Getting SSI for Premature Infants or Infants With Low Birth Weight

Preemies and infants with low birth weight or other developmental problems are often eligible for SSI disability payments for their first year of life.

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Children who are born before 37 weeks gestation are considered premature, and some suffer from many side effects. Low birth weight is the most common effect of premature birth.

Symptoms of Premature Birth

Because low birth weight and premature birth generally go hand in hand, the symptoms of the two cannot be separated. Below are the impairments most commonly seen with premature birth and low birth weight children.

Short-Term Problems

Short-term effects suffered by preemies can include breathing problems, including respiratory distress syndrome, lack of oxygen to other organs, anemia, jaundice, low blood pressure, patent ductus arteriosus (PDA), an opening between two major blood vessels leading from the heart, bleeding in the brain, hydrocephalus (liquid accumulation on the brain), difficulty maintaining body temperature, which can lead to hypothermia, difficulty feeding due to an underdeveloped gastrointestinal system and poor ability to suck and swallow, hypoglycemia (low blood sugar), and infections, including the risk of sepsis (a very dangerous infection in the blood stream).

Long-Term Problems

Long-term problems caused by premature birth may not show up until later in childhood or even adulthood, especially cognitive delays and psychological issues. They can include:

Also, those who are born premature with a low birth weight are more likely to have Type 2 diabetes and cardiovascular disease as adults.

How Your Child Can Qualify for SSI Disability Benefits

Children who are disabled may qualify for disability benefits through Supplemental Security Income (SSI). To be considered disabled, a child must have an impairment or group of impairments that case marked and severe limitations in their functioning and is expected last at least twelve months (or cause death). There are both medical and income requirements that must be met to qualify for SSI benefits. To qualify medically for SSI, your child's condition must meet or equal the requirements of one of Social Security's impairment listings in its "Blue Book" or Social Security must agree that your child's condition "functionally equals the listings."

Meeting or Equaling a Listing

The effects of premature birth and low birth weight vary greatly depending on how premature and small a newborn is when born. While Social Security does not have a specific impairment listing for premature birth or low birth weight, there is a listing that addresses developmental and emotional impairments in children up to one year of age (which are very commonly seen in premature or low birth weight babies). This listing, Listing 112.12, looks at the overall functioning of a young child and how that level of functioning compares to others of the same age. The listing generally requires that the infant be significantly delayed (taking twice as long to reach milestones as others) in the areas of cognitive/communicative development, motor development, and/or social development. To determine if your baby might meet the requirements of this impairment listing, you should go over the requirements of Listing 112.12 with your child's pediatrician and/or a disability lawyer.

There are also several other listings that those who are born premature or with a low birth weight may meet. Below are the listings that children born prematurely or at low birth weights may qualify for.

  • Listing 103.02- Decreased lung functioning
  • Listing 100.00- Growth impairment
  • Listing 102.02/04- Vision loss
  • Listing 102.10- Hearing loss
  • Listing 103.03- Asthma
  • Listing 104.04(D)- Congenital heart disease (if PDA requires surgery and child will remain disabled up to one year of age)
  • Listing 105.08- Malnutrition caused by a digestive tract disorder
  • Listing 105.10- Need for a feeding tube to get nutrition
  • Listing 109.08- Diabetes
  • Listing 111.06/09- Motor dysfunction or communication problems caused by a neurological disorder (if hydrocephalus or bleeding in the brain leads to a brain injury)
  • Listing 111.07- Cerebral palsy
  • Listing 112.00- Mental disorders, including depression, mental retardation, anxiety, attention deficit hyperactivity disorder (ADHD), and developmental delays
  • Listing 114.07- Immune deficiency disorder (if infections lead to hospitalizations or do not respond to treatment)

In order to meet a listing, your child's condition must meet all of the requirements of the listing, and medical evidence must be provided that supports the meeting of each requirement. Alternatively, if your child's condition doesn't meet a listing exactly but your child's impairments are similar to those found in a listing, your child's condition could be considered medically equivalent to the listing, if they are as severe and long lasting as the impairments in the listing.

Functionally Equaling the Listings

If your baby can't meet or equal any of the listings above, he or she may still be able to receive benefits if Social Security agrees that their limitations in functioning are "functionally equal to the listings" -- basically, that they are as severe as other those caused by other conditions listed in Social Security's Blue Book.

Social Security looks at six "domains of functioning" to determine whether your child's condition is severe enough to meet this standard. Social Security created these six domains to cover all aspects of a child’s functioning. The domains are:

  • learning and applying information
  • completing tasks
  • interacting socially
  • moving about and manipulating objects
  • caring for himself or herself, and
  • health and physical well-being.

Your child must have a "marked" limitation in two domains of functioning or an extreme limitation in one domain of functioning for Social Security to agree that your child's condition is functionally equal to the listings. Children who were born prematurely or at low birth weight may suffer from physical impairments, such as vision and hearing problems, breathing problems (including asthma), low blood pressure, frequent infections, trouble with feeding, anemia, decreased physical skills due to neurological problems (such as difficulty walking or decreased use of hands or fingers), heart problems, and diabetes, which can limit your child’s ability to complete tasks, move and manipulate objects, or care for themselves.

Mental impairments caused by prematurity or low birth weight can include cognitive impairments, learning disabilities, cerebral palsy, behavioral problems, and mental disorders (including asthma and depression). These mental impairments can limit your child’s ability to acquire and use information, complete tasks, interact with others, care for themselves, or understand how to take care of their health and physical well being.

For more information, see our article on functionally meeting the children's disability listings.

Presumptive Disability

Social Security recognizes that there are some impairments that are almost always found to be disabling. Because of this presumption of disability, for some conditions Social Security will begin monthly payments immediately after you apply for SSI, for up to six months while a decision is made on your application. Children who have any of the following impairments may qualify for presumptive disability payments.

  • Cerebral palsy with marked difficulty with walking, speaking, or hand and arm coordination
  • Low birth weight
  • Prematurity (with birth weight limit based on gestational age at birth)
  • Total deafness, or
  • Total blindness.

To qualify for presumptive disability for low-birth weight, your baby must be six months or younger and have a birth weight below:

  • 4 pounds, 6 ounces if born at 37 weeks or later
  • 4 pounds, 2 ounces if born at 36 weeks
  • 3 pounds, 12 ounces if born at 35 weeks
  • 3 pounds, 5 ounces if born at 34 weeks
  • 2 pounds, 15 ounces if born at 33 weeks, or
  • 2 pounds, 10 ounces if born earlier than 33 weeks.
For more information, see our article on advance presumptive payments for SSI.

Continuing Disability Review

After your child is approved for benefits, his or her case will be reviewed periodically during "continuing disability reviews" (CDRs) to determine if he or she is still disabled. Generally, reviews occur every three years. However, children who were approved for disability based on low birth weight will have their case reviewed before they reach the age of one year. For more information, see our section on CDRs.

by: , Contributing Author

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