How to Observe Premature Infant Behavior

Three Parts:Knowing What to Watch Out ForCaring for a Premature BabyUnderstanding the Causes and Concerns

Premature babies are those that are born at seven months or before 37 weeks of gestation. Premature babies account for one in every eight births in the USA.[1] Most premature babies have slower development rates than other babies born at more than 37 weeks of gestation, and problems may arise from their immature organs or weak immune systems. Therefore, it is important to observe premature infants carefully to identify any developmental issues.

Part 1
Knowing What to Watch Out For

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    Understand the difference between your baby's gestational age, chronological age and corrected age. There are three different ways of calculating your premature baby's age, all of which must be taken into account when tracking your baby's growth and development.
    • The term gestational age refers to the baby's age as calculated from the mother’s first day of her last menstruation cycle. This number is very important for identifying your infant's development and growth levels before birth.
    • Your baby's chronological age refers to the age that is calculated from the point that the infant is born. This term describes the age for all the newborns, and it represents your own age.
    • The last term is called the corrected age which refers to the correct age of your infant as if he continued his natural uterine journey. It’s calculated by subtracting the number of weeks your baby was premature from his chronological age. For example, if your infant was born four weeks early, and his age now is twelve weeks, this means that his corrected age equals eight weeks (Chronological age “12” – Early weeks time “4” = Corrected age “8”).
    • It's important to understand that while a premature baby's development may be slow in terms of their chronological age, it might be right on track in terms of their corrected age. Therefore, it's important to keep the corrected age in mind when watching out for issues with growth and development.
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    Observe your premature baby's weight gain. Premature babies tend to gain weight more slowly than full-term babies, but this is usually not a cause for concern. A record is kept with the doctor and chart is plotted on a graph to check whether the baby's weight gain is on track.
    • Full-term babes usually gain weight at a rate of 30 ounces per day. However, the rate of weight gain will be slightly different for a premature baby.
    • Premature baby’s tend to gain weight at a slightly slower rate than full-term. Hence keeping weight records helps you and your doctor to understand and track their progress.
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    Watch out for signs of respiratory distress. Premature babies have underdeveloped lungs and they may have low cry or even end up with respiratory difficulties. Therefore, it's important to watch out for any respiratory distress signs once the baby is discharged from the hospital.
    • If your baby is experiencing respiratory issues, they may find it difficult to breathe, have shallow breathing or need to work hard to breathe. You can tell if this is happening if the baby is flaring their nostrils, takes more than 50 breaths er minute, or starts to turn blue.
    • As soon as you notice any of these signs, your baby should be rushed to the hospital. If your child is prone to respiratory problems; keeping a nebulizer at home might also be helpful. A nebulizer is a device which is used to administer medicines for any respiratory problems.
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    Look for the development of ear infections. Premature babies are prone to infections, as their immune system is not yet fully developed. Hence these kids tend to have low immunity and are particularly prone recurrent ear infections.
    • Depending on the severity of the infection, ear drops and acetaminophen for fever can be administered - just be sure to consult with your doctor first.
    • Also remember to sit your baby in a semi-upright position while breast feeding - otherwise the breast milk can trickle down to the ears and cause an infection.
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    Be watchful for any problems with your baby's eyes. Premature baby's are prone to a number of eye conditions, such as retinopathy of prematurity (ROP) which is a medical condition that usually happens with premature baby's of early gestation, due to the incomplete development of tiny blood vessels in their eyes. In severe cases, this condition can lead to blindness.
    • Your pediatrician will observe any signs of this condition at your regular appointments and will transfer you to a specialized eye doctor for treatment.
    • Another condition sometimes found in premature babies is strabismus or crossed eyes. However, this condition often heals itself if the baby continues to develop normally.
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    Take note of when the baby reaches certain milestones. Premature infants develop more slowly and hence have delayed milestones. For example, you should take note of when your child first lifts his head off the bed. For a full-term baby, this should ideally happen at 2 months.
    • Noting how long it takes for your premature baby to reach certain milestones will help you to identify if your baby is developing normally (albeit more slowly) or whether there may be a deeper developmental issue.
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    Observe when the baby first starts picking things up. A baby will ideally start picking things up at around 4 months, but in premature babies this can be little delayed.
    • By 9 months, most babies will have mastered the pincer grasp i.e picking up objects between the thumb and fingers, proving fine motor development has occurred. This may also be delayed in premature infants.
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    Keep track of when your baby starts to smile, roll over and "speak". Normally developing babies tend to start smiling at people around three months, while premature babies may take longer.
    • Full-term infants learn to roll over or move their limbs by four months, while premature babies take an extra 2 to 3 months to reach these milestones.
    • Babies will usually try to "speak" in mono syllables by 5 to 6 months, so pay attention if your baby says "mama", "papa", "gaga" or anything of that sort.
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    Be aware that premature infants may take a while to start crawling or walking. Crawling usually starts by 9 months in full-term babies, but it may take premature babies up to a year. Following on from this, full-term babies often start walking at the age of 12 months, but premature babies take longer.
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    Watch out for positive signs of your baby's development. There are also some positive signs to watch out for which indicate that your baby is growing and developing normally. These are also important to take note of, as they will help to put your mind at ease.
    • Some good signs include: your baby being relaxed - which you can tell by his facial expressions and the movement of his legs and arms, your baby making noises and sounds, sucking on his fingers, lifting his legs up and displaying normal mood changes (not suddenly being aggressive or sleepy).
    • All of these things show that your baby is on the right path in terms of muscle development and that he is gaining more control over his muscles.

