Premature 4 month old baby

Your Preemie's Growth & Developmental Milestones

​Was your baby born more than 3 weeks early? Read on f​or information from the American Academy of Pediatrics about developmental milestones for your preterm baby.

Keep in mind that babies develop at their own speed and in their own way. However​, parents of preemies will need to adjust their baby's age to get a true sense of where their baby should be in his development.

Your Child's ​Progress

You know your child better than anyone else. Even with an adjusted age, you will want to see him move forward in his development. For example, your child should progress from pulling himself up, to standing, and then to walking. When you watch him carefully, you will see ways he is growing well. You will also know whether he needs more help.

Remember to take your child to his recommended well-child (health supervision) visits. At each visit, your child's doctor will check his progress and ask you about the ways you see your child growing. See the next section, Developmental Milestones.

Developmental Milestones

Here is information about how babies and young children typically develop. Examples of developmental milestones for ages 1 month to 6 years are listed. The developmental milestones are listed by month or year first because well-child visits are organized this way.

For a preterm baby, it is important to use the baby's adjusted age when tracking development until 2 years of age so that his growth and progress take into account that he was born early.

What is your child's adjusted age?______________________. See milestone for the adjusted age in the next section.

NOTE: Ask your baby's doctor about Early Intervention (EI)—extra care some babies and children receive to help them develop.

At 1 Month (4 Weeks)

Social

• ​Looks at parent; follows parent with eyes

• Has self-comforting behaviors, such as bringing hands to mouth

• Starts to become fussy when bored; calms when picked up or spoken to

• Looks briefly at objects

Language

• ​Makes brief, short vowel sounds

• Alerts to unexpected sound; quiets or turns to parent's voice

• Shows signs of sensitivity to environment (such as excessive crying, tremors, or excessive startles) or need for extra support to handle activities of daily living

• Has different types of cries for hunger and tiredness

Motor

• ​Moves both arms and both legs together

• Holds chin up when on tummy

• Opens fingers slightly when at rest

At 2 Months (8 Weeks)

Social

Language

• ​Makes short cooing sounds

Motor

• ​Opens and shuts hands

• Briefly brings hands together

• Lifts head and chest when lying on tummy

• Keeps head steady when held in a sitting position

At 4 Months (16 Weeks)

Social

Language

Motor

• ​Supports self on elbows and wrists when on tummy

• Rolls over from tummy to back

• Keeps hands unfisted

• Plays with fingers near middle of body

• Grasps objects

At 6 Months (24 Weeks)

Social

Language

• ​Babbles, makin​​g sounds such as “da," “ga," “ba," or “ka"

Motor

• ​Sits briefly without support

• Rolls over from back to tummy

• Passes a toy from one hand to another

• Rakes small objects with 4 fingers to pick them up

• Bangs small objects on surface

At 9 Months (36 Weeks)

Social

• ​Uses basic gestures (such as holding out arms to be picked up or waving bye-bye)

• Looks for dropped objects

• Plays games such as peekaboo and pat-a-cake

• Turns consistently when name called

Language

• ​Says “Dada" or “Mama" nonspecifically

• Looks around when hearing things such as “Where's your bottle?" or “Where's your blanket?"

• Copies sounds that parent or caregiver makes

Motor

• ​Sits well without support

• Pulls to stand

• Moves easily between sitting and lying

• Crawls on hands and knees

• Picks up food to eat

• Picks up small objects with 3 fingers and thumb

• Lets go of objects on purpose

• Bangs objects together

At 12 Months (48 Weeks, or 1 Year)

Social

Language

• ​Uses “Dada" or “Mama" specifically

• Uses 1 word other than Mama, Dada, or a personal name

• Follows directions with gestures, such as motioning and saying, “Give me (object). "

Motor

• ​Takes first steps

• Stands without support

• Drops an object into a cup

• Picks up small object with 1 finger and thumb

• Picks up food to eat

At 15 Months (60 Weeks, or 1 ¼ Years)

Social

• ​Imitates scribbling

• Drinks from cup with little spilling

• Points to ask something or get help

• Looks around after hearing things such as “Where's your ball?" or “Where's your blanket?"

