Special Care Nursery

Grand River Hospital is the sole provider of neonatal services in Waterloo North. We provide care for moderate to high risk infants. High risk deliveries at 33 weeks gestation or less are referred to teaching centers, primarily Hamilton Health Sciences Centre and London Health Sciences Centre. Grand River Hospital accepts patients back from these centers as young as 29 weeks gestation and multiples return as one unit.

The special care nursery is currently comprised of 16 baby bays. We provide a wide range of comprehensive services in a developmental care setting.

• Care in the nursery
• Things to bring for baby
• Feeding your baby in the nursery
• Going home
• Feeding your baby at home
• Immunization schedule
• Safety first
• Weight conversion chart

Care in the special care nursery

We hope that a better understanding of the special care nursery will make things a little easier for you. This site answers some of the most common questions families ask us. If you have any other questions, contact the hospital - we want to work with you to make your baby's stay in the special care nursery a positive one for your family.

A special note for families who have come here from a neonatal intensive care unit

Transferring from one hospital to another may be stressful. You may see a temporary change in your baby's feeding pattern, behaviour, or oxygen needs. Although your baby is closer to home, we understand that it may be hard to leave the familiar setting of the neonatal intensive care unit. You will probably have many questions about how things work in our special care nursery before you feel comfortable - please ask them!

Working together for your baby - people on your baby's team

You are the most important person to your baby. Your baby knows your voice and is comforted by your presence, your touch, and your scent. You can be involved in your baby's care in many ways. You may touch and talk softly to your baby if you are not able to hold him/her. You may kangaroo care when baby is well enough to be held. You may feed, dress, and hold your baby as much as your baby can handle, depending on his/her size and health.

Who will be caring for my baby?

Nurses are in the unit at all times. Each nurse coordinates the care of a number of babies, depending on their health status. The special care nursery nurses have experience working in neonatal intensive care units and continue to update their education in the care of special care nursery babies.

If your baby is in the nursery for more than 48 hours, a primary nurse accepts the role of organizing your baby's care.

Your baby will be under the care of a paediatrician who visits once a day to assess your baby's progress and make changes as needed to the care. After 5:00p.m., on weekends and holidays, there will be another paediatrician on-call, who is familiar with your baby, to handle emergencies. A social worker is available to assist families experiencing the stress of having a baby in the special care nursery. She also helps families find resources in the community once your baby is home from the hospital.

Other staff - a nutritionist, physiotherapist, occupational therapist, respiratory therapist, and chaplain are also available as required. The paediatrician or nurse will arrange for any of these services if you think it would be helpful for you and your baby.

Feeling comfortable in the special care nursery

The special care nursery is a large, open room that allows staff to observe your baby at all times. Your baby's bed may be moved around the room depending on your baby's needs and those of others. Do not be alarmed if your baby's bed has been moved - it usually means your baby is getting better and closer to going home.

Different pieces of equipment are needed to care for babies: isolettes, warmers, heart monitors, oxygen monitors, and intravenous lines are some of the equipment used. Your baby's nurse will explain the purpose of any equipment being used for your baby. Please ask questions about them.

Sometimes families need some privacy, some quiet time alone, at the baby's bedside. The large, open space makes this difficult, but your nurse can provide you with a privacy screen if you wish. If your baby is well enough, you may take him/her with you to the small quiet room across the hall from the special care nursery.

When your baby is well you can arrange for a bath demonstration with the nurse. We encourage you to bath your baby on a regular basis. This should be done before your baby's feeding. We want you to feel comfortable handling your baby before going home.

Things to bring in for your baby

Please bring:

• Disposable diapers:

	Newborn, 0-10lbs if your baby is less than 6lbs
	Size 1 if your baby is over 6 lbs.

• Sleepers and undershirts

You can also bring:

• Linen
• Bath items
• Personal items: Pictures of parents and siblings, stuffed toys (limit two), recording of parents voices, only if you can't be here often.

