By: Shiri Kertin, developmental physiotherapist, with a master's degree in occupational therapy

Congratulations! The hospitalization period in the premature baby is over and you are home. The development of a premature baby (with a normal neurological system) is very similar to the developmental stages of a baby born at term, but it has unique characteristics. Many premature babies show characteristic developmental difficulties in the first two years of their lives. Sometimes the difficulties accompany them throughout their lives and sometimes they pass. The developmental difficulty is created due to the immaturity of the body's systems and there are influences from the premature baby's environment. From a neurological point of view, there are difficulties in the sensory system (hypersensitivity or hyposensitivity of the system), movement (changes in muscle tension/tone), and in the body's regulatory systems (heat-cold, satiety-hunger, sleep-wakefulness). In addition, some premature babies have digestive difficulties (reflux, etc.), and difficulties in the respiratory system that affect cardiopulmonary endurance. All of this and more affect the development of the premature baby.

Studies show that the younger the week a premature baby is born, the greater his risk of developing developmental difficulties and depends on the complications that occurred in the preterm period (such as cerebral hemorrhage). In addition, studies have found that premature babies born in later weeks (34 and above) are also at high risk of developing developmental delays compared to babies born at term. An encouraging fact is that most premature babies manage to bridge the developmental gaps by the age of two, and some even earlier. The most common developmental difficulties are delays in acquiring milestones such as rolling over, crawling to walking, delays in acquiring language and communication, delays in playing, and sensory and emotional difficulties. In addition, there are difficulties in transitioning to eating solids, and sometimes there are difficulties in sleeping and falling asleep. Each premature baby has its own rhythm and developmental characteristics. It is possible that one premature baby will be able to quickly complete motor gaps and be late in language/play, while another premature baby will be the opposite. There are premature babies who do not need treatment at all, but in any case it is recommended to seek diagnosis and developmental treatment, as needed. The first professional who meets the premature baby and his family is a developmental physiotherapist. The developmental physiotherapist is licensed by the Ministry of Health to treat premature babies. The physiotherapist will guide and instruct on motor, sensory, emotional, intellectual development, daily functioning and eating. Premature babies born under 33 weeks and/or with a birth weight of less than 1500 grams are eligible for premature follow-up through the health services. If you are seeking private advice, ask to see certification certificates and a valid license from the Ministry of Health.

Welcome home!

The home environment can be a supportive environment for the premature baby's emotional, sensory, and motor development. Here are some helpful tips for transitioning home from prematurity:

Hug, kiss, wrap him/her in warmth and love, and also in a carrier/swaddle/hammock. Continue the position of collecting the premature baby's body with a rolled towel/diaper, called a "nest" or "pretzel". This position will encourage contact, soothing, and a physiological fetal flexion position (important for the muscular system). From a safety perspective, it is recommended to place the "nest" under the bed sheet.

Age-appropriate play: Talk and sing to him/her. In the first few months, the parent is the most interesting "toy." From two months of age, the baby can be exposed to solitary play.

In terms of the sensory system: Continue kangaroo position, teach premature baby massage – massage has long-term effects on self-soothing functions, sleep and eating. Reduce stimuli from light, noise and unpleasant touch. It is recommended to illuminate the house with dim lighting or daylight. It is recommended to play pleasant, calm music, and show one toy at a time.

For premature babies who suffer from reflux, it is recommended to raise the mattress. A good method is to place a large binder under the mattress, at the head of the bed.

In terms of traffic systems – To prevent torticollis (head tilt), maintain symmetry in the position of the premature baby's neck by holding it with a different hand at a time, positioning the neck correctly while swaddling using a rolled diaper, and changing the position of the toy/mobile/book in the bed, dresser, and stroller once a week.

Place the premature baby on his stomach whenever he is awake. The instructions for laying on his back are for sleep time only. Lie in front of him and talk/sing to him or help with an interesting sight/game.

Wishing you a pleasant and easy transition home!