Premature and low birth weight babies

If you have a premature baby or your baby had a low birth weight, you might have questions about how to care for them and sleep them safely. Use this guide to help you.

A woman sits on the sofa at home and helps her cute toddler daughter hold her baby brother for the first time. The big sister appears excited and proud.

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Safer sleep and premature or low birth weight babies

Following safer sleep advice is important for all babies, but it’s especially important for babies who were born prematurely (before 37 weeks) or who weighed less than 5.5 pounds (2.5kg) at birth. This is common in twins and multiples.

Premature and low birth weight babies have a greater risk of sudden infant death syndrome (SIDS). It’s not known exactly what causes SIDS, but the good news is that safer sleep advice can greatly lower it. Safer sleep advice is usually for babies up to 12 months old, but if your baby was born prematurely, follow the advice for a year from their due date, rather than when they were born.

It’s good to get into a routine and follow our safer sleep advice for every sleep, day and night. In particular, take a look at:

A baby is sleeping in a safer sleep position. They are on their back with a clear cot around them. They have dark hair and medium skin, and their arms are held up at either side of their head. They are sleeping.

Preparing to come home

How your baby sleeps in hospital can be different to how they should sleep at home. Remember that in the neonatal unit they are under constant supervision, and may be slept in a certain way for medical reasons.

In neonatal units, babies may wear hats, or have rolled-up towels in their incubator. When they come home, the safest way for them to sleep is on their backs, with no hat, and with no rolled-up towels or other items, unless your team advise you otherwise.

Your neonatal team will prepare them to come home, for example starting to sleep them on their backs, and will talk to you about what they need for safer sleep.

Safer sleep essentials

The safest way for a baby to sleep is on their backs, in their own separate sleep space but in the same room as you for at least the first six months:

They should have their own sleep space such as a cot or Moses basket.
It should have a firm, flat, waterproof mattress with no soft raised sides or cot bumpers – as it’s possible for the baby’s face to press against them, blocking their breathing.
Keep the cot or Moses basket clear of any extra items such as towels, pillows, duvets, soft toys or loose bedding that could cover baby’s face.
Avoid products that keeping your baby in one sleeping position such as wedges, straps, pods or nests.
For bedding, all they need are sheets or a blanket firmly tucked in no higher than shoulder height, or a baby sleeping bag.
If you use a baby sleeping bag, make sure it fits well so the baby can’t slip down inside. Manufacturers usually state the size according to the baby’s weight. Also check it’s the right tog for the room temperature. Your baby should be 8.8 pounds or 4kg before you use a baby sleep bag.

A baby in a blue baby grow is sleeping on their back in a wooden cot with a firm mattress.

Babies may find it hard to get used to a new sleeping position at first, but keep putting your baby onto their back. Speak with your health visitor, neonatal outreach team or GP if you are worried about how they are coping.

If your baby needs to be given oxygen at home, it’s still safest for them to sleep on their backs. Your team will let you know if you need to increase the amount of oxygen.

Hats

Premature babies often sleep with hats on while they’re on the neonatal unit. Once they come home, stop using hats indoors. Babies lose heat through their heads so wearing a hat indoors can mean they get too hot, which increases the risk of SIDS.

Smoking

If you or your partner smoke while you’re pregnant or after your baby is born, the risk of SIDS is much higher, so quitting is one of the most protective things you can do. Keep your baby out of smoky areas and don’t let people who smoke near them. Keep your home, car and other places your baby spends time smoke-free, to keep them as safe as possible. Find out more and see where you can get help to quit.

Reflux

Babies with reflux should still sleep flat on their backs. It may be best to talk to your health visitor or GP if you are worried about your baby’s health. Sometimes medicines can help with reflux.

Demonstration of what the room thermometer looks like for babies' rooms. It is a two-sided piece of card with a thermometer on the front, and the ABCs of safer sleep on the back.

Temperature

It’s important to keep your baby at a comfortable temperature: not too hot or too cold. Getting too hot increases the risk of SIDS, so take off hats indoors, keep an eye on the room temperature. Check your baby’s temperature regularly.

Keep the temperature between 16 and 20°c

It’s a good idea to use a room thermometer to make sure every room where your baby sleeps is an ideal temperature, between 16 and 20°c. You can purchase one on our online shop. This will be cooler than the neonatal unit, as babies on a neonatal unit often find it harder to keep warm. Your baby will be kept in hospital until they can maintain their own temperature.

Check your baby’s temperature regularly

To make sure your baby isn’t getting to hot or cold:

Feel the back of their neck or chest. If their skin feels hot or sweaty, they’re getting too hot. Don’t use their hands or feet to check, as they usually feel colder than the rest of their body.
You can also use a digital thermometer under their armpit. A normal temperature in babies and children is about 36.4°C (97.5F) but this can vary slightly. A temperature of 38°C (100.4F) or above is usually considered a fever.

What to do if they’re too hot or cold

If your baby is too hot, take some layers off and check them again. If they’re too cold, add more layers. If they seem unwell, or don’t warm up if they’re cold, phone your doctor. If you get an answerphone message, call the number given on the message or call NHS 111. Call 999 if your baby is in difficulty or in an emergency. You may also find our free Baby Check app useful. It’s designed to help parents know whether their baby needs to see a doctor.

Car seats and slings/carriers for premature babies

Car seats

A car seat is essential for safe travel, even for a short trip from the hospital. These tips will help you use them safely.