***Label all items with your last name.

Feeding your baby in the special care nursery

Breastfeeding your baby

You can successfully breastfeed your baby in the special care nursery. The nurses are experienced in helping new mothers and special care babies breastfeed. If you are having difficulty and need extra assistance, the hospital's lactation consultants are available to help. They also operate a telephone warmline and clinic that you can call after you go home - (519) 749-4300, ext. 2263.

A small private room with an electric breast pump is located across the hall from the special care nursery. Ask your baby's nurse how to obtain a breast pump kit.

Criteria for discharge

• Paediatrician's order for discharge
• Your baby must nipple feed at all feeds
• Your baby is appropriately gaining weight
• Discharge planning and teaching is complete

Getting ready to go home

Some families need help in caring for their baby at home. A meeting can be arranged with caregivers from the community, who will come in to the hospital to meet you and your baby before you go home. If your baby has special needs, a community support group may be able to give you help and support.

If travelling by car when you leave the hospital, your baby must be placed in a safe infant car seat.

As much as you want to go home, it may feel strange to not be surrounded by hospital staff. Call us anytime if you have questions once you are home with your baby. We receive phone calls from most parents.

• Adapting the home environment
• Feeding in the nursery
• Feeding for the first year
• Immunization
• Safety first
• Weight conversion chart

Adapting the home environment for the premature infant the first 24 hours home

Your baby may react differently during his first 24 hours at home than he did in the special care nursery. He may sleep more than usual or cry or become restless. This is probably the result of another very different environment. It may last only a day or two or for as long as a week.

The first week home

During the first week:

• keep a dim light on and/or radio low where your infant sleeps
• limit the number or visitors
• expect feeding to be slow and tiring

When your baby fusses, try the following:

• reduce light and noise
• offer a pacifier
• hold your baby close to you
• place your baby in his bed on his side with boundaries all around
• wrap your baby snugly, but not too tightly
• avoid doing several activities at once; reduce activity; be still and quiet with your baby

Remember that each new stage builds on the food introduced earlier. For example, breast milk, or iron-fortified commercial formula should remain in your child's diet up to 9-12 months of age.

Age	Food	Why
0-4 months	- Breast milk with vitamin D supplement or - Iron-fortified commercial formula	- Meets all your baby's nutritional needs
4-6 months	- Iron-enriched infant cereal	- You baby requires more iron by this stage
6 months	- Pureed vegetables followed by pureed fruit	- Your baby needs more vitamins and minerals now
7-8 months	- Pureed meat, poultry and alternatives - Finger breads and cereals (ie. crackers, toast)	- A good source of protein and iron - Encourages your baby to chew when teething
9-12 months	- Mashed family foods - Finger foods - Pasteurized whole undiluted cow's milk	- Introduces a variety of textures and encourages chewing, coordination and independence - Introduce homogenized milk when a baby is getting a mixed diet (closer to 12 months)
After 12 months	- Egg white - Peanut butter - A variety of table foods	- Earlier introduction may cause an allergy - A balanced diet is important

Premature Babies

The introduction of foods should be based on your baby's corrected age rather than their birth date. Corrected age is equal to the age that your baby would be if he/she was born after a nine-month pregnancy (ie. at the "due date".)

Example: Pablum is to be introduced 4 to 6 months after a nine-month pregnancy. If your baby was born 1 and 1/2 months early, you would introduce pablum at 5 and 1/2 to 7 and 1/2 months from the birth date.

Children need different vaccines at different ages. It is important for children to be immunized on time according to the recommended schedule. For more information, contact your doctor or public health nurse.

