You will hear this term if your child is judged by doctors to weigh less than other children of the same sex and at the same age. When your baby is born, he will likely weigh less than most other babies.
If your baby weighs less than 2.5 kg at birth, he is considered low birth weight.
You may hear other terms with similar meanings. If your baby is not growing in the womb as quickly as other babies at the same stage, he will be called . Other terms that may be used include low weight for gestational age or intrauterine growth restriction (IUGR).
Sometimes these definitions are imperfect because they are based on comparisons with average data. For example, your child may be small simply because that is a characteristic of your family.
It is not always easy for doctors and obstetricians to determine the body weight of a baby in the womb. Measuring the size of your belly is one method. If your baby appears small, you will be referred for an ultrasound.
What can cause low body weight and the birth of a low birth weight baby?
There are many reasons. Some people are simply smaller than others.
Parents who are below average in height and weight, or who themselves had low birth weight, may have small children. If this applies to you, tell your doctor and midwife.
Other causes of low birth weight for a given gestational age include:
- Problems with the placenta, such as preeclampsia, which reduces blood flow to the fetus. This can cause developmental delay (FGR) because the baby will not receive enough oxygen and nutrients.
- High blood pressure (hypertension) can also interfere with blood flow to the fetus through the placenta. This may result in the birth of a low birth weight baby.
- Twins or triplets are more likely to be born small because they don't have enough room to grow.
- Sometimes children are small because they have inherited some disease.
If you suffer from any physical or mental disorders, this may slow down your baby's growth. The reason for the birth of a low birth weight baby may be:
- advanced untreated infection, such as a urinary tract infection or uterine infection
- a diet that is severely deficient in nutrients and calories
- chronic diseases such as heart, lung or kidney disease, diabetes
- or serious financial difficulties
- taking drugs such as heroin or cocaine
- eating too much
- smoking
How can I help my child?
In many ways, a “good start” for your baby depends on you. You can get started right now:
- if you have a medical condition such as diabetes or diabetes, talk to your doctor about how it can be managed during pregnancy
- Don't drink more than one or two glasses of wine a week, or don't drink alcohol at all
- eat balanced and watch
- Get help if you think you may have problems quitting drugs
- quit smoking
Changes in your lifestyle will have a beneficial effect on the health of your unborn child. Quitting smoking during pregnancy has been shown to help reduce the risk of having a low birth weight baby. Special courses or programs can help you cope with smoking, alcohol or drug use while you are pregnant. Be sure to have regular gynecological checkups during pregnancy so that any potential problems are caught and prevented early.
Where can I get help?
Talk to your doctor about any concerns or concerns you have about your pregnancy. You can also read our articles and find out:
- principles of healthy eating during pregnancy
- how to quit smoking
Many parents are familiar with the problem of children who have a reduced body weight, who eat poorly and do not keep up with their weight gain. Usually, low weight, both at birth and in the future, is very worrying for parents, as this may indicate health problems and deviations from normal physical development. Why do children gain weight poorly, although all the conditions for a full gain have been created for them? Let's try to understand this problem in more detail.
Who are low birth weight babies?
Pediatricians call low-birth-weight children those babies who do not gain the required body weight by a certain period of gestation (weeks of pregnancy). Or those who gain weight poorly after birth for months, and it is difficult to feed them, you have to almost force feed them, or those children who seem to eat normally, but at the same time their weight is gaining at an extremely low rate. This often greatly worries the local pediatrician observing the child, and no less greatly worries the parents themselves, looking at the neighbor’s toddlers, growing by leaps and bounds. At the same time, children develop quite normally, but weigh very little. According to medical terminology, such low birth weight babies can be called differently; this group also includes premature babies who have low body weight due to being born prematurely. The general name for such a deviation in weight from the norm, which unites all possible variants of reduced weight in children in comparison with age norms, is the term malnutrition (low nutrition level) used by doctors. In world sources, another term is taken as a basis - this is a violation of nutritional status. In essence, this is the same thing, but in our country it is the term malnutrition that is adopted. Today we will talk about the problem of the development of prenatal malnutrition - this is a type of malnutrition that develops in utero, before the birth of a child. In this case, babies with malnutrition are born on time, but have a low birth weight. Sometimes, in connection with this phenomenon, another term appears - IUGR (intrauterine growth retardation), but this does not always correspond to the true state of affairs, although most often low birth weight and IUGR go hand in hand. Why might such a problem arise? Why would the child’s intrauterine development suddenly be delayed if the mother herself gained weight during pregnancy? Why are children born so small?
