Growth and development for premature babies

How might prematurity affect my baby’s growth and development?

Babies who are born early (known as premature or preterm babies) have a higher chance of not meeting their growth and development milestones compared to babies born at term. The earlier in pregnancy your baby is born, the higher their chance is.

This is because they’ve had less time to grow and develop in the protective environment of your uterus.

Most preterm babies will catch up and develop just like other children their age. Those who have developmental concerns will mostly have mild disabilities that don’t stop them living a happy and independent life. However, some may go on to have serious disabilities.

What developmental concerns could my premature baby have?

Developmental issues may include:

• cerebral palsy
• difficulties with vision or hearing
• learning delays
• autism
• attention deficit hyperactivity disorder (ADHD)
• difficulties or delays with gross motor and fine motor skills
• difficulties or delayed speech development

You might first notice some of these when your child is a baby or a toddler. Other issues may not show up until they go to school or not at all.

How will my premature baby’s growth and development be checked?

All children in Australia are entitled to free visits with a child and family health nurse to monitor their growth and development. These visits are timed at important stages in your child’s development, from birth until they start school. This helps detect issues as early as possible so your child can be offered treatment and support.

Your child health nurse will weigh and measure your baby to check that they’re growing well. They will also check that your baby is reaching the developmental milestones expected for their age. They can do this by examining your baby and asking you to fill out a questionnaire.

Babies born after 32 weeks

If your baby was born after 32 weeks, weighed more than 1500 grams and had no major health concerns, visits from a child health nurse might provide all the monitoring they need.

If your child health nurse thinks that your baby is not growing or developing as they would expect, they might invite you for extra visits. They might advise you to see your doctor or refer your baby to another health professional such as a physiotherapist or speech therapist.

Babies born before 32 weeks

If your baby was born before 32 weeks, they have a higher chance of growth and development delays and health issues in general. It’s important to have regular check-ups with a doctor or child health nurse at 4 months, 8 months, 1 year, 18 months and 2 years of corrected age. It’s recommended to continue these check-ups until they are at least 4 years old.

Your doctor or child health nurse will refer your baby to a specialist growth and development clinic if there any health concerns. Some babies born before 32 weeks are routinely referred to a specialist growth and development clinic. Different hospitals have different guidelines about this.

When your baby is ready to go home from hospital after birth, their doctors will tell you if they recommend going to a specialist clinic.

Will my baby's corrected age be used?

Yes. If your baby was born early, their growth and development will be checked according to their corrected age. This refers to how old they would be now if they had been born on their due date.

Your baby’s corrected age will be used until they catch up to other children their age. This usually happens by the time they turn 2 or 3 years.

How do percentile growth charts work?

A growth chart is a graph that shows how well your baby is growing. You can’t tell how your baby is growing from a single measurement — you need to see a pattern over time.

There are charts for weight, height and head circumference (the measurement around your baby’s head). There are different charts for males and females.

Each time your baby is weighed and measured, a mark is made on the chart. These marks are compared to the curved lines on the chart. Each line represents a healthy growth pattern.

The lines show you what percentile your baby is on. This just means how big they are compared to other babies their age. It usually doesn’t matter where your baby is on the chart, as long as they are growing along their curve.

What developmental milestones can be expected?

You can use the following lists as a guide to what babies can do at different ages. These are called developmental milestones.

1 to 2 months corrected

Your baby will probably be able to:

• smile
• make eye contact
• move their arms and legs, but not in a controlled way

4 months corrected

Your baby will probably be able to:

• laugh and make sounds like they’re trying to talk
• turn their head to find a voice or sound
• follow a moving object with their eyes
• hold their head up
• hold a toy if you put it in their hand
• put their hands and toys in their mouth
• lift up their head and chest while lying on their tummy

6 months corrected

Your baby will probably be able to:

• sit while being supported
• roll from tummy to back and from back to tummy
• reach out to take a toy
• control their head movements
• bear their weight on their legs while being held

9 months corrected

Your baby will probably be able to:

• babble with many different sounds
• sit up by themselves
• crawl or pull themselves across the floor
• recognise people they see often
• react when you call their name

1 year corrected

Your baby will probably be able to:

• pull themselves up into a standing position
• walk around furniture
• pass things from one hand to the other
• feed themselves with their hands
• show they are anxious around strangers
• enjoy looking at picture books
• clap their hands

Your baby will probably be able to communicate by:

• pointing to things they want
• understanding a few words
• waving goodbye

2 years corrected

Your baby will probably be able to:

• walk and run
• climb onto things
• throw, kick and roll a ball
• scribble with a pencil
• eat with a spoon
• drink from a cup

Your baby will probably be able to communicate by:

• saying about 50 words
• putting 2 words together
• understanding simple questions
• following simple instructions
• naming 5 different parts of their body

How can I support my premature baby’s growth and development?

You can help your baby by staying positive, working together with their team of health professionals and seeking help early if you’re concerned.

You can support your baby’s growth by making sure they are getting enough breast milk or formula. You might be advised to give them vitamins or extra calories — only do this if your doctor has recommended it. Once they are eating solids, offer them a variety of healthy foods.

Avoid smoking — this can affect your baby’s growth.

You can support your baby’s development by:

• making eye contact, smiling and talking or singing to them
• copying their expressions or sounds
• giving them toys to look at and hold — especially rattles, picture books and toys with different textures and colours
• giving them a massage
• putting toys above them and on either side to look at
• putting them in different positions — on their back, in a bouncy seat, cuddled or swaddled
• checking that they turn their head equally to each side

It’s important to give your baby tummy time. This helps them learn to control their head, neck and shoulders. During tummy time, make sure that your baby is awake and never left alone.

How can I use milestones positively?

It’s helpful to know which developmental milestones your baby should be reaching at their current corrected age. You’ll have a better idea of how to play with your baby in a way that encourages their development.

You’ll also notice if your baby is not doing what’s expected and can take them to the doctor or child health nurse to be checked.

Resources and support

If you are concerned about your baby’s growth or development, talk to your doctor or child health nurse.

Visit Miracle Babies or Life’s Little Treasures for information and support.