Reader's Question: Developmental timing when babies were born premature

Here's a quickie, but an important question. Quickie because I can actually answer this in a few sentences and also because I have been smacked with a cold that I caught from my kids and my head is snotty. (On a total side-note: Does anyone know if this whole thing about people with colds/viruses only being contagious for the first 24 hours from when they caught the cold is true? Because I caught this a whole week after my kids and I haven't been around anyone sick. So CLEARLY this means that any scientific evidence out there about incubation and contagion periods is wrong. ALL WRONG. Because I'm SIIIIIIICK. Anyone know anything about this? <sniff>)

On to the REAL question of the day:

I have a 13 week old but he was born 4 weeks early so if we count from his due date he would have been 9 weeks old instead of the 13.  Anyway, since you say... that it's not about the how but the when, do I look at him at his chronological age or his adjusted age when referring to sleep issues and training?  Right now, he has a hard time falling asleep and/or staying asleep for longer than 30 minutes on his own but when he's in my arms or in my wrap, he sleeps for hours at a time.  I've been working at getting him to fall asleep on his own by establishing a naptime routine and putting him down drowsy but awake, sometimes it works and sometimes it doesn't, sometimes he cries, sometimes he doesn't.  I don't let him cry it out but sometimes I do let him fuss it out.  I don't want to cause my baby any harm by doing this if he's just not ready due to him being a preemie.  He's about 12lbs, and is healthy except for a bit of reflux (currently trying to control it without meds but will be reevaluating that in a couple of weeks if necessary).  He coos, laughs, smiles in response to mine and spontaneously just like my 3 year old did at this age except that my 3 year old did it earlier than this one.  So what's your take on 4 week preemies and sleep?

My take is that you adjust for the number of weeks the baby was premature. ESPECIALLY in the first year, but the rule of thumb is up to the 2nd year. So, if you've read about the oncoming 4-month transition, you should really be thinking about it around the 5-month mark. And remember, our age spans are still approximations. I usually advise parents to start becoming wary of any big changes they're making, including sleep training, about a month prior to the stage transitions we delineate here and in the book (because some kids DO hit them early and others a little later, we're just talking averages here). So, it's TOTALLY normal for a 9-week old (adjusted) to have trouble napping anywhere else except near or ON your body and it's very, VERY common for naps to last only 30-45 min at this age. They'll lengthen significantly AROUND 6 months for most kids. Until then, I'd suggest using any gentle approach you feel good about and doing whatever works for you and your baby to get as much sleep as consistently as possible. 

BTW, the same adjustments aren't usually made the other way around, if your baby was born PAST his or her due date. There's a few reasons for that, including that we're sometimes pretty bad at figuring out exactly when conception occurred so due dates are notoriously "approximate" and also because cognition and perception doesn't develop in the same ways in the womb as it does outside of it. Make sense?

If you had a premature baby (or babies, as in my case), has your child hit the sensitive developmental windows or cognitive milestones at his adjusted or "actual" age? Both my boys hit their stage transitions about a month later than average (they were born at 36 weeks). But by 2, there were no difference with their same-age peers in terms of general timing.

Comments

[Cloud]

People are contagious as long as there is live virus in their system. For most people, the tail end of a cold is just your body mopping up after the fight- all the virus is dead. I suspect that the length of time you're infectious is variable. 24 hours sounds too short to me. You are probably at your most infectious then, but still infectious later.

Also, some viruses can persist on surfaces (door knobs, etc) for a while- how long they persist depends on the type of virus.

Finally, you could have been infected but not yet symptomatic for a day or two. The incubation time varies with type of virus and person, too.

My daughter was only 5 days early, so I have nothing on the real question!

[Isabela]

@Cloud: See? I just KNEW someone smart would pipe up with the answer. THANK YOU. The way you put it makes perfect sense to me.

[Christy]

My son was 4 weeks (and one day) early and after watching him around the time of a few expected developmental leaps/sleep regressions, I decided he was about two weeks behind schedule. That's just one data point and I'm sure it varies, but once I figured out the two-week thing, it did seem to hold pretty consistently for us the first year (he's two now).

[Judy B]

E arrived at 33 weeks and just "graduated" from his Early Intervention program. He's closed most of the gap between his birthday and his due date. He's almost 15 months, but should be just 13, so sleep wise I guess he would still fall in a good window.

We co-sleep most of the night and are in the category you blogged about earlier because we haven't really "sleep trained". Once in a while he'll have a day or two where he won't let us out of the room until he's really konked out- but usually we can put him down a couple hours before we go to sleep. So I haven't noticed much difference in his age vs. sleep habits, but there is definitely a developmental gap they need to close and I'm sure sleep would be in that gap.

Preemies are usually expected to be caught up by 18-24 months, to where you wouldn't notice any developmental differences.

[fahmi]

Thanks for the bit about late babies! The kid was born exactly on his due date, and he pretty much hit all his milestones on the dot, or a day before or so. The kidlet was born two weeks late, but he seems to be pretty much on track within a week. But he seems to be going pretty fast because he is the secondborn. Knowing about how 'off' he is has helped tremendously.

[Anita]

If the original questioner is still reading, I'd suggest getting your child on the reflux medicine. Our preemie daughter had reflux and she's gone from a crier/screamer/poor sleeper to a sweet, funny, flirty GOOD sleeper on the meds! We can also tell when she's outgrown the dose b/c she goes back to crying/poor sleep.

HTH!