Typically, a baby grows in the womb for 40 weeks before being born. Babies born at 40 weeks are called full-term. If a baby is born earlier than 37 weeks, that baby is called premature, or “preterm” or a “preemie.” In the US 12–13% of infants are born premature.
According to Baby Center Canada, in Canada, about seven per cent of babies are born prematurely each year, with 1.5 per cent of babies born before 32 weeks and only 0.4 per cent of babies are born very early, before 28 weeks. The majority of preterm infants are born near term (34 or more weeks gestation.) While these infants are smaller than full-term infants at birth, they tend to catch up with their full-term peers rapidly. The earlier a “preemie” is born, the higher the risk for complications in infancy and later in life – but more premature babies than ever are surviving and thriving.
What to Expect in Your Preemie’s First Year
Having a premature baby brings up a lot of questions and some uncertainties. Normal questions that the mother of a preemie may have:
Is my premature baby going to have health problems?
What are the common health problems for premature newborns?
Will my baby have long-term health problems?
Will my baby grow up to be smaller than other children of same age?
Will my baby walk, crawl and talk at the same time as other babies?
In general, premature babies are at higher risk for problems with breathing and problems with their hearts. Shortly after birth, preterm babies are also at higher risk for serious infections and bowel problems. Some preterm babies may have longer-term health problems like cerebral palsy, respiratory conditions, and learning difficulties – but these problems are more common among the tiniest, earliest-born babies.
Your baby might not turn out to be smaller than other children the same age – it’s just that premature babies might reach their development milestones more slowly than other “full-term” kids who have the same birthday. But in the long run, many premature babies grow up to be “normal” healthy kids who reach a “normal” size and height. Medical care for premature babies has improved dramatically in recent years, and many pre-term babies go on to have a very normal and healthy life, regardless of the challenges they face in their earliest days.
Keeping Track of Milestones
Many parents worry that their pre-term babies might not walk or talk or achieve other development milestones as soon as other kids. But remember that milestones are only guidelines – every baby is different – preemie or not. Whether a baby is premature or not, there’s no way to predict exactly when they will hit milestones.
Instead, there’s a “range of normal” that spans when most babies accomplish these big developmental goals. These infants may stay in the hospital for one or two weeks after birth to ensure that they are feeding well and gaining weight at a healthy rate before they go home.
During infancy, at home and at childcare, these infants may need more frequent and smaller feedings than full term infants. They may need additional layers of clothing or blankets to keep warm during the first few months of life. All preemies should have a regular health care provider and a “medical home” to keep track of their ongoing growth and development.
The most important thing is to make sure your child is moving forward in his/her development. Don’t worry so much about milestones – but if you want to get a better perspective on how to evaluate your child’s development, check out this set of guidelines on preemie milestones.
Understanding Your Baby’s Adjusted Age
Another concept to keep in mind is the idea of “adjusted age” – because the truth is, premature babies aren’t really the same “age” as other babies that have the same birth date. For preemies, many pediatricians recommend using an “adjusted age” to determine this “range of normal” for child development milestones. Adjusted age helps level the playing field by taking into account just how early your baby was born. After all, had your baby not been premature, she would have had a lot more time in your womb to get ready before she was expected to achieve milestones!
When you use an adjusted age, the range of normal gets shifted. For example, while most full-term babies will sit up between 4 and 7 months, a baby born two months early can be expected to do this between 6 and 9 months.
To find your child’s adjusted age, count the number of weeks between her birth date and her due date, and subtract that amount of time from her current age.
For example, a 6-month-old baby who was born 8 weeks early, would have an adjusted age of 6 months minus 8 weeks, or about 4 months. At 10 months old, her adjusted age would be 8 months, and at 16 months old, her adjusted age would be 14 months. Keep this in mind when trying to figure out if your baby is developing “normally” for his/her age. It might be strange or frustrating to see other people’s babies crawling, toddling or walking before your baby is ready to do those same things, but remember that premature birth can result in a few development delays compared to kids “the same age.”
Parents of preemies need to keep in mind that although milestones are important for keeping track of your child’s overall development, they don’t provide a complete picture of your child’s health. In the long run, your baby will more than likely turn out to be at the same physical, mental and emotional developmental level as all the other “normal-age” kids in her class.
The Importance of Breastfeeding
The first year of parenthood of a preemie is often filled with uncertainty and special challenges, but premature babies are often surprisingly strong and resilient, and breastfeeding is one thing you can do to make sure that you give your preemie the best start.
Moms often feel powerless when they give birth to a baby prematurely. It can be hard to have a baby being looked after in the NICU (Neonatal Intensive Care Unit) because the hospital environment impacts early bonding newborn rituals and the baby’s own delicate condition.
However, even if your baby is born premature, one of the greatest gifts you can give your baby is to pump breastmilk to nourish them through those early days, weeks and months. When a baby is born prematurely, every second counts. And, especially when breastfeeding babies in the NICU, every drop of breastmilk counts.
Sleeping Through the Night
Along with the other developmental milestones, preemies often take a bit longer to sleep through the night. According to HealthyChildren.org, a pre-term baby might not be able to sleep a full 6-to-8 hours a night until 6 to 8 months of age, or later. Play with your baby during the day and keep night feedings quiet and efficient – this will help the baby feel tired at night and establish a more regular routine.
Eating Solid Foods
In general, babies are ready to be introduced to solid foods starting at the age of six months. However, it’s more complicated for preemies. Talk with your doctor to see when they recommend starting solid foods for your baby – taking into account the baby’s “adjusted age” and other factors that are particular to your child’s specific health situation. Instead of basing your decision on the baby’s age alone, consider the overall picture of how the child is developing – make sure he or she is showing signs of being ready for solid foods, such as: exhibiting curiosity about solid foods, holding up his or her own head, absence of the tongue thrust reflex (to push foods and other objects out of the baby’s mouth), and other milestones. Your baby’s age is less important than his/her overall visible readiness for solids. If the baby does not seem to be ready for solid foods yet, don’t worry and don’t rush! It’s better to wait a bit longer to introduce solids, because after all, breastmilk is the only food that your baby really needs for the first 12 months of life!
Having a premature infant brings more than its share of worries and challenges, but in many ways, there has never been a better time to bring a preemie into this world. With the amazing medical advances of recent years, and the great resources available for raising your premature baby during the first year of life and beyond, it’s more possible than ever for even the tiniest babies to grow up to lead long, normal, healthy lives. In a few years, you might be amazed to think that your child was ever so small.
Are you the parent of a preemie? What has your experience been like during the first year of your child’s life? Leave a comment and let us know, or join the discussion on our Medela Singapore Facebook page!