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This is my daughter Margaret @1 day old. She is resting her arm on a preemie pacifier!
5 Ways Being a Preemie Impacts Learning
Pregnant with Quads at 26w4d. I would go into labor 2 days later.
Pregnant with Quads at 26w4d. I would go into labor again 2 days later.

November 17th is World Prematurity Day.  The topic of preemies impact my life in a huge way! The title picture is my daughter, Margaret, taken the day after she was born. Her arm is resting on a preemie pacifier!  My surviving quadruplets were born at 27 weeks.  Due to their prematurity, we lost our daughter, Martha, the day after she was born. The other three children survived their premature arrival into the world, but that impacted them in every facet of their lives.  Of course, at the time (a decade ago), I had no idea of the challenges my children would face.

Did you know 11% of all births worldwide occur before 37 weeks and that 2.5% of births happen before 32 weeks? Between 30 and 40 weeks of gestational age, a baby experiences growth of the cerebellum. When that process is interrupted, it can cause two of the five topics we will discuss today… motor coordination and cognitive (intellectual) problems.

Picture of my children at 8m or 5m adjusted
Picture of my children at 8m or 5m adjusted

Developmental/Cognitive Issues

Cognitive issues have been cited in many studies.  One recent study looks at the subtle forms of cognitive impairment that might be missed on standardized neuropsychological testing in both adults and children who were born prematurely with no brain lesions (damage).  While another study looked at children with enlarged cerebral ventricles in the brain, which point to changes in the white and grey matter in the brain (which my daughter has), causing developmental delays including cognitive delays.

So what kind of developmental delays might you see?  It depends, but in general, children have been diagnosed with a variety of issues including autismcerebral palsyintellectual delayvisual perceptionvisual motor integration (which often leads to dysgraphia), Executive Functioning Disorder/ADHD, along with suffering academically in math and spelling.


Language-based disorders are prevalent in premature infants.  Preemies display slower rates of vocabulary growth, and by school age, children born preterm demonstrate language functioning below that of full-term peers.  These weaknesses persist into later childhood and adolescence with one study showing weakness into adulthood.   At the same time, at every developmental level, there are striking individual differences in language outcomes in children born preterm. Why?  Experimental studies have shown that a variety of visual information processing skills in preterm infants could be linked to an increased risk of receptive language outcomes.

Executive Functioning

Executive Functioning is such a massive topic I have a couple of blog postson the issue! The hallmark of ADHD is executive functioning disorder, but not all people who have Executive Functioning Disorder have ADHD. Having good Executive Functioning (EF) skills is critical for academic success.  So what does EF do?

Executive functioning helps you:

  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience
  • Multitask

Lacking EF has been scientifically acknowledged to be essential for academic success.  A child only lacking EF skills may never show behaviors in the classroom; however, a child having the combination of Sensory Processing Disorder (SPD), and a lack of EF skills, will often have behavioral events at school.


ADHD, or lack of Executive Functioning control, is incredibly common in children who were born prematurely. Often the inattention and impulsivity, along with sensory issues that are not addressed (also common in children with ADHD), will cause a child to have behavior problems at school.  Many times the behavior is a cry for help due to a lack of support. If your child experiences behavior problems in school please visit us at IEP/504 Assistance and Special Needs Parenting Advice to get assistance with educational advocacy.

Motor (Gross and Fine)

Children who are born before 35 weeks run a risk of having gross motor impairments.  The younger the baby, and the lower the weight of the baby at birth, increases the odds the child will have a gross motor impairment.  One study showed approximately 60% of premature infants displayed scores in the average range for gross-motor functioning by the time the child reached 2 years of age.  This means up to 40% of children born prematurely could suffer a gross-motor impairment.

Prematurity impacts fine motor skills too. For extremely premature infants (those born before 28 weeks; like my children) they are at high risk for reading, math, and fine motor delay. Even children born closer to term (29 weeks to 35 weeks) may still suffer some neurological effects of prematurity including fine and gross motor skills.

I hope this shines a light on why it is so important to try and stop premature birth.  It can cause a life time of issues.   I will end with a picture of my children. They are now 10 years old.

James is towards the top of the stairs, followed by Margaret, and then Joseph.
James is towards the top of the stairs, followed by Margaret, and then Joseph.

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