1. SMALL FOR DATES
Definition
• A small for gestational age baby is one who is
usually small for the number of weeks spent in
the womb. This term refers to weight not length.
Clinical features
• The baby usually looks small
2. Clinical features cont...
• has all the organs well formed but small
• ribs are easily seen and the abdomen is
narrow
• the baby is wasted due to lack of
subcutaneous tissue
3. Predisposing factors
Maternal factors
i. Poor nutritional status
ii. Infections like malaria and HIV.
iii. Uterine abnormalities e.g. bicarnuate uterus.
iv. Bad obstetric history e.g. history of abortions
and pelvic inflammatory diseases.
Fetal causes
4. Fetal causes
i. Multiple pregnancies for example twins who
are competing for nutrition.
ii. Intra uterine diseases e.g. syphilis, Human
Immune Deficiency virus (HIV), rubella.
Placental factors
i. Chorioammonites which leads to uterine
growth retardation
5. Placental factors cont..
ii.Abnormal cord insertion – this will affect blood
circulation
iii.Single umbilical artery. This may affect proper
fetal circulation.
long cord – This may affect transportation of
nutrients to various fetal organs hence cause
uterine fetal growth retardation.
6. Medical investigations
1. Get blood for rapid plasma reaction to rue
out congenital syphilis
2. blood slide if child has fever to rue out
malaria infection
3. blood for full blood count to rue out anemia
4. blood for polymerase chain reaction to the
out HIV infection.
5. Blood for assessment of random blood sugar
to rue out hypoglycemia.
7. History taking from the mother
• Ask the mother if she attended antenatal
clinic regularly. This helps to know if all the
possible interventions like blood test for HIV,
syphilis and other examinations were done
promptly.
• Ask about history of maternal infections like
malaria, hypertension, HIV and renal faire.
• Also find out if prompt treatment was done.
8. Medical therapy
• Since these children are susceptible to
infection drugs to prevent infections can be
given e.g. cefotaxin 100mg/kg body weight for
fourteen days.
• If any infection is detected through lab
investigations there are supposed to be
treated accordingly.
• Can give dextrose 10% to prevent
hypoglycemia.
9. Nursing care
Aims of the nursing care
1. To improve nutritional status
2. prevent infections
Psychological care
• Teach the mother about the condition of her
child so as to allay anxiety
10. Psychological care cont..
• Also tell the mother about the interventions
which will be done on the child to improve the
nutritional status and prevent infections like
insertion of a nasal gastric tube to improve on
the feeding that is if the child is unable to suck
and also restrict visitors to promote rest.
• Tell the mother on how to take care of the
child like good hygiene practices which may
prevent infections.
11. Nutrition
• Encourage the mother to breast feed the child
to promote good nutrition and health of the
child.
• If the child can not breast feed encourage and
teach the mother on how to express breast
milk and useof a cup for feeding.
• A nasal gastric tube can also be inserted to
improve child’s nutritional status if he/she has
poor sucking reflexes.
12. Nutrition cont...
• Feeds should be given two hurly and
calculated according to weight
• If child has hypoglycemia glucose 10%
dextrose can be given to prevent
hypoglycemia and brain damage
• Intravenously, 5mls per kg body weight start.
13. Environment
• ensure that the environment is clean to prevent
infection
• Accessories being used should also be clean at all times
• Should be nursed in neonatal ICU because care for such
babies is given promptly.
• Should be nursed in a quite, well ventilated room to
promote rest and air circulation.
• Also the room should have enough light to prevent
bacterial manifestation
• Also the baby must be kept warm at all times to
prevent hypothermia.
14. Observations
• Vital signs should be done regularly to
monitor recovery.
• Temperature to rue out hypothermia
• Apex pulse to be done to rue out tachycardia
or tachypnoea
• Observe breathingpatterns of the child to rue
out dyspnea and apnea.
• Observe skin color to rue out jaundice
15. Obs. Cont...
• Observe for input and out put to rue out
overfeeding
• Observe for abdominal distension to rue out
retention of feeds. (constipation)
• Also observe for the color, frequency and
consistency of meconium to rue out
abnormalities like diarrhea.
16. Elimination
• Monitor passage of meconium to rue out
constipation.
• Monitors passage of urine, ask the mother if
nappies are normally wet this is done to
ascertain patency of the body parts (orifices)
17. Information Education and
Communication
• Encourage the mother to exclusively breast
feed the child also re-emphasize on the
benefits of breast milk
• Also encourage on the importance of under
five clinic because this helps to monitor the
child’s growth and recovery and also acquiring
of vaccines which help in boosting the childs
immunity.
18. IEC cont...
• Advise the mother to practice good hygiene
practices so as to prevent infections.
• If drugs are dispensed to the child advice the
mother to give the child drugs correctly and
also reemphasize on the side effects.
19. Complications
1. Hypothermia – due to poor metabolic process in
the production of heat. Also due to exposure to
the cold and poor subcutaneous tissue which
promotes rapid heat loss.
2. Hypoglycemia –
• may be due to poor feeding.
• May be due to decreased hepatic stores and
reduction of subcutaneous fat stores that are
quickly utilized by the body.
20. Complications cont..
• The baby may present with apneic disorders,
lethargy and poor feeding.
• Untreated hypoglycemia may lead to brain
damage and consequently death.
