Sga brochure-final draft.pub

Small-for-Gestational-Age
What Does "SGA" Mean?
SGA (small-for-gestational-age) general y describes any in- fant whose birth weight and/or length was less than the 3rd per- centile (adjusted for prematurity). "IUGR" is a term also com-monly used, and describes the smal infant who had poor fetal Introduction
length growth demonstrated while in-utero by ultrasonography. Between 3% and 10% of live births each year are "SGA" is currently used to describe any child born smal er than described as "smal -for-gestational- age" (SGA). In average in both length and weight. In this brochure, we wil be addition, older children who are of short stature and focusing on the SGA child whose length and possibly weight has underweight may be labeled SGA by their physicians. not caught up to what is appropriate for their age, and for whom There are many variances in the definition of SGA, but doctors can not determine any reason for the child's smal ness. general y, SGA describes a child whose birth weight and/or length is/was less than the 3rd percentile (with How is SGA Diagnosed?
age adjusted for prematurity). In addition, when ultra- sound evidence demonstrated poor fetal growth while Pediatricians usually begin by looking at al the possible in-utero, an infant is also described as being factors for a child being born too smal - maternal, environ- “IUGR" (intrauterine growth retardation). These defini- mental, and others. A pediatrician may send an SGA child to a tions are descriptive terms and are not specific diagno- geneticist, to see if the child's features fit any number of short- stature syndromes (some determined with lab tests, others by The factors behind why an infant is born SGA can be examination). An endocrinologist may run other tests, again quite complex. The factors include fetal (such as ge- ruling out al possible endocrine and metabolic reasons behind netic syndromes), maternal (such as substance use or infection), placental, and/or demographic (mother's age, Recal that between 3% and 10% of live births are smal -for- gestational-age -- we are focusing on the smal subset of these But setting aside these possible reasons, the fact is births where the children's growth stays on their lower growth that 9 out of 10 infants born SGA do experience catch- curves and does not "catch-up" to any higher percentile. Some- up growth by the age of 2 years, and usual y by 6 times an unknowing doctor may say "wel , your child is OK be- The MAGIC Foundation is a national non-profit months of age! It is the smal er subset of SGA children, cause he is stil fol owing his own growth curve." Never mind organization created to provide support ser- the 1 of 10 who fail to achieve catch-up growth by age 2, that the boy's growth curve is below the 3rd percentile! that we wil focus on in this brochure- - - the short SGA vices for the families of children afflicted with a What are Typical SGA Characteristics?
wide variety of chronic and/or critical disorders, These include "idiopathic" SGA children -- children Clearly, the typical SGA child is shorter and thinner than his who are smal for unknown reasons - - parents who are syndromes and diseases that affect a child’s or her peers. But the range of other characteristics can vary. A of normal height, history of non-smoking/non-drinking, list of common characteristics and more information on SGA is growth. Some of the diagnoses are quite com- lab tests have ruled out known causative factors, etc. It can be frustrating to be the parent of a short SGA child, you want answers to why your child isn't growing. In this Characteristics Seen in Almost all Short SGA Children:
brochure, we hope to offer information on SGA children, and to answer some of the possible questions you may low birth weight; probably low birth length inadequate catch-up growth in first 2 years persistently low weight-for-height proportion Prof. of Pediatrics, Chief of Pediatric Endocrinology lack of muscle mass and/or poor muscle tone Penn State University, Milton S. Hershey Medical Center Continues and develops through membership Col ege of Medicine, Division of Pediatric Endocrinology Open to Insert
6645 W. North Avenue
Asst. Prof. of Pediatrics, Div. of Pediatric Endocrinology Oak Park, IL 60302
This brochure is for informational purposes Weil Medical Col ege of Cornel University 708-383-0808/fax 708-383-0899
contributing physician assumes any liability for its content. Consult your physician for Parent Help Line/800 3 MAGIC 3
www.magicfoundation.org
Other Common Characteristics of Short SGA Children:
d) keeping glucose gel with you at al times How Can I Help my SGA Child Grow?
