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Given a head start, tiny babies can flourish

Carla, a spunky 5-year-old, was happy to visit again with the child psychologist. This year he had a table and tests in his room. Carla knew this would be a serious time.

The testing was lengthy, especially after a full day of kindergarten. Carla worked with the tester for almost two hours.

The next day Carla's parents were relieved and happy with the results _ Carla's scores were in the high average range.

Why are Carla's scores impressive? Why are her parents relieved?

Carla was a low-birth-weight baby. She weighed 4{ pounds at birth and lives in the inner city. Only 10 years ago, low-birth-weight babies like Carla were very much at risk for continuing problems, including low IQ scores. IQ is often a predictor of traditional school success.

More than 250,000 infants born in the United States each year are low birth weight. Until recently, it was thought that the combination of a vulnerable medical beginning and poverty could not be overcome by special efforts.

Children who were low-birth-weight infants were provided with special educational help in elementary school, but the effects were not impressive; IQ test scores showed the same depressed levels that were previously seen with low-birth-weight children who did not receive special help.

Six years ago, clinical researchers began a new strategy. They reasoned that the low-birth-weight baby's inabilities to gain from its already impoverished family might be at least as important as low birth weight itself. The baby's parents might not understand the special needs of their child. Baby and mother, because of difficulties associated with low birth weight, might have a poorer chance of forming a magical bond that is so special in infancy.

Babies do a great deal of learning in their first months of life. This early learning probably requires the special bonding of infant and mother.

Could it be, the researcher reasoned, that providing special help for these tiny babies before their growth could catch up with normal body weight and functioning would make a difference? Could intervention in the first days and weeks prevent lower intelligence and behavior problems that often follow low birth weight?

The low-birth-weight babies in several large studies are now 5 years old _ old enough to estimate IQ. Children like Carla, who received special help with her parents when she was very young, scored an average of 13 IQ points higher than low-birth-weight children who did not receive special help in infancy.

These results are impressive for three reasons.

1. They prove the effectiveness of seeing a very young infant as already a person, with relationship and learning needs. They prove that help for children and their parents in the first weeks of life can have lasting benefits.

2. They show the effects of inborn problems can be overcome, or at least affected by careful parenting efforts.

3. They suggest that government funding for children at risk for school failure should at least be partially directed at children from birth on.

Many of the low-birth-weight children and their parents received similar special help. Her parents were counseled with other parents of low-birth-weight babies. An infant worker visited with the newborn and her parents at their home weekly. The parents learned about growing up stages in infancy, and about what was normal, as well as underdeveloped, about Carla.

Parents in the studies were helped to understand the effects of prematurity and low birth weight on the newborn's alertness, behavior and abilities to form a two-person relationship.

"I still remember when you told us about Carla's mood, or temperament, and how it would be easier and more fun if we could see how it was special," her mother said. "I thought she couldn't see, much less play with me, because she was only 4 pounds.

"It wasn't too long before we both got curious. We explored together with those games and her dad stayed home and played with us too!" her mother recalls.

Mom found that she and her premature infant could communicate many months before there were words. She proudly described how Carla was curious about shapes and noises at just 3 months, and how she found "better games than the doctor brought."

As toddlers, the children were helped with problem solving games, and they were taught social skills. Language development was emphasized.

While it is clear, by 4 years old, that efforts in infancy and in the toddler years improved IQ scores, it is unclear whether other areas of functioning will show gain. This will be evident as the children grow older, and social skills and behavior can be evaluated.

It is not yet known what particular efforts in infancy and during the toddler years resulted in higher intelligence test scores. Perhaps the improvement suggests that special needs of low-birth-weight children continue for years.

Perhaps they suggest that special help for school achievement must occur years before beginning school.

Regardless of the specific causes of improvement, the improvements are large, and should alter the way low-birth-weight babies are evaluated and treated in the future.

Dr. Schwarzbeck is a consultant to families and schools in Seattle. He teaches at the University of Washington School of Medicine.