Born Too Soon: Understanding Prematurity, Brain Development, and the Nervous System

Why a child’s earliest experiences may matter long after leaving the NICU

This past week, I had three separate conversations with educators and mental health professionals about children born prematurely—some as early as 22 to 32 weeks of gestation.

Three conversations. Three different perspectives. One important connection.

What if some of the challenges we’re seeing in children today have roots in developmental experiences that began long before they entered a classroom?

As someone who has spent decades working in early childhood education, movement, and nervous system awareness, this is a conversation I believe we need to have more often.

Not to label children.

Not to define them by their birth history.

But to better understand the whole child.

When Development Begins Outside the Womb

A full-term pregnancy is approximately 39–40 weeks.

During the final trimester, a baby’s brain undergoes remarkable growth. Neural connections develop rapidly, sensory systems mature, and networks involved in movement, attention, learning, and regulation continue to organize.

Now imagine a baby born at 24, 26, or 30 weeks.

Instead of completing those developmental weeks in the womb, the baby continues developing in the outside world—often in a neonatal intensive care unit (NICU).

The NICU provides lifesaving medical care. But the environment is very different from the womb.

There may be medical procedures, unfamiliar sounds, bright lights, disrupted sleep, and periods of separation from caregivers.

Even with excellent medical care, these early experiences can influence development.

The nervous system is still developing. And the environment matters.

This does not mean premature babies are destined to experience developmental difficulties. Many grow into healthy, thriving children and adults.

But research shows that children born very or extremely prematurely have increased risks for certain developmental challenges.

And some of those challenges may not become apparent until years later.

What Happens When These Children Enter School?

Here’s where the conversation becomes especially important.

A child born prematurely may enter kindergarten appearing to be developing typically.

They may be bright, curious, verbal, and socially engaged.

But as educational expectations increase, challenges may begin to emerge.

Perhaps the child:

• Struggles to maintain attention or follow multiple directions.
• Becomes overwhelmed in noisy or busy environments.
• Has difficulty transitioning between activities.
• Appears clumsy or struggles with coordination.
• Experiences anxiety or becomes frustrated easily.
• Needs additional time to process information.
• Has difficulty organizing tasks or managing emotions.

Sound familiar?

These are challenges educators and parents describe every day.

And while premature birth is certainly not the explanation for every difficulty, it may be one important piece of the developmental picture.

Research has identified increased risks for differences in executive functioning, motor coordination, attention, learning, and emotional health among children born very prematurely.

Sometimes what looks like a behavior problem may actually involve a developmental skill that needs additional support.

The Nervous System Connection

This is where I want to bring another perspective into the conversation.

We often focus on what children are doing.

But how often do we consider what their nervous systems are experiencing?

The autonomic nervous system helps regulate breathing, heart rate, digestion, physiological arousal, and responses to stress.

For babies born extremely prematurely, these systems are still maturing.

Early medical experiences, sleep disruptions, illness, and caregiver interactions may influence how these physiological systems develop.

That doesn’t mean every child born prematurely has a dysregulated nervous system.

It means we should remain curious about how early development may contribute to a child’s current needs.

When a child struggles with attention, transitions, sensory input, or emotional regulation, we can begin asking different questions.

Instead of only asking:

“Why won’t this child listen?”

We might ask:

“Is this child overwhelmed?”

“Are we expecting a developmental skill that is still emerging?”

“Does this child need more time, movement, predictability, or connection?”

Biology before behavior.

Not as an excuse for behavior, but as an invitation to understand what may be contributing to it.

Sensory Processing: The Missing Piece?

Three sensory systems are especially important in my work through Move Into Calm™.

Proprioception helps us understand where our body is in space through information from our muscles and joints.

The vestibular system supports balance, movement, and spatial orientation.

Interoception helps us recognize internal signals such as hunger, fatigue, breathing, and physical discomfort.

These systems contribute to how children experience and navigate the world.

Some children born prematurely experience sensory processing or motor coordination differences.

A child may struggle to sit comfortably, coordinate movements, tolerate certain sensations, or recognize when they are becoming overwhelmed.

And sometimes those challenges are interpreted as behavioral concerns.

This is why movement, body awareness, and sensory-informed support deserve a place in conversations about development.

Not because movement fixes prematurity.

But because development is embodied.

