Small for Gestational Age: When Baby Is Born Smaller Than Normal

WORDS PROFESSOR DR MUHAMMAD YAZID JALALUDIN

PROFESSOR DR MUHAMMAD YAZID JALALUDIN
Senior Consultant Paediatrician and Paediatric Endocrinologist
UM Specialist Centre

Most babies seem small when they first come into the world, but for some, they truly are smaller when compared to their fellow babies-in-arms.

This condition is known medically as small for gestational age (SGA for short).

Gestational age, by the way, is the length of time a baby spends growing in their mother’s womb.

Small for gestational age babies that weigh below 2,500 g at birth are additionally considered to have low birth weight.

SMALL FOR GESTATIONAL AGE CAN BE MEASURED AND DETECTED AFTER A BABY IS BORN

After a mother has given birth in a hospital or clinic, nurses will clean the newborn and giving them a quick check for any abnormalities. The nurses will also measure the length and head circumference of the baby as well as weigh.

These measurements inform healthcare professionals whether or not a baby is small for their gestational age.

POSSIBLE CAUSES OF SMALL FOR GESTATIONAL AGE

Pregnant women should go for their antenatal check-ups to monitor for and manage any problems that might result in a small for gestational age baby
The mother’s health during pregnancy
  • Presence of infections or medical conditions such as heart disease, uncontrolled diabetes, thyroid disease, or high blood pressure
  • Drinking alcohol or smoking
  • Poor nutrition during pregnancy
The mother’s age

The risk of having a small for gestational age baby is significantly higher for women aged 30 and above that have never given birth before, as well as all women aged 40 and above, compared to women in their 20s.

The mother’s height

Women that are short are at risk because their smaller wombs and shorter birth canals influence the growth of their foetus.

Family history

Interestingly, research has shown that the risk of having a small for gestational age baby can be influenced as far back as two generations.

If the pregnant woman and/or her own mother were small for gestational age babies, the foetus has a higher chance of being born small for gestational age.

Issues with the placenta during pregnancy
  • Placental insufficiency, which happens when the blood vessels in the uterus that are supposed to transform into the blood vessels of the placenta do not change as they should, can lead to placental infarction
  • Placental infarction sees the disruption of the blood supply to the placenta, resulting in the death of placental cells, placental abruption (the placenta partially or completely separates from the uterus before childbirth), and structural abnormalities of the placenta
  • All these conditions cause the foetus to receive insufficient nutrients and oxygen from their mother, thus affecting their growth
Chromosomal or genetic abnormalities

These abnormalities include those that give rise to Down syndrome and congenital abnormalities such as structural defects of the heart, kidneys, lungs, or intestines.

Other possible causes

Catching an infection while in the womb or being part of a multiple pregnancy (twins, triplets, etc) can also negatively affect a foetus’s growth.
SMALL FOR GESTATIONAL AGE COMPLICATIONS AFTER DELIVERY
  • As they have only small amounts of fat or energy stored away, they may have a low body temperature at birth. This can result in hypothermia, where the body loses heat faster than it can produce it. If this condition is prolonged, the baby can die as their heart and brain cannot function well at these sub-optimal temperatures.
  • The lack of fat and glycogen stored in a small for gestational age baby’s liver can cause hypoglycaemia, where they have low blood sugar levels that are unable to match their body’s needs. This can cause the baby to have seizures and/or brain damage. If the hypoglycaemia is prolonged, the baby may die or develop long-term neurodevelopmental deficits, including cerebral palsy.
  • As they are deprived of sufficient nutrients in the womb, small for gestational age babies become ‘programmed’ to hoard whatever nutrients and calories they receive. This means that after birth, they can very easily put on weight if their caloric intake is not carefully monitored. Thus, these babies are prone to obesity and its associated conditions (diabetes, high blood pressure, high cholesterol, osteoarthritis, heart disease, etc). This “programming” lasts throughout their lifetime.
  • Their growth rate can influence when they achieve puberty. Small for gestational age babies that catch up in their growth very quickly might experience early puberty. On the other hand, if they are slow in growing, their puberty might be delayed.
  • Persistent short stature.
SMALL FOR GESTATIONAL AGE, FORTUNATELY, CAN BE MANAGED

Generally speaking, small for gestational age babies should be able to catch up in their growth within the first six months to two years of their life with good nutrition.

In fact, 85% of these babies achieve normal height and weight for their age and gender by two years of age.

Some children require a longer time and there is still some leeway until the age of five to allow them to catch up in growth to their peers.

However, by five years of age, 8-10% of small for gestational age babies would still be smaller than normal, and this is the time that parents and doctors need to start discussing treatments for the child.

