It’s not the same! 6 Ways Preemies Develop Differently From Their Term Peers

August 18, 2022

I'm katie, OTD, OTR/L, NTMTC, CNT & founder of blooming littles

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Premature babies are rock stars! I think most people who’ve seen one grow up can agree on that. They go from the coziness of the womb into this crazy world, and they learn to breathe, eat, gain weight, regulate their temperature…and during all of that they’re also building the foundation they need to do developmental skills and participate in “baby“ activities. 

Whew! It’s a lot. Did you hear me mention rock stars?

Because of everything preemies have going on, plus having underdeveloped and immature body systems and brains, they have a higher risk for having neurologic impairment or developmental delay. They are also at greater risk for having behavioral and social concerns, as well as a mental health diagnosis.

This is one HUGE reason why I created The Preemie Interaction eGuide! To walk you through every week of your preemie’s development while they’re in the NICU. With information about how they’re learning to move and interact, to specific ways you can support them along the way. 

You can learn more about the Preemie Guide here!

Those correlations between premature birth and more negative developmental outcomes is one of the reasons why you and I matter. The way we care for babies directly impacts their development. You CAN change the course of your baby’s development by being intentional in your interactions, by decreasing pain, supporting their body systems and building trust. If you’re looking for ways to create intention with your baby, here are some blog posts that will help you get started!


How to create a healing space for your baby in the busy NICU

In order to do our very best job at understanding how best to support premature babies so they can meet later skills like rolling over, sitting up, smiling, cooing, and engaging in play at the beach…we have to know what sets the development of premature babies apart from term babies.

As a developmental therapist in the NICU, these developmental facts guide my clinical decision-making as I interact and evaluate preemies on a day-to-day basis.

Let’s dive in!

1. Preemies typically have more hypotonia (which can feel like a “softer” or “floppier” muscle tone)

What is muscle tone?

Well, muscle tone is essentially how much tension your baby’s muscles have when they are at rest. Preemies commonly have what we call hypotonia, which means they have a low muscle tone.

What does that mean?

The muscles may feel squishy, and babies generally have to work a little harder to move and hold their bodies in certain positions. Or, it may make it more difficult for them to tuck their legs or bring their hands to their face while they move or learn to eat.

Hypotonia can lead to some body positions that are not supportive and can contribute to positioning concerns we’re often looking out for as developmental therapists.

Here’s one way to think about muscle tone. 

Think about a hair tie. When your hair tie gets old and isn’t stretchy, there’s less tension…which means you have to wrap the hair tie more times around your ponytail to keep it in place. That’s kind of what hypotonia is.

Another way I’ll describe it is that it can feel like trying to get out of a deep, comfy chair. You have to engage your muscles a little bit harder to stand up out of there.

Muscle tone is one of the big things we evaluate when we look at your baby’s neurodevelopmental status.

If your baby is diagnosed with hypotonia, they may qualify for early intervention therapy services. This is a great thing to ask your social worker, neonatal therapist, or medical team about.

2. Preemies have to cope with more stress than term babies.

Did you know it’s estimated that babies in the NICU experience average between 17-25 painful procedures a day? From a heel stick to a lab draw, there are a lot of essential tasks that medical providers need to do to care for your baby. 

Higher levels of pain and stress impact the way a baby’s brain connects, grows, and forms. And, this can influence a baby’s ability to communicate, learn social and emotional behaviors, or process sensory information.

Keep a lookout for your baby’s stress cues. And don’t forget about 10 of the most unexpected signs your NICU baby may be stressed.

That’s why I created this free webinar…to share some practical ways you can decrease your baby’s stress during painful procedures. You CAN have an impact!

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A post shared by Katie | NICU Therapist (@bloominglittles)

4. Preemies develop from feet to head instead of head to feet.

3. Preemies have to focus on basic body systems first before developmental skills.

When a baby is born full-term and without medical concerns, their body has matured to the point where it can process important tasks like regulating their temperature, breathing, and feeding safely, so they’re able to then work on developmental skills like looking at your face, smiling, kicking their legs, and touching their hands together.

If a baby is born prematurely, they often have to focus on those basic body systems first (thank goodness they’re so smart!).

So, for example, if your baby is requiring oxygen via a ventilator, their body is working hard on the task of breathing. And because of that, they won’t be showing you a lot of interaction cues.

Their body is prioritizing the super important things first!

Once they’ve learned to breathe and regulate their heart rate and hold their temperature, then they’re going to start working on some of those sweet developmental skills like bringing their hands to their face or kicking their legs back-and-forth.

Did you know that babies who are born term move through developmental skills from their head to their feet? 

This is why when you look at a baby who’s in the womb, their head is really big, and they have a smaller body. That brain is growing really rapidly!

Then after a term baby is born, they progress through developmental skills from head to toe. They are going to develop some head control before they are able to reach for something with their hands. Then they’ll progress to reaching for their toes and getting up on all fours into a crawling position

After preemies are born, they develop in the OPPOSITE direction, from their feet to their head. So their developmental progression may look like this…

Legs start tucking into their body.

Then, arms start coming together to midline.

Head control develops for turning their head side-to-side.

Amazingly, once a preemie reaches their due date, their development switches back to head to toe!

5. They have a harder time moving against gravity, so they have a lot of straight movement instead of tucked movement.

Let me tell you, friend…gravity isn’t just for astronauts to worry about. Gravity has a huge impact on preemie babies.

Because preemies generally have hypotonia, that low muscle tone, it makes it more difficult for them to hold themselves in that tucked body position we’re looking for. Gravity is working against them, making it extra difficult.

We don’t usually think about the impact that gravity is having on the way we move and experience the world, but in reality…if we drop something, gravity brings it to the floor. So it actually has a huge impact on the way we are engaging with the things around us.

As the force of gravity is pulling down on your baby’s arms and legs, it makes it a lot harder for them to move and gradually brings your baby’s arms and legs into a straight and flattened position. This is one reason why your baby may be swaddled or have some positioning equipment that keeps them all tucked up and cozy.

6. Preemies are often sleepier OR more excitable!

Have you ever noticed that your preemie seems to sleep a lot? Or maybe you’ve noticed that when you touch them, they wake up and seem almost hyper active? 

Preemies have a really hard time regulating how asleep or awake they are. They often jump between the two pretty quickly.

This means, preemies are generally sleepier OR more excitable than term babies. This can impact how they interact with you when you’re holding them, or how they engage during a feeding.

All of these developmental differences we’ve been talking about are rooted in research that compared preemies and term babies way back in the 80s and 90s. This research has continued as we work to create more supportive environments and experiences for preemies so that we can decrease the risk for some of those negative developmental outcomes.

Do any of these surprise you??

What’s a big milestone your baby has overcome recently?

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