Developmental & Pulmonary Clinics
As the time for your baby’s discharge gets closer, you’re probably excited as well
as being a little nervous. You may have many questions or some concerns about your
● Will my baby be slow in his/her development?
● What should I look for?
● How can I help my baby?
● What activities or toys are best for him/her?
These are all normal concerns of parents who have a premature or sick infant.
Babies develop differently and many things influence their development—
genetics, development of the nervous system, home environment—just to name a few.
Babies and toddlers grow and learn new skills at an incredible rate. Therefore, it is
important that you have your baby’s development checked periodically during the first
two years by the baby’s primary care physician. Very low birth weight and sick babies
are at a greater risk for falling behind in their development.
Not all babies admitted to the NICU are seen by our Neonatal Follow-Up
Program—called Baby STEPS— only those babies with special needs who were less than
30 weeks’ gestation at birth, had a birthweight of less than 1500 grams, were on a
ventilator for at least five days, have a congenital defect, or who had an difficult
delivery. There are 2 different clinics within the Neonatal Follow-Up Program—the
Developmental Clinic and the Pulmonary Clinic. You will know before your baby is
discharged from the NICU if he/she will be coming to one of the clinics. Your baby may
be seen in one or both of the clinics at different times. Babies are seen, evaluated and
community referrals made, as needed, by a team composed of a Neonatologist, a
Psychologist, a Nurse, a Physical Therapist, an Occupational Therapist and a Speech
Baby STEPS 1
Therapist for feeding problems. Not all members of the team see all babies at every
visit; there currently is no cost for the Neonatal Follow-Up Program.
The Developmental Clinic
What is the Clinic? Does my baby need to go?
1. The premature infant's brain does not mature as fast after birth as it would have if
your baby had stayed in your uterus and not been born early. This may make your
baby a little later in doing some of the usual baby activities, or milestones, such as
rolling over, sitting and standing.
2. Since your baby was born early, we don’t use his or her calendar age alone when
evaluating your baby’s development. Instead, we look at your baby’s development
using two measurements:
a. Length of your pregnancy (gestational age)
b. Baby’s age in weeks (calendar age)
3. The Calendar Age + the Gestational Age is your baby’s “adjusted age.” If a baby is
born at 28 weeks’ gestation and is six weeks old today, we expect that baby to act
like a baby who was born today at 34 weeks. (28 + 6 =34 weeks).
4. We look at “Adjusted Age” for growth and development until your baby is 2 years
old. Most babies born at 28 weeks or greater usually catch up by 2 years of age;
babies born at less than 28 weeks usually catch up by 3 years of age.
5. Here are some of the milestones we look for. (Remember, these are adjusted ages!)
a. 1 month of age: Hands fisted; lies in the position you placed him/her in; lifts chin
briefly when on tummy; occasionally puts a hand to the mouth; rolls to side but
does not turn over.
b. 2 months of age: Lifts head when on tummy; strong movement of arms and legs
when lying on back; turns head from side to side.
c. 3 months of age: Follows objects from side to side; props self up on forearms
with knees bent; able to hold head up briefly when on tummy.
d. 4 months of age: Rolls over from front to back; reaches for a dangling toy; takes
a hold of objects placed in hand (using whole hand, not just the fingers); brings
hands together in the middle (midline); plays with fingers; begins to ‘coo.’
Baby STEPS 2
6. Your baby will be seen in The Developmental Clinic every 6 months until 24 months of
age. If we find your baby is late or delayed in meeting his/her milestones, we will
talk with you and your baby’s doctor. Treatment can be started if necessary, and may
include simple exercises you do at home with your baby or may be a more formal type
of therapy. Remember, each baby is different and does things at a different pace,
but there are activities that you as a parent can do with your baby to help them
reach their milestones. We have brochures explaining developmental activities you
can do with your baby and which toys are best. Please ask us for the brochure during
your baby’s visit to the clinic; there is no charge for these brochures.
The Pulmonary Clinic
1. The Pulmonary Clinic follows those babies who are discharged home on oxygen, apnea
monitors and/or medications to help their breathing. These babies are seen once a
month to evaluate their ongoing respiratory (breathing) needs. We change the
oxygen and/or medication according to how it is tolerated by the baby, and
discontinue the monitor only after we have discontinued the oxygen. A Neonatologist
and Respiratory Therapist will see your baby during this visit.
1. While your baby is in the NICU, the Clinic Coordinator will give you information about
2. You will receive a letter at your home address telling you to call and schedule an
appointment for your baby. Please call the phone number listed in the letter to
schedule the appointment time. If you do not call, you will not have an appointment.
3. It is important to continue seeing your baby’s doctor. Visits to the Developmental
and/or Pulmonary Clinic do not take the place of regular doctor visits.
Reviewed/Revised: 1/07, 1/10
Baby STEPS 3