Premature babies: development

Many babies born early have difficulty staying awake, taking in sights and sounds, and responding positively to touch. A preemie may be using a lot of her energy to eat, grow and block out intense light and sound and has little energy left for social interaction.

Sometimes parents feel inadequate if they are unable to establish eye contact or to feel the special bond created by positive responses to touching and looking at each other. Rest assured these early difficulties are normal.

Let your baby be your guide to interaction

At first, when you try to look at and talk to your baby, she may look away, fall asleep or become limp. Your baby is signalling that she's not ready to look, listen and move all at the same time. If that's the case, limit your interaction to letting your baby just look at your face. Later you can use a soft, whispering voice to encourage her to follow the movement of your head as you slowly move it from side to side. But for the time being, respect your baby's signals by looking away or by being quiet. You're giving her a break so she can get ready for more interaction. Feeding is an especially difficult time for many fragile infants because it takes so much concentration and organisation to eat, look and listen. Being quiet during this time might be the best strategy. Your baby will signal when she can handle more stimulation.

Understanding a preemie's signals

'I'm overwhelmed' signals that a preemie might need to slow down or take a break include:

• faster breathing or pauses in breathing

• bearing down (as if having a bowel movement)

• paling or reddening of skin colour

• yawning

• hiccuping

• changing body tension, such as extending legs or arms or going limp

• sudden jerky movements, twitches, startles

• arching

• sticking out tongue

• getting fussy and staying that way for a long time

• looking away during social interaction

• going to sleep when he's supposed to be awake

'I'm ready' signals that a baby is more organised and able to handle incoming information include:

• steady breathing rate

• stable skin colour

• soft movements of arms and legs

• quiet alertness

• looking steadily at a face or object

• going to sleep and sleeping peacefully at appropriate times so he's got energy, when awake, to take in information

Other helpful tips for supporting your preemie:

Provide a soothing environment

Your baby may be sensitive to light, sound or new experiences so be especially careful when she is tired or trying to concentrate on difficult skills such as feeding or listening to your voice. Be aware of places and situations that tend to be overwhelming to her and try to avoid them. Just taking a fragile infant to a supermarket may be too much sensory input; she may need more time and maturity to be able to handle all the stimulation that a trip like this creates.

Be aware of pacing and timing

Be sensitive to your baby's need to wake on her own. Pre-term babies are working on organising their sleep-wake schedules as well as coping with care-giving from different people. Look for signals that she is ready for play but be sure to give your baby pauses when she needs to recover or take a nap.

Offer continuity and predictability

Just like most adults, babies need to know what to expect next. It reduces anxiety and helps them to perform better. Providing a set daily schedule, using the same caregiver, and putting the baby to sleep in the same bed are examples of how to create an organised and predictable world for them. This helps them feel safe so they relax and learn new skills more easily.

Supplement your baby's efforts to help herself

As they grow, babies learn to do things for themselves, and they feel the pleasure of success. However small, attempts to calm themselves – sucking on a hand, for example – are rewarding and set the stage for more tries. A fragile baby may need additional help. One way is to support her shoulder so she can move her hand to her mouth to suck on it more easily. Another is using your arm to let her brace her foot so she feels more stable. These small supports have a big impact on your baby's achievements.

Handle and position her carefully

When your baby is awake, it is important to move her gently and slowly. Babies who have been born early are still working hard to move smoothly and to keep their arms and legs from dangling or extending. Holding your child close so she feels support and warmth from your body or swaddling her in a blanket will be necessary until her movements are more purposeful and controlled. Premature babies sometimes have difficulty with fast movements, and you're likely to see 'I'm overwhelmed' signals when they are moved quickly or without a blanket or body support.

Look out for your baby's own strategies for becoming more organised. These include:

• grasping and holding on to blankets, your finger or other objects

• bracing their feet on the bedding

• putting their hands on their face or into their mouth

• sucking on a dummy or a finger

• tucking their bodies by bending arms and legs forwards

You'll soon be familiar with your own baby's special ways of communicating and be able provide the support she needs to interact with the world.