Updated April 2014, next review April 2017

Taking your premature baby home from hospital

Growth and development after prematurity

Premature birth can affect the way your child develops. Early intervention is important, so assessments from your healthcare team are crucial in ensuring that your baby gets the right care.

Watching your child develop can be one of the most fascinating aspects of parenthood. As your baby's brain and body grow and their pathways gradually connect up, babies learn to smile, then crawl, walk, speak - and develop many other skills along the way. If you're concerned that your baby may have health problems, the excitement you feel as you watch him develop may be mixed with worry.

Factors influencing your child's development

Premature birth can affect the way your child develops, and the earlier your child was born, the higher the risks, so you need to keep an eye out for any area where you think there could be a delay. However, it's all about striking a balance: every child develops in their own unique way, and your baby's development will depend on a range of factors, including his genetic make-up, and the environment and influences around him.

How their time in hospital can affect premature babies

There can be some delays in the development of motor skills among premature babies, partly due to treatments when they are small, such as being on a ventilator, although growing awareness of positioning techniques is helping to reduce this. If a baby's experiences in the unit prevent him from developing appropriate muscle tone, this can have a knock-on effect. For example, if he achieves sitting latter than expected, this in turn can delay subsequent skills, such as hand function. It appears to be becoming less common among babies with a birthweight of 1 to 1.5kg.

Prematurity and growth

Premature babies start small, and although they do tend to catch up as they get older, children born very prematurely still tend to be smaller and lighter than their classmates. However, as our knowledge of nutrition continues to develop, and with extra supplements available to support premature babies' dietary needs, this may change.

As premature babies develop through childhood and adulthood, it becomes harder to know which of their traits and characteristics are a result of premature birth rather than other factors.

As your child was born prematurely, he will be considered in a high risk group for developmental problems and he is likely to have more assessments of his progress than a term baby would. This is because early detection and diagnosis of any potential problems is key to prevention. Many low-birthweight babies and their families are invited to attend follow-up or neurodevelopmental clinics so that the healthcare team can assess the baby's progress and intervene early where treatment is needed. Where possible specialty services will be co-ordinated so that you do not have to attend many appointments. Follow-up visits will also be scheduled during the first years of his life.

As well as looking at how your baby is developing, the healthcare team will regularly check his weight, head circumference and height (also known as length) to make sure he is growing as expected.

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Understanding your baby's growth chart

You will be given a Personal Child Health Record, or 'red book', which has growth charts to help plot your baby's growth and compare it with the average growth for his age. Babies born at less than 32 weeks are plotted in the low-birthweight chart. Babies born at 32-37 weeks are plotted in the preterm chart until two weeks after their estimated due date and from then on are plotted in the main charts, but with their gestationally corrected age.

How centile charts work

Babies' progress is described in measurements that are called centiles because they relate to average percentages. The curves on the chart show the usual progression for a baby, as a baby's weight will normally increase and level off at certain ages. So, for example, if your baby's height is in the fifth centile for his age, that means that if you lined up 100 children in order of height, your child would be at number five, with a child at the 100th centile being the tallest. There are separate charts for girls and boys, as boys tend to be heavier.

The centiles for weight and height should usually be similar - if they are very different from each other, this may indicate that your baby is overweight or underweight, and your team may need to adjust the feeding regime.

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Developmental milestones

Rather than 'targets' to be measured, it's more helpful to view milestones as signals that some premature babies might need extra help. Throughout your child's early life, the healthcare team will observe his development and measure his progress against milestones. These are usually carefully worked out targets based on the average age at which children tend to develop certain skills. For example, 8-18 months is the average age when a child will start trying to walk on his own. The milestones have been designed to help professionals spot problems early.

Early babies are given time to catch up

If your baby is born prematurely, his milestones will be assessed from the time of his due date, not from when he was actually born. By the age of two, his development will often even out with his peers, and you can use his actual birth date instead. In very premature babies, sometimes this is extended to three years of age.

Making progress, step by step

Going back to our example of the walking milestone, if your child doesn't start walking at 10-18 months, this does not necessarily indicate a problem, and your child may well catch up later on. The healthcare team will flag it up anyway, and may refer you to a specialist, as in some cases it could be a sign that he could need some treatment or therapy to support his development.

To read more about potential disabilities or health problems after a premature birth, click here.

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Using milestones to your advantage

You can use milestones to your advantage in three ways:

  • to encourage your baby's development. For example, if you know that babies can start to roll over from about two months of age, you might notice him trying to flip himself over and might give him a helping hand
  • to keep your baby safe. You will be less likely to leave your baby lying on a sofa if you know there is a chance he could roll and fall off
  • to spot whether your little one could be falling behind. If there may be a problem in a particular area, you can seek advice more quickly.

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Try to avoid comparing your child to others

It's easy to become very focused on comparing your child with other children. Some parents find themselves thinking of milestones as 'targets' that indicate the success or failure of their child. Instead, try to see them as signals that can open doors for you if help is needed. Missing a milestone doesn't necessarily mean that there's any kind of problem.

To read more about potential disabilities or health problems after a premature birth, click here.

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The following organisations can give you more information about the topics covered in this section.


Sources

BMJ Best Practice (2011) Premature newborn care, follow up, recommendations, http://bestpractice.bmj.com/best-practice/monograph/671/follow-up/recommendations.html

DH (accessed Sept 2011) National Service Framework for Children, Young People and Maternity Services: Standard 8, 4, http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4869232

Jane E Norman, Ian A Greer (2005) Preterm labour: managing risk in clinical practice, Cambridge University Press, p126

NHS Choices (accessed Sept 2011) Health A-Z, Birth to five, Health and development, Height and weight, http://www.nhs.uk/Planners/birthtofive/Pages/Yourchildsweightandheight.aspx

Rennie JA (2005) Roberton’s Textbook of Neonatology (4th edition), London, Churchill Livingstone

UK/WHO (2009) Plotting preterm infants, Growth Charts - Fact Sheet 5, Royal College of Paediatrics and Child Health

Vaivre-Douret L, et al (2004) Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants, 'European Journal of Paediatric Neurology' Vol 8, No 1, p21-34

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On this page


Factors influencing your child's development

How their time in hospital can affect premature babies

Prematurity and growth

Understanding your baby's growth chart

Developmental milestones

Using milestones to your advantage

Try to avoid comparing your child to others



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Feedback on health information

TIP

As the parent, you may notice a developmental delay before anyone else does. If you strongly feel that something is wrong, be persistent in asking for help.

'If you have a premature baby it can be really hard spending time with term babies because everything takes your child that much longer. Lots of people didn't "get it" - they had expectations of what a baby should be doing. I felt like I had to explain my whole story every time I spoke to a different person, even though I was still traumatised. In highsight, I wonder if I should have just pretended he was younger than he actually was.'

JESSICA

 

DID YOU KNOW?

The team will measure your baby's development in a range of areas, including physical, social, emotional, cognitive, sight and hearing.

'The other babies we knew were sitting up at a year. She walked when she was 20 months, but really she was much younger because she was born so prematurely. If became very important to me that her development was acceptable and within the right timeline.'

DEBBIE

DID YOU KNOW?

If your child is having difficulty with his development, then getting therapy or treatment very early on (known as 'early intervention') can often make a big difference.

'Sometimes his friends are developmentally more advanced, and I think: "Come on John, catch up!" There are things he should be doing, but you learn to deal with it.'

EMILY