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Low birthweight

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KEY POINTS

  • Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces.

  • Some low-birthweight babies are healthy, but others have serious health problems that need treatment.

  • Premature birth (before 37 weeks of pregnancy) and fetal growth restriction are the most common causes of low birthweight.

  • Being a person of color is not a cause for having a low birthweight baby. However, communities of color are disproportionately affected by racism. This affects their health and well-being and increases the risk of pregnancy complications.

  • Go to all your prenatal care checkups during pregnancy. Your health care provider tracks your baby’s growth and development at each visit.

  • Talk to your provider about what you can do to help reduce your risk for having a baby with low birthweight.

What is low birthweight?

Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces. Some babies with low birthweight are healthy, even though they’re small. But having a low weight at birth can cause serious health problems for some babies. A baby who is very small at birth may have trouble eating, gaining weight and fighting off infections. Some may have long-term health problems, too. About 1 in 12 babies (about 8 percent) in the United States is born with low birthweight.

What causes a baby to have a low birthweight?

There are two main reasons:

  • Preterm birth.
  • Fetal growth restriction (also called intrauterine growth restriction or small for gestational age). This means a baby doesn’t gain the weight they should before birth. Some babies may have low birthweight simply because their parents are small. Others may have low birthweight because something slowed or stopped their growth during pregnancy. Your health care provider measures your belly and uses ultrasound to help track your baby’s growth during pregnancy. Ultrasound uses sound waves and a computer screen to show a picture of your baby while you’re pregnant.

If your provider thinks your baby’s growth is being restricted, you may have ultrasounds more often (every 2 to 4 weeks) to track your baby’s growth. Your provider also may do other tests such as heart rate monitoring and tests to check for infections or birth defects. Babies who have birth defects are more likely to be born too early.

Are you at risk of having a low-birthweight baby?

Some things may make you more likely than others to have a low-birthweight baby. These are called risk factors. Having a risk factor doesn’t mean you’ll definitely have a low-birthweight baby, but it may increase your chances. Talk with your health care provider about what you can do to reduce your risk.

Medical risk factors for having a low-birthweight baby

  • Preterm labor. This is labor that starts too soon, before 37 weeks of pregnancy.
  • Chronic health conditions. These are health conditions that last for a long time or that happen again and again over a long period of time. Chronic health conditions need to be treated by a health care provider. Chronic health conditions that may lead to having a baby with low birthweight include high blood pressure, diabetes and heart, lung and kidney problems.
  • Taking certain medicines to treat health conditions, such as high blood pressure, epilepsy and blood clots. Tell your provider about any prescription medicine you take. You may need to stop taking a medicine or switch to one that’s safer during pregnancy.
  • Infections. Certain infections, especially infections of the internal reproductive organs during pregnancy, can slow a baby’s growth in the womb. These include cytomegalovirus, rubella, chickenpox, toxoplasmosis and certain sexually transmitted infections.
  • Problems with the placenta. The placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord. Some problems in the placenta can reduce the flow of oxygen and nutrients to the baby, which can limit the baby’s growth.
  • Not gaining enough weight during pregnancy. Pregnant people who don’t gain enough weight during pregnancy are more likely to have a low-birthweight baby than those who gain the right amount of weight. If you have an eating disorder or have been treated for an eating disorder, tell your provider. Your provider can check on you and your baby carefully throughout pregnancy to help prevent complications and make sure you’re both healthy.
  • Having a baby who was born too early or who had low birthweight in the past.
  • Being pregnant with multiples (twins, triplets or more). More than half of multiple birth babies have low birthweight.
  • Smoking, drinking alcohol, using street drugs and abusing prescription drugs. Pregnant people who smoke are more than 3 times as likely to have a baby who weighs too little at birth than people who don’t smoke. Smoking, drinking alcohol, using street drugs, and abusing prescription drugs during pregnancy can slow the baby’s growth in the womb and increase the risk for preterm birth and birth defects.
  • Exposure to air pollution or lead
  • Being a member of a group that experiences the effects of racism and health disparities.
  • Domestic violence. This is when your partner hurts or abuses you. It includes physical, sexual and emotional abuse.
  • Age. Being a teen (especially younger than 15) or being older than 35 makes you more likely than other parents to have a low-birthweight baby.

