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 them 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.

Your baby's development will depend on a range of factors, including:

  • genetic make-up
  • the environment
  • influences around him. 

Development milestones are based on averages. Not meeting given milestones is not just an issue for pre-term babies. Term babies sometimes do not meet development milestones either.

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 prevents them from developing appropriate muscle tone, this can have a knock-on effect. For example, if they achieve sitting later than expected, this in turn can delay subsequent skills, such as hand function.

Delays appear 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, they will be considered in a high risk group for developmental problems and they are likely to have more assessments of their progress than a term baby would. This is routine, not because there is something wrong or there will be something wrong but because early detection and diagnosis of any potential problems are 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 their life.

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

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 their 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 their 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.

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 their development and measure their 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 their own. The milestones have been designed to help professionals spot problems early. Remember that term babies may not meet development milestones either.

Early babies are given time to catch up

If your baby is born prematurely, their milestones will be assessed from the time of their due date, not from when they were actually born. By the age of two, their development will often even out with their peers, and you can use their 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 they could need some treatment or therapy to support their development.

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 them trying to flip themselves over and you can give them 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 they 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.

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.

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

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

Sources

  1. BMJ Best Practice (accessed Sept 2016) Premature newborn care, follow up, recommendations, http://bestpractice.bmj.com/best-practice/monograph/671/follow-up/recomm...
  2. DH (accessed Sept 2016) National Service Framework for Children, Young People and Maternity Services: Standard 8, 4,http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
  3. Jane E Norman, Ian A Greer (2005) Preterm labour: managing risk in clinical practice, Cambridge University Press, p126
  4. NHS Choices (accessed Sept 2016, Next review due: 09/02/2017) Health A-Z, Birth to five, Health and development, Height and weight, http://www.nhs.uk/Planners/birthtofive/Pages/Yourchildsweightandheight.aspx
  5. Rennie JA (2005) Roberton’s Textbook of Neonatology (4th edition), London, Churchill Livingstone
  6. UK/WHO (2009) Plotting preterm infants, Growth Charts - Fact Sheet 5, Royal College of Paediatrics and Child Health
  7. 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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    Health problems and disability

    Premature babies are more susceptible to certain health problems than term babies, so your healthcare team will take special care when assessing your child's development.

Last reviewed on October 3rd, 2012. Next review date October 3rd, 2016.

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Comments

  • By Anonymous (not verified) on 4 Oct 2017 - 08:32

    hi my twin girls were born at 32 weeks with birth weight of 1750 & 1650
    they are 6 months now healthy but weighing both 5kg should I be worried

  • By Midwife @Tommys on 4 Oct 2017 - 12:02

    Hi Thank you for your comment.

    Premature babies may be a bit smaller to babies that are born at term, but you say that they are healthy and doing well so this is reassuring. If you are concerned about their weight then the best advice would be to see your health visitor. She will be able to weigh them both and see how their growth is doing, if there is anything to be concerned about then the health visitor will be able to help you further. Hope this helps, Take Care, Tommy's Midwives x

  • By Anonymous (not verified) on 17 Sep 2017 - 23:53

    Hi I get birth before two month and my son stay in NICU for 39 days. He born in 31 week. My concern that he does not take my breast so I Pump. Should I be worry that my son will never take my breast? He born with 1.2kg and now he is 2.3 kg and he is two month old now.

  • By Midwife @Tommys on 18 Sep 2017 - 09:34

    Thank you for contacting Tommy's and Congratulations on the birth of your baby!
    Not everyone finds breastfeeding easy. Some babies - and mothers - take to breastfeeding straight away, while for others the experience of expressing or getting the baby to latch on (attach) to the nipple becomes a real struggle.
    If breastfeeding or expressing isn't going well for you, it's very important that you seek advice as soon as possible to help. A sympathetic breastfeeding adviser should be able to help you work out what's going wrong and provide practical solutions, either in person or by phone or email. Many hospitals have excellent breast feeding support staff who are there to help you overcome practical difficulties you may experience.
    If you're struggling with breastfeeding, ring one of these helplines for support and information:
    Association of Breastfeeding Mothers: 08444 122 949
    La Leche League: 0845 120 2918.

  • By Anonymous (not verified) on 12 May 2017 - 07:50

    My precious granddaughter was born at 33 weeks, 3lbs. 6 ozs. and is an ivf baby from egg and sperm donation. We have waited 20 years for her after her mother was wrongly diagnosed with cancer and 19 and made infertile.

    She is developing well and started to walk at 16 months although was very late getting her first teeth. She loves whole milk but is a really fussy eater and feeding her is a real struggle. She now weighs about 21 lbs at 18 months old and is at nursery.

    How much actual food does she need at this age and should she be given supplements because she is a poor eater ? She's so precious and much loved.

