Premature babies: chance of development problems

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 problems.

Late preterm babies
Late preterm babies are born just a little bit early – at 34-36 weeks. Most premature babies are late preterm.

Many of these babies’ organs are fully developed, but many changes are still happening in their brains.

These babies have a very small risk of development problems and breathing difficulties compared with babies born at term. They might need to stay in hospital to put on weight and learn to feed by coordinating their sucking, breathing and swallowing.

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 problems. They’re even more likely to get development problems if they also have medical complications while in the neonatal intensive care unit (NICU).

If you have any concerns about your baby’s development, trust your instinct and speak early to your child and family health nurse, GP or paediatrician. Your child might sometimes need to see other professionals too, like audiologists, optometrists, speech pathologists, occupational therapists, physiotherapists and dentists.

Language development in premature babies

Most premature babies develop language in the same way as term babies, but their language development might 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 problems can also sometimes be an early sign of hearing, thinking or learning problems.

Physical development in premature babies

The majority of premature babies have typical physical, strength and muscle development, although premature children tend to be shorter and lighter than children who were born at term.

Muscle and strength problems
About 40% of very premature children have mild motor impairments. These include problems with:

• fine motor skills – for example, holding a pencil
• motor planning – for example, working out how to walk around obstacles
• visuomotor coordination – for example, copying shapes
• sensorimotor skills – for example, picking up a full glass without spilling the contents.

Some preterm babies have cerebral palsy. The chance of cerebral palsy is higher for very premature babies and for babies who are very sick in the NICU.

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 the shape of the roof of their mouth, but others 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

The majority of premature babies have typical hearing, vision and sensory awareness.

Hearing
Premature babies are more likely to be deaf or 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 are diagnosed later on. It’s important to diagnose and deal with deafness, because children need to hear properly to develop language, social and communication skills.

Vision
Children who are born prematurely are more likely to have vision impairment 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 sensitivity
Some parents say that their preterm children have sensory sensitivities, like heightened sensitivity to light, noise or certain fabrics. Some premature babies don’t like having things put in their mouths and can have trouble feeding. And premature babies might have a lower pain threshold than full-term babies.

Thinking and learning development in premature babies

The majority of premature babies have typical thinking and learning development and do well at school.

A few children who were born early have thinking and learning difficulties. For example, they have problems with reading, planning and staying on task.

You might not notice any problems until your child goes to school. Children who were born early might need some extra support at school.

Social and emotional development in premature babies

The majority of premature babies have typical social and emotional development, but they might behave differently from term babies.

For example, in the first year of life, premature babies are less likely to interact with others compared with term babies. They’re more likely to look away to avoid getting overwhelmed, and they might get irritable more quickly.

As your baby matures, these things will be less of a concern. And learning to read your premature baby’s body language can help you tell when your baby wants to engage and when they want to stop.

Social and emotional problems
Social and emotional problems are problems with fitting in, following rules and being social with other children and adults.

Most children sometimes have tantrums, get upset and push your boundaries. But children born prematurely are more likely to have difficulty coping with and managing their emotions. They can 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 early are more likely to have conditions like attention deficit hyperactivity disorder, autism, anxiety and depression than children who were born at term.

But these problems are still uncommon in children 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 also help to make some development problems less severe and help children with early delay catch up by later childhood or the teenage years.

Corrected age

Knowing your baby’s corrected age can help if you have development concerns.

Corrected age is your baby’s chronological age minus the number of weeks or months early they were born. 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 outcomes for multiple premature babies are similar to those for single premature babies.