Premature Birth and Neurodevelopment
Children born before 37 weeks gestation (full term pregnancy is 40 weeks) are considered premature. Their early birth means they miss critical weeks of prenatal protection for their developing brain and body, and this presents risks for neurodevelopmental differences.
During the last month of pregnancy, a child’s brain intensifies in the creation of new synaptic connections, and neuronal fibers are strengthening the myelin coating that allows for efficient communication between cells. Neural pathways are being organized to support sensory processing, motor and cognitive development.
The premature brain and nervous system are more vulnerable to early injury. A common risk factor includes disrupted oxygen supply (hypoxia) to the brain before, during, or after birth, which can lead to injury in the white matter (myelinated areas of neural fibers), but it can also cause bleeding in the brain. This can include intraventricular hemorrhage (IVH). Premature infants can be prone to infections, which can contribute to inflammation that can affect the developing brain or nervous system too. Another important factor to consider is birth weight. If a child is small for gestational age, they are at higher risk of neurodevelopmental differences.
But even for premature children with a brain injury, developmental delays may not be apparent during infant and toddler years. Challenges may become apparent later, once demands increased at school, home, and with friendships. Every child has strengths, and they will use these to help support weakness. However, when a child is still struggling, it becomes critical to put into place accommodations and interventions needed to bolster, remediate, and overcome those weaknesses.
Children born premature don’t have one single profile of strengths and weaknesses. They are just as unique as typically developing kids, but there are some common patterns evident with a neuropsychological assessment. This includes more difficulties with visuospatial skills, motor skills, processing speed, attention, executive functioning, social and adaptive skills. When a premature child has a brain injury, their neuropsychological profile may be better explained by the injury location.
Here are a variety of parent concerns that can emerge for children born premature:
Pre-Kindergarten: Problems following directions, engaging in group activities, regulating behavior (e.g., high activity level, trouble appreciating physical boundaries), tolerating frustration, communicating with others, learning early academic skills, completing daily routines at home, toilet training, sensory processing differences, or separation anxiety.
School-Age: Reduced motor strength or coordination, difficulty with focus and concentration, staying on task, disruptive behavior, dislike of handwriting, slow progress in reading or math, rushing through tasks to get them done, needing extra time or cues to complete grade level work, needing frequent reminders for self-care routines (e.g., brushing teeth, bath), somatic or physical complaints (e.g., stomachaches, feeling sick, headaches), worry, forgetfulness, impulsive behaviors, low frustration tolerance, difficulty maintaining same-age friendships.
Teen years through early adulthood: Problems following through with age typical chores, ongoing need of reminders for self-care, trouble keeping up with schoolwork, disorganization, procrastination, trouble planning, difficulty maintaining same-age friendships, symptoms of anxiety or moodiness, and delays in community integration (e.g., driving, volunteer/paid work). Young adults may need extended support after high school when it’s not a good match for them to leave home for college.
Families of children with early developmental delays who required therapies and special education services tend to be more connected with resources. It can be more isolating for families to find resources when developmental challenges emerge later. Regardless of age, explore programs and resources for parents and children across the developmental continuum at FOCUS (Families of Children Under Stress) of Georgia: https://focus-ga.org/program/ If you believe that your child’s weaknesses are not being adequately supported and you want to better understand your child’s strengths, a neuropsychological evaluation may be helpful. Reach out to us for a free consult: [email protected]