However, the initial commitment can be for a trial period e) making prior arrangements with your doctor and of at least 6 months to determine growth response. The local ER to start IV glucose if feeding is impossible Simplistical y, there are two aspects of the SGA child's injection is a simple subcutaneous (top layers of skin) fasting hypoglycemia & mild metabolic acidosis f) having urine ketone sticks at home (over the counter) growth -- weight and height. Particular attention should be injection every night. Most children and parents who generalized intestinal movement abnormalities: Monitor skeletal maturity (bone age x-ray) annual y paid to weight gain during the first 2 to 3 years of life, as have chosen this treatment think it has turned out far a) esophageal reflux (may be silent with no spitting many children born SGA may struggle to gain weight better and far easier than they expected. If you are inter- Treat your child according to his age not his size. (although ironically, some children born SGA may gain ex- Arrange safe, age-appropriate activities; buy age- ested in talking with other families who have chosen or cessive weight during childhood). As previously discussed, appropriate clothes; and expect age-appropriate declined growth hormone therapy, MAGIC can connect a pediatric GI doctor can help diagnose and treat, or rule blue sclera (bluish tinge in white of eye) out, any GI medical issues that may impede an SGA child's Watch your child's psychosocial and motor development. ability to gain weight. Reflux (often silent) and delayed late closure of the anterior fontanel (soft spot on the Are There any Other Health Issues Associated
Al states have developmental evaluation & intervention gastric emptying appear to be the most common of these GI with Being Born SGA?
services for children less than 3. These programs are problems. A nutritionist can also help provide advice on frequent ear infections or chronic fluid in ears based on the child's needs not parental income. For simple additives and other means of adding calories to a Multiple studies, short-term and longitudinal, have congenital absence of the second premolars children over 3 years, the school district becomes re- child's diet. There are also medications like the antihista- found an increased risk of health problems such as insu- delay of gross and fine motor development sponsible for providing these services. Take advantage mine "cyproheptadine" (brand name: Periactin) which can lin resistance, cardiovascular disease, hypertension, delay of speech and oral motor development of this; intervention can make a world of difference for act to increase an SGA child's appetite. Please contact obesity, and type 2 diabetes among adults who were delayed bone age early, later fast advancement MAGIC for more in-depth literature on this topic. born SGA or with low-birth weight. Explanations for early pubic hair and underarm odor (adrenarche) The second growth aspect is length/height. More than Seek appropriate consultation for recurrent ear infec- these risks vary from intrauterine nutrition to genetic early puberty or rarely true precocious puberty 90% of children born SGA catch-up to normal height by 2 to tions, or any other medical issues. But remember: 3 years of age. Among those who do not, inadequate ca- causes. In addition, some correlations have been found classical or neurosecretory growth hormone deficiency a) Only emergency surgery should be done until the loric intake may contribute to growth failure. If optimum between persistent short stature and psychosocial diffi- possible attention deficit disorder (ADD) or specific learning caloric intake can be attained, some "catch-up" in weight culties and/or behavioral problems. Clearly, a great deal b) A young underweight SGA child should NEVER be and height growth curves may occur. If a child is still sig- of research still needs to be done to narrow down and fasted or kept NPO for more than 4 hours for ANY nificantly short after this period, and the child is 2 to 3 years clarify the exact risks of being born SGA and identify old or older, then the family may consider growth hormone which children are at risk. Until then, children and adults What Should I Do If My Child is Diagnosed SGA?
c) For surgery, IV glucose should be given during the therapy in order to increase the child’s height growth veloc- born SGA should be monitored careful y by their physi- procedure and continued in the recovery room until • Make sure your child is measured careful y & frequently. It is important to note two things. First, research has not KEEP YOUR OWN RECORDS. Find an endocrinologist found any means except growth hormone therapy to stimu- who knows how to treat SGA children's growth failure late catch-up growth, maintain a normal height during child- Coping with the time-consuming special attention and What Can I Expect Regarding My Child's Cognitive
Abilities?