Rates of low birthweight in the United States 

Black babies are more likely than others to weigh less than they should at birth. The rates of low birthweight among different ethnic groups are:

  • About 1 in 7 Black babies (about 13 percent)
  • About 1 in 12 Asian babies (about 8 percent)
  • About 1 in 13 Native American or Alaska Native babies (about 8 percent)
  • About 1 in 14 Latinx babies (about 7 percent)
  • About 1 in 14 White babies (about 7 percent)

March of Dimes recognizes that racism and its effects are factors in the health disparities in pregnancy outcomes and babies’ health. We must work together to bring fair, just and full access to health care for all moms and babies.

Does a low birth weight cause problems for the baby? 

Yes. Babies who weigh less than they should at birth are more likely than babies whose weight is normal to have health problems. Some need special care in a hospital’s newborn intensive care unit (also called NICU) to treat medical problems. These include:

  • Breathing problems, such as respiratory distress syndrome (also called RDS). Babies with RDS don’t have a protein called surfactant that keeps small air sacs in a baby’s lungs from collapsing. Treatment with surfactant helps these babies breathe more easily. Babies who have RDS also may need oxygen and other breathing help to make their lungs work.
  • Bleeding in the brain (also called intraventricular hemorrhage or IVH). Most brain bleeds are mild and go away on their own. More severe bleeds can cause pressure on the brain that can cause fluid to build up in the brain. This can cause brain damage. In some cases, a surgeon may insert a tube into the baby’s brain to drain the fluid.
  • Patent ductus arteriosus. Patent ductus arteriosus is when an opening between 2 major blood vessels leading from the heart does not close properly. This can cause extra blood to flow to the lungs. In many babies who have patent ductus arteriosus, the opening closes on its own within a few days after birth. Some babies need medicine or surgery to close the opening.
  • Necrotizing enterocolitis. This is a problem in a baby’s intestines. The intestines are long tubes that are part of the digestive system. The digestive system helps the body break down food. Necrotizing enterocolitis can be dangerous for a baby and can cause feeding problems, swelling in the belly, and other complications. Babies who have necrotizing enterocolitis are treated with antibiotics and fed through an intravenous, or IV, tube. Some babies need surgery to remove damaged parts of intestine.
  • Retinopathy of prematurity. This eye disease is what happens when a baby’s retinas don’t fully develop in the weeks after birth.
  • Jaundice. This is a condition that makes a baby’s eyes and skin look yellow. It’s caused when there’s too much of a substance called bilirubin in the blood.
  • Infections. The immune system protects the body from infection. In a baby who is born too early, the immune system may not be fully developed and may not be able to fight off infection.

Does a low weight at birth cause problems later in life?

Babies who are born weighing too little may be more likely than others to have certain health conditions later in life, including:

  • Diabetes
  • Heart disease
  • High blood pressure
  • Intellectual and developmental disabilities
  • Metabolic syndrome
  • Obesity

If you’ve had a baby who weighed less than they should have at birth, talk with their health care provider about what you can do to help your baby be healthy. As your child grows, make sure they eat healthy food, stay active and go to all their health care checkups. Regular checkups can help your baby’s provider spot health conditions that may cause problems as your baby grows older. These checkups also help make sure that your child gets all the vaccinations they need to stay protected from certain harmful diseases.

If my baby has developmental delays, do they need early intervention services?

Yes. If your baby has developmental delays, it’s important to get early intervention services as soon as possible. Developmental delays are when your child doesn’t reach developmental milestones when expected. Early intervention services can help improve your child’s development. They can help children from birth through 3 years old learn important skills. Services include therapy to help a child talk, walk, learn self-help skills and interact with others.

The CDC program Learn the signs. Act early offers tools and information for parents who think their child may have developmental delays. You can find your state’s contact information for early intervention services. You don’t need a doctor’s referral or a medical diagnosis to ask for a free screening.

