"Can I Actually Do This?" — What Parents Feel on the Day a Premature Baby Comes Home

A study of 409 parents leaving a newborn intensive care unit found that good teaching helps partly by changing what parents believe about their own influence

Researchers asked 409 parents of premature babies, on the very day their baby was discharged from a newborn intensive care unit, how good the hospital's teaching had been and how ready they felt to care for their child [1]. Parents who rated the teaching more highly did feel more capable — and part of that link, about 15%, ran through something unexpected: how strongly those parents believed their own actions could shape their baby's health.

The Problem Behind the Research

There is a particular kind of quiet that families describe on the drive home from a neonatal intensive care unit, or NICU — the hospital ward for newborns who need close monitoring. For weeks or months, a team of nurses and doctors has been watching every breath, every feed, every change in colour. Then the doors close and it is just the parents and a baby who is smaller and more fragile than the babies in the parenting books.

For a long time, the medical answer to that moment was information. Hospitals built discharge checklists: how to feed, which medicines, when the follow-up appointment is, what the danger signs look like. This was a real improvement over the informal advice that came before it, and it was built on genuine need. Premature babies do run into trouble after they go home — among even relatively healthy babies born a few weeks early, unplanned returns to hospital in the first month are common enough that hospitals track the rate as a measure of how well they are doing [2]. And for the smallest babies, how things go in those early weeks and months feeds into their development for years afterwards [3].

But when researchers actually sat down and listened to parents leaving the NICU, the checklist did not describe what they heard. Interview studies found parents who could recite the instructions perfectly and still felt they had no business being in charge [4]. What they were short of was not facts. It was the sense that they were allowed to act, and that acting would make a difference.

Meanwhile, the science of discharge teaching had become quite precise about measuring the teaching itself. Researchers developed questionnaires that separate out what information parents needed, what they actually received, and how well it was delivered — and showed that these things predict how ready parents feel and how they fare once home [5]. What nobody had pinned down was the middle step. Good teaching helps. But how?

What the Researchers Did

A team at a large teaching hospital in Linyi, in Shandong Province, China, tried to answer that [1]. Between May and October 2025, they approached parents whose premature babies were about to be discharged from the hospital's NICU. Three or four hours before going home, each parent filled in three questionnaires on paper. The parent surveyed was whoever would be mainly responsible for the baby at home. In the end 409 parents completed valid questionnaires — 203 fathers and 206 mothers — an unusually high response rate of about 95%.

The first questionnaire asked parents to rate the discharge teaching they had received, scored out of 180. The second measured a psychological trait with a slightly forbidding name: internal locus of control. Stripped of jargon, it is the extent to which a person believes that what happens to them follows from what they themselves do, rather than from luck, fate, or other people's decisions. The idea goes back to psychologist Julian Rotter in the 1960s [6], and the specific eight-question version used here was developed a decade later [7]. The third questionnaire measured caregiving competence out of 172, across three parts: what parents knew, what they could do, and their attitude toward caring for their baby.

Then came the analytical step. Rather than only asking whether good teaching and confident parents go together, the researchers asked whether the connection between them runs partly through that sense of personal control. This kind of question — does A affect C partly by way of B? — is called a mediation analysis. The framework they used comes from nursing theory that treats leaving hospital not as an event but as a transition into a new role, one that support can either smooth or fail to smooth [8].

One thing to hold onto: this was a snapshot, taken at a single moment. It was not an experiment. That matters for how much weight the findings can carry, and we return to it below.

What They Found

The average caregiving competence score was about 121 out of 172 — solidly middling, with plenty of headroom. But the breakdown is the part worth sitting with. Of the three components, attitude scored highest, practical ability came next, and knowledge came last. In plain terms: these parents wanted to do well and were largely willing. What they were missing was specific know-how about premature babies.

That should be reassuring to any parent who feels overwhelmed, because it locates the problem outside of them. It is not a deficit of love or determination. It is a gap in information that a hospital can close.

The second finding is equally striking, and it goes against intuition. The things that predicted how prepared a parent felt were all facts about the parent: whether they had raised a child before (first-time parents scored about 110, experienced parents about 126), their level of education, their job, their household finances, and whether they were the mother or the father. Nothing about the baby made a measurable difference — not how early the baby was born, not the birth weight, not how long the NICU stay had been, not how sick the baby had been at birth. Parents of a very premature baby were, on average, no less prepared than parents of a baby born a few weeks early.

As for the central question: parents who rated the teaching more highly did score higher on competence, and the researchers were able to split that connection into two parts. About 85% of it was direct — consistent with parents simply having learned more. The remaining 15% ran through internal locus of control: better teaching went along with a stronger sense that one's own actions matter, which in turn went along with greater competence. The statistical test the researchers used, repeated across 5,000 resamples of the data, confirmed that this 15% slice was unlikely to be a fluke.

What This Means for Families

The most useful takeaway is not about statistics at all. It is that feeling capable is part of being capable, and it can be built deliberately. If you are a parent preparing to take a premature baby home, that gives you some concrete things to ask for.

Ask to do the care yourself, under supervision, before discharge day — not to be shown, but to actually do it while a nurse watches. Feeding, bathing, medicines, temperature-taking. Ask staff to watch you and tell you what you did right, specifically. Practising the task and hearing that you did it correctly is precisely the experience that builds the sense of control this study measured. There is also good trial evidence that structured, family-focused support around discharge improves both how babies grow and how competent parents feel [9], so asking for a structured programme rather than an ad hoc chat is reasonable.

