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Premature baby development: common concerns

0-8 years

Most premature babies have normal development. Extremely premature, low birth weight and sick babies have a higher risk of development problems – but even in these cases, many babies develop normally.

Corrected age and concerns about development

It’s always important to keep a careful eye on your premature child’s development. But it’s also worth remembering that there’s a big range of ‘normal’ when it comes to development.

Also, corrected age can be very useful if you’re worried about your child’s development. For example, if your child is one year old but was born three months early, her corrected age is only nine months. That means you’re best to compare her to babies aged nine months, rather than one year.

But if you take corrected age into account and you’re still worried about your child’s development, speak to your GP or paediatrician.

After you leave hospital, your premature baby will need to have regular health and development checks. You can have these checks with doctors at your hospital’s outpatient clinic. Or you might choose to register with a private paediatrician – ideally one who has experience with premature babies – soon after your baby leaves hospital.

Language development in premature babies

Children learn language at different rates. The majority of premature babies develop normal language, but their language development is often, but not always, delayed.

Smaller and more premature babies are at greater risk than late preterm babies. Compared with full-term children, on average very premature school children have more trouble saying things and understanding what is said to them. Late preterm children can also have language delays.

But this doesn’t mean that every child who was born early will have a language problem. Some will, but others will have excellent language development.

And you can help your child learn language by making sure your home environment is full of talking and listening. Reading to your child and singing will help too.

If your child does have a language delay, the earlier you pick it up and get started with early intervention, the better.

Language problems can also sometimes be an early sign of hearing or cognitive problems. Contact your GP or your child’s paediatrician if you have any concerns. If the paediatrician is concerned about your child’s language development, one of the first steps is to have your child’s hearing checked.

Find out more about your baby’s language development, as well as language delay and speech disorders.

Physical development in premature babies

The majority of premature babies have normal physical and motor development.

Prematurely born children do tend to be shorter and lighter than full-term peers. If these babies were very sick, it can sometimes affect their growth up until at least 12 years old. But others catch up during the preschool and school years.

Motor problems
Physical and motor problems are more likely with very preterm and low birth weight babies.

Medical staff will check for early signs of physical movement and body control problems – for example, differences in muscle tone on different sides of your child’s body – while your baby is still in the neonatal intensive care unit (NICU). Referrals for early intervention are often based on these examinations.

After your premature baby goes home, you can have his physical development checked by a physiotherapist or a paediatrician, and compared with corrected age development.

About 40% of very premature children have mild motor impairments. These include problems with:

  • fine motor skills – for example, putting puzzle shapes together or holding a pencil
  • motor planning – for example, understanding, planning and doing something like walking around fallen blocks
  • visuomotor coordination – for example, writing and drawing
  • sensorimotor skills – for example, feeling the weight of a full glass and picking it up without spilling the contents.

About 10-15% of preterm babies have major motor impairment, which is often known as cerebral palsy.

The risk of cerebral palsy is higher with very preterm babies whose brains haven’t fully developed (up to 45% of cases of cerebral palsy happen this way). About 10-15% of very premature babies have cerebral palsy. Babies who are very sick in the NICU also have a higher risk of cerebral palsy.

Getting a clear diagnosis of cerebral palsy before 12 months isn’t always easy. This is because a diagnosis considers developmental skills like sitting up, crawling and walking.

Teeth
Premature babies are more likely to have dental problems than full-term babies. Smaller and sicker babies are most likely to have problems. This might be because they were sick, because they had a breathing tube pressed against the roof of their mouth, or because they didn’t get as much calcium and phosphorus as a baby in the womb.

Teeth problems can include the following:

  • Abnormal tooth enamel (the white outer covering of a tooth): the tooth might look grey or brownish, or have an uneven surface. Cavities can form more easily in teeth with poor enamel. Brushing teeth regularly helps. If your child doesn’t like having things put in her mouth, an occupational therapist or speech therapist can help.
  • Late teeth: premature babies’ teeth often come a few months later than full-term children’s teeth, but they’ll still come in the usual order.
  • A high arch or groove in the roof of the mouth: this can have an impact on speech and bite. Most children adapt to the shape of the roof of their mouth, but others might need braces later.

It’s a good idea to visit a paediatric dentist who understands how premature babies’ teeth develop. Ideally visit the dentist by the time your child is one year old, so that from the early days the dentist can monitor your child’s dental progress.

Sensory development in premature babies

The majority of premature babies have normal sensory development. But premature babies are more likely than full-term babies to have hearing or visual impairments.

