Grace in Life

The last two months have taken me away from the world of preemies. We’ve been building a house. I started back to work for the first time in two years. M graduated from therapy. It’s like we’ve hit cruise control as we fly down the highway away from the Preemie Years.

Both kids are having incredible growth spurts. At M’s two-year check-up, she was already in the 30th percentile; as a three-month-old, she still weighed 5 lbs, so her growth over the last six months has been phenomenal to witness. J apparently doesn’t want to be outdone, or shorter, than his sister, and finally he’s not the smallest 4-year-old we know. He’s gone from 2T clothes to 4T clothes in less than six months.

My preemies are big kids now. They run and jump and play. They scream and fight. They have crying fits and tantrums. They laugh and squeal with joy. They climb and slide and dig in the dirt. They eat and talk–and eat and talk at the same time. We’re so busy that some of these moments pass me by, but, honestly, at least fifteen times a day, I pause just for a second to reflect on these people my babies have become. I never lose sight of who they were, the limitations they faced, and the dark places that trapped us.

I have no doubt that I am a better mother and a better person than I was before it all, but sometimes I still feel tangled in memories that I cannot seem to quite escape. For the first time in more than fifty months of mothering, I scheduled no therapy this month. I talked to no therapist. There were no discussions about development and ability and goals for the future. Some parents never get there; some kids always need extra help. And that fact crosses my mind nearly every time I watch the kids play. From the outside, I look like every other mom at the park, but I’m not thinking of what I’ll cook for dinner or what time we’ll leave. I’m always here and there, in the now and past, comparing the tiny baby images in my head to the children I see running around me.

Just when I think maybe it’s time for me to bow out of this community, something pulls me back. Today, I got a beautiful e-mail from a reader telling me her story, which sounds much like mine and probably yours too. She said things only mothers of preemies say; her words take me right back to that place. And now I’m not so sure I’ve said all I want to say about having tiny babies.

One thing that I’ve been thinking lately about these last four years is that one of my favorite statements about parenting small children was never more true than with preemies: “The days are so long, but the years are so short.” It is difficult, challenging, and exhausting work, parenting children who have special needs. Then, you blink, and that tiny baby who fit in the hollow of your chest is so heavy you can barely carry him. But, with our babies, there’s also another line too: “The babies are so tiny, but their spirits are so big.” And the more time that passes, the more I believe that there’s just something special about tiny babies who are a steady reminder of grace in life.

Confessions of a Preemie

I just saw a wonderful post written by a NICU nurse that outlines all the differences between what we expect from a full-term baby and the reality of a preemie. I remember in those first days with J being completely swamped by all the new terminology, the murky expectations, and lots and lots of fear. Over time, just like any other new mama, I began to understand the basics of J’s care, what he wanted and needed, and what made him special and unique. For preemies, though, there are so many variables that make understanding your tiny baby challenging. I hope Nurse Jodi’s explanation can help! Here’s the link to her original post: Confessions of a Preemie.

The Preemie Brain

KROMKRATHOG/freedigitalphotos.net

KROMKRATHOG/freedigitalphotos.net

There are misconceptions about what it’s like for a baby born three months early, and they generally revolve around the idea that a baby who can live, even with extensive intervention, is basically just a tiny version of a full-term baby. And that just isn’t true. At all.

Preemie brains are wired differently. Especially the brains of preemies born months early.

I’ll admit it. Sometimes, I’m a little brusque when people question why my kids have therapy. I really try to be open and honest about all aspects of having a preemie, because if someone bothers to be interested, I want to share what I know. But, there is an element of the population that asks questions in a judgmental way. Why would a baby need therapy? Don’t I know preemies will catch up eventually anyway?

And they’re wrong. Babies often do need therapy, for a variety of reasons, and just like we seek out medical care, as parents we should be open to occupational, physical, and speech therapies. It is our job to change therapists or end a therapy program if we see that it isn’t working for our child, but I don’t understand being closed to the options available for your child before trying any of them. And I don’t know why another parent would question my child’s need for therapy. Besides, so much research shows how malleable a small child’s brain is. The more you encourage it to rewire itself around the damage caused by such an early birth, the more possibilities exist for that child.

