How likely are premature babies to have development concerns?
Most premature babies go on to develop like babies born at term. But the earlier that premature babies are born, the more likely it is that they’ll have development concerns.
Late preterm babies
Late preterm babies are born just a little bit early – at 34-36 weeks. Most premature babies are late preterm.
These babies’ organs are almost fully developed, but many changes are still happening in their brains.
These babies have a very small chance of development concerns compared with term babies. They might need to stay in hospital to put on weight and learn to feed by coordinating their sucking, breathing and swallowing.
Moderately premature and very premature
Moderately premature babies are born at 32-34 weeks. Very premature babies are born at 28-32 weeks. These babies have a higher chance of development concerns compared with late preterm babies.
Extremely premature babies
Premature babies born earlier than 28 weeks and babies born with extremely low birth weight of less than 1 kg have the highest chance of development concerns. They’re even more likely to have development concerns if they also have medical complications while in the neonatal intensive care unit (NICU).
If you have any concerns about your baby’s development, speak early to your child and family health nurse, GP or paediatrician. Your child might sometimes need to see other professionals too, like audiologists, dentists, occupational therapists, optometrists, physiotherapists and speech pathologists.
Language development in premature babies
Most premature babies develop language in the same way as term babies, but sometimes their language development can be delayed. They might have more trouble speaking and understanding what’s said to them, compared with children who were born at term.
Language delay or other language difficulties can also sometimes be an early sign of hearing, thinking or learning difficulties.
Physical development in premature babies
Most premature babies have typical physical, strength and muscle development, although premature children tend to be slightly shorter and lighter than children who were born at term. Physical development can be delayed in very premature babies or premature babies who’ve had significant medical complications.
Muscle and strength difficulties
About 40% of very premature children have mild physical, or ‘motor’, difficulties. These include difficulties with:
- fine motor skills – for example, holding a pencil
- gross motor skills – for example, walking or working out how to walk around obstacles
- visual-motor coordination – for example, drawing something they’ve seen, like a shape
- sensori-motor skills – for example, picking up a full glass without spilling the contents.
Some premature babies have cerebral palsy. Very premature or very sick babies have a higher chance of having cerebral palsy.
Teeth
Premature babies are more likely to have dental problems than term babies.
Dental problems can include the following:
- Tooth enamel problems – the tooth might look grey or brownish or have an uneven surface. Cavities (holes) can form more easily in teeth with poor enamel. Brushing teeth regularly helps.
- Late teeth – premature babies’ teeth often come a few months later than term babies’ teeth, but they’ll still come in the usual order.
- A high arch or groove in the roof of the mouth – this can affect speech and bite. Most children adapt to this, but some might need braces later.
It’s a good idea to visit a paediatric dentist at around 12 months or when your baby’s first tooth comes through, whichever happens first.
Sensory development in premature babies: hearing, vision, sensory awareness
For the majority of premature babies, hearing, vision and sensory awareness develops in the same way as term babies. Some very premature babies will have difficulties with their sensory development.
Hearing
Premature babies are more likely to have hearing loss than term babies, but very few children have severe problems in both ears that need hearing aids or cochlear implants.
Most babies have their first hearing screening test while they’re still in hospital. This picks up most hearing problems, but some problems are diagnosed later. It’s important to diagnose and manage hearing loss early because children need to hear well to develop language, social and communication skills.
Vision
Children who were born prematurely are more likely to have low vision or blindness than children who were born at term. They’re more likely to develop mild visual problems like short-sightedness or long-sightedness, squint, reduced contrast sensitivity or problems with depth perception.
Most severe eye problems are picked up very early. Very premature babies have regular eye tests while they’re in hospital, which can lead to early treatment.
Sensory awareness
Some parents notice that their preterm children have sensory processing difficulties, like heightened sensitivity to light, noise or certain fabrics.
Some premature babies become very sensitive to things being put in their mouths. This is called oral aversion. It can cause trouble with feeding. And premature babies might be more sensitive to pain than full-term babies.
Thinking and learning development in premature babies
Most premature babies develop thinking and learning skills in the same way as term babies, and they usually do well at school.
A few children who were born prematurely will have thinking and learning difficulties. For example, they might have problems with reading, spelling or basic maths skills.
Mild difficulties might not be obvious until children go to school. Children with thinking and learning difficulties sometimes need extra support at school.
Social, emotional and behavioural development in premature babies
Most premature babies develop social, emotional and behavioural skills in the same way as term babies.
Some premature babies behave differently from term babies. For example, in the first year of life, premature babies might interact less with others compared with term babies. They might look away from others to avoid getting overwhelmed, and they might get irritable more quickly.
As babies mature, these things will be less of a concern. And learning to read premature babies’ body language can help you tell when babies want to engage and when they want to stop.
Social and emotional difficulties
Some children who were born prematurely have difficulties with social situations. This includes difficulties with fitting in, following rules and interacting with others.
Most children sometimes have tantrums, get upset and push boundaries. But children born prematurely are more likely to have difficulty coping with and managing their emotions. They might find it hard to stay calm, eat well and sleep well. Some might experience lower self-esteem or find friendships difficult.
Children who were born prematurely have a slightly higher chance of having conditions like attention deficit hyperactivity disorder, autism, anxiety and depression than children who were born at term.
But all these concerns are still uncommon in children who were born prematurely.
Children develop well in loving, stable, stimulating and safe home and school environments, where they can form close relationships. These kinds of environments can help to make some development concerns less severe. They can also help children who have early delays catch up by later childhood or the teenage years.
Corrected age
Corrected age is your baby’s age now (their chronological age) in weeks or months minus the number of weeks or months early they were born. So if your baby is 11 weeks old but was born 8 weeks early, their corrected age is 3 weeks – that is, 3 weeks post their due date.
Corrected age can explain things that look like slow growth or delays in development in the early years. That is, your baby might seem to have delayed development if you compare them with a baby of the same chronological age. But if you use your baby’s corrected age, it might show that your baby’s development is tracking OK.
Twins, triplets and quadruplets are often born early. If you’re worried about your multiples, it might help to know that health and development outcomes for multiple premature babies are similar to those for single premature babies.