developed bacterial sinusitis (which is uncommon), an antibiotic may be needed. Before an antibiotic is prescribed, your child's doctor will ask about other signs and examine your child to make sure an antibiotic is the right medicine. 

4.  Aren't antibiotics supposed to treat ear infections?  

Not all ear infections are treated with antibiotics. At least half of all ear infections go away without antibiotics. If your child does not have a high fever or severe ear pain, your child's doctor may recommend observation initially. 

Because pain is often the first and most uncomfortable symptom of ear infection, your child's doctor will suggest pain medicine to ease your child's pain. Acetaminophen and ibuprofen are over-the-counter pain medicines that may help lessen much of the pain. Be sure to use the right dose for your child's age and size. In most cases, pain and fever will improve within the first 1 to 2 days. 

There are also ear drops that may help ear pain for a short time. You can ask your child's doctor if your child should use these drops. Over-the-counter cold medicines (decongestants and antihistamines) don't help clear up ear infections and are not recommended for young children. 

Your child's doctor may prescribe antibiotics if your child has fever that is increasing, more severe ear pain, and infection in both eardrums. 

5.  Aren't antibiotics used to treat all sore throats?  

​​No. More than 80% of sore throats are caused by a virus. If your child has sore throat, runny nose, and a barky cough, a virus is the likely cause and a test for "strep" is not needed and should not be performed. 

Antibiotics should only be used to treat sore throats caused by group A streptococci. Infection caused by this type of bacteria is called "strep throat." Strep throat generally affects school-aged children and not children younger than 3 years. 

If your child's doctor suspects strep throat based on your child's symptoms, a strep test should always be performed. If the test is positive, antibiotics will be prescribed. 

6.  Do antibiotics cause any side effects?  

Side effects can occur in 1 out of every 10 children who take an antibiotic. Side effects may include rashes, allergic reactions, nausea, diarrhea, and stomach pain. Make sure you let your child's doctor know if your child has had a reaction to antibiotics. 

Sometimes a rash will occur during the time a child is taking an antibiotic. However, not all rashes are considered allergic reactions. Tell your child's doctor if you see a rash that looks like hives (red welts); this may be an allergic reaction. If your child has an allergic reaction that causes an itchy rash, or hives, this will be noted in her medical record

7.  How long does it take an antibiotic to work?  

Most bacterial infections improve within 48 to 72 hours of starting an antibiotic. If your child's symptoms get worse or do not improve within 72 hours, call your child's doctor. If your child stops taking the antibiotic too soon, the infection may not be treated completely and the symptoms may start again. 

8.  Can antibiotics lead to resistant bacteria?  

The repeated use and misuse of antibiotics can lead to resistant bacteria. Resistant bacteria are bacteria that are no longer killed by the antibiotics commonly used to treat bacterial infection. These resistant bacteria can also be spread to other children and adults. 

It is important that your child use the antibiotic that is most specific for your child's infection rather than an antibiotic that would treat a broader range of infections. 

If your child does develop an antibiotic-resistant infection, a special type of antibiotic may be needed. Sometimes, these medicines need to be given by IV (vein) in the hospital. 

9.  What are antiviral medicines?  

Influenza (flu) is a viral infection that can cause cold symptoms for which an antiviral medicine will work. An antiviral medicine may be prescribed for children that are at higher risk of becoming severely ill if they get the flu. For most other viruses causing cough and cold symptoms, there are no antiviral medicines that work or are recommended. 

10.  How can I use antibiotics safely?

  • Antibiotics aren't always the answer when your child is sick. Ask your child's doctor what the best treatment is for your child.
  • Ask your child's doctor if the antibiotic being prescribed is the best for your child's type of bacterial infection. For instance, certain antibiotics such as azithromycin are no longer effective for the bacteria causing most ear and sinus infections.
  • Antibiotics work against bacterial infections. They don't work on colds and flu.
  • Make sure that you give the medicine exactly as directed.
  • Don't use one child's antibiotic for a sibling or friend; you may give the wrong medicine and cause harm.
  • Throw away unused antibiotics. Do not save antibiotics for later use; some out-of-date medicines can actually be harmful. Call Poison Help at 1-800-222-1222 or check the US Food and Drug Administration Web site for information on the safe disposal of medicines.