When it comes to preemies and brain damage–caused by oxygen deprivation, brain bleeds, holes in the brain, and overstimulation to an immature neurological system–the jury is out. No one can tell you exactly how a child will do in a year or two years or ten years. This is why early intervention is critical and why developmental milestones are so crucial. Sure, the preemie born two months early won’t roll over or sit up on the same schedule as a full-term baby. But, when he isn’t rolling over at 7 months old, doctors and therapists begin to worry that larger issues like cerebral palsy exist. It’s not just about catching a preemie up to a full-term baby; each milestone met is evidence that a baby’s brain is continuing to grow and develop.

I also get frustrated when people tell me they have a preemie, who was born three weeks early, and that they understand what it’s like to have a preemie. I’m not taking away from the fact that a birth experience three weeks early can be a surprise and stressful, but the long-term concerns and care for a baby born at 34 weeks or later is completely different from all the risks of babies born MONTHS early. A baby born at 26 weeks has an entirely different experience from one born at 36 weeks. The earlier the baby is, the more risks for complications; it’s exponential. Before I was a mother, I’m sure I didn’t know the realities of having preemies–the therapies, diagnoses, interventions–but I know I wouldn’t have assumed that a baby can pop out of the womb three months early and act like a full-term baby. Babies are never meant to come into the world weeks and weeks early, and just because we have the capabilities to give them a great shot at life doesn’t mean the journey is easy. For most preemies born before 32 weeks, it takes years–yes, years–to catch up developmentally, and they may continue to face the challenges of being a preemie well into their childhoods and beyond.

Not all preemies are created equally. Another misconception is that because a neighbor had preemie twins born at 29 weeks who were typically developing babies within months of their release from the hospital, my experience should mirror that one. Each preemie is different, as different as their experiences and personalities and genetic makeup. So many NICU journeys overlap, but each one is unique. There is no baby whose story is just like anyone else’s. Miraculous stories should be shared, but sometimes the miracle is that a baby lived in the first place, not in how fast he bounded out of the hospital. Sometimes, when the expectation is that a baby should come home before her due date, it sets an unfair bar of achievement. And expecting a preemie who comes home to act like a full-term baby is not a fair standard either. It sets the whole family up for disappointment and frustration, and it takes away from all the miracles achieved on a daily basis.

I was hard on J. I knew in my head that his development would take longer, that he would be a baby well into his second year. But, I wasn’t prepared for the reality. I pushed him hard to walk and talk. Now, I better understand that he did hold himself back, as it is in his nature to do. J doesn’t rock the boat or take risks, and walking is risky for a baby because it involves falling. I see that J needs time and space and encouragement, and any frustration on my part hurts his progress. I also know more preemies than I did as a brand-new mother. I better understand that J’s health itself should be celebrated; we are so fortunate for it. I wish I’d focused on that fact more and worried less. But, I felt that I was constantly explaining to the world at large why my 17-month-old wasn’t walking, why my 2.5-year-old wasn’t talking, why my 3-year-old was wearing 24-month clothes. That’s all part of the journey, though.

Looking back, J tackled developmental goals impressively; it was just done with his characteristic caution and quiet reserve. He wasn’t showy. He didn’t develop in leaps and bounds, as my daughter does. Each day was a slight improvement on the day before, until before we knew it he was a typical 3-year-old. I was so frustrated that J didn’t walk until he was 17-months old, when he had the ability a month or two earlier. Then, enter M, who didn’t walk until she was nearly 20 months old and 17 months adjusted age, 3 months past the norm. M is healthy, strong, physically-active; I think she’ll be an athlete with her energy level, determination, and competitive spirit. But, she walked much later than J, and had he been my second child instead of my first, I would have better appreciated all of his achievements. Preemies are just on their own schedule.

