NICU Family Guide

By this point you have likely met the friendly faces of our Transport Team. They travel with their fully functional portable NICU which has everything your baby needs to make it safely to CHEO. Their isolette is heated and your baby is secured in a 5-point harness. Their equipment allows for transport of the most complex NICU patients and our team is specially trained to care for them en route. Members of the team are usually a registered nurse or respiratory therapist who are trained in both roles, called a transport clinician. They are always only a phone call away and in constant communication with the neonatologist (specialized newborn doctor) who approves and recommends the treatments your baby needs. There may not be room in the ambulance or plane for a parent to accompany their baby, but we do our best to accommodate this when possible.

We have three main rooms, which we call “pods” that are identified by colours – yellow, blue and green. There are two rooms near the central desk that make up the “pink pod” The colours do not represent anything other than the location of your baby. Babies of any degree of illness can be in any pod. There are times when we have to move babies from one pod to the other to balance out numbers and keep the workload even for our nurses.

There is a screen located next to the unit clerk’s desk where you can see the location of your baby and the name of the nurse assigned for that shift. If your baby has moved location within the unit, this will always be up to date. Your baby will never be moved outside of the unit without notifying you first.We also have one isolation room. It is used for special procedures and patients with suspected infections.

Unit entrance:

NICU clerks desk

Parent, caregiver and visitor presence policies

Please review the following information before arriving at CHEO.

Parents and caregivers are important members of the care team. They actively work with us to provide vital health information only they know and give emotional support in the way only a parent or caregiver can.

For infection prevention and safety reasons, we have limits on how many parents, caregivers and visitors can be onsite at one time. We also limit the number at the bedside.

We appreciate your patience and understanding in keeping everyone safe, particularly during the peak viral season.

Allowed number of parents, caregivers and visitors

Last updated: March 2026

Clinic and Surgical Day Unit appointments

• TWO parents or caregivers are allowed to accompany children and youth while at CHEO for clinic and Surgical Day Unit appointments.

Emergency Department visits

• ONE parent or caregiver is permitted to accompany children and youth while at CHEO's Emergency Department.

Staying at the hospital (admitted to CHEO's inpatient units)

• A maximum of TWO parents or caregivers are permitted at the bedside at a time. 
• Only ONE caregiver of immediate family can stay overnight.

Visitors

• During non-peak viral season, visitors are permitted with a maximum of TWO at the bedside.

Exceptions to these rules

We recognize that some families (e.g., people with disabilities) require additional support to help the patients, parents or caregivers. If you are coming to Emergency, please discuss your need for an exception upon arrival at CHEO Emergency. If you are staying as an inpatient, please discuss this with your care team.

Who can't enter

Parents and caregivers who do not pass the entrance screening.

It is important to us that your child or youth receives the care they need. If you require an exception to any of our caregiver/visitor policies to ensure that your child/youth can access care, please contact a member of your care team or reach out to CHEO's Patient Experience team (experience@cheo.on.ca or 613-737-7600 ext. 3078).

Self-screen for illnesses including measles, cold and flu

To make sure we are always putting safety first and minimizing any chance of transmission of infections, please use our quick and confidential illness self-screening tool if you have symptoms or may have been exposed to viral illnesses like cold, COVID, flu or measles.

It will guide you on what to do next and help keep everyone at CHEO safe.

Illness self-screening form

Where to enter

All children, youth, parents/caregivers and visitors must enter through the Main Entrance unless you are seeking care from our Emergency Department. Other entrances are closed.

Frequently asked questions about coming to CHEO

For your baby's safety, the NICU is a locked unit. Once you visit the Admitting Office, located near the main entrance, you will be identified as a parent and will receive one unit access pass per family. There is a deposit fee for the pass card which you will be refunded at the end of your stay. 

Once you have your access pass, you can swipe yourself in and out of the unit. If you do not yet have an access pass, there is a video phone and doorbell at the NICU doors that you can use for staff to let you in. For everyone’s safety, please do not share your pass with anyone else.

You can call the unit at any time for an update on your baby. When you identify yourself as a parent, ask to talk to your baby’s nurse to receive an update.

