Congratulations! Your baby is coming home. Your baby's discharge from the hospital can be one of the most emotion-filled experiences you will have. This moment you've been waiting for has arrived; you are finally your baby's caretaker at last! The weeks of life and death situations are behind you. You may have many questions and concerns. The following is a list that you may wish to bring up with your baby's hospital careproviders and well as the pediatrician.
Feeding
1. Baby's Diet:
_____ Breastmilk
_____ Breastmilk with supplementation:
_____ type: _______________________________________________________________
_____ amount: ____________________________________________________________
_____ number of times each day: _____________________________________________
_____ Formula: ____________________________________________________________
_____ amount: ____________________________________________________________
Water? __________________________________________________________________
Vitamins? ________________________________________________________________
2. Frequency of feedings:
_____ when baby is hungry (on demand)
_____ when hungry but at least every _____ hours
_____ every _____ hours
3. Special position for feedings? _______________________________________________
4. How can we tell when baby has enough to eat? ________________________________
__________________________________________________________________________
(ten or more wet diapers daily, satisfaction after meals, healthy growth pattern, etc.)
Sleep
5. Sleeping:
_____ allow baby to sleep
_____ wake to feed if baby has slept more than _____ hours
6. Sleeping position:
_____ baby should sleep in ___________________________ position
Crying
7. Should I let the baby cry? _______________________________________________
_____ if so, for how long? _________________________________________________
_____ if not, how shall I comfort him/her? ____________________________________
Home Care
8. How warm should the house be? _________________________________________
9. What should the baby wear? ____________________________________________
______________________________________________________________________
10. What should we sterilize? _____________________________________________
______________________________________________________________________
11. When can we allow people into our home? ________________________________
12. Can people other than parents and siblings hold the baby? ___________________
13. Can we take the baby out? If so, where or where not? _______________________
______________________________________________________________________
14. What happens if a family member gets sick? _____________________________
______________________________________________________________________
Special Medical Care
15. What medications is the baby on?
Drug #1 ________________________________________________________________
_____ Reason ___________________________________________________________
_____ Frequency _________________________________________________________
_____ Dose _____________________________________________________________
_____ Call doctor if you see these signs ______________________________________
_____ __________________________________________________________________
Drug #2 ________________________________________________________________
_____ Reason ___________________________________________________________
_____ Frequency _________________________________________________________
_____ Dose _____________________________________________________________
_____ Call doctor if you see these signs ______________________________________
_____ __________________________________________________________________
Drug #3 ________________________________________________________________
_____ Reason ___________________________________________________________
_____ Frequency _________________________________________________________
_____ Dose _____________________________________________________________
_____ Call doctor if you see these signs ______________________________________
_____ __________________________________________________________________
16. Should baby be kept away from:
_____ pets_________________________ _____ sick people
_____ people smoking _______________ _____ crowds
Other: _________________________________________________________________
Future Medical Appointments
17. When should baby have his/her next well baby check up? _____________________
18. Suggestions of local pediatricians? ________________________________________
19. At which symptoms should the doctor be called in case of illness? ______________
________________________________________________________________________
20. Next Follow-Up Program appointment: _____________________________________
21. Other appointments: ___________________________________________________
________________________________________________________________________
________________________________________________________________________
22. When should the baby get his/her immunizations? ___________________________
Special Situations
23. Is my baby at risk for SIDS? _____________________________________________
24. If the baby is going home on a monitor, who should I call with questions?
________________________________________________________________________
25. If needed, where can I find:
_____ an infant stimulation program ___________________________________________
_____ an early intervention program ___________________________________________
_____ a follow-up program __________________________________________________
_____ a physical therapist __________________________________________________
_____ occupational therapist ________________________________________________
_____ speech therapist _____________________________________________________
_____ audiologist _________________________________________________________
_____ ophthalmologist ______________________________________________________
_____ cardiologist _________________________________________________________
_____ developmentalist _____________________________________________________
_____ orthopedist _________________________________________________________
_____ visiting nurse ________________________________________________________
_____ lactation consultant ___________________________________________________
_____ other: ______________________________________________________________
26. Other special situations:
Tracheotomy care _________________________________________________________
_____ call with problems: ___________________________________________________
Gastrostomy care _________________________________________________________
_____ call with problems: ___________________________________________________
Incision care ______________________________________________________________
_____ call with problems: ___________________________________________________
27. If my baby needs future surgery:
_____ Type of surgery: _____________________________________________________
_____ Surgeon ____________________________________________________________
_____ Hospital ____________________________________________________________
_____ Phone _____________________________________________________________
_____ When surgeon should be contacted _____________________________________
Equipment
28. Baby will need this equipment:
_____ crib_____________________ _____ baby swing
_____ carseat__________________ _____ baby sling
_____ cool mist vaporizer_________ _____ bottles
_____ thermometer, nose syringe__ _____ blankets, sleepers
_____ other special equipment: ___________________________________________
29. I know how to:_________________ Questions:
_____ bathe the baby______________ ________________________________________
_____ feed & burp the baby_________ ________________________________________
_____ make the formula ___________ ________________________________________
_____ dress the baby _____________ ________________________________________
_____ hold & soothe the baby _____ ________________________________________
_____ give all medications _________ ________________________________________
_____ get help if needed ___________ ________________________________________
30. What will the baby like to play with? _______________________________________
________________________________________________________________________
Important Phone Numbers
32. Hospital Social Worker: _________________________________________________
Local Pediatrician ______________________________________________________
Local Ambulance: 9-1-1 or: ______________________________________________
Support Parent: _______________________________________________________
Lactation Consultant: ___________________________________________________
Breastfeeding Counselor: _______________________________________________
Other: _______________________________________________________________
_____________________________________________________________________
Other Comments/Questions
This parent participation questionnaire was originally prepared by members of Intensive Caring Unlimited, a Philadelphia/Southern New Jersey based parent support group and adapted/updated for use for StorkNet.
