Prematurity and Child Mental Health Risks: Key Insights for Parents

Every parent dreams of having a healthy, full-term baby. But for over 10% of newborns, that hope turns into unanticipated concern with a premature birth — delivery before 37 weeks' gestation. Though medical advancements have substantially improved survival rates for preterm babies, the long-term implications on their mental health are increasingly worrying. Studies have shown that premature children are more prone to mental health issues than those born at full term.

What's covered:

The premature connection: the link between prematurity and mental health

Early challenges, long-term impact: how prematurity can affect mental well-being

Early intervention: setting premature children on a path to thriving

A nurturing journey: promoting mental health in premature children

The link between prematurity and mental health

A link between prematurity and children having mental health conditions has been consistently found by researchers. An increased risk of mental health issues was noted in a 2022 review that explored the mental health trajectory of children born 'very prematurely' (VPB), or earlier than 32 weeks' gestation. These children were more likely to develop mental health issues, including anxiety, depression, and attention deficit hyperactivity disorder (ADHD).

That risk was heightened if the child had complications around birth or had to spend a long time in the neonatal intensive care unit (NICU). Additionally, the study found that parents of VPB infants were also more likely to have anxiety and depression, which correlated with their child's outcome.

Why premature children are more susceptible

Multiple factors contribute to why preterm babies are at higher risk of developing mental health conditions, which can be divided into biological factors, environmental factors, and parental influences.

• Biological factors. These factors encompass everything, from disruptions in brain development and increased susceptibility to neurodevelopmental conditions like autism spectrum disorder (ASD) and ADHD to medical complications.
• Environmental factors. These include early life stressors, such as the time spent in the NICU, that could hinder parent-infant attachment and limit social interactions — both important for healthy early development. Additional risk factors include parental mental illness, or exposure to trauma.
• Parental influence. It comes from stress and anxiety that could indirectly impact a child's mental health through caregiver interaction. The researchers also noted that limited confidence in parenting could further complicate addressing the emotional needs of a preterm child.

The role of brain development

Brain development in regions associated with attention, emotional regulation, and social interaction is one of the most explored areas of focus among researchers. Studies found that premature infants have smaller brain volumes in these areas, and they may also experience a disruption in brain connectivity that may lead to an increased chance of developing mental health issues later on.

Early difficulties that premature children face

Babies born before 37 weeks of pregnancy often go through a range of emotional and social problems. These may stem from a variety of issues, including the baby's prematurity, the environment they were born in (if they were in the NICU), and even the emotional stress parents experienced.

Here are some of the common problems premature children may face:

• Sensory overload. Born with underdeveloped sensory processing systems, children are oversensitive to sights, sounds, smells, and touch. This may cause them to cry more frequently, become irritable, and have difficulty sleeping.
  
• Emotion regulation. Difficulty in regulating emotions can manifest as tantrums, outbursts of anger, or withdrawal. This is due to the immature development of the brain, as well as the potential early exposure to life stressors, impacting the ability to develop coping mechanisms.
• Social interactions. Due to limited early experience in face-to-face communication (usually, as a result of having spent time in NICU), their reduced ability to read facial expressions, and lack of joint attention skills, premature children may become shy when it comes to interacting with others.
• Low self-concept. Those who were born prematurely may develop low self-esteem due to reasons ranging from separation from parents in the NICU and medical procedures. This affects confidence levels and social interaction.

Do mental health problems persist into adulthood?

Premature children are at risk of developing mental health issues that can persist even into adulthood, leaving a wide range of challenges that could affect their quality of life.

Attention deficit hyperactivity disorder

Very preterm children are two to three times more likely to get ADHD than full-term babies. Symptoms of ADHD can include inattention, impulsivity, and hyperactivity, among others. People who have this condition may have difficulties in everyday life functions, from work performance to relationships.

Anxiety disorders

Compared to full-term babies, those born early are twice as likely to develop an anxiety disorder. These disorders encompass various forms, such as separation anxiety disorder or social anxiety disorder, characterized by heightened worry, fear, and avoidance behaviors that lead to substantial distress and impairment.

Depression

Children who were born prematurely have an increased risk of developing depression later in life. Depression is characterized by consistent sadness, loss of interest in things that used to be enjoyable, and changes in eating or sleeping habits. People with depression often find that it's hard to enjoy life or feel motivated.

Schizophrenia

While the percentage is lower compared to other conditions mentioned here, premature children still have a higher chance of getting schizophrenia than non-premature kids. Schizophrenia is a severe mental illness that can cause hallucinations, delusions, and disorganized thoughts and behaviors.

The importance of early intervention

Early intervention plays a crucial role in preventing the development of more severe mental health problems later in life. By addressing mental health issues early on, we can help children acquire the necessary skills and coping mechanisms so they can better handle their emotions and behavior.

Some common early warning signs include:

• Emotion regulation difficulties, including frequent tantrums, annoyance, or isolation.
• Finding it hard to create friendships, socialize, or adhere to rules and routines.
• Schoolwork challenges, late speech development, and difficulties with fine motor skills.
• Sleep cycle disruptions or irregular meal habits.
• Extreme anxiety, uneasiness about ordinary situations in life.
• Irritability or lack of interest in activities that used to be interesting.

It's important to note that routine visits to the pediatrician can assist in identifying potential concerns in the early stages. Comprehensive developmental and psychometric assessments offer additional insights into the overall progress of a premature child, including their mental well-being.

Strategies for parenting a premature child

Parents play a vital role in fostering their child's mental health, regardless of whether they were born prematurely or not.

Nonetheless, there are some strategies to consider when it comes to premature children:

• Establish a nurturing and supportive environment. Create a place that is safe, loving, and secure in which your child feels protected.
• Consistency is key. With set routines, lots of skin-to-skin contact, and positive interactions.
• Encourage social interactions and play. Direct your child’s activities toward other children where they can participate in age-appropriate activities.
• Teach healthy coping mechanisms. Advise your child on regulating emotions and destressing through practices like deep breathing, relaxation skills, and open discussions about their feelings.
• Maintain open communication. Assist your child in sharing their inner thoughts, feelings, and experiences. Listen without judgment and offer support and encouragement.
• Seek professional help if needed. If you believe that your child is experiencing mental health difficulties, do not hesitate to consult a professional, either a pediatrician or a developmental specialist.

Despite medical advancements and improved survival rates, childhood mental health development is still challenged by being born prematurely. Placing emphasis on the interplay of biological, environmental, and parental factors is crucial when recognizing the importance of early identification, intervention, and support. We need a comprehensive approach to the mental health side that covers regular screenings, psychosocial interventions, family-centered care, and community resources.