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What are the criteria for preterm baby?  

Sometimes pregnancy ends before the due time, and labour occurs prematurely. This may happen because of the intense emotional upset, various traumas and health conditions, abnormal course o pregnancy, mother’s alcohol abuse and other reasons. In such case, we speak of the premature birth. According to the World Health Organization,

• Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
• Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015 (1).
• Three-quarters of these deaths could be prevented with current, cost-effective interventions.
• Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.

In the recent years, it has been one of the major world healthcare problems of both medical and social character. Infants are considered premature (preterm baby) when born before 37 weeks of gestation, have weight less than 5.5 pounds and height 11.8 – 13.5 inches. However, birth weight as a measure of prematurity is dubious. Sometimes, full-time babies may weigh less than 5.5. pounds. In this instance, doctors diagnose prenatal (inherent) oligotrophy or intrauterine growth retardation. However, did you know that preterm baby who receive massage and take gymnastic exercises grows much healthier and stronger?

Requisite conditions for strengthening and physical development of preterm infants.

Premature baby needs close attention. Caretaking routine needs to be thoroughly thought of and well-organized. Only with good nutrition and proper care, will the preterm baby get a good chance to catch up on their age-mates and grow up healthy. After a premature birth, the medics examine a newborn and place them into an intensive care unit (couveuse or incubator), where they spend some time prescribed by the doctor before the hospital discharge. Then finally this difficult period is over.       

Taking care of a premature baby at home.

Boston Infant Trainer recommends: keep the baby on breast feeding if you can. Breast milk has unique qualities. It provides all the necessary nutrients for your preterm baby which makes it indispensable. Take the child to the breast as often as you can. If it is difficult for a baby to grab the nipple and he or she tires quickly while sucking, offer them some expressed breast milk from a bottle. Signs of sufficient nutrition of a preterm baby are body weight gain, boost in physical development, frequency and quality of defecation.

Sleep-wake routine for preterm infants needs to be sparing. Children with body weight of less than 3.85 pounds can be shifted to other sleep regime with a delay of 1-2 or even 3 months.

Premature nursery room needs to be exceptionally clean. The body of a preterm baby can not regulate its temperature. Therefore, try to keep the room temperature at the same level of 75-79 F degrees that would be comfortable and safe for your child.  Avoid drafts and temperature difference. There’s no need to envelop the preterm child weighing over 4.4 pounds. Those who weig less than 4.4. pounds should be dressed in warmed up clothes with a hot water bottle placed over the blanket. It is necessary to keep the baby’s feet constantly warm. By the end of the first month of life most of the preterm infants don’t require any additional warming.

Premature baby’s skin needs thorough care and attention. You can start bathing your child the day after the umbilical cord falls off. Do it every day using boiled, cooled off water.
If a child weighs  5.7 – 5.9 pounds walking and sleeping in the open air are permitted in the warm time of the year. Try to take your child out for walks more often starting from the 2-3 weeks of age. In the summer, your baby can spend all the time between the feedings outside.

General strengthening procedures for a preterm baby.

Boston Infant Trainer recommends: to strengthen the protective functions of the body, resort to massage, preterm baby gymnastics and cold training. For a massage technique or a set of gymnastic exercises with regard to your baby’s needs, consult a professional therapist.  During the first year of life, a child’s body has great potential for regeneration of functions and systems that have been damaged or delayed in development. The beneficial effect of individual development classes and strengthening training (which suggests playing, gymnastics and massage) is difficult to overestimate. Premature baby who receive massage and take gymnastic exercises are 2-3 times less prone to respiratory viral diseases, their muscular tone normalizes faster, their emotional state improves – they begin to smile and watch the moving objects earlier, etc.

Requirements for premature baby massage and physical development gymnastics.

