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The establishment of breastfeeding in the small-for-gestational-age baby

02 February 2020
10 min read
Volume 28 · Issue 2



Term babies born smaller than expected for a given gestation are at greater risk of short- and long-term health conditions. Breastmilk is the optimum nutrition for all babies and offers specific protection from the risks that follow from being born small for gestational age.


To explore breastfeeding outcomes for babies born with a birthweight below the 10th centile.


Data were collected on all women giving birth in one maternity unit in the north of England over a year. Method of feeding at three time points was compared between small-for-gestational-age and appropriately grown babies.


Small-for-gestational-age babies were significantly less likely to be breastfeeding at discharge from hospital and community services compared to larger babies.


This study suggests that small-for-gestational-age babies are disadvantaged in establishing breastfeeding.

The term small for gestational age (SGA) refers to an infant born with a birthweight ‘lower than expected for a given duration of gestation’ (Tudehope et al, 2013). More specifically, it applies to babies born with a birthweight below the 10th centile as measured by either a customised or a standard population growth chart (Royal College of Obstetricians and Gynaecologists, 2013). This category may include those babies who are constitutionally small and those whose growth has been restricted due to fetal conditions or as a result of placental insufficiency related to maternal factors, either pre-existing or conditions acquired during pregnancy. It includes babies of low birthweight defined as below 2 500 g which has been the conventional standard used to determine which babies have additional postnatal care requirements, including feeding support.

The recent increased use of the customised growth chart potentially enables a more accurate distinction between those babies who have growth restriction and those who are constitutionally small (Gardosi and Francis, 2009). A range of factors including the mother's height, weight, parity and ethnicity are used to calculate an appropriate weight-range trajectory for each baby. This could result in a 3 kg baby being an average weight for one mother while considered SGA for a different mother.

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