Language

• ​Uses 3 words other than names

• Speaks in what sounds like an unknown language

• Follows directions that do not include a gesture

Motor

• ​Squats to pick up object

• Crawls up a few steps

• Runs

• Makes marks with crayon

• Drops object into and takes it out of a cup

At 18 Months (72 Weeks, or 1½ Years)

Social

• ​Engages with others for play

• Helps dress and undress self

• Points to pictures in book or to object of interest to draw parent's attention to it

• Turns to look at adult if something new happens

• Begins to scoop with a spoon

• Uses words to ask for help

Language

Motor

• ​Walks up steps with 2 feet per step when hand is held

• Sits in a small chair

• Carries toy when walking

• Scribbles spontaneously

• Throws a small ball a few feet while standing

At 24 Months (2 Years)

Social

• ​Plays alongside other children

• Takes off some clothing

• Scoops well with a spoon

Language

• ​Uses at least 50 words

• Combines 2 words into short phrase or sentence

• Follows 2-part instructions

• Names at least 5 body parts

• Speaks in words that are about 50% understandable by strangers

Motor

• ​Kicks a ball

• Jumps off the ground with 2 feet

• Runs with coordination

• Climbs up a ladder at a playground

• Stacks objects

• Turns book pages

• Uses hands to turn objects such as knobs, toys, or lids

• Draws lines

At 2½ Years

Social

• ​Urinates in a potty or toilet

• Spears food with fork

• Washes and dries hands

• Increasingly engages in imaginary play

• Tries to get parents to watch by saying, “Look at me!"

Language

• Uses pronouns correctly

Motor

• ​Walks up steps, alternating feet

• Runs well without falling

• Copies a vertical line

• Grasps crayon with thumb and fingers instead of fist

• Catches large balls

At 3 Years

Social

• ​Enters bathroom and urinates by herself

• Puts on coat, jacket, or shirt without help

• Eats without help

• Engages in imaginative play

• Plays well with others and shares

Language

• ​Uses 3-word sentences

• Speaks in words that are understandable to strangers 75% of the time

• Tells you a story from a book or TV

• Compares things using words such as bigger or shorter

• Understands prepositions such as on or under

Motor

• ​Pedals a tricycle

• Climbs on and off couch or chair

• Jumps forward

• Draws a single circle

• Draws a person with head and 1 other body part

• Cuts with child scissors

At 4 Years

Social

• ​Enters bathroom and has bowel movement by himself

• Brushes teeth

• Dresses and undresses without much help

• Engages in well-developed imaginative play

• Language

• ​Answers questions such as “What do you do when you are cold?" or “What do you do when you are you sleepy?"

• Uses 4-word sentences

• ​Speaks in words that are 100% understandable to strangers

• Draws recognizable pictures

• Follows simple rules when playing a board or card game

• Tells parent a story from a book

Motor

• ​Hops on one foot

• Climbs stairs while alternating feet without help

• Draws a person with at least 3 body parts

• Draws a simple cross

• Unbuttons and buttons medium-sized buttons

• ​Grasps pencil with thumb and fingers instead of fist

At 5 and 6 Years

Social

Language

Motor

• Balances on one foot

• Hops and skips

• Is able to tie a knot

• Draws a person with at least 6 body parts

• Prints some letters and numbers

• ​Can copy a square and a triangle

At School Age

Ongoing Issues Your Child May Face

As preterm babies get older, some of them may face ongoing physical problems (such as asthma or cerebral palsy). They may also face developmental challenges (such as difficulties paying attention or lack of motor control). This may be especially true for babies who were very small at birth.

Once your child reaches school age, it will be important for you to work closely with his teacher and other school staff to identify any areas of concern. They can also help you find the right resources for help. If the school does not have the resources your child needs, his teachers can help you find local groups or programs to help him do well in school. You are not alone! Your child's teachers and health care team are dedicated to helping you meet all his health and educational needs.

All children will babble before they say real words. All children will pull up to a stand before they walk. We are sure that children will develop in these patterns. However, children can reach these stages in different ways and at different times. This is especially true if they were born preterm. Take some time to think about your child's development and answer the following questions. Contact your child's doctor if you have any questions about your child's development.

Your Child's Development

• How does my child like to communicate?

• How does he let me know what he is thinking and feeling?

• How does my child like to explore how to use his body?

• Does he prefer using his fingers and hands (small muscles)?

• Does he prefer using his arms and legs (large muscles)?

• How does my child respond to new situations?

• ​Does he jump right in?

• Does he prefer to hang back and look around before he feels safe?​

• How does my child like to explore?

• What kinds of objects and activities interest him?

• What do those interests tell me about him?

• What are my child's strengths?

• In what ways does my child need more support?

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Milestones of First 18 Months

Written by Jennifer D'Angelo Friedman

All parents are concerned about their children hitting certain milestones on time. But when your baby comes early, those first few months and years can be a time of watching and waiting. Because preemies face greater health risks, you may worry more about whether your child will do certain things on time.

Laurel Bear, MD, a pediatrician at the Children’s Hospital of Wisconsin, can ease your concerns. Premature babies have the same milestones as babies born on time -- if you adjust the typical timeline for their early birth, she says.