Additional Information:

Last Updated



Antibiotics and Your Child (Copyright © 2010 American Academy of Pediatrics, Updated 05/2014)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information including links and audio, please go to the following website:


Military Families: Child Care Support During Deployments

For your family, it may be that frequent moves have made it harder for children to know grandparents and other relatives. On the other hand, these family members may play a vital supportive role to your children during deployments and will have the opportunity to forge close lifelong relationships.

If extended family will play a greater role in caring for your child during deployment than they did previously, there are key things to keep in mind to allow smoother transitions.

Planning Ahead = Smoother Transition

Try to make transitions between caregivers go as smoothly as possible. For example, grandmother may arrive in advance of the deployment so she will represent continuity and be associated with the loving nature of your home. Beyond that, children will benefit by seeing that the temporary caregiver has genuine respect for the deployed parent. If she arrives the day of departure, she may be associated with confusion or be viewed as a replacement.

No child will appreciate anyone replacing a parent, and that can breed unnecessary resentment. Fostering closeness between your children and a temporary caregiver far in advance will make your children feel more secure.

Try to have the caregiver connect prior to deployment through visits, phone calls, or social media. If you will be relocating to a family member’s home while your spouse is away, try to visit there prior to the move or, if that is not possible, use digital photos to familiarize your children with the environment.

Communicating Your Plan to Your Children

Children and adolescents need to know “who will take care of me” and that the adults around them are sensitive to their needs. You and your spouse should have a discussion with your children and caregiver.

The discussion should be targeted to the age of your children and should include the following key points:

  • You have given a great deal of thought about who can best help to care for your children.
  • Explain why this person was chosen. Ideally, you should be able to say that you have chosen someone who also loves your children.
  • Reinforce that this is temporary and that the caregiver does not replace the deploying parent.
  • The caregiver represents you and should be respected.
  • Explain that the distant parent will always be thinking of the children and will stay in contact whenever possible, but because of distance will be unable to give the daily attention the children deserve. Because you care so much for your children, you have carefully chosen someone who will do a good job of caring for those everyday needs.

Discussing Your Parenting Style with the Caregiver

You and your spouse should also find the opportunity to discuss your parenting approach with the caregiver. It’s important that your children experience consistency of care rather than having to adjust to new approaches. You should discuss parenting style, and the blend of control and rules with warmth and support. Ideally we strive for a balance between rules and warmth, remembering that discipline means guidance, not control, but adults disagree about these things. Even married couples don’t always see eye-to-eye on parenting style, but well-functioning households do the best they can to disagree behind the scenes to present a united front to the children. When they don’t, children learn to play parents off of each other. It’s important that you discuss this openly in advance so children don’t receive confusing messages.

If the temporary caregiver clearly understands your approach, hopefully she will remain as consistent as possible in maintaining that approach. Don’t be surprised if your extended family member from a different generation holds a different parenting philosophy than you do. She may be more lenient, or she may think you are too passive and she would be stricter. This is all the more reason to work this through openly in advance. This will make the household run more smoothly during deployment and hopefully prevent the returning service member from having to respond to a 7-year-old shouting, “Grandma never told us what to do.”

Additional Information from

Additional Resources:




Kenneth R. Ginsburg, MD, MSEd, FAAP

Last Updated



Building Resilience in Children and Teens: Giving Kids Roots and Wings, 3rd Edition (Copyright © 2015 Kenneth R. Ginsburg, MD, MS Ed, FAAP, and Martha M. Jablow)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


All information provided by  For additional information including links and audio, please go to the following website:

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