Premature babies are more likely to have cerebral palsy (often caused by periventricular leukomalacia (PVL)), developmental delays, visual and hearing impairments, breathing problems and cognitive / intellectual disabilities than full term babies. Premature babies should receive therapy as soon as possible to help decrease the likelihood (or severity) of these problems, which is why early intervention programs are very important.
Indeed, research shows that ongoing health issues are a major problem for some babies born preterm. Once a baby is discharged from the neonatal intensive care unit (NICU), she should receive a diagnostic evaluation, which consists of assessments from doctors, nutritionists, speech / language therapists, hearing and vision specialists, developmental specialists and more. Each state is required to evaluate babies at risk for (or who were diagnosed with) developmental delays or disabilities, which almost always includes premature babies who were in the NICU. The baby’s primary care physician should follow up with the baby when she is 18 – 22 weeks old, or by 24 weeks corrected gestational age.
Birth injuries are very common in premature babies, which is why it is very important for doctors to prevent premature birth whenever possible. Listed below are some birth injuries that can occur when a baby is born prematurely or when her labor and delivery is not properly managed:
- Periventricular leukomalacia (PVL)
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia, cerebral cortex or watershed region, but it sometimes includes PVL.
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders
- Speech delays
- Vision and hearing problems
In this article, we discuss the long-term problems that a premature baby may face, the importance of early intervention, intervention programs, and developmental milestones that may help parents recognize potential cerebral palsy or developmental delays in their child.
PREMATURITY & COGNITIVE AND MOTOR IMPAIRMENTS
Screening for cognitive and motor impairments is crucial for the identification of premature babies who would benefit from early intervention programs and special education school programs. This should include screening for neurodevelopmental problems that occur more often in premature babies, such as cerebral palsy and learning disabilities. Premature babies are also at risk of having difficulties with complex language function.
PREMATURITY & CEREBRAL PALSY
Cerebral palsy occurs in about 5 – 10 % of VLBW (very low birth weight) and ELBW (extremely LBW) babies who survive. During office visits, these babies’ doctors should closely observe them for signs of cerebral palsy, such as hypotonia (baby is floppy / limp), spasticity, abnormal postural reflexes, increased muscle tone and deep tendon reflexes. Babies who have any of these signs should be immediately referred for evaluation by a pediatric neurologist. A diagnosis of cerebral palsy requires further evaluation from a multidisciplinary team that includes neurologists and physical and occupational therapists.
PREMATURITY & LANGUAGE / LEARNING DELAYS
Learning delays and language delays are very common disorders in children born prematurely. The younger a baby was at birth, the higher the risk of experiencing these delays. Screening for cognitive dysfunction, learning delays and language delays is crucial so that early intervention can take place. Developmental evaluations should be based on the baby’s postmenstrual age and not on the chronological age until the child is 24 months of age or older. All premature babies should receive referrals to high-risk development clinics and Early Child Intervention Programs.
PREMATURITY & HEARING PROBLEMS
Most premature babies are screened for hearing loss before being discharged from the NICU. Hearing screening should be repeated when the baby is 5 – 6 months corrected gestational age or sooner if the baby exhibits signs of hearing problems. If the baby has an abnormal hearing test, formal assessment from a hearing specialist (audiologist) should be performed. If the baby has a type of hearing loss called sensorineural hearing loss, she will need help from a group of specialists that includes an audiologist, otolaryngologist (ear, nose and throat doctor) and speech therapist. Sensorineural hearing loss means the main cause of loss lies in the eighth cranial nerve, the inner ear or the central processing centers of the brain. The eighth cranial nerve transmits sound and equilibrium (balance) information from the inner ear to the brain.
PREMATURITY & VISION PROBLEMS
Premature babies, especially VLBW and ELBW babies, are at an increased risk of developing an eye condition that can cause blindness and other problems. This vision problem is called retinopathy of prematurity (ROP).
ROP is the second leading cause of childhood blindness in the U.S. When a baby is born prematurely, the blood vessels in her eyes may not be fully developed. If the blood vessels develop normally, ROP will not occur. If the vessels grow and branch in an abnormal way, the baby will have ROP. Giving a premature baby too much oxygen can cause abnormal development of the vessels in the eyes. This is because excess O2 causes normal blood vessels to degrade and cease to develop. When the baby is taken off of supplemental O2 or it is turned down (excess oxygen is removed), blood vessels quickly begin forming again and they grow abnormally and into the wrong part of the eye, causing ROP.
All babies born prematurely should be tested at regular intervals for ROP, especially those who were given supplemental O2. Early intervention can prevent the disease from becoming severe or affecting the baby’s eyesight. In addition to prematurity, excess oxygen and low birth weight, other risk factors for ROP include infection and heart defects.
