Institute for Child Development

What is meant by "monitoring at the Child Development Institute"?

Among the many recommendations you will receive upon release from Pagya, this recommendation will also appear. You may have already met professionals in the field of child development, such as a physical therapist, occupational therapist, speech therapist or dietitian, during your stay at Pagia. After discharge, this professional team will meet with you to help promote the development of the premature baby, reduce gaps and prevent complications.

Each baby is also under developmental monitoring as part of "a drop of milk", but a multi-professional clinic is uniquely tuned to the development of premature babies.

Who will you meet at the Child Development Institute?

In the first stage, a developmental assessment is performed by a neurodevelopmental doctor, a nurse and a physiotherapist. The doctor is the head of the team and guides the follow-up and treatment. If necessary, especially in low-weight premature babies or with eating or feeding difficulties, you will also meet with a dietitian, at any stage where this is necessary. The baby undergoes a general, neurological and developmental examination and the doctor, and any professional - will assess whether there is a gap in the baby's functioning from what is expected for his age, what are the recommendations for reducing the gap if it exists, and what is the recommended frequency of follow-ups. At the same time, the parents will meet with a social worker who will provide information on the rights due to the parents of premature babies and provide help In terms of exercising rights if necessary. Later, the parents will meet as necessary and according to the doctor's decision with professionals from the field of occupational therapy, from the field of communication disorders (communication clinic), and developmental psychology.

Why is it important to come to the Child Development Institute?

Since at the Child Development Institute there is a multi-disciplinary approach by a multi-professional team working in close cooperation, it is recommended to arrive early (up to three months from the moment of release from the hospital) in order to enable detection of developmental problems at a young age, early treatment as needed and guidance of parents on a variety of topics, such as: correct guides, transitions between guides (lifting the baby)

and specific exercises that promote the baby's motor achievements and improve head and body control. According to the guidelines of the Ministry of Health, all premature babies born under 1500 grams must be monitored at the Child Development Institute. Obstetrician doctors can recommend this follow-up to additional babies, according to the course they went through in the hospital. In light of the significant achievements of the intervention at a young age, when the brain is in the process of rapid changes, it is important to emphasize the early suspicious signs of disability and to accept the professional recommendations regarding the intervention of developmental treatments and treatments in the home setting.

Premature babies from a neurodevelopmental point of view

One of the main issues that worries parents of premature babies is the consequences of miscarriages on their child's development. Below is an answer to some of the common questions that arise from parents in Pagia:

Do premature babies develop like normal babies?

The answer is "yes and no". If you look at the progress of premature and newborn medicine in recent decades, you can see a significant improvement in the medical care that supports the cardiac, respiratory and gastrointestinal (digestive) systems. The general improvement in the treatment of premature babies has significantly reduced the level of brain damage that causes severe neurological damage, but still the newborns who were born prematurely, and especially extreme prematurity (under 32 weeks of pregnancy) - are at risk of brain damage. On the other hand, there is a constant improvement in the treatment of the various systems, such as: in breathing, maintaining body temperature, treating anemia and preventing the growth of abnormal blood vessels in the eye.

Why is the risk of developmental damage relatively high in premature infants and in particular in extreme premature infants?

A premature baby's brain and the blood supply to the brain, like the premature baby itself, are still far from ripe, especially in premature babies born before the 32nd week of pregnancy or with a birth weight of less than 1500 grams, therefore - the earlier the birth and the lower the birth weight, the higher the risk of brain damage. Other causes of brain damage in a premature baby are: respiratory disease, infections, lack of closure of the fetal connection between the blood circulation of the body and the lungs or damage to the intestines of premature babies. The young age and low birth weight of premature babies together with the health complications typical of premature babies may cause a decrease in blood flow, bleeding or inflammatory damage to the premature brain. The strength of the damage to the brain is amplified due to the immaturity of the brain and significantly increases its sensitivity to damage - all this at significant stages for the development of the brain. The encouraging part is that despite the high risk of brain damage, as a result of the improvement in treatment in recent decades, there has been a significant decrease in brain damage that causes severe developmental disabilities.

What are the meanings of brain injuries?

Significant brain injuries, the frequency of which increases significantly in the previously defined risk groups, include: cerebral palsy (5%), visual impairment (3%), hearing impairment (3-1%),

Intellectual disability (7%), social communication disability, autism (10-5%) and epilepsy (2%) up to milder impairments (which are common) that include coordination problems, sensory processing problems, language impairments and social communication difficulties whose frequency varies in different articles between % 50-20 premature babies .

The risk of developmental damage in premature babies born over the 32nd week of pregnancy is significantly lower (this is assuming that the course of the stay in the preemies was without complications). These premature babies may also suffer more frequently from the mild neurological complications.

When do you see the injury?

Brain imaging in US or MRI in the brain are tools for the early detection of brain damage. It must be remembered that this is a prediction and although we know what the risk of developing an injury is in connection with a certain finding in the imaging, there is always the chance that there will be no injury at all. It is important to note that a neurological examination during the stay in the Peg is very limited and insensitive (unfortunately also for predicting normal development), so assessments of developmental damage based on a neurological examination alone must be taken with limited responsibility. A developmental test can detect risk, but the level of certainty increases as age advances.

