Infants who may experience developmental delays due to problems during pregnancy, at birth, or after delivery are referred to as high-risk infants. This group generally includes premature (preterm) infants, full-term infants with low birth weight, and infants who require care in a neonatal intensive care unit after birth.

Which infants are considered premature?
Infants born before 37 weeks of gestation are classified as premature. Those born between 34–36 weeks are considered late preterm, 32–33 weeks moderate preterm, 28–31 weeks very preterm, and those born before 28 weeks are classified as extremely preterm.

What does low birth weight mean?
A birth weight below 2500 grams is considered low birth weight. If the weight is under 1500 grams, it is classified as very low birth weight; if under 1000 grams, it is extremely low birth weight.

What problems can occur in high-risk infants?
During the neonatal period, issues such as brain damage due to lack of oxygen (hypoxic-ischemic encephalopathy), respiratory distress, jaundice (hyperbilirubinemia), and eye problems related to underdeveloped blood vessels (retinopathy of prematurity) can occur. Additionally, 5–15% of premature infants may develop permanent neurological conditions like cerebral palsy.
High-risk infants are at risk for delays in motor, sensory, cognitive, and social development. These may include muscle weakness, delays in rolling over, sitting, crawling, and walking, as well as early difficulties with sucking and swallowing and delayed speech development later on. High-risk infants may have trouble self-soothing, cry frequently, avoid movement, or exhibit sensory problems such as hyperactivity or excessive need for stimulation.

Who should monitor high-risk infants?
The level of risk is determined according to the definitions above, and a multidisciplinary team may be involved depending on the infant’s needs. This team can include neonatologists, developmental pediatricians, pediatric neurologists, special education experts, occupational therapists, speech-language therapists, and pediatric physiotherapists.

How is the development of high-risk infants assessed?
At our institution, the neuromotor development of high-risk infants is assessed by physiotherapists who are well-versed in typical infant development and skilled at observing and analyzing infant movements. Spontaneous movements, positional transitions (e.g., rolling from back to tummy), movement strategies (crawling, scooting, creeping), reflexes, and muscle tone are comprehensively evaluated to determine whether the infant is developing typically or deviating from typical development. Based on this evaluation and in agreement with the family, an early intervention program is initiated.

What is an early intervention program?
An early intervention program involves physiotherapy approaches that begin as early as possible (ideally from birth) and continue up to 24 months of age. Depending on the child’s risk level and condition, therapy may continue through school age, especially if neurological impairments are present.

The goal of physiotherapy is to utilize the brain’s plasticity (its ability to adapt and reorganize) to promote the acquisition of typical motor patterns and help the child achieve the highest level of independence possible. The first 2–3 years of life are critical, as brain and nervous system development is most rapid during this period. Therefore, early intervention significantly improves treatment outcomes.

What therapy approach is used to support motor and sensory development in infants?
The most widely used approach worldwide is the Bobath (neurodevelopmental) therapy concept. The aim of Bobath therapy is to maximize the functional abilities of children with neurodevelopmental disorders. Bobath therapists design individualized therapy programs for each infant and also focus on providing environmental adaptations, enhancing parent-infant communication, involving the family in therapy, and teaching how to extend therapy throughout the day. The infant is continuously reassessed, and the program is adjusted based on needs to ensure treatment effectiveness.

How can I access evaluation and early intervention programs for high-risk infants?
At our institution, the Bobath Therapy Unit offers evaluation and early intervention programs for high-risk infants. Infants are assessed within the Bobath framework, and their development is supported with a physiotherapy program tailored specifically to their needs.