choosing a daycare for your preemie

thanks sara for writing this up! you rock! it's going to be helpful to so many people. :)


I was glad when Charla asked me to share my experiences on going back to work after having a preemie. Since I didn't start my blog (http://takingontheworldwithourboy.blogspot.com) until my son was 9 months, I had never written or really spent a lot of time reflecting on what that experience was like for me. I had so much to say, I asked Charla if we could make this two posts! This post is about the daycare that we chose for my son, in light of concerns about his health.

My son, Marino,

was born at 32 weeks due to HELLP Syndrome. 32 weeks is considered a fairly safe gestational age as far as prematurity goes. He was small (3 pounds, 2 ounces) needed CPAP (ventilator) for a few days and had some other issues, but we had a relatively easy four weeks in the NICU. However, to quote Jim Bob Duggar, "never trust a preemie." Ten days after we arrived home from the NICU, our healthy baby developed late onset Group B Strep which progressed to sepsis and then bacterial meningitis. We spent another 14 days in the hospital (this time the Pediatric ICU). We were terrified and the doctors at the hospital made sure we understood how truly fragile Marino's immune system was before we brought him home again.

My maternity leave was 17 weeks long, but it was nothing like the leisurely days of walks and naps with the baby that I anticipated when I was pregnant. We had to completely quarantine Marino until he was four months old, due to his weakened immune system. I was recovering from serious complications from my c-section, Marino was colicky and I was dealing with serious anxiety regarding Marino's health (and my own, to an extent). My anxiety was compounded by fears about exposing him to other children once I went back to work. If you're curious, hiring a nanny was cost prohibitive for us. The cost of hiring a nanny where we live is approximately 40% more per month than what we pay for daycare (which is already a lot of money...about 25% of our net income).

We had found an in-home daycare for Marino before he was born, and we still thought that would be the best place for him. The in-home daycare was close to my job and there was only one other child there, so we believed the limited exposure to germs and more individualized care would be best. In some ways, it was great. His colic stopped as soon as he started daycare. I think the combination of increased stimulation and a specific daily schedule helped. I know he was adored there. But there were some concerns...the primary one being that the tv was on all day. By week two, the provider declared "he has a favorite show" (which was particularly disturbing since we didn't allow him to watch tv at home). We had other concerns, as well. Marino was behind in his gross motor skills, and we didn't feel as though his daycare provider had the experience to work with him in this regard. She also dismissed any of my concerns about his health with a flippant "Oh, he'll be fine!" which may be a perfectly appropriate thing to say to the mother of a healthy child, but not a mother who has had a seriously ill child. I also always felt like I was intruding if I came to visit him during the day (even if I gave her fair warning of when I was coming).

Our physical therapist told us about a daycare for medically fragile children, and it just happened to be a mile away from my job. The center is run our local chapter of The ARC (the Association for Retarded Citizens...yes, the name makes me cringe, too, but the organization was founded in the 1950's, when "retarded" was the politically correct terminology) and receives funding from the state, the United Way, and a variety of other non-profit organizations. Tuition is on a sliding scale, based on income (a great benefit if you live in a very high cost of living area like we do). Nurses are on staff at all times, and they are capable of administering medicine and other medical procedures needed.

I had reservations initially, since I wasn't sure he was medically fragile "enough" to need to be there. As I learned more about it, I came to understand that the children there range from having severe cognitive and physical disabilities to having severe reflux to having bad allergies. The common link is that the parents of each of these children felt they needed some extra observation to get through the day that they wouldn't receive in a traditional daycare. I started Marino there when he was 5 and a half months old (he spent a month at the in-home daycare).

The care Marino receives there is excellent. There are a teacher and an assistant teacher in each room (so a 2/6 staff/child ratio), but there are also several nurses there at all times, as well as a Nurse Administrator, an Education Director and an Administrative Specialist. This means, that if my son is in "a mood" and wants to be held all day, there is someone there to do it. I receive detailed information about what he's eaten, when he slept, when he was diapered, his daily activities, and any medical procedures administered. He also gets weighed monthly, which is a great perk for a preemie mom obsessed with weight gain!

I feel that the staff there genuinely love him and they know him better than anyone (with the exception of my husband and I, of course). They understand "Marino speak", they know how he likes to eat his foods, how to get him to go to sleep, etc. He developed severe asthma when he was 9 months old and the nurses know the difference between his usual asthma symptoms and the need for an urgent call to mom. They administer his nebulizer with ease. When he had second degree burns on his hands and needed several bandage changes a day, I had no fear about his being cared for at daycare. The bottom line is that if I had put him in a regular daycare center, I would have had to miss many more days of work than I've had to with him being at a daycare for medically fragile children.

I highly recommend any parents of premature babies or babies with any medical issues contact their local chapter of The ARC or their county Department of Health and Human Services to see if there is a center like ours in your area. Marino will start at a Montessori preschool in the Fall, when he is 26 months old. I have a lot of fears about this, of course, but I think he is ready to be in a typical preschool environment. I also have the benefit of knowing that if he isn't receiving the care he needs there, I have a center available to me where I know he is loved and will thrive.


everyone be sure to check out marino's blog taking on the world with our boy. sara has a great post running called 5 on friday- 5 special reasons why she loves her son every week. it makes me think about all the things we have to be thankful for with our little ones.
her post about what do do for preemie parents was actually the inspiration for the turns this blog has taken... it was such a help for me that i thought... i bet a lot of people could benefit from posts like that... and early bird's "new to the nicu" section was born.
a big thank you to sara- we hope to have more guest posts from her in the future! 

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