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Physical therapy, occupational therapy, and speech therapy are the three main options for premature babies in the United States. Each field has its own specialized training and certifications, and each addresses specific developmental challenges that preemies may face.
Which preemies should have these therapies?
Many premature babies don't need special therapies. But because preemies are at increased risk for development delays, it's a good idea to discuss the issue with your child's doctor. Ask her how your child is progressing and whether she thinks a referral for a developmental evaluation is warranted.
Physical therapy can help your baby improve her gross motor skills and learn better ways to move her body. This often means improving muscle tone. Problems with muscle tone are fairly common among preemies because the parts of the nervous system that control muscles are not well developed.
Muscle tone has nothing to do with strength. It's the amount of resistance a person's muscles give in response to an outside force. Muscles that are high in tone feel tight when you try to move them, while muscles that are low in tone feel loose.
"When muscle tone is too high, babies can have stiff muscles and tight joints. When it's too low, they may have trouble supporting their trunks," says Joshua Alexander, a pediatrician and associate professor of physical medicine and rehabilitation at the University of North Carolina School of Medicine.
Among other things, physical therapists help babies with high tone maintain or increase their range of motion and help those with low tone gain better body control so they have a solid base of support for big movements. To help a baby with low tone, for example, a therapist might encourage her to lift her head by showing her interesting pictures while she lies on her tummy.
A speech therapist can help with feeding difficulties, which are common among preemies for a number of reasons. The muscles needed to suck, swallow, and eventually chew have not had enough time to develop – and a preemie's brain isn't yet able to coordinate these muscles.
Some babies are uncomfortable with the sensation of having something in their mouth, or, at the other extreme, aren't sensitive enough to feel food in their mouth. Babies who have been fed intravenously or through a tube are especially likely to face these issues.
A speech therapist can help your baby develop the breathing rhythm and muscles needed for sucking and swallowing at the breast, or the muscle coordination needed to chew solid foods.
Speech therapy can also help your child use her mouth, lips, and tongue to communicate more easily. Depending on your baby's age, a therapist may work with her on talking, responding to language, and expressing her needs.
Occupational therapy can help your baby tackle the basic activities of her everyday life – what occupational therapists call "activities of daily living" (ADLs). Examples of baby ADLs include eating, playing, and interacting with others. Depending on your child's strengths and needs, the occupational therapist may help her learn to play with toys, develop her feeding skills, improve her fine motor skills, or manage "sensory inputs," such as touch, sounds, and lights.
How parents can help
What parents do at home can also be therapeutic. As simple as it sounds, a little skin-to-skin contact (sometimes called kangaroo care) between you and your infant can go a long way to help her grow and develop. Even if it's only for a few minutes a day, holding your diaper-clad baby against your bare skin can ease crying, steady her heartbeat and breathing, and even help her eat well and gain weight.
Preemies also do better when parents work together with their child's doctor and therapists to take care of problems early and make home life smoother for everyone.