Ask An Expert: Your Preemie's Gross Motor Development With Leah Turk, PT, DPT

Although every expectant parent is given a due date on which they can expect their little one to arrive, every baby has their own idea on when they want to make their grand entrance. Some babies decide to arrive a little early, some are more punctual, and others need an eviction notice. Sometimes, little ones arrive much earlier than they’re supposed to, and are considered to be preterm or premature when born before 37 weeks gestation. Because preemie babies are born before they’re ready, they aren’t quite as physically developed as full-term babies. They are often unable to control their body temperature, and may have excessive weight loss or unstable vital signs. Many preemies end up staying in the NICU after birth, need extra care, and take a little longer to catch up developmentally. Because parents of preemie babies are so used to tracking the numbers (weight, measurements, and levels) they may find themselves obsessing over every developmental milestone as well. However, since development varies even among full-term babies, it’s important to remember not to hold preemies to the average milestone timeline. 

To learn more about gross motor development in babies who are born premature, we spoke to Leak Turk, PT, DPT. As a pediatric physical therapist and a mom who has worked in several major hospitals throughout Texas treating a variety of pediatric patient populations, Leah developed a considerable following on her Instagram, @thePTparent. She uses this account to not only share her experiences as a new mom, but to also share her knowledge as a physical therapist, teaching grateful parents developmental activities to do with their babies and kids.

Q: What exactly is adjusted age and how does it affect gross motor milestones?

LT: Adjusted age is a way to “adjust” for prematurity when considering development. It allows us to “even the playing field” and gives a better idea of how your baby is tracking with their milestones by adjusting for their prematurity, rather than comparing them to babies the same age who were born full-term. If a baby is born before 37 weeks, then we consider that pre-term and use an adjusted age for their milestones rather than their chronological age. If your child was born before 37 weeks, you’ll want to consider tracking their milestones based on an adjusted age, rather than their actual age.

Q: For babies who are born premature, should milestone expectations be changed to reflect their adjusted age?

LT: Yes! If your baby is born before 37 weeks and we’re looking at their milestones, it may seem that they are a little “behind” for their actual age. However, when we adjust for their prematurity, your baby is still on track! For example, if your child’s actual age is 3 months, but their corrected age is 1 month, then they should not be expected to meet all of their 3 month milestones just yet. They may not meet all of them until their corrected age is 3 months, and their actual age is around 5 months.

Q: Will a baby who was born two months premature be much more delayed than a baby who was born one month premature?

LT: In general, yes. The earlier a baby arrives, the longer they may need to catch up… but most do get there! For example, a baby born at 35 weeks may not be caught up to their peers at 6 months, but may be within the normal range by 12 months. And a baby born at 27 weeks or less may not catch up until they’re 2 or 3 years old. Most preemies do catch up to their peers who were born on time, but usually the more premature they are, the more time it takes to fully catch up.

Q: What should parents expect from a baby who is born extremely premature? What does their first year look like in terms of development?

LT: A baby who is born extremely premature or has faced significant medical issues may need a little more time to reach their milestones. They will greatly benefit from using their adjusted age when looking at their developmental milestones, and parents can expect for their baby to develop skills closer to their adjusted age. It may take up to 2-3 years before their baby is completely caught up with their peers as far as development goes.

Q: What can parents do to make sure that their preemie baby meets gross motor milestones?

LT: I would suggest that parents be familiar with what gross motor milestones are expected around what age and then provide opportunities for their baby to work on these skills around the expected times (with adjustment for prematurity). There are tons of great resources out there to refer to! One that I particularly like is https://pathways.org. 

Q: Since gross motor expectations for preemie babies look different, how will parents know when to seek help from a pediatric physical therapist?

LT: Gross motor skills have expected age ranges, where we usually see the majority of babies are performing a certain skill by a certain age. For example, we typically expect most babies will be rolling back to belly anytime between 4 to 6 months of age. If parents feel that their baby is not meeting skills within those ranges, after adjusting for prematurity, then they should talk with their physician or contact their local early childhood intervention to get an evaluation by a therapist. Here is a link to help find ECI services in your state: https://www.cdc.gov/ncbddd/actearly/parents/states.html.

Q: Do all preemie babies need to see a physical therapist?

LT: No. Some babies are able to meet their motor milestones on their own, especially with an adjustment for prematurity when looking at gross motor skills. There are, however, still some cases where physical therapy, and possibly other therapies are warranted in order to ensure the best possible outcome for development.

Q: Is it possible for a premature baby to still meet their milestones on time without factoring in adjusted age?

LT: Yes! It is definitely possible, and I have personally seen instances where a baby is born premature and meets their milestones within their chronological time frame without any adjustments for prematurity. 

Q: At what age do preemie babies typically catch up with their full-term peers?

LT: Usually, we adjust for prematurity until 2 years of age. You don’t need to adjust for prematurity throughout their entire childhood, but it will give you a better picture of when they should be meeting their milestones for the first 2 years. Most premature babies reach the same developmental milestones as their peers in 2-3 years. After that, any differences in size or development are most likely due to individual differences, rather than their premature birth.

Q: What advice would you give parents who feel anxious about their preemie baby’s development?

LT: I would tell parents that it is completely NORMAL to feel anxious about their child’s development, especially when their baby was born premature! Don’t ever feel like you can’t ask questions or bring up concerns with your child’s care team. They are there to support you! I would also add that, when in doubt, get the evaluation. There is absolutely nothing negative that can come from being proactive in your child’s care. Therapists are happy to see you whether they are recommending ongoing PT or if they feel your child doesn’t require additional therapy. We love to help you and ease those anxious feelings!