Screening by an ophthalmologist should be performed on all VLBW babies or on babies with a gestational age of less than 30 weeks. Screening should also be performed on premature babies who have birth weights greater than 1500 grams or a gestational age less than 30 weeks whose course in the hospital places them at an increased risk of ROP.
Premature babies are at risk for other vision problems, including reduced visual acuity, strabismus, myopia and stigmatism, and should be screened by an ophthalmologist at 9 – 12 months of age.
WHAT IS “EARLY INTERVENTION” FOR CHILDREN AT RISK OF CEREBRAL PALSY, DEVELOPMENTAL DELAYS & OTHER PROBLEMS?
Early intervention programs address any delays in development with the hope that the child will have improved function and will not need services later on. Services include speech therapy, occupational therapy and physical therapy.
Early Intervention Programs in Michigan
In Michigan, children under three years of age who have developmental delays may be eligible for early intervention services through the states Early On program, which is administered by the Michigan Department of Education Office of Early Education and Family Services.
Children with special needs can face many issues in getting a free and appropriate education. Some may need special education services, while others may need modifications to make school accessible or medical assistance to make it safe. For some students, struggles with learning or behavior require special management to avoid school disruption.
WHAT ARE “SPECIAL EDUCATION SCHOOL PROGRAMS” FOR CHILDREN WITH CEREBRAL PALSY & SPECIAL NEEDS?
Approximately 1 out of every 7 children in the U.S. have special needs. There are numerous special needs programs that help these very special kids. They include tailored programs to help children with special needs such as cerebral palsy. There are have been significant scientific advances over the last few years, and new treatments have been developed that can greatly improve the well-being and lifestyle of children with special needs.
“Special education” refers to services given to students with disabilities through the Individuals With Disabilities Education Act (IDEA). Students in special education require significant modifications in their educational programs; they may need extensive remediation, smaller-group settings, adaptations to their workload, a slower paced curriculum, or other adjustments to suit their abilities and limitations as determined by a team of educators working together. The team develops an IEP, or Individualized Education Program (or Plan), a legal document that lists exactly what the school will do and what goals have been set for the student. Students in special education may be taught in a regular classroom with supports, a self-contained classroom, or a special school for students with similar disabilities.
Not all children with special needs require special education. Those with physical disabilities, medical issues, or learning problems who do not require a major adjustment of an educational program may benefit from a 504 plan, which is a benefit of disability law that aims to make education accessible for every student. If a 504 is not necessary or obtainable, parents may still get special assistance for their child by providing materials to the teacher and school officials and making recommendations as to the best ways to help the student and make her successful. Although the school’s cooperation will not be mandated in this circumstance, good educators will want to help a child with special needs maximize her potential.
Special Needs Education Programs in Michigan
There are 197 special needs public schools in Michigan. The Beekman School in Lansing serves grades K – 12 and has an outstanding student to teacher ratio of 4:1. Bert Goens Learning Center in Lawrence also serves children of all grades. It has one of the best student to teacher ratios of 3:1.
DEVELOPMENTAL MILESTONES & CEREBRAL PALSY, DEVELOPMENTAL DELAYS, INTELLECTUAL DISABILITIES & LEARNING DISABILITIES
Many children with cerebral palsy, developmental delays, cognitive (intellectual) disabilities and learning disabilities are diagnosed shortly after birth. However, in some children it may take a few years for these problems to be noticed. For any child experiencing developmental delays, early diagnosis is critical because without timely intervention, valuable early treatments and therapies may be missed.
Brain injuries that cause permanent brain damage often occur during or shortly before or after delivery. Birth asphyxia, infection, hypoxic ischemic encephalopathy (HIE) and brain bleeds are conditions that can cause brain damage that result in cerebral palsy and developmental and intellectual delays and disabilities.
Many parents struggle with the question of whether their child is developing normally, especially if their baby is premature or pregnancy or labor and delivery were abnormal, risky or traumatic. Parents should never hesitate to speak with their child’s physician. Research shows that 70 – 80% of all disabilities in children are detected by parents.
Developmental milestones are used for assessment of a child’s development, and are a set of functional skills or age-specific tasks that most children can do at a certain age. These milestones are simply guidelines to help determine if a child is keeping up with other children her age. In addition, children who suffered certain moderate to severe brain injuries and cerebral palsy may only be able to reach milestones through therapies and interventions. Other children with severe brain injuries may never reach certain milestones.
Listed below are a few of the many developmental important milestones up to age 3.
Milestones at two months of age and older
- She can briefly calm herself and may bring her hands to her mouth and suck on her hand.
- She makes cooing, gurgling sounds.
- She turns her head towards sounds.
- She begins to follow objects with her eyes and recognizes people at a distance.
