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No Place Like Home: Premature Infants, Socioeconomic Status, and Development
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No Place Like Home: Premature Infants, Socioeconomic Status, and Development


Premature infants face a variety of medical challenges. They may have difficulty breathing and may require extra oxygen or a respirator. They may develop serious infections because of their immature immune systems. They may have abnormalities of their underdeveloped hearts, circulatory systems, or kidneys or they may develop bleeding in their brains. They may have difficulty taking in and absorbing enough nutrition orally and may require special intravenous nutritional solutions.

Both the medical complications of being born too early and the treatments that are used to combat these problems carry short and long−term risks. Normal physical, mental, and emotional development can be threatened and many former premies have learning disabilities as well as physical disabilities.

The greatest risk for decreased school readiness was not past or current medical history, but low socioeconomic status.

By the time children reach school age, they need to have developed certain skills to be prepared to learn to read and write, follow directions, interact socially with their classmates, and to be able to feed and relieve themselves in order to be successful in the classroom setting.

What are the best ways to help preemies “catch up” to their full−term peers? A recent study in the July issue of the journal Pediatrics looked at the factors which negatively and positively impacted school readiness in 135 premature infants' medical and social histories. (1) All the infants in the study had required ventilator support and medication to help their breathing. Their medical records from infancy were reviewed for information about how early they were born, their birth weights, what types of medical problems they had in the nursery and what treatments were needed, and what chronic medical problems and treatments they required when they went home When they were 5−6 years old, their caretakers provided information about their special education needs, their current health problems, and their ongoing need for medications or special equipment for feeding, breathing etc.

The children underwent neurodevelopment and school readiness testing and assessment of their health. Their families' socioeconomic status was determined by obtaining the head of household's highest educational attainment and their current occupation. Of the 135 premies, one−third were not ready for age−appropriate school. Of the group that was ready for school, 15% required special education services.

The researchers found that being male, having a non−white mother, and having a lower birth weight were negative factors in neurodevelopmental outcome. Boys were twice as likely to have lower school readiness than girls. Lower socioeconomic status was linked to decreased thinking and reasoning skills when the children were tested at two years, and at entry into kindergarten.

Many of the children received Early Intervention (EI) services. While socioeconomic status did not influence whether a child received these services, children who were more socially advantaged and had Early Intervention were more likely to be ready for school than those EI participants who were less socially advantaged.

The researchers found the greatest risk for decreased school readiness was not past or current medical history, but low socioeconomic status. They thought perhaps this was because families with lower SES had social/family environments that did not contain as much stimulation, developmentally appropriate interactions with caregivers, and exposure to oral language, books, toys, and other materials that stimulate the development of thinking skills. They also speculated that other problems of having lower socioeconomic status, such as poor nutrition, decreased access to community resources, single−parent household, and increased psychological stress in the family might contribute to the poorer developmental outcome of the preemie.

The researchers concluded that excellent medical management early in life, while of course important, is not enough alone to give preemies the support they needed for normal or near−normal development. The child's home environment plays a major role in influencing the long term mental and physical development of premature infants.

September 1, 2009


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(2) Comments have been made

Esther Entin, M.D.
In order to continue to help your child reach her full potential it may be helpful to look at the world from her perspective and imagine what new challenges a preschool setting might pose for her. The types of situations that a child faces as she enters school will gradually require higher level reasoning and memory skills. These include solving more complex problems, waiting one's turn, sequencing tasks, and reading social cues. She will start to understand when to apply new rules, how to keep track of her possessions, and how to negotiate shared items and shared play spaces. Sometimes children who were born prematurely can have difficulty filtering out the many stimuli in the environment and attending to the main focus of activity. Being surrounded by the noise and distraction of many other children can pose stresses that adults underestimate. It's a good idea to keep in close touch with your child's teachers both to find out how she is doing and to remind them of her early vulnerability. If a concern about learning or behavior arises, it may be useful to discuss the issue with her physician, or with a specialist in child development. It's useful (and much more accurate) to think of development as an on ongoing process, rather than an absolute success or failure. As with any child, it is important to follow good parenting practices such as minimizing the presence and distraction of TV/DVD's and other screen based entertainment in your environment, reading aloud regularly, conversing with your child during routine tasks and outings, and providing her with age- appropriate and developmentally appropriate toys and play opportunities. Breaking large tasks down into small steps and allowing her to participate to the degree that she is able is an effective way for her to gain both skills and self-confidence and for you to enjoy the pleasure of her company.
Posted Mon, May. 24, 2010 at 10:17 pm EDT
I have a premature daughter. She is now two and a half years old, and is doing great developmentaly. I am trying to figure out the best ways to teach her and help her to beat the odds of developmental delays. Do you have any advice, or additional information on ways to help her be ready for school?
Posted Mon, May. 10, 2010 at 1:43 pm EDT

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