Children learn, connect, and participate through their bodies—not just their thinking brains.

What About Emotional Regulation and Mental Health?

Research has also identified increased risks for anxiety, attention difficulties, and certain neurodevelopmental conditions among children born very prematurely.

For parents, this information may raise questions.

For professionals, it should encourage curiosity rather than assumptions.

A child’s emotional regulation develops through a complex interaction of biology, relationships, experiences, and environment.

This is also where relational health matters.

Early responsive caregiving, connection, predictable routines, and supportive relationships all contribute to healthy development.

And we cannot overlook the experiences of parents.

Having a baby in the NICU can be emotionally overwhelming. Some families experience significant anxiety, uncertainty, grief, or traumatic stress.

Supporting the caregiver is part of supporting the child.

Adults go first. Connection before correction.

These principles apply in homes, classrooms, and therapeutic settings.

What Can Parents and Educators Do?

First, understand that a child’s birth history may be relevant—even years later.

If a child was born extremely or very prematurely, that information can help guide developmental conversations and assessments.

Second, look beyond behavior.

Consider attention, sensory processing, motor coordination, sleep, communication, learning, and emotional well-being.

Third, support the child’s nervous system through developmentally appropriate experiences.

Movement breaks, predictable routines, opportunities for body awareness, supportive relationships, and sensory accommodations may help children participate more comfortably.

Simple activities such as wall pushes, balance games, rhythmic movement, and gentle breathing awareness can provide opportunities to explore movement and body sensations.

These activities should always be individualized. They are supportive strategies, not substitutes for developmental evaluation or specialized services.

And finally, recognize when additional support is needed.

Pediatricians, occupational therapists, physical therapists, psychologists, speech-language pathologists, and educational specialists can all play important roles.

The Conversation We Need to Have

What struck me most about these three conversations wasn’t simply the topic of prematurity.

It was how easily early developmental history can become disconnected from the challenges children experience years later.

We talk about attention.

We talk about behavior.

We talk about anxiety.

We talk about learning differences.

But are we consistently asking about the child’s developmental history?

Not every challenge can be traced back to premature birth.

And birth history should never limit our expectations for what a child can accomplish.

But it may offer valuable information that helps us provide more appropriate support.

Before we ask a child to regulate, focus, sit still, or manage emotions, we need to consider the developmental capacities and supports that make those expectations possible.

That is where neuroscience, early childhood education, mental health, and body-based learning begin to intersect.

And that is where Move Into Calm™ can help bridge the conversation.

Because regulation isn’t simply about managing behavior.

It’s about understanding the developing brain, body, nervous system, and relationships that support a child’s ability to thrive.

Every child has a developmental story. The more we understand it, the better we can support them.

A Final Thought

If you’re a parent of a child born prematurely, this information is not meant to create worry or suggest that something is wrong with your child.

It’s an invitation to better understand their unique developmental journey.

And if you’re an educator or mental health professional, perhaps it’s an invitation to ask one more question before making assumptions about behavior.

What might this child’s earliest developmental experiences help us understand about their needs today?

Let’s Continue the Conversation

Through Move Into Calm™, I work with parents, educators, and organizations to explore how movement, breath, sensory awareness, and nervous system-informed practices can support children and the adults who care for them.

If you’re seeing challenges with attention, sensory processing, emotional regulation, or classroom participation, let’s explore what may be happening beneath the behavior.

Schedule a free Calm Chat or learn more at www.moveintocalm.com.

Move Into Calm™ — Movement • Breath • Nervous System Awareness

Research and Further Reading

1. American Academy of Pediatrics (2023). Primary Care Framework to Monitor Preterm Infants for Neurodevelopmental Outcomes in Early Childhood. Pediatrics.
2. NICE (2017). Developmental Follow-up of Children and Young People Born Preterm (NG72).
3. van Houdt et al. (2019). Executive Function Deficits in Children Born Preterm or at Low Birthweight: A Meta-analysis. JAMA Pediatrics.
4. Brydges et al. (2018). Cognitive Outcomes in Children and Adolescents Born Very Preterm: A Meta-analysis. Developmental Medicine & Child Neurology.
5. Anxiety and Depressive Disorders in Children Born Preterm: A Meta-analysis (2021).

This article provides general educational information and is not a substitute for individualized medical or developmental assessment.