'Adjusted Age' Explained

Newborns who've spent less than 37 weeks in the womb are considered premature. A normal pregnancy lasts about 40 weeks.

To figure out what a child should be doing and when, it's important to look at their adjusted age (also known as the corrected age). That's based on Mom’s original due date, Bear says.

For example, when a baby is born 2 months premature, and is now 4 months old, "we’re not going to expect them to be doing what a 4-month-old is doing. We’re really looking at what a 2-month-old should be doing,” she says.

Most preemies do catch up to their peers who were born on time, but it’s important to be patient, Bear says. A baby who’s faced significant medical issues may need a little more time to reach her milestones.

“We look at them and say, ‘This little baby spent a long time trying to survive.’ What should this baby be doing? I give them a little bit of a break. You may be 6 months old, but you spent 2 months in the hospital.”

The earlier an infant arrives, the longer she may need to catch up -- but most do get there, Bear says. A baby born at 36 weeks may not be caught up at 6 months, but may be at within the normal range by 12 months. A baby born at 26 weeks or less may not catch up until they’re 2-and-a-half or 3 years old.

The First 18 Months Adjusted: A Timeline

Just like with full-term babies, milestones for premature infants can vary. But Bear says some key things should happen around the following times:

2 months adjusted

• Begins to control her head
• Makes sounds like cooing and different cries
• Smiles at people
• Recognizes parents and caregivers

4 months adjusted

• Lifts her head up and looks around while on her tummy
• Rolls over
• Follows faces and objects

6 months adjusted

• Sits on her own
• Gets on her hands and knees
• Starts to crawl
• Looks at toys
• Is curious about things out of reach
• Babbles consonant and vowel combinations (dada, baba, mama)

9 months adjusted:

• Crawls everywhere
• Pulls to stand
• Understands “no”
• Copies sounds and gestures
• Has more vocal variety
• Plays peek-a-boo

12 months adjusted

• Cruises along furniture
• Begins taking solo steps
• Starts to stand alone
• Picks up small items
• Responds to simple questions like “Where’s Daddy?”
• Tries to say words you say
• Uses simple gestures, like shaking her head “no” or waving “bye-bye”
• Cries when parents leave
• Has favorite things, like a stuffed animal or blanket
• Begins to say Mama with meaning (she knows Mama is Mama)

15 months adjusted

• Walks with coordination
• Squats
• Can do shape sorters or simple puzzles
• Has three words besides Mama and Dada she uses to name things or to ask for things
• Looks at or points to pictures in books
• Follows more directions

18 months adjusted

• Walks up stairs
• Begins to run
• Pulls a toy when walking
• Can undress
• Drinks from a cup and eats with a spoon
• Has a vocabulary of about 18 words
• Says and shakes her head “no”
• Points to what she wants

Every Baby Is Different

Even after adjusting for age, it’s important to remember that no two babies are the same.

The key is to look at each baby individually, says Martha Caprio, MD, associate professor at NYU Langone Medical Center. Parents might call one week worried that their baby hasn’t reached a milestone like rolling over, then report back that it happened a week later. Most babies will get to their developmental goals, she says.

“When parents don’t use the [age] adjusted milestones, that’s when it becomes an issue,” Caprio says.

Premature baby: development by month

Nursing methods for premature newborns are developing rapidly these days. It happens that babies are born with a weight of 500 grams. How do doctors assess their condition? What indicators of development should be guided by in order to understand whether everything is normal for the baby?

In the official language

Russia switched to the medical birth criteria approved by the World Health Organization in 2012. They are determined by the presence of the following signs in a newborn: breathing, heartbeat, pulsation of the umbilical cord, or voluntary muscle movements.

According to these parameters, a premature newborn is an infant weighing over 500 grams, over 25 centimeters tall, born at the 22nd week of pregnancy. Every year, 5-10% of such children are born from the total number of newborns around the world.

Today there are all conditions for nursing "early" children.

Early help

A 500g baby is not just very small. In such babies, the organs and systems are immature, the immune system does not work at full strength, so the body of prematurely born children is very vulnerable and susceptible to the effects of various adverse factors. What does not harm the health of full-term babies may affect a child with extremely low body weight.

Children weighing 1000-1499 g and less than 1000 g are most at risk of developing various diseases. Moreover, the shorter the gestation period, the higher the risk that the baby may have several problems at once.

The sooner doctors can identify possible pathologies and disorders, the sooner it will be possible to start adequate treatment, facilitate the adaptation of the baby to the air environment and provide him with the most favorable opportunities for development.

Three ages of premature baby

Usually a person's age is calculated from the moment of his birth. But for each premature baby, doctors determine three ages at once.

