Seeing patterns in a premature baby: what logging can and can't tell you

After a few weeks at home you've written down hundreds of lines: feeds, diapers, naps, spit-ups. It's tempting to look for answers in there. Why is he unsettled every evening? Is she drinking less than last week? Sometimes your notes show a real pattern. Sometimes they show something that only looks like one. This article is about telling the two apart.

What logging does well

It shows what happened. That sounds obvious, but it's the biggest benefit. At three in the morning nobody remembers exactly when the last feed was. At the appointment the paediatrician asks how often he's spitting up, and you have an answer that doesn't depend on your memory or how tired you are.

Trends over days. One feed tells you little. A daily total tells you more, and one week next to another tells you more still. Is the share taken by mouth going up? Are the night-time stretches getting longer? Slow changes like these are almost invisible when you're in the middle of them, but easy to see on a chart.

Comparison with your own baby. The most useful comparison is with your baby last week. Every baby has a rhythm of their own. What's a busy day for one is ordinary for another. A baseline of a week or two of your own baby's data shows what's normal for them.

Better conversations with your care team. A paediatrician, dietitian or health visitor can do more with "for the last four evenings he took 20 ml less by mouth" than with "things are a bit worse". Your notes make your question concrete.

Where it stops

A pattern isn't a cause. Perhaps you notice he's unsettled after feeds where he drank a lot by mouth. That could mean something. It could also be that you mostly give the bottle in the evening, and he's more unsettled in the evening anyway. Two things that happen together don't have to be connected.

Small numbers bounce around. With a few entries a day, the gap between a normal day and an unusual one is small. Three dirty diapers on Tuesday and one on Wednesday may just be chance. The less data you have, the more careful you need to be. Look at several days in a row rather than one outlier.

What you don't log doesn't exist in your data. At night you sometimes forget a diaper, or log a feed an hour late. On busy days you write down less than on quiet ones. So a day with few entries isn't necessarily a quiet day. That's how a "pattern" can appear that's really about you, not your baby.

Times are approximate. If you log the end of a feed, the gap between feeds can look shorter or longer than it was. A nap you only started recording ten minutes in looks shorter. That's fine, as long as you remember the clock isn't accurate to the minute.

Growth charts aren't targets. On a WHO chart or the Fenton chart for premature babies, your baby sits on a particular line, a centile. That number isn't a score. A baby on the 10th centile isn't less healthy than one on the 50th. Doctors mostly look at the course over time: is your baby growing roughly along the same line, or drifting away from it? A single reading on scales that were set slightly differently says little about that.

Milestones come with a range. Developmental checks, such as the Dutch Van Wiechen assessment, give an age by which most babies can do something. For a premature baby that's the corrected age. A milestone that hasn't happened yet is something for the health visitor to keep an eye on, not a verdict.

A few rules of thumb

1. Look at several days. Something that's different three days running is more interesting than a single outlier.
2. Compare with your own baby. Not with the neighbours' baby, and not with a table.
3. Log the ordinary too. A record of only the hard moments paints too bleak a picture.
4. Bring it along, and let the team draw conclusions. Your notes are material for the conversation, not its outcome.
5. Trust your instinct as well. If something feels wrong even though the numbers look normal, call. A chart doesn't see everything a parent sees.

Sources

• World Health Organization. WHO Child Growth Standards, 2006.
• Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics, 2013.
• The Van Wiechen developmental assessment, as used by the Dutch youth health service (JGZ).

About Hidje

In Hidje, Patterns shows charts over 7, 14 or 30 days. The "Worth noting" card compares today with the past one to two weeks of your own baby, and only appears once there are at least five days with enough entries. That's precisely to avoid the pitfalls above. Hidje doesn't diagnose and doesn't give advice. It puts what you've logged in order, so you can have a better conversation with your doctor.