I am just now fully realizing something critical: a preemie brain is phenomenally different from a full-term brain. Sometimes, we expect to see a preemie with asthma or glasses but not a preemie who takes two years to walk. I think this is because the stereotypes are based on a dated understanding about the capabilities of NICUs. The current medical technology is amazing, so many babies who come out of the NICU are in excellent outward health. They look perfectly healthy, but the NICU can’t alter the reality that a baby’s brain is not made to regulate temperature and breathing or to process the nerve sensations of the human touch at 26 weeks. I have witnessed how my babies are wired a bit differently. My husband and I now contribute some of the quirks of our children, which mirror no one else in the family, as having to do with the extraordinary feats of their brains. Sensations like light and sound are just different to preemies, even in babies who aren’t diagnosed with any other condition. Our preemies are easily over-stimulated and hard to relax. They don’t want to be rocked or held. They struggle to fall asleep. They cannot sleep in the car despite how exhausted they are, even on 12-hour road trips. In fact, the more exhausted they are, the less able to fall asleep they become. My son screamed for his first months at home, and the only way to wind him down was to push him in his stroller around the house in circles until he grew drowsy. His body would twitch as he struggled to relax. And we have literally held my daughter down until one by one her muscles relaxed; we could feel her falling asleep from her legs, to her arms, to her hands, and finally her eyelids. Sure, some full-term kids have some of the same problems, but to the extent that we notice it? We are regimented about nap times and bed times, about routines, and about sleep environments for a very good reason; sleep can be a challenge.

Another anomaly is that both of our preemies were left-side dominate as tiny babies, when almost no one in our families is left-handed. The conventional wisdom that you won’t know if a child prefers one hand over another until age 3? Hogwash! Ask our long-time physical therapist, and she’ll be our expert witness. The first hand both kids used to put a tiny, baby fist in their mouths? The left. The arm they first used to pull up? Their left. The first steps they took? With their left foot. My kids are complete opposites in temperament and personality, and the strengths of one are the weaknesses of the other; yet, they share left-handedness. More preemies are left-handed than full-term kids, and I would love to see more research concerning why, not just because it’s interesting but because I think it has to do with unusual brain development. A better understanding of that brain development could also shed light on all sorts of risks that our preemies face: autism, SPD, ADD/ADHD, cerebral palsy…and the list goes on and on.

Preemies are exceptional, in every sense of the word. They are amazing and unique, and they aren’t just tiny versions of bigger babies. It’s a completely different experience, and I guess I’m just a little out of breath with saying so. I love questions and curiosity; I like relating to other parents and sharing our experiences. Just because this is my life doesn’t mean I’m not curious about all the unique aspects of parenting that someone else has experienced. I just don’t want to have to justify why my child receives therapy or additional medical oversight or state medical services. I’m tired of explaining that part, like I’m some sort of taker of the medical system or some over-reacting stage mom.

I’m just a mom who has preemies, and I’m doing what any mom with tiny babies would do.

All Preemies Aren’t Created Equally

M, a few days old

In the NICU, everything is relative.

The term preemie can mean a multitude of things: everything from a baby born at 36 weeks and 6 days gestation who weighs 7 lbs and never spends a night in the NICU to a baby born at 22 weeks who weighs 14 oz and spends 200 days in the hospital.

Sometimes, strangers tell me they know a preemie who was the tiniest baby they’ve ever seen–their “tiniest” baby was my two-month-old. M weighed exactly 5 lbs when she left the hospital at 60 days old. At her smallest, she weighed 1 lb. 15 oz.

In fact, I was our family’s preemie until my kids showed up. I weighed 5 lbs 6 oz at birth and was born 4 weeks early. Everyone talked about how tiny I was, how my head fit in the palm of my dad’s hand. Little did we all know that a whole baby can fit in the palm of a hand!

I remember when J was first born, I wanted desperately to know what his survival odds were, but I was too terrified to ask anyone. The doctors and nurses didn’t like discussing a baby’s prognosis because no one really knows. A 23-weeker can surprise you by coming home with no oxygen six weeks before her due date, and a 32-weeker can linger long after everyone thought she would go home. I knew a baby with a brain bleed whose doctor told his mother, as a way of explaining his brain damage, that he would play on the football team but he would not be the captain. Now, at 4-years-old he’s Leader of the Pack, well above his developmental goals and smart as a whip.

