Look in any baby book, or on any parenting website, and you’ll find a milestone calendar – a list of developmental goals, both cognitive and physical, and the approximate age at which your baby should achieve them.
But what if your baby was born premature? Is he or she still expected to achieve milestones at the same age as babies that are full-term? No – at least, not for the first couple of years. Full-term babies (any baby delivered after 37 weeks) have had more time to develop in the womb, and those last few weeks or months in utero make them much more physically prepared to hit milestones on schedule.
“Preemies essentially have two birthdays,” says Marianne Bracht, a parent resource nurse in the neonatal unit at Mt. Sinai Hospital in Toronto. “Their due date, and the actual date that they were born. Everything – growth, intake, developmental and social milestones – should be calculated from the due date. With one exception: immunizations, which should be administered on schedule from the baby’s birth date.”
For example, if a full-term baby is expected to crawl at around eight months, a baby who was eight weeks premature would be expected to reach that milestone around 10 months. Many pediatricians believe that a preemie’s “adjusted age” may be better for predicting motor-related milestones than cognitive ones – premature babies tend to be less delayed in cognitive milestones, such as babbling and talking.
Of course, there is always a range of “normal” when it comes to development, and genetics and a baby’s level of attention and stimulation play a huge role as well. If mom is petite in stature, her baby will likely fall on the smaller end of the scale as well. “Babies who live in their car seats, exersaucers and jolly jumpers, instead of on the floor, can be delayed developmentally,” says Marianne. “And with the Back to Sleep campaign (which promotes laying babies to sleep on their backs), babies in general are spending less time on their stomachs. Tummy time and floor time is even more important for preemies than full-term babies.”
Preemies usually have more after birth care – more regular checkups, developmental assessments and tests – than their full-term counterparts. “It’s also very important for preemies to be referred to early-intervention programs,” says Marianne (for more, see sidebar.) “These parents need to really advocate for their infants, and ask questions about what they can do once the baby comes home, and about what is available in their community.” Not that they need convincing – Marianne says parents of preemies tend to be extra vigilant in keeping on top of their baby’s health and development. “They leave the hospital with so much information, they are so prepared.”
When can parents stop thinking in terms of their baby’s “adjusted age”? Somewhere between age two and three, says Marianne, although some very small babies may take a bit longer to catch up. After that, differences in size or development are likely due more to your baby’s genetic make-up than being born prematurely.
Early Intervention Programs
Premature babies can reap huge developmental benefits from various types of therapy after they come home from the hospital, and in the following months and years. Your child’s doctor can provide more information, and determine whether your baby should undergo a developmental evaluation.
Physical therapy helps develop your baby’s gross motor skills and muscle tone. It encourages increased range of motion and new and better ways to move.
Speech therapy helps the functioning of your baby’s lips, mouth and tongue. It can help older babies and children with vocalization and talking, and younger ones with feeding difficulties, which are common among preemies.
Occupational therapy helps your child with many of the basic activities of everyday life, from playing to socializing. An occupational therapist may help work on anything from your child’s fine motor skills to how to better process sensory information like light and sound.
