BOX 8-2

Infant Health and Development Program

Premature babies with low birthweight are more likely than babies with normal birthweight to have a range of health and developmental problems, including lower IQ, cerebral palsy, less emotional maturity, less social competence, and attentional difficulties. Many low-birthweight, premature infants are also considered doubly vulnerable because they are also more likely to experience environmental risks such as living in poverty, having a single parent, or being the child of a teenage mother.

The Infant Health and Development Program was a large, randomized clinical trial to determine the efficacy of an intervention designed to promote the physical health, and cognitive and socioemotional development of low-birthweight, premature children. The program provided services for 985 children from birth through age 3 at 8 different sites throughout the United States. All of the children received pediatric surveillance and community referral services. The families of one-third of the children also received family support through home visits throughout the program. Beginning at age 1, the children from these families participated in full-day educational child care in eight child development centers, and their parents participated in regular group meetings. Data on the health, behavior, and cognitive development of all of the children were collected during the 3 years of the program, as well as at ages 5 and 8.

Infants participating in the intervention demonstrated improved behavioral functioning (e.g., higher IQ scores, vocabulary gains, and fewer behavioral problems) at the conclusion of the intervention, when they were 3 years old (Infant Health and Development Program, 1990). At age 5, only the heavier low-birthweight infants (i.e., 2,000-2,500 grams) continued to show gains that distinguished them from the children that did not receive the intervention (Brooks-Gunn et al., 1994). By age 8, even the gains of the heavier infants had been substantially diminished (McCarton et al., 1997). The authors have speculated about the outcomes that might have emerged if they had continued the program up to school entry.

SOURCES: Brooks-Gunn et al. (1994); Gross et al.(1997); McCartonet al. (1997).

The evaluation literature on these interventions offers good news about the capacity of early childhood programs, which emphasize individualized developmental care, as well as initiatives focused on parental coping and training in optimal parenting skills, to improve health outcomes and decrease developmental delays in premature infants. It thus appears that the developmental problems associated with prematurity and low birthweight can be mitigated by intervention. However, this is such a complex biological phenomenon that relatively nonspecific interventions may not be the

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