Part 2
Caring for a Premature Baby

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    Breastfeed your baby for the first six months. Try to exclusively breastfeed your premature baby for 6 months before starting them on other food. By breastfeeding the baby exclusively for 6 months you give them the necessary antibodies they need to fight infection.
    • Babies can’t produce their own antibodies until 6 months of age, so they survive on antibodies made by the mother.
    • Hence, it is advised to breastfeed at least until the baby can produce his own antibodies, so he can build his immunity and not fall sick.
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    Feed your baby 8 to 10 times per day. Your premature baby may need from eight to ten feedings every day. Try to space these feeding evenly throughout the day.
    • Don't feed your baby less than 8 times per day or he may get dehydrated due to the lack of fluids.
    • You can tell that your baby is well-fed and hydrated by the number of diapers you change each day. Changing six or seven diapers a day is a sign of good nutrition.
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    Try kangaroo mother care. Kangaroo mother care is encouraged for premature babies. This is a process whereby the mother is encouraged to hold the baby close to her chest, allowing the baby's body to follow the mothers respiratory and heart rate.
    • This enhances the baby's circadian rhythm and promotes their overall health.
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    Attend all scheduled appointments with the pediatrician. Make sure to attend all scheduled appointments with the pediatrician so your baby's growth, development and overall health is properly monitored.
    • The pediatrician will ensure that your baby has all of the required vaccinations to prevent illness and infections.
    • Don't hesitate to ask the pediatrician about any questions or concerns you might have regarding your baby's development. They will be happy to answer your questions and put your mind at ease.
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    Install a special car seat designed for premature babies. If you need to travel anywhere with your baby, be sure to use a special car seat designed for premature babies. These tend to be smaller and more secure.
    • A newborn baby's Car Seat should always be placed securely in the back seat of the car, and should be rear facing.
    • If you're still worried, have someone sit beside the baby while you're driving for additional safety.
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    Put your baby to sleep on his back. It' very important to put your baby to sleep on his back rather than on his stomach, to avoid any stomach or gastric problems. This can also help to prevent sudden infant death syndrome (SIDS), a condition often responsible for infant deaths.

Part 3
Understanding the Causes and Concerns

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    Understand the risk factors for premature birth. There are several conditions and circumstances that make giving birth to a premature baby more likely. These include:
    • Diabetes: The imbalance of sugar and insulin predisposes a diabetic mother to early uterine contractions and premature delivery.
    • Hypertension: High blood pressure during pregnancy can stimulate early delivery. It causes excessive release of proteins in the urine which can lead to condition called pre-eclampsia or eclampsia, which accelerates preterm labor.
    • Smoking: Smoking causes vasodilation (constriction of blood vessels). This poses a great threat, as it decreases the blood supply to the placenta and initiates labor.
    • Infections like rubella, mumps, measles, syphilis etc could pose threat to early deliveries. Infections tend to release prostaglandins which are the same substances that are used to initiate the labor.
    • Teen pregnancy: Teenagers tend to experience more stress during pregnancy which isn’t good for the baby, as the excessive release of stress hormones can induce labor.
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    Be aware of some of the common problems experienced by premature babies. Premature infants are at slightly higher risk for everything (compared to a full-term baby) since they don’t have enough time for development in the womb. However, some of the most common problems include:
    • Breathing problems. Since their lungs haven’t fully developed premature babies face breathing issues. They are usually given steroids to increase the lung functioning keep them stable.
    • Temperature problems. Pre-term infants have low levels of fat on their body due to early birth. This causes instability in body temperature, as they are unable to retain heat properly.
    • Feeding problems. Premature babies are often weak and lethargic. This is because their muscles aren’t well developed and hence they tend to have feeding issues.
    • Jaundice. As the body isn’t developed completely, it finds it difficult to flush out the bilirubin (a yellow pigment found in bile) produced by the liver, giving the baby a yellow color.
    • Infection. Premature babies are prone to infections due to decreased immunity and a lack of antibodies in their systems.


  • Various hospitals and institutions offer information and knowledge on premature babies. They conduct seminars for parents which are helpful. Also various support groups are available which gives emotional support.

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Categories: Babies and Infants | Baby Health