Growth hormone therapy
  • The main treatment for small for gestational age babies that do not manage to catch up in growth by the time they are four to five years old
  • Will enable them to achieve their optimal final height as adults, through improving muscle and bone growth
  • Helps increase the breakdown of fats, to address the tendency of small for gestational age babies to accumulate fat and become obese
Good nutrition
  • Nutrition plays a critical role in the first two years of life in promoting a child’s growth
  • Their diet must be carefully monitored as they are prone to becoming overweight; on the other hand, when they are not fed enough, they might become stunted
  • Parents need to do a careful balancing act when it comes to feeding their small for gestational age baby
Regular physical activity
  • As the child grows, parents also need to encourage and allow their child to be active
  • Doing so will prevent excessive weight gain and help stimulate the natural production of serotonin and growth hormone to help the child grow
  • Such physical activity must be vigorous enough that the child’s heartbeat increases and they sweat.
Proper sleep
  • It is critical that children are asleep at the latest by 9 pm, as the peak time for the body to produce its natural growth hormones is between 10 pm to 12 am.
  • Sleeping later, as many Malaysian children tend to do, will cause them to miss this critical period of growth hormone secretion.

What Every Parent Should Know about Congenital Heart Defects in Children

WORDS DR CHOO KOK KUAN

DR CHOO KOK KUAN
Consultant Paediatrician and Paediatric Cardiologist
Subang Jaya Medical Centre

The most common heart disease among children is known as congenital heart defects.

This condition occurs when the heart or the blood vessels near the heart do not develop normally before birth.

HOW COMMON IS THIS CONDITION?

According to our Ministry of Health, the incidence of congenital heart defects among children is about 8 to 10 per 1,000 live births.

With an average of 500,000 deliveries in Malaysia each year, the number of children born with congenital heart defects is about 5,000 a year, of which two-thirds will require surgical intervention.

THE CAUSES & RISK FACTORS

Most congenital heart defects have no known cause.

They may sometimes run in families.

Some congenital heart defects may be associated with genetic disorders, such as Down syndrome, Turner syndrome, Williams syndrome, etc.

Some children have a higher risk of developing congenital heart defects if the mother has diabetes or rubella, or has taken certain medications such as anti-epileptic drugs, during pregnancy.

DETECTION OF CONGENITAL HEART DEFECTS

Sometimes a heart defect can be diagnosed before a baby is born.

However, defects are usually identified days or even months after birth, when symptoms become obvious.

Less serious congenital heart defects may not show any noticeable signs or symptoms, so they may only be diagnosed later in childhood.

It is also possible to have a heart defect and show no symptoms at all.

POSSIBLE SIGNS THAT A BABY OR YOUNG CHILD MAY HAVE CONGENITAL HEART DEFECTS
  • Rapid breathing
  • Bluish discolouration commonly noticed around the lips, fingernails, palms of the hands, and soles of the feet
  • Shortness of breath during feeding, leading to poor weight gain
  • Poor growth
  • Recurrent lung infection
WILL A CHILD WITH CONGENITAL HEART DEFECTS BE OKAY?

As a result of medical advancements, the outlook for congenital heart diseases is increasingly positive.

Most children with this condition reach their adulthood.

In fact, children with simple conditions may lead completely normal lives, while those with more complex conditions usually face more challenges that can nevertheless be addressed with the right measures in place.

6 THINGS THAT EVERY PARENT OF CHILDREN WITH CONGENITAL HEART DEFECTS SHOULD KNOW AND DO
  1. Heart medications can be very strong and dangerous if not given correctly. Parents must understand how much medicine to give and how to give it. If the child takes a blood thinner, parents must have clear instructions on how to give this medicine safely.
  2. Ensure the child eats well and receives adequate nutrition. They often tire when eating, so they eat less and may not get enough calories.
  3. Prevention of infections is crucial. Although an infection in the heart (endocarditis) is uncommon, children with heart defects have a greater risk of developing this. Good dental hygiene goes a long way toward preventing endocarditis by reducing the risk of tooth or gum infection. Parents can get more information from cardiologist about the latest guidelines on antimicrobial prophylaxis against infective endocarditis. These children must also get all the recommended vaccinations.
  4. Most children with a congenital heart defect can be physically active without restrictions. In fact, children are encouraged to be physically active to keep their hearts fit and to avoid obesity, unless they have a few specific heart conditions.
  5. Emotional support will help children who may have self-esteem issues because of how they look. They may have scars from surgery, and they may be smaller, or have limits on how active they can be.
  6. As children transition to adulthood, parents can gradually teach them about their heart defect and guide them in how to care for their own health without being overly protective.

Must-Know Facts about Respiratory Syncytial Virus

WORDS DR LEE ONN LOY

DR LEE ONN LOY
Paediatrician
Mahkota Medical Centre
WHAT IS RESPIRATORY SYNCYTIAL VIRUS? 

Respiratory syncytial virus (RSV for short) is a common respiratory virus that usually causes mild flu-like symptoms, except in infants and elderly people.

There are two sub types of RSV, RSV-A and RSV-B, which co-circulate during the same season with alternating predominance.

However, we do not test for sub types in Malaysia, mainly because we do not have seasonal weather and there is no difference in disease severity between the two sub types.

