Parenting Children Born Preterm
The Hospital for Sick Children, Toronto
University of Toronto
North Shore Children's Hospital, Salem, Massachusetts
Each year, from 2% to 9% of newborn babies require specialized care in a neonatal intensive care unit (NICU). The majority of these are babies born prematurely (before 37 weeks of age) and weigh less than 2,500 g (5 lb) at birth. Modern medical technology has doggedly pushed back the frontiers of viability so that as we enter the twenty-first century an increasing number of babies as young as 23 to 24 weeks gestation with weights as low as 500 g are surviving. Parents of all preterm babies confront unique problems engendered by the timing of the birth, a prolonged hospital stay, and distinctive patterns of behavior and development in the infant's early years. In this chapter we review these problems and their effects on parents. In doing so, we focus on parent — infant interactions and relationships in these early years, but include some information on later development. In part, this emphasis reflects the fact that the infancy years have been the most intensively studied. Infancy is the time when these children are most different from others and most challenging to their parents. This review is selective rather than comprehensive and, aside from background history, concentrates on general themes of recent interest.
The chapter includes five main sections. It begins with a history of changes in care of preterm infants and the resulting effects on parents. The second section outlines the conditions that are unique to preterm infants and their parents: the timing of birth, the nature of the hospital experience, and behavioral characteristics of preterm behavior and development. The third part outlines theories of parent — child relationships and their respective interpretations of prematurity. The fourth reviews research on parent — infant relationships, and the fifth considers interventions designed to improve parent — child relationships in this group. Throughout the chapter we use the terms preterm and premature interchangeably. Quotes from parents of prematurely born infants are interspersed thoughout the text to convey firsthand experience of some of the phenomena we discuss.