Last reviewed: June, 2021

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Your Newborn's Growth (for Parents)

From your baby's first day, doctors will keep track of weight, length, and head size. Growth is a good indicator of general health. Babies who are growing well are generally healthy, while poor growth can be a sign of a problem.

How Big Are Newborns?

Newborns come in a range of healthy sizes. Most babies born between 37 and 40 weeks weigh somewhere between 5 pounds, 8 ounces (2,500 grams) and 8 pounds, 13 ounces (4,000 grams).

Newborns who are lighter or heavier than the average baby are usually fine. But they might get extra attention from the doctors and nurses after delivery to make sure there are no problems.

Different things can affect a baby's size at birth. The length of the pregnancy is important. Babies born around their due date or later tend to be larger than those born earlier.

Other factors include:

  • Size of parents. Big and tall parents may have larger-than-average newborns; short and petite parents may have smaller-than-average newborns.
  • Multiple births. If you have twins, triplets, or more, you can count on your babies being a bit small. Multiples have to share their growing space in the uterus, and they're often born early, which leads to small size at birth.
  • Birth order. First babies are sometimes smaller than brothers or sisters born later.
  • Gender. Girls tend to be smaller, boys larger, but the differences are slight at birth.
  • Mom's health during pregnancy. Things that can lead to a lower birth weight include a mother with high blood pressure or heart problems; or one who used cigarettes, alcohol, or illegal drugs during the pregnancy. If the mother has diabetes or is obese, the baby may have a higher birth weight.
  • Nutrition during pregnancy. Good nutrition is vital for a baby's growth — before and after birth. A poor diet during pregnancy can affect how much a newborn weighs and how the infant grows. Gaining a lot of weight can make a baby more likely to be born bigger than average.
  • Baby's health. Medical problems, including some birth defects and some infections during the pregnancy, can affect a child's birth weight and later growth.
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What About Preemies?

Premature babies generally are smaller and weigh less than other newborns. A preemie's weight will largely depend on how early he or she was born. The time an infant missed being in the womb was growing time, so the baby has to do that growing after birth.

Many pre-term babies are classified as having "low birth weight" or "very low birth weight." In medical terms:

  • Low birth weight means a baby weighs less than 5 pounds, 8 ounces (2,500 grams) at birth. That's the case for about 1 in every 12 babies in the United States, so it's quite common.
  • Very low birth weight means a baby weighs less than 3 pounds, 5 ounces (1,500 grams).

Most babies with low birth weight or very low birth weight were born prematurely.

Premature babies get special medical attention right away after they're born. A specialist called a neonatologist may help care for them. Many preemies spend time in the neonatal intensive care unit (NICU) while they get medical care.

Is Bigger Better?

A baby with chubby cheeks and dimpled thighs once was many people's picture of a healthy newborn. But a baby born much larger than average may have special medical problems that need attention.

Some very large babies — especially those born to mothers with diabetes, including gestational diabetes — may have problems for a few days keeping blood sugar levels up. They might need extra feedings or even IV (given into a vein) 

glucoseto keep those levels from falling too low.

Will My Baby Lose Weight?

Yes, at first. Babies are born with some extra fluid, so it's normal for them to drop a few ounces when they lose that fluid in the first few days of life. A healthy newborn is expected to lose 7% to 10% of the birth weight, but should regain that weight within the first 2 weeks or so after birth.

During their first month, most newborns gain weight at a rate of about 1 ounce (30 grams) per day. They generally grow in height about 1 to 1½ inches (2.54 to 3.81 centimeters) during the first month. Many newborns go through a period of rapid growth when they are 7 to 10 days old and again at 3 and 6 weeks.

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Should I Be Concerned?

