Tommy's PregnancyHub

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.

A member of the healthcare team will usually visit you at home within the first few days of leaving the baby unit. They will weigh your baby and check that you are settling in well together at home.  

How might premature birth affect my baby’s development?

Most premature babies develop as expected and have healthy childhoods.  But there is a higher chance of premature babies developing a long-term illness or disability compared with babies born at full-term. Babies born before 32 weeks are especially at risk because they have had less time to develop in the womb. Babies born with severe complications, such as a brain injury or infection, also have a higher risk. 

You can speak to your health visitor or GP if you’re worried that your baby isn’t reaching their milestones, such as rolling over or crawling. 

How will my premature baby’s development be checked?

All babies have routine clinic appointments to monitor their development. Some premature babies have extra appointments so that any possible problems are picked up early. 

The healthcare team will use your baby’s developmental age to assess their growth and development in the first 2 years. 

Using your baby’s corrected age

Reaching developmental milestones may take a little longer for premature babies by comparison with babies born at full term. This is because they are younger. Your baby will be assessed according to their ‘corrected age’. This is your baby’s age from your due date, rather than the day they were born. 

After the age of 2, your child will have the same checks as other children their age. If your baby was born before 28 weeks, they will be offered an extra check when they are 4 years old. 

At your clinic appointments, the healthcare team may measure and weigh your baby. They may ask you how well your baby is feeding and what they’re doing. For example, whether they are rolling over or sitting up, depending on their age. They will also ask if you have any questions or concerns about your baby’s growth or development. 

If your baby needs support or further tests, they may be referred to a specialist. Specialist services, such as physiotherapy, speech therapy and support from a dietitian are often co-ordinated so you can see more than 1 specialist in a single clinic visit.  

You should also be offered emotional support to help you and your family cope with the effects of having a premature baby.   
The NHS website has more information about the development checks offered to all babies.

Understanding your baby's growth chart

Before you leave hospital, the healthcare team will give you a Personal Child Health Record, which is also called the 'red book'. This has growth charts to plot your baby's growth and compare it with the average growth for their age.  

If your baby was born before 32 weeks, their growth will be plotted in the low-birthweight chart. Babies born at 32–37 weeks are plotted in the preterm chart until 2 weeks after their estimated due date. After that, they are plotted in the main charts using their corrected age, which is measured from your due date rather than their birth date. 

How do centile charts work?

The centile charts in your baby’s red book show how quickly your baby is growing and how their size compares with children of the same age. For example, if your baby's length is in the fifth centile, it means they are the fifth longest out of 100 babies of the same age. There are separate charts for girls and boys, as boys tend to be heavier.  

Your baby's measurements for their height and weight should be on similar centiles. If they’re very different from each other, this may show that your baby is overweight or underweight. The healthcare team may recommend changing how often and how much you feed them.  

Your baby’s weight or length centile may change as they get older, but they usually only go up or down 1 centile. Speak to your health visitor if your baby’s measurements vary more than this. 

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 so try not to worry too much.

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. But try to keep in mind that all babies are different and will develop at their own pace, no matter when they were born. Not reaching a milestone doesn’t necessarily mean that there is a problem. 

Using milestones positively

You can use milestones positively in different ways:

  • to encourage your baby's development – for example, if you know that babies can start to roll over from about 2 months, you might notice them trying to flip themselves over and you can give them a helping hand
  • to keep your baby safe, by being aware of what they are and not able to do
  • 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.

Your baby’s development 

At 1 month corrected

Your baby’s motor development

Your baby may:

  • wave their arms and legs, wiggle and squirm when they are on their back
  • turn their head when they are on their tummy
  • watch their hands as they move them.

Your baby’s language development

Your baby may:

  • cry when they are hungry, wet, tired or wants to be held
  • make cooing sounds such as “ooh” “gah” and “aah”
  • make sounds back at you when you talk to them.

Your baby’s social and emotional development

Your baby may:

  • smile when you talk to them
  • get excited when they see you.

At 4 months corrected

Your baby’s motor development

Your baby may:

  • move their head from side to side when they are on their back
  • hold their head up so their chin is about 3 inches from the floor for at least 15 seconds when they are on their tummy
  • hold their head steady when you hold them in a sitting position.

Your baby’s language development

Your baby may:

  • laugh
  • stop crying when they hear a voice other than yours
  • make high-pitched squeals.

Your baby’s social and emotional development

Your baby may:

  • smile or coo at themselves when in front of a large mirror
  • smile when they see you
  • make sounds when looking at toys or people.

At 6 months corrected

Your baby’s motor development

Your baby may:

  • lift their legs high enough to see their feet when they are on their back
  • roll from their back to their tummy, getting both arms out from under them
  • support their own weight while standing if you are holding their hands.

