Any parent of a premature baby recognizes the medical obstacles. But new research suggests that the challenges facing premature children don't necessarily end when the baby leaves the hospital. A severely premature baby is one born at 32 weeks or less, but recent studies have also examined the emotional and cognitive differences among children born moderately prematurely, between 32 and 35 weeks gestation. However, each group faced a different risk of behavioral problems according to whether they were severely premature or just moderately so.
Externalizing problems are behaviors that show outwardly, such as hyperactivity, poor attention and difficulty interacting with peers. According to a 2012 study published in the Archives of Childhood Disease, slightly less than 70 percent of children born moderately prematurely acted out through these externalizing behavior problems by the age of 4 or 5. Additionally, a study published in Early Human Development found that 76 percent of babies born severely prematurely showed a low, but fairly consistent, number of externalizing problems.
Internalized problems include psycho-emotional problems such as depression and anxiety. Although these problems aren't externalized in the same way, depression or anxiety obviously impacts a young child's social and academic life. According to Archives of Childhood Disease, moderately premature children were two and half times more likely than full-term children to experience these internalized problems. In a 2009 Pediatrics study, severely premature children were at greater risk for cognitive delays in addition to psychological and emotional problems.
While the risk of internal and external difficulties is clear among moderately and severely premature babies, other factors can increase the risk to premature child. According to the Pediatrics study, the risk of behavior problems in premature children was exacerbated by the poor maternal health as well any maternal emotional and psychological issues. Such factors are known to increase the risk of behavior problems even among children born to full-term, but being a preemie increases this risk even further.
The common recommendation from each study was for behavioral and cognitive therapy and intervention for children born prematurely. Like any impairment, strengthening deficits early on, before a child begins formal schooling, can potentially reduce the severity of certain problems. The study in Archives of Childhood Disease also notes that that children born moderately prematurely, particularly girls, should undergo mental health problems before such internalizing factors affect their academic and social life.