Newborns are so small, and it can be hard to know if your baby is gaining weight the way he or she should. You may worry that your baby has lost too much weight in the first few days or isn't taking enough breast milk or formula. If so, talk to your doctor, who may ask you about:

  • How many feedings a day your baby gets. A breastfed baby may feed about 8 or more times in a 24-hour period; formula-fed babies usually eat less often, perhaps every 3 to 4 hours. A lactation (breastfeeding) counselor can make suggestions to increase comfort and improve technique, if a mom needs extra help.
  • How much your baby eats at each feeding. A baby generally nurses for at least 10 minutes, should be heard to swallow after 3 or 4 sucks, and should seem satisfied when done. At this age, formula-fed babies may drink up to 3 to 4 ounces (90 to 120 milliliters) at a time.
  • How often your baby pees. A breastfed baby may have only 1 or 2 wet diapers a day until the mother's milk comes in. Expect about 6 wet diapers by 3 to 5 days of age for all babies. After that, babies should have at least 6 to 8 wet diapers a day.
  • How many bowel movements your baby has each day, and what they're like. Newborns may have only one poopy diaper a day at first. Poop is dark and tarry the first few days, then becomes soft or loose and greenish-yellow by about 3 to 4 days. Newborns usually have several poopy diapers a day if breastfed and fewer if formula-fed.

What Else Should I Know?

Being small or large at birth doesn't mean a baby will be small or large later in childhood or as an adult. Plenty of tall teens began life as small babies, and the biggest baby in the family can grow up to be a petite adult.

By the time they're adults, kids tend to resemble their parents in size. Genetics, as well as good nutrition and your attention, will play a large part in how your baby grows in the years to come.

Whether your baby starts out large, small, or average, in the next few months you can expect your little one to keep growing fast.

Reviewed by: Madhu Desiraju, MD

Date reviewed: October 2018

Strategy Map - How to Improve Newborn Health

The Centers for Disease Control and Prevention uses a variety of indicators to measure the health of newborns. One important indicator is low birth weight, which is determined for newborns weighing less than 2500 grams or 5.5 pounds. Some low birth weight babies are healthy, but others may experience serious health problems such as nutritional problems, weight gain and immunodeficiency, as well as possible long-term health problems, all of which require further treatment. Low birth weight is also a strong indicator of infant mortality.

In 2007, when the Healthy People 2020 goals were set, the national rate of low birth weight babies was 8.3 percent. The goal by 2020 was to reach 7.8 percent. The latest data puts the US low birth weight rate at 8.31 percent in 2018. You will map which parts of the country are on track and which are falling behind. Your map will take into account the racial disparity in low birth weight for different racial groups in the United States. Several studies have shown that black and African American women are more likely to have a low birth weight baby than other racial and ethnic groups. A 2018 New York Times article cites a study published by the Robert Wood Johnson Foundation and the University of Wisconsin that says the number of low birth weight babies in the United States has increased for the first time in 10 years, driven by a rise in black babies, born with low body weight.

In this lesson, you want to propose policies to the state government to improve newborn health and help achieve the CDC goal of no more than 7. 8% of newborns in the United States weighing less than 5.5 pounds. To help protect you, you'll create a policy map focusing on the state with the highest low birth weight rate, symbolize the map to show which counties are most in need of intervention, and include racial disparity information for the low birth weight rate. birth. You'll make sure the map communicates clear strategic goals visually, and then publish it as a web app.

This lesson is aimed at government officials, foundations, and advocacy groups who seek to communicate persuasively public health outcomes and drive positive change in policy or resource allocation for vulnerable communities.

This lesson was last tested on April 1, 2022.

View finished product0020

Lesson plan

Creating a strategy map

Adding data and customizing symbology to display statistical distributions to identify districts requiring intervention.

    45 minutes
Publish results as a web application

Create a web application to communicate information to decision makers.

    15 minutes

Strategy maps show where political intervention is a priority. It is also important to consider that the map must be clear and understandable to elected officials who may not have experience in the area where you are an expert. The card should also be persuasive and motivating to take action. You'll create a strategic map that shows how much newborns weigh in each county across the United States. Then you will focus on the state of Mississippi. This map should draw attention to the districts where efforts should be focused to improve the health of newborns.