Age at Vaccination	Diphtheria Tetanus Pertussis	Poliomyelitis	Hib1	Mumps Measles Rubella	Tetanus Diphtheria2	HepatitisB3
Birth						Infancy OR Preadolescence (9-13 years)
2 Months	X	X	X
4 Months	X	X	X	X
6 Months	X	X	X
12 Months				X
18 Months	X	X	X	X4
4-6 Years	X	X		X4
14-16 Years					X

• Injury prevention
• Safe transportation

1. Never leave a child unattended.
2. Always check when purchasing or borrowing a used crib, equipment or toy to ensure that it meets current safety regulations.
3. Be sure to protect your child with sunscreen suitable for infants and children when outdoors.
4. Make sure that toys are age appropriate for your child. Keep up-to-date on recalls.
5. Ensure that your car seat is installed according to manufacturer's instruction and that your baby is buckled up correctly.
6. Always check the temperature of bath water to ensure it is not too hot.
7. Use plastic outlet covers on electric outlets.
8. Because of possibility of suffocation, never use ribbons, strings or necklaces around baby's neck or pacifier.
9. Keep all small objects (like buttons, coins, pins, and jewelry) out of baby's reach. A baby can easily choke on them.
10. Keep emergency telephone numbers handy. It is a good idea to keep a list of fire department, police, ambulance, doctor, and poison-control numbers on the fridge.

Choosing safe child-related products

During any given day, parents turn to a number of child-related products. Some of these products have standards regulating their design and construction, but many products do not have strict safety regulations. Products that are regulated are:

cribs cradles car seats playpens strollers

pacifiers sleepwear toys gates walkers

When choosing products for children, it would be nice if cost was not an issue, but for most, it is a factor. When deciding how best to spend our limited dollars, we must look at safety first. Then, if there is money left, look at the "extras". In other words, one must look at the crib and car seat first - then items like highchairs and strollers - then things like change tables and mobiles.

When deciding which items to buy or ask for as gifts, look at…

• Which items are a must in order to provide a safe area for my child?
• Which items can I safely use regularly over a long period of time?
• Which items do I feel are a must based on our lifestyle?
• Are there some items (that meet current standards, if applicable) that I can borrow?
• Are there some items that I can safely buy used?

When making specific selections, check each product…

• Are there safety standards or regulations for this product?
• Are all exposed corners and edges smooth and rounded?
• Are there any parts loose, cracked, broken, or missing?
• Are there tears in the vinyl or cloth padding?
• Does all metal tubing have end caps that do not come off?
• Are their holes that little fingers or toes could get stuck in?
• Does the product have a wide, stable base?
• Does the product have skid-proof feet (if applicable)?
• Will the safety belt actually restrain?
• Are all spring or folding mechanisms covered or out of a child's reach?

When deciding where to buy child-related products, check the store policy…

• Will the store take the item back if I find it does not work for me?
• Will the store take it back if I have two of the same items?
• Does the store sell replacement parts for the product?
• Will the store fix the product?

Once you have bought and taken the product home, remember to...

• Always put the purchased unit together exactly as the manufacturer says.
• Use the product only if the child fits within the age, weight and height limits.
• Check the product on a regular basis for tears, broken parts, etc.
• Make repairs as soon as possible and before the product is used again.
• Never change or alter the product in any way.

REMEMBER:

A child related product is only as safe as how you use it. SUPERVISE YOUR CHILD AT ALL TIMES WHEN USING ANY PRODUCT. The only child related product made for use without direct supervision is a crib.

What every premature or small baby needs to know…before riding in the car. Every baby deserves to be protected, in case of a car crash. However small you are when you are ready to go home from the hospital, you can ride in a car seat that suits your size and medical needs. The restraint device your parents choose is especially important if you weight less than 2.5kg (5 and 1/2lbs).

The Basics of Protection

• The safety seat must be the right size for you.
• The seat must meet Canadian Motor Vehicle Safety Standards (CMVSS 213.1).
• It must be used correctly, with you fastened into the car seat, and the seat fastened to the car.
• You should ride in a place where an adult can watch you. (not in front of an airbag).