Start the exercises for preterm infant 30 min before or 45-60 min after feeding. Massage or gymnastics are prohibited before bedtime. Exercises need to be done at the same time every day on a regular basis. Complete set of exercises for physical development and strengthening of premature infants needs to be repeated 2-3 times a day, in some cases 4-6 times. The whole duration of the training session not to exceed 15 min. The room should be well aired, recommended temperature 68-75 F. Initial exercises are based on the innate reflexes of a newborn. Due to their specific physiological characteristics, preterm babies get cold and tire very quickly. Considering this, you can split a set of exercises in two parts with a little rest pause between them at first. All exercises need to be done in a consecutive order incorporating different muscle groups. Begin preterm baby gymnastics with breathing exercises and repeat them regularly within one session. You shouldn’t fully undress the baby during the first workouts. While performing the arm exercises, cover the bottom part of the infant’s body with a cloth. Don’t take off their bodysuit when you do the leg gymnastics.

Boston Infant Trainer states that every session should include elements which can stimulate auditory and visual response of the child. From the age of 3-4 months accompany the exercises with verbal commands (e.g. “take the ring”). Staring from 8-9 months teach the child to follow the voice instructions. Exercises should gradually become more complex over a long period of time. But necessarily taking into account individual reactions and physical features of the baby. At the smallest sign of fatigue, reduce the exercise load (including the number of repetitions, tempo, span of motion, difficulty of the exercises, alternation of effort with rest-pauses and breathing exercises)

All techniques of classical massage can be applied in premature baby massage: stroking, rubbing, kneading, vibration, soft tapping, some methods of acupressure. Different massage moves should be applied with regard to age restrictions. Particularly, starting from 1.5 months strokes are allowed, at 3 months – rubs, from 6 months – kneading, from 8 months – tapping. Provided there are indications, massage is conducted by a certified professional every day, in courses of 10-20 sessions. Quantity and frequency of therapy sessions may vary from a single one to long-lasting courses with a monthly break between them for as long as it is required.

Massage technique and gymnastic for strengthening of preterm infants.

Massage methods and gymnastics for premature babies are developed with regard to their physiological capability: imperfect breathing function, low adaptive capability in changing environment (metabolism and thermoregulation), immaturity of nervous and muscular systems. Therapy includes classical and acupressure massage techniques and gymnastics. They may be applied simultaneously or successively (by turns). Approaches vary depending on the age of the child. During the first months of life, shallow massage techniques with soft and gentle strokes are used. Step by step, the therapist introduces such elements of massage as tapping, vibration, rubbing.
For a 1 moth-old child use sparing massage with gentle strokes. At 1,5-2 months combine it with gymnastics that stimulates motor skills development. At the age of 3-4 months practice turning on one side, then on the other. At 4-5 months train a child to intentionally reach for a toy and grab it. 5-6 months encourage active crawling. At 7-8 months induce (never force!) them to sit or stand. Exercises in the sitting position are performed if a child can hold their back straight. 9-10 months – standing with support holding on to a barre (handrail). 11 months – walk training while holding on to a handrail. 12-13 months – walking without support.

Start gymnastic exercises for development of motor skills at 2,5 months if a child’s birth weight is less than 1750g, or 1-1,5 months earlier if the weight is above 1750g.

Massage techniques for strengthening and development of preterm babies.

Classical massage. All traditional methods of baby massage including strokes, kneading, vibration and tapping can be applied. Duration of every technique 0,5 – 2 min. The skin of the newborns is dry and thin. Therefore, start the massage with soft techniques (gentle strokes) gradually moving on to more intense ones (soft vibration, soft rubbing and tapping, kneading).

Acupressure. Pressing certain reflexogenic zones with one or two fingers. Strong and short pressure tones up various groups of muscles. Soft and longer pressure releases the muscular tension.  However, even though anyone can master classical massage techniques, only a trained specialist or a parent who completed a full training course in acupressure can perform this type of massage.

Special exercises for strengthening and development of premature babies. Special exercises consist of active, passive and reflex elements. They are aimed at activation of motor skills, strengthening of various groups of muscles, enhancement of body functions and systems, general improvement of health. It can be combined with massage, physiotherapy or as a separate procedure starting from the first month of life.
The sooner you introduce gymnastics the more steady results you will get, and it will be much easier to form the correct dynamic stereotype. Pay special attention to the core motor skills which are imbedded in everyday life tasks. In the first half-year of life train your child to turn from belly to back the right way. As the incorrect motion work leads to spine deformation.

