On this page

• What Is Infant Prematurity?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Infant Prematurity?

Signs and Symptoms

In Infants

Infants born prematurely have a higher risk of developmental and health concerns. These risks vary and may depend on factors such as how early they were born or whether they had other health complications before birth. Not every preterm infant will have these signs or symptoms:

• Physical appearance at birth such as:

• Small size with a disproportionately large head
• Thin, shiny, and translucent skin (may appear reddish in lighter-skinned children)
• Lack of or reduced body fat and muscle, making the baby look very lean
• Soft, flexible ears with little cartilage
• A weak cry
• Reduced muscle tension

• Respiratory symptoms. Due to immature or underdeveloped lungs, the baby may have breathing problems and may require oxygen support or a machine to help them breathe.
• Neurological symptoms such as:

• Feeding challenges (due to weak or not yet present suck/swallow reflex or suck/swallow/breath coordination)
• Lethargy or low activity levels
• Increased risk for seizures in some cases
• Increased risk for swelling or bleeding in the brain (due to developing blood vessels)

• Cardiovascular symptoms, such as a heart murmur or poor blood circulation related to immature heart structures.
• Gastrointestinal symptoms such as,

• Feeding intolerance or slow weight gain
• Increased risk for NEC (necrotizing enterocolitis), a serious condition of the intestines.

• Temperature regulation issues (difficulty maintaining body temperature due to immature skin and a lack of body fat)
• Immune system weakness (increased risk of infections due to an underdeveloped immune system)

In Mothers

Several signs and symptoms in the mother may signal risk of preterm labor, which can lead to premature birth. Recognizing them early can prompt quick medical attention that may help prevent or delay preterm delivery. These signs and symptoms include:

• Regular or Frequent Contractions
• Low, dull backache that is constant or rhythmic and different from usual pregnancy discomfort
• Cramps (similar to menstrual cramps) in the lower abdomen, with or without diarrhea
• Vaginal discharge. An increase in the amount or a change in the type of discharge (watery, mucus-like, or bloody). A small amount of bloody mucus discharge occurs as the body prepares for labor.
• Leaking of fluid. If the mother’s water breaks prematurely (rupture of membranes), a sudden gush or a continuous trickle of fluid can occur.

If a pregnant woman experiences any of these signs before 37 weeks, contact a healthcare provider immediately.

How Is It Diagnosed?

Often, the baby expected due date is set during the first trimester using ultrasound-based dating. If an ultrasound was not done, a medical professional may estimate how far along the pregnancy is based on the mother’s last menstrual cycle.

Prematurity is diagnosed by the baby’s gestational age at birth. The diagnosis also may be confirmed by the delivering medical professional or a neonatologist after birth through physical and neurological exams. A scoring system such as the Ballard Score (also called the New Ballard Maturity Assessment) may be used to estimate gestational age when the degree of prematurity is unclear.

How Can a Physical Therapist Help?

Physical therapists, especially those trained in neonatal and pediatric care, play a major role in supporting the healthy development of premature infants. They often start helping in the neonatal intensive care unit, or NICU. They also support babies and families after discharge. Your physical therapist will work with other health care providers to give your child the best care possible.

Since premature infants’ bodies and systems are not fully developed, physical therapists often help them during their maturation and growth. They also require handling, holding, and care that is different from infants born full term. Early physical therapy for preterm infants may include:

• Special holding and handling
• Positioning
• Providing an environment that promotes good posture and alignment, joint health and development, and muscle strength
• Helping the baby manage their level of alertness (deep or light sleep, drowsy, quiet alert, active alert, and crying). This is known as state regulation. 
• Promoting overall development 

Physical therapists teach and coach caregivers as they learn to care for their baby. Physical therapists help the family learn the baby’s signals and cues for when they welcome interaction, need help, or need a break. They will work with you to learn ways to care for a premature infant both in the hospital and after discharge home.They may teach you how best to hold and feed your baby, how to safely position them for quiet sleep, and other tasks essential for growth. Your physical therapist will do a complete evaluation and design a treatment plan to help your baby with developmental milestones. The treatment plan may be designed to:

Support motor development. Your child’s physical therapist will work with you and your child to promote healthy movement and prevent delays. They may use positioning techniques to avoid muscle tightness or flat head syndrome. Physical therapy also encourages improved head control, rolling, sitting, crawling, and eventually walking.

