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Intrauterine growth retardation means that the child during pregnancy was not able to reach its genetic growth potential. Reasons may be on mother’s side, the inability of the child or unknown. This disorder affects around 4-8% of all children and requires a intensive monitoring of the pregnancy as the risk of complications are significantly higher.
The cause of the disorder is unknown and a variety of risk factors play a certain role. Main risk factors are placenta insufficiency (the placenta may be insufficient) or genetic abnormalities of the child. There are a variety of causes why the placenta does not function adequately. It might be too small, deformed or show structural changes. Problems on mother’s side (although the placenta is children’s tissue) such as malnourishment, infections, high blood pressure, diabetes mellitus, or toxins (for example tobacco smoking, excessive use of alcohol, some illegal drugs like cocaine) can lead to a reduced supply for the child. The child simply gets too little of everything: nutrients, oxygen and all other offerings it gets from it’s mother. This under-supply can additionally lead to child-stress.
In obstetrics the term SGA (small for gestational age) is also used. This simply means that the child is too small and/or too light for the week of pregnancy. Most of these children are small due to their constitution, i.e. due to the small size of their parents or grandparents. It is interesting that many of these children show so-called catch-up growth in their first two years.
Expectant mothers tend to blame themselves for the problem of their child. Doctors always want to find the reason for the problem: “Is the problem due to the mother’s behavior during pregnancy or is it the problem of the child?” This question and it’s possible answers can add to the feelings of guilt. Thoughts like “Do I have enough hormones? Am I too thin or am I not eating enough? Is my smoking to blame? Am I doing perhaps too much sport and thus using blood my child would need?”, can preoccupy mothers. In some cases one or the other reasons may apply. Statistically for example mothers who smoke have smaller children. The placenta however is childlike tissue and the child wants to live and grow and takes more or less everything it needs. Mothers knew this for a long time saying “every child costs a tooth”, because the child asks for so big amounts of calcium from the mother that her teeth become loose.
As most causes of childhood growth disorders can not be cured, the question of guilt is worthless. However causes may be interesting for science.
Every mother wants to provide her child with optimal conditions for development during pregnancy. This needs a balanced diet, avoiding toxins (tobacco, alcohol, etc.) an attempt to reduce the risk of infections and use of recommended vitamins.
So-called catch-up growth is mostly observed in children had a stop of growing in the last trimenon, at the end of pregnancy. The reason is mostly a placental-insufficiency. Affected children need a high caloric diet after birth in order to catch up. In fact, they are mostly able to do this naturally by oral feeding. Only a few children need a feeding tube to increase the quantity of food. The discussion whether children have less development when they are too slow to put on weight is under discussion. Most data on poor development of intelligence originates from areas of famine therefore cannot be applied to developed countries.
Whatever the cause may be a child suffering from IGUR should feed itself. This is because the “natural” oral food intake is normally better tolerated, causes less side-effects and may lead to a better weight gain.
If the IUGR child has had a tube placed it is important to know if catch-up growth is expected. This is only the case when the child was first affected in the last trimester of pregnancy. If this isn’t the case no attempt should be made to make the child fatter by giving calorie-rich food. It should always be discussed with the local pediatrician. After birth goals of weight-gain may be unrealistic and may not represent the “future path” of the child. Many mothers and families find themselves in a vicious circle of child’s refusal and doctors orders. In the end the whole family may be only concerned with weight gain. Suffering from a genetic disorder “normal” growth can not be achieved and cannot work out as the genetic potential limits weight gain.
NoTube children who are supplied with a feeding tube and are prescribed large quantities of food in order to catch-up. Unfortunately even some of studies performed by our co-workers (Malnutrition in children with feeding tubes and Side effects of long term enteral feeding) show that catch-up growth does not appear in ⅓ despite large volumes of food. Sadly more food than the child needs may lead to side-effects such as vomiting and retching. We are afraid that too much food may be wrong and we try to reduce anxiety in parents. We accompany the child and its family on the natural path of the child. When the child finds joy in eating, it may find its inborne cycle of hunger and satiety.