IUGR baby development.

[Fluffy0610]

Hi,
My son was born at 37 weeks by section, due to symmetrical IUGR, at 4lb 14. He is now 7 weeks and has remained on the 0.4th centile, including his head circumference. He hasn't been diagnosed with microcephaly, but his head circumference is being monitored. The cause of the IUGR is unknown. I am driving myself to despair with not knowing if he's going to have development problems or the effects the IUGR will have on him.
Does Anyone else with a similar situation have a story to share ? TIA.

Hello Fluffy0610,

My youngest daughter was delivered by c/sec at 37 weeks. Turned out she was 42+ but had been missed as she had symmetrical IUGR throughout so everyone had assumed I had my dates a month wrong. She was well under the 0.4th centile, went into hypo-thermic shock at birth but was very well cared for by the Neo-natal team and was placed under a neo-therm and on a heat pad. She did not do so good though and went on to have severe failure to thrive on top. She was sent to BCH and lost just over 40% of her tiny birth weight and very nearly died by the time she was 6 weeks. It was a further 6 before I knew if she might make it. Along the way she was tested for metabolic disorders and growth disorders including Russel Silver as she looked so elf like. Turned out she was just one of those tiny babies at the very bottom of the growth scale and her features were petite with no fat.

She was referred to a pediatric dietician and consultant in growth who worked out an incredibly high caloric diet of fortified EBM and pepti-junior. She flat lined well below the 0.4th until 3 months when she gained an imperceptible 10g! It took till she was 6 months before she was 5lb and 12 months before she reached 11lbs. She stayed under the 0.4th centile till she reached 14 and had a very unexpected growth spurt. She is still petite but no longer stands out as way too tiny from her peers. Her head is still on the 0.4th centile but she does not have micro-cephaly - her head is in proportion to the rest of her and it did grow, it was just grew along the 0.4th centile.

Elly probably had IUGR from the first trimester. Symmetrical IUGR occurs earlier than asymmetrical IUGR and is the less common form of IUGR. They do take far longer to catch up with growth than babies with asymmetrical IUGR. They often stay in the lower centiles for prolonged periods but they should still grow and follow their own lower centiles. Elly did need physio and OT for poor gross motor skills [dyspraxia] and she is profoundly dyslexic. There is a slightly increased risk for specific learning difficulties in babies with symmetrical IUGR compared to asymmetrical, those like Elly who develop failure to thrive and had a rough ride to survive are more likely to have difficulties on top. She did have routine follow ups and this was picked up so she had support in place through school as well as physio and OT delivered at school to help her gross motor skills improve. She still needs a very high caloric diet to maintain her weight but now that makes her the envy of her friends! The best bit was she wore out her prem sized 3-5lb clothes before she could ever outgrew them, the worst bit was trying to find tiny shoes for her when she started to walk.

Hopefully your lovely little lad will completely avoid the failure to thrive option and will simply steadily follow the 0.4th is his own sweet little way.

If you have any questions your welcome to ask.

Thank you triballeader for taking the time to reply. Gosh, what an awful experience for you and your little girl. Oscar has put on around 1lb a week, which I thought was reasonable, but the health visitor is concerned because that weight gain isn't enough for him to move out of the 0.4th centile, he just follows it.
Yes , baby was average size at 12 weeks then 10 days behind at 20 weeks, so the growth restriction must have started in the second trimester. Did you ever find out the cause of your IUGR? I hate not knowing why this happened to my little boy.
Can I ask when you noticed that Elly had some development issues?did she meet the typical baby milestones like smiling, sitting waking etc? I feel like im just waiting for Oscar to have something wrong with him and am finding it so hard not knowing when or if he'll show signs of a problem ☹️

Wow a whole 1lb a week, now that impresses me because the hospital staff would party if Elly managed 1oz in a week. If Oscar is simply following the 0.4th it may well be he is just a small child.

The 0.4th and the 99.6 centiles act as a flag for health visitors to be more vigilent as some babies, like Elly, may be failing to thrive or have other not spotted yet health needs. You may end up with a hospital referral for a health investigation just to be on the safe side. The ordinary A5 size centile charts tend not detailed enough for tracking small gains. Elly had a special chart from BCH that was designed for babies with faltering growth and or weight gain. It was A2 in size and could show very fine detail and mere hints of improvement as opposed to her standard chart. That one just looked awful for months.

