What happens when a child is born premature?
Children who are born premature are at higher risk for post birth complications. This can include both long term and short term issues: breathing or heart issues, cognitive delays, physical delays, feeding issues, vision issues and a host of other medical issues. Depending on the severity of immediate medical concerns that are impacting the child after a premature birth, the child may or may not need to be in the neonatal intensive care unit (NICU). In the NICU children receive specialized care to stabilize their function. After a NICU stay a child may step down to a less intensive placement or general pediatric floor. Some may be discharged directly home.
What happens when the child goes home?
When the child goes home, the long term issues may not be resolved and some may not even be observed yet. Parents are sent home with their high needs child with minimal assistance. Their child had been monitored 24 hours a day by a medical team and now it is the parent who is monitoring the child. NICU’s do provide teaching on how to manage devices such as feeding tubes or ventilators. They help the families to understand when they need to reach out to their medical provider for additional assistance. Generally, however, parents feel woefully unprepared for what will happen once they arrive home. This can cause a great deal of anxiety on the part of the parents. When this anxiety exists it can cause conflict within the family unit, decrease bonding time with parent and child and cause a general sense of ineffectiveness as a parent. They also feel alone and isolated from others as they doubt others understand how they feel and what they are going through.
Why should a child receive an Early Intervention referral?
Early Intervention is less clinical than other pediatric providers. We provide service in the child’s natural environment. We focus on the family as a whole. Coaching is provided to the caregivers to enhance development. This is to ensure strategies and interventions are provided daily, not just when an early intervention provider is present. We tend to spend more time with a family and their child than other providers. This allows for a closer relationship with the family and provider. It also provides more accurate reporting of a child’s function and parents capacity to assist. This more in depth understanding and relationship helps providers to identify concerns about the child that other providers might not notice or parents may not share. We help families with the difficulties that arise as they happen, as we see the family regularly, instead of waiting for the next scheduled physician appointment. As providers, we foster our relationships with these families, so we can have open and honest conversations about how they are feeling, how their child is doing and what are the struggles that are impacting the whole family.
How does Early Intervention Help?
As noted previously, Early Intervention provides services in the natural environment. This allows the providers to see how the child and the family are functioning in their own environment - their home. This is very different from the hospital or outpatient environment. In the NICU babies are poked and prodded regularly. They are constantly bombarded by the unnatural sounds that exist in NICU. These babies are not afforded the same quiet environment that they would have experienced in the womb. Nor are the babies born early with no NICU stay. They too did not have the typical amount of time for systems to develop before their abrupt entrance into the world. This in turn causes some dysregulation. When the child goes home they are now in another foreign environment. They may require help to adjust to their quiet or busy home, new sleep environment/routine or a new feeding routine. We assist in promoting development in areas of physical, social/emotional, adaptive (includes feeding), cognitive and communication skills. We focus on the family unit as this new routine starts to evolve. We work to include siblings or other family members within these new routines. They, like the parents, were negatively impacted by the early birth of their sibling/relative. It can cause stress and anxiety in a different way than a traditional birth. They may be learning about a feeding tube or breathing tube. Just the idea that their sibling/relative did not come home with the parents initially can be difficult to understand for the younger sibling or relatives. Our goal is to help the family adjust and adapt to their new child and the new routines that are required. We want to help them feel comfortable with their new routines. As we help the family adjust and become more confident in their skills it develops their confidence as a parent and allows for them to become effective advocates for their child.
Overall there is a need for children and families who are premature, with varying degrees of needs, to find support. Early Intervention is primed to be that support. I encourage every Early Intervention provider to advocate provision of services for any premature child. I encourage parents of every premature baby to reach out to your local Early Intervention provider to request an evaluation for services. My hope is that services in the future are provided to all children who are premature. The earlier services are started the better.
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