Ask staff to explain things back-to-front: instead of listening to instructions, tell them what you plan to do and let them correct you. Nurses call this "teach-back", and it surfaces the gaps that nodding along conceals. Interview studies with mothers of premature babies describe exactly this kind of hands-on, supported rehearsal as the thing that turned instruction into genuine confidence [10].

If you are a first-time parent, or the father who will be the main caregiver, know that the data put you in the group that tends to arrive at discharge day less prepared — and that this is a reason to ask for more teaching time, not a judgement about you. Parents' sense of competence around discharge sits at moderate levels quite generally [11]; you are not unusual.

One important caution, and the researchers would endorse it. Believing your actions matter is helpful. Believing you are solely responsible is not. Premature babies get readmitted, catch infections, and have setbacks for reasons that have nothing to do with their parents. Anxiety after a birth is common and can itself get in the way of the relationship with your baby [12]. Confidence should mean "I can handle this and I know when to call", not "any problem is my fault".

What This Study Cannot Tell Us

Because everything was measured at one moment, the study cannot prove that better teaching causes parents to feel more capable. It is also possible that parents who already felt confident simply rated their teaching more generously. And it was done at a single hospital in one Chinese province, among two-parent families where both parents were involved in care — so it does not speak to single parents, or to the many families where a grandparent is the main caregiver. The finding that mothers scored higher than fathers probably says more about who does most of the daily baby care in that community than about mothers and fathers anywhere.

What Researchers Are Working On Next

The natural next step is a proper experiment: give some families the usual discharge teaching and others teaching deliberately designed to build confidence and a sense of agency, then follow both groups for a few months to see whether the second group's babies do better — fewer readmissions, fewer emergency visits. That would turn what this study observed into something a hospital could act on with confidence. Researchers are also looking at other things that might sit in the middle of the chain, such as anxiety, and at whether the picture looks the same in families the study excluded.

For now, the practical message is modest but real. Discharge teaching is not just an information transfer. It is also the moment when a hospital either does or does not hand a parent the belief that they are the right person for the job. Asking for that, out loud, is a fair thing to do.

References

  1. Gong J, Tian F, Chi Q, Li A, Li J, Hu Q. Association between discharge teaching quality and caregiving competence among parents of preterm infants at NICU discharge: the mediating role of internal locus of control. Frontiers in Pediatrics. 2026;14:1826901. doi:10.3389/fped.2026.1826901 ↩
  2. Amsalu R, Oltman SP, Baer RJ, Medvedev MM, Rogers EE, Jelliffe-Pawlowski L. Incidence, risk factors, and reasons for 30-day hospital readmission among healthy late preterm infants. Hospital Pediatrics. 2022;12(7):639–649. doi:10.1542/hpeds.2021-006215 ↩
  3. Consales A, Porro M, Gangi S, et al. In-hospital growth and long-term neurodevelopmental outcomes of very low birth weight infants. Frontiers in Pediatrics. 2023;11:1180068. doi:10.3389/fped.2023.1180068 ↩
  4. Ma RH, Zhang Q, Ni ZH, Lv HT. Transitional care experiences of caregivers of preterm infants hospitalized in a neonatal intensive care unit: a qualitative descriptive study. Nursing Open. 2021;8(6):3484–3494. doi:10.1002/nop2.899 ↩
  5. Weiss ME, Sawin KJ, Gralton K, et al. Discharge teaching, readiness for discharge, and post-discharge outcomes in parents of hospitalized children. Journal of Pediatric Nursing. 2017;34:58–64. doi:10.1016/j.pedn.2016.12.021 ↩
  6. Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs. 1966;80:1–28. doi:10.1037/h0092976 ↩
  7. Levenson H, Mahler I. Attitudes toward others and components of internal-external locus of control. Psychological Reports. 1975;36(1):209–210. doi:10.2466/pr0.1975.36.1.209 ↩
  8. Meleis AI, Sawyer LM, Im E-O, Hilfinger Messias DAK, Schumacher K. Experiencing transitions: an emerging middle-range theory. ANS Advances in Nursing Science. 2000;23(1):12–28. doi:10.1097/00012272-200009000-00006 ↩
  9. Huang L, Zhao BY, Li XT, et al. Effects of an online family-focused parenting support intervention on preterm infants' physical development and parents' sense of competence and care ability: a randomized controlled trial. International Journal of Nursing Studies. 2024;149:104625. doi:10.1016/j.ijnurstu.2023.104625 ↩
  10. Tajalli S, Parvizy S, Ebadi A, Zamaniashtiani F, Kenner C. Understanding the experience of the mothers' ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis. BMC Pediatrics. 2025;25(1):72. doi:10.1186/s12887-024-05338-1 ↩
  11. Huang L, Wang X, Liu G, Li X, Zhang Y, Zhao B, et al. Parenting sense of competence among Chinese parents of premature infants: a cross-sectional study. BMC Pregnancy and Childbirth. 2023;23(1):399. doi:10.1186/s12884-023-05703-5 ↩
  12. Field T. Postnatal anxiety prevalence, predictors and effects on development: a narrative review. Infant Behavior and Development. 2018;51:24–32. doi:10.1016/j.infbeh.2018.02.005 ↩