Taking J’s temperature when he was about a week old.

While J’s odds of survival were around 80%, he had a 66% chance of having a disability at age 3; he has no disability. He was born too fast for steroid shots to develop his lungs; yet, he was only on the ventilator for a few days. He didn’t catch his first cold until he was 17 months old, and his first serious illness was this spring as a 3.5-year-old.

How he did this well remains mostly a mystery to me. He was healthy in the womb, he was in the 70th percentile when he was born, and my obgyn was so proud of the fact that he was intubated immediately after birth so that he never went without oxygen. He responded well to the surfactant given to him after birth that helped his lungs inflate properly, which meant less time on the ventilator. Less time on the ventilator reduced the scarring in his lungs, which impacts lifelong respiratory health. One bit of good fortune translated into more good fortune, but that addition doesn’t always work. Sometimes, it just seems that there’s no rhyme or reason to the outcomes.

J is not the norm for a 26-weeker. In fact, our pediatrician loves to show him off to visitors in her office, always asking my permission to share his story. J shows us what is possible with preemies. A few times this year, I’ve seen the cost of saving preemies thrown around with so little consideration for what those numbers mean. Sure my children together racked up over $1 million in hospital care, but their excellent care at birth has hopefully paved the way for decades of healthy living in which they will need little healthcare. So what if it is expensive to save babies? I hate to see our priorities when we as a society say we are unable or unwilling to give babies a chance at life.

Much has changed in NICUs in the last 30 years that has expanded the possibilities for preemies. More and more kids like J go on to live relatively normal lives thanks to all the advances. But, what is surprising is that there is still so much disparity from one hospital to the next. Within my own town, two hospitals will attempt to resuscitate 22-weekers, while another one won’t intervene until the baby is at least 24 weeks gestation. Sometimes, a baby’s chances depend on the medical care available in those first critical minutes. And the disparity doesn’t stop there. The quality of the doctors, nurses, specialists, and therapists can vary widely. Techniques common in one hospital are rare in another one, and conveniences such as bedside breast pumps might seem like perks when really they can alter the health of a baby at a time in their lives when breast milk is medicine.

So, my 26-weeker isn’t someone else’s 26-weeker. One preemie’s path in no way defines the journey for other babies.

I’ll admit that I am a preemie snob. Please forgive me. It’s not just my own children but all the other babies I’ve met along the way who give me pause when a grandmother brags about her miracle born five weeks early. I don’t doubt that baby is a miracle–all babies are treasures of good fortune–and I don’t doubt that any hour with a baby in the NICU is a miserable one. It’s just that it’s challenging for All the Preemie Mamas to keep our mouths shut. We want to brag about the miracles we’ve seen, the things that shouldn’t have happened, all the dozens and dozens of babies we watched work their way through the NICU who wouldn’t have lived more than a few hours or days just three decades ago. Their accomplishments shouldn’t be diminished by the preemie down the street who weighed 4.5 lbs at birth, was breathing on his own at 33 weeks, and spent only two weeks in the hospital. That story is amazing, but goodness could I tell you some humdingers.

Like the barely 24-week twins whose mother was prepared to lie about their gestation to make sure they were resuscitated at birth. Or the 26-weeker who came off oxygen at age 10. Or the set of quads whose mother was encouraged to abort two of them to increase their survival odds. The stories go on and on and on.

Preemie stories are just as unique as the babies who inhabit them, each one of them different and special.

Seriously, I should write a book…

The Preemie Lifestyle


There is a myth that when you bring your baby home you put the NICU journey behind you.It’s what we all want to believe when we’re struggling through the emotions of having a hospitalized baby. We keep focused on that beautiful day when we’ll peel out of the hospital parking lot for the very last time with the baby in tow. And it’s a good thing that we have a goal as we trudge in and out of days in the NICU.

But, the crashing of fantasy and reality can be brutal.

After a couple of months of struggling through sleepless nights, a punishing pumping/breastfeeding schedule, and what I call the Two-Month Screaming, I began to fall into a depression. We were under our winter quarantine, I felt isolated, and the days were long and taxing.