Chronological

This indicator is familiar to everyone. It is counted from the moment the child is born. If the baby was born on December 1, then on January 1 he will be 1 month old.

Gestational

This is the age that is equal to the number of completed weeks of pregnancy at the time of delivery. It is counted in weeks and days. For example, a child was born on January 1 at 25 weeks and 5 days. In this case, his age is 25 weeks, rounding up does not occur.

Adjusted

This is the child's age minus the "missing" weeks. It is considered relative to 40 weeks.

Corrected age = chronological age - (40 weeks - gestational age)

For example, the child's chronological age is 4 months (i.e. 16 weeks). The baby was born at the 28th week of gestation, that is, 12 weeks earlier (term delivery = 40 weeks). Corrected age of the child: 16-12 = 4 weeks (or 1 month).

This means that if a full-term baby usually starts crawling around the age of 9months, then for a child born 3 months premature, it is permissible to start crawling at the age of up to 12 months. This is by no means considered a pathology. In addition, if a premature baby was sick after birth and, for example, was connected to a ventilator, this period will affect its development. In this case, such a baby will learn everything a little later.

The most commonly used skill scale for preterm infants, adjusted for age.

Peculiarities of psychomotor development

Each child is individual, and one should not compare different children with each other. It is quite natural that a baby born at 34 weeks is more likely to catch up with his full-term peers than a baby born at 27 weeks. What indicators do doctors focus on? What should parents pay attention to?

Pediatrician Natalya Maykova tells about what scientists know today.

1. The child develops gradually and progressively.
2. In premature babies, skills are formed in approximately the same sequence as in full-term babies, but adjusted for corrected age.
3. The individual characteristics of a child's development are related to his gestational age (the gestational age at which he was born) and his condition at the time of birth. That is, the more problems the baby experienced in the first months of his life, the longer it will take him to acquire new skills.
4. For an adequate assessment of the pace and level of development of the baby, dynamic monthly monitoring of the child is necessary.

Monthly development

There is an approximate list of skills and abilities that can be expected from a premature baby in the first 18 months of his life. However, it is worth remembering that one should focus not on the chronological age, but on the corrected one.

Of course, conditional standards cannot be applied to absolutely all premature babies, but they can serve as a guideline for both doctors and parents.

Only prematurely born children, as a rule, need special conditions and constant medical supervision. Often these babies are fed through a food tube and supported by their breathing through artificial oxygen supply.

2 months of corrected age

The baby holds his head well, his first coos, smiles appear. The child begins to listen, recognize native people and rejoice when communicating with them.

4 months

The child lies confidently on his tummy, raises his head, looks around. He watches over objects and people. Some babies are already well rolled over on their stomach and back.

6 months

The child learns several skills at once: he learns to sit, crawl, stand on all fours. Babble appears in the baby’s speech when he repeats the same simple syllables: “ma-ma-ma”, “yes-yes-yes”, etc. He enthusiastically plays with toys and various objects. He is interested in those that are out of his reach, and tries to crawl up to them or reach out to them.

9 months

Baby crawls everywhere, gets up, reaches for objects, plays with them. More and more new syllables appear in his "lexicon", he tries to imitate new sounds. At this time, the child begins to understand the word "no" well.

12 months

By the age of one, children, as a rule, are already completely catching up with their peers who were born on time, both physically and psycho-emotionally. They already know a lot: they take their first steps, walk holding on to walls and furniture, bend down and pick up objects from the floor. The speech of a one-year-old child is actively developing: the baby consciously pronounces new words, enters into communication, answering the questions posed. He likes to communicate with the help of gestures: he waves his hand, shakes his head, nods. During this period, the child begins to get upset at the moments of the absence of a close adult nearby.

15 months

The child's vocabulary grows quickly. He can, upon request, point his finger at objects, animals, body parts. The coordination of movements improves, the gait becomes confident, the child knows how to squat. The kid's games with simple educational toys (cubes, pyramid) become conscious. He learns to sort objects, to solve simple puzzles.

18 months

At this age, the child can confidently use a spoon and drink from a cup. He knows how to go up and down the stairs, tries to dress and undress on his own. The child communicates emotionally, uses more and more words in speech.

Specialists: a pediatrician and a neurologist can help parents evaluate the harmonious development of the baby. Doctors will notice “weak points” in the development of the child in time and help develop a plan for his further observation and, if necessary, treatment, which includes not only drugs, but also massage, physiotherapy exercises, kinesitherapy and other modern methods.

It is important to remember that the development of a premature baby largely depends on the care and responsible attitude of parents to the recommendations of doctors.

Photo: Collection/iStock

how a child develops

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