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Small Step

A Small Step: from Cradle to School !

Dear Parents,

You are now proud parents of a newborn! The birth of your baby is one of the most exciting events in your life and a moment you will always cherish. While every child brings his own joys and challenges, you may be worried because your baby was born earlier than expected and may have some health problems at birth; requiring special care in the NICU. But as you will see, while premature infants may need extra care at first, they have bright futures. Every year, about 11% of babies are born prematurely. But, thanks to medical advances, children born after 28 weeks and weighing more than 1200 grams, have a 95% or better chance of survival. They usually catch up in height and weight with their peers by 2 years of age.

Your baby’s first year is a time of great change, just as it would be if she had been born on or near her due date. A child’s development is a complex, ongoing process. No two children mature at the same rate or in the same way. If your child was born early, you should think of her progress in terms of "corrected age." For example, if your baby was 8 weeks early, adjust your expectations by 2 months. Therefore, a 4 month old premature baby may act like a full-term 2 month old. Try not to compare your child with full-term babies; but do watch the multi-faceted development of your baby.

If there are any developmental problems, the important thing is to detect them early, so that your child can be helped to adapt. Some problems can show up right away; others do not show up for some time. You are in the best position to monitor your child’s development. Become familiar with your child’s general pattern of development, and if you think your child is showing signs of a delay in hearing, vision, speech, movement or learning then see your pediatrician as soon as possible. Early intervention programs that work with children from birth to 3 years may do a lot to lessen any long-term effect on your child’s learning.

Reaching developmental milestones in premature babies can vary tremendously and it is likely that they will reach major milestones later than babies born full term. This is because your baby is; in fact younger and your baby should be assessed according to the corrected age. By developmental milestones; we refer to various facets of child development like: physical (weight, length, head size etc), gross motor (muscle development, stability, locomotion, posture etc), fine motor (finger skills, eye-hand coordination), cognitive / mental (thinking, understanding, memory, intelligence etc), language (receptive and expressive), social (knowing self, family, pears and society) and emotional (fears, happiness, mood etc).

Most of the times; normally the necessary hardware (i.e. brain size, differentiation, neuronal wiring (connections) and recruitment /specialization of brain areas) development occurs in mother’s womb during 30th to 40th weeks of pregnancy. Brain grows substantially (4 to 5 folds) during these last 2 months of pregnancy. This is achieved quite peacefully lying curled up in uterus; with no disturbance from light, noise and activity!

But in premature birth; baby misses all these developmental events and on the top of that; after birth it lies helplessly on hard, straight bed in NICU; with all medical team buzzing around; bombarding relentlessly with strong light, continuous noise and frequent handling. With this background; we start intervening right in the NICU with the help of nursing staff, therapist and obviously the parents! Simple techniques like baby positioning, keeping fixed touch-time, avoiding unnecessary light and sound, keeping baby in isolation (and keeping relatives away!?), oro-pharyngeal massage (to improve suck-swallow coordination), kangaroo care (especially a good weight, stable baby is kept close to mother’s body which maintains warmth, security and improves breast-milk flow!) and many more small but development-friendly ideas are used to improve quality of life of the ‘fighting little ones’.

By the time baby is getting ready for a discharge; we assess the baby on developmental scales, hearing assessment (OAE- Oto-Acaustic-Emmission), vision - especially retinal assessment, neurological signs, neuro-sonography, cardiac Doppler and screening for inborn errors of metabolism. This is the first point; when we as a developmental team get introduced to the parents. The routine medical care, nutrition and vaccination continue with your primary pediatrician.

At follow-up visits; which are monthly in first 3 to 4 months; and then at 3m interval till age of two and half years; we request the parents to visit the ‘Small Step Child Development Centre’. At these well-planned visits a customized assessment and intervention plan for each baby is designed; so that it will continue to help you till you and your child are confident enough to enter the school (3 years). The assessment is done by the team of Developmental Pediatrician, Neuro-developmental Therapist and child psychologist on standardized developmental scales. To get best results, let us follow the triage of Regular assessment and follow up + Timely interventions + Parental education and motivation. This handbook is an effort to share the scientific knowledge about caring the ‘fighting little ones’ and prepare the parents for early intervention program.

Our attempt is a SMALL STEP taken together by the baby; the parents and the developmental team to minimize the developmental difficulties the baby may face and to facilitate the multifaceted development over the roller-coaster journey from the ‘cradle to the school’!

Dr. Suneel Godbole, Developmental Pediatrician

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