Baby too small

IUGR—Why Is My Baby Small and What Can Be Done About It?

What is IUGR?

IUGR stands for intrauterine growth retardation. This means that your baby is growing slowly and doesn't weigh as much as your doctor expected for this stage of pregnancy. If your unborn baby weighs less than most babies at this stage, your baby might have IUGR. IUGR is also used to describe a baby who weighs less at birth than most babies at the same stage. For babies who are born near their due date (meaning, they aren't premature), the dangerous weight is anything less than 5 pounds, 8 ounces.

Your doctor might suspect IUGR if he or she thinks your baby is growing slightly less than would be expected. IUGR is usually diagnosed during an ultrasound examination. Doctors most often find it during the 6th, the 7th or the 8th months of pregnancy.

It's important to know that IUGR only means slowed growing. These small babies aren't mentally slow or retarded. Most small babies grow up to be healthy children and adults.

Why is my baby small?

Doctors know many of the causes of IUGR but are only able to be sure about the cause in about one half of babies who have IUGR. The most common reasons for a baby to be small are the following:

The mother smoked cigarettes during pregnancy.
The mother drank alcohol during pregnancy.
The mother had high blood pressure during pregnancy.
The mother had infections during pregnancy.
The baby has chromosomal abnormalities (like Down syndrome).
The mother used certain medicines during pregnancy.
The mother is small (less than 5 feet tall or weighing less than 110 pounds).

Why is my baby's size important?

The best predictor of a baby's survival and good health is its birth weight. Babies born with low birth weight might have problems near the time of birth. Because of the danger of some of these problems—such as difficulty holding a normal body temperature or fighting infection—your doctor will do some tests to find out if your baby is growing well, both before and after birth.

What tests might be done on my baby?

Two tests can find out if your baby has IUGR and keep track of your baby's growth in the womb. These tests are the ultrasound exam and the nonstress test. The first kind of test, the ultrasound exam, is used to find out if your baby has IUGR. This exam is done every three to four weeks to make sure your baby is still growing right. The ultrasound exams let your doctor look at your baby's internal organs and measure the amount of fluid around the baby.

Special ultrasound exams are called biophysical profiles. During a biophysical profile, the person who does the exam will also watch your baby's breathing, muscle tone and movements.

The other test is the nonstress test. This test is usually done in the doctor's office, but it might be done in a hospital. A nonstress test measures how fast your baby's heart is beating. A healthy baby normally has a heartbeat that gets faster as the baby moves around. A nonstress test takes about 20 to 30 minutes to do. It might take longer if your baby is asleep.

Sometimes your doctor wants to watch your baby's heartbeat while your uterus contracts (squeezes together). This is called a contraction stress test. There are two ways to help you have contractions for just a little while. First, your nipples will be warmed up. Sometimes this makes your uterus start contracting for a little while. If that doesn't work, you could take a special medicine (either oxytocin or pitocin), to make your uterus contract just for a little while.

What happens if a test isn't normal?

If one of the tests isn't normal, your doctor may want to do other tests. Your doctor may also try to start your labor early (induce labor) if you might have a problem.

What will the doctor do to help my baby?

If your baby is very small when it's born, your doctor can give it oxygen through a nose tube, fluids through a tube in a vein and, sometimes, antibiotics.

What can I do to help my baby?

You can do five important things to help your baby grow big enough before it's born:

If you smoke—quit now. Cigarettes hurt the placenta, which is your baby's only way to get “food.” It's never too late to quit smoking. Babies gain one half of their weight in the last three months before being born.
If you drink alcohol—quit now. Even one drink a day makes it more likely that you will have a small baby. You could even have a baby with brain damage caused by the alcohol. This can happen in all months of pregnancy.
If you use illegal drugs—quit now. Almost all illegal drugs make babies too small to be strong and healthy. You may need your doctor's help to quit so you don't have withdrawal problems.
Eat a good diet. Ask your doctor to tell you the best foods to eat.
Keep all your appointments for doctor visits and tests.