What are the reasons for having low birth weight babies?
There are quite a lot of reasons for a child to be born low birth weight, and in each specific case they will be different and special, sometimes it will be a combination of a number of factors. To understand this survey and understand the reasons for the birth of such small children, it is worth starting from the very beginning of pregnancy and, as it were, looking inside the pregnant uterus. So, from the moment of conception until about sixteen weeks of pregnancy, the unborn baby is a very small lump of cells, rapidly growing and dividing, turning into tiny organs and tissues. In just three to four months, one cell turns into a baby up to fifteen centimeters in length with arms and legs, nails, a beating heart and its own feelings and emotions. After sixteen weeks, the baby’s cells are no longer dividing at such a rapid pace, not so actively, but those cells that are already present begin to grow quickly and intensively and “get fat”, increase in size - up to thirty-two weeks the baby is growing rapidly and gaining weight . From this period until the moment of birth, the future baby practically does not form new tissues, while all existing organs mature, and the baby himself grows and actively gains weight. Depending on which of these three periods the problems of the mother’s body will arise, the form and severity of the development of IUGR will depend, and the baby’s weight at birth will depend on this.
The reasons for the birth of children with low weight at the time of birth are the very young age of the mother, when her body itself is still immature (this is up to eighteen to twenty years), or the birth of children by women after forty to forty-five years. In addition, the child’s weight is significantly affected by the presence of diseases in the mother during pregnancy - a decrease or increase in blood pressure, kidney disease (pyelonephritis and glomerulonephritis), the presence of diabetes mellitus, manifestations of chronic tonsillitis, the presence of anemia, carious processes. The development of low weight is also influenced by the presence of viral infections during pregnancy, existing gynecological diseases both before and during pregnancy, as well as previous miscarriages and abortions, cycle disorders and hormonal imbalances. The weight of children before birth is no less strongly influenced by gestosis of pregnancy, constant stress, eating disorders of the woman herself to please her figure, the presence of bad habits, unsatisfactory living conditions and occupational hazards.
Why are all these factors so influential? It's simple - these reasons lead to disruption of normal blood circulation and functioning of the placenta, and this, in turn, leads to disruptions in the supply to the fetal body of both nutrients necessary for normal growth and development, and oxygen, which the fetus needs in very large quantities. Fetal hypoxia is the most basic cause of suffering in all organs and systems of the baby; first of all, the endocrine, nervous and immune systems of the fetus suffer from it, that is, all those systems that are mainly responsible for the normal growth and development of the fetus. Since the functions of the placenta are disrupted, this disrupts the supply of nutrition to the fetus, which means it causes a slowdown in the growth and development of the fetus - this is what the doctor sees.
If adverse effects were exerted on the fetus in the earliest stages of its development, before sixteen weeks of pregnancy, when the most intense cellular processes in the baby’s body take place, then disturbances in the development of the fetus will be the most obvious and pronounced. Such a child at the time of birth will have not only low body weight, but also very short stature. Outwardly, these children will look quite normal, they will just be uniformly reduced in both height and weight. But, at the same time, in the body of such children there will be more developmental problems; their manifestations will not be visible immediately, but will gradually begin to manifest themselves. After this period, the influence of harmful factors will mostly be reflected in the weight of the fetus, while at birth the babies will look thin and have a long body. That is, the growth of such children may be quite normal for the duration of pregnancy, but body weight is usually less than three kilograms. After a low birth weight baby is born, the pace and mechanisms of development in such children will be their own, special. And all this will depend on at what stage of pregnancy, how long and how strongly the negative factors influenced the fetus, what exactly they were and how irreversible the disorders became.
Groups of low birth weight children
Among neonatologists and pediatricians, a special classification of low birth weight babies has been adopted, which divides them all into four main groups based on weight and height. These include:
The first group - children are born with completely normal height, but at the same time have low weight. Usually, from the first days of life, such children have a rather restless character, they scream a lot, sleep poorly and restlessly, can exhaust the whole family with their whims and feel calm only in the arms of their parents, they do not latch on well or suck a bottle well, they burp a lot, May confuse day and night. With such a restless nature, weight gain per month may be uneven and low, which will cause concern to doctors and parents. This can continue for quite a long time, but in the end the weight is usually corrected.