There may be times when your baby’s nurse is busy caring for your baby or busy at shift change (around 7:30 both in the morning and in the evening) when they cannot come to the phone. In that case we’ll arrange a call back at a more appropriate time.

Babies in our unit are at high risk for infections and hand washing is one of the best ways to keep them safe.

Start by removing your outside jacket (if applicable) and store it in the shelving unit in the corner of your baby’s room, this is your space.

Next, remove all rings, watches, bracelets and any jewelry below the elbows. Please give a good scrub to your hands, being sure to get beneath the nails, between each finger, and the backs of the hands. Dry thoroughly with the paper towel provided.

Hand washing videos:

• Just Wash Em
• Where Have Your Hands Been?
• Clean Hands Count 
• Brother John handwashing song

You are able to use your cell phone while in the unit. There is a UV cleaner that we recommend you use to sanitize your phone, especially when you first arrive in the unit and before you head into your baby’s room.

Each room is set up with a bed most appropriate for your baby. This can be a heated overbed, an isolette or a cot. Sometimes there is a lot of equipment setup on all sides of your baby’s bed, depending on their needs. You may use the pull-out bedchair or the rocking chair. The cupboards in the corner are for you to store your jacket, purse and other personal items. Some parents choose to wear indoor shoes while in the unit or bring linens for their baby and store them here. 

You’re welcome to bring a photo or a drawing from a sibling to personalize the space. Some choose to bring books to read to their baby and store them here. We can provide a breast milk pump for this corner, and there is a white light switch that is dimmable for you to access an overhead pot light.

In the Ronald MacDonald family lounge across the hall, there is a small kitchenette where you can store meals and heat up with a microwave. Be sure to mark food with your name. There is a second family lounge located on the 5th floor (5 West).

You are welcome to have a small snack or drink from a covered beverage at the bedside, however larger or smell-producing meals are to be kept outside of the unit. You’re welcome to eat your meal in the family lounge, at one of the many picnic tables outside or at the Rainbow Café seating on the 1st floor.

Visit CHEO’s Amenity page for more information.

Staying at CHEO? Order food to your bedside. 

CHEO patients, parents and caregivers can now place an online order for food right to the bedside, using the CBORD® Patient™ app! Click here for more information, and to download the app.

There is a pull-out bed chair at each baby’s bedside where one parent can stay the night. The NICU and PICU share a few parent sleep rooms located in the Ronald McDonald Family Lounge. These sleep rooms are reserved for parents arriving from out of town at night or parents whose child is extremely sick or awaiting surgery in the morning and want to remain in hospital. They are intended for short-term accommodation.

Visit CHEO’s Amenities page for information about Ronald McDonald House and Rotel which are located next to the hospital.

Parking is available on-site. To purchase a parking pass, visit the security office, located on the 2nd floor near the emergency department. Many parking pass options are available and our Security team can help you find the most economical option.

The NICU is located on the 3rd level. The main entrance is located on the 2nd level of CHEO. Visit our Maps and Locations page to see maps of each floor at CHEO.

Click through our glossary to learn more about the terms and phrases you might hear your baby's care team using. You can click on the letters below to jump to the words starting with each letter.

A B C D E F G H I J K L M N O P R S T U V

A

ABO incompatability

Occurs when the mother has a blood type that does not match with baby’s blood type. It can cause jaundice and anemia in the baby, which will be monitored.

Acidosis

An excess of acid in the blood.

Arterial line

A catheter placed in the artery to monitor blood pressure (invasive) and can be used to draw blood work.

Anemia

Low level of red blood cells or hemoglobin in the body.

Antibiotics

Medicine used to treat bacterial infection

Apgar Score

Scoring tool used at birth that gives a quick idea of how well your baby is doing in the first few minutes of life.

Apnea

A pause in breathing that lasts more than 20 seconds. Common in premature babies.

Aspirate/Aspiration

1. When a fluid or air is removed from the baby’s body.
2. When baby breathes milk or fluid into their lungs

B

Bilirubin

Yellowish substance made when red blood cells are broken down. Normally processed by the liver and excreted in urine and stool. When it builds up you can notice your baby’s skin or eyes having a yellow/orange colour.

Bili lights

Phototherapy or light treatment that breaks down bilirubin to prevent or treat jaundice.