Make sure the car seat fits both your car and your baby, especially if your baby is small when leaving the hospital.
Check with neonatal unit staff if it’s safe for your baby to travel home in a car seat. Your baby may need a ‘car seat challenge’ at the unit to check they fit properly.
Avoid driving long distances with pre-term and young babies. Research has found that young babies may be at risk of breathing difficulties if they sleep upright in a seated position for too long. Babies should only be in car seats while traveling.
On longer trips, stop and take regular breaks. Take your baby out of the car seat they can stretch and move around.
If possible, have an adult sit in the back with the baby or use a mirror to keep and eye on them.
Take them out of the car seat when not in the car and place them on a firm, flat surface such as a cot or Moses basket. This will avoid overheating and keep their airway clear.
If your baby changes their position and slumps forward, stop straight away, then take them out of the car seat and sit them upright before continuing on your journey.

Slings and baby carriers

Slings and baby-carriers are useful for holding a baby hands-free, however they are not always used safely. Although there is no reliable evidence that slings are directly associated with SIDS, there have been a number of deaths worldwide where infants have suffered a fatal accident from the use of a sling. These accidents are particularly due to suffocation, and particularly in young infants.

If you choose to use a sling or baby carrier, it’s very important to follow the TICKS guidelines from the UK Sling Consortium.

Tight
In view at all times
Close enough to kiss
Keep chin off the chest
Supported back

The guidelines are to make sure your baby’s airways are kept clear and open. They allow you to check that they can breathe easily and that they’re not overheating.

Breastfeeding

Research shows that breastfeeding significantly lowers the risk of SIDS. Even breastfeeding for few days is better than none, and some people choose a combination of breastfeeding and formula feeding, but breastfeeding exclusively for at least six months is linked to the lowest risk.

After six months, The Department of Health recommends continue breastfeeding for as long as the mother and baby want, while adding in appropriate weaning foods. Premature babies have a higher risk of infection, and breastmilk protects your baby from many infections and diseases.

Breastfeeding can be hard and sometimes it isn’t possible to breastfeed directly if your baby was born early. You could try expressing your breastmilk using a pump. If you are struggling, your midwife or health visitor can support you. The colostrum (first milk produced in the first days after giving birth) contains the most infection-fighting antibodies. The neonatal team can help work out how you can give this to your baby.

Frequently asked questions

How do I sleep my twins or multiple babies more safely?

Premature or low birth weight multiples are often slept close together on the neonatal unit. This is to mimic how they were in the womb (known as the intrauterine environment) and support the development of their vital functions such as their heart rate and breathing.

We suggest co-bedding twins, triplets or quads in the same cot so you can share a room with them if you don’t have enough space for multiple cots. This means you can keep an eye on them and reduces the risk of sudden infant death syndrome (SIDS).

There are other reasons you might want to co-bed your twins, triplets or multiples too. Some research suggests that putting twins in the same cot can help them regulate their body temperatures and sleep cycles, and can soothe each other.

Find out how to co-bed your babies

How is a premature baby cared for?

Premature babies will be cared for in a Neonatal Intensive Care Unit (NICU), and the neonatal team will keep a close eye on them. They may be slept in a certain way for medical reasons, which is different to how they should typically sleep at home. For example, premature babies may wear hats, or have rolled-up towels in their incubator.

Your team will prepare them to come home, for example they may start sleeping your baby on their backs as per safer sleep advice, and will talk to you about what they need to stay safe and comfortable.

Are babies born prematurely at higher risk of SIDS?

Premature babies and babies born at a low birth weight have a higher risk of sudden infant death syndrome (SIDS) than other babies. It may be reassuring to know that SIDS is quite rare, with less than 200 cases per year, but there are steps you can take to lower the risk further.

Following our safer sleep advice for all babies is often the best thing you can do. For example, sleeping your baby on their back, keeping them away from cigarette smoke, and using a firm. flat mattress. Your team will advise you if there are medical reasons to do things differently, such as using oxygen.

Are babies born of low birth weight at higher risk of SIDS?

Should my premature or low birth weight baby sleep differently at home than they did in hospital?

It’s likely that your baby will need to sleep differently when you bring them home to how they were slept in hospital.

In neonatal units, babies may wear hats, or have rolled-up towels in their incubator. When they come home, the safest way for them to sleep will be on their backs, with no hat, and with no rolled-up towels or other items, unless your team advise you otherwise.

Remember that in the neonatal unit they are under constant supervision, and may be slept in a certain way for medical reasons. Your team will prepare them to come home, for example they may start sleeping them on their backs, and will talk to you about what your baby needs for safer sleep. Our safer sleep advice for all babies is usually the best advice for premature and low birth weight babies as well.

A baby is looking to their side with a huge, wide open grin. They have light to medium skin and the mum is looking down at them and smiling, with her face closely pressed to the baby.

Remember

Caring for premature or low birth weight babies requires a little extra attention to our safer sleep advice. Always lay babies on their backs to sleep, use a firm mattress with no soft items, and keep their sleep space smoke-free. Keep the room temperature between 16-20°C, and avoid overheating. Breastfeeding, even for a few days, significantly reduces the risk of SIDS and boosts the baby’s immunity. Avoid co-sleeping, and always ensure your baby’s safety in car seats and carriers. Your healthcare team will provide specific guidance to help ensure a safe environment for your little one.

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