When is a baby too small? Managing third-trimester fetal growth restriction | Your Pregnancy Matters

What can we help you find?

Refine your search: Find a Doctor Search Conditions & Treatments Find a Location

Appointment New Patient Appointment
or Call214-645-8300

MedBlog

Your Pregnancy Matters

July 6, 2021

Your Pregnancy Matters

Patricia Santiago-Munoz, M. D. Obstetrics and Gynecology

The third trimester is generally considered the home stretch of pregnancy. For most patients, it’s a less stressful time regarding fetal health, since the risk of miscarriage drops significantly after the first trimester and most patients have had the opportunity to learn about the health of their baby through second trimester ultrasounds and screening tests.

However, it’s not uncommon for mild to moderate growth disruptions to occur in the third trimester. Often, these healthy babies are simply small because their parents are small in stature or they were small babies themselves. But in approximately one-third of small babies, we find a potentially serious health problem called fetal growth restriction (FGR), which is associated with low birthweight, developmental problems, and stillbirth.

FGR refers to babies who are below the 10th percentile for estimated fetal weight, which means they’re smaller than approximately 90 percent of babies at the same gestational age. There are many potential causes of FGR, which generally fall under maternal, fetal, or placental complications.

Every patient who gets prenatal care is screened for FGR at every visit by taking regular belly measurements. We’re checking your fundal height – from the top of your uterus to your pubic bone. This number helps estimate the baby’s size and whether it is growing as expected.

After 20 weeks, the fundal height should correlate approximately with how long you’ve been pregnant. For example, it should measure approximately 20cm at 20 weeks’ gestation, 30cm at 30 weeks, etc. If your baby measures smaller than expected, we’ll confirm its size with an ultrasound.

“Generally, growth restriction is associated with either maternal risk factors, fetal anomalies, or a problem with the placenta – and sometimes a combination of these situations. Some risk factors can be controlled, and some cannot.”
Dr. Santiago-Munoz

Is my baby small-but-healthy? Or could it be FGR?

By definition, babies diagnosed with FGR fall below the 10th percentile for estimated fetal weight and fundal height. Even if the baby is growing steadily, they may be diagnosed with FGR if they are below that benchmark.

But following these definitions FGR is sometimes over-diagnosed. Longstanding best practices data show that babies in the 3rd percentile or lower are more likely to have an FGR-related complication, and those above the 3rd percentile are more likely to be constitutionally small (based on non-health-related family history of smaller stature).

The UT Southwestern MFM team follows standard of care protocols for babies below the 10th percentile. We investigate every scenario to avoid taxing patients with undue stress related to overdiagnosis and over-management of FGR. Our goal is to understand:

Why your baby is small,
Whether your pregnancy is at risk of serious complications, and
Whether early delivery or continued monitoring is the safest choice for you and your baby.

To answer these questions, we rely on two diagnostic tools: amniotic fluid measurement and Doppler ultrasound examination of the umbilical cord. These evaluations may help determine the origin of the FGR and guide further management.

What can cause FGR?

Generally, growth restriction is associated with maternal risk factors, fetal anomalies, or a problem with the placenta – and sometimes a combination of these situations. Some risk factors can be controlled, and some cannot.

Maternal risk factors

Some of the most common maternal risk factors for FGR include:

Certain autoimmune conditions, such as lupus
Certain viral infections, such as rubella or malaria
Pregestational diabetes
Having twins or more
Hypertension (high blood pressure)
Smoking, drinking alcohol, and substance use

While it is tough to quit smoking, it’s best to quit before becoming pregnant. However, quitting smoking during pregnancy is proven safe and beneficial for you and the baby. Your prenatal care provider can connect you with effective, judgment-free smoking cessation or substance use treatment designed specifically for pregnant patients.

