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.
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.
- BMJ Best Practice (accessed Sept 2016) Premature newborn care, follow up, recommendations, http://bestpractice.bmj.com/best-practice/monograph/671/follow-up/recomm...
- 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...
- Jane E Norman, Ian A Greer (2005) Preterm labour: managing risk in clinical practice, Cambridge University Press, p126
- 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
- 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
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.
ℹLast reviewed on October 3rd, 2017. Next review date October 3rd, 2020.
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
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.
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 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
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.
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
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.
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
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
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
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.
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 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
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.
By Midwife @Tommys on 1 Mar 2018 - 14:44
Hi, Thank you for your comment.
Congratulations on the birth of your baby. It sounds like he is doing really well and gaining weight. Babies can have what is called a startle reflex where they almost jump like they are surprised, this can be very normal. Sometimes babies can be jittery when they have low blood sugars and this can happen from poor feeding and low temperature. As we cannot assess you baby, we would recommend that if you are worried to contact your GP or health visitor who will be able to check baby over and then you will feel reassured. Hope this helps, take care, Tommy's Midwives x
By Anonymous (not verified) on 14 Nov 2017 - 09:37
Hello, my daughter was born on 9. Oct. 17, due date 2. Nov.17, birth weight was 3.150 kg, and by 2 weeks weighed only 2.640 kg. She's been on a Yo-Yo weight gain and loss. She's now 3.000 kg at 5 weeks, the Dr. & Pead. Suggested Parenteral feeding. Is her growth ok or should we be worried? Thanks.
By Midwife @Tommys on 15 Nov 2017 - 10:46
Hello, Thank you for your comment.
Babies that come early can sometimes have difficulty absorbing nutrients from the milk that they get and this can cause them to loose weight. If they have lost more then 10% of their birth weight and not gaining enough as they should, then tube feeding or parenteral feeding may be used. This is so baby can receive the correct amount of nutrition into the blood stream which will allow baby to just rest, sleep and grow, whilst not having to use up any additional energy feeding for itself. The nutrients can just concentrating on growing baby, once this starts then additional feeds will be introduced one at a time, so that your baby can be monitored and thrive. It is reassuring that she is now gaining weight but your Paediatrician may just want to monitor your baby. Hope this helps, if you would like any further support or advice then please email us on [email protected] or call us on 0800 0147 800 Monday to Friday 9am-5pm. Take Care, Tommy's Midwives x
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 Sarah (not verified) on 15 Feb 2018 - 22:55
Hi my daughter was born six weeks early she's now 8 months old. She can't sit up on her own yet and has only tried to roll over occasionally she can pick toys up and use both hands. Please can you give me some advice on how to help her
By Midwife @Tommys on 16 Feb 2018 - 09:40
Hi Sarah, please try not to worry that your baby is not yet sitting independently. It is important to remember that her age will still be adjusted for her prematurity so her development would be expected to be that of a 6-7 month old at which stage often babies can not sit totally independently. If you have not already, doing some regular 'Tummy Time' is great for physical development, if you are unsure what this is, just link on this click for more information: https://www.babycentre.co.uk/a25009969/tummy-time
As a general rule, try to let her have regular floor time for play. If you are concerned about her development then do speak with your health visitor, she would also normally have a development review with the paediatrician at the hospital when she is one year old as she was premature. I hope this helps, but do touch base with your health visitor for support. Tommy's midwives x
By Maryam (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 Janet Tidswell (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
Hope this helps
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 Ray (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 Mrs zubair (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.
By Rita Ghatala (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.
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 Robin (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 Kesha (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