The US Centers for Disease Control and Prevention (CDC) has set a goal of no more than 7.8 percent of newborns weighing less than 5.5 pounds (2.49 kg) by 2020. Your map will show the counties that are close to meeting this target and the counties with the most significant emissions where the intervention could have the greatest impact.

Adding data to a new card

First, you need data. ArcGIS Living Atlas of the World contains a lot of authoritative GIS data, where you can find county data on how much newborns weigh.

  1. Sign in with an ArcGIS organization account.
  2. At the top of your organization's home page, select Resources. Click the Living Atlas tab.
  3. In the Search for Living Atlas Layers window, enter County Health Data. Select County Health Rankings 2020 from the search results.
  4. Click the Data tab.

    Data attributes are displayed as a table. There is a lot of data in this table, so you need to look in the list of field names to see if there is what you need.

  5. Click in the top corner of the Field.

  6. Type Birth in the search bar.

    The search will return several results, many of which refer to the percentage of newborns with low birth weight. You will be able to use this layer on your strategy map. You'll bookmark this layer in case you need to come back to it later.

  7. Click the Overview tab. Below the sample image, click Add to Favorites.
  8. On the item page, click Open in Map Viewer. (You may need to click the arrow next to Open in Map Viewer Classic first.)
  9. On the Contents (dark) toolbar, click Save and Open, then click Save As.
  10. In the Save Map window, enter the following parameters:
  11. Click Save Map.

Finding Patterns by Country

Before focusing on your state of interest, you will learn about some patterns across the country to better understand the newborn weight situation. When looking for patterns in your data, it's helpful to try styling your data in different ways.

First, you'll change the basemap. Typically, the default is the Topographic basemap, which was created as a reference map. To highlight your data, you'll use the Human Geography Map basemap, which has fewer topographic features.

  1. On the Contents toolbar, click Basemap and choose Population Geography Map.
  2. On the Resources toolbar, click Layers. In the Layers panel, expand County Health Rankings 2020 and select the County layer.

  3. On the Settings (light) toolbar, click Styles.
  4. In the Styles panel, under Select Attributes, click the delete button to remove the Life expectancy attribute.

  5. Press the + field.
  6. In the Add Fields window, find birthweight, click % Low birthweight, and then click Add.
  7. Under Style Selection, for Count and Amount (Size), click Style Options.
  8. For Subject, enter Above and Below.
  9. Double-click the value of the middle marker on the histogram, type 8. 31 and press Enter.
  10. Change bottom marker to 7.8.
  11. Change the top marker to 11.
  12. Click the Zoom in slider button to see each of the breakpoints on the histogram more clearly.

  13. Click the Character Style button.
  14. In the Symbol Style panel, for Color Bars, select the Orange Gray 1 scale.
  15. In the Style Options panel, click Done. In the Styles panel, click Done.
  16. Save the card.

Pop-up settings

When you click data on the map, a pop-up window will appear with information about the attributes of that data. It would be helpful for your users if they could select a county and see the percentage of low birth weight babies in that county.

  1. Click any county on the map to open its pop-up window.
  2. Close the pop-up window.
  3. On the Settings toolbar, click Customize pop-ups.

    The Pop-ups panel for the County layer appears.

  4. On the Pop-ups panel, click the Options button for Text and then Delete.

  5. Click Add Resource and choose Text.
  6. In the text editor that appears, type (or copy and paste) the following text:
  7. Select the text {v037_rawvalue}, click the Bold button.

  8. Select the text 8.3 percent, click the Bold button and then OK.
  9. On the Settings toolbar, click Customize Margins.
  10. In the Fields panel, find the birthweight and click % Low birthweight.
  11. In the Formatting window, for Number of significant digits, select 1 decimal place. Click Done.
  12. On the Settings toolbar, click Customize pop-ups. In the Pop-ups panel, click Add Resource and select Chart.
  13. In the Customize Chart window, click Select Fields.

  14. In the search bar, type birthweight and select the following fields:
  15. Click Finish. In the Customize Chart window, click Done.
  16. In the Pop-ups panel, in the Media section, for Title, type % of low birth weight babies by race and ethnicity, and for Description, type Hover over each column to see more information.