Fetal anomalies

Heart conditions are among the most common fetal problems that cause FGR. Genetic abnormalities such as trisomy 21 (Down syndrome) also tend to result in babies that are smaller compared with the general population. Fetal anomalies are also more frequently associated with stillbirth.

Problems with the placenta

The placenta, like any organ, can develop improperly. Sometimes the umbilical cord is inserted in the wrong place on the placenta or only one umbilical artery forms develops in the cord instead of two, situations associated with reduced placental blood flow to an otherwise healthy baby.

In rare cases, we see a placental tumor called a chorioangioma, disrupting normal function. Placental issues are often the cause of late-onset growth complications.

How is FGR diagnosed?

The diagnosis is based on ultrasound, and most centers use the 10th percentile cutoff to raise the alarm of possible fetal growth restriction. The next step is to have a discussion with the patient about her health history and her prior obstetrical history.

If a patient’s previous baby was less than 6 pounds at birth but was full-term and healthy, her current baby simply may be constitutionally small. If this is her first, or if previous babies were bigger, we will be more concerned about FGR. In either case, we will check the amniotic fluid and umbilical blood flow to help in the evaluation of placental function.

What happens next?

If the amniotic fluid and Doppler ultrasound are normal, we’ll watch the baby over the next few weeks and, if steady growth continues with no new concerns, that’s a good sign. The actual delivery timing will depend on how well the baby continues to grow and whether the amniotic fluid and the Doppler testing remain normal.

We generally recommend delivering the baby as close to the due date as possible to reduce the risk of needing long-term, specialized care after delivery. If the baby is:

Between the 3rd and 10th percentiles for size, we try to get them to 38 weeks gestation.
Smaller than the 3rd percentile, we try to get them to 37 weeks.

Often, our specialized team can safely get babies to 38 or 39 weeks before delivery, provided they have no other risk factors. Centers with less FGR management expertise tend to deliver earlier to avoid the risk of stillbirth. However, the earlier a baby arrives, the longer they typically stay in the neonatal intensive care unit (NICU).

Since the causes and severity of IUG can be so varied, your care plan will be customized based on your needs. Some patients are hospitalized for daily fetal heart rate monitoring. If you are hospitalized, we may recommend a complete course of steroids to help support fetal lung development before delivery.

If you end up needing early delivery, it does not mean an automatic cesarean section (C-section). Many babies are otherwise healthy except for being small, so it is likely safe to try vaginal delivery. Babies that are severely growth restricted or that have abnormal Doppler patterns may not do well with labor, so C-section may be indicated. A discussion with your doctor is always recommended.

What care will the baby need after birth?

Depending on how premature the baby is and the severity of its health problems, the newborn may need to stay in the NICU. Sometimes, these babies have trouble breastfeeding at first because they burn so many calories trying to latch and nurse.

Babies who are growth restricted often need many extra calories – more than breast milk or regular formula can provide. Our NICU specialists will work with nutritionists to supplement your baby’s diet with specialized, calorie-rich formula.

Many babies who start out being bottle-fed after growth restriction can learn to latch and breastfeed once they grow stronger. Patients who want to breastfeed are welcome to begin pumping to start building their milk supply.

It can be scary to learn that your baby is smaller than expected. Sometimes, babies simply grow on their own developmental curve. With specialized care during pregnancy and after delivery, most babies diagnosed with FGR in the third trimester have good outcomes.

To visit with a pregnancy care provider, call 214-645-8300 or request an appointment online.

Growth disorders in children. Child grows too slowly or too quickly

home > Symptoms of childhood diseases: section information > Growth disorders in children. The child is growing too slowly or too quickly.

A B C D E F G H I K L M N O P R S T U F X C H W Shch E Yu Ya

How tall a child will be depends on several factors: nutrition, heredity and health. Growth rates are determined by the genes of the parents, so children, tall or small for their age, do not suffer from growth disorders. If the baby was born large, it does not mean that when he grows up, he will certainly be tall.

