Living with Babies Born Small
Here are explanations on how to spend your time in the hospital, interacting with your baby, developmental care, family visits, team medical care, mother's heart, and what the father can do.
In the Hospital
Interacting with the Baby
Physical contact is important for any baby. The warmth of the parents' hands, the feeling of being cuddled, and the feeling of skin touching, will help your baby's emotional stability and good sleep.
Touching
Touching is one of the physical contacts with a baby. Once you get used to touching your baby, try using your palm as much as possible and feel your baby’s head, back, and hips, with a large area of your skin.
Holding
If your baby is fretting, gently wrap him/her with the palm of your hands. Wrap your baby gently to let him/her know that "he/she is cuddled, everything is okay, and that he/she is not alone".
Kangaroo Care
Sit down so you can relax, unbutton so that your chest is showing, hold your baby face down, and hold the baby so his/her skin is touching your skin. Feel the warmth of one another and spend a relaxing time together.
At first you may think "Is it okay to touch the baby? Will I make him/her cry?" and be scared to touch the baby. Touching is good experience for the baby. Closely watch your baby and get used to touching him/her slowly.
Developmental Care
Care for development is called "developmental care". This promotes the growth and development of the baby by providing an environment as close as possible to the mother's womb. Details of care varies depending on the facility, but here we will introduce the main types of care.
Positioning (maintaining fetal posture)
A good posture for your baby is to be round, just like when he/she was in the mother's womb. Wrap the baby with blankets or other cloth so that he/she can maintain this posture.
Type of care according to sleeping conditions
Carefully watch how well your baby sleeps and awakes, and try to avoid taking care of the baby when he/she is sleeping very deeply. Try to find the best timing that is comfortable for the baby, to take care of him/her.
Consideration to light and noise
A baby feels light and sound through the amniotic fluid when he/she is in the mother’s womb. When the baby comes out, he/she feels light or noise more strongly, so dim the lights to make it soft and try not to make loud noises.
It is important that the parents work together with the nurses for developmental care. One good way for developmental care is appealing to the five senses, such as talking to the baby. Let’s start with what you can do.
Family Visits
Being with the family gives great energy to a baby. Please go visit your baby. Touch the baby gently and talk to him/her. The baby will surely feel very comfortable hearing the voices of his/her mother and father that was also heard in the womb. While visiting, you can touch your baby, change his/her diaper with the nurse, and wipe your baby’s body. The nurse will help deepen the bond between the baby and your family.
Visiting hours will differ depending on the facility. Considering the prevention of infection, visitors are often limited to mothers and fathers, but depending on the facility, grandpas, grandmas, and siblings can also visit. If the baby’s siblings would like to visit, it will be good to have them vaccinated in accordance with their age and keep them in a good state of health.
Infection control during visits
For newborn babies still in hospital, having their families visit is significantly meaningful and gives them great energy for them to grow in a healthy way. However, because newborns are immunologically immature and susceptible to infection, infection control during visits is extremely critical.
What you can do before you visit
If adults have even a slight cold, it may cause infants to develop a severe disorder. Inform medical staff if you have any symptoms of illness. Information about contact with epidemic diseases, such as COVID-19, is important. You must have a correct understanding of the information.
What to do when visiting your baby in NICU
It is extremely important to carry out correct hand hygiene. Hand hygiene includes washing your hands with soap under running water, and disinfecting your hands using alcohol-based hand sanitizers. Wash your hands with soap under running water for at least 20 or more seconds and dry them thoroughly. Rub alcohol-based hand sanitizer into your hands for a minimum of 15 seconds. In particular, do not forget to wash your thumbs and fingertips, including your fingernails.
Carry out hand hygiene before and after touching your baby and after touching nearby medical equipment and objects. Be careful not to touch your hair or mask that you are wearing during a visit.
Team Medical Care
In the NICU/GCU, not only doctors and nurses, but also people from various occupations are involved in order to support babies and their families as a team.
Pharmacist
The pharmacist works with the nurses, preparing IV drips for the babies and giving explanations to the family about the medicine they will be taking home.
Clinical Psychologist
Clinical psychologists will watch over the development of the babies. They will also give mental support for the families because the hospitalization of a baby in the NICU/GCU is often an unexpected event in life.
