All parents are concerned about their children hitting certain milestones on time. But when your baby comes early, those first few months and years can be a time of watching and waiting. Because preemies face greater health risks, you may worry more about whether your child will do certain things on time.
Laurel Bear, MD, a pediatrician at the Children’s Hospital of Wisconsin, can ease your concerns. Premature babies have the same milestones as babies born on time -- if you adjust the typical timeline for their early birth, she says.
'Adjusted Age' Explained
Newborns who've spent less than 37 weeks in the womb are considered premature. A normal pregnancy lasts about 40 weeks.
To figure out what a child should be doing and when, it's important to look at their adjusted age (also known as the corrected age). That's based on Mom’s original due date, Bear says.
For example, when a baby is born 2 months premature, and is now 4 months old, "we’re not going to expect them to be doing what a 4-month-old is doing. We’re really looking at what a 2-month-old should be doing,” she says.
Most preemies do catch up to their peers who were born on time, but it’s important to be patient, Bear says. A baby who’s faced significant medical issues may need a little more time to reach her milestones.
“We look at them and say, ‘This little baby spent a long time trying to survive.’ What should this baby be doing? I give them a little bit of a break. You may be 6 months old, but you spent 2 months in the hospital.”
The earlier an infant arrives, the longer she may need to catch up -- but most do get there, Bear says. A baby born at 36 weeks may not be caught up at 6 months, but may be at within the normal range by 12 months. A baby born at 26 weeks or less may not catch up until they’re 2-and-a-half or 3 years old.
The First 18 Months Adjusted: A Timeline
Just like with full-term babies, milestones for premature infants can vary. But Bear says some key things should happen around the following times:
2 months adjusted
- Begins to control her head
- Makes sounds like cooing and different cries
- Smiles at people
- Recognizes parents and caregivers
4 months adjusted
- Lifts her head up and looks around while on her tummy
- Rolls over
- Follows faces and objects
6 months adjusted
- Sits on her own
- Gets on her hands and knees
- Starts to crawl
- Looks at toys
- Is curious about things out of reach
- Babbles consonant and vowel combinations (dada, baba, mama)
9 months adjusted:
- Crawls everywhere
- Pulls to stand
- Understands “no”
- Copies sounds and gestures
- Has more vocal variety
- Plays peek-a-boo
12 months adjusted
- Cruises along furniture
- Begins taking solo steps
- Starts to stand alone
- Picks up small items
- Responds to simple questions like “Where’s Daddy?”
- Tries to say words you say
- Uses simple gestures, like shaking her head “no” or waving “bye-bye”
- Cries when parents leave
- Has favorite things, like a stuffed animal or blanket
- Begins to say Mama with meaning (she knows Mama is Mama)
15 months adjusted
- Walks with coordination
- Can do shape sorters or simple puzzles
- Has three words besides Mama and Dada she uses to name things or to ask for things
- Looks at or points to pictures in books
- Follows more directions
18 months adjusted
- Walks up stairs
- Begins to run
- Pulls a toy when walking
- Can undress
- Drinks from a cup and eats with a spoon
- Has a vocabulary of about 18 words
- Says and shakes her head “no”
- Points to what she wants
Every Baby Is Different
Even after adjusting for age, it’s important to remember that no two babies are the same.
The key is to look at each baby individually, says Martha Caprio, MD, associate professor at NYU Langone Medical Center. Parents might call one week worried that their baby hasn’t reached a milestone like rolling over, then report back that it happened a week later. Most babies will get to their developmental goals, she says.
“When parents don’t use the [age] adjusted milestones, that’s when it becomes an issue,” Caprio says.