Physical Therapy Guide to Infant Prematurity
Premature or preterm birth occurs at least three weeks before a pregnant mother’s due date. Full-term age for a newborn baby is considered to be 40 weeks. Any baby who is born before 37 weeks is premature. In the United States, one in nine babies, or about 11%, are born prematurely. That means that more than 500,000 U.S. babies are born too soon each year. The premature birth rate in the U.S. has risen by more than 30% in the last 25 years.
Improved technology and advanced care are increasing the survival rate of younger newborns. Now babies born as early as 22 weeks are surviving. However, any infant born too soon is at risk for health and developmental disabilities. Babies who are born at full-term but are small (less than 5.5 pounds), also have many of the same health problems as babies born too soon. The younger and smaller a baby is at birth, the greater their risk for health problems. Physical therapists design treatment plans to help premature babies develop to their full potential.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Infant Prematurity?
Infant prematurity is the term used for babies born before the average due date of 40 weeks. When a mother gives birth before 37 weeks of pregnancy, the baby is called premature. Most premature babies are born by Cesarean section. A baby who arrives too early can have trouble breathing, feeding, and maintaining body temperature. Significant growth and development occur in the last weeks of life in the womb, so it is very important for babies to reach full-term.
Babies born after 34 weeks but before 37 weeks are called late preterm babies. Although late preterm babies weigh more than babies born earlier, they may still have health problems. Even babies born between 37 and 40 weeks may show some of the health concerns of premature babies.
Possible Causes of Prematurity
The baby's or the mother's physical makeup may contribute to the possibility of premature birth. Genetic factors are known to play a part in at least 40% of premature births. All of the genes contributing to premature birth are not yet known. Recent research shows that one of the genes may be carried by the mom, and another by the baby. The presence of either of these genes may cause a premature delivery. Several other risk factors are known. But any pregnant woman can deliver too soon, even if she is not at risk.
Known risk factors for giving birth early include:
- Mothers who are younger than 19 or older than 40 years of age.
- Mothers who had a prior preterm delivery.
- Previous concerns with the mother's uterus.
- High blood pressure that begins in a mother after the 20th week of pregnancy.
- Premature ruptures of the placenta or the amniotic sac.
- Race/ethnicity. African American women, for example, are at a higher risk to deliver babies too soon.
- Lack of health care while pregnant.
- Low social or economic status.
- Use of drugs such as tobacco, cocaine, or amphetamines during pregnancy.
Signs and Symptoms
Several symptoms may show mothers that an early birth is about to occur, or an early onset of labor is beginning:
- Leakage of amniotic fluid.
If any of these symptoms occur, call your doctor immediately! Early labor can sometimes be stopped to allow the pregnancy to continue.
Mothers with increased blood pressure after the 20th week of pregnancy also are at risk for early delivery. These women should be watched very closely by their doctors.
Signs of prematurity in infants vary depending upon the age and weight of the baby at birth. They also can be related to the difficulty of the pregnancy, labor, and delivery. Infants born too early or with low birth weight are at risk for many problems including:
- Problems with organ function.
- Poor vision and hearing.
- Language problems.
Infants born during the eighth or ninth month of pregnancy (33 to 37 weeks), spend more time in the hospital. Babies born at this term have more health problems during the first two years of life than babies born at full-term.
How Is It Diagnosed?
Often, the expected due date of the baby is known. This date can be also be confirmed by tests. A family will know if a baby is arriving before the due date. If it is known that the baby will arrive early due to problems and the pregnancy cannot continue much longer, doctors will admit the mother to a hospital. They will closely monitor the mother and baby until the baby is born.
If the due date is not known, the health care providers who attend the birth will estimate the age of the baby. To do this they use several measures of the baby, including:
- Muscle tone and movements.
- Natural reflexes.
- Skin and hair.
Hospital staff will test for age whenever prematurity is a possibility.
How Can a Physical Therapist Help?
A physical therapist is an important partner for parents of any child born prematurely. Physical therapy should begin as soon as possible after birth, when the baby is healthy enough.
Your physical therapist will work with other health care providers to give your child the best care possible. Often, the baby will be in a neonatal intensive care unit. This allows your child’s health care team to work together to make the best of your baby’s growth and maturation. Teamwork also helps prevent infection and any possible complications.
Your physical therapist will help you understand your premature baby's needs. They will work with you to learn the safest ways to care for a premature baby. They may teach you how best to hold and feed your baby, how to safely position your baby for quiet sleep, and other tasks. Your physical therapist will do a complete evaluation and design a treatment plan to help your baby develop skills and muscle strength.
Evaluation. Your physical therapist will follow all the guidelines in place for newborn care in the NICU. They will perform an evaluation that includes a detailed birth and developmental history. They also will observe:
- How well your baby moves.
- How your baby interacts with the environment.
- Your baby's ability to keep calm and alert.
