Understanding Preemie Development

One of the most exciting things about having a baby, is watching them grow, develop, and learn.

Our hearts sing when our baby smiles for the first time.

Our eyes well up with tears of joy as we hear our baby’s first laugh.

We celebrate as our baby sits up on their own, crawls, pulls up, stands, walks.

These are all exciting milestones that our babies achieve, but sometimes it can be a bit nerve wrecking for the parents of premature babies, as we wonder if our babies will ever check off those milestones.

Premature babies have to play catch-up, in a sense. I’ll use my son’s timeline as an example, though my son has been doing extraordinarily well, and was sometimes ahead of schedule, even.

My son was born at 29 weeks (and 2 days) gestation, meaning he still had about 11 weeks that he was supposed to cook. He had almost 3 months that he was supposed to grow and develop in utero to prepare for the outside world.

Instead of doing that growing where it would have been easy peasy, he had to do it in a hospital incubator.

Lungs that should not have had to work yet were figuring out how to breathe.

Eyes that should have been developing further were straining to see.

Limbs that should have been tucked up snug and tight were free to flail and grasp.

When my son was born, he was not a typical “newborn”. He was not a full term baby, which means, regardless of how well he did while in the NICU, he was not ready to be in the world 11 weeks early.

My son came home after a 52 day stay in the NICU (23 days before his due date), weighing just over 4 pounds. He was still on his NICU schedule of eating every 3 hours, day and night (I had to wake him in the middle of the night to feed him, because he would not wake himself to eat).

When June 21st, 2018 came (his due date), we started measuring milestones. We used (and still use) his due date to gauge at what rate he “should” be developing. Technically, by that point, he was almost 3 months old.

Most 3 month old babies start tracking with their eyes, holding their head steady, coo-ing, rolling over, etc. My teeny tiny little 4 pound baby was not ready to do any of those things! My itty bitty mister was working on newborn milestones. He was working on eating a bottle and keeping it down, instead of projectile vomiting it everywhere. He was practicing staying awake long enough for me to gush over him and cover his toes in kisses.

Technically, my son got a sort of “head start” in the world (though, I don’t see it that way and I’m sure other preemie parents would agree with me that an early start is not a good thing in this situation) but he was also developmentally behind.

In the preemie world, we refer to our babies age by their “actual age” or their “adjusted age”.

What does that mean? Thanks for asking! Let me explain.

A baby’s actual age is just that, the age they really are.

A baby’s adjusted age, is how old they would be had they been born on their due date.

That means, that on June 22nd, 2018 (the day after my due date), my son’s actual age was 10 weeks and 6 days old, but his adjusted age was 1 day old.

There is a big developmental difference between a baby nearly 3 months old, and one just born, and our expectations for what those babies should be able to do is dramatically different, would you not agree? Please say yes.

Now, as the mother of a handsome, preemie, baby boy, I have stressed myself out far too much over milestones, actual versus adjusted age, and when he “should” be achieving different milestones. I use the quotes around the word “should” because babies do everything on their own timeline, regardless of if they are born early, at term, or late.

Of course, I’m not a medical professional in any sense of the word, but it seems to me that babies don’t care what the experts say or recommend. They don’t care that the other babies in daycare already started aahing and cooing, or that none of the other babies have started to pull up to a stand yet. Babies do what they want, when they want (for the most part) and we just go along with it and try to encourage them as best we can.

Back on track though, even full term babies can be late in achieving their milestones. As a preemie mom, I stressed far too often about my son not hitting milestones when the books said he should. I had to remind myself all the time that while his actual age was 6 months, his adjusted age was closer to 3 months. Now that my son is almost 1 (which I’m having a hard time wrapping my head around) I have to remember that his adjusted age is more like 9 months.

My son cannot yet get from a prone position to a seated position by himself yet.

My son does not yet crawl.

My son has not yet started really saying “mama” or “dada” (other than mingled in with baby babble).

My son can sit without support.

My son does pull up to a stand (though he only does it when someone reaches out to him and he uses their hands to pull up).

My son has started feeding himself finger foods like a champ.

Notice, he does things that othrt 9 month old baby do, not things a 1 year old does. Guess what, that’s totally normal for a preemie! As far as our pediatrician and I are concerned, he is right on track, as he should be.

Sure, he is still a little guy and can still fit into some 3-6 month clothes, but he is developing as he should. He has come a long way from his 2lb 14oz beginning, and I am darn proud of him!

I have had strangers tell me that he’s too small for his age.

I’ve been told that I should get him into physical therapy or occupational therapy to get him crawling, because he is almost 1 and hasn’t started crawling yet.

People that don’t understand prematurity are trying to rush him, when he’s exactly where he should be.

A premature baby won’t likely catch up to their peers in development until approximately age 2, give or take. Some premature babies will always be smaller than their peers, while others grow to 6 feet tall! Just like full term babies, our preemies will develop and grow at their own pace, and they will check off their milestones as they are ready.

It’s hard to see other babies the same age as your child meeting their milestones, but keep in mind that your little miracle is working harder than his full term peers, and he is absolutely perfect going at the pace he is.

She may be a little behind other babies in her actual age group, and possibly even behind babies in her adjusted age group, but never forget where she started and how far she has come.

Our babies had a difficult start, and they are rockstars, checking off goals as they are ready.

So don’t let anyone tell you that your baby is anything less than absolutely perfect, and don’t stress when they take their time growing up.

Enjoy it.

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