Some babies may be smaller than others during pregnancy. However, what’s important is that your baby grows at a healthy rate in your womb, regardless of their size.
Here’s what you need to know about your pregnancy if you have been told by your doctor or midwife that your baby is small or growing slower than expected. Your doctor or midwife may refer to a slower growth as ‘small for dates’, ‘small for gestation’ or ‘fetal growth restriction’.
Why is my baby small?
Most babies who are smaller than expected are healthy. In some cases, babies are small and appropriately grown, given the size of their parents and their ethnicity.
However, up to 10% of pregnancies will be affected by ‘fetal growth restriction'. This is a more serious complication that means your pregnancy must be closely monitored. In many instances, babies with fetal growth restriction are small because the placenta hasn’t developed well enough to keep up with the baby’s growing needs for nutrients and oxygen, although a cause may not always be found.
Risk factors for having a baby with fetal growth restriction include:
How is a baby's size measured?
During routine antenatal check-ups, your doctor or midwife will use a tape measure to estimate the growth and size of your baby by measuring your abdomen, from your pubic bone to the top of your uterus (or fundus). This is known as the ‘symphyseal fundal height measurement’ (SFH) and gives some indication about a baby’s growth during pregnancy.
If you have risk factors for fetal growth restriction, or if your baby has been diagnosed with this, your baby’s growth may be monitored more closely by ultrasound, instead of using a tape measure.
Every pregnancy is unique. Your doctor or midwife will track your baby’s growth at each check-up. They will talk with you about next steps if there are signs that your baby’s growth has slowed.
Should I be concerned if my baby is small?
Most small babies will be healthy. However, if your baby has fetal growth restriction, this increases the risk of complications and, sadly, also the risk of stillbirth. Your doctor and midwife will monitor you and your baby’s health closely to reduce the risk of this happening.
You can monitor your baby’s health by attending your scheduled antenatal visits and keeping a close eye on your baby’s movements. If you are concerned about your baby’s movements at any stage, call your doctor or midwife immediately.
Your doctor or midwife may also talk to you about the best time for your baby to be born. Sometimes it may be necessary for your baby to be born early, before your due date. Every situation will be different; your doctor or midwife will give you personalised advice each step of the way.
Generally a baby with fetal growth restriction can still be born via normal vaginal delivery, but you and your baby may need extra care both during labour and after the birth. This means it’s best to give birth where you can access specialist medical services.
Talk to your doctor or midwife about the best place for you to give birth.
Can I do anything to reduce the risk of having a small baby?
Often there is nothing you can do to prevent a baby being small. But looking after yourself during pregnancy is important to help reduce the risk of having a baby with fetal growth restriction. You should:
What to expect if your baby is born with low birth weight?
If your baby weighs less than 2.5kg at birth, their head may appear to be a lot bigger than the rest of their body. They may look thin with little body fat.
Babies of low birth weight or those who are born prematurely, may need to be admitted to the neonatal intensive care unit (NICU) or special care nursery (SCN).
Some of the challenges faced by babies with low birth weight can include:
- breathing or heart problems
- low oxygen levels at birth
- difficulty maintaining body temperature
- difficulty feeding and gaining weight
- infection
- bleeding on the brain (called ‘intraventricular haemorrhage’)
- problems with their eyes and vision
- problems with their intestines
These conditions are more likely to occur in premature babies and those with fetal growth restriction.
If there are no other complications, low birth weight babies usually 'catch up' in their physical growth. In later life, however, people who were born smaller than average are more likely to develop diabetes, obesity, heart problems and high blood pressure.
Here are some questions you might want to ask your midwife or doctor:
- What does having a small baby mean for me and the health of my baby?
- Will I need more regular check-ups during pregnancy? If so, what does this include?
- How will I know if my baby is well?
- Will having a small baby affect how and where I can give birth?
- Does having a small baby affect my next pregnancy?
Who can I talk to for advice and support?
Always talk to your doctor or midwife first if you have any concerns about your pregnancy, your own health or the health of your baby.
Sources:
Stillbirth Centre of Research Excellence (Your baby's growth matters), Department of Health (Pregnancy care 2020 edition), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Perinatal post-mortem examination)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: April 2022
ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS
Very low birth weight (VLBW) is a term used to describe babies who are born weighing less than 3 pounds, 4 ounces. It is very rare that babies are born this tiny. Only about 1% of babies born in the U.S. are very low birth weight.
The main cause of a baby having VLBW is being born too early. This is called preterm or premature birth. Premature means a baby is born before 37 weeks of pregnancy. Very-low-birth-weight babies are often born before 30 weeks of pregnancy. A premature baby has less time in the mother’s uterus to grow and gain weight. Much of a baby's weight is gained during the later part of pregnancy.
