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Later problems of premature babies (Part 1)

The Vulnerable Child

What is the Vulnerable Child Syndrome?
Sometimes parents continue to think of their former preemie as fragile and susceptible to problems even though the child is physically and developmentally healthy. They become overly protective, worry excessively, and unknowingly slow or change their child’s development. The former preemie may fail to develop self confidence and/or a sense of independence.

How can I prevent the Vulnerable Child Syndrome?
First, try to interact with this child like you would if s/he had been born at term. Encourage socialization and age-appropriate activities. When considering expectations and when to introduce activities in the first two years of life, use the child’s “corrected age”, his/her age corrected for the number of weeks of prematurity. For example, if your baby is ten months old and was three months premature, your expectations should be that for a seven month old. After age two, you do not need to correct for prematurity.

Things you can do to prevent the vulnerable child syndrome:

  • Encourage interactions with other children their age
  • Let them do things by themselves when they can
  • Let them have opportunities to make decisions; give them choices
  • Find play experiences outside your home, such as at parks, play groups
  • Give words of praise when they do things independently
  • Don’t be too quick to intervene in trial and error learning
  • Set appropriate limits and be consistent with them
  • Establish consistent routines so they know what to expect and can develop independence in following the routine
  • Don’t speak for them if they are capable of expressing themselves
  • Talk to them in age-appropriate language, (not baby talk to a 3 year old)

Learning Problems

How common are learning problems in former preemies?
Learning deficits or learning disabilities at school age occur in about 10% of children born at term. They are more common in former preemies; the smaller and sicker the preemie, the greater the risk. Up to 45% of infants weighing <3 1/4 lbs. at birth have one or more abnormalities on testing at school age. It is usually not possible to predict at the time of discharge or during early development who might develop these problems. Sequential evaluation over time is the best predictor. Knowing what problems might develop can make you alert to signs of difficulty. Early diagnosis enables early evaluation and intervention. On the other hand, being overly concerned and always questioning your child’s development may be detrimental in itself. Problems which are normal at a younger age may be abnormal at a later time. If you have a question about your child’s development or performance, talk to your child’s doctor or teacher or have your child tested.

What are the most common learning problems at school age?
Eye-Hand Coordination Problems

  • difficulty with copying pictures or words, especially if there are many objects in the picture
  • difficulty with puzzles
  • difficulty learning handwriting

Language Problems

  • difficulty following directions, especially if there is more than one step
  • difficulty putting things in a logical order
  • poor vocabulary for age
  • difficulty learning to read
  • not understanding the meaning of sentences
  • inability to tell one sound from another
  • avoiding classroom participation
  • difficulty remembering words

Thinking Problems

  • poor memory, difficulty memorizing words, tables; forgetting assignments
  • difficulty with spatial relationships such as size, distance
  • problems with sounds and their symbols
  • difficulty with abstract thinking
  • difficulty making decisions or making poor decisions
  • poor common sense
  • slow to grasp new concepts

Behavior Problems

Are behavior problems common?
Behavior is a complex interaction of a child’s biologic vulnerabilities, innate strengths, a nurturing environment and parenting styles. A problem in any single area may lead to undesirable behaviors. A mismatch between these areas (for example a very strong-will child with a parent who is unable to set limits) can also emerge as behavior problems. Behavioral problems are not limited to infants who were born prematurely, but they are more common in former preemies. Children with other learning problems are at greater risk for behavioral problems, and behavioral problems can interfere with learning.

What behaviors might be a sign of future problems?
Behavior problems usually start before school age. They often are exaggerations of normal responses or behaviors, or persistence of behaviors beyond the usual age where they are common.

Some of these include:

  • Too aggressive at play, other children won’t play with him/her
  • Temper tantrums- severe, long, or age-inappropriate
  • Won’t comply with requests
  • Can’t tolerate any change in routine
  • Excessive fears
  • Can’t play quietly
  • Can’t stay seated for meals or short activities
  • Always moving

How will I know if my school age child has behavior problems?
Almost all children have periods of time when they misbehave or go through difficult stages. Your child’s teacher or school will probably alert you if your child’s behavior is out of the usual range. However, if you have concerns, discuss them with your child’s teacher or pediatrician.

Common signs of behavioral problems include:

  • Doing poorly in school
  • Difficulty paying attention
  • Not completing projects or tasks
  • Not following directions
  • Difficulty sitting still for even short periods of time; always moving
  • Impulsive behavior; acting before thinking about it
  • Fighting, bullying or stealing

The above listed behaviors usually catch a teacher’s attention quickly. Another behavior pattern is one characterized by anxiety and withdrawal.

Signs include the following:

  • Extreme shyness
  • Not wanting to play or be with others
  • Extreme fears or worry about the unknown, such as new activities or places
  • Being over-sensitive to touch or sound

What can I do about behavior problems?
Children who have these problems are often in need of greater structure in their environment and more defined limits. Sometimes parents of preemies are reluctant to set limits, enforce rules or deny their child’s requests because the child had to go through so much in the early months or because they don’t want to dampen their child’s strong will that made him/her a survivor. But, consistency in rules and limits and more structure often lead to a more secure environment in which to develop. If behavior problems persist or get worse, discuss them with your child’s doctor or pre-school teacher.

(Copyright University of Wisconsin Medical School, Pediatrics Department)

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