Sets of gymnastic exercises and massage techniques for premature babies of the first year of life. I set of exercises for newborns

• 2-3 weeks of age.
  

Breathing exercises.

1. Starting position – mother holds the baby face to face with her. Perform rhythmic pressing of the baby’s back moving your hand from the neck towards the small of the back.

2. Initial position – baby lies on the back. Perform rhythmic pressing of their chest, its front and side parts avoiding the breastbone.

Reflex exercises.

1. Bending of the foot. Hold the baby’s foot with your thumb and index finger. With the thumb of your other hand press the sole of the baby at the base of the foot. This makes the foot bend.

2. Unbending of the foot. With a dashed stroke of your thumb slide along the inner edge of the foot (from the big toe to the heel). Continue the motion on the outer edge of the foot (from the heel to the small toe) – the foot unbends.

3. Laying out on the belly. Baby raises their head or turns it to the side. This exercise is recommended before every day feeding, starting from 30 sec and up to 1 min.

Breathing exercise.

Baby lies on the back. Spread their arms bended at the elbow during the breathe in, then softly press them to the side part of the chest on the breathe out.

• 1 to 3 months of age.
  

Breathing exercises.

1. Mother holds the child facing her. Perform rhythmic pressing of the baby’s back, move your hand from the neck towards the small of the back.

2. Baby lies on the back. Perform rhythmic pressing of their chest, its front and side parts avoiding the breastbone.  

Passive exercises.

1. Baby lies on the side – first on the left one, then on the right one. Support the baby with your left hand. With your right hand hold their bent arm by the elbow and raise it up on the breathe in. Then put it back and press it to the baby’s belly and chest on the breathe out.

2. Baby lies on the back. Let the baby grip your thumb. With your free hand stroke the inner and outer surfaces of the arm starting from the hand and towards the shoulder.

Reflex exercise.

Baby lies on the back. Let the baby grip your thumbs firmly with both hands. Use your thumbs to press softly on the palmar surface of the baby’s hands.

Passive exercises. 

1. Baby lies on the back. Stroke the back and outer surface of the shins and thighs – from the feet up to the hip avoiding the knee cap.

2. Stroke the back of the baby’s feet. Take one foot holding it with two or three fingers by the heel. Stroking is performed with the thick of the thumb from the base of the toes towards the ankle going round the ankle cuff front-to-back.

Reflex exercise for feet.

1. Baby lies on the back. Bending of the foot. Hold the baby’s foot with your thumb and index finger. With the thumb of your other hand press the sole at the base of the foot. This makes the foot bend.

2. Unbending of the foot. With a dashed stroke of your thumb slide along the inner edge of the foot (from the big toe to the heel). Continue the motion on the outer edge of the foot (from the heel to the small toe) – the foot unbends.  

Passive exercises.

Stroke the belly clockwise with one hand without pressing on the liver (right upper quadrant below the ribs). Support the baby with the other hand.

Reflex exercises.

1. Support reflex. Hold the infant upright by the armpits facing you. Child’s feet should push against the surface. When the half-bent feet of the child touch the ground or the table their legs stretch and unbend.

2. Walking reflex. Hold the infant under the armpits slightly tilting their body forward. When you direct the movement away from you, this invokes a stepping reflex.

3. Laying out on the belly.

Passive exercises.

Baby lies on the belly. Stroke them with a palm from the head to the buttocks and back – from the buttocks to the head with the back side of your hand.  

Reflex exercise for back muscles.

Set the child chest-down on your palm. Stepping 1cm from the spine, make massaging moves with the cushions of your thumb and index fingers from the shoulder blades towards buttocks and back. Do it on both sides from the spine simultaneously in parallel lines. The body of the infant will bend in an upward arch.

Passive exercises.

1. Put the infant on the belly with support on the forearms.

2. Chest massage. Initial position – lying on the back. Stroke the intercostal muscules with your fingers from the middle of the chest towards the sides without pressing the breastbone.

3. Exercise on a gymnastic ball. Put the baby belly-down on the ball and swing it gently. Rock the ball from side to side, forward and backward. 