Some parents say that their preterm children have sensory sensitivities, like heightened awareness or sensitivity to some sensory stimuli like noise or certain fabrics. Some research backs this up.

Some premature babies don’t like having things put in their mouths and can have trouble feeding. And premature babies can have a lower pain threshold than full-term babies.

Hearing
Children who were born prematurely are more likely to have hearing impairment than full-term children.

But this is still only about 2-6% of premature babies, and it’s more common in very preterm babies. Even fewer children have severe hearing problems in both ears that need hearing aids or cochlear implants. 

Most babies have their first hearing screening test while they’re still in hospital. This picks up most hearing problems, but some are diagnosed later on. It’s important to diagnose and deal with hearing impairment, because children need to hear properly to develop language, social and communication skills.

Vision
Children who are born prematurely are also more likely than full-term children to have vision impairment.

Premature babies are more likely than full-term babies to develop mild visual problems like short-sightedness or long-sightednesssquint, contrast sensitivity, or problems with depth perception.

Only 1-12% of premature babies develop severe visual problems, and this is more common in very preterm babies. Most severe visual problems will be picked up very early. Very premature babies have regular eye tests while they’re in hospital, which can lead to early treatment.

Thinking and learning development in premature babies

Right from the start, your child is learning about the world all the time, building thinking skills by experimenting with how things work.

The majority of premature babies have normal thinking and learning (cognitive) development.

Very preterm or extremely low weight babies and those who had a lot of medical complications have a higher risk of thinking problems. A very small proportion of children who were born prematurely will have severe thinking and learning impairment.

Health professionals often use IQ tests to check children’s thinking skills. Average scores for very preterm or very low birth weight children are in the normal range, but they’re also typically slightly lower than the average for full-term children of the same age.

This means that most preterm children can do well at school.

Thinking and learning difficulties
You might not notice any problems until your preterm child goes to school. This is when children need to put their thinking skills together in problem-solving activities. For example, reading involves visual memory, hearing memory and letter recognition. If your child has a weakness in one of these areas, it might interfere with his ability to learn to read. Your child might need some extra support at school.

Children born prematurely can have problems with planning and staying on task (called executive functioning), but a loving, stable, stimulating and safe home environment can help your child improve these skills.

If you have any concerns, speak to your child and family health nurse, kindergarten teacher, GP or paediatrician. If your child does have a development delay in thinking and learning, it’s good to pick it up early. This way you can get started with early intervention.

Social and emotional development in premature babies

Social and emotional development is about learning to recognise and manage feelings, understand how others are feeling, express feelings and interact positively with others.

Being able to manage feelings is important for all areas of development. It helps with paying attention, working towards goals, developing friendships, gaining autonomy and thinking about what’s happening for others.

The majority of premature babies have normal social and emotional development, but they can behave differently from full-term babies.

For example, crying is a baby’s way of communicating that she needs something. Premature babies in the neonatal intensive care unit (NICU) tend not to cry much, except perhaps during painful procedures.

Crying in full-term babies increases over time and usually peaks at 6-10 weeks old, often with more crying in the evening. Healthy premature babies have a similar increase in crying, which peaks at about six weeks corrected age.

In their first year, premature babies are more likely to go to sleep instead of interacting. They might also look away or get cranky. They’re less likely to engage in social interactions than full-term babies.

As your baby matures, this will be less of a concern. You can help by learning to read your premature baby’s body language, which will help you tell when your baby wants to engage and when he wants to stop.

When you respond to your premature baby’s needs, she’ll gradually learn to come out into the social world and communicate more.

Social and emotional problems
If a child has ‘social and emotional problems’, it means the child is having trouble fitting in with his environment, following rules, and being social with other children and adults.

It’s normal for all children to sometimes behave badly, get upset and break the rules.

But children born prematurely are more likely to have difficulty coping with and managing their feelings. They can find it hard to stay calm, eat well and sleep well. Some might experience lower self-esteem or find friendships difficult.

Premature children are more likely than full-term children to have conditions like attention deficit hyperactivity disorder, autism spectrum disorder, anxiety and depression. But these problems are still uncommon in children born prematurely.

Twins, triplets and quadruplets are often born early. If you’re worried about your multiples, it might help to know that outcomes for multiple premature babies are similar to those for single premature babies.

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Last updated or reviewed
12-05-2016

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Raising Children Network is supported by the Australian Government. Member organisations are the Parenting Research Centre and the Murdoch Childrens Research Institute with The Royal Children’s Hospital Centre for Community Child Health.

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