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Supporting Your Preemie's Development

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by By Joy Browne, R.N., Ph.D.

Babies born early can be the most sensitive and wonderfully responsive infants. Parenting a preemie means learning about the abilities of these amazing newborns and understanding the challenges and rewards of their development.

Preemies can test ideas about parenting. Many babies born early have difficulty staying awake, taking in sights and sounds, and responding positively to touch. Sometimes parents feel inadequate if they are unable to establish eye contact or to feel the special bond created by positive responses to touching and looking at each other.

But remember that your baby may be using a lot of his energy eating, growing, and blocking out intense light and sound. There might not be a lot left over for social interaction. Understanding when your baby is available for interaction, and when he isn't, is important for beginning a positive, nurturing relationship with him. These early, emerging relationships are critically important for his cognitive and emotional development later on.

  A Preemie's Signals

  Parents' Strategies

A Preemie's Signals

Babies are able to communicate their needs through their movements, their ability to become alert or go to sleep, and their physiologic reactions such as changes in breathing and skin color. Infants born early may be more sensitive than full-term infants and react to even slight changes in their environment and handling.

"I'm overwhelmed." Signals that a preemie might need to slow down or take a break include:

  • faster breathing or pauses in breathing
  • bearing down (as if having a bowel movement)
  • paling or reddening of skin color
  • yawning
  • hiccupping
  • changing body tension, such as extending legs or arms or going limp
  • sudden jerky movements, twitches, startles
  • arching
  • sticking out tongue
  • getting fussy and staying that way for a long time
  • looking away during social interaction
  • going to sleep when he's supposed to be awake

  • "I'm ready." Signals that a baby is more organized and able to handle incoming information include:

    • steady breathing rate
    • stable skin color
    • soft movements of arms and legs
    • quiet alertness
    • looking steadily at a face or object
    • going to sleep and sleeping peacefully at appropriate times so he's got energy, when awake, to take in information

    "I'm helping myself."Babies also have their own strategies for becoming more organized. These include:

  • grasping and holding on to blankets, your finger, or other objects
  • bracing their feet on the bedding
  • putting their hands on their face or into their mouth
  • sucking on a pacifier or a finger
  • tucking their bodies by bending arms and legs forward

  • Each baby organizes himself differently, which helps him take in new sensations in his own way. You'll soon be familiar with your own baby's special ways of communicating and be able provide the support he needs to interact with the world. This emerging relationship with your baby is the most important foundation for his physical and emotional development.

    For more on understanding your preemie's signals, click here.

    Parents' Strategies

    Understanding how your baby communicates is the first step to a nurturing relationship. The next one is supporting your preterm infant's emerging organization. The following strategies will help.

    Provide a soothing environment. As you already noticed, your baby may be sensitive to light, sound, or new experiences. Be especially careful when she is tired or trying to concentrate on difficult skills such as feeding or listening to your voice. Be aware of places and situations that tend to be overwhelming to her, and try to avoid them. Just taking a fragile infant to a grocery store may be too much sensory input; she may need more time and maturity to be able to handle all the stimulation a trip like this creates.

    Be aware of pacing and timing. Preterm babies are working on organizing their sleep-wake schedules as well as coping with caregiving from different people. Their sleep may sometimes be interrupted, or they may be rushed through a diaper change. Be sensitive to your baby's need to wake on her own. Look for signals that she is ready for play. Match your handling of her or your social interaction to what her signals tell you. Be sure to give your baby pauses when she needs to recover or take a nap.

    Offer continuity and predictability. Just like most adults, babies need to know what to expect next. It reduces anxiety and helps them perform better. Providing a set daily schedule, using the same caregiver, and putting the baby to sleep in the same bed are examples of how we can create an organized and predictable world for them. This helps them feel safe so they relax and learn new skills more easily.

    Supplement your baby's efforts to help herself. As they grow, babies learn to do things for themselves, and they feel the pleasure of success. However small, attempts to calm themselves—sucking on a hand, for example—are rewarding and set the stage for more tries. A fragile baby may need additional help. One way is to support her shoulder so she can move her hand to her mouth to suck on it more easily. Another is using your arm to let her brace her foot so she feels more stable. These small supports have a big impact on your baby's achievements. And they just may help put off a fussy period.

    Handle and position her carefully. By now you know about the importance of putting your baby to sleep on her back. When your baby is awake, it is important to move her gently and slowly. Babies who have been born early are still working hard to move smoothly and to keep their arms and legs from dangling or extending. Holding your child close so she feels support and warmth from your body or swaddling her in a blanket will be necessary until her movements are more purposeful and controlled. Preterm babies sometimes have difficulty with fast movements, and you're likely to see "I'm overwhelmed" signals when they are moved quickly or without a blanket or body support.

    Let your baby be your guide to interaction. The periods of play and wide-eyed alertness that parents so enjoy may be limited at first. Babies need to conserve their energy by resting and sleeping. But as they mature, that changes. At first, when you try to look at and talk to your baby, she may look away, fall asleep, or become limp. Your baby is signaling that she's not ready to look, listen, and move all at the same time. If that's the case, limit your interaction to letting your baby just look at your face. Later you can use a soft, whispering voice to encourage her to follow the movement of your head as you slowly move it from side to side. But for the time being, respect your baby's signals by looking away or by being quiet. You're giving her a break so she can get ready for more interaction. Feeding is an especially difficult time for many fragile infants because it takes so much concentration and organization to eat, look, and listen. Being quiet during this time might be the best strategy. Your baby will signal when she can handle more stimulation.

    Pay attention to yourself. The birth of a baby is a challenging time for the whole family and for Mom in particular. Caring for a preterm baby adds extra tension. That's why it's important to ask for emotional and physical support from friends, family members, care providers, and counselors. You want to be in the best shape possible to help your baby, and that means paying attention to your own needs, too.

    Joy Browne, R.N, Ph.D., is assistant professor of pediatrics at the University of Colorado School of Medicine and director of its Center for Family and Infant Interaction. She also directs the Colorado Newborn Individualized Developmental Care and Assessment Program (NIDCAP) and the Family Infant Relationship Support Training (FIRST) program and is president of the Colorado Association for Infant Mental Health.


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