  • By Midwife @Tommys on 12 May 2017 - 14:22

    Thank you for your comment. You and your family must be so happy with the birth of your granddaughter after her mothers infertility and then IVF. She sounds like she's growing and developing normally.
    It's quite common for children of this age group to become fussy eaters-they are becoming more mobile and aware of their environment, wanting to play etc. I assume she has no underlying health problems that could be affecting her appetite.
    It is encouraging that she still enjoys her milk and this will provide some of her nutrition. She may prefer to 'graze'-eat lots of small healthy meals or snacks rather than 3 big meals a day.
    I would advise that her mother discusses her fussy eating with her Health Visitor as they are involved with checking her growth and development.
    NHS Choices advise that it's particularly important for picky eaters to have children's vitamin drops until the age of five.

    I have attached a link that may help
    http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/fussy-eaters.aspx

    Hope this helps

    Marianne
    Tommy's Midwife

  • By Anonymous (not verified) on 8 Mar 2017 - 17:43

    My GRANDSON WAS BORN 8 WEEKS EARLY, IT TOOK HIM A WHILE TO CRAWL AND WALK, MY QUESTION IS HE JUST TURNED 3 2 MONTHS AGO AND HE SAYS SOME WORDS, WHEN YOU TELL HIM TO SAY A WORD, SOMETIMES HE WILL AND MOST THE TIME HE WONT, SHOULD WE BE WORRIED.

  • By Midwife @Tommys on 9 Mar 2017 - 10:19

    Hi, If you have concerns about his development it is best to seek advice from your health visitor or GP. Best wishes to you and your grandson.

  • By Anonymous (not verified) on 4 Mar 2017 - 21:51

    Hi my baby was born at 26 weeks, he is now 2yrs and is smart. Im not too worried about his intellectual development because i can see that he is smart but a little slower than others. However he ia very small in height and weight. Kids that are 1yrs ols weigh much more than him im scared that he wont grow so im thinking to take him doctors !!!!!!

  • By Midwife @Tommys on 6 Mar 2017 - 09:25

    If you are concerned, then it is always best to get a medical opinion - either via your GP or Health Visitor.
    Take good care of yourself and your lovely son.

  • By Anonymous (not verified) on 11 Apr 2017 - 14:16

    what is the wieght of ur baby ? I have premature baby she was born at 27 weeks was only one kg.now she is 16 month old but only 6.5 kg .I m so worry about her .

  • By Midwife @Tommys on 11 Apr 2017 - 14:36

    Hi, it would be best to see your health visitor and have your child weighed. They should ideally be following the centile that they were born on and this will have been adjusted for prematurity. If there are concerns about her weight then the health visitor can refer your child for a review.

  • By Anonymous (not verified) on 22 Feb 2017 - 18:18

    Hi my son was born at 23+6w weighed 1lb 3oz

    Today he is 24+6 weeks actual (8+5 adjusted) apart from chronic lung disease you wouldn't know he was a Prem baby

    He's started to smile, coo and started to get the Attachment phase, he's become very clingy and separation anxiety is this normal for this early on, I was told this shouldnt happen yet. Does that mean my son is advanced for now :)

  • By Midwife @Tommys on 23 Feb 2017 - 11:43

    Hi and congratulations on your success. How lovely that he is doing so well. The first few smiles are so special but perhaps especially for those babies that had such difficult beginnings.
    Best wishes

  • By Anonymous (not verified) on 5 Sep 2017 - 16:07

    Hi there, my son was also born at 23 +4 days Wt 1 lbs. he is 6 months corrected. Separation anxiety is very common. Even though your son can't see you properly now but still need your presence. My son was very clingy for 3 months corrected. He used to sleep on me even. Things started getting better from 4 mnths onwards when he started playing and seeing.
    Good luck!!!

  • By Anonymous (not verified) on 8 Feb 2017 - 20:57

    Hi my premature baby is 5 months now and struggling with posture and sitting on his own, he was born at 35 weeks weighing 1,7kg. should I be worried?

  • By Midwife @Tommys on 9 Feb 2017 - 12:06

    Hi, Most term babies are sitting up by 6 months but some still need support with cushions, so it is still early for your baby. If you are concerned about his development though, please contact your health visitor. If you haven't seen her/him recently you can find contact details in your red book.

  • By Anonymous (not verified) on 6 Feb 2017 - 17:31

    My Twins were born @ 35 weeks . They are Now 7 months old. I feel like they are a little behind . they can sit up for a while but some times they need support . They can't crawl at all. They kick there legs and scoot very little . Everything else is great watching them grow . but what can I Do to Help them Crawl and pick up toys

  • By Midwife @Tommys on 7 Feb 2017 - 10:19

    Hello and Congratulations on your twins!
    Every baby develops differently and each reach milestones in their own time. It sounds like your babies are doing well and seem active and interested in things around them. However if you are concerned, I would advise you to speak to your health visitor for support with this, who can advise on what to expect and provide essential support and advice.

  • By Anonymous (not verified) on 15 Jan 2017 - 22:00

    My son was born at 34 weeks. He is now 7 months old and weighs18pounds.and he's breast fed exclusively. He can sit on him own and crawl around a little. He also uses things to help him standing. He picks things up and can hold a cup at his mouth

  • By Anonymous (not verified) on 9 Dec 2016 - 11:04

    My baby was born at 28+1 weighed 1.35kg. Now 11+5 weeks. He does cry though little. He tends to "grunt". He does tend to sleep more than a newborn at term, we're not quite at his EDD. Is his behaviour normal or known with preemies?