The second group - the baby’s body weight at birth is usually low, while growth is slightly behind the norm. In such babies, inhibitory reactions of the body are predominant, they can sleep for a long time and a lot, they need to be woken up every time for feeding, they sluggishly and reluctantly suckle at the breast or formula, refuse complementary foods, and feeding becomes a whole operation - since children eat little and with with great reluctance. Such children may simply turn away from any food or do not open their mouths to be fed. Such children may also lag somewhat behind in psychomotor development - they begin to hold their heads up, sit, walk and talk later than their peers; they begin teething later than usual and the large fontanel closes.
The third group is children with proportionally reduced weight and height, who look like a very reduced normal baby. Usually, after birth, such children do not cause any special trouble in terms of feeding and care, but the development of such children is slower than usual, their height and weight do not increase as actively as in ordinary children, as would be expected by age. Psychomotor development will also be slow; these children often get sick for a long time, since their immunity is sharply weakened.
The fourth group consists of children with profound disorders of intrauterine development, with noticeable delays in weight, growth and mental development. Such children have significant deviations in both weight and height gains and skeletal development; these are usually children with disabilities and developmental problems. Such cases are rare. Usually children have the first three groups of problems.
Tomorrow we will continue this topic.
The physical development of children is assessed by systematically determining body mass (weight), height, head circumference, chest, the relationship between these indicators and their compliance with age standards. The average weight of a full-term baby at birth is 3500 g, its fluctuations are possible within the range of 2500-4500 g. By the 3-5th day of life, maximum weight loss occurs, amounting to 6-8% of birth weight, and by 7-10 days the weight is restored. Then weight gain begins: in the 1st month of life - 800 g; for the 2nd month - 1000 g; by 4.5 months, birth weight doubles, by 1 year the weight triples and averages 10-10.5 kg. In the first years of life, weight gain averages 2 kg, in the prepubertal period - 5-6 kg.
The physical development of low birth weight and premature babies occurs differently; the dynamics of their body weight differs significantly from those of full-term children. Low birth weight children show a weight loss of about 9%; in children born before 1000 g, weight loss reaches 15%. Their weight restoration occurs slowly - up to 2 weeks or more. Achieving the weight of a normal full-term baby up to 3200-3500 g and a length of 50-51 cm in premature and low-birth-weight babies occurs by 1-1.5 months (if body weight at birth is 2000-2500 g), by 2-2.5 months (1500 -2000 g) and by 3-3.5 months (1000 g). The average monthly increase in body weight in the first half of life ranges from 600 to 800 g, in the second - 800 g.
The height of a newborn child is 50 cm (height fluctuations are possible from 45 to 55 cm). Monthly growth increases in the first half of the year are 1-2 cm. During the first year of life, the child grows by 25 cm, and his height by the year reaches 75 cm. In the second year of life, height increases by 12 cm, in the third year - by 7-8 cm , then the child grows by 5 cm per year, and by the age of 4 his height doubles, and by the age of 12 it triples compared to his height at birth. The growth process of a child is influenced by many factors: quality of care, nutrition, physical activity, etc. Heredity is also of great importance.
The chest circumference of a newborn is 34-35 cm, by one year - 48 cm, head circumference - 35 cm, by one year - 46 cm.
Anthropometric indicators can be assessed using centile or sigma tables and indices.
Chulitskaya index: 3 shoulder circumferences + hip circumference + lower leg circumference - height = 20-25 cm for children under 1 year. A decrease in the index indicates malnutrition, an increase indicates paratrophy.
Erisman index: chest circumference - 1/2 height = 10012 cm. This index is used to assess the physical development of schoolchildren.
During each preventive examination, it is advisable to note your height and weight on a growth chart, which can be used to determine whether your weight is appropriate for your height.
