If your baby is unwell when you go home

After leaving the neonatal unit, you may be concerned about your baby becoming unwell. This is something many parents experience, especially when they have become used to the support of the unit staff. Many parents worry that they will not be able to notice the signs that their baby is becoming unwell.

Babies who are born premature or sick may have weaker immune systems than babies born at full-term. It is important to be prepared if your baby is at high risk, particularly in the winter months. This is to reduce the risk of infection. We have more information about common infectious illnesses.

Some babies may be more snuffly when they come home from the unit, or you may hear a quiet sniffling sound. This may be because of the change in atmosphere and temperature, and more dust at home. The snuffling will settle down, but this may take a few weeks. If your baby seems well otherwise and is able to feed, try not to worry. If you hear a wheezing, whistling or grunting noise when your baby is breathing, you should see your doctor immediately.

If you are concerned about any changes in your baby’s behaviour, you should see your GP. You can also call 111 for medical help over the phone.

Call 999 immediately if you think your baby might be seriously unwell.

How to check your baby's temperature

Many parents worry about their baby being too hot or too cold. You can firstly check your baby’s temperature by feeling the back of their neck or tummy. It is normal for a baby’s hands to feel cooler than the rest of their body.

To check your baby’s temperature, you can place a digital thermometer under their armpit. Your baby’s temperature should normally be between 36.5 and 37.5°C (97.7 to 99.5°F).

For more information on how to take your babies temperature see the NHS website.

Readmission to a children's ward

Your baby may need to be readmitted to hospital after they come home. Common reasons for readmission include infection, breathing or feeding difficulties and jaundice (yellowing of the skin and whites of eyes or changes to the skin around the lips and gums). If this happens, it may be a worrying and upsetting time, especially when your baby has overcome so many difficulties already.

Babies who need to be re-admitted to hospital are likely to be admitted to the children’s ward, not the neonatal unit. This is a different environment to the neonatal unit, so may feel strange in comparison.

For example, the children’s ward might be:

• Bigger and louder than the neonatal unit.
• Busier, with more families and staff.
• The patients might be children up to age of 18 years.

In a children’s ward parents may be expected to look after their child and stay with them 24 hours a day.

You can talk to staff to explain that your baby spent time on a neonatal unit and how you are feeling. They will be happy to listen and support you.

Readmission from neonatal care to the Children’s Intensive Care Unit

This is known as PICU (Paediatric Intensive Care Unit).

If your baby becomes very unwell after you have been discharged from neonatal care, they may be readmitted to the paediatric intensive care unit also known as PICU, for example if they need help with their breathing from a ventilator because of a severe chest infection.

PICU looks after very unwell babies and children of all ages and can be a busy, fast-paced environment. We hear from parents that this can be a difficult adjustment after spending time on a neonatal unit.

It can help to bring your baby's discharge letter from the neonatal unit if you are admitted to PICU so that the team there have as much information about your baby as possible.

Your nearest PICU may not be in your local hospital or where your baby or babies received neonatal care. If your baby needs to travel between hospitals to reach a PICU, then specialist critical care transport ambulances will be arranged. See our section on transferring your baby to another hospital. If you would like to know more about PICU please ask the neonatal team who will be happy to discuss this.

The risk of babies needing admission to PICU is higher for those who were born more preterm. Babies born before 28 weeks' gestation are at the greatest risk, however even for this group, the majority of children will not need PICU admission.

Find more information on NICU to PICU readmission rates.

How to know if your baby is becoming unwell

Some parents worry about how to recognise the signs that their baby is becoming unwell. Here are some of the things to look out for:

• Being more fretful than usual. This means they may be restless, crying more than usual, or fussier than usual.

• A high or low temperature.

• Refusing or being reluctant to feed.

• Vomiting more than usual.

• A change in stools - more frequent, watery or ‘explosive’ than usual.

There are some signs that might show that your baby needs urgent medical advice. These include:

• Blotchy skin or a rash that does not fade if you press the side of a clear glass firmly against the skin.

• Pausing for a few seconds between breaths.

• Being paler than usual.

• Being unresponsive, floppy, or not waking up as easily as usual.

• Showing signs of jaundice (yellowing of the skin, the whites of eyes or the skin around their lips and gums).

• Difficulty breathing (for example, their breathing being quicker and louder than usual).

• A wheezing, whistling or grunting noise when your baby is breathing out.

The Lullaby Trust have a Baby Check app that you may find helpful. It takes parents through 19 checks that they can do if their baby show signs of becoming unwell. The app is available on Android and Apple devices.