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Children develop at different rates.  Boys are often talk later girls, while reaching motor milestones sooner.  Preemies are notorious for developing on their own schedule.  Some delays are cause for further evaluation while others truly are not a big deal.  All delays should be brought to the attention of your child's pediatrician.

Here is a list of "hallmark developmental milestones" to keep an eye on.  Be sure to address any concerns with your child's physician.  Listen to your gut.  If your doctor dismisses your concerns you may want to find a different physician.  If "wait and see" feels wrong, don't be afraid to ask for a referral to a developmental pediatrician or other specialist.

Don't forget to use your child's adjusted age when it come to reaching milestones.  Some physician use adjusted age up to the third year.  So don't forget to use their due date instead of their birth date.  Save yourself from some worries and frustration:  DO NOT COMPARE YOUR PREEMIE WITH TERM BABIES.

At 4 Months:
Follow and react to bright colors, movement, and objects?
Turn toward sounds?
Show interest in watching people’s faces?
Smile back when you smile?

At 6 Months:
Relate to you with real joy?
Smile often while playing with you?
Coo or babble when happy?
Cry when unhappy?

At 9 Months:
Smile and laugh while looking at you?
Exchange back-and-forth smiles, loving faces, and other expressions with you?
Exchange back-and-forth sounds with you?
Exchange back-and-forth gestures with you, such as giving, taking, and reaching?

At 12 Months:
Use a few gestures, one after another, to get needs met, like giving, showing, reaching, waving, and pointing?
Play peek-a-boo, patty cake, or other social games?
Make sounds, like “ma,” “ba,” “na,” “da,” and “ga?”
Turn to the person speaking when his/her name is called?

At 15 Months:
Exchange with you many back-and-forth smiles, sounds, and gestures in a row?
Use pointing or other “showing” gestures to draw attention to something of interest?
Use different sounds to get needs met and draw attention to something of interest?
Use and understand at least three words, such as “mama,” “dada,” “bottle,” or bye-bye?

At 18 Months:
Use lots of gestures with words to get needs met, like pointing or taking you by the hand and saying, “want juice”?
Use at least four different consonants in babbling or words, such as m, n, p, b, t, and d?
Use and understand at least 10 words?
Show that he or she knows the names of familiar people or body parts by pointing to or looking at them when they are named?
Do simple pretend play, like feeding a doll or stuffed animal, and attracting your attention by looking up at you?

At 24 Months:
Do pretend play with you with more than one action, like feeding the doll and then putting the doll to sleep?
Use and understand at least 50 words?
Use at least two words together (without imitating or repeating) and in a way that makes sense, like “want juice”?
Enjoy being next to children of the same age and show interest in playing with them, perhaps giving a toy to another child?
Look for familiar objects out of sight when asked?

At 36 Months:
Enjoy pretending to play different characters with you or talking for dolls or action figures?
Enjoy playing with children of the same age, perhaps showing and telling another child about a favorite toy?
Use thoughts and actions together in speech and in play in a way that makes sense, like “sleepy, go take nap” and “baby hungry, feed bottle”?
Answer “what,” “where,” and “who” questions easily?
Talk about interests and feelings about the past and the future?

Remember these are just guidelines.  If you child is a month behind, it may not be cause for concern as long as they do meet them.  They may just need a little more encourage and support than a term baby.  It's better to be safe than sorry.  We know how important early intervention is, so take advantage of it.  You don't have to "wait and see." 

For a list of early intervention (birth to three) contacts by state click here.  If your child is three or older contact for your school district for an evaluation.  You can find a more comprehensive checklist at

by on Aug. 8, 2009 at 12:59 PM
Replies (11-13):
by Head Admin on Apr. 24, 2010 at 11:07 PM

A baby in the womb environment:

*has no need to breathe or digest

*is in a stable, comfortable temperature

*is protected from injury

*is surrounded by water and the boundaries of the uterus

*stays curled up and is gently "rocked" much of the time

*is protected from intense lights, sounds, or touches

*epxeriences day/night rhythm


A baby in the NICU environment:

*breathes and digests

*feels gravity and flat, dry surfaces

*is unable to regulate body temperature

*experiences frequent interruptions of rest and sleep from noise, lights, and handling.

*experiences painful procedures


What you can do:

*approach your baby slowly and quietly

*observe your baby's state of consciousness. ie. is she awake or asleep, is her heart ratea nd oxygen stable?

*softly talk, sing, or read to your baby.

*prepare your baby for touch by speaking softly to the baby prior to touching him/her.

*touch your baby with a gentle steady touch.

*move baby slowly.

*hand swaddle or kangaroo care.

*introduce each activity one at a time i.e. touch or talk but do not do both at once.

