Growth and development after prematurity

Premature birth can affect the way your child develops. 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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  • Baby with hearing aid.

    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, 2017. Next review date October 3rd, 2020.

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Comments

  • By Archana (not verified) on 7 Feb 2019 - 03:59

    Hello.
    My baby's due date was 4th December but she was born on October 31st.
    My question : should I consider her 2 weekspremature ( 35 to 37 week ) or 5 week Premature.

    Also her cognitive developments seems to be on time with full term babies( smiling, cooing etc) but her physical developments ( neck holding , hand eye coordination , swatting at objects etc) seems to lagging. Is this normal?

  • By Midwife @Tommys on 7 Feb 2019 - 16:09

    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.

  • By tania anvar (not verified) on 4 Feb 2019 - 08:19

    27 week twin babies, now 1 year old is not holding head properly. not rolling, sitting. now doing physiotherapy 3 times a week. nicu usg brain was normal. they do recognise us, smile , says papa , mama, hold toys, laugh , smile,
    only prob not holding head normally

  • By Maya (not verified) on 1 Feb 2019 - 11:04

    My daughter is 1.8 months and still has partial neck holding ,daily she has her physiotherepy what are the more ways I can help her she is 30weeker born

  • By Midwife @Tommys on 13 Feb 2019 - 13:06

    Hi Maya- the people best placed to answer your questions are the staff caring for your daughter in NICU, if she is still an inpatient now, or her health visitor if she is now at home. They will have full access to her medical history and know what is to be expected of her at this (born) gestation. All the best, Tommy's Midwife

  • By erika dudley (not verified) on 26 Jan 2019 - 19:08

    Hi my son was born at 34 5/7 weeks old. He didn’t start to crawl until he was 10 months. Started walking at 15 months and said mama at 16 months but he doesn’t say it often. He will go and get things when I call them out but he is not speaking a lot of words. He will act like he’s talking in sentences but it’s jabber. He just turned 18 months. Should I be concerned

  • By Midwife @Tommys on 29 Jan 2019 - 14:05

    Hi Erika Dudley- the person best placed to assess your son is your Health Visitor or a Paediatrician. They will know your son's history and be able to inform you if his development is on track or not. This isn't a midwife's speciality area I am afraid. Our area of expertise only covers up to 6 weeks of life. Not beyond. All the best, Tommy's Midwife

  • By Nainai (not verified) on 22 Jan 2019 - 06:43

    My father and her wife has a PREMATURE baby, she is now at her 5 months of age from birth. She is now 5 months and still looks like a 1 month old full term baby, she can see and hear (they say) but her physical condition is slower. Question is, she being like that is still normal? And at what age shall she walk, talk and be a normal like that of normal babies?. Thanks. Hope i may get a further explanation. TIA

  • By Midwife @Tommys on 28 Jan 2019 - 15:39

    Hi Nainai,
    We assess premature babies from their orriginal due date, for example if she was 3 months premature, we would expect all her development to be 3 months later. But of course, all babies are different and they progress at different rates. We wish her all the very best for the months ahead. Best wishes

  • By JOJO (not verified) on 21 Jan 2019 - 15:06

    HI my son was born on the 25/12/2018 and is going to 4 weeks tomorrow. What i wanna ask is, do i consider his growth from is actual due date to judge his feeds. Right now he wakes like every 3 hours to feed and he drinks a min of 60ml to 75ml and at times can do 90ml straight on his own. But a month old baby should be drinking 120ml. So will will he start 120 from now or will it be 1 month from his actual do date that he will actually be required to take 120ml. And he has grown considerably since being home from the 14/01/2019.
    THANKS

  • By Midwife @Tommys on 28 Jan 2019 - 10:56

    Great to hear that your baby is thriving and putting on weight. I would suggest that you talk to your health visitor about feeding. They are well qualified to look at the needs of your baby as an individual and advise about when to increase the feeds. Best wishes

  • By Avtar (not verified) on 12 Jan 2019 - 01:58

    My baby is born in 32 weeks and he is premature. We are in hospital from 17 days. My baby sleep all the day. Is this affect to baby health and tell me at what level sleep is important for him.

  • By Midwife @Tommys on 14 Jan 2019 - 14:31

    It is quite normal for babies this age to sleep all day. I am assuming from your message that he is still in special care in the hospital. He will just be waking for feeds at this stage and after he is cleaned and changed he will go back to sleep. Please be reassured.