How to be Comfortable in a Car Seat

• You should always ride facing the back of the car.
• Your bottom and back should be in contact with the bottom and back of the car seat.
• Rolled-up diapers or small receiving blankets along the sides of the seat, around your head, and between your legs behind the crotch strap may make a better fit. I
• If you have an add-on car seat pad, it must have slits in the back, exactly matching the harness slots for straps to be pulled through and no thick padding behind your back or bottom.
• You should recline at a 45-degree angle. If the vehicle seat slopes so that your head flops forward, your parents should tilt your seat back just enough so that your head rests comfortably without falling forward. To do this, a firm roll of cloth can be placed under the front of the car seat below your feet.
• Shoulder straps must be in the lowest slots, the harness must be snug and the chest clip at armpit level.

What Your Parents Should Know Before Choosing a Seat for You

• If your parents already have a car seat, you may be able to use it when you are very small, depending on how it fits. Many models can be adapted with padding as long as they don't have a shield.
• Car seats with shields in front should not be used when you are very small because your face or chest could hit the shield in a crash.
• Car seats with a space of 13.75cm, or less, between the crotch strap and the seat back, will keep you from slouching too much.
• Car seats with shoulder harness slots located 25cm, or less, about the seat bottom will work best to hold your body in place in a crash.
• Shoulder straps must be in the lowest slots. Household carriers or feeding seats are not strong enough to protect you in a crash.

If you use Special Medical Equipment

An apnea monitor, portable oxygen tank or other equipment must be anchored to the floor of the car, or under a seat, so they won't fly around in a crash, and injure you or someone else.

Seat Suitable for Premature Infants

This is a list of seats with shoulder harness height of less than 25cm. New models may also fit these criteria. Seats with a crotch depth of more than 13.75 cm can be padded for a better fit.

Seat	Crotch Depth	Should Strap Height
Century Assura/Affinity	20 cm	19 cm
Century Smart Fit	21 cm	19.7 cm
Cosco Arriva/Turnabout	19 cm	19 cm
Cosco TLC	15 cm	23.5 cm
Cosco Turnabout Auto Reel	17.8 cm	19 cm
Evenflo Joy Ride/T. Tandem	17.5 cm	20 cm
Evenflo Discovery/F. Choice	18.4 cm	19 cm
Fisher Price Safe Embrace	18.5 cm	22 cm

Adapted from a fact sheet published by the American Academy of paediatrics. This information is not a substitute for the medical care and advice of your doctor.

Your doctor may recommend that your baby lie down while travelling in a car. The Cosco Dream Ride is approved in Canada (CMVSS 213.5) as a car bed for infants weighing from 1.8-4.5 kg (4-10 lbs.) For information, contact SOS Rehab at 1-800-667-3422.

Weight Conversion Chart

Example - 5lbs. 6oz = 2438 grams

	Ounces   0	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
Pounds	Grams	28	57	85	113	142	170	198	207	225	284	312	340	369	387	425
1	454	482	510	539	567	595	624	542	680	709	737	765	794	822	850	879
2	907	9336	964	992	1021	1049	1097	1106	1134	1162	1191	1219	1247	1276	1309	1332
3	1361	1389	1418	1446	1474	1501	1531	1559	1588	1616	1644	1673	171	1729	1758	1786
4	1814	1843	1871	1898	1928	1956	1984	2013	2041	2070	2098	2126	2155	2183	2211	2240
5	2268	2296	2325	2353	2382	2410	2438	2461	2495	2523	2552	2580	2608	2637	2665	2690
6	2722	2750	2778	2807	2835	2863	2892	2920	2948	2977	3005	3034	3062	3090	3119	3145
7	3175	3204	3232	3260	3289	3317	3374	3343	3402	3430	3459	3487	3516	3544	3572	3601
8	3629	3657	3687	3714	3742	3771	3799	3827	3856	3884	3912	3914	3969	3997	4025	4059
9	4082	4111	4139	4168	4196	4224	4253	4281	4309	4338	4366	4394	4423	4451	4479	4508
10	4536	4564	4593	4621	4640	4678	4706	4735	4763	4791	4820	4848	4876	4905	4933	4961