  17. Click any county to view the customized popup.
  18. Close the pop-up window and the Pop-ups panel, then save the map.

Identify counties for intervention

The country map you have created is a supporting context for addressing low birth weight in the United States. However, at the state level, decision makers may have more power to influence policy decisions in the counties. In addition, you want to explicitly highlight the counties within the state that need targeted interventions to help the state meet the CDC 2020 goal.

To do this, you will first identify which state has the hardest time achieving the 2020 goal. You'll save a copy of your map and filter the data to show only the counties in that state. You'll then customize the symbols for counties based on how far the current proportion of low birth weight infants are from the 2020 target, as well as based on racial disparity.

You can complete this workflow in any other US state if you wish.

  1. In the Layers panel, hover over the County layer and click the Hide Layer button to turn it off.

  2. Scale the map so that the State layer is visible on the map.
  3. In the Layers panel, click the State layer to select it. On the Settings toolbar, click Styles.
  4. In the Styles panel, for Select Attributes, delete Life expectancy. Click + Field and add % Low birthweight.
  5. For Number and Amount (Color), click Style Options.
  6. In the Style Options panel, update the following:
  7. Click Done in both style panels.
  8. On the Contents toolbar, click Save and Open and choose Save As. Enter the following parameters:
  9. Click Save Map.

    You are now working on a copy of the original map. Now we need to filter the data.

  10. In the Layers panel, click County, then click the Show Layer button to turn it back on.
  11. On the Settings toolbar, click Filter.

    The filter uses an expression that determines which objects in the layer to display. You can create expressions using certain fields and attributes. In your data there is a field with the names of the states, and we will use it.

  12. In the Filter panel, click Add Expression.
  13. In Expression build expression State is MS.
  14. In the Filter panel, click Save.
  15. On the Layers panel for the County layer, click the Options button and then Zoom To.
  16. On the Settings toolbar, click Styles.
  17. In the Styles panel, under Select Style, in the Numbers and Amounts (Color) window, click Style Options.

    In the Style Options panel, you can view a histogram of the distribution of low birth weight data for the state.

    The cutoffs you set at the national level will remain, but the average has changed to 12.3 percent. While this average does not account for population differences between counties, the CDC provides statewide statistics on several health-related topics. In 2019 CDC reports, Mississippi's average low birth weight birth rate was 12.3 percent.

    Reducing low birth weight in counties already below the national average is likely to require large investments and achieve little. It's more useful to focus on the counties with the highest percentages. Although these counties will require large investments, they will greatly improve the state averages.

    Far fewer resources will be needed for counties that are only slightly above the CDC 7.8 target, so these counties should also be allocated for intervention. Your political map will highlight two groups of counties: those that are above the CDC target and those that are barely above it.

    To display these counties on the map in a way that makes it clear which counties should be targeted for intervention, you will use classified colors for counties with defined ranges of values, rather than a continuous color bar that gradually changes color as you zoom in or out. decreasing values. This style will immediately make the map more readable and tell the decision makers a simple and clear story.

    Since the classifications you use should automatically focus only on counties above the CDC target, you should use a high to low theme.

  18. In the Style Options panel for Theme, select High to Low.
  19. For Symbol Style, under Color Bars, change All Color Bars to Red and Yellow and choose Orange 4.

  20. Under the histogram, turn on Data Classification.
  21. Set the markers on the histogram (from bottom to top) to 8.3, 12.3 and 15.6.
  22. In the Method section, click the label > 15.6 - 24.39 and add - More than double the 2020 CDC target, greatest need for intervention and press Enter.

  23. Add the remaining labels as follows:
  24. Click Done in both style bars.
  25. Save the card.

    Next, you'll add a copy of the County Health Rankings layer and symbolize it based on racial disparity. This will add an important point to the map by providing a broader context for the types of interventions needed to address the high rate of low birth weight infants.

Add data on racial disparity

An important consideration in public health work is racial disparity and how this can affect intervention prioritization and methodology. You'll add a second layer that shows the proportion of low birth weight babies born to black and white mothers.