I’ll admit that I wondered to myself, “What have I done?”

Parenting is rarely what you imagine, envision, or daydream. It is both better and worse. But, when you start out with a baby in the NICU, you drain so much of your emotional reserves in those early days. I found that I had little left for the journey after the NICU.

I came to a realization when J was six months old and he was evaluated for therapy. A social worker had mentioned all the services available for preemies as we were leaving the NICU, but I had no idea the kind of delays J would have. He wasn’t even rolling over at six months old. In fact, he didn’t roll over until he was closer to 9 months old and had spent three months in physical therapy.

It began to dawn on me that leaving the NICU wasn’t the destination or the endpoint. Having a preemie was a lifestyle. It involved Synagis shots and physical therapy and teachers who specialized in developmental delays. I wiped down surfaces with the zeal of a woman who feared one illness might kill her baby. Our entire family was vaccinated. My career disappeared into the background indefinitely. Getting J healthy was my singular focus. I felt that I owed it to him to give him as good of a start as I could, especially because I had evicted him from my body at 26 weeks.

Once I had M early too, this way of life really did become normal. I talk regularly with other preemie parents. I blog about preemie issues. I strategize on ways to help M catch up with her peers. Not a day goes by that I don’t think about where we’ve been. Raising preemies is a lifestyle, at least while they’re small children and maybe forever. The jury is out on where this journey goes, but for now it is all-consuming.

For a long time, I lived from one developmental goal to the next. I always focused on where we were going. But, sometimes we just need to slow down and appreciate where we are.

These children are hilarious and bright and energetic and enthusiastic. And so resilient. They could be poster children for all that is possible.

Would I see them this way if I hadn’t witnessed their beginning? Holding your baby in the palm of your hand changes you. Watching your two-pound baby breathe all on her own challenges everything you’ve ever believed. I’ve written before about the magic of having preemies, and it is so true. For all the difficulties, some of our moments in the NICU could take your breath away with their beauty.

Victories are sweeter, because they are so hard-fought. Walking isn’t just putting a few wobbly steps together; it’s the pinnacle of an uphill climb that began at birth, it’s the achievement built upon months and months of therapy. So what if everything takes longer, if it all seems so challenging, if sometimes I am so exhausted at trying to be a great mother? They are worth it all.

I didn’t choose the Preemie Lifestyle; it chose me. And I wouldn’t trade it.

Waiting To Walk

It took J forever to walk.

By forever, I mean 17 months.

Actually, in retrospect, I thought it took J forever to walk, but now I have M to put his development into perspective. M always has this effect on me. She is nothing like J, and her story is nothing like J’s. She is exuberance to his reserve. She is fearless to his caution. She is defiant to his obedience. She had 3.5 more weeks in the womb than he did, which any preemie parent knows is just about a lifetime. She also had two rounds of steroid shots to develop her lungs just before birth; J did not.

M is almost 16 months old. By adjusted age, she is nearly at the point when J was hanging onto his walking wings for dear life, taking his first steps of hard-fought independence. Despite all their differences and her perceived advantages, it appears that she will walk no earlier than he did.

If J changed everything in my life, turned it all upside down and inside out, then how could M be such a surprise? She has shown me that even when you think you’ve made sense of the world, you probably are still just a sweet, little babe in the woods, naïve about your own naivety. So much of my frustration with J was misplaced because I compared him to unfair goals and children who weren’t born prematurely. Now, I realize that every goal he met, every step of forward progress he made, was nothing short of miraculous.

Not to take anything away from M, because she has overcome odds too, but it was J who was thrown to the wolves at 26 weeks with so many challenges. In his caution and reserve, sometimes we miss the magic of his accomplishments. They aren’t done in explosive fits or with gleeful giggles, like with M, and so sometimes we look up one day and find that tiny changes have compounded into J becoming a totally different child.

Now, as I await the tentative first steps of another late walker, I also realize something else. The early years of raising premature babies are different from the norm; in fact, they are vastly different. And even though the kids are all different too, there are some commonalities that preemies share that we cannot escape.

