Here are some frequently asked questions and useful information on babies born small.
The baby’s medical care is covered by the Medical Subsidy for Children program. The maximum age of the child may vary depending on the municipality, but this is applicable from the day the child is born in any area, so it is okay to expect that no medical expenses will be incurred even if the baby is hospitalized and/or receive medical care immediately after birth. However, parents are responsible for the costs of disposable diapers, artificial milk, swaddle blanket (clothes), and other items that will also be used at home. In addition, if your baby are transferred to another hospital using an ambulance or private ambulance of a certain hospital, you may be charged a transportation fee for the vehicle determined by each medical institution or private company. In addition, an actual cost set by each hospital is required for the test to detect a hearing impairment called Automatic Auditory Brainstem Response (AABR, screening test for congenital hearing loss) at an early stage.
For underweight babies weighing 2,000 g or less, babies judged to be physically premature, and babies who require surgery, there are public services such as "Financial and medical support for premature babies" and "Financial and medical services for self-reliance (for persons under 18 years with disabilities)". If your child is admitted to the NICU/GCU, check with your doctor to make sure your child is eligible.
Starting in 2017, the "Child-rearing Generation Comprehensive Support Center", is being established as an institution to provide support to all children and their families. The purpose of this institution is to provide continuous support throughout pregnancy to child-rearing, and public health nurses will be assigned to provide consultation for pregnant women. It is stipulated that this institution will formulate supporting measures, provide necessary information, and coordinate with relevant organizations, in order to provide comprehensive support including "Maternal and child health service" such as health checks and "Child-rearing support service" such as local child-rearing support institutions. This institution is scheduled to be established in all municipalities by the end of 2020. For more information please visit the municipal office in your area of residence.
Commonly, a baby will be able to hold his/her head up at about 3 to 4 months after the expected date of birth. For children under the age of 3, development of their motor function will be evaluated according to their corrected age. Being able to hold their head up, is a development in motor function so it is adequate to evaluate based on their expected date of birth. However, for very low birth weight infants born under 1,000 g, it may take about 6 months for them to be able to hold their heads up, so the doctor will evaluate in combination with other general conditions.
In Japan, it is appropriate to start introducing solid food for full-term infants (babies born between 37 weeks 0 days and 41 weeks 6 days) around 5 to 6 months after birth, and even for babies born early, the corrected age of 5 to 6 months will be a good time to start introducing solid food. Sometimes, the baby will let you know when to start the introduction of solid food. That is when the baby reacts by staring at what the adults are eating, muffles their mouth, or drools. These are signs showing that their body is ready to take in solid food. Also, if the baby stops to push out the spoon put into their mouth using their tongue, it may be time to start introducing solid food as well.
However, the smaller the baby’s birth weight, the slower the development of feeding behavior tends to be, and even when looking at their corrected age, they may start 1 to 2 months late.
It is necessary to consider in order, the development of the baby’s motor functions from before he/she can sit down. For example, babies that cannot hold their head up or does not have a firm waist cannot suddenly sit down, so the examination will be made by evaluating the level of development in their motor function that has already been acquired. Generally, babies will be able to roll over 1 to 2 months after they hold their head up (5 months in corrected age). Also, 2 to 3 months after they hold their head up, they will be able to sit down by supporting themselves with their hands (7 months in corrected age). Then, 2 to 3 months after they sit by supporting themselves with their hands, they will be able to sit on their own with both of their hands free (9 months in corrected age).
As explained above, development of their motor function will be acquired through appropriate sensory stimuli. It is very important not to leave the baby alone and repeat playing with him/her so the baby can move their body to stimulate their senses.
Your baby is not eating any solid food... That must make you very worried.
For babies born small, development in their feeding ability will also differ from the average. Especially for very low birth weight infants born under 1,500 g, it is necessary to consider comprehensively, their motor function, developmental status, and development of their feeding ability. It is said that the smaller the birth weight of the baby, the slower the development of feeding ability will be. Especially the timing for beginning solid food and shifting to 2 meals a day for very low birth weight infants born under 1,000 g will be 1 to 2 months later, even by corrected age. Therefore, it is important to confirm the developmental stage of each baby and proceed individually and closely.