hood, and increase an SGA child's adult height. The United services necessary to care for an SGA child can be over- • Find a pediatrician who is wil ing to learn from experts States F.D.A. approved growth hormone therapy as "…long- whelming, especial y if you try to face it alone. Good about SGA children, and will coordinate care and opin- An infant with SGA is general y born with normal intel i- term treatment of children who were born SGA and who physicians may have no experience with routine needs gence. Learning disabilities and ADD may be increased in have not achieved catch-up growth by the age of 2." Sec- of SGA children. Day-to-day chal enges such as feeding, • Have your child evaluated by a pediatric gastroenterolo- incidence in SGA. Autism and similar disorders like perva- ond, most SGA children are not GH deficient according to formulas, fitting clothes, school issues and peer pres- gist if your child struggles to gain weight. She/he may sive developmental disorder (PDD) may also be increased. It standard testing measurements. Studies are ongoing, but it sures can be less stressful if you are in contact with consider a test for slow gastric emptying and reflux (the is unclear whether these problems just appear to be increased appears that many of these short SGA children do not re- other families who "have been there". Making connec- latter preferably with a pH probe test). spond normally to growth hormone and thus require more in SGA, are innate to SGA, or are related to SGA through tions between families with similar issues and facilitating • Get adequate calories into your child. Insufficient nutri- growth hormone than the typical child. Instead of being early malnutrition and hypoglycemia, both of which are pre- sharing of information and experience is a major goal of tion & low blood sugar damage the developing brain and growth hormone “deficient”, experts now the MAGIC Foundation’s RSS/SGA Division. We can children to be growth hormone “insufficient.” put you in touch with other people who have had, and • Take necessary measures to prevent hypoglycemia in Does a Delayed Bone Age Mean My Child Will Have
Deciding About Growth Hormone Therapy
young SGA children. Pay special attention to the night Catch-Up Growth Later?
The treatment of SGA children's problems should when everyone is asleep, anytime your child is il or not The decision to begin growth hormone therapy for an be approached in a systematic and timely fashion. eating normal y, and when your child is unusual y active Although most if not al SGA children have a bone age that SGA child can be an easy decision for some parents, and a The major problems that require intervention in the is relatively delayed compared to their chronological age, difficult one for others. Not al parents choose this treat- various age periods are al different, but most al these • Know clues that hypoglycemia (or the spil ing of ketones) studies have shown bone age to be an unreliable predictor of ment for their child. We at MAGIC wil support you in what- problems can be solved or dealt with successful y if adult height in SGA children. One possible reason is that ever choice you make. However, remember that growth you get the help you need. It is beyond the scope of a) waking to feed at night past early infancy many SGA children experience a rapid acceleration of their hormone therapy is the only treatment currently available to bone age just prior to the onset of, and during, puberty. this brochure to go into specifics on various treatment c) extreme crankiness improved by feeding Within a span of just 12-18 months, an SGA child's previously Your doctor wil help you in this decision process, and protocols. Feel free to contact MAGIC for more in- delayed bone age can quickly surpass his chronological age, many factors must be considered. Factors discussed may negating any "extra growing time" that usual y is present with include potential incremental height for your child (based on Most importantly, be your child's #1 advocate, trust your parental gut instinct, and love your beautiful SGA • Prevent hypoglycemia (primarily in the underweight SGA the parents' height), whether your child can benefit from the It is therefore important to monitor an SGA child's bone possible added muscle mass and strength, your child's age, child. We at MAGIC wil be here to help you in what- a) feeding frequently during the day & night age, to ensure that it does not begin to advance. For the bone age, other health issues of your child, and insurance older SGA child, bone ages are also used to determine if any coverage or the possible pharmaceutical company assis- c) adding glucose polymer in infant's, & cornstarch incremental height remains for the child (as long as the bone tance. Growth hormone therapy requires a commitment. in child's, bed- & night-time feeding

Source: http://www.magicfoundation.org/downloads/SGAbrochurefinaldraft.pdf