  • By Anonymous (not verified) on 22 Jun 2017 - 22:24

    My daughter was born at 28+5 and is now 11 weeks old she has only just started to cry and mainly only does this before a feed and very little she also sleep quite a lot she is my 1st so I havnothing. Compare her to. It was her due date yesterday. Health visitor is happy with her progress s hopefully this is the norm xx

  • By Anonymous (not verified) on 8 Dec 2016 - 17:54

    my 32weeks premature ,,.is just that he's noise have been blockd for 2months and he nurse say they can give him nothing.... ... and im worried wil he get bigger h's alm0st 4m0nths and are so small is it i cnt n0tice that he is growing . . . ..

  • By Midwife @Tommys on 9 Dec 2016 - 10:10

    Hi, your baby should be getting weighed regularly (at least monthly) and this should be being plotted on his growth chart in his red book. Ideally a baby should followed along the centile they were born at however this can vary a little. If his growth is dropping a centile or more then the health professional should talk to you about the feeding and his well being to see if there is any further support needed. If you have not had him weighed for a while then you can access baby weigh in clinics in your area or speak with your health visitor about you concerns. Tommy's Midwives x

  • By Anonymous (not verified) on 16 Nov 2016 - 22:05

    Hi, my daughter was born at 30 weeks and weighed 1.1kg. She is now one and has recently had her 1 year development check however they done a 10 month check to allow her some extra time. She was in the 'black area' for everything and has had to be referred to specialists. She has had many complications at birth and since and I'm concerned, is there any advice you could give?
    Thank you in advance.

  • By Midwife @Tommys on 18 Nov 2016 - 09:21

    Hi, I would advise you to speak to your health visitor for support with this. The development check is a screening tool and not diagnostic so it is difficult to say if there is a problem or not without a further referral. When she had her review they can provide you with activities to do with your daughter to encourage her development.

  • By Midwife @Tommys on 9 Nov 2016 - 10:02

    Hi
    You should discuss this with your Health Visitor as your baby is now over 6 weeks old . It may be that you should try a different milk and see if that helps but you will need to discuss this with your Health Visitor. Try not to be too concerned

  • By Anonymous (not verified) on 8 Nov 2016 - 16:50

    our baby boy was born on week 31st. his weight on birth was 2.35 kg, now he is five Kg at age of 2.5months. however recently when we increased his milk intake from to 4oz, he is vomiting once a day and also has decreased the intake. is it a worrying sign? we went to doctor and he said thats fine and vomiting is normal but watever he takes in one diet, he vomits.

  • By Anonymous (not verified) on 16 Oct 2016 - 14:38

    My son head os 45 cm on his 1st birthday and that is on 15 percentile i m so worry

  • By Midwife @Tommys on 17 Oct 2016 - 09:19

    I would suggest that you ask your health visitor or Gp about your son's growth and go from there. Try not to worry at this stage.
    Take care

  • By Anonymous (not verified) on 5 Oct 2016 - 12:28

    My premmie was born at 33weeks n 5 days. She is 6months old now,very active,healthy with no complaints. She has not started sitting up but she can sit with support. When can she start sitting up

  • By Midwife @Tommys on 5 Oct 2016 - 16:02

    Hi, it is great news to hear that your daughter is doing so well. In regards to her development I think it would be good to make an appointment to discuss her developmental milestones with your Health Visitor who will look at this in context with her premature arrival too.

  • By Anonymous (not verified) on 9 Oct 2016 - 23:32

    My baby who was born at 35 weeks started to sit at 10 months and started to walk at 18 months my doctor said it is normal for premature babies to catch up late

  • By Midwife @Tommys on 17 Oct 2016 - 09:20

    Speak to your health visitor, he or she will be able to discuss your daughters progress and development in more detail with you, knowing your child's history.

  • By Anonymous (not verified) on 7 Nov 2016 - 15:52

    Hi, it was same with my lo. She started sitting by herself at 8 month and made her first steps at 13 months

  • By Anonymous (not verified) on 30 Sep 2016 - 09:50

    Want to get news or advice for baby's development.

  • By Midwife @Tommys on 30 Sep 2016 - 09:56

    Hello, for further information about the early days of development for a premature baby you can download our app or you can speak to us on the pregnancy line 0800 0147 800. However if your baby is older than about 6 weeks then you should have a health visitor who you can speak to for advice about your baby's development.

  • By Anonymous (not verified) on 22 Jun 2016 - 02:33

    Hi pleas some one help me my baby 9 months she has problem on her neck ( torticolis) . But some time she is good but some time is nt and the side is change time to time.

  • By Midwife @Tommys on 23 Jun 2017 - 15:48

    Hi, if your baby has been diagnosed with torticollis then they can be referred to a physio for support and exercises you can do with her which will hopefully improve this, most babies will improve with support. You can also speak with your health visitor for advice and support too.

  • By Anonymous (not verified) on 12 May 2016 - 16:34

    Fantastic

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