It doesn’t seem to matter that M’s personality is nothing like J’s, or that she’s a girl and he’s a boy. It doesn’t seem to matter that she crawls and he didn’t, or that she had 25 more days of development in utero. Here we are at 16 months with a baby who isn’t yet walking. And in my world, that is perfectly normal.

Why We Walk

I never participated in a charity walk or race before my kids were born. Sure, I donated to other people’s causes, and I volunteered my time. But, I never directly participated in fundraising for a national charity.

This will be our fourth year to walk in our city’s March for Babies fundraiser for the March of Dimes. Because we are moving this year, it will likely be our last.

Why do we participate? For many reasons. The first year we were just coming out of a very long nine months. J was born 14 weeks early, and then he was hospitalized for 3 months. He came home in October to RSV season, and we were quarantined for five months in a place where we had no family and very few friends. During that winter, I lived for the March of Dimes walk. In the spring. When our lives would finally thaw and we would begin to operate as a normal family. When I could take my son into public and, for the first time in his 9 months, I could show him off. When people would see me as I was: a new mother. When we could go to stores and restaurants and sporting events and all the other places I’d dreamed we’d go during those months of isolation.

That first March of Dimes walk was a chance to enjoy the sunshine and warm weather with friends we’d made in the NICU. They were like us: pent-up, exhausted, emotionally-spent, fragile. But, they were also like us: deliriously happy to reenter civilization, with healthy babies.

And I’ll be brutally honest: That first March of Dimes walk was a chance to actually celebrate. To breathe. To relax and enjoy being a family of three. We had been in survival mode for so long that there had been little time to celebrate. And, if I’m being truthful, other than having the support of our parents, we had felt alone during those nine long months. So many of our family and friends were scattered in all the places we’d lived, and their physical distance often translated to a distance emotionally. They had no idea what our daily lives actually looked like. And though I’m sure they cared, we felt that little surrounding the surprise birth of our son had been celebratory. There were no showers, no parties, nothing to mark the homecoming of our miracle. And if I’m being really honest, I was terrified for a long time to celebrate J. He was a 26-weeker. Anything can happen to a 26-weeker in the NICU, and all through RSV season, I held my breath, praying that an illness wouldn’t unravel all the health he had worked so hard to gain.
I’ve often wondered how my son was so fortunate. How could he have no lung damage and be born so early, without the benefit of steroids to strengthen his lungs for the ridiculous task of breathing 14 weeks too soon? How? As I’ve learned more about prematurity, I’ve come to realize that question has many answers, but one contributing factor was the surfactant his lungs received in his earliest hours. They allowed his lungs to inflate and receive the oxygen that every cell in his body needed. So, surfactant not only helps the lungs but every other precious part of a preemie’s tender body. March of Dimes researchers are credited with developing the surfactant therapy that likely made a difference in J’s outcome. Would he have lived without it? Maybe. Would he have the same quality of life? Definitely not.
Our second March for Babies walk was miraculous because we were with my friend with quads. Here we were, two healthy, young women back on our feet after two difficult years, and sprawled in front of us in strollers were five preemies, the largest of whom weighed 2 lbs. 8 oz. at birth. In fact, I added all of our babies’ weights and discovered that together they weighed just over 12 pounds. I thought all our days with tiny babies were behind us, and I delighted in our future.
Last year’s walk was difficult because my husband was on a business trip in London and was unable to participate, but it was no less significant to us. In that last year, I had gotten pregnant, had a relatively uneventful high-risk pregnancy, developed a surprise case of severe preeclampsia, had another 2.5-lb baby, and weathered another NICU stay. There I was at the same walk representing not one preemies but two tiny babies.
Somehow, it seems fitting to make this walk our last. It doesn’t mean that we won’t continue to donate to the March of Dimes, and it certainly doesn’t mean that we won’t continue to find ways to give back to our preemie community. If we meet our goals this year, we will have raised over $5000 for the March of Dimes, which is exciting for us. But, with moving and leaving so much of our NICU days behind us, it feels like it is time to say goodbye to the March for Babies walks as well.