Physical Therapist
Especially babies born prematurely and small, may need support for motor development, so the physical therapist will check the posture and movements of the body and will also perform respiratory rehabilitation.
Discharge Coordination Department
The staff in this department will contact the local community nurse and make adjustments as they discuss any preferences with the family that they may have, so that the family can receive the support in their area of residence that suits them.
In addition, there are other supporting staff such as dietitians who prepare milk, and social workers who you can consult with to learn about the medical system. The support system differs depending on the facility, but if you have any concerns or problems, do not hesitate to consult with us.
The Mother’s Heart
Pregnancy and childbirth will bring about major changes to the mother's body. The balance of a mother’s body that adjusted to pregnancy will change back to the original balance after giving birth, and the mother also has to adapt to a new lifestyle taking care of the baby. It is common for anyone to experience temporary instability as a result of this rapid change in the hormones.
On the other hand, when someone faces an unexpected situation such as your child being hospitalized, it takes a certain amount of time to accept the reality. Questions like "Why?" or a feeling of anger like "Why is this happening to me?" will come to mind, but it is very natural for people to be depressed with a reality that can't be helped even when you try hard. Especially, while your baby is still unstable you will fluctuate between hope and despair each time you hear from the medical staff.
Some may also think that you must be strong because you are a mother. But no one can immediately adapt as a mother. It is okay for the mother to evolve as a mother slowly with the baby. Do not strain yourself and think "I have to try hard!", and have the people around you understand the feelings that you are going through. Then, slowly start with what you can at your own pace.
What the Father Can Do
When a baby is born prematurely and small, the father may not be able to think straight with "shock and anxiety" more than "happiness". The father may be in panic, but he will be given many roles such as, "explanation from the doctor on the baby’s medical condition", "hospitalization procedures", and "supporting the mother".
While the father takes care of these roles, the baby will be growing day by day. To be honest, it will be unfortunate if you miss these miraculous days. Working at the same time may be hard, but please go visit your baby as much as you can. The baby will be happy, and that will heal the mother’s mind and body. The "shock and anxiety" will decrease and "feelings of relief and growth of your baby" will increase.
There are many things that only the father can do.
Caring for Siblings at Home
During Hospitalization
Older siblings always look forward to seeing new babies. As such, they may feel afraid or worried if their new baby sister or brother cannot be discharged from the hospital. Under such circumstances, explain the reason why the new baby brother or sister cannot come home. Show them videos or photos of their struggling baby brother or sister. Although they may at first say they feel sad, they should cheer for their baby sister or brother, and finally say with a smile that the baby is cute. We adults learn what is important by watching them genuinely accept a new baby sister or brother without prejudice.
Handling of siblings varies by hospital. Try telling hospital staff what you would like to do. In the NICU, healthcare providers value family-centered care. Feelings of mothers may take form.
After leaving the Hospital
When a newborn baby is brought home from the hospital, siblings may start behaving in babyish ways. Remember that this is proof that the older siblings have received enough affection from their parents. You should feel confident.
Older siblings may have mixed feelings. They may think the baby is cute, but dislike being deprived of their mother's affection. Support how they feel and give them lots of praise when they are able to accept the new situation. Have them help with their new sister or brother and tell them how grateful you are. It is also effective to specially reserve time for them to have their mother all to themselves.
This is where fathers come in to the picture. The father should create chances to play with older children more than ever. By doing so, not only will the children smile but the mother will too.
Towards Discharge
Preparing for Discharge
Before leaving the hospital, family members may feel excited but at the same time may be full of anxiety.
If you have any concerns, you should speak with the medical staff before leaving the hospital. In addition, it is a good idea to confirm in advance whom to consult in case of any problems after discharge.
When preparing the environment for your baby at home, you will no doubt see a variety of useful childcare items. However, it is not necessary to have everything ready from the beginning, and it is better to start with the minimum essentials and purchase additional items little by little as needed.
Once you have prepared a certain number of items, try to imagine what daily life at home will be like. Ask your family and those around you to cooperate so that you can enjoy raising your child. It is also helpful to become familiar with local public and private services , such as those available through community public health nurses.
Locally Available Childcare SupportNEW!