  • By david (not verified) on 26 Jan 2019 - 17:15

    yes for your child to sleep all day is normal and good for development

  • By Bhawana devkota (not verified) on 31 Dec 2018 - 20:05

    Hi my son born at 28 weeks 5 days , now he will be 2 yrs in Feb . He dont response when we call his name and he dont speak much otherwise he is active in other things should I have to be worried for these things or this is normal . Thank u

  • By Midwife @Tommys on 9 Jan 2019 - 12:50

    Hi Bhawana
    You should take your son to your family doctor for assessment first. They may suggest that he has a hearing test if he has not already had one.
    Premature babies can develop at different rates to a baby that was born at term. The people best placed to examine and review your son, would be a paediatric doctor or a health visitor if your family Dr is unable to determine if this is a concern for your son.
    Please take care. Tommy's Midwife

  • By Bismita sarmah (not verified) on 21 Dec 2018 - 09:38

    Hi my baby girl born on 36 week.her birth weight 2.4 kg.now she is 1 month old and weight 2.7 kg....is it ok

  • By Midwife @Tommys on 3 Jan 2019 - 12:31

    Hi Bismita,
    Your midwife, GP and health visitor should be supporting you with monitoring your baby's weight. All weights should be plotted in the back of her red book on a centile chart, as long as her weight is tracking a centile then this is fine. If you have any concerns about her weight or want it checked then do contact your health visitor.
    Best wishes
    Tommy's midwife

  • By Anonymous (not verified) on 8 Dec 2018 - 21:00

    My granddaughter born at 26 weeks doesn’t make any sounds. She is now 6 months old from the time of birth. She was intubation and extubated many times

  • By Midwife @Tommys on 12 Dec 2018 - 15:17

    Hi, I can understand that you must be very worried but please talk to your doctor to understand the reasons, and remember that children develop at different rates. Take good care of her, Tommy's midwives

  • By Saqib (not verified) on 19 Oct 2018 - 12:35

    Hi my son was born in 30weeks with a birthweight of 1.25 kgs. Now he is into 38th week and weighs around 2.3 Kgs. I am concerned about his head circumference which we feel is small. Any suggestions how much should the head circumeference be for a 30 weeker who is now into 38th week? Thanks

  • By Midwife @Tommys on 23 Oct 2018 - 12:06

    You must talk to the doctors who are caring for your son. They will be able to tell you if this is normal or if his head is small. I hope he is thriving and that you will have him home soon.

  • By Vishal sahi (not verified) on 31 Aug 2018 - 02:38

    My son is 32weeks born with 1.6kg birth weight... He started crawling 8 months... started walking on 18months by his own... Now my question is he turned 25 months as counted with his born date not with his due date..... He bubbling few words he try to speak words but there is no clarity of words he point to object but cudnt sound enough to define the object through words or any other sounds... Is it a cause of concern.. I had concerned with peditrician he said it is normal though I took him to speech therapist to check is ear he to said it is normal... Pls guide us on this issue....

    With warm regards
    Major Vishal Sahi

  • By Midwife @Tommys on 31 Aug 2018 - 15:23

    Hi Vishal,
    If your son has been reviewed by a paediatrician and a speech and language therapist then please take reassurance in this and that his speech will develop in his own time. I would suggest to speak with your son's health visitor for advice about encouraging speech development and any ongoing concerns you may have.
    Best wishes
    Tommy's midwife

  • By Varsha (not verified) on 23 Sep 2018 - 10:39

    Hi... Gt to see your question
    4 days before I gt my son in 34 weeks with 1. 8 kg.. From that day they have been keeping him in the NICU. . Now I am worried about the way I should take care of him when he comes out.. Let me know how you used to feed him , what all foods you gave him

  • By Midwife @Tommys on 24 Sep 2018 - 15:26

    Hi Varsha, It is important that you take advice from your paediatric team who will advise on the best feeding methods for your baby. You should be supported when he comes home so try not to worry. Best wishes to your little one and to you.

