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Expert Q&A:
At what age should we stop treating my infant as a preemie?

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David Schonfeld
Answered by David Schonfeld M.D.

"I became a pediatrician because I enjoy being with kids," says David Schonfeld. "I'm fascinated with the way that children view the world and learn to interact with it. I'm particularly interested in figuring out how to help children understand and adjust to illness and difficult situations, such as the death of a family member or a crisis in their family or community." 

Dr. Schonfeld is a developmental-behavioral pediatrician and the Thelma and Jack Rubinstein Professor of Pediatrics at Cincinnati Children's Hospital Medical Center (CCHMC). He completed the six-year B.A./M.D. program at Boston University, a pediatric residency at Children's Hospital of Philadelphia, and a developmental-behavioral pediatrics fellowship program at the University of Maryland before joining the faculty at Yale, where he worked for 16 years before relocating in July 2005 to Cincinnati. He remains as a Professor Adjunct of Pediatrics at Yale in order to continue his research in New Haven Public Schools. In July 2005, he became the new Director of the Division of Developmental and Behavioral Pediatrics at CCHMC.

Dr. Schonfeld is a member of the National Commission on Children and Disasters, the Mental Health Subcommittee of the National Biodefense Science Board Federal Advisory Committee, the American Academy of Pediatrics' Disaster Preparedness Advisory Council (having served on the AAP's Task Force on Terrorism), and the National Children's Study Federal Advisory Committee. He is a past President (2006-2007) of the Society for Developmental and Behavioral Pediatrics and past Chair (2004-2008) of the Committee on Pediatric Research of the American Academy of Pediatrics (AAP). He has served as a member of the initial Subboard of Developmental-Behavioral Pediatrics of the American Board of Pediatrics. 

His clinical expertise in pediatric bereavement and extensive experience in school crisis response led to his funding to establish a National Center for School Crisis and Bereavement at CCHMC. His research involves children's understanding of and adjustment to serious illness and death and school-based interventions to promote healthy behavior and risk prevention. He has authored elementary school curricula in both AIDS and cancer prevention education at the elementary school level, which have been evaluated through multiple randomized, controlled trials.

Dr. Schonfeld lives with his wife, Joanne, a landscape architect, and one of their two teenage daughters (the oldest attends college in California), who have tried patiently to teach him what he really needs to know about being a parent.

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Question


My preemie was born 10 weeks early. He is now 6 weeks corrected. I know they catch up by their second birthday, but at what age do we stop treating him as a preemie?

Answer


Infants born more than three weeks before their due date (in other words, before 37 weeks gestation) are considered premature. We don't expect such infants to be as advanced in their development as other infants of the same age, because they didn't have the chance to mature fully in utero before they were born. That is why we "correct for prematurity" on most tests of infant development. If you might expect a full-term infant to do something at 20 weeks of age, for example, you might not expect an infant born 10 weeks premature to reach the same milestone until closer to 30 weeks of age (20 weeks of age + 10 weeks correction for prematurity). This method of correction for prematurity is really just an estimate. Infants that are ill after they are born may take longer to catch up (since they don't learn well while they are sick), and some infants will need less time to catch up (if infants are healthy, they can learn some skills faster once they are born than if they had remained inside the uterus, since there are different opportunities for them to learn and interact with their environment once they are born).

We only correct for prematurity up until 2 years of age on most tests because after that point, a number of weeks doesn't make that much of a difference. It's kind of like the difference in ages of spouses. When they both are young, it seems like a big difference if one spouse is 19 and the other is 24, but by the time of the 25th wedding anniversary, the difference doesn't seem that great -- there is often a real difference in maturity between a 19- and 24-year-old, but not that much of a difference between a 44- and 49-year-old.

In many areas of health and development, such as getting immunizations, premature infants are treated based on their actual age. So your infant should be getting his first round of immunizations in a few weeks, at his 2-month checkup, unless there are major medical issues that preclude this. As for how you should treat your own child, I would suggest you treat your premature infant just as any parent should treat any infant -- based on what your child's current needs and strengths are. Once a premature infant has reached his due date and is well enough to be discharged from the hospital, you probably no longer need to treat him "as a preemie." If your child has some remaining medical problems that were due to being born premature, then you obviously need to attend to those needs. Ask your health care provider if you have specific concerns about your son's health. But if he is otherwise healthy, it's time to view him as a healthy child. He may have been born earlier than expected, but he's here now and that's what matters most!

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Member comments
Not catching up
My son was born at 36 weeks and i feel like hes not catching up as fast as im expecting him to. I do..

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