- She can hold her head up and push up with her arms when lying on her stomach.
- She makes smother movements with her arms and legs.
Milestones at four months of age and older
- She is beginning to babble and babbles with facial expression.
- Her cry is different, depending on the reason for the cry, such as showing hunger, pain or being tired.
- She can use eyes and hands together and she reaches for toys with one hand.
- Her eyes move from side to side as she follows moving objects.
- She pushes up on her elbows when lying on her stomach.
- She holds her head steady without support.
- She pushes down on her legs when her feet are on a hard surface.
- She may be able to roll over onto her back from her stomach.
- She swings at toys in front of her and can shake a toy when she’s holding it.
- She brings her hands to her mouth.
Milestones at six months of age and older
- The baby knows faces that are familiar and starts to recognize if someone is a stranger.
- She puts vowels together when babbling, such as “ah,” “eh,” and “oh,” and likes taking turns with her parents while making sounds.
- She starts to make consonant sounds, such as “m” and “b.”
- She looks around at objects that are close.
- She continues to bring items to her mouth.
- She begins to pass items from one hand to the other.
- She starts to sit with no support.
- She rolls over in both directions.
- She supports her weight on her legs when standing and she might bounce.
- She rocks back and forth and may crawl backward before crawling forward.
Milestones at nine months of age and older
- The baby may be afraid of strangers and is clingy with familiar adults.
- She makes different sounds, such as “mamamama” and “babababa.”
- Her eyes move in the path of something as it falls.
- She looks for items that she sees people hiding and she can play peek-a-boo.
- She can smoothly move objects from one hand to another.
- She can pick very small items such as cereal with her thumb and index finger.
- She can get into a sitting position and sit with no support.
- She pulls to stand and can hold onto something to stand.
- She can crawl.
Milestones at one year of age and older
- The baby is shy with strangers and cries when her parents leave.
- She puts out an arm or leg to assist with getting dressed.
- She responds to simple requests.
- She makes gestures, such as shaking her head “no” or waving goodbye.
- She is making sounds that have more changes in tone and sound more like speech.
- She explores things by banging and shaking or throwing them, and she bang 2 things together.
- She looks at the correct object when it is named.
- She is beginning to use things correctly, such as a comb for her hair and a cup for drinking, and she can put things into and take things out of a container.
- She can release objects from her hands without help.
- She pokes items with her index finger.
- She follows simple directions, such as when a parent tells her to pick up a toy.
- She gets into a sitting position by herself.
- She is able to pull herself up to stand and can walk around.
- She may take a few steps and stand with no assistance.
Milestones at 18 months of age
- The baby enjoys handing items to others as part of play, and plays games of pretend, such as feeding a doll.
- She says many single words.
- She understands the use of common items, such as a telephone, brush or spoon.
- She enjoys scribbling on things.
- She is able to follow simple verbal commands without any gestures, such as sitting when her parent says to sit down.
- She can walk alone, and may be able to run up steps and run.
- She drags toys while she walks.
- She can help undress herself.
- She can drink from a cup and eat with a spoon.
Milestones at 2 years of age
- The child copies other people.
- She can speak in 2 – 4 word sentences, and repeats words she overhears.
- She follows simple instructions.
- She might use one hand more than the other.
- She builds towers of 4 blocks or more.
- She plays make-believe games that are simple.
- She completes rhymes and sentences in books that are familiar.
- She begins to sort shapes and colors.
- She finds items, even when hidden under 2 or 3 layers.
- She can stand on tip toes and throw and kick a ball.
- She can run and climb onto and off of furniture.
- She can walk up and down stairs while holding onto something.
- She is developing fine motor skills and can make or copy straight lines and circles.
Milestones at 3 years of age
- The child copies adults and friends.
- She understands the idea of “mine,” “his,” or “hers,” as well as “in,” “on,” and “under.”
- She can get dressed and undressed by herself.
- She can follow instructions that only have 2 or 3 steps.
- She knows her name, age and sex, and knows her friends’ names.
- She talks well enough so strangers understand her, and she can carry on a conversation using 2 or 3 sentences.
- She is able to use the buttons, lever and moving parts on toys.
- She puts together puzzles with 3 or 4 pieces.
- She understands what “two” means.
- She can turn book pages one at a time.
- She can copy a circle with a pencil or crayon.
- She screws and unscrews jar lids and turns door handles.
- She builds towers that have many blocks.
- She can easily climb, run and pedal a tricycle.
- She walks up and down the stairs, placing one foot on each step.
PREMATURE BIRTH & BIRTH INJURY LAWYERS HELPING CHILDREN WITH CEREBRAL PALSY & HIE FOR ALMOST 3 DECADES
If you are seeking the help of a birth injury lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades.
Birth injury lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as being one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.