Regulatory problems

Preterm newborns are not able to tolerate the amount of stimuli that is usually involved with a newborn.  This includes holding, stroking, sound, light, and pain.   They require more uninterrupted sleep and an environment that is not brightly lit, quiet and less handling.  What happens when a newborn arrives?  Everyone wants to hold the baby, stroke the soft skin, talk loudly amongst themselves and stimulate the baby while he/she is trying to feed.  They do not consider what effect all of this stimuli on their immature neurological system may have.

One consequence is failure to regulate.  What does this mean?  The baby is unable to calm himself/herself when over stimulation is occurs.  They go into a overload mode that looks like they are asleep.  They are actually removing themselves from the stimuli by shutting down their systems.  The can go from crying to sound asleep in a minute.  This is often seen with attempts at breast feeding when they are not ready for it or too tired to attempt.  They resist, then basically "pass out." This article is an excellent discussion of regulation issues and other issues that are important with babies born prior to 37 weeks.  Of course, the earlier, the more problems, but also the sicker the more problems.  Click on the link to read this informative article.  Premature Infants: A later look.

Parents must be educated on this issue if we are to prevent long term problems with self calming and behavior.  As mentioned in the article, feeding problems, excessive crying and sleep disturbances can last for years, not just weeks.  Consider the number of children diagnosed with ADHD or Attention Deficit Disorders.  Some of this is related to their gestation at birth.

A familiar sign we see from preterm babies is the "how sign."  You may wonder what this is.  Regarding the old westerns with cowboys and Indians, when the Indians greeted the white man, they put up their and in a gesture of welcome.  Preterm babies do this to signal "STOP."  They are overstimulated and have recognized this.  They are asking us to leave them alone, so that they can collect themselves and may breastfeed or bottle feed.  Watch for their "cues."