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What does it mean when a child is small? Because for one woman their baby will be 2 kg and for another 3 kg.

An unborn baby is small if, during pregnancy, the size or estimated weight on the scan is within the lowest 10% of babies. This means the lowest ten in 100 children. So we’re talking about the 10th percentile or below. Weight is judged by weight gain, never from one scan. This means that to assess whether a child is really small or has limited growth, a minimum of 3 ultrasound scans should be performed every 2 weeks. Sometimes if there is an alarming lack of growth, decisions can be made more quickly.

A child’s weight is influenced by many factors, including:

  • Your height and weight – taller, heavier women tend to have heavier children
  • Whether you or your partner were a small child
  • Your ethnicity – for example, South Asian women tend to have smaller children (this should be assessed individually and is most likely related to the mother’s / father’s height)
  • The number of babies you have – there is a tendency that your baby may become heavier with each pregnancy but this depends on many factors such as your lifestyle, diet, etc.
  • Whether your child is a boy or a girl – boys are usually heavier.

If your child is in the 10th percentile and above and growing at their own pace and all other parameters are normal, use the BRAIN methodology in communicating with staff.

Your baby may be small due to a combination of the above factors. If this is the case, your baby will most likely be healthy and you won’t need to be induced labor as it’s just because your baby is small. 

However, sometimes babies are small because they are not growing as well as expected. This is called “Growth restrictions” and this could be beacuse:

  • The placenta is not working as well as it should – this could be due to health problems such as high blood pressure or pregnancy complications such as pre-eclampsia (you can find out more about pre-eclampsia here
  • Smoking, taking drugs or severe anemia can also affect the way the placenta works
  • Infection during pregnancy that may affect the baby
  • The development of a child with a developmental or genetic problem

Is there anything I can do to reduce the risk?

Some of these threats can’t be changed or eliminated, but some are actively influenced by:

  • Cut down or stop smoking – your midwife or GP may refer you for support to help you stop smoking.
  • Do not use recreational drugs, especially cocaine.
  • Living a healthy lifestyle and eating healthy reduces the risk of having a young child. You can attend our workshop on Pregnancy Care
  • If you have an increased risk of pre-eclampsia, it may be advisable to take a low dose of aspirin (75 mg once a day) from 12 weeks of pregnancy until birth.

NICE speaks clearly. Section 1.2.7.1 says In the event of severe growth restriction in the fetus with confirmed fetal impairment, labor induction is not recommended. You can print it out if you have an appointment with your consultant.

Some studies have shown that only 10% to 36% of children with a birth weight below the 10th percentile are detected during pregnancy, Monier et al. (2014) found that only 21.5% of children who found had SGA (small by gestational age) was suspected during mother’s pregnancy. This confirms that we are still not very good at detecting SGA, which is one of the problems. And it confirms that inducing labor in 100% of these mums has huge consequences for the 80% of babies who turn out to be a healthy, normal weight. 

As usual in such situations, I would like to strongly refer you to BRAIN and its decision-making methods. It’s also a good idea to get your AIMS Guide to Induction as now, induction of labor is now almost as popular as caesareans. You should know about both births in order to be able to make decisions based on medical facts and not someone else’s opinion or fear.

To help you make choices that are right for you and feel confident enough to make them, book on to our next workshop. It will be delivered by Anna, who’s an experienced Antenatal Teacher and Doula. She’ll use evidence-based information to tell you everything you need to know from pain relief and places of birth to how to communicating with your midwives and consultants, so you can feel calm, confident and in control. Click link below for more info 👇