How will I know if my baby is developing well?

The development of a baby born on time is equivalent to the development of a premature baby according to his corrected age. The neurological development can be affected by the lack of weight gain of the premature baby and a neurological problem can be reflected in small head circumferences for the age. Hence, monitoring weight gain and head circumference is of great importance in premature babies. An increase along the growth curve of head circumference and weight is very encouraging in terms of neurological development, but on the other hand deviation from the curves increases the risk of developmental damage. The high risk of damage to hearing and vision in premature infants requires examinations at the age of several months. An ophthalmologist will check the maturity of the blood vessels in the retina. The auditory system is tested by BERA/ABR tests that test the neural activity of the auditory system directly by electrodes that record its activity. This is not the place to go over all the milestones of a baby's development, but it is important to note a number of developmental "milestones" (up to the age of one and a half) that parents should pay attention to. We note again that a normal neurological examination before discharge is limited and neurodevelopmental problems may appear in the first months of life:

Around the age of 3 months corrected: the baby should make eye contact, follow and smile at his parents, make the meowing sounds and also he should raise his head while lying on his stomach. Inability to make eye contact, inability to lift the head from the bed (hypotonia), tilting the head to one side (torticollis), movement of one side more than the other or lack of response to voices - are red flags.

Around the age of 6 months corrected: most babies will turn from their stomach to their back and vice versa, move from side to side in bed, reach for an object and pass it from hand to hand. They will mumble and have a mutual "conversation" of making sounds with the parents. Red flags will include an increase in muscle tension mainly in the legs (which will make it difficult to change diapers) or one side of the body (which will cause asymmetry in body movements) as well as the baby's lack of responsiveness to the environment (reaching out for objects or turning his body or eyes to people approaching him), or a baby who does not make sounds (a baby who is too quiet).

Around the age of 9 months corrected: most babies will begin to crawl and/or sit up, put objects in a box, follow a missing object, begin to say syllables, respond to their name and develop a clear distinction between relatives and strangers. The acquisition range of these abilities is wide and a distinction must be made between delaying the acquisition of crawling ability or skipping a stage. Motor delay can be a "red flag" at this age if there is an increase in muscle tension, asymmetry in body movements and a delay in creating communication by seeking parental contact.

Around the age of one corrected: the baby is expected to pull himself to a standing position and walk along objects, is expected to tap cubes and try to feed himself with a spoon. Linguistically, he can acquire first words, point to objects he is interested in and request contact with his parents in order to get their approval for his actions or show them new things he has learned. New red flags in addition to the traffic problems described earlier are lack of voting and lack of mutual communication with parents.

Around the age of one and a half corrected: the baby is expected to walk, build a 3-cube tower, scribble on a page, acquire a vocabulary of 20-50 words, learn several body parts and animals, understand simple instructions such as "fetch the ball" and play a reciprocal game. Red flags are lack of acquisition of words and lack of reciprocity in the relationship between the baby and the environment.

What can the parent do to promote the development of the baby - his premature baby?

During the stay in the preemie, it is very important to establish a contact of touch, voice and visual appearance of the parent with the preemie - everything depends on his state of health. Body to body contact, talking or singing and making eye contact have been proven in many research works to improve the development of premature infants and the relationship between parents and premature infants. It is very important during the stay in the preemie and also after release to maintain optimism regarding the development of the preemie in the future, this is also because the prediction of developmental damage is limited but mainly due to the fact that optimism will improve the relationship between you and the preemie.

What is the importance of follow-up in child development institutes?

After discharge, the preemie must be cared for as any new born baby and according to the recommendations of the staff at the preemie. Parents of premature babies who were born before the 32nd week of pregnancy, with a birth weight of less than 1500 grams or who have a suspected brain injury or developmental delay should begin follow-up at the Child Development Institute until the age of three months (according to urgency). The initial diagnosis and follow-ups are of great importance. Many works have shown that early identification of a developmental problem and early intervention led to an improvement in the abilities of premature infants at later ages. Working in a multidisciplinary team is critical to providing care that will meet both the needs of the premature baby and the support for the family during the upbringing of a child who is at risk of significant developmental problems.

In conclusion

Prematurity and especially extreme prematurity carries a risk of developmental delay. It is possible to reduce gaps and promote the development of the premature baby. As far as the parents are concerned, maintaining optimism along with receiving recommendations and working together with child development professionals will help promote and improve the functioning of the baby and his family.

Participated in writing the episode:

The director of the institute Dr. Lydia Gabis
Neurodevelopmental doctor
and in charge of a clinic
Dr. Omer Bar Yosef
communication clinicians Dr. Ariela Yokel, head of the KT team
Dorit Shmertz, Adi Golan-Yitzchaki
Physiotherapy Yaffe Krakow-Bogen, head of the physiotherapy team
Sherry Stoller
Occupational clinics Shmoena Lev-On, head of the occupational therapy team
Tova Shotan
Psychology Rebecca Sofrin, head of the team of psychologists
Dil Saba
female attorneys Merav Herman-Rez, head of the legal team
Sharon Segal-Frizat
Clinical Dietitian Yael Shemaya
head nurse These are Aviv
Grammatical edit Shirley Fisher

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