4 Ways Premature Baby Development Can Look Different

• Premature baby development can look different because preemies need to regulate key systems like breathing and heart rate before they can catch up on growth outside the womb.

• Understanding your preemie’s cues, muscle tone, and positioning helps you support their growth and comfort during early development.

• Tracking preemie milestones using corrected age and engaging in early, expert-recommended activities can help promote healthy, steady growth between healthcare visits.

Was your baby born before 37 weeks of pregnancy? This is considered preterm birth, and 1 in 10 babies are born this way worldwide. Babies born early, or “preemies”, haven’t had as much time to grow and develop in the womb. Because of this, their early development can look a little different from full-term babies.

Below, we’ll walk through four common ways preemie development may differ, and how you can support your baby along the way.

Note: Every premature baby is unique. Factors like how early Baby was born and any medical complications can affect their development journey differently. Your healthcare team is the best resource for understanding your baby’s individual needs.

1. They Communicate Differently as Newborns

Babies find ways to communicate as soon as they come into the world! Crying is a major way they do this—it helps them express when they are hungry, tired, uncomfortable, and more.

Preemies are often born with immature respiratory systems, which means they have less lung capacity and energy for crying. They may cry softly or not at all.¹ This can make it harder to understand their needs.

But preemies have plenty of other ways to “talk”! They use small body movements and facial expressions to show when they’re engaged, need a break, or are ready to stop interacting. We categorize these cues into Go, Slow, and Stop cues.

Here’s what they look like:

• Go cues (happy and engaged): Wide eyes, smooth movements, and hunger cues like hands to mouth, and sticking out tongue

• Slow cues (disengaged and need a break): Struggling arm movements, yawning, frowning, hiccups, sneezing

• Stop cues (disengaged and need to stop): Whining, fussing, placing a hand out to stop

Full-term infants will show these cues too, but preemies often use more hand movements to get their message across.

Watch this video to learn more about these cues and see them in action!

2. Premature Babies May Have Lower Muscle Tone

Many premature babies are born with low muscle tone, or hypotonia. This means their muscles are softer and don’t resist like they’re meant to—kind of like old elastic that doesn’t snap back when stretched.

Hypotonia in preemies happens because the parts of the brain that control movement are still developing.² Babies with hypotonia might feel a little “floppy” and have less control over their movements. This can make some early skills, like lifting their head or coordinating sucking and swallowing, a bit more challenging.

With time, practice, and support from therapies like physical, occupational, feeding, or speech therapy, babies with low tone can make wonderful progress.³

3. Preemie Positioning Looks More “Stretched”

Full-term babies often spend their final weeks in a curled-up position—knees tucked in and arms bent—because space in the womb gets tight! This “flexed” positioning helps them bend their body to develop different motor skills once they’re born.

Preemies, however, may not grow big enough to curl up like this before birth, so they’re usually born in a more extended, or stretched-out, position. They might lie with arms straight out and legs in a “froggy” position. Lower muscle tone can contribute to this extended posture.⁴

Both flexion (curling) and extension (stretching) are important for development. Your preemie may just need a little extra help learning to bend and bring their limbs toward their body. Activities like swaddling, side lying, bringing arms and legs to midline, and Tummy Time can all help.

4. Their Development May Happen at a Slower Pace

In the womb, Baby’s brain grows a lot faster than everything else. That’s why their head looks almost alien-like in ultrasounds! During the final weeks of pregnancy, the rest of the body begins catching up and preparing for life after birth.⁵

For babies who are born early, that growth continues—but now outside of the womb.⁶ This means their bodies may still need to learn how to regulate basic systems like breathing, heart rate, and body temperature. This, in addition to hypotonia and any medical complications they experience, can slow down their development.

Once those basic systems are more regulated and Baby’s medical concerns are addressed, they can devote more energy to skill-building and growing stronger. Over time, they begin to follow the same developmental pattern as full-term babies. This is why it’s important to track your preemie’s progress using their “corrected age” (also called "adjusting for prematurity")—so you’re comparing milestones based on when they should have been born, not their actual birth date.

What can you do to support your preemie’s development?

Remember: every preemie’s journey is different. Some may catch up quickly, while others take a little longer. Both are completely ok. The key is giving Baby time, support, and love. Early Intervention and ongoing therapies can make a big difference in helping get their development on track.

You can also use the Pathways.org Baby Milestones App to track development based on corrected age. Between appointments, try expert-recommended activities designed for preemies, like Massage+ 30, 10, 5. This is a simple massage routine backed by 40+ years of research that supports growth and bonding in both preemie and full-term babies.

Watch how Massage+ 30, 10, 5 works below, and explore more preemie resources here.

Sources

1. healthychildren.org. Caring for a Premature Baby: What Parents Need to Know. Published October 31, 2019. Accessed October 8, 2025. https://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Caring-For-A-Premature-Baby.aspx

2. Cleveland Clinic. Hypotonia in Babies. Published December 29, 2021. Accessed October 8, 2025. https://my.clevelandclinic.org/health/diseases/22223-hypotonia-in-babies

3. Heller A, Agarwal S. Hypotonia. Disorder Directory. Published June 2022. Accessed October 8, 2025. https://www.childneurologyfoundation.org/disorder/hypotonia/

4. Ahmed M, Iqbal M, Hussain N. A structured approach to the assessment of a floppy neonate. Journal of Pediatric Neurosciences. 2016;11(1):2. doi:https://doi.org/10.4103/1817-1745.181250

5. Vizzari G, Morniroli D, Tiraferri V, et al. Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth. Pediatric Research. 2022;94(1):365-370. doi:https://doi.org/10.1038/s41390-022-02402-3

6. Mamelle N, Lazar P. Etude allométrique de la croissance relative de la tête et du corps chez le foetus et le nouveau-né [An allometric study of the relative growth of the head and the body of the fetus and of the new born (author’s transl)]. J Gynecol Obstet Biol Reprod (Paris). 1979;8(8):703-709.