Breast milk fortifier

Calories and nutrients added to breast milk. May be in powder or liquid form.

Blood gas

Blood sample that tells us how well your baby is exchanging oxygen and carbon dioxide when they breathe.

Birth weight

Measured weight at the time of birth. Sometimes birth weight may be estimated depending on your baby’s condition.

Blood pressure

Can be measured non-invasive lay by using a pressure cuff that inflates or measured invasively by an arterial line in the arms, legs or umbilical cord.

Bolus

An amount of fluid given over a short period of time.

Bradycardia

Slow heart rate. In babies this is noted as under 100 and often worrisome under 60 beats per minute.

C

Catheter

A thin, flexible, plastic tube. There are many types and it may go by different names depending on where it is placed.

Chest X-ray

An X-ray to look at your baby’s chest to see placement of tubes or look at the condition of their lungs or heart.

Chest Tube

Inserted by a physician or advanced practitioner. A chest tube is used to drain fluid or air in the lungs.

CPAP

Continuous positive airway pressure. A machine to help your baby breathe that pushes air through a mask or prongs in their nose to help keep the smallest air sacs in their lungs open and make it easier for them to breathe.

Cyanosis

A blueish colour that is caused by low oxygen saturation. Acrocyanosis is a blueish colour to the hands and feet which can be normal during the first few days of life.

Corrected Gestational Age

The baby’s current age in weeks, starting from the date of conception. For example, a baby born at 35 weeks gestation who is now 5 weeks old would be 40 weeks corrected (term).

D

Desaturation (desat)

When the oxygen level in the blood falls below a set target. This target may vary depending on the baby’s age or condition.

E

EBM

Expressed breast milk. The milk a mother produces.

ECHO

Echocardiogram is an ultrasound of the heart that shows the structure and function of the heart.

Edema

Swelling caused by extra fluid in the tissues of the skin.

Electrolytes

Important chemicals such as sodium and potassium in the blood that must be in balance for the body to work properly.

Exchange Transfusion

Extremely high levels of bilirubin may need to be treated by removing blood from the baby and exchanging it with donor blood to bring down their bilirubin levels.

Extubation

Removing a breathing tube.

F

Fontanelle

There are two soft spots on a baby’s head where skull bones have not yet come together. These are normal and will close within a year.

Full Term

A baby who is born between 37-42 weeks gestation

G

Gastroschisis

A birth defect that allows an opening of the abdominal wall and the baby is born with abdominal organs outside the body.

Gavage feed

Feeding by a tube in the nose (NG) or mouth (OG) which is common when a baby is too premature to eat, or has breathing, digestive or other issues that don’t allow them to take food by bottle or breast.

Gestational Age

The length of time between conception and birth, measured in weeks and days.

GERD

Reflux (or gastroesophageal reflux disease) similar to heartburn, when stomach contents come back up the esophagus. This may cause discomfort or cause premature babies to spell.

GBS

Group B Streptococcus is one of the most common infections babies can be born with and can be quite serious for them. Mothers are routinely swabbed for this around 36 weeks gestation and given antibiotics before the baby is born if possible.

G-Tube

Feeding tube on the abdomen that is surgically placed directly to the stomach. Used for babies who cannot feed by mouth for the long term.

H

Head Ultrasound

Test to check brain structure and blood flow. Routinely monitored in premature babies who are at risk for brain bleeds due to the fragile vessels in their brain.

Heel Prick/Poke/Stick

A way to take blood for testing but using a small lancet on the baby’s heel. Also known as a cap (capillary) sample.

HFO

High frequency oscillation. A type of breathing machine that provides tiny, fast breaths that makes your baby’s chest appear to wiggle. It is a gentle mode of ventilation used when we have difficulty with conventional breaths.

High flow oxygen

Similar to CPAP, a non-invasive breathing support.

Heart Murmur

Additional sound heard in a baby's heartbeat. Sometimes normal in the first day or two of life, but may be an abnormal finding.