The only thing I can think that might have contributed was my previous pregnancy. I had severe hydronephritis had a c/sec aas soon as I reached 37 weeks and became pregnant 8 months later. My other daughter had asymetrical IUGR but it was mild [10th centile] and she soon caught up [3months] She has moderate dyslexia and is still a dainty adult size 8. With Elly I was monitored throughout as a high risk mum and had hospital based consultant only care throughout. There is not always a reason why some babies are born at the lower end of the centile charts just as there is not always for those born at the upper end. Some babies are tiny and some are very large with the huge majority of babies falling between.The charts exist to help HV to try and pick up babies who may be quietly struggling and need a follow up to ensure they are well and thriving.

Remember my daughter had a rough neonatal period and very severe failure to thrive. Oscar is gently growing so is unlikely to have the same kind of problems. Developmentally Elly spent most her time in a baby-sling next to my skin because she was so small and struggled to maintain her core body temprature. She interacted with me and did show age aprobraite interests. It took her longer to pull herself into a stand as she was simply too small to manage to grab things to pull herself up with. she could sit but would fall over a lot but that was a gross motor difficulty] She could hold up her head and would reach for toys. She showed more interest in very high contrast toys. Her tiny hands made holding toys difficult, she went for toys with fabric tags they seemed to be easier for tiny fingers to grab hold of. She was very hypertactile and needed something soft and cuddly to stroke and hold at all times [dyspraxia]She could talk but rarely did but that was thanks to her habit of letting her elder sister do the talking for her. Socially she was smart as an example she had worked out by 18 months she could scrounge cream cakes off older ladies in the tea shop by staggering towards them and lisping 'ake'most of whom mistook her for a very advanced eight month old baby and she always got cake! She could walk but did not fit even the first crawling baby soft shoes till she was 20 months old. I bought a decent child back carrier that she easily fitted it till she was at school so she was above every-ones feet and could see what was happening around her.

Every baby develops different skills at a differing rate, as an example Elly talked early as she spent so long face to face with me she talked well and had a good vocabulary but she was slightly delayed in walking due to her size. She had good fine motor skills but poor gross motor skills. Go with your gut instinct- mine was telling me her inability to sequence, extreme continuing clumsiness and lack of awareness of where her arms and legs were needed looking at as it was not quite right even allowing for her size. Remember most babies with IUGR do fine once they begin to grow after the first few days. Elly had continued problems with maintaining her core body temp, her mouth was too small for a prem teat so she was syringe feed like a kitten. She flatlines and fell off the centile chart as she did not grow at all till she was past 3 months and she lost 40% of her birth weight contributing to her more complex specific learning difficulties. She is very bright [ed psych assessed her at 130] its just the bits controlling gross movement and sequencing probably did not get enough nutrients to help them grow at the right kind of times. Her growth was minimal till she was 14.

Your lovely son Oscar is slowly growing and gaining weight albeit on the 0.4th.so is far less likely to have the same kind of problems. Most little boys even with symetrical IUGR catch up between the ages of 2-3 years.

If you are worried you might fine it useful to contact the Child Growth Foundation in the UK as they offer support and info for IUGR.

Oops, meant half a pound a week. He's now 8lb at 8 weeks old. He is a very unsettled baby so uses up a lot of energy crying and not sleeping too.
His sister is incredibly bright and hit milestones months before average, which doesn't help as they'll naturally be compared.
Glad to hear your little girl has come through her tough start so well 😊

Hi there,

My daughter was born at 37 weeks too, weighing a bit less - 4lb 8oz. Her IUGR was caused by my pre-eclampsia. She was born in good condition and breastfed straight away but became too weak to latch for long enough after losing weight after birth. We fed her with a syringe and cup and she eventually was able to breastfeed exclusively. Her weight was below the bottom of the chart and it took ages to reach the 0.4th centile, which she hit at 4 months. After that she began to catch up and by 22 months was on the 50th centile for weight and 75th for height. She’s now two and very healthy and strong.

She hit all her milestones on time (on the later side of the normal range for gross motor, each time causing anxiety and then hitting it right before it became a concern). In everything else - fine motor, speech, social - she has always been very advanced.

I hope this encourages you that it is possible the road may get easier further on. It was very hard in the beginning with people constantly remarking on her size and making comparisons. But now two years on you would never know she had a difficult start. Things turned a corner for me in that department once people started commenting on how well she talks rather than her size.

Your LO’s growth sounds fine as he is following his own curve and there is plenty of time in which catch up growth may happen. As for head circumference my daughter had a huge growth spurt between 8 and 20 weeks, which caused concerns of its own, but turned out to be fine and the rest of her caught up!

We think that our daughter’s initial slow growth after birth may have partly been due to digestive issues, which are common in IUGR babies. She had reflux and a dairy allergy. After I cut dairy out of my diet her growth picked up. She has grown out of both now. That might be something to consider getting checked out? My daughter was very unsettled too until that was fixed.

Wishing you and your LO all the best.