When assessing the neuropsychic development of a child, neurological examination (assessment of the child’s reflex responses) and behavioral reactions are used. A child is born with a number of unconditioned reflexes: proboscis, searching, sucking, Babkin, Moreau, Babinekiy reflexes, etc. Many reflexes, such as Kernig, Bauer, supports, disappear by 3-4 months. At the 2nd-3rd week of life, the child fixes his gaze on a bright object and follows a high-raised toy. By 1-1.5 months of age, he begins to hold his head up, coordinated movements of his hands develop (he brings his hands closer to his eyes, nose, and looks at them). From 3 months, the child feels his hands, moves his hands through the blanket and diapers. From 5 months he grasps objects, but at the same time makes a lot of unnecessary movements, and only by 7-8 months does the coordination of the motor and visual analyzers appear.
At 4-5 months, the coordination of back muscle movements improves, the child turns over from back to stomach, at 5-6 months - from stomach to back. At 6 months, the child begins to sit, and at 7-8 months, crawling. At 8-9 months, the child stands in the crib, steps his feet along the back of the crib. By the age of one year he takes his first steps. Some children begin to walk at 10-11 months, others at 1 year 4 months.
From 2-3 weeks, during the feeding process, the baby examines the mother’s face, and from 8 weeks he smiles at her. At the age of 5 months, he recognizes his mother among other people. After 6-7 months, active cognitive activity is formed, and after 9 months, emotional activity intensifies.
By 2-3 months the child is “booming”, by 5 months there is a long melodious “booming”, and at 7 months babbling appears. At 10-11 months, the child pronounces individual words, by one year and 10-12 words, by 1.5 years - whole sentences, and looks at pictures with interest. At 2 years old, he perceives simple stories and fairy tales; by the 3rd year, speech takes a leading place in communication.
The doctor learns about the development of movements, communication skills, and speech development from a conversation with parents and through contact with the child.
Based on materials from Pariyskaya T.V. and Orlova N.V. ". Directory of a family doctor"
Low birth weight babies are considered to be those whose weight at birth, regardless of gestational age, is less than 2500 g. Low birth weight newborns are divided into three categories: 1) premature (gestational age less than 37 weeks), whose weight corresponds to gestational age; 2) premature, small for gestational age; 3) full-term and post-term newborns, small for their gestational age. Children belonging to categories 2 and 3 have intrauterine developmental delay. Intrauterine growth retardation occurs in 3-7% of all births. The diagnosis is made if the baby's birth weight is below the 10th percentile for gestational age.
Growth ratio is also used to diagnose intrauterine growth retardation. It helps to diagnose intrauterine growth retardation not only in low birth weight newborns, but also in those whose weight is more than 2500 g. The growth coefficient is the percentage ratio of the weight of the newborn (in grams) to the body length (in centimeters) raised to the third power.
Height coefficient = weight (g) ґ 100%/[body length (cm)] 3.
A.Classification. Intrauterine growth retardation is an obstetric diagnosis that is made when there is a noticeable delay in fetal development. Intrauterine developmental retardation can be symmetrical or asymmetrical. With asymmetrical intrauterine growth retardation, which is more common, only the circumference of the fetal abdomen, the size of the head and the length of the tubular bones are normal. Symmetrical intrauterine growth retardation is much less common and is characterized by a proportional decrease in all sizes of the fetus.
B.Pathogenesis. According to Winick, the normal development of the embryo and fetus is divided into three phases. The first covers the period from the 1st to the 16th week of intrauterine development, when a rapid increase in the number of cells occurs. Subsequently, from the 16th to the 32nd week, cell division slows down and they begin to increase in size. From the 32nd week of intrauterine development, cell division almost stops.
Manifestations of intrauterine growth retardation depend on the disrupted phase of development. Symmetrical intrauterine growth retardation occurs as a result of chromosomal abnormalities, infections and the influence of exogenous factors in early pregnancy. Asymmetrical intrauterine growth restriction usually occurs late in pregnancy. Its main cause is placental insufficiency. The cause of intrauterine growth retardation often cannot be determined, and measuring parts of the fetal body does not always allow one to accurately determine its type.
IN.Diagnostics. Clinical data are confirmed using ultrasound. Since the diagnosis is made by comparing the size of the fetus with normal ones for a given stage of pregnancy, it is only possible if the exact stage of pregnancy is known.
