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Risks in Adopting a Pre-Term or Low Birth Weight Baby

By Patricia Irwin Johnston, author of Adopting: Sound Choices, Strong Families

Overview of the potential developmental outcome when considering the adoption of a pre-term or low birth weight LBW baby.

Parenting is fraught with risks, no matter how children join their families. Among the few extra risks adoption may carry are those that arise for a child born earlier and/or smaller than average. Mothers whose circumstances aren't conducive to parenting their babies themselves and so plan adoption for their children are often at substantial risk for the circumstances that lead to low birth weight (LBW) babies. A birthmother may have been ill or poorly nourished herself due to monetary and social circumstances. Women under seventeen and those who do not receive early prenatal care are at increased risk for delivering pre-term. A birthmother may have been under extreme emotional pressure or have denied her pregnancy and attempted to control her changing body shape by dieting-starving both herself and her baby. Smoking, drinking and using drugs of any kind-over the counter, "recreational," or prescription medication-during pregnancy contributes to the births of both pre-term and low birth weight babies. Many of these factors may be a part of the lives of women whose children become available for adoption.

In North America, babies who weigh less than 2.5 kg (5 lbs 8 oz) at birth-whether born at term (37-42 weeks gestation) or pre-term-are said to be of low birth weight. The reason for the low birth weight-that is, whether the baby was born too early (pre-term) or arrived at term but was considered small for his gestational age (SGA)-can signal different problems with different long-term outcomes.

On the other hand, what is considered average birth weight in North America and Western Europe is not necessarily average in South America, Asia, India, the Philippines, and other countries. It is important, then, for pre-adoptive parents and the pediatrician they have chosen to care for their coming child to be familiar with the size and weight norms of the ethnic group and/or country of origin of the child they are preparing to adopt when evaluating any information given to them about the child's prenatal history, birth history, and early weeks or months of life.

The most reassuring thing you can know about LBW is that, while it requires special attention and care, most children who are born otherwise healthy and without the complications of some of the more serious factors contributing to LBW (such as a pregnancy awash in alcohol or drugs, or severe maternal malnutrition) overcome their low birth weight and "catch up" with their peers. On the other hand, parents should be aware that LBW babies seem to be at slightly higher risk for developing learning disabilities, hyperactivity and attention deficit disorder, and sleep disturbances. Because of the wide variation in outcomes, there are no guarantees that an LBW baby-even one who receives the best interventional medical care and loving nurturing from permanent parents right from the moment of birth-will grow to be healthy and "normal." Furthermore, when adopting, one cannot be assured that an accurate birth and prenatal history can be obtained.

Pre-term (you may be more familiar with the older term premature) babies have not had a full in-utero gestational period, and so tend to be susceptible to problems having to do with being ready to live outside the womb. They have a limited ability to keep themselves warm, and may have poorly developed sucking reflexes and underdeveloped bowels. The immaturity of their lungs may cause breathing problems, making them more susceptible to apnea. They are often anemic, due to the fact that most of the iron storage a baby needs to make healthy red blood cells is transferred from his birthmother during the last three months of pregnancy. Babies who are severely pre-term (usually weighing less than 3 lb 8 oz or 1.5 kg) are significantly more likely to have seriously disabling conditions such as cerebral palsy, blindness or deafness. Among U.S.-born babies, two-thirds of LBW babies are pre-term.

Many of the factors that lead to pre-term birth can also lead to the full-term births of babies who are small for gestational age. SGA babies are most often LBW not because they were born too soon, but because they and their birthmothers did not receive proper prenatal care. These babies usually have experienced some degree of intra-uterine growth retardation. SGA babies are often of average length, but are very thin, so that they too have problems with retaining heat and need to be kept warm. They need fortified formula and vitamins, and while they are less often in need of intensive care at birth than are premature babies, they are indeed in need of special care.

For many years studies of the outcome of babies born small did not try to distinguish the differences between pre-term and small-for-gestational-age babies, so that the older the infant care book to which you are referring for information, the less likely you are to see these described separately. Now, however, some studies have begun to separate pre-term and small-for-gestational-age babies into two distinct groups, and these newest studies indicate that long-term outcome in terms of learning abilities seem to be better for those children who are LBW because of prematurity (except for those who are severely pre-term) than for those who were small for gestational age and may have experienced intra-uterine growth retardation.

Parents of babies suspected of, or known to have been, LBW should attempt to acquire as full a health history as possible of their child and his birthparents, and should make their concerns clear to their pediatrician and seek her help. While LBW children are sometimes easily overstimulated, it is important to give LBW children plenty of nurturing stimulation, both physically (games and exercises) and intellectually (conversations and lots of being sung and read to). Of course this is what all children need, and one would assume that parents who have run the gantlet of adoption would be more than eager to engage in active parenting.

My oldest child was born pre-term and came home to us at ten days old weighing just 4 lbs, 8 oz. My husband and I were just as anxious about the health of our pre-term son as any parent can reasonably be expected to be. The good news is that, just as do most actively parented preemies, he turned out great and is now, in adulthood, normal both in size and in intelligence.

Pat Johnston is a well regarded publisher, prolific author, and adoption advocate. This article is excerpted from her book, Adopting: Sound Choices, Strong Families, a thoughtful guide to adopting and adoption. Excerpted from Chapter 15 "Adjustments in the First Year Together" (Perspectives Press, 2008).

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