If necessary, gentle hands-on treatment may be used. This will help the physical therapist determine how your child’s head, trunk, arms, and legs move. They may also test for certain natural reflexes. Physical therapists know the importance of addressing your baby's needs using a team approach. They will review the evaluations of other professionals and may recommend more evaluations by other health care providers.
Treatment. Treatment in the NICU will focus on positioning, handling, feeding, and posture. The physical therapist will work with you on ways to help communicate between the baby and the family and to promote the baby’s development. After the baby leaves the NICU, a physical therapist may work with you and your baby to:
- Promote movement and developmental skills.
- Prevent or reduce muscle or joint problems.
- Develop good head positions.
- Maintain or improve muscle strength.
- Adapt toys or activities to promote fun movement and play.
- Increase your baby's daily activities to encourage their participation, first in the family, and later in the community.
Treatments may include:
Education. Your physical therapist will make suggestions for positioning, holding, and carrying your baby that are best for both of you. They will teach you important skills, such as safely positioning your baby on their back for sleep and on the stomach for play.
Fostering developmental skills. Some babies born too early have problems with their development. Your physical therapist will help your child learn to master skills such as holding up their head, sitting up, crawling, pulling themselves up to stand, and walking. Physical therapists offer hands-on training for movement, feeding, and play. Your physical therapist also may suggest changes that you can make at home to encourage your baby’s movement, communication, hearing, vision, and play skills.
Increasing strength. Some babies born too soon may have decreased muscle strength or tone. Your physical therapist will teach you exercises and play activities that you can do with your baby to keep or increase their strength. They will choose games and fun tasks that promote muscle strength throughout the body.
Remember, you and your baby are not alone! Research shows that children who participate in fun, early-intervention physical therapy programs can expect to benefit with improved thinking and movement skills. Early-intervention physical therapy may be provided in the home or at another location, such as a hospital or physical therapy outpatient clinic.
Can This Injury or Condition Be Prevented?
All pregnant women should seek excellent prenatal care. They should also follow the vitamin and diet recommendations of their health care providers. To prevent premature births, mothers should follow these specific guidelines:
- Achieve and maintain good health before getting pregnant, including a healthy weight.
- Get prenatal care as early as possible in the pregnancy.
- Continue to get prenatal care until the baby is born.
- Gain the right amount of weight during pregnancy.
- Don’t smoke, drink alcohol, or use drugs.
Premature labor contractions can sometimes be stopped or delayed with medicine. Other medications given to mothers during premature labor may reduce some of the early problems for the baby. Any woman who thinks that she is in premature labor should get medical help immediately!
The March of Dimes’ educational campaign, Healthy Babies are Worth the Wait®, aims to decrease the number of preventable preterm births. The program focuses on education, improving care, and reducing deliveries by choice before 39 weeks. The March of Dimes pays for research related to infant prematurity, and develops programs to inform women of the risk factors for premature birth.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat many conditions or injuries. You may want to consider:
- A physical therapist who is experienced in pediatrics. Many hospitals with NICUs will have a listing of early intervention services as well as a follow-up clinic. You may want to work with the physical therapist at the hospital and a physical therapist who has a local pediatric practice, who will work with you and your child in the home, a clinic, or community environments.
- A physical therapist who is a board-certified pediatric clinical specialist or who completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to babies born too soon.
- A team approach. Experienced pediatric physical therapists understand the importance of working with other health care professionals to maximize outcomes for children born prematurely.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping children with prematurity or other neuromuscular disorders.
- Be prepared to describe your child's symptoms in as much detail as possible, and report activities that make their symptoms worse.
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following resources and articles provide some of the best scientific evidence related to infant prematurity. The sites and articles listed here are linked either to a professional organization or to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Association of Women's Health, Healthy Mom & Baby. 40 reasons to go the full 40. http://www.health4mom.org/zones/go-the-full-40/. Accessed March 16, 2020.
March of Dimes. Before or between pregnancies. https://www.marchofdimes.org/pregnancy/before-pregnancy.aspx. Accessed March 16, 2020.
US National Library of Medicine, MedlinePlus. Premature infant. https://medlineplus.gov/ency/article/001562.htm. Accessed March 16, 2020.
Centers for Disease Control and Prevention. Preterm birth. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm. Reviewed October 21, 2019. Accessed March 16, 2020.
HealthyChildren.org. Health issues of premature babies. https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Health-Issues-of-Premature-Babies.aspx. Updated February 26, 2016. Accessed March 16, 2020.
McQueen D, Lakes K, Rich J, et al. Feasibility of a caregiver-assisted exercise program for preterm infants. J Perinat Neonatal Nurs. 2013;27(2):184–192. Article Summary in PubMed.
Prins SA, von Lindern JS, van Dijk IS, Versteegh FG. Motor development of premature infants born between 32 and 34 weeks. Int J Pediatr. 2010;2010:462048. Article Summary in PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.