“I can’t believe they’re 4 months old already! We try to take newborn pictures when they’re around 10 days old, so they’re really too old at this point. Let’s shoot for doing 6-month pictures.”
So went a text conversation with a photographer when I inquired about doing newborn pictures with the Tagalongs.
I started to respond that, while the Tagalongs were 12 weeks old chronologically, they were only a few days old in terms of size (between 7 and 8 lbs) and development. In fact, their doctors considered them newborns—hence the inquiry about newborn pictures. But Caleb had been particularly c-o-l-i-c-k-y that week (if we spelled it, it didn’t happen), and I didn’t have the energy to explain, so I just sighed with disappointment and responded “OK.”
A few days later, a friend asked if the Tagalongs were starting to smile, while another friend inquired whether the Tagalongs were starting to babble. “No,” I responded to each. I knew that both were 4-month-old milestones, but I still felt the tendrils of frustration creep in.
We parents of multiples are told to ignore that feeling when it comes to the development of our babies. Because so many of our babies are born prematurely, we get to experience developmental delays with them. That’s why we speak in terms of actual versus adjusted age when talking about our babies’ development. While other people’s 2-monthers are doing X, Y, and Z, our 2-month preemies won’t be seeing X, Y, and Z for another 2 months—or more. The neonatologists and nurses, NICU case managers, early intervention therapists, and pediatricians tell you time and time again not to compare your preemies to “regular” babies. But it’s really dang hard not to—especially when it’s staring you in the face on social media.
What is actual age?
Actual age is how old your babies are chronologically. In our newborn picture scenario, it had been 12 weeks since I’d delivered the Tagalongs , so they were 12 weeks old.
What is adjusted age?
Adjusted age, also known as corrected age, is how old your babies are based on their due date. It is determined by subtracting your babies’ prematurity from their actual age.
Consider the Tagalongs. They were born at 28 weeks, so they were 12 weeks premature. Applying the equation above to our newborn picture scenario, their adjusted age was 0 months, making them effectively newborns.
Which age should I use?
Both, with a heavy lean toward adjusted age.
Adjusted age effectively corrects for your babies’ prematurity. Because your babies were born early, their brains and neurological systems haven’t developed to what they would if your babies had been born at term. Simply put, they need time to “catch up.” Most medical professionals will use adjusted age when assessing your babies’ development because it gives them a more accurate picture of where your babies are at.
But keep in mind that babies develop at different rates for different skills. We commonly found that the Tagalongs were closer to adjusted age when it came to their motor skills but actual age when it came to their sleep skills. So, while the Tagalongs had yet to crawl at 9 months, we were deep in the throes of the 9-month sleep regression hell. Frustrating all around.
While doing the math can be difficult (especially for an English weenie like me), it really is best if you can think in both actual and adjusted age when discussing your babies’ development. When posing questions to my social media groups, I usually included both the actual and adjusted ages in my post with the following formula: actual age (in months)/adjust age (in months). I found that doing so helped me receive responses that more accurately addressed what was going on.
How long do I have to use adjusted age?
Most medical professionals will use adjusted age until around the actual age of 2. By then, most premature babies are believed to have caught up to term babies developmentally. Remember that babies develop uniquely, so your babies may catch up more quickly or more slowly.
Or one baby could catch up sooner or slower than the other two. The Tagalongs have been followed closely by a developmental pediatrician since they were released from NICU. Every 6 months or so, we trek 100 miles for a 2-hour evaluation. At actual age 2½, James and Caleb were released from her care because their evaluations showed that they had caught up. Danae, however, was still exhibiting signs of a speech delay, so she remained under the doctor’s care. While it was frustrating to not have all our children exit the doctor’s care, we reminded ourselves that we have three very different children with three very different needs.
How do I respond to family and friends?
I’m a big proponent of education—especially when it comes to a topic many people aren’t familiar with, like infant prematurity. Explain in simple terms what prematurity means for your babies’ development. You don’t have to go into actual age and adjusted age if you don’t want the headache, but you might be surprised at how people respond to that extra nugget of knowledge.
Request that loved ones alter their language. Encourage them to ask, “What are your babies up to?” instead of “Are your babies doing X, Y, or Z yet?” Doing so acknowledges not just that your babies are moving at a different pace because of their prematurity but that babies in general move at different paces when it comes to development.
And finally, assure family and friends that your babies are being monitored closely by medical professionals who specialize in pediatrics and prematurity. While your babies might not be followed by a developmental pediatrician like ours were, their pediatrician most assuredly has their prematurity in mind when evaluating them and addressing health issues or concerns.
How do I deal with my frustration toward this?
Remember that actual age and adjusted age are for just a season. They are your whole life right now, but in terms of your babies’ entire life, they’ll likely be just a small chapter in a great big book. Acknowledge your feelings, talk about your feelings with people in your situation, but try not to be consumed by them.