After being discharged, various professionals in your community can support the daily life of your baby and family.
As your child grows, the number of people involved will increase. Here, we introduce some of the key individuals who are involved soon after discharge.
Public Health Nurse
Public health nurses serve as the first point of contact in your municipality for families with newborn babies.
The "Home visits to all households with infants (Hello Baby Program)", led primarily by public health nurses, is an initiative carried out by municipalities under the Child Welfare Act.
This program targets all households with babies up to four months old, with visits from public health nurses, midwives, and others experienced in child-rearing.
During these visits, they listen to any concerns or worries about child-rearing and, if needed, introduce local childcare support services.
Visiting Nurse
Based on home-visit nursing instructions prepared by the attending physician at the hospital, nurses visit your home with coverage provided by medical insurance. Taking into account information from the hospital stay, they provide support such as managing the baby’s health at home, organizing care, managing medical devices (e.g., suction equipment), and offering advice and support on child-rearing and child development.
Coordinator for Children Requiring Medical Care or Consultation Support Specialist
They listen to your concerns and difficulties in daily life and connect you with the necessary support services.
For example, they support you in using welfare services such as developmental support centers, helpers, or short-stay facilities by assisting with the procedures required to obtain a beneficiary certificate and helping you choose appropriate service provider.
Childcare support initiatives differ between municipalities. When receiving a visit under the “Home visits to all households with infants (Hello Baby Program)”, feel free to ask the public health nurse about anything that concerns you. In addition, local public information magazines often include introductions to childcare support services, so be sure to check them as well.
Disaster-Prevention MeasuresNEW!
Disasters can occur at any time.
It is important to always be aware of how you will gather information in the event of a disaster.
You should discuss the following matters with your family in advance:
- How your family will communicate with each other
- Which evacuation sites are accessible from your home
- Whether your emergency kit is ready
Your emergency kit can become quite large. In addition to the items you need for daily life, it may include items for your baby, and if your baby requires medical care, it will also contain the supplies needed for that care. Keep everything together so that it is ready to take with you at any time.
Also, anticipate situations such as power outages or water stoppages, and consider what you can do at home to prepare. It is very important to strengthen your self-sufficiency, that is, to be prepared in advance to protect your own life and your family's lives and daily living in emergencies such as disasters.
In addition, check the initiatives offered by your local municipality. Recently, more and more municipalities have been implementing their own unique programs.
During emergencies, staying connected with your local community is very important. Let your neighbors know that you have a baby by participating in local community events. Everyday outings can serve as valuable practice for evacuation drills.
After Discharge
Living and Taking Care at Home
When you start living with a new family member, there may be many things you feel worried or concerned about. However, your baby is looking forward to being at home.
First, try to adjust the rhythm of your daily life. You will need to shift from a lifestyle centered on adults and older children to one focused around your baby. It may be difficult immediately after leaving the hospital, but you will gradually become accustomed to it.
As you spend your days with your baby, you may have various concerns , such as the baby not stopping crying, not drinking milk as expected, or whether the baby is gaining enough weight. When everything about life with a baby is new, even small things can be worrying.
Do not keep your worries or difficulties to yourself. Talk with medical staff, local public health nurses, or visiting nurses. Sometimes, taking a short break away from your baby to refresh yourself may also be helpful. Try not to be too tense, and aim to enjoy caring for your baby.
Attending the Hospital and Periodic Health Examinations
You may feel nervous when attending the hospital for the first time. You may have many concerns, such as what you should bring with you, how to get to the hospital, or what to do when it is time to breastfeed while you are there.
Before going to the hospital, it is a good idea to prepare your belongings in advance and to mentally run through how you will travel. Packing diapers and a change of clothes can also be helpful. Another item that is easy to forget is the Mother and Child Handbook, so be sure to carry it with you whenever you go out.
When you actually see the doctor at the medical checkup, you may feel nervous and find it difficult to ask everything you wanted to. Therefore, it can be reassuring to write down in advance what you want to tell or ask the doctor. Nowadays, many mothers also make good use of smartphones and helpful apps.
Infection Control
Infection control at home is different from that in the NICU. You cannot maintain an aseptic environment as you did in the NICU. Certainly, if your baby was born small, you may worry that they have weaker immunity. However, there is no need to be overly sensitive.
