We measure early childhood in milestones – the first smile, first step, that very first word. Parents are encouraged to track what their baby can do, but sometimes this can cause anxiety and frustration when you feel your child is not making strides in development compared to others.
It is very common for children that spend time in the NICU to experience a developmental delay of one kind or another compared to their typical peers. Some of these effects might be immediately apparent, and others will take years to emerge. It’s tempting to throw the milestone charts out entirely, but remind yourself why we track milestones in the first place. With tracking, we can recognize and celebrate how one skill builds upon the next while monitoring what areas we might need to work on. We watch to make sure that our babies are following a progression that will give them the tools they need to thrive.
While your child will follow their unique path, there are certain benchmarks and milestones they will need to visit along the way. Consider breaking your child’s early development down into a broad set of categories so you create unique, personalized goals for your child based on the things you want them to achieve – like being healthy, learning to communicate, move, and play.
Your child’s developmental journey began early in the womb. As their bodies and brains developed, they progressed along a path unique to them and their environment. While we used to think that most children were prepared to enter the world after 35 weeks, we now understand just how much development happens in the final month of pregnancy. When babies are born early, that development must continue outside of the womb.
Your baby’s NICU team will do everything they can to create a developmental care environment where your child can grow and develop in a way that mimics the womb. Developmental care not only includes monitoring the noise volume, light level, and activity in the NICU but also includes being thoughtful when positioning your baby and in determining how much sleep they get.
Listen: NICU Now episode 10: Understanding Developmental Care in the NICU
All of this is done to help your baby achieve physiological stability. Without that, progress tends to be harder to make. Progress is usually not measured in days but in accomplishments. Your child must reach certain goals before being considered for discharge. They must learn to regulate their body temperature, remember to breathe, be able to take all their feedings, and gain weight. While, as a general guideline, many babies can do this by their original due date, age is not an indicator of when your baby will graduate from the NICU.
Once your child’s brain and body have developed enough to be physiologically stable, you will begin to focus on building the broader skills your child needs.
First and foremost is communication. In the NICU you learn how to read your baby’s cues, the most basic way they communicate what they need. This conversation with your baby will continue once you go home. Even the tiniest babies can express their mood with a grimace, a hand over the eyes, or a stiff posture to let you know they may be distressed. Conversely, a relaxed, symmetrical, organized posture and steady gaze tell you your baby is ready to talk with you. Babies love the sound of your voice and the rhythm of your movements. Talk with them every chance you get. Carry them with you and explain what you are doing. Ask permission to change their diaper, put their clothes on, or pick them up. Beginning at just a few months of age infants will mimic your expressions and coo in response to your voice. Even if your baby is quiet, their eyes and gaze will do the talking.
As your child grows, communication with you will advance. No matter how your baby develops, keep in mind the larger goal is communication – the give and take of information between you and your child. There is more than one way to accomplish this. Babies who can’t yet speak can often sign. Children with limited motor skills can use eye gaze. It doesn’t matter the mode; the goal is communication.
Eventually your baby is going to express the desire to get around on their own. What begins as holding their head up during tummy time progresses to rolling, scooting, sitting, and crawling. The muscle control, strength, coordination, and gross motor skills it takes to walk are incredibly complicated. Even in typically developing children, there is a very broad range of ages at which it is considered normal to start walking.
Don’t get too hung up on one mode of getting around. There are lots of ways to accomplish this goal. If your child is having a difficult time putting all the skills together to walk, there are many tools to support mobility. Walkers, gait trainers, orthotics, and wheelchairs are all significant modifications to help with walking. Some children may benefit from occupational and/or physical therapy so talk with your pediatrician and care team about what might help your child.
Just like adults, babies learn how to make sense of things through exploration, trial, and error. Give your little one safe opportunities to explore and learn. Help them see the connection between cause and effect. Show them their actions have a predictable response. Most children quickly discover ways to get what they need – and what they want. Young babies learn easily the connection between crying and getting picked up. Soon they will even make sense of more complicated things and will learn to put the pieces of their world together.
Babies enter the social arena ready for love and care. As they develop, their social skills grow too. They smile readily and giggle when they are happy. They protest and complain when they are feeling upset. You seldom need to wonder what they are thinking.
One of the most amazing transformations you will experience is when your baby begins to share and enjoy things with you. They will start to point to different objects and then move to requesting things. “Joint attention” to an object or game is a sign that your baby sees themselves as part of a larger social world. It is one of the first hallmarks of social understanding. Soon they will transition from playing side-by-side with others to joining in activities together. Your little one will start to seek out other children and become excited to be around them. Coincidentally, this is the time when we start to see the first signs of independence and defiance – both desirable qualities you want in a child.
No matter what your child’s developmental journey is, keep the larger goal in mind. Once you see your child for all the amazing things they can do, you’ll be less likely to focus on their struggles. Remember that children are incredibly inventive and resilient. They will find ways to meet their communication, mobility, and social needs. Follow their lead and put as many supports in place as possible. Give them every opportunity to succeed, celebrate the milestones along the way, and you will be amazed by what they accomplish.