5. How can preschool professionals support preterm-born children before they start school?
This page suggests ways in which professionals can support children in their preschool setting.
Supporting a child’s early development is a journey which starts before they begin attending a preschool setting and extends through to the transition to school. As preschool professionals, you have an important role to play in this journey.
There are four sections, each of which relates to a different stage in the preschool journey. Each section contains key messages about what you can do to support children in that stage.
Click on each section to find out more about how you can support preterm born children in your setting.
Understand the experience of preterm birth and its impacts on the child and the family
Be aware that children may have developmental difficulties as a result of their preterm birth, especially if they were born very or extremely preterm (before 32 weeks of gestation). These difficulties often start to become apparent in the years before they start school and often include problems with attention and concentration, thinking and problem solving, moving about and handling objects, and communicating and interacting with peers. It is important to remember that most preterm babies will not have difficulties later in life, especially those born just a few weeks early, but for those that do, it is important to be aware of these so any difficulties can be identified early.
Be aware that the experiences and effects of preterm birth do not end at discharge from hospital. Parents of preterm babies may have been through a very stressful time and this may have a lasting impact on their mental health and wellbeing. If they are comfortable to do so, parents may want to talk about their experiences. It is important to try to understand the family’s journey, to interact with sensitivity, and to demonstrate that you understand the impact preterm birth can have on children and families.
Undertake training
Provide training for all staff about preterm birth and the impact it can have on children’s development so they are better able to understand families’ experiences and support those children who may need it. You can use this e-learning resource to provide free training for all staff.
Become a “Prem Aware” setting by attaining the “Prem Aware Award”. This is an award scheme run by The Smallest Things charity to recognise schools and preschool settings that are well prepared to support preterm born children and their families. It will help families feel reassured to know that a setting has the Prem Aware Award and that staff are trained and well prepared to support them and their child. If your setting already has the Prem Aware Award, make this visible on your website or in other information for parents. You can find out more about the award here.
Review and revise your existing processes
Consider including on your admission form, website, or information for parents, the contact details for someone in your setting who parents can contact to discuss issues relating to prematurity. It can make prospective parents feel reassured to know that there is someone at the setting who will understand their experiences and potential concerns. This might not be the child’s Key Person in the end, but should be someone at the setting who has received training about preterm birth and who can act as an informed first point of contact.
Be aware that children who were born preterm may be more susceptible to illnesses and infections than children who were born at full term, particularly respiratory illnesses, and that these may have more serious consequences than for other children. For this reason, parents of preterm born children may be particularly concerned about their child’s health. Consider how you share and enforce your illness policy and how you might communicate the need for vigilance and co-operation from all parents, just as you would for sensitivities regarding a nut allergy, for example.
Establish good communication practices from the start
Get to know the child and family before admission. Ask about the child’s birth history, including their gestational age at birth, the family’s experiences of preterm birth, and any concerns they may have about their child’s health or development before they enter your setting. Include a question asking about the child’s birth history on your admission form.
Consider practices which cultivate a close relationship with the family and child from the start. For example, you might wish to offer a home visit/s for the child to spend time with their Key Person prior to a child joining the setting
3. Supporting children while they attend your preschool setting
Create a network around the child built on strong communication practices
Work in close partnership with the child’s family. Discuss with the family ways they can support their child’s development at home and encourage them to send updates and photographs of activities using your setting’s preferred communication tool or app.
The family may be in contact with other agencies or healthcare professionals, such as a paediatrician or therapists. Ask the parent to share the results of any assessments or any reports or letters with you so that your staff have the most up to date information about the child’s health and development. Consider inviting these professionals into the setting to work with the child or to give advice or training to staff. This may benefit other children in your setting as well.
Consider an integrated approach to assessment which collaborates with other agencies such as healthcare.
Establish good communication and information sharing with other preschool settings the child may attend.
Know who to refer the family to if they need support or express concerns about their child’s health or development.
Be aware of the importance of good, consistent relationships between the setting and the family. Establish robust information sharing practices within your setting which build and move the child’s story along with them. Ensure that anyone working with the child understands their needs and can give an informed, sensitive report as required, for example when telling parents how their child has been at the end of the day.
Become familiar with common experiences related to preterm birth
If a child experiences a lot of absence due to illness, consider ways to enable them to send and receive updates to maintain relationships with the child and family and to show they are being kept in mind.
Be aware of the concept of ‘corrected age’ in healthcare assessments. A child’s corrected age is the age they would be if they had been born at term, on their expected due date. For babies who are born very or extremely preterm, this might result in a difference of up to three months between their chronological (i.e. actual) age and their corrected age. In healthcare settings, very preterm born children’s development is often considered in relation to their corrected age rather than their chronological age to take account of their prematurity. Parents are often familiar with this term and may also consider their preterm child’s development in relation to their corrected age. It can therefore be helpful to consider where a child is in relation to their corrected age when assessing their development and communicating the results with parents.
Be aware that children may have had lots of assessments prior to joining the setting and parents may have concerns around how their child is doing, or may feel anxious about assessments in general. Consider how you carry out assessments and the language you use when communicating the results to parents. Small things can be big things to the child and their family; consider ways to celebrate the child’s achievements and successes.
The transition to school can be a particularly stressful time for parents, especially those whose children may have additional support needs. Share information with the child’s new school so that the school has the most up to date information about the child’s development and so that parents don’t have to retell their story, which can be difficult or upsetting for them.
Help them get to know the school
Consider offering accompanied visits to the child’s new school to support both the child and family in transition.
Delaying school entry
Parents of preterm born children might consider whether delaying their child’s entry to school is appropriate. At present, there is no firm evidence whether delaying school entry or going to school at the age-appropriate time is better for children who were born preterm. It might be best for children to enter school at the right time so that they can receive support from the earliest opportunity if they need it, rather than delaying entry to school. If parents request help in deciding whether to delay their child’s school entry, you can signpost them to resources available here on the website of Bliss, the UK charity that supports babies born preterm and their families.