Hypoglycemia

Low blood sugar (glucose) level

Hypotension

Low blood pressure

I

Infusion

Every day our NICU Team meets for their daily rounds. Rounds start at 9:30 but it takes a few hours to get around to each patient. The team reviews your baby’s condition over the last 24 hours and makes a plan for the next 24 hours. There is sometimes open discussion or teaching for residents included and a lot of medical terms being said. The team will make sure that you understand all of the important pieces of what was said and give you an opportunity to ask questions. Some parents find it helpful to write down their questions so they don’t forget them when the whole team is there to ask. If a lengthier discussion is needed on a certain topic, sometimes we need to prioritize and come back later to discuss details. 

We can arrange to have you attend rounds by secure video conference or fill you in on discussions later in the day if you cannot be there in person.

Because sleep is so important for your baby’s development, we try our best to set a schedule for your baby’s care or “handling” to minimize disruptions. If your baby is being fed, all of their care is then clustered around their feeding times. Often these times are every three hours and either start from 8am or 9am and continue around the clock every 3 hours.

If your baby is not being fed, we may aim to provide care every 4 hours. There may be occasions we will adjust these times to coordinate with a test that needs to be done or based on your baby’s cues.

Sometimes the tubes and wires can be scary and overwhelming. Your baby is still there behind all of it and there are many things you can do to care for them. You can talk or sing to your baby in a quiet voice, but sometimes it is hard to know what to say to your baby. For these times, we are lucky to have books donated to the unit as a special gift from the family of Jack & Mia. You can read this book that is given to your family or any other book you choose to bring in.

You can also hold their hand or show them a small toy. If they are well enough you may be able to try supervised tummy time to help strengthen their back and neck muscles.

You can always get involved in your baby’s care by taking their temperature and washing their face or cleaning their mouth and eyes when needed. You may need some help with the wires at first, but you can help change your baby’s diaper around the time of their feed or handling time.

Family members who cannot visit in-person may want to spend time with the baby by video call. We kindly ask that you use earphones and a quiet voice to respect the space of the other babies in the unit.

When your baby first arrives in the NICU, they usually have several tests or procedures, consults, or exams from physicians which makes daytime quite busy. We also like to give you time to cuddle your baby during the day. This means that we usually reserve bath time for the night shift as there is more available time. Weights tend to be done at the same time as the bath and on Saturday nights we take all of your baby’s weekly measurements (height and head circumference). 

As your baby gets better and is moving closer to home, days become less busy with tests and procedures. At this point we encourage parents and caregivers to be more involved in daily care and we can teach you how to bathe your baby during the day or evening if you prefer. While this routine usually works well, let us know early if there is another arrangement that we can try to accommodate. 

With your baby’s handling times, you’re welcome to provide care such as eye and mouth care when needed and a diaper change. The nurses will help you navigate all of the equipment and wires.

It is common in the NICU that babies are not ready to feed by mouth for the first while for various reasons depending on their condition. In this case, your baby will receive all of the nutrition they need via an IV. This total parenteral nutrition is called TPN and is made up of sugar, electrolytes, vitamins and the fats your baby needs to grow. It is made especially for your baby based on their blood values.

If your baby is ready to receive small amounts of breast milk or formula, this will be offered by a nasogastric tube (NG). The NG tube is inserted in their nose or mouth, travels down their esophagus to their stomach and can deliver milk. If your baby has no issues breathing and is showing signs that they are ready to bottle, breastfeed or chestfeed, they will be allowed to try feeding by mouth. Sometimes it takes a few tries for them to learn how to feed by mouth and build enough energy to get through an entire feed. We often use a feeding tube to give any remaining milk they were unable to take by mouth.

As much as possible, we encourage all parents to provide kangaroo care which involves uninterrupted time for either parent to hold your baby skin to skin. Your baby will be in just a diaper and rest on your bare chest. 

We recommend that you make sure you’ve had something to eat and drink and gone to the bathroom prior to holding your baby. This will help make sure you are available for at least 60 minutes but kangaroo care can last several hours if you’re able. It can take some time after transferring to your skin before your baby really settles in and it is best to minimize disruption. This time is so precious with your baby and we advise you to soak it all in and not pick up your phone and maintain skin to skin contact with your baby for as long as possible.