For the sake of brevity, this lesson will only examine the difference between black and white mothers, but it is strongly recommended that racial and ethnic differences be taken into account for all demographic groups within a given population area. We suggest that you try this workflow, considering all available data for each racial and ethnic group.

  1. In the Layers panel, for the County layer, click the Options button, then click Rename. Add (%LBW) to the end of the layer name and click OK.
  2. Click Add Layer and search the Living Atlas for the County Health Rankings 2020 layer and add it to the map.

  3. In the Add Layer panel, click the back arrow.
  4. In the Layers panel, expand the newly added County Health Rankings 2020 group layer and rename the County layer adding (Ratio % Black to % White).
  5. With the County layer selected (Ratio % Black to % White), click Filter on the Options toolbar.
  6. In the Filter panel, click Add Expression and create the expression State is MS, then click Save.
  7. On the Settings toolbar, click Styles.
  8. In the Styles panel, under Select Attributes, delete the Life expectancy field and click + Expression.
  9. In the expression designer window, next to New expression, click Edit.
  10. Replace the current text with Ratio % Black LBW to % White LBW and click Save.
  11. In the Expressions box, create or copy and paste the following:
  12. Click OK.
  13. In the Styles panel, for Select Style, select Color and Size. Click Style Options.

  14. In the Style Options panel for Theme, select Above and Below.

    The map will update to show chevron symbols where the share is above or below the average. You want to determine if black mothers have a lower low birth weight score, so adjust the histogram accordingly.

  15. On the histogram, change the end values ​​to 0, 1, and 2.

  16. Under the histogram, for Size Range, move the slider to 20.

  17. both style panels.

  18. On the Settings toolbar, click Customize pop-ups.
  19. Disable Enable Pop-ups.

    Now the only layer that will display popups is County (%LBW).

  20. Save the card.

You have created a policy map that shows racial disparity for the proportion of low birth weight infants from black and white mothers, in addition to the counties with the highest rates of low birth weight infants in Mississippi. The map shows which counties in Mississippi are most in need of effective interventions to help the state move closer to the CDC goal of 7.8% of babies born with low birth weight by 2020.

You previously created a strategic map to show priority counties for increasing prenatal programs in Mississippi. You want your strategy map to be presented to the target audience in your administration in a clear and easy to understand way. To do this, you will create a web application.

A web application is a customized user interface that defines the look and feel of your map, adds (or reduces) functionality, or helps you make your map compatible with various media sources. The decision makers who see your map are not GIS experts, but a web application that simplifies the user interface and draws attention to the most important details is ideal for them.

Selecting an application template

First, you will publish the map and select the ArcGIS Instant Apps template. You will use the Sidebar template.

  1. Open the Priority Counties for Prenatal Programs card if needed.
  2. In the Contents pane, click Share Map.

  3. In the Publish window, click Public (public) and click Save.
  4. On the Contents toolbar, click Create App and select Instant Apps.
  5. Locate the Sidebar template and click Select.
  6. In the Create Title Application window, enter Priority Counties for Prenatal Programs and click Application Setup.

    The application configuration window opens with an interactive preview of your application. The generated app is based on the selected template. Next, you'll customize app elements to help users understand your map.

Web application setup

When configuring the application, you can use the default express installation steps, which offers a subset of customizable options. You can accept all the default stops or search for the settings you want to change. If you didn't use express for settings, you'll be prompted to disable express to access all customizable options available in the app.

You will change the color scheme to a lighter one to complete the map. You'll update the sidebar to include detailed map information, popup content, and a legend to help users better understand the map.

  1. In the configuration panel, click the Theme and Layout step and change the mode to Light.

    Application preview is updated to show changes; the draft is saved automatically.

  2. On the vertical toolbar, click Search settings and enter details.
  3. In the list of suggestions that appears, click Edit Detail Content.

  4. Click Continue when a message appears prompting you to turn off express mode.

    The configuration panel now includes all available configuration settings and is opened via the Sidebar install.

