Assessing Growth Rates in Infants: Normal Development

Assessment of Growth Rate

Hello, doctor.
I would like to know if my baby's growth record indicates slow growth.
My twins were born at 37 weeks and 2 days in October 1998, with a birth weight of 1750 grams, a height of 48 cm, a head circumference of 30.5 cm, and a chest circumference of 25.5 cm.
On November 23, they measured 51 cm in height and weighed 3.5 kg with a head circumference of 35 cm.
On December 21, they were 53 cm tall and weighed 4.6 kg with a head circumference of 36 cm.
On February 19, 1999, they measured 59 cm in height, had a head circumference of 38 cm, and weighed 5.5 kg.
On March 5, they were 60.5 cm tall, had a head circumference of 40 cm, and weighed 5.5 kg.
Is this growth rate considered slow? Currently, they are drinking about 120 ml of formula every three to four hours.
What is considered a normal growth rate, and recently they have been experiencing constipation, with stools resembling sheep droppings or being hard and somewhat elongated, occurring about once every two days.
Since March 27, they have had a few visits to the doctor and were prescribed a yellow liquid laxative, which helped them pass softer stools for a few days.
However, on the night of April 14, they again had hard stools resembling sheep droppings, with very little output, about the size of a thumb.
They have not had any bowel movements since then, even after stimulating the rectum.
I am unsure if this is related to the formula they are drinking or the amount, as I added some old-fashioned puffed rice powder to their formula around mid-March.
They are drinking S26 formula, and I noticed some blood around their rectum.
What should I do? I appreciate your response to my questions.
Thank you, and I wish you peace and joy.

YouLüDMM, 20~29 year old female. Ask Date: 2010/04/15

Dr. Xiao Kaiwen reply Pediatrics

As long as your baby's growth proportions are consistent with their height, weight, and head circumference recorded in the child health handbook, and do not fluctuate significantly, it is considered normal.
The growth rate you have noted for your baby appears to be within the normal range.
Feeding 120 cc approximately every three to four hours, with a total daily intake of 800 cc, should be sufficient for a 5.5 kg infant.

For constipation relief, you can try giving a small amount of water (about 15 cc) between meals for younger infants.
For babies over four months old, you may offer diluted fruit juice with a higher concentration (higher osmotic pressure).
Once your baby has started on solid foods, it is advisable to provide high-fiber options such as vegetable purees and fruit purees.

You can also try soaking your baby's bottom in warm water at a consistent time each day (such as in the morning) or stimulating the anal area with a rectal thermometer about 2 cm inside after feeding, which can trigger the rectal reflex and encourage bowel movements.
Additionally, two to three hours after feeding, you can gently massage your baby's abdomen in a clockwise direction to stimulate intestinal peristalsis, or apply a warm, damp cloth to the belly before massaging to promote bowel movement and alleviate bloating.
If these methods do not yield improvement, it may be worth considering whether the formula brand is suitable for your baby.
Trying a different brand of formula or introducing a small amount of probiotics may also be beneficial.

Reply Date: 2010/04/15

More Info

Assessing growth rates in infants, particularly in the context of twins, requires careful consideration of various factors, including gestational age, birth weight, and developmental milestones. In your case, your twins were born at 37 weeks and 2 days, which is considered full-term but on the lower end of the gestational spectrum. Their initial weights and heights at birth were 1750 grams and 48 cm, respectively, which indicates they were small for gestational age (SGA).
When evaluating growth, it is essential to track the growth parameters over time and compare them against standardized growth charts. The World Health Organization (WHO) provides growth standards that can be used to assess the growth of infants and children. For your twins, the growth trajectory appears to be within the expected range for their age, especially considering their initial low birth weight.
From the data you provided, it seems that your twins are gaining weight and height, albeit at a slower pace than average. For instance, by the end of December, one twin was 53 cm tall and weighed 4.6 kg, which is a significant increase from their birth measurements. However, the growth rate does seem to slow down in the following months, with only a slight increase in height and weight noted in March.
In general, infants should gain about 150-200 grams per week in the first few months of life and grow about 2.5 cm in length per month. By the time they reach 6 months, the growth rate may slow down slightly, but they should still be gaining weight and height consistently. If your twins are not meeting these benchmarks, it may be worth discussing with a pediatrician to rule out any underlying health issues.

Regarding the constipation issue you mentioned, it is not uncommon for infants to experience changes in bowel habits, especially when transitioning to formula or introducing new foods. The hard, pellet-like stools you described could indicate that the infant is not getting enough hydration or fiber in their diet. It's crucial to ensure that they are receiving adequate fluids, especially if they are primarily on formula.
If you suspect that the formula or the addition of rice cereal is contributing to the constipation, it may be beneficial to consult with a pediatrician about adjusting their diet. Sometimes, adding a small amount of water or pureed fruits like prunes can help alleviate constipation. However, it is essential to consult a healthcare professional before making any significant changes to your infant's diet.

The presence of blood in the stool, as you mentioned, is concerning and should be addressed promptly. It could be a sign of a fissure or irritation in the rectal area, often caused by hard stools. If the bleeding persists or if you notice any other concerning symptoms, such as a lack of appetite, lethargy, or significant changes in behavior, it is crucial to seek medical attention immediately.

In summary, while your twins' growth may appear slower than average, it is essential to consider their birth weight and gestational age. Regular monitoring of their growth patterns and addressing any feeding or digestive issues with a pediatrician will help ensure they are on the right track for healthy development.

Similar Q&A

Understanding Growth Concerns in Preterm Infants: A Pediatric Guide

Hello Doctor: My son is currently 2 months old, born at 38 weeks gestation. At birth, he measured 43 cm in height, weighed 2.17 kg, and had a head circumference of 30 cm, which classifies him as a low birth weight infant (due to my wife's uterine embolization). A pediatricia...

Dr. Xiao Kaiwen reply Pediatrics
1. Your baby is classified as a low birth weight infant. Since the degree of low birth weight varies among infants, the timeline for "catching up to the growth curve on the pediatric growth chart" also differs. Pediatricians typically do not focus on this issue. What is...

Assessing Developmental Delays in Infants: Understanding Milestones and Testing

Hello, Dr. Hsiao! My brother is now nine months and five days old. Today, we took him to see a neurologist who assessed his development and said, "His development is only at the level of a seven-month-old." I looked at the developmental milestones for 9-10 months in the...

Dr. Xiao Kaiwen reply Pediatrics
The development of parental records in the child health handbook does not necessarily require full compliance to be considered normal. There is considerable variability in the neurological development of infants and young children of the same age, and such variability can still b...

Understanding Genetic Disorders in Infants: Growth Assessment and Delayed Development

For newborns and young children, it is important to be aware of genetic disorders such as cystic fibrosis, sickle cell disease, and phenylketonuria (PKU). Growth assessment should be conducted through regular monitoring of weight, height, and head circumference, comparing these m...

Dr. Xiao Kaiwen reply Pediatrics
Developmental milestones refer to the expected developmental achievements of children at various stages. They can generally be categorized into: (1) social behavior skills, (2) cognitive and visual abilities, (3) language and auditory skills, (4) fine motor skills and self-care a...

Understanding Growth Patterns in Pediatric Development: A Parent's Concern

Hello, Doctor! My daughter is almost one year and seven months old, but her height is only 78 cm (weight 11 kg). Her growth curve has consistently remained around the 10th percentile. The pediatrician told me that as long as she is on the growth curve, I shouldn't worry too ...

Dr. Shi Zhongxian reply Pediatrics
After Miss has reviewed the letter, I believe that your daughter's thyroid function and growth development are both normal. There is no need to worry.