SECTION 4. EMOTIONAL CARE OF THE AT-RISK INFANT Behavioral Outcomes in Low Birth Weight Infants

Low birth weight infants are at increased risk for behavioral and emotional problems. The Infant Health and Development Program was designed to evaluate the efficacy of intense pediatric and family support on reducing developmental and behavioral problems in low birth weight, premature infants. The major findings of this and other studies are presented in this article. Pediatrics 1998;102:1293–1297; behavior, low birth weight, infants, preterm infants, Infant Health and Development Program, development, intervention. ABBREVIATIONS. LBW, low birth weight; IHDP, Infant Health and Development Program. In the last decade, the survival rate for low birth weight (LBW) infants has increased markedly,1 raising questions about their subsequent health and development. A number of studies have found that LBW infants are at increased risk for developmental delay2 and for a variety of medical complications in infancy compared with their normal birth weight counterparts.3 At later ages, LBW children tend to have lower scores on tests of cognitive functioning4,5 are more prone to difficulties in behavioral adjustment,4,6,7 and are at risk for having learning problems and poor academic achievement,8 even when cognitive test scores are normal.9,10 The risk of cognitive deficits is present for all birth weights #2500 g, although the risk increases as birth weight decreases.4,11,12 The likelihood of adverse developmental and scholastic outcomes also is greater with socioeconomic disadvantage13–15—itself a risk factor for LBW and prematurity—and this places many LBW premature infants at dual risk from both biologic and environmental factors.16,17 This article focuses on only one developmental aspect of LBW infants: behavior. The following are the primary issues explored. • Are LBW infants at increased risk for the development of emotional and behavioral problems? • What are the behavioral problems seen in LBW children? • Is there a role for intervention? REVIEW OF BEHAVIORAL OUTCOME STUDIES IN