Identifying early learning delays in preterm infants

Do you remember a few months back when we learned that preterm infants don’t seem to catch up to their peers’ language skills by school age? Well, this study took a look at how premature and full-term infants learn, and found some interesting differences we can add to our list of things to watch in our preterm cases.

The authors repeated assessments on 23 full term and 30 preterm infants over a period of 18 months to see if there were changes in how the infants performed on means-end tasks, which included a towel or a turntable as the means, and a fun toy as the end. In other words, the authors recorded whether the babies could pull the towel or turn the turntable to get a toy. Success requires a whole bunch of sensory, motor, and cognitive abilities to interact, and typical infants can complete a one-step means-end task like towel pulling by about 8 months (see here for an older study). They also recorded how much time the infants spent exploring, how many different ways the infants interacted with the task, and how many times the infants successfully completed the trials.


The authors found that all infants got better at getting the toy with age, but preterm infants as a group were less likely to succeed in both tasks compared to full-term infants (2.25 times less likely in the towel task and 1.55 times less likely in the turntable task). The authors also found differences in how the babies explored during the tasks. While everyone explored more over time, babies who explored more early in development had more success with the means-end tasks overall. Not only that, but preterm babies showed more variability in their exploration later in development than the full-term babies. As it turns out, we decrease the variability in exploration as we fine-tune our skills. Think about it this way—when we learn a new skill, we try it this way, try it that way, try it another way, and store maps for the most efficient ways to do the skill. We explore less as we get good at it, but pre-term babies continued to explore different behaviors longer than full-term babies in the means-end tasks.

OK, got it. But how can we use it? Diagnostically, we could use these tasks during assessments (the authors suggest the towel task for 5- to 7-month-olds and the turntable task for 11- to 13-month olds). Red flags would include lack of exploration in earlier ages and lots of variability in exploration later in infancy. For intervention, we should remember to encourage infants to explore solutions. Instead of modeling the solution, have fun in the learning process! We can also call attention to the end object so infant can see what happens to the toy when she acts on the towel or the turntable. Help these babies become the little scientists they were born to be!


Cunha, A. B., Babik, I., Ross, S. M., Logan, S. W., Galloway, J. C., Clary, E., & Lobo, M. A. (2018). Prematurity may negatively impact means-end problem solving across the first two years of life. Research in Developmental Disabilities. Advance online publication. doi: 10.1016/j.ridd.2018.03.007