Babies in the neonatal intensive care unit (NICU) communicate in a different way than healthy newborns. Wondering how you can know what your preemie needs? Here you’ll learn 10 unexpected ways your NICU baby is showing you they’re stressed, overwhelmed, or overstimulated. Plus, one amazingly supportive thing you can do about it.

Even when your baby is premature, tiny, and fragile—you can learn to understand them. Babies are constantly communicating with us, letting us know how they’re feeling and what they need.

Part of understanding your baby’s communication is knowing when they are feeling stressed or overwhelmed. 

Now, I know that taking in information like this can be challenging as a parent. We don’t want to imagine for a second that our child is experiencing any kind of discomfort or pain. 

I remember when my son was in the NICU and he had an IV placed. I was imagining what that felt like for him. It hurts. BUT, understanding when our babies are stressed, overstimulated, or in pain is important for us as parents. 

When you know some of these unique, different ways that sick, medically fragile babies show stress, you’ll be able to swoop in and comfort your child. That’s the goal, to help you know when your baby needs YOU. 

Make sure you scroll to the end to learn something you can actively do with your baby when you see these cues! 

Please know: Though many of these signs I’ll talk about indicate stress for NICU babies, they won’t ALWAYS mean your baby is stressed. For example, we’ll talk about how the hiccups can be a sign of stress for immature babies (especially preemies). But, if you notice your baby has the hiccups, that doesn’t automatically mean we should assume they are stressed out. Always look for multiple cues and collaborate with your baby’s bedside nurse to neonatal therapist to understand how to read these cues better. Sometimes, it’s just the hiccups. 

Here are 10 unexpected ways your NICU baby may be showing you they are stressed, overwhelmed, or overstimulated.

1. STOP HAND

This is when your baby puts their arm out and spreads their fingers. It kind of looks like they are giving you a high-five. If your baby is showing you this sign, it means, “I need a break,” or “This is too much.” That means it’s time to stop what you’re doing and provide comforting touch.

2. STIFF, STRAIGHT LEGS

You may be thinking…my baby loves to stretch. And maybe they do. But, if your baby has stiff, straight legs during their care, it’s usually a sign they are overstimulated. Guide their legs back in towards their tummy and provide some containment before continuing.

3. FACIAL GRIMACE

This one may be more obvious. You may see your baby wrinkle their eyebrows and have a concerned look on their face. You may know immediately that your little one doesn’t like what is happening.

4. HICCUPS

Yep, the hiccups can be a sign of stress in NICU babies. This usually happens when a baby is overstimulated or is trying to cope with too many different things. You may notice your baby gets the hiccups at the end of their nursing assessment.

Hiccups are also more common in really premature or young babies who aren’t able to show us more obvious stress cues. BUT, remember…sometimes the hiccups just means the hiccups. 

If you want more information on understanding your baby’s stress signs and looking for cues, download The Preemie Interaction Guide. It’s full of cheat sheets, photos, videos, and guidance to support you as you learn about your preemie’s development.

5. LOOKING AWAY FROM YOU

This is also called “gaze aversion”. This is your baby telling you they aren’t able to handle any more input. They are trying to make things easier by looking away from you. Try decreasing the stimulation around them like dimming the lights or quieting your voice to help your baby cope. 

Want to teach your baby good coping skills? Here are 5 things you can do with your NICU baby.

6. INCREASED BREATHING RATE OR HEART RATE

Both of these are a sign of stress, pain, or overstimulation. Your baby may show these signs if they are premature or have a lot of medical involvement. You will notice your baby is breathing faster or the numbers on their monitor are increasing. 

7. GOES FROM AWAKE TO ASLEEP SUDDENLY

Preemies and other NICU babies have to learn how to transition between different arousal states. If your baby is awake and suddenly seems completely asleep (without a transition through a sleepy phase), then they were likely overwhelmed by their environment. Let your baby rest and re-organize before attempting to wake or interact with them.

8. FLAILING MOVEMENTS

Do your preemie’s arms and legs flail around during their assessment or diaper change? Those flailing, disorganized movements are a sign your baby needs some support. They don’t have the muscle strength to bring themselves into a comforting posture. If you see this, use your hands to provide your baby with some containment (like a hand hug!).

9. SNEEZING

Nope, there isn’t anything tickling your baby’s nose. This is often a signal your baby is overstimulated. Your baby may sneeze if they have had a lot of activity or interaction. Just remember, preemies can get overstimulated really easily.

10. YAWNING

Baby yawns are adorable, but in preemie babies…yawning can be a sign they are stressed. They may even yawn and give you a stop hand at the same time. Just take a break and give your baby some time to re-organize.

Do your best not to feel overwhelmed when you see some of these cues. Sometimes it’s just a cute yawn indicating they’re tired, especially if your baby has reached their due date and is nearing going home. 

what to do when you see these signs of stress…GIVE A HAND HUG!

Use these signs to understand what your NICU baby is telling you.

I love that your baby is able to communicate their needs with you! It’s a good thing they show us these behaviors, because we need to be in tune with their needs.

One of the best ways to support your baby when they show signs of stress or overstimulation is a hand hug (as neonatal therapists, we call this, facilitated tuck!).

• If you’re in the middle of a diaper change and your baby’s arms and legs are flailing, give them a hand hug. 
• Taking your baby’s temperature and your partner is there too? One of you gives a hand hug while the other takes the temperature.
• Have a 26 week preemie who can’t be held yet? Give them a hand hug during their nurse assessment.

Hand hugs have the power to comfort your baby and decrease their pain and stress. 

Need the answers to ALL your hand hug questions?

Head over to ONE THING I TEACH EVERY NICU PARENT TO DO WITH THEIR BABY—A HAND HUG!

You are on your way to knowing exactly what your NICU baby needs. 

Every baby is different, and your neonatal therapist or bedside nurse can teach you ALL about the special behaviors your baby is showing you. 

What special ways does your NICU baby show you what they need?

Did you learn something new here you can take to your baby’s bedside today?