It was a fall evening in Toronto when six-year-old Myles took to the ice at the Air Canada Centre to play Timbits hockey during a Maple Leafs intermission. Strong, aggressive and fast, Myles scored a goal. It was a monumental moment for the boy, and one that his mom, Sara Archambault, would have been hard-pressed to imagine when he was born extremely early, at 26 weeks and one day gestation, and a mere one pound, 11 ounces. “When I flash back to him crying in the incubator to just being so athletic and so confident, it’s amazing,” she says.
So just when do premature babies—most of whom are born between 32 and 36 weeks—catch up to their peers? “In terms of how the baby looks and for motor skills, in the first couple of years of life the baby will start to look like anyone else,” says Paige Church, a neonatologist, developmental paediatrician and director of the neonatal follow-up clinic at Sunnybrook Health Sciences Centre in Toronto. After the first couple years, a preemie’s height and weight will be largely determined by genes, rather than size at birth. Myles is now almost four feet, and one of the tallest kids in his grade one class.
Babies will meet milestones based on their corrected age—their chronological age minus the number of months born early. So, if your baby was born two months early, he’ll probably start sitting when he’s around eight to nine months old (compared with six to seven months old for a full-term baby), crawling by 10 to 11 months (versus eight or nine months) and pulling to stand by 12 months (instead of 10 months). By age two, he should be engaging in all the same physical activities that you’d expect of a two-year-old born at term. However, just like for babies born at term, there is a range of what’s considered normal. If your baby is meeting milestones out of order, though, or he doesn’t seem to be doing a skill the way you’d expect (like only using one side of his body when pulling up to stand), then that could be a concern, says Church.
Leonora Hendson, a neonatologist who runs a preemie follow-up clinic at Alberta Children’s Hospital in Calgary, adds that babies born extremely early (before 32 weeks, and especially before 28 weeks) who are dealing with health issues may take longer to develop motor skills. “The children who have lots of respiratory infections and respiratory problems are often more motor-delayed, because they’re going to use their energy on their lungs, not on sitting and crawling and rolling, because they get distressed,” she explains.
When it comes to language skills, a preemie often takes longer to catch up, says Church. Words start to emerge around 12 months corrected, and by two years corrected, kids should have a decent vocabulary and be combining two words together. “By somewhere between three years old corrected and three years old chronologic, we start to see them spontaneously stringing the words together into phrases,” says Church. She adds, though, that even if a preemie has caught up in expressive language (what she can say) by age three, she might still have difficulty with some of the subtleties and nuances of language, like understanding that some words have two meanings, or following very complex sentences, she says.
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The last thing to catch up for premature babies is social-emotional maturity, says Hendson, which can often persist into the early years of school. “Overall maturity can be a challenge,” says Hendson. “We also have children in our clinic who have a lot more trouble with attention, sitting still, focusing and being impulsive.” Hendson says this delay is no longer attributed to simply being born early, but rather the way the brain develops after it’s out of the womb.
“We know that babies grow their brains best in utero. We do the best we can in the NICU, but it’s an abnormal environment,” says Hendson. Church adds: “The part of the brain that’s developing in the NICU experience is the part that does some of that higher-order thinking, organizing and the social stuff, so it would make sense that the development of it may not be as robust, and it may take some exercising and time for it to catch up.” She adds that the younger the baby is when it’s born, the greater the potential for any issues, including health and behavioural challenges.
Church recommends short playdates for a preschooler struggling with fitting in with his peers, and perhaps enrolling him in day programs, like library, music or gymnastics, or even part-time daycare if it’s an option. Both Hendson and Church recommend thinking about holding your premature baby back a year from entering kindergarten, to give him a chance to develop those motor and social skills.
While Myles was walking by age one, by age two it was clear his speech was delayed. “It came out very aggressively,” says Archambault. “He was hitting, biting and fighting.” Myles started speech therapy and by three and a half, his language was “through the roof” recalls his mom, but he still struggled with impulsive and aggressive behaviour when he started kindergarten.
Archambault has kept in close contact with Myles’ teachers to deal with his behaviour, and she enrolled him in hockey at the suggestion of another parent. “It’s become his outlet,” she says. “He can still be a bit defiant. He is still very impulsive. But his grade one teacher has been able to rein him in.” Archambault says his confidence has spilled over into his academics, and he is now excelling at reading and writing. “What more could you ask for, from a rocky start to where he is now?”