Physical Movement

Evidence  

https://bmjopen.bmj.com/content/11/1/e044491 

Jeanie Cheong, Kate Lillian Iona Cameron, Deanne Thompson, Peter J Anderson, Sarath Ranganathan, Ross Clark, Benjamin Mentiplay, Alice Burnett, Katherine Lee, Lex William Doyle and Alicia J Spittle 

The La Prem study is the first time Australian researchers have investigated the long-term health and development of premature babies born between 32 and 36 weeks. Clinicians assessed the babies while in the hospital and followed them up at two years of age, and together with a psychologist assessed the children’s health, cognitive and behavioural development. 

Researchers found that compared with full term (37 weeks-plus) healthy babies, babies born moderately-to-late preterm were: 

• three times more likely to have delays in their language and motor skills development  

• twice as likely to have delays in cognitive development such as ability to perform tasks and follow directions 

• more likely to have difficulty coping in different social settings

Associate Professor Jeanie Cheong, who led the research, said the findings were important as traditionally it had been thought that moderate-to-late premature babies did not experience significant long-term problems associated with premature birth. 

“While not all moderate-to-late preterm babies experience problems, with 21,000 children born between 32 and 36 weeks in Australia each year, even a small percentage of affected children will have significant implications for both healthcare and educational providers,” Assoc. Prof. Cheong said. 

Education 

Discovery – hands and toes  

When babies are first born, their hands often rest closed, in a fist position, with their thumb inside and they initially start moving their whole arm when they see a toy placed in front of them. The grasp reflex first helps a baby hold their hand tightly around objects and toys such as a rattle, that are placed into their palm. From 2-3 months corrected age, they may start to realise they have hands and will start using their vision to inspect them and bring them to their mouth. Once they discover their hands, their hands become a wonderful toy. They will find them fascinating, and start moving and clasping them together, and will play with them endlessly. By 8 months of age, they can keep their hands open most of the time, and will be able to use them to reach, grasp, bang objects and accidentally drop them, transfer items between both of their hands and bring objects and food to their mouth to explore.  

All babies learn through their senses and their sense of touch is an important one. Hanging toys above your baby from an early age, e.g. from a baby gym, will allow their hands and feet to randomly hit and touch them. After several attempts, as their coordination develops, they will begin to realise they have the power to direct their hands or feet to touch the toys they are looking at. Babies will often enjoy repeating a newly learned activity, which develops cause effect.  

Babies not only play with their hands and fingers, but by 6 months corrected age, will have developed enough core strength, allowing them to bring their feet to their mouths to suck and explore their feet and toes. Sucking often calms babies and offers them security while also promoting body awareness.  

Rolling 

Rolling over is a major milestone for your baby. Every baby is different and having a baby that was born premature or sick can affect when they hit and achieve milestones. Babies, when positioned onto their side, will often learn to roll from that side onto their back first. Once they have developed their head control and upper body strength, it is common for babies to next learn to roll from their tummy onto their back. It can take longer and extra time for them to roll from their back onto their stomach.  

Giving your baby tummy time for short periods every day, encourages development of head, neck and shoulder strength, which is needed for them to master rolling. You can start tummy time as early as 1 week. Tummy time can take place while holding them upright on your chest while sitting in a reclined position or by placing them flat on a blanket or play mat spread on the floor. Offering very short periods of tummy time to start with, several times a day and slowly increasing this time gradually, will allow your baby to slowly develop their strength. Playing together on the floor and engaging with them by singing, reading and showing them colourful toys will help them master their skills and start enjoying tummy time sessions.  

Sitting up  

Once babies develop their neck, shoulder and core strength, they will be able to hold their head up briefly and then start actively moving their head side to side while being supported in sitting. Once placed into a sitting position, they will sit for a few short seconds by leaning on their hands for support. Your baby will topple over to one side many times until they learn to balance and keep themselves upright. It’s important to keep your baby safe by sitting close to them or positioning them on a blanket or soft activity mat or with a ‘U” shaped cushion behind them, to help catch them as they fall. To help your baby learn to sit independently, you can sit them between your legs on the floor and read books and sing to them. Putting toys within their reach will make sitting up even more fun. Babies, by 9 months corrected age, will have developed enough strength and control, to sit on their own without using their hands for support.  