Improve muscle strength and tone. Your physical therapist will perform activities to help with low muscle tone (hypotonia) or sometimes high muscle tone (hypertonia). They also may use gentle stretching and strengthening activities tailored to your baby’s age.

Prevent or Treat Developmental Delays. Your physical therapist will monitor your child’s milestones and adjust treatment and activities to help your baby stay on track. They also will work with you to identify any early signs of delay and treat them early.

Assist with Feeding and Breathing. Your physical therapist will provide help with body positioning to improve feeding and lung function. They also will address problems with sucking, swallowing, and breathing coordination, consulting with a speech or occupational therapist if needed.

Support Sensory Development. Sensory systems continue to develop after preterm birth.Your child’s physical therapist will use calming techniques and gentle exposure to touch, sound, and movement to reduce stress. They also promote bonding through skin-to-skin contact (kangaroo care).

Family Education and Support. Your physical therapist will guide you and other caregivers on how to handle, hold, and position your preterm baby safely.They may provide treatment in the home or in outpatient clinics. Your physical therapist will track your child’s developmental progress and adjust activities as the baby grows. They also will provide home exercise programs to do with your child between visits.

Monitor for Conditions. Physical therapists are trained to identify and screen for other conditions that sometimes develop in preterm infants. They will closely monitor your child for any signs of:

• Torticollis (tight neck muscles that cause the head to tilt)
• Plagiocephaly, brachycephaly, or dolichocephaly (flat head syndrome)
• Joint deformities (shortening of muscles, flattening of joints)

Can This Injury or Condition Be Prevented?

All pregnant women should seek access to prenatal care. The baby’s growth and the mom’s health can be monitored for risk factors during prenatal visits. They should follow all the recommendations outlined by their health care providers.

While not all premature births can be avoided, early and regular prenatal care and healthy lifestyle choices can reduce the risk. Some premature births result from factors beyond anyone's control, such as infections or medical conditions. However, many others are linked to things that can be changed or managed.

To help reduce the risk of a premature birth, mothers should:

• Manage Chronic Conditions. Control diabetes, thyroid issues, and high blood pressure to lower risk. Treat infections (especially UTIs or vaginal infections) right away.
• Avoid Smoking, Alcohol, and Drugs. These increase the risk of placental problems, low birth weight, and early labor.
• Maintain a Healthy Pregnancy Weight. Being underweight or overweight can increase the chance of complications. Eat a well-balanced, nutritious diet and take prenatal vitamins (especially folic acid).
• Reduce Stress. High levels of chronic stress or trauma can increase preterm birth risk. Support from loved ones, therapy, or stress-reducing activities like yoga can help.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions and injuries. You may want to consider:

• A physical therapist who is experienced in pediatrics. Many hospital NICUs have physical therapists treating infants during the hospital stay. Many NICUs will also have a list of early intervention services as well as a follow-up clinic to monitor development and provide physical therapy services. Physical therapists can 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, completed a residency or fellowship in pediatric or neonatal physical therapy, or is board-certified in neonatal therapy. This physical therapist has advanced knowledge, experience, and skills that apply to babies born too soon.
• A team approach. Experienced pediatric physical therapists understand the importance of working with other healthcare professionals to maximize outcomes for infants born prematurely.

Pediatric Physical Therapists:

• Specialize in infants, children, and adolescents.
• Are trained to assess and treat developmental, motor, and neuromuscular issues.
• Work in settings like hospitals, clinics, or through early intervention programs.
• Can help both in the NICU and after discharge.

Neonatal Physical Therapists:

• Specialize in pediatric physical therapy or have completed a residency or fellowship training in pediatric or neonatal physical therapy.
• Specialize in working with premature or medically-fragile newborns.
• Typically work in the NICU.
• May hold certifications like:
• Neonatal Developmental Care Specialist
• Certified Neonatal Therapist

Early Intervention Physical Therapists:

• Work with premature infants after they leave the hospital, often through home visits.
• May offer their services as a part of government-funded or private early intervention programs.