Benefit of Kangaroo Care for babies

Skin-to-skin or kangaroo care has been shown to have many benefits for your baby. It helps them:

• Regulate their breathing, heart rate and temperature 
• Prepare them for breastfeeding or chestfeeding
• Manage pain during painful procedures
• Decrease crying and stress

Studies show when you and your baby are skin to skin in the same environment, you produce antibodies to microorganisms in this environment which. These antibodies appear in your breast milk within a few hours and the immunity is passed on to your baby. It also is shown to help with sleep and brain development

Benefits of Kangaroo Care for parents:

• decreases parental stress
• helps you gain confidence in caring for your baby
• is an opportunity to bond with your baby
• improves milk production and eases the transition to breastfeeding or chestfeeding
• decreases risk of postpartum depression

Modified Kangaroo Care

If your baby’s condition prevents them from being held, there are modified forms of kangaroo care you can provide.

Finger Holding – your baby can hold your finger as a comfort measure

You may choose to bring in some blankets, facecloths, or clothes for your baby. Make sure items are washed in a scent-free detergent prior to bringing them in. Your home should be smoke-free before your baby’s arrival as the scent of smoke can cause them difficulty breathing. Make sure your items are labeled with their name (usually on a tag). While we try our best to keep things clean, babies are messy beings. Blankets will frequently be soiled and have to be brought home to be laundered. Just in case, do not bring items that are very precious to you or you would not like to be lost or accidentally damaged.

Your journey in the NICU with your baby is unique. Thanks to the CHEO Foundation, we have created a bravery beads program. In the parent area of the NICU you will find colourful beads that each have a special meaning. You can create a representation of your baby’s journey in the NICU by collecting a special bead for each test, procedure or occasion they go through. Each one has a meaning and this collection you create will be a testament to their story for years to come.

As your baby’s health improves, they may not need NICU care any longer. If they are not requiring the specialty care of our NICU, there are times when it is appropriate to send them back to their birth hospital or transition to another unit at CHEO before they’re ready for home. While the care may look different in different areas, know that this is a positive move towards the goal of you bringing your baby home. This will give you the opportunity to become even more involved in your baby’s everyday care.

What you can do to ease this transition?

Get involved in your baby’s care early on. While you are in the NICU, try to learn as much as you can to become the expert in your baby’s care. If your next step is the inpatient wards at CHEO, parents are expected to stay with their baby. Most parents who have had their baby home already want to stay and are used to caring for their child. This parent-led care model can be a big change for parents of babies who have been in the NICU but this is progress towards going home! Learning how to lead your baby’s care early on will help.

Ask for help! Child Life is there to improve your child’s experience. They can help coordinate volunteers to cuddle your baby when you need a break. Social Workers are there to support you and help you navigate the health care system. Spiritual Support are there to listen and help you through difficult times. Patient Experience is there to respond to questions or concerns you may have about your time at the hospital.

If it is determined that your baby cannot eat for more than a few days, we will add in extra nutrition that includes all of the vitamins, proteins and fats they need to grow and thrive. This intravenous (IV) nutrition is called Total Parenteral Nutrition or TPN. Your baby’s TPN is prepared every day and adjusted to your baby’s specific nutrition needs based on their blood values. They will have regular blood work drawn to make sure they’re getting the right amount of everything they need. We will often make adjustments in the rate of TPN as we try giving your baby more of your milk by mouth or through a feeding tube.

When a baby is ready to start receiving milk, there may be several reasons why we need to start with a tube or bottle feed. Premature babies start to develop a stronger suck and coordinate with their swallow around 32-34 weeks gestational age. Some full term babies may not be able to feed by mouth if they have breathing, neurological, digestive or other issues. If your baby’s breathing or suck prevents them from being able to take their feed by mouth, we will insert a nasogastric (NG) tube in their nose that will deliver the food directly to their stomach. This allows your baby to safely receive milk without the risk of choking (aspiration). Tube feeding allows them to save their energy for growth and development.

After not feeding for some time, your baby will start with a small amount of breast milk or formula. This small amount of milk that is meant to get your baby’s digestive tract used to the idea of feeding is called a trophic feed. When your baby is tolerating trophic feeds we will slowly increase the amount of milk they receive.

Your human milk is designed to give your baby everything they need. Mothers of premature babies produce milk with a different makeup than those of full term babies. It has more calories and a different nutritional makeup that changes as your baby grows. When your baby is old enough and healthy to feed on their own, they will begin showing signs of readiness to feed. Opening their mouth, rooting and showing a strong suck are all some of the signs they’re ready to start feeding. Even for full-term, healthy babies this sometimes takes a bit of practice, patience and learning for both mother and baby. Your baby’s nurse can share  tips to help you succeed.

