Premature babies develop at a slightly different rate than full term babies. Here is your guide to all the developmental milestones for premature babies.

Waiting for baby’s milestones is a source of excitement for parents everywhere, but for parents of premature babies, it is also a source of stress and confusion. One one hand there’s the worry about whether the prematurity will affect the baby’s normal development, and on the other hand there’s the confusion about how to check if their baby’s hitting all their milestones at the right time.

The confusion is understandable, since the calculation for premature babies’ milestones is a little different from that of full term babies. Here, there is some math to do in calculating the baby’s adjusted age.

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Calculating the Adjusted Age for Premature Babies

A foetus is programmed to develop a certain way, according to a specific schedule which usually ends by 40 weeks in the womb. Even when the baby is born before that, the development proceeds the way it would as if the baby were still in the womb. This is why doctors don’t rely only on the baby’s actual birth date to track development; the baby’s estimated due date is also important. The baby’s age based on this due date is called the ‘adjusted age’ or ‘corrected age’.

For instance, if the baby was born 2 months early and is now 6 months old, she  can’t be compared to a full term 6 month old baby, since she has missed out on 2 months in the womb. As a result, her adjusted age will be 4 months – the age she would have been if she had spent her full 40 weeks in the womb. Now, her milestones and development will be tracked with the 4 month age in mind.

Doctors use the adjusted age when tracking anything related to the baby’s development, usually till about 2 years of age since most preemies catch up with their full term peers by then. However, even with the adjusted age, there are some other factors that may affect a premature baby’s milestones.

Factors affecting Milestones of Premature Babies

1. Birth Date

A baby is considered premature if she is born before 37 weeks in the womb. However, how early the baby is born affects her rate of development. Premature babies are divided into four categories based on their gestational age at birth:

• Late preterm – Born from 34 weeks – 37 weeks
• Moderately preterm – Born from 32 -34 weeks
• Very preterm – Born from 25 – 32 weeks
• Extremely preterm – Born before 25 weeks

The earlier the prematurity, the longer it will take for the baby to catch up with her milestones and it’s also likely that she will have other medical issues which slow down development. Late preterm babies catch up quite fast, and many of them don’t need to be tracked with their adjusted age for long.

2. Birth Weight

Along with how preterm the baby is, the weight of the baby also plays an important role in her development. A lower birth weight indicates a higher chance of health problems and slower development. Heavier babies are more likely to be stronger and achieve milestones faster. Babies in the NICU are also fed very slowly and carefully, and this can lead to slow weight gain.

As mentioned above, premature babies continue to develop outside the womb, just as they would inside. The difference is that they are now exposed to much more stimuli, for which they are not yet ready. Here is a quick look at what to expect in babies born at different stages of prematurity.

26 Weeks

• Opens eyes sometimes but can’t focus yet
• Has poor muscle tone and can’t curl up
• Cannot suck or feed on his own

28 Weeks

• Starts to blink eyes, opening it occasionally
• Can’t focus eyes or move them together
• Can respond to the mother’s voice

30 Weeks

• Has better muscle tone and can move and stretch
• Responds to pleasant sounds
• Starts to develop the rooting reflex

33 Weeks

• Has more controlled movements
• Can bend arms and legs
• Can focus on a single object at a time
• Starts to suck more strongly

36 Weeks

• Can move head from side to side
• Has good muscle tone
• Can close eyes and turn away
• Starts breastfeeding

Before looking at what to expect at each age, it helps to get a general idea by looking at the top 3 developmental milestones in premature babies.

Sitting – In most cases, premature babies learn to sit up on their own somewhere around 6-7 months, and this is usually the first significant milestone noticed by parents.

Walking – Premature babies learn to walk somewhere around 18 months, though many do walk later. When a preemie walks depends largely on how much exercise their muscles get.

Talking – Preemies usually talk around the same time as full term babies, as long as they’ve had enough exposure to speech and language in their environment

Developmental Milestones for Premature Babies

Important note: These milestones are for the adjusted age of a premature baby. For instance, if your baby was born 2 months early and is now 6 months old, you need to look at the adjusted age of 4 months. In any case, there are several factors that affect your baby’s development, so this is to be considered a general guideline. Please avoid comparing your baby with another baby, even if he/she was born premature since every child is different.

2-3 Months adjusted

Physical

• Can control head movements
• Makes different sounds

Cognitive

• Smiles at people
• Recognizes parents and primary caregivers

4-5 Months adjusted

Physical

• Lifts head up if placed on tummy
• Rolls over

Cognitive

• Follows faces and objects
• Smiles at parents’ faces

6-8 Months adjusted

Physical

• Can sit up on his own
• Can get up on her hands and knees
• Starts crawling

Cognitive

• Looks directly at interesting things or toys
• Is interested in reaching out
• Babbles with two syllables (dada, baba, mama)

9-11 Months adjusted

Physical

• Can crawl properly
• Starts pulling up to stand with support

Cognitive

• Participates in games like ‘Peek-a-boo’
• Makes more sounds and copies some sounds
• Can understand the meaning of ‘No’

Tips to encourage Premature Babies

1. Be very gentle with premature babies as they are not ready for all the stimulation of the world outside the womb. Hold them very gently and avoid sudden movements. Speak in very low tones and keep away from others for a few months.

2. Initiate breastfeeding as soon as possible. For premature babies, sucking on the breast is hard work, and it may take some time till they’re ready for that. But you can still pump and get them to feed on breast milk. It is the best thing they can have to gain weight and grow.

3. Practice kangaroo care or baby wearing, especially in the early days after baby is born. This will let baby know that he is cared for and safe and he will grow stronger much faster.

4. Stick to a predictable routine. It helps to reduce anxiety in little babies and provides them with a safe and stable environment, putting them at ease so they can focus on developing.

5. Be aware of what milestones are coming up. One advantage of this is that you can offer your baby a helping hand to roll, sit or crawl. The other is you can take adequate childproofing precautions.

6. Once baby has become familiar with the world around him, encourage lots of free play. Make sure they get enough tummy time while awake which is crucial to develop all the gross motor skills needed for other milestones.

7. Encourage cognitive development by talking to baby. Saying what you’re doing while doing it helps improve language skills. Read every day and sing songs with repetitive phrases.

8. Be patient with your little one. Being born premature is a feat in itself and your baby has achieved something massive by surviving it! Don’t rush your baby for anything – it can backfire.

It can be hard replying to questions from friends, family and neighbors about why your baby is not crawling/sitting/walking yet – especially if you live in India! Explain the concept of corrected age to them. They may be confused, in which case just say that your doctor thinks the baby is doing fine for his age, and you’re going for regular checkups.

Specific signs to watch out for

Premature babies are vulnerable to an eye condition called Retinopathy of Prematurity, which can be serious. Schedule regular eye exams so that you can spot anything early. Preemies are also likely to have more trouble with their teeth, so have regular dental appointments for the baby too.

The most important thing to remember when tracking milestones for premature babies is that the focus should be on making progress, rather than achieving a certain milestone by a certain age. If you still feel something is wrong, don’t be afraid to bring it to your doctor’s attention. As with most other things, early detection is crucial for treating developmental delays.