To determine whether the development of the baby is normal or not, the pediatrician measures the length and weight, chest and head circumference at each scheduled examination. For the proper development and growth of the baby, he needs to eat well and fresh air, and healthy sleep. With a slight lag in growth or advance, it is important that the growth rate be maintained. (For example, children of the first year of life, the first 3 months grow at 3 cm / month, then slow down the growth rate).

DOCTOR'S CONSULTATION

Call your pediatrician if you notice:

the child does not grow, loses weight, or, conversely, he has an excess of mass

WARNING!

Children with sufficient physical activity develop and grow faster than children who spend a lot of time at the computer or TV, they have a sedentary lifestyle and grow more slowly.

ASK YOURSELF	POSSIBLE CAUSE	WHAT TO DO
The growth rate of a 1-2 year old baby has slowed down sharply. The child has begun to lose weight and is not gaining enough weight	Hypotrophy	Pediatrician consultation required to find out the reasons (this may be due to nutrition, the influence of certain diseases, etc.)
The child has a normal growth rate, but compared to his peers, he lags behind in growth	Constitutional features (small stature)	Make sure your baby gets all the nutrition he needs and he has a normal physical activity. Discuss your concerns with your pediatrician at your scheduled check-up
The child has a slow growth rate, sharply lags behind peers in growth.	Endocrine disorders (lack of growth hormone, insufficient thyroid function, etc.)	Go for a consultation with a pediatrician , if necessary, you need an examination and endocrinologist consultation
The child is normally built and healthy, but ahead of peers in growth	Constitutional features (large stature)	Make sure your baby gets all the nutrition he needs and he has a normal physical activity. Discuss with your child the features of his growth, if he is shy, this will help him stop slouching.
After the disease, the child began to grow worse	Growth retardation after illness	Make sure your little one is getting all the nutritious food they need and is having normal exercise and being active. If appetite or weight gain does not return after recovery after a few weeks, then Pediatric consultation required .
The child has a chronic disease (kidney or thyroid disease, gastrointestinal disease (colitis, etc.), or congenital chromosomal disease	Chronic disease interferes with normal growth	Consultation pediatrician must make sure that the child receives everything necessary for the underlying disease, that he has a balanced diet and sufficient physical activity
The child has increased mobility in the joints, arms and legs are long and thin. The child himself is tall and thin, mental development is normal, and muscular development is insufficient	Congenital disease (Morfan's Syndrome), accompanied by developmental disorders of the skeleton and sometimes the heart	Consultation of a pediatrician is needed , if necessary, he will refer to a specialist
Sudden rapid growth in a child of preschool or school age, coarse features. The head and lower jaw, hands look disproportionately large.	Excess growth hormone	Make an appointment with the pediatrician , he will refer you to an endocrinologist for examination if necessary.

FOR INFORMATION

Help with certain growth disorders

The rapid and disproportionate growth of a child under adolescence is very rarely associated with a disease of the pituitary gland, where growth hormone is produced. In these cases, the growth of long bones (limbs) and the lower jaw is especially accelerated.

On the contrary, with a lack of growth hormone, the child may remain very small. If the diagnosis is confirmed, replacement treatment may be needed to bring the child to an acceptable adult height. Such treatment is prescribed only for true hormonal disorders. In other situations, growth hormone is usually not used.

Children may be stunted as a result of exposure to infection, alcohol or drugs in utero; due to chromosomal disease; premature birth. In most cases, the diagnosis is made during fetal development or immediately after childbirth, and the necessary treatment is prescribed.

Pediatric appointment prices:



Inspection by the Pediatrician of the child to receive a certificate + certificate	1950
Departure of a pediatrician, Consultation at home (Moscow)	5400
Consultation of a pediatrician at home for the second child	1950 900

Pediatricians:

Avzalova Darya Evgenievna

Pediatrician, neonatologist

Experience: 18 years
Reviews: 7

Call to house