This paper highlights the research literature on neonatal risk factors and explores the paradox that these factors present. Clinical and retrospective studies indicate that children who have developmental problems have had birth complications. On the other hand, birth complications do not predict developmental problems. Data from a longitudinal study of preterm infants are presented. A group of 59 preterm infants from English Speaking homes was assessed repeatedly from birth to age 5. A significant percentage of the children performed within the normal range or above, at each assessment period. Obstetrical and postnatal complications were not significantly related to developmental performance at any assessment period yet sickness was not to be dismissed as a risk factor. At age five, all of the children who performed poorly had experienced complications in the neonatal period. Responsive caregiving appeared to be an important factor in modifying and supporting cognitive development.