1. Fetometry. Ultrasound determines the circumference of the fetal abdomen (the most reliable indicator of growth), biparietal size and head circumference, as well as the length of the fetal thigh. If asymmetrical intrauterine growth retardation is suspected, the ratio of the head circumference to the abdominal circumference, as well as the length of the thigh to the fetal abdominal circumference, is determined. Since false-positive results are often observed, when diagnosing intrauterine growth retardation based on ultrasound data, it is important to take into account changes in not one, but several fetometric indicators.
G.Tactics for pregnancy management in cases of suspected intrauterine growth retardation
1. Prenatal care. Intrauterine growth retardation is a risk factor for fetal death. With intrauterine growth retardation caused by placental insufficiency, the prognosis can be improved with early diagnosis and timely treatment, including delivery.
Stress and non-stress tests are performed. The biophysical profile (assessment of the condition and growth of the fetus) is determined using fetal ultrasound and CTG. The results are assessed by comparing the following parameters: respiratory rate, number of movements, heart sounds, amniotic fluid volume and heart rate variability during a non-stress test. In addition, Doppler studies measure blood flow in the umbilical cord vessels and uterine arteries. Repeated ultrasounds of the fetus are performed.
If intrauterine growth retardation is suspected, regular monitoring is indicated. Timely diagnosis is important for developing further management tactics.
2. Due date depends on the condition of the fetus. If the suspicion of intrauterine growth retardation is not confirmed (the fetus is growing and the parameters of the biophysical profile remain within normal limits), delivery is carried out no earlier than the 37th week of pregnancy after confirmation of the maturity of the fetal lungs. Indications for early delivery are lack of growth, severe oligohydramnios and impaired fetal heart rate variability. An individual approach to the management of a pregnant woman is an important condition for a favorable outcome in cases of intrauterine growth retardation.
D.Treatment. For intrauterine growth retardation caused by infection and chromosomal abnormalities, no treatment has been developed. For intrauterine growth retardation of unknown etiology, the only treatment method is bed rest. Previously, great importance was attached to the nutrition of pregnant women. However, recent research has shown that malnutrition is rarely a cause of intrauterine growth retardation. The effectiveness of nutritional supplements and vitamins in the treatment of intrauterine growth retardation was low. The administration of heparin, beta-agonists, blood substitutes, and abdominal decompression also proved ineffective.
E.Management of childbirth. The method of delivery depends on the position and presentation of the fetus, the maturity of the cervix, and the variability of the fetal heart rate in response to uterine contractions. With intrauterine growth retardation, accompanied by oligohydramnios, positive stress and negative non-stress tests, fetal hypoxia often develops during childbirth. In order to avoid severe fetal hypoxia, cesarean section is indicated. If it is decided to give birth through the natural birth canal, the woman in labor is placed on her side. For oligohydramnios, warm saline solution is administered intraamnially. After birth, the child is immediately transferred to a neonatologist. Due to the fact that during fetal hypoxia intrauterine passage of meconium is often observed, equipment is prepared to prevent aspiration. The early neonatal period is often complicated by impaired thermoregulation, hypoglycemia and hyperbilirubinemia.
Body weight is an important criterion for the development of a baby. Birth weight is included in the mandatory primary system for assessing the baby’s condition - the Apgar scale. How a baby gains weight after birth is important in determining his general condition, which is why the baby is weighed at every pediatrician appointment.
In this article we will talk about age-specific weight standards, and also give the opinion of the famous pediatrician Evgeniy Komarovsky on what to do if a child is overweight or does not gain the required weight.
About the norms
All children are individual, and this also applies to weight. Some are born large, while other newborns born at the same time weigh less and there is nothing unusual in this, because their parents are different (big and thin, tall or short). Birth weight plays a big role for premature babies; the degree of prematurity is determined by it, as well as by the exact gestational age.
Normal weight for a full-term baby is on average 2.6-4 kilograms. The range of normal values is quite wide.
After birth, weight gain will be monitored monthly for up to a year.
Unlike height, which is a more stable indicator of the correct development of a baby, his body weight can be more labile: weight decreases or increases under the influence of various reasons. Even within one day, according to Komarovsky, parents can see different values on the scale.
- if the child is under one year old, then his weight is m+800n, where m is birth weight, and n is age in months;
- if the child is already one year old and up to the age of ten, they use another formula, in which the normal body weight is 10 + 2n, where n is age in years;
- if the child is over 10 years old, then for the calculation they use a formula in which the normal weight is 30 + 4 * (n-10), where n is age in years.