  5. In the Edit detail content section, click Edit.

  6. In a text editor, copy and paste the following:
  7. Press Enter to add a blank line of text. Click the Bulleted List button and add the following bulleted list:
  8. Click OK.
  9. On the vertical action toolbar, click Interactivity and choose Explore/Navigate.
  10. In the Navigation section, enable Navigation Border and click Customize.
  11. In the Set Navigation Boundary window, set up a bounding box around the state of Mississippi.
  12. Click Confirm.
  13. On the configuration panel, click Publish. In the Publish window, click Confirm.

Viewing and publishing the application

Now that you have configured and published your application, you will review it and confirm any changes you have made. You'll then update your sharing settings so you can share the app with stakeholders and decision makers.

  1. In the Share window Click Launch to open the application in a new window.
  2. Click the Details tab to view the added description.
  3. Click the Legend tab.
  4. Click the Information tab and click any county on the map.
  5. Close the application window.

    You have finished viewing the application and are ready to share it.

  6. In the Instant Apps configuration window, close the Sharing window and click Exit. In the confirmation window, click Exit.

    On the application item page that opens, you can enter information, a description, and terms of use, such as a description, terms of use, and author and source information.

  7. Click Publish.
  8. In the Publish window, select Public and click Save.

    At the bottom of the item page, in the URL section, there is a link that you can copy and share with interested parties to view your application. (If you are going to make changes, click the Customize button.)

In this lesson, you found public data, styled it in a meaningful way, and set up informative pop-ups to create a policy map for low birth weight in Mississippi. You then created a web application that is detailed and easy to use for decision makers.

This workflow can be replicated for many different geographies and with many types of health and demographic data, not just low birth weight. Which region of the US or part of the world are you interested in? What complex issues and problems can be illustrated on a strategy map? Try exploring ArcGIS Living Atlas for a wide range of maps and start mapping.

More lessons can be found in the Learn ArcGIS Lesson Gallery.

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  • Image card William Fortunato from Pixabay

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Your child has had a colostomy. This procedure involved cutting part of the colon (large intestine) and sometimes removing it. The end of the colon was attached to a small hole made in the abdominal wall. It forms a passage called stoma . Stool and mucus exit the body through this opening into a receiving pouch. Below are instructions for home care after a colostomy. The doctor and nurses can give you additional instructions for your child.

Home Care

Care for your child's healing stoma as shown. Ask your child's doctor or nurse for instructions on caring for an ostomy. It will be your reminder for stoma care.

Be sure to do the following after surgery:

  • Care for your child's stoma as instructed.

  • Wash surgical incision(s) with soap and water and dry by blotting, except when directed not to wash. Your child can shower or bathe as needed, but avoid getting water directly on the incision.

  • Inspect the healing incision(s) daily for redness, discharge, swelling, or peeling of the skin. Call your doctor right away if you notice any of the following in the lightly colored box below.

  • Follow all doctor's instructions for monitoring the amount of discharge into the colostomy bag.

  • Do not allow your child to lift anything heavier than 5 lb (2.27 kg) until the doctor says it is okay.

  • Do not allow your child to play rough play or contact sports. But let your child be active, for example, go for walks. When traveling in a car for long periods of time, stop frequently so your child can stretch.

  • Ask the doctor when your child can return to school. Most children are able to do this 2-3 weeks after surgery.

  • Give your child all prescribed medicines and vitamins as directed. Don't skip your medications.

  • Do not give your child over-the-counter medicines until the doctor tells you that it is okay.

Special instructions

  • Stoma may be temporary (used for a short time) or permanent. Your child's healthcare provider can tell you more.

  • Tell your child's teachers and school nurse that your child has an ileostomy.

  • The ileostomy pouch is odorless and can be hidden under clothing. The pouch can be emptied in the toilet in privacy.

  • A child with an ileostomy can still play most sports. Talk to your doctor about your child's special needs.

Follow-up appointments

Book your follow-up appointments as you were told.

When to call the doctor

Call the doctor right away if your child has: