Day Care for the Child Born Prematurely

The Infant Health and Development Program (IHDP) has contributed to our knowledge of the role of high-quality, educational day care in the lives of children with special needs. The IHDP was a randomized clinical trial to evaluate the efficacy of a comprehensive early intervention program in improving the health and developmental outcomes of low birth weight (LBW), premature infants. One component of this program was the provision of special day-care centers for the children receiving this intervention. The rationale for the IHDP was based, on the one hand, on documented need. Low birth weight children are known to be at risk for a variety of medical complications in the first year of life.1-3 Thereafter, the major area of risk is delayed cognitive development, which often leads to difficulties in learning and school achievement.4-6 An increased risk for behavior problems might exacerbate these school-related difficulties.7-9 The outcomes of LBW infants have been the subject of several recent reviews.2,10-12 On the other hand, there was some evidence of effectiveness of early interventions for LBW infants, although these tended to be reports of early outcomes at single sites.13,14 More compelling was the evidence of longer-range improvement in cognitive development resulting from comprehensive early interventions for disadvantaged children of normal birth weight14,15 Given the increasing survival of premature infants, including those of very low birth weight, it was considered important to test the efficacy of such an intervention for this at-risk population in a randomized trial. The models for the IHDP were two longitudinal comprehensive programs, Abecedarian and Project CARE,16 which combined home visits, parent support, and a comprehensive educational curriculum within special day-care centers.