Thus, it is easy to understand that a baby at 7 months, if he was born weighing 3500 grams, should weigh no less than 3500+ 800x7, that is, 9 kilograms 100 grams. A 2-year-old child weighs 10+2x2, that is, 14 kilograms. Just plug in your values and you can focus on the norm.
You can make it simpler and use a table or calculator for height and weight depending on age. Pediatricians also use tables at appointments, since this significantly reduces the time a child is seen, because the doctor does not need to do mathematical calculations.
Naturally, if the norm is significantly exceeded and in situations where the child is not gaining weight well, you need to carefully consider and eliminate the possible reasons why this is happening.
Height and weight calculator
Reasons for the lag
The most active weight gain occurs in the first six months of a child’s life, then the pace slows down, because the child’s physical activity increases - he learns to crawl, sit, and this requires large energy expenditures. Low birth weight children sometimes gain weight more actively than babies born rich; the gain in such babies can be more intense.
A significant lag in real body weight from the norm can be a consequence of malnutrition and malnutrition, diseases of the gastrointestinal tract, as well as any other congenital or acquired diseases.
Naturally, the pediatrician will identify the causes, prescribe tests, and give recommendations on diet.
If a child is slightly behind the norm in weight, but he is active, mobile, inquisitive, feels great and has normal tests, there is nothing to worry about, says Komarovsky. It is dangerous if a small increase and a lag behind the standards are accompanied by pallor, lethargy, and some other symptoms that make parents think about a possible illness, it is important to immediately go to the doctor, says Evgeny Komarovsky.
Complaints from parents that the child has a big belly at 2 years old and weighs 10 kg, as well as that the child at one year old weighs only 8 kilograms instead of the required 10, should be considered in each specific case, taking into account a complete medical history. The doctor needs to know what weight the child was born with, how he feels in everyday life, and also see what build the parents have.
It is quite clear that a sharp decrease in body weight can be a sign of quite serious diseases and common helminthic infestations, and therefore laboratory diagnostics in this case cannot be avoided.
For parents of little ones who eat little and not every time, Komarovsky advises to calm down and stop trying at any cost to fatten the child up to the age standard. The approach is the same: if you feel normal and healthy, then you don’t need to do anything to correct it.
Why does the excess occur?
Excessive weight gain is most often due to the fact that the baby’s parents overfeed. Excess weight is formed when the degree of energy expenditure does not correspond to the amount of food received. An infant who sleeps most of the day gains weight better and faster than an active and moving two-year-old.
Fluctuations in weight up (or down) are also possible during intense hormonal changes, for example, this is how a teenager loses weight or gains weight during puberty. Some pathologies of the thyroid gland and other endocrine disorders can cause childhood obesity, but this happens much less frequently than the banal and widespread overfeeding of a beloved child.
A child over 2 years old may be overweight due to a sedentary lifestyle and little activity; the risk of acquiring extra pounds is higher in children who are allowed to eat and drink unhealthy but very tasty fast food, lemonade, and chips.
What to do? Show your child to a doctor, if necessary, examine him, do blood tests, check the functioning of the gastrointestinal tract and receive recommendations for smooth and careful weight loss.
An adequate increase in physical activity while stopping the practice of force-feeding usually helps. Evgeny Komarovsky advises giving food to a child only when he himself asks for it.
You cannot feed your child in front of the TV screen: being carried away by the picture, he eats more than what he should.
Parents should also pay attention to their own eating habits; poor nutrition usually runs in the family. Fatty and fried foods, smoked foods, spicy foods, fast food, and an abundance of sweets should disappear from the child’s diet. Instead, vegetables and fruits, stewed, boiled and baked meat and fish should come. It is worth giving up lemonade and various store-bought sweets.
Why is it important to monitor your child's weight? Excess weight is dangerous at the stage of starting to walk, because it creates increased stress on bones, joints, cartilage, ligaments and the spine. In children with excess body weight, flat feet are more often registered at a later age. Obesity is fertile ground for the development of various diseases, as well as a factor in reducing immunity.
For more information about weight standards, see the next program by Dr. Komarovsky.
