Growth Concerns in Preterm Infants: A Pediatric Guide

Children's growth issues?

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 pediatrician was present at birth and immediately assessed the baby's health, and everything was found to be normal.

At 47 days old: height 49 cm, weight 3.9 kg, head circumference 36 cm.

At 2 months old: height 51.5 cm (height percentile: below the 1st percentile), weight 4.5 kg (percentile: between the 5th percentile), head circumference 37.1 cm (percentile: between the 3rd and 5th percentiles).
I would like to ask:
1.
How long after birth should my son catch up to the growth curve on the pediatric growth chart?
2.
Following the first question, which percentile line on the growth chart (3rd percentile, 15th percentile, 50th percentile, etc.) should he reach to be considered normal? Otherwise, should we go to the hospital for further examination?
3.
He is currently primarily breastfed, with occasional formula (S26).
Given my son's current situation, can we switch to a premature infant formula? I would like him to grow faster, so I am seeking your opinion on using premature infant formula.

Thank you for taking the time to answer my questions.
Thank you.

Mr. Chen, 30~39 year old female. Ask Date: 2010/12/28

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 important is (1) whether there are any associated congenital anomalies or intrauterine infections, or if it is simply a case of maternal-placental insufficiency, and (2) whether there is normal growth in height, weight, and head circumference after birth (the standard for infants in the first six months is an average weight gain of 900 grams to 1 kilogram per month and a height increase of 2.5 to 3 centimeters; your baby should meet these standards).

2.
Similarly, if height and weight gain do not meet the standards, a hospital evaluation is necessary, rather than focusing on "catching up to the growth curve on the pediatric growth chart."
3.
Formulas for premature infants are designed to accommodate their poorer kidney function and reduced sodium retention capacity, thus they contain higher sodium levels than standard infant formulas.
Your baby, being a term infant, does not require this type of formula.

Reply Date: 2010/12/28

More Info

When it comes to understanding growth concerns in preterm infants, it is essential to recognize that these children often have unique developmental trajectories compared to their full-term counterparts. Your son, born at 38 weeks gestation and classified as a low birth weight infant, is currently experiencing growth patterns that warrant careful monitoring and evaluation.

1. Timeline for Catching Up on Growth Charts: Generally, preterm infants are expected to catch up to their peers by the age of 2 to 3 years. However, this timeline can vary significantly based on individual circumstances, including the infant's health status, nutritional intake, and any underlying medical conditions. It is crucial to have regular check-ups with a pediatrician who can assess growth parameters such as weight, height, and head circumference against standardized growth charts specifically designed for preterm infants.

2. Target Growth Percentiles: For preterm infants, the goal is not necessarily to reach the 50th percentile immediately but rather to follow a consistent growth trajectory that ideally aligns with their adjusted age. The adjusted age is calculated by subtracting the number of weeks the infant was born prematurely from their chronological age. For instance, if your son is 2 months old chronologically but was born 2 weeks early, his adjusted age would be approximately 6 weeks. It is generally acceptable for preterm infants to be in the 3rd to 15th percentiles as they grow, as long as they are following their growth curve consistently. If they fall below the 3rd percentile or show a significant drop in their growth curve, further evaluation may be necessary.

3. Feeding Considerations: Your current feeding regimen of primarily breast milk with occasional formula is a good start. Breast milk provides essential nutrients and antibodies that are crucial for your infant's development. However, considering your son’s growth patterns, it may be beneficial to discuss the possibility of using a preterm infant formula with your pediatrician. Preterm formulas are specifically designed to provide higher caloric density and additional nutrients, which can support faster growth in infants who were born with low birth weight or who are at risk for growth delays.
In addition to these considerations, it is essential to monitor your son’s overall health and development. Regular pediatric visits will allow for tracking his growth and development milestones, which include physical, cognitive, and social-emotional aspects. If there are any concerns regarding his feeding, growth, or developmental milestones, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

In summary, while it is normal for preterm infants to have different growth trajectories, consistent monitoring and appropriate nutritional support can help ensure that your son is on the right path. Engaging with your pediatrician about growth charts, feeding options, and developmental milestones will provide you with the best strategies to support your child's growth and health.

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