מהי ההגדרה המדויקת ל

What Is the Precise Definition of

Translated from Hebrew by Claude AI. The original Hebrew text is preserved on the same page.

'The sharp transition from the hospital, where the preemie was so well cared for, to home, is extremely difficult for the parents — and the story begins with the return home.'

"Chas v'shalom, I don't want to be ungrateful — Hashem answered our prayers and gave us a child. Until he was out of danger, until he was discharged from the NICU, we were waiting for him at home — but the difficulties haven't stopped."

"Maybe I'm not a good enough mother. I have friends with eight times as many children."

"I devote all my time to him and I hear the crying — he's simply not okay."

"I started crying when I heard my children talking to each other and saying that his name isn't really 'Chaim Matanya' but 'Pag' [preemie].

I hadn't noticed that I, even after five years, am still calling him 'Pag.' When will this story end?"

"We thought that after all the efforts — doctors, medications, occupational therapy and so on — our child would be fine once he reached the classroom. But now I've again gotten a phone call from the Rebbe, who spoke to me about my son's difficulties."

This article comes to "share" with you — the parents of children born very "early," before the 32nd week of pregnancy and/or at a low birth weight (between 1,500–2,500 grams) or very low birth weight (under 1,000 grams). These are the clinical terms for weights under two and a half kilograms, or birth before term.

There are miracles and wonders in medicine's ability to bring tiny newborns into "the light of day" and care for them until they become "NICU graduates" and come home. But for many families — especially for the mothers — the story does not end with coming home.

In the developmental-psychology literature, there is recognition of parents' anxiety about going home with a child who, until just a short time earlier, had been treated by an entire team using the most advanced electronic medical equipment. How can we, as parents without any experience, possibly substitute for what he had?

From the developmental-psychology literature, we learn that preemies tend to cry more frequently and more intensely. It isn't clear whether this is because the small stomach empties quickly, or due to other physiological reasons, but the fact is that parents of preemies tend to feel themselves less effective and less successful than parents of newborns of higher birth weight — despite their many efforts.

Professional studies from abroad show an increase in physical aggression among parents of newborns born as preemies, compared to parents of other newborns. The hypothesis is that the parents, out of helplessness due to the prolonged treatments and/or the constant crying, turn their frustration into anger and aggression toward the baby.

Difficulties in building the bond between mother and infant can develop when the children are of low birth weight, are children with hypersensitivity to their environment, or are infants whose mothers were addicted to drugs or alcohol. In them, the capacity for eye contact with the mother is reduced, and they are therefore considered children at risk for impaired development of their ability to connect socially.

The development of the capacity for social communication depends on a mother who can attune herself to her child's signals. Over the course of the first year, a communicative system needs to be built between mother and child. He cries to different degrees and wants different responses from his mother. With children who cry a great deal due to various physiological causes — for example, digestive problems — a difficulty arises in forming an understanding of these signals between them and the mother. The mother, too, cannot distinguish between the signals her child is sending. Nor is the baby himself able to differentiate between the sensations he has so as to "signal" to his mother precisely what he wants at that moment.

Because of the difficulties in the infant's expression of these "signals" and in the environment's ability to understand him and meet his demands, these children develop interpersonal suspicion as well as difficulty in forming mutual trust. The child will not be able to be confident that if he cries, his mother will understand that he wants a clean diaper, or to drink, or just to play. He will not believe in her ability to understand, and a lack of trust will also develop in him toward those around him — whether they really "want to" or "can" meet his basic needs. These children, according to the literature, grow up to be adults who do not believe in their own ability and who lack trust in other people — components of personality disorders and disorders in the interpersonal system.

There is also information in the literature attesting to learning difficulties, particularly in language and arithmetic, among children born at very low birth weight.

The studies surveyed for the writing of this article paint a somewhat difficult picture. At the same time, it was found that there are factors that may reduce the difficulty of adjustment in children born at low birth weight.

Two factors have important influence on the preemie's development. In studies done with families that have a preemie child, it was found that when the father was more active in caring for the child — the preemie — was present for more hours, helped more with homework and so on — the children functioned better both emotionally and academically than other children born at the same weight who had identical or even higher intelligence. In other words, at least with regard to the development of preemies, the father's contribution is vital.

Likewise, it was found that preemies born to mothers with higher education — with at least twelve years of schooling — succeed in adjusting better than those born at the same weight with the same complications to mothers with less education. One can understand from this finding that the mothers' education gives them problem-solving ability and deeper understanding, and the mother will be less helpless in times of distress.

Another important factor — though less important than the factors mentioned earlier — was socioeconomic level (economic/social status). At the start of the research it was actually thought that the economic/social level would be the most important factor in shaping the emotional and educational adjustment of preemies, but as noted above, the mother's level of education and the father's cooperation were the factors that more strongly secured the preemies' future.

In addition, the traits or style of the parents in coping with difficulties and in problem-solving generally were also a very significant factor in the families' ability to help their children and themselves in difficult situations such as the birth of a child with very low birth weight.

As can be understood from these findings, it is clear that more education in mothers leads them to open a book, to enjoy things on a different level, and to value themselves on several planes — therefore it is important for the support system (husband, family, neighbors, etc.) to encourage the mother of the preemie to go out and hear a shiur on the parashat hashavua and the like, in order to strengthen this point in her.

Various treatments such as physiotherapy, occupational therapy, and language treatments (with a speech-language clinician) that accompany the child at young ages may rehabilitate him so that at older ages he won't need help. But it is also important to know that for most newborns born at very low birth weight, there may be a learning disability. I believe this information is important for us so that we will be ready to assist and provide the necessary help once the problem or difficulty is felt by the child — so that he will not accumulate "failures" and a low self-image because of them.

As noted at the beginning of the article, the information mentioned refers to very small children and/or those born much before their due date. The vast majority of preemie children are above these sizes and succeed in closing the gap after their birth, and they are not "destined" to have difficulty in their studies — but they are at risk. As noted, an accumulation of failures can be prevented through the alertness of the educational system and of the parents.

By the same measure, one must sometimes also understand the desire and need of certain parents to finally be done with the various "treatments" that weigh on them so heavily — but not to the point of becoming "deaf and blind" to difficulties that are within our ability to address.

In every situation one can see the half-full cup or the half-empty cup.

I see the half-full cup as three-quarters full. Hashem gave the wisdom to researchers to help Him bring forth and assist fresh and pure souls in coping with life. We are only His vessels, to fulfill this blessing.

You are not alone. You have succeeded in the great task of bringing a child into the world. From now on, there are groups of parents, social workers, and psychologists who are familiar with the difficulties you are experiencing. Reach out a hand for help — and we hope to be a tool of help for you.

In the end — all's well that ends well — or in the words of Kohelet — "the end of the matter, all having been heard" — and He listens to our prayer that everything will work out.

From Horim Choshvim, Issue No. 10