  • By Amy (not verified) on 9 Nov 2018 - 17:38

    My daughter was born at 27 weeks. She did ok in most areas, but she too was very slow to talk. Granted, at the time my husband was deployed in Iraq and due to her health I had to keep her home alone with just me. So she probably didn't hear as much talking as the average baby? Anyway, I taught her some simple sign language: drink, please, thank you, food, etc. That way she could still communicate with me. Eventually, she caught up. Now she's 13 and if you didn't know she was born early, you'd never know she was born early :) Good luck

  • By Caz (not verified) on 1 Aug 2018 - 21:08

    Hi my fraternal twins were born at 33 + 1 weeks weighing 4lbs each they are now 21months old my little girl has over taken my little boy since he could crawl and she is doing amazing like another toddler her age but my little boy only started walking 4 months ago and has lost interest in playing and engaging with others and health professionals are really worried that he may be deaf and have referred him for more tests and paediatric assessments at the hospital i am convinced this has something to do with them being born so early and without evidence to back up what the professionals may or may not think it is i don't want my little boy put a label on him at such a young age am i right to think that that any advice or thoughts thanks

  • By Midwife @Tommys on 3 Aug 2018 - 12:58

    Dear Caz,
    I am afraid it is a bit of a waiting game waiting for him to have his hearing tested to see if there are concerns. It sounds like you are being supported by professionals, if they have further concerns about his social interaction and development then he may be referred to a child development centre for a more in depth assessment. Do speak with your health visitor for support as needed.
    Best wishes
    Tommy's midwife

  • By Lisa (not verified) on 16 Nov 2018 - 20:06

    Babies hearing can be tested at birth now...ask you doctor. Regardless if they can hear or not American Sign Language will improve their learning and development incredibly!

  • By Kibi (not verified) on 24 Jul 2018 - 13:50

    My child was born at 36 weeks weighing 2kg , she catched up well with weight but her developments has always been behind. She is now 3 yrs 2months and just started talking. I took her to speech therapist suspecting she could be autistic but they said she is fine. It is normal for every development to be behind because of birth weight?

  • By Midwife @Tommys on 27 Jul 2018 - 11:28

    Hi Kibi,
    It is reassuring that your daughter has been reviewed by a speech and language therapist and they are not concerned, they would normally give you advice as to how to support your daughter with her speech and activities you can do with her. Do be in touch with your health visitor for on going support, if she does not catch up and then can be referred for another review with the speech therapist.
    Best wishes
    Tommy's midwife

  • By Julie (not verified) on 1 Jul 2018 - 18:26

    Hi my son was born at 29 +2 weeks. He is 4 years old and doing really well but has trouble jumping, is this a common feature of preemies? Should we be doing more to help him? Thanks

  • By Midwife @Tommys on 2 Jul 2018 - 14:59

    It would be best to discuss this with your health visitor. Children develop at very different rates and there are many reasons for difficulties both physically and mentally. If he has no other physical difficulties there is no reason to think that he won't jump when he is ready.

  • By Julie (not verified) on 3 Jul 2018 - 20:43

    Thank you

  • By [email protected] (not verified) on 24 Jun 2018 - 17:26

    I was born premature,am getting to 20 years but I still look like a small girl, I notice I begin adding weight recently, does it mean my development stage is now starting fully?

  • By Midwife @Tommys on 27 Jun 2018 - 11:34

    Hi, thank you for your post. I'm afraid this isn't my area of expertise. I would advise you to go and see your family doctor to discuss any areas of concern developmentally. If there were any issues of particular concern you could then be referred to a specialist

    Warm wishes
    Anna-Tommy's midwife

  • By Anonymous (not verified) on 21 Jun 2018 - 07:16

    My baby was born @36 week.weighing 6.4 pounds and When we had a born screening the doctor said we nees to repeat because they found out that my baby was premature.as my baby grew up ,we noticed that there are birthmarks in some parts of her baby,like in forehead and private part. Is the birth mark of my daughter can treated?? And is it cause of being a pre mature baby?

  • By Midwife @Tommys on 22 Jun 2018 - 15:16

    Hi,
    Birthmarks are not normal due to prematurity, they are very common and many babies have them. They can fade over time or sometimes they do not go and are part of the person for all their life. If you are noticing changes then do see your GP for advice.
    Best wishes
    Tommy's midwife

  • By Anonymous (not verified) on 4 May 2018 - 11:49

    My son was born at 34 weeks. He didnt spend a lot of time on his tummy when he first came home due to colic and issues with the way he held his arms almost behind him. Hes now 10 months can sit up unsupported but doesnt push or pull up into a sit. He pulls himself into stand but is unsteady on his feet with no sign of cruising. He looks to crawl and holds himself up on his hands well but as soon as he tries to put his knees under him he flattens out. He gives me 5 and puts out his hand when I ask him to dance but he doesnt point clap hands or wave. Im worried because I dont really know what is a delay to be concerned about.

  • By Midwife @Tommys on 4 May 2018 - 13:48

    Hi - Thank you for your message. All children progress at uniquely different rates. Yous son sounds lovely but if you have nay concerns please contact your health visitor for an assessment and advice.

