NICU Transitions

Transitions are often difficult. When we move from one phase to another, we have to learn new rules, procedures, and expectations. This is very true in the NICU. Depending on how early or fragile your baby was when he/she was born, you may go through several transitions while you are in the NICU. Here is a brief overview of some of those transitions and some tips on what to expect.


1) Critical - Babies who are born very small, early or with major medical issues are classified as critical. Especially in the beginning, these babies often have 1:1 care which means one nurse is assigned to only take care of him/her. When doctors do their rounds, they see these patients first. The doctors will usually check on these babies more often throughout the day. During this time, the nurse can easily focus on you when you visit since they are only taking care of your baby. You will most likely feel a heightened sense of urgency as your baby is in an important time that can often determine how well they do down the line. They usually have to do more tests during this time including x-rays, ultrasounds, lab work, etc. Don't be afraid to ask the nurses what tests are being done that day and ask for the results of those tests when you call or visit.

2) Once babies move out of the critical stage but still require a lot of support, they will often have 2:1 care - meaning that one nurse will take care of two babies. Doctors will see your baby after the most critical patients. The nurses are still very focused on your baby however they may have to work with the other baby in their care while you are there.

3) Feeder/Grower - After your baby gets past big hurdles such as ventilation, being able to take regular feedings, etc. they usually move into the stage called "feeder/grower." This is literally the state where babies need to eat and grow bigger so they can go home. Some babies start in this phase and go home from there. During this time your baby may be on 3:1 care - meaning one nurse has three babies. They will often put newer nurses or nurses who are covering from pediatrics with these babies. This may mean that the nurse won't be as familiar with your baby or any special requests that you have. Don't be afraid to let them know if they aren't doing something that is normally done. The good news is that this is usually a phase where the parents get to spend a lot of hands on time with the baby. You can hold your baby more, give them more baths, feed them regularly, etc. This phase is preparing you for when you finally get to take your baby home. The doctors normally round on these babies last so don't be surprised if it is mid-morning or early afternoon before they give orders for the day.

Once your baby is getting closer to going home, it may feel like your baby isn't getting as much focused attention as before. In a way - that is a good thing. The nurses are still making sure that your baby is getting what he/she needs but they are in a much more stable condition and getting ready to go home to you so they don't require the same level of nursing care. I remember one evening when my daughter was in the NICU and had been there for 4 months already. I came in late one night and one of the nurses had her out and was trying to play paddy cake with her. It was great to see her being treated like a "normal" baby and really made me realize how far she had come.

As your baby moves through different phases, try and get an idea of what to expect. How many babies is your nurse assigned too? What new things can I do as a parent? When do the doctors normally come around to see my baby? If you get moved to a new room or floor, find out if there are different rules or locations for things.