Developmental strategies for the preterm baby in the first year - Sunnybrook Neonatal Follow-Up Clinic
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Developmental strategies for the preterm baby in the first year

These recommendations are based on corrected age. Your baby’s corrected age is calculated based on your baby’s original due date.

First Month


  • Sometimes babies who spend time in an NICU have difficulty calming themselves, so the use of a soother is a good calming strategy.
  • Sucking on a soother has been shown to be an effective strategy that will calm and keep the baby calm.
  • When a baby is calm, this helps the baby learn about their environment and their caregivers.
  • The best shape is one that is round and not flat on one side. This shape promotes normal tongue action.

Midline head

  • By making a roll and placing the baby’s head on it, this will help the baby keep the head in midline. By keeping the head in midline, this can begin to assist the baby to make eye contact.

Second Month:

Play mats and tummy time mirror

  • It is time for “tummy time” to be on the floor. Lots of tummy time will help your baby’s will increase the strength of the abdominal and shoulder muscles. This will help the gross motor skills such as sitting, crawling and eventually walking.

Eye contact and smiling:

  • With every opportunity you want to encourage eye to eye contact which is different than following a toy or object around the room. Eye contact is the beginnings of language and learning. With time, you want to encourage longer and longer eye contact. Your face is the best toy!
  • In addition, you want to ensure that your baby can look to the right and to the left equally.

Third Month:

  • Hurray! More tummy time on the floor!
  • At this point, babies are staying awake for longer periods. Therefore, there are more opportunities for more tummy time!
  • For every half hour that they have been awake, they should be doing a couple of minutes of tummy time to build their tolerance
  • Tummy time tip: make sure they are putting weight through their forearms.

Fourth Month:

  • Floor seat – always put the seat on floor for safety.
  • Promote pivoting on tummy – place toy at each side to encourage your baby to look from side to side and eventually reach and start to move.

Fifth Month:

  • Start giving food by spoon.
  • Put your baby in a high chair with slight recline for good support while they are learning to eat more solid foods.
    • Regarding the introduction of solids: guidelines tend to vary, but recommendations typically state no later than 6 months and no earlier than 4 months. But guidelines also note that readiness for solids needs to be based not only on age, but other indicators which include the ability to sit with support and showing interest or readiness. Generally, for the large majority of our preterm population these behaviours are evident at approximately 5 months corrected age, however this is individualized according to need.

  • You may start with purees or slightly thick food.
  • Smooth textures are better, avoid lumps.
  • Offer one new food every 3-4 days.
  • You can start with cereals, fruits or vegetables or meat.
  • Protein (meat, beans, lentils, eggs) and fat (avocado, yogurt, butter, margarine, olive oil) are important for growth and brain development.
  • It is recommended to start peanut butter between 4-6 months to avoid the risk of peanut allergy.
  • Messy is learning!

6 Month:

  • Using a ball to encourage propped sitting
  • Two hands forward on the ball for support

7 Month:

Begin to encourage self feeding – puffs, “crunch and melt” textures, crackers.

8 Month:


  • To achieve independent sitting, the hands are not being used for support
  • Encourage two hands for play
  • If sitting is still unsteady, you can use a box, laundry basket for support
  • A basket in the tub can make bath time easier and safer

Side sitting – to move out of sit towards tummy.

  • Place toy at 45 to encouraging reaching towards the side 

9 Month:

  • Elevated sitting can occur on a box, pot or stool to strengthen independent sit balance.
  • You can also place the box in front of a small table to encourage sit to stand.

10 Month:

  • Standing at a table or support
  • Getting to stand independently, through half kneel.
  • Your baby will get to stand on their own when they are ready.
  • Encourage baby to turn around from side to side.
  • Encourage baby to side step “cruising” to left and to right.

11 Month:

  • Using a push toy to encourage supported stepping.
  • A push toy such as a shopping cart or a wagon can be made more stable by placing heavy objects (bag of sugar, rice or apple juice cans) in the basket. This will ensure that the toy will move more slowly.

12 Month:

  • Brief independent standing may start to occur. Some babies, but not all, may be taking a few steps.