For babies, having adults prepare their environment can help prevent infection to some extent. Adults can protect their babies by following basic daily practices, such as washing their hands thoroughly, avoiding taking the baby into crowded places, and limiting contact with people who have cold symptoms. It is also important not to be overly anxious and to take walks on sunny days while avoiding crowds. If you notice any symptoms that concern you, consult your doctor.
Timing for Vaccination
Vaccinations for babies born small are given on the same schedule as for full-term babies, using the same vaccine doses without reduction.
In addition, vaccinations are administered based on the calendar age counted from the baby’s birthday, rather than the corrected age based on the expected due date.
Vaccines for Haemophilus influenzae type b (Hib)※1, pneumococcus※2, hepatitis B※3, and rotavirus※4 can be given from 2 months of calendar age, and the DPT-IPV combined vaccine※5 can be given from 3 months of calendar age.
Because some babies born small may still be hospitalized in the NICU or GCU after reaching 2 months of age, vaccinations are sometimes given during hospitalization.
Even if a baby is born small, adverse reactions to vaccinations (such as redness at the injection site or fever) do not occur more frequently, and sufficient immunity for disease prevention can be achieved.
Simultaneous vaccination is also possible, so please refer to the vaccination schedule and make sure vaccinations are given without delay.
Please note that the following three changes to the vaccination schedule were made in May 2025. If you have any questions or concerns, consult your attending physician.
| Item | Eligible Individuals | Details of changes | Period |
|---|---|---|---|
| Special Measures for MR Vaccine | Infants eligible for the first or second dose period who have certification from the municipal mayor | Vaccination is allowed even if the eligible vaccination period was missed | April 1, 2025 to March 31, 2027 |
| HPV Vaccine Transitional Measures | Individuals born between FY1997 and FY2008 who received their first dose between 2022 and 2025 | The second and third doses are covered by public funding | Until March 31, 2026 |
| Additional COVID-19 Vaccine | Children aged 5 to 11 who are eligible for vaccination | Addition of DAICHIRONA® intramuscular injection (for ages 5 to 11) | From May 19, 2025 |
*1A vaccine that prevents infections caused by Haemophilus influenzae type b.
*2A vaccine that prevents infections caused by pneumococcus (such as meningitis, sepsis, pneumonia, and otitis media).
*3A vaccine that prevents infections caused by the hepatitis B virus.
*4A vaccine that prevents infections caused by rotavirus (such as gastroenteritis and encephalitis).
*5A vaccine that prevents diphtheria, pertussis, tetanus, and polio (poliomyelitis).
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*The information may be updated. Please check the latest information.
What fathers can do at home
We suggest that fathers devote themselves to their babies without becoming self-conscious as long as time allows. Please stare at your baby, give it a rub-down, hold your baby in your arms, and speak to it. Experience the cuteness of your baby through parenting as much as you want.
We think it will be wonderful if the time fathers have for themselves becomes the time they spend with their babies.
Parenting is not an obligation. It is an opportunity for fathers to take advantage of an experience that they can only enjoy now. Try parenting on your own initiative rather than feeling that you are just helping.
You may not be able to take care of your new baby like your wife can. Even so, you should not give up. Some day, you will see a look on your baby's face or hear it laugh in a way that you and your wife have not heard.
After giving birth, mothers may be physically weak and emotionally erratic, but they will still be committed to caring for children and keeping up with the housework. Though you may be tired when you come home from work, we feel that you should ask your partner what happened during the day, share laughs and surprises, and tell your partner that you are grateful.
Attending Schools
Elementary schools are divided into regular classes, special support classes, and special support schools. In regular classes, one or more teachers are assigned to every 40 children, and in special support classes, one teacher is assigned to every eight children. Sometimes a child may enroll in a regular class, and attend a special support class for studying language or math only. For babies born small who may be in delicate health or have a small physique, there is also a system to delay school start. According to a national survey of babies born under 1,000g, about 74% are enrolled in regular classes.
While considering the parents’ opinion, all persons involved with the child such as educators and medical staff, will determine which school the child will attend, where he/she can enjoy participating in classes and events everyday and feel confident.
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