Developmental Difficulties

When Premature Infants Fall Behind

By Gwen Morrison

When a baby is born prematurely or at a low birth weight, there may be developmental delays that are not seen in the early days of infancy. Often it is within the first few years that these delays, or other problems, are discovered.

"Children who are at increased risk for developmental problems include those born very prematurely or at very low birth weight," says Sheena Carter, Ph.D., a developmental psychologist at Emory School of Medicine in Atlanta, Ga. "While most prematurely born children develop beyond any problems associated with their early experiences, frequently there are developmental issues that need to be addressed as early as possible in order to prevent further complications."

Carter is part of a multidisciplinary team that provides developmental follow-up services to high-risk children served by the Emory Regional Perinatal Center. Carter stresses that periodic re-evaluation is important during infancy and early childhood, as most developmental difficulties emerge slowly over time.

According to Carter, "catch-up" refers to a more-rapid-than-typical growth to make up for the earlier loss in growth velocity. She says it does happen – typically for head growth shortly after term age and frequently for height in the preschool period, and sometimes as late as adolescence for height and weight. Not all children experience this catch-up, and some will always be small.

"Some of the variables that influence the potential for catch-up growth include size for gestational age at birth, genetic growth potential, nutritional factors and neurological injury," says Carter. "It is not possible to accurately predict the later growth of an individual child."

Jennifer Pinto-Martin is a nursing professor at the University of Pennsylvania who has been involved in the Neonatal Brain Hemorrhage Study, the largest regional study of premature babies. These babies have been studied for 14 years. "While many babies born prematurely do very well in terms of growth and development, many have physical and psychological problems that emerge as the child grows up," says Pinto-Martin. "We have found that poor school performance and the need for special education is not always recognized when the child first enters school, but may be more apparent by third or fourth grade."

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