• Baby exercises for 3-5 months.

Repeat every exercise 4-5 times. Some of the massage techniques are given in the sets of exercises above. Hand massage includes stroking and circular rubbing.

Breathing exercise.

Crossing arms on the chest. Initial position – baby lies on the back. Put your thumbs into baby’s hands and hold them with your other fingers. Spread the baby’s arms out to the sides during the breathe in. Then bring them in across their chest on the breathe out.

Passive exercises.

1. Leg massage. Stroking, rubbing in circular motion, kneading, stroking. Place the baby’s leg between your palms so that one of your hands covers the outer surface of the shin and the other hand lies on the back one. Then perform forceps moves with your both hands kneading the leg up to the thigh in a circular motion.

2. Bending and unbending both legs at once. Initial position – baby lies on the back. Grip the back lower part of the baby’s shins holding their feet. Bend the legs in all joints, pressing them to the child’s belly (knees of the baby should be spread widely apart), then straighten the legs.

3. Turn the baby from belly to back to the left and to the right.

4. Buttocks and back massage. Stroking, rubbing, kneading of the long back muscles on both sides from the spine. Hold the muscles with a forceps-like grip. Perform circular and forward translation movement simultaneously moving from the small of the back up to the neck. Knead the buttocks with one hand, place the other one over the pelvic area. Start tapping or pincing the buttocks and finish with stroking.

5. Gliding on the belly. Initial position – baby lies on the belly. Lay your hand under the child’s tummy. Grip the baby’s shin with a thumb and an index finger of your other hand, hold the other foot of the child with remaining fingers (“fork grip”). Lift the child over the table in a horizontal position. Child’s body should bend in an upward facing arch.

6. Belly massage. Perform all types of stroking, rubbing, pincement, end with stroking.

7. Gliding on the back. Starting position – baby lies on the back. Lay your hand under the child’s back. Hold the legs of the baby by the shin in a “fork grip”. Then lift the baby over the table surface in a horizontal position, the neck should bend forward.

Reflex exercises.

1. Grabbing a toy with one or both hands while lying on the belly or on the back.

2. Resistance exercise: а) pushing away the hands of a grown-up, b) pushing away the ball.

Passive reflex exercises.

1. Child lies on the back. A grown-up needs to hold the front part of the infant’s shins. Bend the baby’s legs in the knees and press the soles to the table surface. Bend and unbend the legs by turns without breaking the contact with the surface.

2.  Chest massage. Stroking and rhythmic pressing of the side parts of the chest.

3. “Box” – bending and unbending of the arms. Let the baby grab your thumbs and clutch them in his or her fists. With your other fingers support them by the wrists. Bend and unbend the arms one by one.

Active reflex exercise.

Swinging on the ball. Lying on the belly, the baby should push out from the table with their feet. While on the back, swing the ball in different directions, gradually increasing the range of motion.

Exercises for preterm babies at the age of  5-6 months.

Repeat every exercise 4-6 times. Some of the massage techniques and exercises are described above.

Passive exercise.

Start the set with hand massage: stroking and rubbing.

Breathing exercise.

Cross the baby’s hands on the chest.

Passive reflex exercises.

1. Proceed with leg massage: stroking, rubbing, kneading and stroking again.

2. Put your hands around the ankle cuffs. Place your little fingers on the baby’s heels. Bend and unbend the child’s legs.

3. Hold the legs as written in the previous exercise. Bend and unbend them in turns – one by one. Do it gently and slowly. If needed, combine with vibration.

4. Turn the baby from back to belly.

5. Baby lies on the belly. Place a bright toy in front of the child. The infant should raise him- or herself on the elbows and try to look at the toy, then take it. Do the exercise once.

6. Perform a back and bum massage: stroking, rubbing, kneading, stimulating moves and stroking again.

7. Put the baby up straight holding them by the armpits. Put them on their knees. After that, still supporting the baby, bend them forward a little and “drag” them in a sliding manner. Continue the motion while raising the baby slightly over the table. The child should raise on their knee (first one and then the other), straighten their back, then stand on their foot. Face them towards you, give them a smile and a praise.

