Watching Your Premature Baby
Grow and Develop
Although you have been looking forward to the day when you’re finally able to bring your baby home
from the Intensive Care Nursery, besides being a happy time, this can be a frightening one as well.
All new parents share this kind of feeling, even with full term babies who have been in the hospital
for only a few days. It’s only natural for you to experience a more intensified emotional reaction since
your baby has been in the hospital for several weeks or months. Rest assured, that even though this
may feel scary, you’ll do just fine.
In most cases, your approach to your baby will come naturally. But, we want to share some tips with
you about behaviors and activities typically expressed by premature babies that might seem different
from what you’d expect from full term babies during the first few months of life.
When you first bring your baby home, he/she will have to go through an adjustment period for the
first few weeks. He/she has been used to a chaotic environment at the hospital nursery, with lots of
noise and bright lights. Since he/she has gotten used to this kind of environment, your baby’s new,
quieter setting may seem confusing for awhile. Because his/her brain may still be a bit immature, he/
she may act more irritably than in the hospital nursery, despite all your loving attention and tranquil
surroundings. The baby may be more difficult to console. He/she may be easily overstimulated by
sound, touch, visual interactions, or a combination of these. At first, you might find that your baby
does not respond to comforting measures of quiet and swaddling and may actually need to have the
radio on or the vacuum cleaner running so he/she feels “at home.” At other times, you might find that
your baby responds more to being wrapped warmly and placed in a quiet place without much light
and you might find that he/she eventually will be able to calm himself/herself. The irritability will be
short-lived and as your baby’s brain matures and the baby gets used to his/her new home, he/she
will become more easily comforted.
When your baby first comes home, you might find that feeding practices will be variable. Eventually,
he/she will become vigorous eaters and it may seem to you that they are eating all the time. If it feels
as though you are being eaten out of your house and home, don’t worry, this is typical and healthy for
premature babies. We find that there’s a lot of catchup growth that low-birth weight babies need to
go through. It might take the first two years before they fully catch up to a size that we would expect
them to be, had they not been born prematurely. A substantial amount of rapid growth and a lot of
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“chowing down” to produce that growth will occur especially in the first few months after discharge
from the nursery. Although you might find that your baby seems to eat almost hourly during the day,
this practice should not keep you up all night long.
By the time your baby has been home for six weeks to two months, he/she should be close to
sleeping through the night. Unless there are special feeding problems with your baby, which the
nurses and doctors will tell you about before you take him/her home, there is probably no need to
wake him/her in the middle of the night for feeding. To the contrary, your baby will let you know when
he/she need a bottle or to go to the breast.
Most premature babies catch up to normal size, based on their genetic background. Pediatricians’
opinions may vary about the feeding routine for ICN graduates. But, know that premature babies
grow as well on practically every regimen, whether it is one that relies solely on breastfeeding up to
six months or starting solid food within the first few months after going home from the hospital.
It never feels easy being a parent. The relationship between a parent and child, especially a
newborn baby, can become so intense that it sometimes feels overwhelming. Although your baby is
demanding, especially at first, you also need to take good care of yourself. You need to be able to do
things for yourself that will revitalize you, so you can best care for your baby. Don’t forget to ask for
help. There are probably family members as well as friends who would love to help with baby care.
We strongly urge you to take advantage of their offers.
Hopefully, before you’ve brought your baby home, you have had an opportunity to meet a pediatrician
who will follow your baby’s care. No doubt you’ll find yourself making numerous phone calls to that
physician when you first arrive home. Remember, none of your questions are silly. Babies who were
very tiny at the time of birth will be seen periodically by the staff of the Intensive Care Nursery FollowUp Program, especially during the first year of life. They will help answer questions you might have
and will also be available to consult with your pediatrician.
When referring to the development of a prematurely born baby, we consider “adjusted age” rather
than “chronologic age.” The adjusted age is the age a baby would be if the infant were born on the
due date. Chronologic age is based on a baby’s actual birth date. The reason for this distinction is
that pediatricians have been able to describe “normal” ranges for development in babies only after
they’ve watched hundreds of them born fullterm go through a typical developmental process. To be
able to compare premature babies within this same reference group, we need to consider them from
the point at which they would have been fullterm. We usually use adjusted age in considering the
premature baby for most of their first two years of life, but it becomes a less important concept as
your baby gets older.
There are some differences in the way muscles develop in tiny babies. They might experience some
muscle weakness in the shoulder and trunk muscles that make it difficult for them to push up when
they’re on their bellies and eventually to sit up when we would expect them to, even based on their
adjusted age. These are conditions that will improve with time and usually do not require any special
intervention or therapy. It’s important to remember that all of us, whether born fullterm or premature,
develop at a different rate. Our parents can quickly tell us how as babies we may not have walked as
early as our brother or sister, yet may have been jabbering up a storm long before our sibling uttered
a peep. This will also be true of your premature baby. Parents often get stuck comparing their baby
with books about typical infant development. You can avoid this by simply watching the progress you
see in your own baby. Your pediatrician and the nursery Follow-up Program will help you assess your
baby’s age-appropriate development.
There is a reason why pregnancy lasts nine months. There is substantial body growth as well as brain
growth that needs to occur during this time period. If it doesn’t take place within the mother’s body, it
needs to take place in the big artificial womb we call the Intensive Care Nursery.
In the past, babies born prematurely were at risk for developing neurologic abnormalities and
developmental delays. But, with advances in care in our intensive care nurseries across the country,
chances for neurodevelopmental abnormalities have become quite low. As we have been following
babies from our Intensive Care Nursery over the years, we have found that no matter how tiny they
were at birth, a small percentage of premature infants may have developmental problems, yet another
group may be in the superior intelligence category and the large majority of the babies fall within the
normal range. Although you might encounter individuals who feel that all prematurely born children
need special intervention to foster their development, we have found that what parents do naturally
with their children is probably the best intervention. Lots of love and a common sense approach are
the most important things that parents of an ICN baby can provide.
-- Bob Piecuch, MD