Children born preterm: psychological and neurodevelopmental follow-up in prematurity
The effects of prematurity can be greater and more frequent with lower gestational age and/or birth weight
Outcomes of prematurity
Children born even very preterm follow individual developmental and health pathways.
The effects of prematurity, which can be greater and more frequent with lower gestational age and/or birth weight, are highly variable.
Some are recognisable at an early stage while others, so-called minor effects or outcomes, may occur or be recognised later.
Minor outcomes of prematurity
Minor outcomes relate to development:
- Slight delays in language;
- Slight delays in motor coordination;
- Slight delays in learning;
- Attention deficit;
- Deficits in concentration on play or other activities;
- Delays in achieving small personal autonomies.
In other cases, difficulties may occur in the child’s psychological development and emotional regulation skills with repercussions on behaviour, activity levels and the regulation of functions such as feeding or sleep.
This type of difficulty can occur more frequently in babies born preterm than in babies born at term.
It is useful to give them the necessary attention in good time, taking into account the resources of the child and the family and social environment.
This is why we talk about monitoring and follow-up.
It is important to know that children born preterm, especially those with minor outcomes, are children who tend to recover over time from initial slowdowns and adjustment difficulties.
For this reason, it is important to give them the time they need and at the same time be vigilant in planning and implementing the facilities they may need in good time.
Parents can experience the return to the hospital for the follow-up with different and sometimes conflicting emotions: on the one hand they are happy that their child is being followed, controlled and evaluated in his progress and at the same time they are worried about the possibility of new unexpected difficulties.
All this generally ends when the clinician and parents reflect together on the child’s growth and development.
On the other hand, follow-up allows updates on the evolution of the risk of negative effects of prematurity occurring.
It also makes it possible to adopt appropriate therapeutic tools by sharing the reasons for this choice with the parents.
The difficult context of admission to the Neonatal Intensive Care Unit, the forced separation from the newborn baby and the unfulfilled expectations of the parents, especially at the beginning, but also later, after discharge from hospital, may in some way have frozen the parental function.
During the follow-up, particularly at the first-year check-ups, parents are helped to bring their resources to bear in the best possible way, reflecting on their emotional journey.
Together, it is possible to process, rethink the past and also see what the child is making known about himself.
These meetings are usually held three to six months apart.
They continue like this until about the age of 3 and each one lasts about 60-90 minutes.
After the age of 3, checks are more spread out over time, up to one or two years.
Specific tests and evaluations from this age onwards require additional evaluation time even up to 3-4 close encounters.
Play, exploration, the ability to be with other children, the child’s degree of interest in learning new things, experimenting, drawing, etc. continue to be assessed.
At the age of 4, in particular, we begin to evaluate those functions that the child will use at school in the years to follow, for example reading, writing and using numbers.
For a child born preterm, the 4-year check-up is a check-up that can also guide the timing of entry into primary school, bearing in mind that for these children it is generally better not to anticipate it.
At the follow up meetings, the parents also report on how the child is behaving at school, in sports, in other groups, etc., so that everything helps to get to know him in more ways than one.
In the case of those children born preterm who have suffered major damage as a result of their preterm birth, for example to the neurological or sensory system, the follow up will be integrated with the specialists in charge of the outcome.