Learning to sit by themselves gives your baby a new perspective on their world and enables them to play with toys and engage in activities in a new way. Placing your baby sitting up in a stroller while you are out walking, will increase their interest and desire to sit up, as there will be so much to see outside. Try giving your child lots of opportunities throughout the day to practice their sitting, by helping them to sit up during everyday routines such as dressing, bath time and mealtime routines. 

Once they can sit happily on their own and play, it's just a matter of time until they move onto crawling, standing, and walking.  

Crawling 

After spending lots of time on their tummy and with stronger arm and shoulder muscles, babies between 8- and 9.5-months corrected age, may begin to crawl.  First, they might shuffle and pivot around on their tummy which is known as commando crawling. They will then be able to get onto their hands and knees, on all fours, and start rocking back and forth in this position. They may experiment and appear to crawl backwards first and then figure out that pushing off with their knees gives them the mobility to move forward.  

Crawling presents many benefits for babies, however, some don’t follow the same developmental pattern of sitting, crawling and then walking. Some babies skip the crawling phase, never crawl and may shuffle around on their bottom instead. Other babies may go directly to pulling up to stand and progress to walking from there.  

Once babies start moving around independently, it’s time to start thinking about child proofing your house to help keep them safe. Careful consideration, use and installation of equipment, such as baby gates, child locks, corner protectors, as well as furniture and TV straps are an important step to prevent child accidents. Extra precaution is always required around steps and stairs, as babies and young children are usually very excited by them. It’s suggested to position low furniture away from windows, as they might try use it to climb out.  

Walking 

Before a baby can take their first steps, they will learn to pull themselves to stand at furniture. They will search for lots of opportunities in their surroundings to pull themselves up on everything within reach. After some time, once they have found their balance, they may start holding on with one hand only and will start making sideways stepping movements, along furniture such as a couch, which is called cruising.  You can encourage them to make sideways steps and cruise, by positioning toys just out of their reach on one side. Babies learn through lots of trial and error, practice and play to make it fun. 

Standing or kneeling in front of your baby and holding their hands or body, while they build their strength, confidence and coordination to take small steps, can help them progress with walking. Commercially available ‘walkers’ where your baby sits in a device and pushes themselves around on wheels with their feet, are discouraged, as they encourage poor muscle development and can interfere and delay independent walking. Push walkers, which require your baby to stand independently and take steps by holding onto the device to move it forward slowly, are a great way for your baby to build their confidence and balance to take repeated steps forward. Your baby will learn to take a few steps, often with their arms up high for increased balance, before falling. Most babies by 16 months corrected age, will be able to walk across a small room without support. There is no need for your baby to wear shoes until they are walking confidently.  

Empowerment 

When your baby is premature, they have two ages for the first few years. Their chronological age is how old your baby is from the date of their birth. Their corrected or adjusted age is how old your baby would be if they were born on their due date. It is important to use the corrected or adjusted age when assessing growth and development skills in those first few years. For more information on Corrected and Chronological age visit here https://www.miraclebabies.org.au/content/corrected-chronological-age/gjr92w 

To calculate the corrected/adjusted age, take the chronological age e.g., 12 weeks and subtract the number of weeks he/she was born early e.g. 7 weeks, so their corrected age is 5 weeks.  

Premature babies are known to reach developmental milestones on average, later than full term babies even if adjusting for corrected age. Developmental delays occur more frequently in children who were born premature or if their medical health or condition at birth was more severe.  

As a parent, you are the expert of your child, and you know your child best. Try not to wait if you are having any doubts or concerns about their development. Your paediatrician is a great first point of call if you feel your baby isn’t meeting one or more of their milestones at their corrected age. You can work closely with them to help determine if your baby would benefit from additional support from a therapist such as a Physiotherapist, Occupational Therapist or Speech Pathologist.  

Useful Links 

Pregnancy Birth and Baby  

https://www.pregnancybirthbaby.org.au/growth-and-development-for-premature-babies 

Miracle Babies Foundation 

https://www.miraclebabies.org.au/content/corrected-chronological-age/gjr92w

Raising Children 

https://raisingchildren.net.au/newborns/premature-babies-sick-babies/development/premature-development-concerns 

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