WHO ARE MOST AT RISK WHEN IT COMES TO GETTING INFECTED?

Children are more prone to be infected due to their immature immune systems and first exposure to the virus.

They are often exposed to and infected with RSV outside the home such as in daycare centres or school.

WHO ARE MOST AT RISK OF DEVELOPING SEVERE COMPLICATIONS?

People who are at higher risk of severe RSV disease are:

  • Prematurely born infants
  • Children with congenital heart disease or chronic lung disease such as asthma
  • Children with compromised or weakened immune systems either due to medical conditions or medical treatments
  • Adults with compromised immune systems
  • Elderly people with existing health problems or co-morbidities
HOW DO I KNOW IF I MAY HAVE CAUGHT RSV?

Symptoms of RSV are just like those of normal flu, such as:

  • Fever
  • Cough
  • Decreased appetite
  • Lethargy
  • Wheezing and difficulty in breathing

Consult a doctor if you or a family member show these symptoms.

HOW IS RSV TREATED?

There is no ‘one size fits all’ treatment for RSV.

We usually treat it with paracetamol and antihistamines.

If a child catches the virus, the doctor will monitor the child to ensure that they are eating and drinking well.

When there is no improvements seen, and when one becomes lethargic and develops wheezing and breathlessness, they should be admitted for fluid infusion, regular nebuliser therapy, and oxygen when necessary.

WHAT CAN PARENTS DO TO PROTECT THEIR CHILDREN FROM RSV?

Firstly, we should know how RSV can spread. Common ways of transmission are:

  • When an infected person coughs or sneezes, and the virus droplets find their way into your eyes, nose, or mouth
  • When you touch a surface that has the virus on it like doorknobs, and then touch your face before washing your hands
  • When you have direct contact with an infected person, such as kissing the face of a child with RSV

There are a few things parents can do to protect their children against RSV such as:

  • Keeping them away from close contact with sick people
  • Teach them and encourage them to wash their hands often with soap and water for at least 20 seconds
  • Teach them to avoid touching their face with unwashed hands
  • Don’t send your unwell kid to school or centres, and limit the time children spend in child care centres during outbreaks if possible
CAN ONE DEVELOP RSV, FLU, AND COVID-19 ALL AT THE SAME TIME?

Yes, but this is not common. Should it happen, though, the complications are going to be very severe with a high risk of death!

Hence, people should go for influenza vaccinations yearly, especially during the COVID-19 pandemic.

Please Take This Short Survey about COVID-19 Vaccination and Your Child

WORDS ASSOCIATE PROFESSOR DR ERWIN KHOO JIAYUAN

The survey is now closed. All parties involved would like to express their gratitude to everyone that participated in the study.
ASSOCIATE PROFESSOR DR ERWIN KHOO JIAYUAN
Consultant Paediatrician
Department of Paediatrics
School of Medicine
International Medical University (IMU)
IT CAN BE CHALLENGING FOR A PARENT TO DETERMINE FACTS FROM FICTION WHEN IT COMES TO NEWS ON SOCIAL MEDIA

Netizens who are vaccine hesitant have an alarming footprint on social media. In a vicious cycle, their hesitance is likely to be fueled by health (mis)information obtained from a variety of sources, including news media such as the Internet and social media platforms.

As access to technology has improved, social media has attained global penetration. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns.

These worries may be magnified in the face of the ongoing COVID-19 pandemic. As the development and subsequent deployment of more vaccines are expected to play a critical role in downstream emerging pandemic control efforts, social media will remain a powerful tool. Most concerning is how (mis)information and (un)substantiated reports on its platforms will threaten to erode public confidence even well before the release of any scientific evidence.

It is not readily evident why social media is so disproportionately successful in promoting vaccine hesitancy as opposed to uptake. Social media users may represent a skewed population sample with baseline misperceptions regarding the benefits and side effects of vaccination whilst simultaneously lacking familiarity with the consequences of vaccine-preventable disease. Moreover, when evaluating the risks and benefits of vaccination in general, the risks may be overestimated and may seem more immediate, and tangible as compared to the more abstract potential benefits of disease prevention.

IF YOU ARE A PARENT WITH A CHILD UNDER 18, PLEASE SPEND 15 MINUTES TO HELP US BETTER UNDERSTAND THE SITUATION

SOcial MEdia on HesitAncy in Vaccine E-survey or in short, SOMEHAVE, is a multinational collaborative study between International Medical University (IMU), the Singapore’s National University Health System (NUHS), National University of Malaysia (UKM) and Universiti Malaya (UM)

The study uses unidentified e-survey for parents with the aim of seeking the impact of social media on vaccine hesitancy.

For the English survey form, please click here (link opens in a new tab).

For the Bahasa Malaysia version, please click here (link also opens in a new tab).

[IRB Ref No: IMU R 279/2021, UKM PPI/111/8/JEP-2021-824, NHG DSRB (Singapore) Ref: 2021/00900]