Your baby’s language development

Your baby may:

  • repeat the sounds you make back to you
  • make sounds like “da”, “ga”, “ka” and “ba”
  • make grunting, growling or other deep-toned sounds when playing with sounds.

Your baby’s social and emotional development

Your baby may:
●    react differently towards strangers than they do with you or other familiar people
●    turn to see where the sound came from if there is a loud noise
●    reach out to pat their reflection when stood in front of a mirror.

At 7 months corrected

Your baby’s motor development

Your baby may:

  • get into the crawling position by getting on their hands and knees
  • sit up straight for several minutes without using their hands and support
  • hold on to furniture without leaning their chest against it for support.

Your baby’s language development

Your baby may:

  • make 2 similar sounds like “ga-ga”,“ ba-ba” or “da-da”
  • look in the direction of your voice if you call to them when out of sight.

Your baby’s social and emotional development

Your baby may:

  • respond to the tone of your voice and stop what they are doing when you say “no”
  • reach out to pat their reflection when stood in front of a mirror.

At 9 months corrected

Your baby’s motor development

Your baby may:

  • walk beside furniture while holding on with only one hand
  • pick up a small toy with only one hand
  • put a small toy down without dropping it.

Your baby’s language development

Your baby may:

  • say 3 words, such as “mama”, “dada” and “baba”.

Your baby’s social and emotional development

Your baby may:

  • follow simple commands such as “come here”, “give it to me” or “put it back” without your using gestures
  • play at least 1 nursery game, even if you don’t show them the activity yourself, such as “clap your hands”.

At 12 months corrected

Your baby’s motor development

Your baby may:

  • take several steps without tripping or falling while standing (if you are holding both hands)
  • stand up in the middle of the floor by themselves and take several steps forward
  • help turn pages of a book

Your baby’s language development

Your baby may:

  • look at the object when you ask them where it is
  • tell you they want something by pointing at it

Your baby’s social and emotional development

Your baby may:

  • play with a doll or cuddly toy by hugging it
  • roll or throw a toy at you so you can return it.

At 15 months corrected

Your baby’s motor development

Your baby may:

  • take several steps without tripping or falling while standing (if you are holding both hands)
  • stand up in the middle of the floor by themselves and take several steps forward
  • help turn pages of a book.

Your baby’s language development

Your baby may:

  • imitate a 2-word sentence, such as “daddy play” or “what’s this?”
  • say 8 or more words in addition to “mummy” or “daddy”.

Your baby’s social and emotional development

Your baby may:

  • offer a toy to their own image while looking in a mirror
  • try to get your attention by pulling on your and or clothes.

At 18 months corrected

Your baby’s motor development

Your baby may:

  • move around by walking, rather than crawling
  • climb on an object, such as a chair, to reach something they want
  • stack a small block or toy on top of one another.

Your baby’s language development

Your baby may:

  • say 2 or 3 words that represent different ideas together, such as “see dog”, “mummy come home”.

Your baby’s social and emotional development

Your baby may:

  • go to another room to find a toy if you ask them – such as “go and get your blanket”
  • point to the correct picture when you say “show me the cat”.

At 24 months corrected

Your baby’s motor development

Your baby may:

  • walk down stairs if your hold onto one of their hands
  • run fairly well and stop themselves without bumping into things
  • get a spoon into their mouth so that the food doesn’t spill too much.

Your baby’s language development

Your baby may:

  • correctly name at least 1 picture if you point to a picture in a book and ask your child “what’s this?”
  • correctly use at least 2 words like “me”, “I”, “mine” and “you”.

Your baby’s social and emotional development

Your baby may:

  • carry out directions such as “put the toy on the table”, “close the door” or “get your book”.

Find out more about your baby’s development

Pammi M (2020) Premature newborn care. BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/671/pdf/671/Premature%20newborn%20care.pdf
 
NICE (2017) Developmental follow-up of children and young people born preterm. NICE guideline 72. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng72

EFCNI (2018) Follow-up and continuing care: overview. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/standards/followup-continuing-care/overview/

EFCNI, van Kempen A et al. (2018) European Standards of Care for Newborn Health: Coordination and integration of care after discharge home. European Foundation for the Care of Newborn Infants. https://newborn-health-standards.org/coordination-care-after-discharge/

NHS.  Your baby's weight and height. https://www.nhs.uk/conditions/pregnancy-and-baby/baby-weight-and-height/ (Page last reviewed: 24 January 2020. Next review due: 24 January 2020)

RCPCH (2013) UK-WHO growth charts - 0-4 years. https://www.rcpch.ac.uk/resources/uk-who-growth-charts-0-4-years
  
Squires, J & Bricker, D (2009) Ages & Stages Questionnaires. A Parent-Completed Child Monitoring System, Paul H. Brookes Publishing Co.