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

Look how far you have come!

As you read through all of this, it is important to remember that your baby came early. While the time in the NICU was important and hard to forget, it is also important to remember that your baby’s brain reached the same level of maturity or development around the time of your expected date of delivery – not when he or she was born. So as you read this, we are referring to ages for your baby based on your expected or due date. Some people refer to these dates as ‘corrected dates’.


1st Month Corrected:

Congratulations on your baby getting to this important milestone! You may be feeling excited or anxious to get started with ‘exercises’ or activities to help your baby’s development. For now, we want to focus on helping your baby to learn about you and how to calm him or herself.

Here are some strategies to do this:

Soother

Sometimes babies who spend time in an NICU have difficulty calming themselves, and the use of a soother can be a good calming strategy.

Sucking on a soother has been shown to help babies calm down and stay calm.

When a baby is calm, this helps babies 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.

SootherMidline head

Premature babies can have difficulty holding their head in the midline as their tummy muscles can be weak. They have not had the chance to use them as much as babies born at term. Helping a baby to hold his or her head in midline allows them to look at you and make eye contact. In order to do this, you can make a roll as shown to help your baby for now.

Baby


2nd Month Corrected:

Now your baby is another month older! Hopefully with time, your baby is more comfortable calming him or herself and you have learned strategies to help your baby with this. Now it is time for ‘Tummy Time’!

We recommend that ‘Tummy Time’ always occurs on the floor, to keep your baby safe. Mats such as these shown allow for a soft surface that can be cleaned and set aside for your baby.

Tummy time on a mat

Lots of tummy time will increase the strength of the abdominal (‘tummy’) and shoulder muscles. This will help with future skills such as sitting, crawling and eventually walking. For more information on how to do ‘Tummy Time’ with your baby, please see our ‘Tummy Time’ video!

We also want to work on your baby’s eye contact and the beginnings of a smile! 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 with a loved one 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.


3rd Month Corrected:

Onward you go!                                                                                                                

At this point, your baby is probably staying awake for longer periods. Therefore, there are more opportunities for Tummy Time!!!

As a goal, we would recommend that for every ½ hour that your baby has been awake, he or she should be doing a couple of minutes of tummy time to build their tolerance. For some parents, this is done with every diaper change as that is a great opportunity for your baby to have some time on his or her tummy. A BIG ‘Tummy Time’ Tip – make sure they are putting weight through their forearms by having his or her arms out in front of his or her shoulders.


4th Month Corrected:

Your baby is increasingly curious which is great. It can now be a great opportunity for a seat on the floor, to allow them to be upright and supported, safely. Always put the seat on floor for safety! There are many different models and many can be bought at second hand stores or passed down from a friend or family member. We have posted one photo as an example of the support we would want for your baby at this stage, with the higher back and sides so that your baby is nestled into the seat. You can put a tray or box in front to allow him or her the chance to play with toys while they sit. This is a type of ‘Tummy Time’ sitting up.

Baby in a seat on the floor

We still also want lots of time on his or her tummy! We can add new challenges with starting to promote pivoting on your baby’s tummy. This can be done by placing a toy at each side (sort of off of his or her shoulder rather than right in front of his or her face) to encourage your baby to look from side to side and eventually reach for the toy and start to move!


5th Month Corrected:

Lots of more exciting changes are greeting you every day. As your baby approaches his or her fifth month, he or she may be seeming more and more interested in what you are eating. In order to introduce solid foods, we recommend that you put your baby in a high chair with slight recline so that they have good support while they are learning to eat. We recommend that you start your baby with pureed or soft food and that you start with smooth textures, not lumpy. For babies that have been in the NICU, and have often had lots of things put into their mouths while there, the babies can develop sensitivity or an increased awareness of the mouth. By keeping the food smooth, it may be easier for your baby to expect and learn to feed. In order to know if your baby has a reaction or allergy to a certain food, we recommend offering a new food every 3 to 4 days to allow time to check. There is no special order that you have to follow to offer your baby solid foods. Some parents start with vegetables or fruits, others with cereal or meat. It is important to know that protein (which comes in the form of meat, beans, lentils) and fat (avocado, yogurt, butter, margarine, olive oil) are important for growth and brain development and should be included as you advance or offer more and more foods.

Certain foods are not recommended early, including peanut butter, eggs, and dairy as they can be associated with allergies that can be significant. These foods can be introduced as your baby becomes a bit more comfortable with solids, closer to the second half of his or her first year.

And remember, messy is learning!

Baby with a messy face


6th Month Corrected:

Your baby is amazing you every day! As your baby approaches the 6th month corrected, he or she may be sitting more and more independently. One thing you can do is use a ball to encourage propped sitting. Please see the picture and note that your child’s two hands should come forward on the ball for support.

Baby on a mat with a ball


7th Month Corrected:

It just keeps getting better and better. Your child is now probably increasingly showing his or her independence and may be expressing an interest in feeding him or herself. We want to encourage this! To start, you can offer foods that are often called ‘crunch and melt’ meaning that they are crunchy to start and then melt or dissolve when they get wet. They include crackers, Cheerios, or puffs. This is also a great way for your child to start to explore different textures, and your child handling the food first with his or her fingers, it prepares them for what is to come!


8th Month Corrected:

As you baby grows, he or she is getting stronger and stronger. You may find that your child is starting to work on sitting on his or her own, without using his or her hands for support. This allows your child’s hands to be free to play! If your child’s sitting is still unsteady, you can use a box, laundry basket for support such as these beautiful models in the photos. Remember this is for the floor!

Baby in a basket

Also a basket in the tub can allow for safer and easier bath times. Remember you must be with your child at all times!

Baby in a basket

The other skill your child may be working towards is getting out of a seated posture and back on to his or her tummy to explore. You can work on helping your child to do this by teaching them to ‘Side Sit’ which allows your child to move out of sitting and towards his or her tummy . In order to do this, place a toy at an angle, off of your child’s side.


9th Month Corrected:

By now, your baby may be already very comfortable sitting and moving from sitting to elevated sitting, or sitting on something. Elevated sitting can occur on a box, pot or stool to strengthen independent sit balance.

You can place the box that your child is sitting on in front of your child to create a small table. This will start to encourage and provide opportunities for your child to go from a seated posture to standing.

Baby sitting on a box


10th Month Corrected:

As your child continues to grow and become increasingly curious, he or she is going to want to start to stand up! This can be encouraged by placing your child near a low table or support, to allow him or her to pull up through a ½ kneeling position.

There is no rush and every child is unique. Your child will get to stand on their own when they are ready!

Baby holding table edge

Once your child is pulling up to a stand, you can encourage him or her to turn from side to side and start to take steps to the left and right. This is called ‘cruising’.

Standing baby


11th Month Corrected:

As your child becomes more and more adventurous, he or she may want to start to take steps but not be ready to do so on his or her own. Using a Push toy is a great way to encourage stepping as it provides support. A push toy such as a shopping cart or a wagon can be great objects but may be too fast for your child. They 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 and give your child time to master their skill.

Baby with push toy


12th Month Corrected:

One year! How exciting! You may find your child is interested in moments of standing or maybe even taking a few steps on his or her own, without any help! That is great! You may also find that your baby is not quite ready and that is great too. Every baby is different and there is much more than just strength that determines when a child will stand and walk.

Baby taking steps


We hope that this helped you as you navigated that first year, filled with firsts and exciting developments! Now on to the next year filled with more exciting developments!