For more information on breastfeeding or chestfeeding, please visit our CHEO breastfeeding and chestfeeding resource page

For parents who are choosing to breastfeed, expressed milk is the best gift you can give your baby until they are ready to go to the breast. It contains so many nutrients and protective properties for their bowel and immune system. It’s no secret that expressing your milk is a lot of work. Even if only for the first few feeds, mother’s milk is proven to provide your baby with lifelong benefits.

We have a double pump for you to use, available at your baby’s bedside. We provide you with one kit that you will be responsible for caring for throughout your stay in the NICU. There is also a lactation room in the Ronald McDonald Family Lounge where you can find a dishwasher to sterilize your kit once a day. In between you will be provided with a bowl and dish soap to wash and air dry your kit at the bedside.

After delivery, the hormone prolactin which helps you produce milk increases. You need to stimulate the breast tissue to encourage milk production. Early breast massage or hand expressing is the best and easiest way to remove this early milk called colostrum. We encourage you to express your milk every 2-3 hours. It may be helpful to set an alarm to keep you on track. During the first few days or weeks it will be necessary to pump through the night as prolactin levels are highest between 02:00-04:00 in the morning. You can find more information on pumping and milk production here.

We recognize that it is a balancing act between sleep, nutrition, your pumping schedule and all of your demands. While you may have never considered pumping when you envisioned taking care of your newborn, keep in mind it is hopefully one step towards breastfeeding or chestfeeding your baby one day soon. 

A Pumping log that may be helpful for you to track the times and amount you pump each session. You may be able to notice trends such as whether your supply increases or decreases based on stress, nutrition, when you spend time near your baby or frequency of pumping.

There are many advantages to expressing milk by hand and it may even be the best way to express colostrum during the early days. Colostrum is particularly thick, rich and nutritious for your baby, but the thick milk can be difficult to extract using an electric pump. Hand expression really helps you get deep into the tissues to help stimulate production and clear the ducts. 

Here is a short video from BC Women's Hospital that explains the technique.

To know when your baby is ready to feed, we will look for cues they are ready to feed. When the medical team has cleared your baby to feed, we will look for signs they are ready to feed such as sucking, rooting or opening their mouth, licking, or bringing their hands to their mouth. If your baby is sleepy, there are some ways of gently waking them. It might be necessary to try timing feeds with moments when they are already awake and keen to feed. With time, they will feel more hungry and be keen to feed. 

If your baby is not feeding by mouth yet, it is important to create positive oral experiences for them. Providing opportunities for non-nutritive sucking such as a pacifier or soother, allowing them to nuzzle at the breast, or sucking on a clean, upside down finger in their mouth to soothe all help create a positive oral experience for your baby. You can also gently stroke their cheek and speak to them when they are happy. Providing a drop of breast milk on their tongue, called Oral Immune Therapy and may be a positive oral experience that also allows them to smell and taste your breast milk while also providing them with antibodies from your milk.

Whichever type of nutrition your baby is receiving, their growth will be closely monitored. We measure their weight daily if possible. The doctors, dietician and nurses will make adjustments to their feed if needed. Premature babies or those with a cardiac condition may require extra calories or nutrients added to their milk.

Sometimes babies require additional nutrition to grow and thrive. There are two types of fortifiers that could be added to your breastmilk; one is made from cow’s milk and the other is made from human milk. Be sure to speak to your baby’s neonatologist and dietitian to understand all of the options and what is best for your baby. You can find more information on breastmilk fortifiers from PreemieWorld here.

There are strict criteria for those who qualify to donate and all milk is collected under strict conditions and stored in a human milk bank. It is then pasteurized to remove any potential germs, yet still contains all of the benefits of breastmilk. This is a similar process that happens with cow’s milk that you buy in the grocery store. 

We do not allow for milk sharing or wet nursing in the NICU. 

If you have excess milk supply and are interested in donating breastmilk for premature and critically ill infants in our province, you can find out more information on Milk Bank Ontario's website.