What premature babies might look like

Premature babies look different from term babies. Premature babies might also look different from each other, depending on how early they were born.

A baby born at 36-37 weeks will probably look like a small term baby.

But an extremely premature baby – for example, a baby born at 24 weeks – will be very small and will fit snugly into your hand. Their skin might be fragile, shiny, translucent or even red in some babies. These babies’ eyelids might be fused shut.

It’s natural to feel worried about the way your premature baby looks, but your baby’s appearance is typical for their gestational age. The neonatal intensive care unit (NICU) team will carefully monitor your premature baby’s skin condition, as well as their weight, length and head size to make sure they’re growing as expected.

Your premature baby’s bones and muscles

When premature babies are born, their bones are all there but aren’t fully developed.

In the last months of pregnancy, a lot of minerals – including calcium and phosphate – are transferred from pregnant women to their babies. In term babies, this helps bones grow and become strong. Also, term babies spend the last few months in the womb stretching and flexing their muscles, which helps their bones to develop too.

Premature babies don’t get as many minerals while they’re in the womb. And they often lose more minerals, especially calcium, through their urine than term babies. They also have less time in the womb to stretch and flex their muscles.

This means it will take many weeks after birth for your premature baby’s bones to grow and get strong.

Helping your premature baby’s bones and muscles to develop

NICU staff will do a blood test to check your premature baby’s bone mineral levels. If your baby’s levels are low, your baby will get calcium and phosphate supplements. Your baby might get vitamin D supplements too.

Your baby might also need extra protein and calories.

All these extra nutrients will help your baby’s bones to grow and strengthen.

Gentle exercises specially designed for premature babies can help your baby gain weight and build strong bones and muscles. It can also help to prevent delay in muscle and movement development. These exercises might include bending, straightening or positioning your baby’s arms and legs.

The exercises will need to fit into your baby’s overall medical plan. They’re usually recommended only when your baby is near their due date and only after your baby has seen a specialist physiotherapist. The physiotherapist will work with your baby and also show you how to do the exercises.

When you take your premature baby home, you can play games that encourage your baby to move their arms and legs. This might include letting your baby kick while lying on the floor, playing ‘Row, row, row your boat’ while gently moving your baby’s arms, and helping them to try tummy time for a few minutes while they’re awake.

Your premature baby’s skin

When premature babies are born, their skin isn’t fully mature.

Skin and sensation
Your premature baby senses and learns about the world mainly through touch, and touch is a key way for you to bond with your premature baby.

But because your baby’s skin isn’t mature, too much pressure on their skin or the wrong kind of touch can be stressful for them. But if you warm your hands and place them gently on your baby’s back or head, it can be soothing – as long as you keep your hands still. Your baby’s nurse will show you how to touch your baby.

Skin and protection
The skin usually protects the vulnerable tissues and organs inside the body against bacteria and viruses. In term babies, the fat under the skin also keeps in heat and fluid and prevents dehydration.

But if your baby was born very premature, infection can get in and fluid can leak out through their immature skin. It’s very important for everyone who touches your baby to have clean hands. Your baby’s skin will become drier, firmer and more protective, usually within 2-3 weeks of birth.

If your baby was born at 30-32 weeks, their skin might look wrinkly and loose. This is because your baby has more skin than a very premature baby, but they don’t have much fat underneath it.

Your baby might not be able to keep a steady body temperature because they don’t have much fat. This is why your baby will be in an incubator to start with. The incubator keeps your baby warm and humidified until their skin strengthens 2-3 weeks after birth.

Your baby’s skin might become dry and flaky. This is because the first layer of skin starts to mature and shed while new skin is made.

Caring for your premature baby’s skin

All neonatal intensive care units (NICUs) will have procedures for caring for premature babies’ fragile skin. For example, your NICU might use a particular oil or cream for premature babies with very dry skin, and staff will take care handling premature babies with very fragile skin.

You can also help to care for your premature baby’s skin by:

• using soft cotton baby clothes rather than synthetics or scratchy, coarse-fibred wool
• checking with the nurse or doctor before you put anything onto your baby’s skin
• learning how to touch your baby – your baby’s nurse or doctor will be able to help.

Without much body fat or muscle, premature babies tend not to move very much. Some of their first movements can be jerky. But as their muscles develop and their nerves start connecting to the brain, their movements become smoother and more controlled.