  • By Clarissa Buchanan (not verified) on 27 Dec 2018 - 17:20

    My granddaughter was born 2 months early and weighed 2 pounds. She is now 21 months old and each developmental phase was a great struggle for her. However, she eventually conquered each one...turning over, sitting up unsupported, sitting up on her own, crawling, standing, clapping, waving, and cruising. She is just now trying to stand on her own and she only says a few words. I was very worried all that time. It was difficult to watch her try and try and try. She developed in much the same way you are describing. She is very alert and does understand what we say to her very well. She is bright and her thinking skills seem to be above average. I would not worry. Your child will crawl and clap and wave and walk when he is ready and able, and soon you will forget that he ever had problems. Good luck and God bless.

  • By Vicki (not verified) on 30 Apr 2018 - 03:24

    My daughter was born at 26+6 weeks. She was discharged on prem formaula (sma prem 2) she is now 18 weeks old (5 weeks corrected) and her feeding seems to be going backwards. She was starting to take 4oz going 4/5 hours between feeds. She now onky takes 2oz every 2 hours. She doesnt have many bowel movements and the ones she does have are stimulated by glycerine (dotor advised liquid glycerine to help sooth and soften). She has also started sticking her tounge out alot after feeds and sometimes looks like she is retching.

  • By Midwife @Tommys on 30 Apr 2018 - 16:48

    Hi Vicky, I think that you should make an appointment to see your health visitor or doctor and have a full assessment including getting her weighed. This could be just her changing pattern but without seeing your baby I can't reassure you. Take care

  • By Osman (not verified) on 16 Apr 2018 - 18:33

    Hi, my baby boy born in 32 weeks, now 11 months old. Still his neck is not strong enough(also when tummy time he cant lift his head even 2 seconds ), we feel he is not strong like other babys like when we holding him. and he is not started rolling over yet, when he will start sitting? Please help me

  • By Midwife @Tommys on 19 Apr 2018 - 14:01

    Hi, Thank you for you comment.

    We would recommend that you speak to your health visitor about getting a physiotherapy referral for your little boy. They will be able to give you exercises to do with him to strengthen him. Keep doing tummy time with him. If you cannot get hold of the health visitor then your GP will be able to help you. Your little boy should be due a one year developmental check so they will be able to asses him then as well. Hope this helps, take care, Tommy's Midwives x

  • By Anonymous (not verified) on 22 Mar 2018 - 06:09

    Both my babies were born 34 weeks, my 1st didn't have any issues when born but my 2nd struggled to gain weight, both babies were socially active, 1st 1 going to day care at age 2 and 2nd 1 going to play centre at age 1 then to kindy just started this year, both of them struggle with kids their own age and prefer adults, is this a common factor for children born prematurely?

  • By Midwife @Tommys on 23 Mar 2018 - 09:32

    Hi,
    Prematurity can affect social development but it is difficult to know whether this would be reason as to why your children prefer adult company. This can also be due to early life experiences or their personality. If you have any concerns about your children then do speak with the school and the health visitor for your 3 year old so you can discuss any concerns you may have. Best wishes, Tommy's midwives.

  • By Toni (not verified) on 13 Mar 2018 - 19:27

    Hi, I just thought I would try and offer a ray of hope to some of you. My son was born weighing 1.8kg as a result of severe pre-eclampsia. My son was small, delicate and terrifying!! I panicked constantly and found myself obsessed with him when he finally came home, I never left his side. He was little when he went off to primary school, he has always preferred being around adults, he still doesn't really understand the big whoop about kids his age, but I have chalked this up to him just being him (maybe my lack of socialising with other parents when he was little) However, I don't dwell as he is happy, he is an old soul. I just wanted to let you know that there is hope, from my experience. I wished I could have enjoyed having my beautiful son morem, rather than being so scared all the time. My son now plays rugby, he is almost 5'6", is witty, mature, intelligent and I couldn't be more proud. I just wanted to say that your little ones won't necessarily always be so little, if you are genuinely concerned about their health get help. Sometimes take that time to just look at them and enjoy them for just being your baby.

  • By Anonymous (not verified) on 1 Mar 2018 - 09:29

    My baby was born at 35 weeks and 6 days at a weight of 2.440 kgs. He is now 1 month old and is gaining weight well. I am worried that his whole body jerks when he is sleeping.i know twitching is normal but the jerking is concerning to me.Im worried that he may have some nervous system disorder.

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