Early heroes:  Early Childhood Education with preterm children

Prematurity is the leading cause of peri and postpartum morbidity and mortality. About 9% of newborns are born prematurely, that is, born with less than 37 weeks of gestational age (GA). The number of gestational weeks determines the development and health of preterm infants. Indeed, the comorbidities associated with a premature birth are aggravated by the decrease in gestational age (especially below 32 weeks) and gestational weight [2, 3], namely: life threat, neurological damage, vision or hearing problems, health injuries (e.g., respiratory, cardiac, immunological, renal) [1, 2].

Prematurity from the infant’s perspective

After birth, the very and extreme preterm (born before 32 weeks) is isolated in an incubator, receiving many times invasive and painful care that is provided by different professionals (rarely by parents). Such hospitalization can take several weeks. However, presently most premature infants manage to survive without serious sequelae. Importantly, in the face of so many adversities, these babies manage to reach expected levels of development, life, and health quality [2].

Prematurity from the parent’s perspective

Most mothers of full-term infants feel love when their baby is born. After birth, mothers of full-term infants are focused and involved with their infant’s care, thinking ahead about their maternal role [3]. However, mothers of very/extreme premature infants have a different experience. Their experience is described as traumatic, with mixed feelings between the fear of infant death, the fear that the infant may survive but with sequelae, and the love felt. For these mothers, anticipating the future is painful [3]. Fathers’ experience is equally painful, as they feel they have a role to support mothers and deal with the responsibility of informing family and friends [3].

Nevertheless, confident parents are more likely to be able to attenuate the impact of prematurity in children’s development.

Later in Daycare and Kindergarten

Educators in their practice with preterm children should consider 3 main aspects:

Form an alliance with parents. In the first contact with school, it is necessary to welcome the families and their infants, generating a feeling of security promoting an open, honest, and regular communication with parents. In school, as in neonatology, parents share their children’s care with professionals, which sometimes generates feelings of fear, loss, impotence [4]. Educators must consider the experience lived by the parents and form an alliance with them. To form an alliance with parents, it is key to answer their doubts, be available to listen and communicate information in a clear and objective way.

Pay attention to developmental aspects. Premature infants may have mild or moderate deficits throughout their development. Vision problems (such as visual discrimination) and hearing deficits are the most frequent, but there is also the risk for vestibular, balance, tonicity, fine motor coordination, and language problems, among others. Educators have knowledge, experience, and spend part of the day with the child, identifying these developmental changes, which may not be detected by the parents. Their role is critical in helping parents to identify and search for appropriate services.

The secret for success lies in the first point: if an alliance between parents and educators has been established, an open communication takes place naturally.

Inclusive education. All children are different, and those prematurely born are not a uniform group of children with a common set of characteristics. The educator must adopt specific strategies and materials for each child. The support of Health or Early Intervention professionals is essential when it comes to seating the baby, feeding, putting to sleep, etc. If the preterm infant cries when his/her diaper is changed, if he/she has reflux during feeding, if he/she falls when he is seated, these needs must be attended with the appropriate      adaptations according to one’s specific demands. Above all, the time and latency of the preterm infant’s response can be different from full-term infants and the adult must keep the pace, waiting with patience and acceptance.

Blog post by Marina Fuertes (Escola Superior de Educação de Lisboa) and Ana Rita Almeida

References

 [1] Antunes, S., Fuertes, M., & Moreira, J. (2020). Um olhar sobre a Grande Prematuridade: A investigação com bebés nascidos com menos de 32 semanas de gestação. In Fuertes, M., et al. (2020, org.). Teoria, Praticas e Investigação II (pp.132-180). CIED: Escola Superior de Educação de Lisboa. ISBN 978-989-8912-02-2