IS MY PREEMIE BABY GROWING ON TIME?

Was your baby born before his due date of 37 weeks of gestation? Did your baby weigh less than the expected weight at birth? As a premature infant, your child may have battled medical challenges at birth and stayed at the Nursery Intensive Care Unit (NICU) for some time. Having been cleared for discharge by his/her health care provider, you are now on guard for your preemie’s growth and development.

Will my preemie baby be able to catch up with other babies born on time? Keep in mind that babies develop at their own speed and in their own way.¹ Most premature babies, as long as they weren't born too early and have no other health problems, catch up well.²

To understand the developmental timeline of your preemie baby, first to consider is how early your baby is born.  There are four classifications of prematurity.³

They are as follows:

• Late premature babies: born between 34 and 36 to 37 weeks
• Moderately premature: born between 32 and 34 weeks
• Very premature: born between 28 and 32 weeks
• Extremely premature: born at 28 weeks of pregnancy or earlier

The dictum is: the more premature your baby is born, the higher possibilities of complications and disabilities later on in their life. Physical and developmental disabilities may be encountered. In the same vein, there are some premature babies who do not have health issues. They are just born early, small for age, but later on grow up along with kids their age.  

Developmental issues may include:⁴  

• difficulties or delays with gross motor and fine motor skills
• difficulties or delayed speech development
• difficulties with vision or hearing
• learning delays
• cerebral palsy
• autism
• attention deficit hyperactivity disorder (ADHD)

Developmental issues may not be apparent immediately. Some of these appear after infancy or toddler days. Some become noticeable when they become preschoolers.

Second approach is to base your preemie’s growth and development on their adjusted/corrected age and not their actual age.  

HOW TO USE YOUR BABY’S CORRECTED/ADJUSTED AGE

To compute for your baby’s corrected age (based in weeks): ⁵

   Actual Age (in weeks) – Weeks born early = Adjusted Age (in weeks)

To illustrate:

• 2-month-old baby born four weeks early
• 2 months = 8 weeks – 4 weeks = 4 weeks or equal to 1-month-old   adjusted age
• 4-month-old baby born four weeks early
  • 4 months = 16 weeks – 4 weeks =12 weeks or equal to 3-month-old

Using your preemie baby’s adjusted age, as a parent you can now track his development by:

• his height and weight gain
• when he reaches his milestones⁶

By age 2-3, the growth and development of most preterm babies would be at par with other babies his age. ⁷ For those who have developmental concerns, regular checkups with your baby’s primary healthcare provider is strongly recommended so that prompt intervention can be initiated. Your healthcare provider can also plot your baby’s anthropometrics (head circumference, chest circumference, and abdominal circumference), height/length, and weight on the corresponding percentile growth chart.  It usually doesn’t matter where your baby is on the chart, as long as they are growing along their curve.⁸

Your Preemie’s Progress – Developmental Milestones

As a parent, you can keep track of your preemie ‘s development into three major areas:

Social, Motor, and Language. Keep in mind that there is a range normal for these milestones. Each baby follows his own developmental timeline, but eventually catches up with kids his age.

The American Academy of Pediatrics (AAP) has outlined age-specific developmental milestones for premature babies. ⁹ These guidelines are not meant to be absolute. The AAP website provides milestones for premature babies up to school age years.  

Below is a sneak peak of desired milestones at 1 month (4 weeks) up to 6 months (24 weeks):

At 1 month (4 weeks) 

Social

• Looks at parent; follows parent with eyes
• Has self-comforting behaviors, such as bringing hands to mouth
• Starts to become fussy when bored; calms when picked up or spoken to
• Looks briefly at objects

Language

• Makes brief, short vowel sounds
• Alerts to unexpected sound; quiets or turns to parent's voice
• Shows signs of sensitivity to environment (such as excessive crying, tremors, or excessive startles) or need for extra support to handle activities of daily living
• Has different types of cries for hunger and tiredness

Motor

• Moves both arms and both legs together
• Holds chin up when on tummy
• Opens fingers slightly when at rest

At 2 months (8 weeks)

Social

• Smiles responsively
• Makes sounds that show happiness or upset

Language

• Makes short cooing sounds

Motor

• Opens and shuts hands
• Briefly brings hands together
• Lifts head and chest when lying on tummy
• Keeps head steady when held in a sitting position

At 4 months (16 weeks)

Social

• Laughs aloud
• Looks for parent or another caregiver when upset

Language

• Turns to voices
• Makes long cooing sounds

Motor

• Supports self on elbows and wrists when on tummy
• Rolls over from tummy to back
• Keeps hands unfisted
• Plays with fingers near middle of body
• Grasps objects

At 6 months (24 weeks)

Social

• Pats or smiles at own reflection
• Looks when name is called

Language

• Babbles, making sounds such as "da," "ga," "ba," or "ka"

Motor

• Sits briefly without support
• Rolls over from back to tummy
• Passes a toy from one hand to another
• Rakes small objects with 4 fingers to pick them up
• Bangs small objects on surface

Regular visits to your child’s primary healthcare provider would be best for tracking for developmental delays. If present, your healthcare provider can recommend appropriate therapies for your child such as:  

• physical therapy
• occupational therapy
• speech therapy

Having a premature baby with developmental delays and other health issues can be overwhelming for parents. Routine checkups and sometimes, visits to the ER, hospitalizations for some preemies, may be a lot to handle. Having a support group can lighten some of the load of monitoring your preemie’s health, growth, and development. Try to bond with your preemie when he is awake; when he is sound asleep, catch some sleep as well or do some self-care.

Watching your baby’s breathing when he is asleep, watching the smile on his face as he travels to dreamland, taking in the sweet smell of babies --- these are precious moments, intangibles, that you, as a parent should experience and cherish. Keep in mind that as long as there is progress in your child’s development in all aspects, he is all set.