To understand your preterm baby’s development, you need to understand the idea of corrected age. The corrected age (c.a.) is calculated from the date your baby should have been born. The chronological age is from the actual birth date.
Especially in the first year, your baby will be developing according to his corrected age, not his chronological (actual) age. His growth, feeding schedule, and overall development, gross motor skill (movements with his arms and legs) and fine motor skill (movements with his hands and fingers), will follow his corrected age. The same applies to his social skills (eye contacts, smiling), and his speech (making sounds-vowels, and the consonants).
Muscle tone is a major factor in how a premature baby’s motor skills develop. A full-term baby usually has normal muscle tone. He’s able to keep himself in a nicely flexed position with arms and legs tucked into the body.
A premature baby often has less muscle bulk and is usually “hypotonic”. This means her muscles are loose and floppy. It will often be hard for her to stay in a flexed position. Instead, she may end up with a more “frog-like” posture. Her trunk may look flat when she’s lying down, rather than rounded.
At first, the baby’s legs may seem stronger because he can pull them up into a flexed position more easily. The arms are weaker. Usually, the baby will hold his arms out at the side. There will only be short moments when he can bring his hands to midline (towards the middle of his body). It’s hard for these babies to keep their hands in their mouths and to stay in a nicely flexed position.
... especially through the trunk, they attempt to gain some control by fixing or stiffening their muscles. They may arch their head, neck and trunk. They may lift their shoulders, make fists with their hands, and/or stiffen their legs and point their toes. As they grow stronger and get more control through the trunk, these other areas will start to relax.
Often babies with weak abdominal muscles will have an umbilical hernia. Usually the hernia goes away when the abdominal muscles become stronger. Your doctor will monitor this.
Premature babies may appear to be constipated and to strain when they have bowel movements. However, their stools are often not hard. The problem has to do with the weak abdominal muscles. The abdominal muscles have to be strong to move the stool out.
There are a number of cues or signs that your baby may give you to tell you whether she is ready for play or other interactions, or whether she is being stimulated too much and she needs a break.
These may be signs your baby is ready to interact:
These signs say “time out”; your baby needs a break:
Keep your baby flexed or curled up.
At first, provide as much support as you can. Then, as your baby is more able to control his own body, you can take away some of the support.
There are many ways to get close to your baby. Touch is the most useful when the baby is stable and showing you signs that he wants to be touched.
Babies love to be carried. Once your baby is stable enough to come out of the incubator, feel free to pick him up and soothe him. Throughout the world, lots of parents carry their babies around with them often. You can carry your baby in your arms, in a sling, or in a front baby carrier. Just make sure that your baby’s head is always well supported.
Many studies show that when parents give their premature babies regular touching, stroking, and loving contact, the babies benefit. They show better growth and development; they take in oxygen better; and their heart rates slow down during and after the massage. While your baby is in the NICU, the staff might encourage you to massage him with oils and creams.
Massage involves things like eye contact, skin-to-skin contact, cuddling, soothing sounds, and smiles, and the smells of the oils or creams. All these things will help you and your baby feel a special closeness. Even when your baby is home, giving him regular massage will help him. You can also use message to help your baby calm down if he is stressed.
To get help or training to massage your baby, please ask the nursing staff for more information and resources.
“The Next Steps? Caring for your Preemie at Home” with permission from the Canadian Institute of Child Health.