Social communication: What preemies and their families need to know

Making and keeping friends

Making friends and keeping friends can be difficult for any child. Children who were born premature might have particular difficulties with the social communication skills needed to make and keep friends. When people talk about “social communication skills” they are usually referring to what someone does when interacting with other people. These skills can affect how a child makes and keeps friends and how well the child is liked by his/her peers – all of which can have an impact on a child’s enjoyment of school, academic skills, mental health, and communication skill development.

Struggles with social communication are common. When a child has trouble fitting in, it can be stressful for the child and their parents. The child’s difficulties may be related to one or more of the following social communication difficulties:

  1. The child has not yet developed the social communication skills to interact successfully with their peers in at least some situations. These skills might include paying attention to others, playing in a way that allows others to enjoy the activity; engaging in back-and-forth conversations and considering others’ needs and feelings;
  2. The child may want to interact and knows what they can do to join their peers but their timing may not be ideal (e.g., telling a joke at a time when people are discussing something serious). This may result in peers moving away from the child;
  3. The child feels uncomfortable (e.g., shy, anxious) interacting with peers despite having developed the necessary skills. This may lead to the child not trying to join peers;
  4. The child’s attention is constantly changing, making it difficult for peers to pay attention to each other.

Strategies to help your child develop social communication skills

Problems fitting in and making friends can be complicated, and so solutions might involve using more than one strategy. Social communication support must be tailored to the needs of your child, your family, and school. It is generally true that:

  • The goals set and strategies used must be a good match for your child’s particular needs;
  • Skills should be taught in ways that allow your child to practise in real life;
  • The child must feel successful practising these new skills;
  • People close to the child (like parents, peers, and teachers) are involved and can help the child practise these developing skills.

It can be helpful for parents to learn more about social communication skills and strategies that help them develop so they can support their child whenever opportunities to interact arise.

The Neonatal Follow-up Clinic at Sunnybrook can support parents and educators with information and resources to help children develop important social skills.

Navigating the social world

Background on social communication skills

As children get older, there is an unspoken expectation that every child will learn how to successfully navigate the social world. Some children seem to do this well without even trying; they make friends easily, they are well liked by their peers, and they appear to enjoy opportunities to interact with same-aged children. Even the most socially skilled children may struggle along the way. For some children, the struggles can be persistent and a source of stress and worry for the child and their parents. Determining which skills to focus on and which strategies will help the most is an important first step. Professionals with expertise in social communication can help you with this (e.g., speech-language pathologist, occupational therapist, psychologist, behaviour therapist, paediatrician, etc.) We at the Sunnybrook Neonatal Follow-up Clinic can help!

What is the relationship between preterm survivors and social skill development?

Research suggests that preterm survivors are more likely to struggle in some aspects of social functioning as compared to their term born peers.

How can we help social communication skills develop?

It’s hard to know where to start given the amount of information available. It may be helpful to speak to a clinician with expertise in social communication to help find a starting point.

Social communication is made up of many different skills. For children who are not developing those skills as expected, we must target these skills directly. Over the last few years, numerous social communication training programs have been developed. These programs might focus on peer play, peer relationship skills, conversation skills, emotional regulation, etc. Some programs are led by trained facilitators, some are classroom-based and led by the teacher, and some incorporate parents or peers as the facilitators, with support from a clinician.

What can you do to help your child’s social development progress?

You have a very important role in helping your children improve their social communication development. This includes:

  • providing a nurturing home environment;
  • arranging social activities so that your child can interact with peers;
  • advocating for preschool and school environments to help with social skill development;
  • seeking out additional professional help when necessary.

If your child is struggling with social communication skills, it may be useful to consider the following questions:

  • “When does my child appear most successful socially? Why might this be?”
  • “In which situations does my child struggle the most (e.g., after a certain amount of time with peers, before/during/after transitions, with one child, with more than one child, in noisy environments, etc.)?”

What role can my child’s school play?

Educators are in a unique and very important position to effect change in the lives of children. School cultures that promote social interaction can better support social and emotional development.

The promotion of social skill development may be more effective if it is offered in multiple settings, with different people, and at different times.

What does this mean for Neonatal Follow Up (NNFU)?

We are invested in the children and families of our clinic. NNFU can support parents by doing the following:

  • Support parents in addressing social communication development early
  • Support parent advocacy to work with schools to promote social skill development
  • Connect families to appropriate local community supports and services


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