Another cause of very low birth weight is when a baby does not grow well during pregnancy. This is called intrauterine growth restriction (IUGR). It may happen because of problems with the placenta, the mother's health, or birth defects. Most very low birth weight babies who have IUGR are also born early. They are usually very small and physically immature.
A baby is more likely to be very low birth weight if he or she is premature or has intrauterine growth restriction. Other things linked to the mother can increase the risk for VLBW, growth restriction, and prematurity. They include:
- Having an infection during pregnancy
- Not gaining enough weight during pregnancy
- Having a previous pregnancy with a low-birth-weight baby
- Smoking
- Using alcohol or drugs
- Being younger than age 17 or older than age 35
- Being African American
Babies with very low birth weight look much smaller than other babies of normal birth weight. A very-low-birth-weight baby's head may look big compared to the rest of his or her body. A baby with VLBW often looks very thin with little body fat. Blood vessels can be easily seen through the skin.
One of the main reasons for regular prenatal exams is to make sure your unborn baby is growing well. During pregnancy, the size of your baby is estimated in different ways. Your steady weight gain is one way of checking on the baby’s growth.
Another way is to measure the top of your uterus from the pubic bone (fundal height). The number of centimeters measured is usually the same or close to the number of weeks of pregnancy. If the fundal height measurement is low for the number of weeks you are pregnant, it may mean that your baby is not growing well.
Other ways to check the baby’s growth are:
- Using ultrasound to estimate the baby’s growth and development. Your healthcare provider can use measurements of your baby's head, belly, and upper leg bone, to estimate his or her weight
- Comparing your baby’s estimated birth weight with his or her gestational age. The provider may use a formula to figure out your baby’s body mass.
A birth weight of less than 5 pounds, 8 ounces is diagnosed as low birth weight. Babies weighing less than 3 pounds, 4 ounces at birth are considered very low birth weight.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Babies with VLBW may need:
- Care in the neonatal intensive care unit (NICU)
- Temperature-controlled beds
- Special feedings, sometimes with a tube into the stomach if the baby can’t suck
- Other treatments for complications
The outcome for a baby with VLBW depends mainly on how much the baby weighs and how many weeks of gestation the baby is at birth. The smallest and earliest babies have the most problems. They are less likely to survive.
Babies with VLBW may have a harder time catching up in physical growth because they often have other problems. Many very-low-birth-weight babies are referred to special follow-up healthcare programs.
Babies with a very low birth weight have a greater risk of developing problems. Their tiny bodies are not as strong as babies of normal weight. They may have a harder time eating, gaining weight, and fighting infection. They have very little body fat. So they often have trouble staying warm in normal temperatures.
Most babies with a very low birth weight are also premature. This can make it hard to separate the problems caused by the prematurity from the problems of just being so tiny. In general, the lower the baby's birth weight, the greater the risks for complications. Here are some of the most common problems of babies with VLBW:
- Low oxygen levels at birth
- Trouble staying warm
- Trouble feeding and gaining weight
- Infection
- Breathing problems because of immature lungs (respiratory distress syndrome)
- Nervous system problems, such as bleeding inside the brain or damage to the brain’s white matter
- Serious digestive problems, such as necrotizing enterocolitis
- Sudden infant death syndrome (SIDS)
Almost all very-low-birth-weight babies need special care in the NICU until they can gain weight and are well enough to go home.
Risks for long-term problems and disability are increased for babies with VLBW. Long-term complications may include:
- Cerebral palsy
- Blindness
- Deafness
- Developmental delay
Talk with your baby's healthcare provider about your baby’s risks for complications.
There have been advances in the care of sick and premature babies. More babies today survive even though they are born early and very small. But preventing preterm births is one of the best ways to prevent very low birth weight.
Regular prenatal care is the best way to prevent preterm births and very-low-birth-weight babies. At prenatal visits, your health and the health of your unborn baby are checked. It is important to:
- Follow a healthy diet during pregnancy. This will help you gain enough weight to help your baby grow and help you stay healthy.
- Not use alcohol, cigarettes, or drugs. All of these can cause low birth weight and other problems for your baby.
Key points about very low birth weight
- Very low birth weight is a term used to describe babies who are born weighing less than 3 pounds, 4 ounces.
- The main cause of very low birth weight is being born too early, called premature birth.
- Treatment for very low birth weight babies includes care in the NICU, temperature-controlled beds, and special feedings.
- In general, the lower the baby's birth weight, the greater the risks for complications.
- Prenatal care is a key factor in preventing preterm births and very low birth weight.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.