8. Belly massage: stroking, rubbing stimulating moves.

9. Lying on the back. Let the baby grab your thumbs, stretch their hands towards you. Gently pull the child into the sitting position while saying “sit”. Pay attention: if a child throws their head back, they are not ready for this exercise yet.

10. Breast massage: stroking and pressing the breastbone.

Baby exercises for preterm baby (6 – 9 months old).

Repeat every exercise 4-6 times. Start the set with crossing the baby’s arms.

Passive reflex exercises.

1. “Box” with rings. Let the baby hold on to the rings or toys (with rounded handles).

2. Turn the child from the back to the belly, to the right and to the left in succession. To do that, hold the bottom third of the baby’s calf with your right hand while showing them a toy with your left hand. As soon as the baby concentrates on the toy, put it on the left or on the right side within the reaching distance of the child. Then, turning the baby’s attention to the toy, ask them to get it by saying “get the toy” or “take it”.

Active reflex exercises.

1. Child should perform back-to-belly turns without assistance or with as little help from a grown-up as possible. Moves should be done in sequence: to the right side, to the belly and then to the left. The grown-up encourages the bay with the words “get the toy” or “turn to the belly”.

2. Crawling after a toy with assistance from a grown-up. Initial position – lying on the belly. Half-bent legs of the child lean against the palm of the grown-up to push out towards a toy that lies in front. Encourage the baby by saying “get the toy” and bend their legs to stimulate the crawling skills.

3. Crawling after a toy without assistance. Initial position – the child lies on the belly. Half-bent legs of the child lean against the palm of the grown-up. Ask the baby to get the toy placed in front of them at 50-60cm distance.

4. Lifting straight legs up with the help of the grown-up. Starting position: lying on the back. Hold the baby’s calves closer to their knees and straighten their legs. Return to the initial position.

5. Doing squats with support. The child may hold on to the rings placed before them with straight hands. The grown-up may hold the child by one hand, or they perform the squats without support.

6. Standing on the feet with support. Starting position – the baby lies on their back. The grown-up presses the child’s feet against the belly and holds them by the arm pits with both hands. Then you need to help the baby sit, and put them standing on their feet. To end the exercise, put the child on their back again.

7. The baby lies on the belly. Let them grab your thumbs, hold their hands with your other fingers. Spread the baby’s hands gently to the sides until they are straight. Then lift their strait hands to the ears. The child should bend their head back and raise it.

8. Child stands on a table facing the grown-up. Repeat the stimulation of “stepping” moves 1-3 times. Support them by the arm pits if the baby’s aged 7 months; hold them by both hands or use the rings at the age of 8-9 months.

9. Child lies on the belly. Place the baby on the table, so that their chest and hands reach beyond the table. The grown-up supports the baby by the hip bone and legs. In this position, the child needs to raise their head over the table stretching their spine in an upward arch. The baby’s arms straighten and reach forward. Encourage the movement with a word or a toy, or help them with an acupressure back massage.

Exercises for preterm babies aged 9 -12 months

Active exercises.

1. In the sitting position, let the baby grab your thumbs, rings or toys. Start with rotating the baby’s arms around the shoulders. Then gently spread their arms out, bring them up to the head, forward and down.

2. While the baby holds on to the rings, make “boxing” moves in the sitting, standing and lying positions.

3. While the child is sitting, hold a toy over their head within their arm’s reach so they can grab it.

4. The child stands. The grown-up supports them by the waist with both hands. Bend the child’s body forward then straighten them up saying “get the toy”.

5. Rolling from back to belly without assistance when asked by the grown-up. 

6. Crawling on hands and knees.

7. Baby lies on the back lifting straight legs without assistance. When asked, grabs the ball from the hands of the grown-up using feet.

Premature birth is not a verdict. As you can see, every effort brings results. If the family strives to strengthen and develop their preterm baby, it is a great contribution to their health and wellbeing in the future.

Boston Infant Trainer can help your preterm child grow up healthy, strong and intelligent. Boston Infant Trainer knows how to help your children in their development. Contact us for 50% off your introductory session in Boston, Massachusetts area.