DEVELOPMENT IN PREMATURE CHILDREN
Nowadays, the number of premature births is constantly increasing. It is the leading cause of death in newborns and has multiple causes. Born premature is defined as a birth before the thirty-seventh week of pregnancy, they represent 7.7% of births. Its forms, causes and consequences are manifold, especially in the future development of the child. Prematurity refers to births occurring during the 37th week of pregnancy. Several causes are the result of a preterm delivery, such as drug or alcohol use or problems with the baby. We can look at the development of these premature infants, described in five developmental spheres: attachment, language, social relations, cognitive skills and motor skills.
The concept of attachment is important for the good development of the child. According to Bowlby (1969), attachment is a regulator of needs for dependence and exploration (autonomy). The child will conduct search and proximity behaviors in stressful situations, but also exploration behaviors once he is comforted. It is this balance between these two acts that will allow the child to acquire a relationship of attachment with his figure of attachment, which gives him all the necessary needs (“caregiver”). Still according to Bowlby (1969), the quality of attachment predicts social and cognitive development, so it ensures development in other behavioral spheres. Attachment relationships may change according to the circumstances of the child’s life, and finally, several attachment figures influence children’s adaptation. Moreover, for an attachment to be created, the parent must develop a certain sensitivity to the needs and signals of the child (recognition, detection and appropriate response, rapid needs).
The links and learning that we develop with our external environment are essential to the child’s later development, interactions or interrelated links allow him to be included in social life (social relations) and the construction of his identity. This skill is therefore fundamental, but precarious for premature infants (Nadeau, L. et Tessier, R. (2003). Relations sociales entre enfants à l’âge scolaire : Effet de la prématurité et de la déficience motrice. Enfance, 55(1), 48-55).
In order to achieve these relationships, it is extremely important for the child to acquire language in order to understand and be understood by peers. Language development goes through different stages. First, the baby will adopt behaviors of crying, chirping and babbling, then the sign language, receptive and express is gradually established. Then, it comes in two phases, the first concerns the linguistic phase of the first words (holophrases, explosion of vocabulary) then the grammatical phase, which therefore refers to the first grammatical sentences (sentences of two words, explosion of grammar and complex sentences) (Bee, H.E. et Boyd, D. (2011). Les âges de la vie: psychologie du développement humain. (4e édition). Montréal: ERPI). Through the review of these articles, we will see that premature children present language difficulties, which will lead to potential deficits in interpersonal relationships.
From an early age, children develop cognitive structures through social and physical interactions with the world around them, as well as through the combination of the maturation of the nervous system and language. Cognition refers to all the mental functions (language, memory, learning …) that we improve as we grow. Among these functions, attention, which is the ability of the mind to focus on an object, is very important. Attentional processes intervene in the memory, they allow the economy of the concentration, a better treatment of the information and a unsaturation of the brain in this treatment (Bee, H.E. & Boyd, D. (2011). Les âges de la vie: psychologie du développement humain. (4e édition). Montréal: ERPI). Premature children also have attentive ineptitudes, we will see their causes and consequences on their development.
Full-term children have a safer attachment relationship than children born prematurely. Moreover, the more children come to the world prematurely, the more likely it is that mothers will have negative perceptions about them, because of adjustment difficulties and temperament characterized as being more difficult. At that time, there are more opportunities that an insecure attachment sets in their mother-child relationship (Laganière, J., Tessier, R. & Nadeau, L. (2003). Attachement dans le cas de prématurité : Un lien médiatisé par les perceptions maternelles. Enfance, 55(2), 101-117). All this leads us to believe that an insecure attachment relationship with the caregiver (mother) leads to more difficulties in creating social links with the child’s peers (Laganière et al., 2003, Nadeau & Tessier, 2003). Since attachment is insecure between mothers and their children, they experience more complications in exploring their environment and reaching out to their peers in a safe way. Studies on language development confirm the hypothesis of Charollais et al. (2010): children born prematurely without intellectual disabilities reveal more weaknesses in oral language at age 6 compared to children who are not not born premature. From a cognition view, school-aged children born before term experience more difficulties in executive functioning than children born at term (Deforge, H., André, M., Hascoët, JM., Toniolo, AM., Demange, V. et Fresson, J. (2006). Développement cognitif et performances attentionnelles de l’ancien prématuré « normal » à l’âge scolaire. Archives de pédiatrie, 13(9), 1195–1201). In general, the data are grouped together through the results of the research, children with a level of prematurity seem to have more difficulties in the proposed tasks of evaluation of the attachment perceived by their parents, language, attentional abilities as well as more problems in social relations (Laganière et al., 2003, Deforge et al. 2006, Nadeau et Tessier 2003, Charollais et al., 2010).
Finally, compensatory strategies can be designed to help pre-school and school-aged pre-schoolers cope with difficulties and respond to everyday situations, whether in their attention to their environment acquisition of language, the attachment relationship and perceptions of the attachment figure of this relationship, on the problems encountered in contexts where motor skills are needed. In the field of attachment, it is strongly suggested to intervene specifically with mother-child dyads in an attempt to change the attachment relationship of the premature child. This would allow the child to develop a safer attachment to the mother. Educational strategies that target the pro-social behaviors of parents taught to their children as well as conformism could help premature children in their social relationships. As for the language, an early and specific education must be adapted to each child concerning the spoken language. Moreover, speech stimulation interventions (in class and at home) are necessary for children who are not born at term and who have language difficulties. To help pre-school children cope with the hardships they face, compensatory strategies that combine parents, children and teachers would be necessary to design, not to mention the implications for practice. It is strongly recommended that all these socialization agents be involved in the process and this, from daycare or kindergarten.
Keywords: Premature; language; attachment; social relationship; cognitive skills