Developmental problems in premmies

Research consistently shows that severe/multiple disabilities occur in only a small number of premmie survivors. The more typical outcome is much more likely to be a learning disorder or group of disorders, perhaps combined with behavioural and motor problems. These can be subtle yet they genuinely impact on the child's chances of academic and social success. They tend not to be recognized or given a name and are sometimes described as "hidden disabilities  (Whitfield, MF., Grunau, RV., & Holsti, L 1997).


Prematurely-born children are at added risk of having these developmental problems. The information set out below will describe only some of the hundreds of studies that have followed the development  of children born prematurely. Remember as you read this information that we now know that parents are the architects of their babies' brains. This is new information to most parents, and parents in years past didn't necessarily know that they could help their child's development. Also remember that these results only show higher incidence for each developmental problem. Most premmies will not have these problems.

However, hopefully these detailed summaries of outcomes is a call to arms for parents. Your premmie needs your best parenting efforts.

Cognitive, language and school achievement

You will find gaps in this information - because some outcomes for some age-groups have not been studied. Cognitive outcomes are the most frequently studied problems in premmies. Studies of social and emotional difficulties in premmies is only recent and there are many fewer studies.

Babies born before 28 weeks of gestation

Outcomes measured at 5-10 years

  • language difficulties and school achievement (Wolke D et al., 2008)
  • cognitive difficulties (Mikkola, K. et al., 2005)
  • cognitive impairment (severe 22%, moderate, 24%, mild 34%) - (Marlowe N et al., 2005)
  • children not reaching good overall achievement at the end of the first year at school - 65% (social/emotional 43%, communication, language, literacy, 60%, mathematics 54%, knowledge 29%, physical 21%, creative 37%) (Quigley, M.A. et al., 2102)
  • significant differences in IQ (Sharp M.J. et al., 2002)

Outcomes measured at 11 years-adulthood

  • significant differences in IQ (Johnson S. et al, 2012)
  • poorer academic attainment, higher prevalence of learning difficulties (Johnson S. et al., 2011)
  • lower cognitive ability, reading, mathematics, higher attendance at special schools, below average attainment (Johnson, S., 2009)


Babies born at less than 32 weeks of gestation

Outcomes measured at 5-10 years

  • all neuropsychological measures except verbal working memory (Lind A., et al., 2010)

Babies born 32-36 weeks of gestation

Outcomes measured at 3-10 years

  • significant difference in IQ (Bayless & Stevenson, 2007)
  • more difficulty in reading and mathematics (Chyi, L.J. et al 2008)
  • % of children not reaching good overall achievement at the end of first year at school (social/emotional 29-32%, communication, language & literacy 54-58%, mathematics 36-41%, knowledge 25-26%, physical 13-18%, creative 23-28%) (Quigley M.A. et al., 2012)
  • lower school achievement (reading, writing, mathematics) success (Peacock, P.J. et al., 2012)
  • delay (4.24%), disability (4.46%), not ready for school 5.09%, needing educational help at 5 years 13.3% (Morse, S.B. et al., 2009)

Babies born at 36-38 weeks

Outcomes measured at 5-10 years

  • % of children not reaching good overall achievement at the end of first year at school (social/emotional 25-29%, communication, language and literacy 47-51%, mathematics 30-35%, knowledge 19-23%, physical 9-12%, creative 18-22%)( Quigley, M.A. et al., 2012)

Executive functions and attention

Many of the executive function skills reported below may not be familiar to you. These are fundamental skills that are required for children to succeed at more complex learning tasks such as reading and mathematics

Babies born at less than 28 weeks of gestation

Outcomes measured at 5-10 years of age

  • selective attention, visual search tasks (Pasman, J.W. et al., 1998)
  • selective attention, visual search tasks, inhibition, planning, self-regulation, visual search accuracy, motor persistence (Marlowe, N. et al., 2007)
  • motor inhibition (tapping) (Harvey, J.M. et al., 1999)
  • verbal fluency (Jennische, M & Sedin, 2001)
  • word fluency, focused attention (Taylor H.G. et al., 2004)
  • executive functions and memory (Taylor, H.G. et al., 2006)
  • planning (Harvey, J.M. et al., 1999; Anderson P. & Doyle, L. 2004)
  • attention, spatial span forwards, visual attention, trail making, attention span & encoding (Shum, D. 2008)


Babies born at 28-32 weeks of gestation

Outcomes measured at 2-4 years of age

  • inhibition, switching, working memory and concept generation (aanoudse-Moens, C.S.H. et al., 2009)

Outcomes measured at 5-10 years

  • selective attention, visual search task (Pasman J.W. et al., 1998)
  • selective attention, visual search task, inhibition (Atkinson, J. & Braddick 2007)
  • verbal fluency (JennischeM. & Sedin, 2001)
  • semantic verbal fluency, shifting (Bohm, B et al., 2002)
  • impulse control, working memory, mental speed (Bohm B. et al., 2004)

Outcomes measured at 11 years -adulthood

  • working memory, letter sequencing, digit span (Saavalainen, P et al 2007)
  • semantic fluency (Allin M. et al., 2008)

Babies born 32-36 weeks of gestation

Outcomes measured at 2-4 years of age

  • spatial working memory (Espy et al., 2002; Caravale, B et al., 2005)

Outcomes measured at 5-10 years of age

  • inhibition/impulsivity (Katz, K.S. et al., 1996)
  • shifting (Bayless S. & Stevenson, 2007)
  • shifting (Espy et al., 2002)
  • Working memory & inhibition (2 & 4 years) (Edgin, J.O et al, 2008, Woodward  L et al., 2011)

Outcomes measured at 11 years- adulthood

  • shifting, inhibition  (Nosarti, C et al., 2008) 




The risk for developmental problems generally increases the earlier a baby is born and the more medical complications they had perinatally. However, many very small babies develop very well, while some older-born babies can have more difficulties. Some things, such a serious damage to the brain, cannot be changed. The one thing that stands out as helping development is "environmental enrichment". There are things you can do with your premmie each day that will protect them from having "gaps" in their thinking abilities. All premmies need their parents' best efforts to help them achieve peak development.

Note: You may not be familiar with the all cognitive sub-skills listed above. Unfortunately, they are the basic underlying skills that need to be OK for a child to learn to read or be able to do maths . Attention problems, for example, not only underpin many academic activities, but are also involved in Attention-Deficit Hyperactivity Disorder (the most common "named" problem following premature birth). When premmies have problems at school, it is most often not because they are not "smart" enough, but because of "gaps" in subskills.