Insights by Erin Karavedas, occupational therapist in the NICU at Rady Children’s Health, Orange County
Supporting your preemie from NICU to home
Bringing home a premature baby, or preemie, can come with a mix of emotions. Along with joy and relief, many parents have questions about what to expect and how to best support their baby’s growth and development.
While every preemie has a unique journey, understanding the challenges they may face and the resources available can help families feel more confident along the way. Whether your baby spent days, weeks or months in the Neonatal Intensive Care Unit (NICU), having the right information and support can make the transition from hospital to home a little easier.
Erin, an occupational therapist in the NICU, shares answers to common questions about premature babies and offers guidance on supporting your preemie’s health and development both in the hospital and at home.
What is considered a premature birth?
A baby is considered premature, or a “preemie,” when they are born before 37 weeks of pregnancy.
Since most pregnancies last about 40 weeks, preemies arrive earlier than expected and may need extra care and support during their first days, weeks or months of life. Every premature baby is different. Some are born just a few weeks early, while others arrive much sooner.
In general, babies born earlier may face a greater risk of health or developmental challenges. However, there is also plenty of reason for hope. Advances in NICU care, therapies and follow-up support have helped more premature babies than ever grow, learn and thrive.
“With the right care and a strong support system, many preemies go on to reach important milestones and lead healthy, active lives,” Erin says.
What are some of the reasons babies are born early?
Premature birth can happen for many different reasons, and sometimes there isn’t a clear explanation.
Researchers and healthcare providers have identified several factors that may be associated with preterm birth, including:
- Carrying multiples, such as twins or triplets
- Infections
- Pregnancy complications
- Concerns about the health of the mother or baby during pregnancy
In some situations, healthcare providers may recommend an early delivery because it is the safest option for the mother, baby or both.
It’s important for families to remember that every pregnancy is unique. Sometimes premature birth occurs despite a healthy pregnancy and regular prenatal care.
“The most important thing for families to know is that there are many resources, treatments and support services available to help premature babies grow and thrive,” Erin says.
What health and developmental challenges can premature babies face?
The challenges a preemie may experience can vary widely.
“From a developmental perspective, challenges can vary greatly,” Erin explains. “The earlier you are born and the more co-morbidities you have, the greater risk of developmental or cognitive delay as they grow.”
Because preemies spend part of their early development outside the womb, their experiences can be very different from those of full-term babies. Even in the NICU, where teams work hard to support development, premature babies are exposed to things they would not experience in the womb, including varying temperatures, bright lights, loud sounds and gravity.
According to Erin, these early experiences can affect how the brain and body learn to interact with the environment.
“This is why we focus heavily on neuroprotection for our small babies and developmental care throughout their stay here to optimize brain and body development,” she says.
Some premature babies may experience delays in gross motor or fine motor skills. As they grow older, some may also face challenges with:
- Staying focused or engaged in class
- Remembering information
- Becoming easily distracted
- Making friends or interacting with peers
- Participating comfortably in social settings
Erin notes that some preemies can also experience sensory challenges that make it harder to stay organized, calm and participate fully in daily activities.
Parents should pay close attention to developmental milestones and discuss any concerns with their pediatrician. If you are seeing these challenges, it is important to discuss them with your pediatrician and school so that your child can get the right resources to help in these areas.
Depending on a child’s needs, providers may recommend services such as occupational therapy, speech therapy or other supportive therapies.
How can parents support their preemie’s health and development at home?
According to Erin, supporting a preemie often starts before leaving the hospital.
“We often ask families to optimize their time in the hospital and even room in prior to discharge so that they are really comfortable with their baby’s care when they go home,” she says. “This allows the parents to be confident caretakers.”
The transition home can take time, and many families need an adjustment period as they settle into a new routine.
Once home, age-appropriate activities and stimulation can help support development and learning. At the same time, parents should be careful not to overwhelm their baby with too much stimulation all at once.
“The way our bodies learn to tolerate different experiences and environments is by experiencing them,” Erin explains. “We want to make sure that our babies have appropriate exposure to our home and the world outside, while taking care not to provide an overwhelming amount of stimulation.”
Many premature babies benefit from outpatient physical therapy or occupational therapy. These specialists, along with your pediatrician, can help guide families on developmentally appropriate activities and provide exercises to practice at home.
For babies who are not receiving therapy services, Erin encourages parents to follow their baby’s adjusted age and developmental milestones when choosing activities.
And remember: development doesn’t have to look complicated.
When babies are young, most of their time will be spent eating and sleeping, so don’t stress about fitting in too many activities. It might just be for a few minutes when they are awake before or after a feed.
Simple activities can go a long way, including:
- Talking to your baby
- Singing songs
- Reading aloud
- Practicing visual tracking using black-and-white cards or your face
- Tummy time, when appropriate
As they grow, they will have more awake time, which will allow for more play and activity. You can never go wrong with talking, singing, reading, practicing tracking with black-and-white cards or your face, and tummy time.”
What should parents know about feeding a premature baby?
Feeding is often one of the biggest milestones premature babies work toward before going home from the NICU.
“Feeding for premature babies, especially very early babies, can often take a long time to develop the skills to be able to eat enough nutrition by mouth to go home,” Erin says. “It is usually one of the last things that we are working on.”
Even after discharge, some babies may continue to need special feeding strategies, such as:
- A slower-flow bottle nipple
- Modified feeding positions
- Additional support from feeding specialists
If feeding challenges continue after discharge, families may be referred to outpatient feeding therapy for ongoing support.
The good news is that families are not expected to figure it all out on their own. If a baby has challenges eating at the time of discharge, outpatient feeding therapy can provide continued support at home.
What parents should remember
Every preemie’s journey is unique. While some premature babies may face health or developmental challenges, early support, close follow-up and a strong partnership with your child’s healthcare team can make a meaningful difference.
Most importantly, remember that you’re not alone. From NICU specialists and therapists to pediatricians and community resources, a network of support is available to help your child grow, learn and thrive.
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CHOC Hospital was named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2026-27 Best Children’s Hospitals rankings and ranked in the neonatology specialty.