It’s not about the money. It’s not just a walk. For us, March for Babies is intensely personal. It’s about making lemonade out of lemons. It’s about encouraging other families like ours. It’s about putting our children’s names and weights on t-shirts and declaring them as the survivors they are. It’s about recognizing the babies who weren’t as fortunate as our babies were, and it’s about calling attention to so many conditions and diseases that remain shrouded in mystery.

To put it simply, we walk for our children and for all the other children like them.

The Importance of Preschool for Preemies

I have become such an advocate for preschool education. In fact, my own personal rule is that I want my kids in part-time preschool as early as possible. I stress that this is a philosophy that we’ve adopted in our own home, and I would never apply it across the board.

What would we have decided if our kids weren’t preemies? I’ll never know. Would I have been working full-time? Probably, which would have meant my kids would have been in daycare. But, my personal decision when J was a baby was that I didn’t want a babysitter overseeing his therapy, and I was at an in-between place in my career anyway. I couldn’t envision seeking full-time employment in the middle of such a difficult time for our family.

Those were our decisions for our family and by no means would I apply what worked for us to other families.

But, I will say this: As babies and small children, preemies are different. They often require trips to specialists, or at least extra visits to pediatricians. They need special protection during cold and flu season, especially against RSV. They often need therapy–and sometimes lots of therapy–to help with eating, walking, and all the other things full-term babies seem to grasp on their own. With J, physical and speech therapy made a huge difference, and I’ve written about how indebted I feel to his therapists. But, another area that I feel has been a key to his success has been preschool.

We’ve been lucky enough to have access to a preschool that specializes in developmental delays. It integrates children at or above their ages in terms of development with those who are delayed for a variety of reasons. Interaction with other children does wonders for preemies, especially when the preemie is an only child, as J was. He was so cautious and reserved that he needed to see what other children his age were doing to encourage him to do more. And playing on a playground or seeing kids in a playgroup didn’t cut it. He needed the academic environment, the structure, and the proven methods that a preschool can provide.

I could write volumes about our experience with his preschool. They have taken a baby who couldn’t walk or talk and encouraged him to be the bright, curious, and energetic boy who was hiding just beneath the surface. J’s delays confined him to a body that didn’t do so much of what he wanted, and all of the hours at school helped free him. It has been a magical transformation to witness.

And it has been eye-opening for me. I’ve had people tell me that developmental delays aren’t a big deal, that kids will catch up, and while that is probably true, a small child’s brain is phenomenally elastic. Studies show that the more a child can do in those first few years, the better that child will do long-term. So, just because many preemies in the past caught up by age 5 or 6, when they were entering kindergarten, doesn’t mean that I should be relaxed about helping my kids reach their full potential as early as possible. And the truth is that many of our preemies now have few comparisons. The development of surfactant therapy in 1990 has contributed to the increased health of the tiniest preemies. I doubt J would have lived without it, and he certainly wouldn’t be as healthy. Our babies are living in the first decades of increased health for preemies, and along with that health comes increased possibilities.

J and M have received home therapy where someone trained in childhood development encouraged me to try different techniques to help my babies. It was home-based and focused specifically on the needs of my children. Sometimes it was helpful, and sometimes it really wasn’t helpful at all. My children do not perform for me the way they do for their teachers and their peers, and I would never claim to be trained or skilled in childhood development the way teachers and therapists are. Not every preemie has access to the kind of resources from which we’ve benefitted. I know we are so lucky. But, I do think that any good preschool could help preemies who meet minimum requirements for enrollment, such as walking or being potty trained, and I think it’s wonderful for preemies to get exposure to other children as soon as they are healthy enough.

All of this is on my mind because M just started attending J’s school last week. She is 13 months old now, and I couldn’t be more thrilled about her opportunity to learn and grow at the place that has done so much for J. (As a side note, neither of my very independent children cared less when I dropped them off for their first days at school. I thought M might look a little sad, since she is more attached to me than J was, but I was totally wrong. She didn’t even give me a second glance!)

From my experience, little kids need interaction with other little kids, and not just in playgroups. But, I’ve said it before and I’m sure I’ll say it many times again: I don’t know anything about raising full-term babies. Preemies are all I know!