Eating solid food is the first step towards adult food. It would be nice to give your baby an opportunity to experience eating as an enrichment of life, rather than experiencing it as having to eat when they’re not ready or against their will.
Babies born under 1,500 g (extremely/very low birth weight babies) are smaller and thinner than full-term-born babies of the same age (babies born between 37 weeks 0 days to 41 weeks 6 days), and they tend to be shorter as well. However, by the time these children reach the age of 2 to 3, their growth will improve and will catch up with the other children.
On the other hand, there are those who cannot catch up and if you do not help them in any way, they may end up short in stature. If the child over the age of 3 and still has a short stature, the child may require examination or treatment for short stature, so please consult with your doctor.
The level of language development can be considered around the age of 1 to 3. However, language development is very different in each child and there are children who can speak well at the age of 1 and a half, to children who did not speak at all until they were 3 years old but suddenly starts to talk when they turn 3. It is also important to consider that hearing loss may be hidden if the baby is not reacting to voices and sounds that the adults are making.
If the baby is not using any meaningful words (such as "doggy", "car", or "mama") when they are 1 and a half to 2 years old, or if they turn 3 and is not speaking any short phrases with more than 2 words (such as "I like doggy" or "mommy hold me") the doctor will examine them very carefully. When a doctor suspects delay of speech in a child, the doctor examines the following problems: (1) cannot vocalize, (2) cannot understand the meaning, or (3) cannot communicate. Therefore, please describe to your doctor, about the specific conversations at home.
Children's motor skills evolve as a result of having interest to the surrounding environment and exploring or questioning them. Playground equipment at places like parks are very colorful because they are designed to attract the interest of children and make them enjoyable, so they can comfortably exercise their whole body without thought. Indoor activities like "riding on the back like a horse" or outdoor activities like "riding on the shoulders"are effective for strengthening the child’s body core and balance. Children are able to gradually improve their muscle strength and endurance by repeating daily activities using their entire body.
However, if the child is leaning when walking, have noticeable dragging movements, or are prone to tripping or falling on flat grounds, consult your doctor as soon as possible.
Basically, it is good to adjust to "a temperature at which adults do not feel cold or hot, or a temperature at which adults feel comfortable in". Most of the time adults are standing or sitting, but babies often sleep and spend time lying down so they will be closer to the temperature of the floor. You may remember learning from the laws of physics that "warm air goes up," and floors tend to get cooler than what we adults feel. Therefore, if your baby spends most of his/her time close to the floor (if you do not use a crib, etc.), you need to be careful to check if it is not too cold. If it feels a little chilly, try dressing the baby with a slightly thicker underwear. If it is too hot, you need to consider dressing the baby with light clothing, lowering the room temperature to a level that adults feel comfortable in, and keeping the baby well hydrated.
Basically, it's best to consult with your pediatrician. Have the doctor decide if you should go to the hospital or not. However, if the attending doctor gave you instructions when your baby was discharged from the NICU/GCU, please follow those instructions.
If your previous child was hospitalized in the NICU due to premature birth or low birth weight, some people may worry the same will happen to your next child. Depending on the cause of the baby being born small and premature (for example, if the mother had to give birth early due to hypertensive disorders of pregnancy), the next child may be born prematurely or underweight for the same reason.
For those who are thinking of becoming pregnant or will be visiting the obstetrics and gynecology unit in the early stages of pregnancy, doctors will also check the progress of the previous pregnancy, so please check with your doctor, the precautions of everyday life to prevent premature birth. Also, consult your obstetrician/gynecologist about the intervals you should have before your next childbirth.
An organization that supports "safety" for pregnancy, birth, and childcare of multiple babies by providing information on multiple births such as twins and triplets.
A home-visit nursing station specializing in infants. We will nurture a fun and warm life for your child and family together.
Parents and Community Network
A community for the parents of premature babies, children with sickness, children with disabilities and their support team. We support mothers and fathers all over Japan who "want to meet" and "want to know".
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