*watch your baby's response and behavior after introducing each activity for stress or stable cues.


Stress cues include:

color change (pale or dusky)


decrease in oxygen level

hiccoughs, sneezing, yawning

splayed fingers, stiff limbs, spitting up

looking away

crying, facial grimace


Stable cues include:

alert focused attention

relaxed tone, face

stable color, oxygen level


by Head Admin on Apr. 24, 2010 at 11:10 PM

If you didn't learn about it in the NICU, I encourage you to read this.

Developmental Care: Overstimulation and Your Premature Baby
By Maren Peterson-DeGroff

Preemies come into the world and to a lot of handling and procedures and stimulus before their neurological system is matured. In the NICU they try to block out stimulus somewhat. But it is impossible, really, with all they have to do to keep them alive and healthy. As a parent the best thing you can do for your child is to pay attention to her cues that she is overstimulated. At first the baby will avert their eyes from you if the stimulation is getting to be too much. (My son, Gabe would avert his eyes if there was more than one face before him, or if the face was too animated -- it was just too stimulating.) They might just close their eyes and try to go to sleep to block it out. Then the baby will start to stick out their toungue as an aversion response, then yawning, and finally start to show agitation in their bodies, arching her back, squirming to get away, fussing, crying, etc.

The trick is to really pay attention and then respond to their signal by reducing stimulus. If you are rocking, patting and singing to your child in a brightly lit room with the TV or radio on and she seems to become more agitated, then stop and recognize all the stimulus in her environment. You could first turn down the lights or stop the singing. You can try a soft repetitive sound, "bababa" that might be more rythmic and soothing. If she is still agitated, crying and arching her back, then stop the patting, etc. until you find the "just right" amount of stimulus from you. Some babies are used to the noise and lights of the NICU, and this is comforting to them. In this case the lights and TV might be good, but the physical patting and rocking might be too much. You will have to experiment and look for the signs. Let her lead you.

Babies who don't have mature neural systems are "disorganized." They can't synthesize all the sensations and stimulus they are receiving, and they need help to get organized. The first thing a full term baby does naturally is to put their hands together in front of their body, to their "center line", to organize. If your child isn't doing this, help her, gently hold her hands together. (I used to do this for Gabe in the NICU when a lot was going on or he was agitated or in pain.) Babies also suck on their hands; you can bring her hands to her mouth if she doesn't on her own. This is calming and organizing. This work to organize is important to the brain development, so your job is to help give her an environment that will allow her to do the work, create the neural pathways in her brain that will be the building blocks for later complex activity. That center line is key to later on development, so help her find it.

Full term babies in the womb also spend a lot of time curled up in a ball, legs and arms tucked in. They try to simulate that in the isolette, but it is really hard. If your child is agitated, you can put her on her tummy on your shoulder, and help get her legs and arms tucked, hand in mouth, maybe wrapped in a blanket, and put one hand on top of her head and one on her bottom. This is a containment that is somewhat like the womb. Babies need that pressure, the "walls" around them. Experiment with your child to see what kind of containment might make her feel better. Sometimes a tightly wrapped blanket (even on older babies) is helpful, but she might hate having her hands down in there. Let her hands stick up over the blanket so that she can grasp them together, to hold her hands or suck on them.. (When Gabe held his hands together I knew he was somewhat distressed, even when seemingly calm, but he was handling it on his own!)

I think a lot of infant toys on the market are too stimulating and complex and chaotic for any baby. I wonder about attention problems in the future. Waldorf folks suggest more subtle environments: pastel colors, a feather on a string spinning in the breeze, a fish tank to watch, curtains blowing, laying under a tree, a candle flame... These foster a deep attentiveness, long curious staring and wondering.

If you stayed with me through all this, I hope it helps. Your preemie is likely to have trouble organizing the sensations in her body and in her environment. You can help her now so she won't be too sensitive later.

Maren Peterson-DeGroff is an educator and advocate for children and families.  She and her husband Dave live in Eugene Oregon with their son Gabriel, who is very healthy and happy.

by on Jul. 18, 2010 at 1:03 PM

 My preemie is now 7 months old, 4 1/2 -5 months adjusted. He sees a physical therapist through sooner start for his delays, he can sometimes roll over but only to one side and only when going from belly to his back, they help me to work with him on that, sitting up, he just started tracking objects, and has several other delays, They are very nice about it and try really hard to get him where he needs to be. He is still on an apnea/heart monitor and has other health problems also. 

I am really thankful for the help he gets with his pt. 

family in the vanChristian wife to my wonderful hubby Jordan, mother to 2 Princesses of the King & 3 of God's Warriors all under the age of 5 :)

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