Small for gestational age -Rakhimol M R. 2nd MSc

PRETERM BABY AND SMALL FOR
GESTATIONAL AGE

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PRETERM BABY
DEFINITION:
A baby born before 37 completed weeks of
gestation calculating from the first day of last
menstrual period is arbitrarily defined as preterm
baby.

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INCIDENCE
Preterm baby constitutes two-thirds of
low birth weight babies. The incidence in the
developing countries is about 20–25%. In
affluent societies and in the developed
countries, the incidence is less than 10%.

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ETIOLOGY
High risk factors:
History:
(1) Previous history of induced or spontaneous abortion or
preterm delivery
(2) Pregnancy following assisted reproductive techniques
(ART)
(3) Asymptomatic bacteriuria or recurrent urinary tract
infection
(4) Smoking habits
(5) Low socioeconomic and nutritional status
(6) Maternal stress

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Complications in present pregnancy:
May be due to maternal, fetal or placental.
MATERNAL:
(a) Pregnancy complications: Preeclampsia, antepartum
hemorrhage, premature rupture of the membranes,
polyhydramnios
(b) Uterine anomalies: Cervical incompetence, malformation of
uterus

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(c) Medical and surgical illness:
Acute fever, acute pyelonephritis, diarrhea, acute
appendicitis
Chronic diseases: Hypertension, nephritis, diabetes, severe
anemia, low body mass index (LBMI)
(d) Genital tract infection:
Bacterial vaginosis, beta-hemolytic Streptococcus,
bacteroides, chlamydia and mycoplasma. „

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 Fetal:
Multiple pregnancy, congenital malformations and intrauterine
death.
 „Placental:
Infarction, thrombosis, placenta previa or abruption.
Iatrogenic:
Indicated preterm delivery due to medical or obstetric
complications.
Idiopathic: (Majority):
Premature effacement of the cervix with irritable uterus
and early engagement of the head are often associated. In the
absence of any complicating factors, it is presumed that there is
premature activation of the same systems involved in initiating.

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MANIFESTATIONS OF PREMATURITY:
The clinical manifestations differ with the degree of prematurity.
Anatomical:
 Weight is 2500 g or less
 Length is usually less than 44 cm.
 The head and abdomen are relatively large; the skull bones are
soft with wide sutures and posterior fontanel.
 The head circumference disproportionately exceeds( 3cm) that
of the chest. (normally, the head circumference is greater than
the chest circumference at birth and the difference is about 1.5
cm).

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 Pinnae of ears are soft and flat.
 The eyes are kept closed
 The skin is thin, red and shiny, due to lack of
subcutaneous fat and covered by plentiful
lanugo and vernix caseosa.
 Muscle tone and general activity is poor.

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 Plantar deep creases are not visible before 34
weeks.
 The testicles are undescended
 The labia minora are exposed because the labia
majora are not in contact.
 The nails are not grown right up to the finger
tips.

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Physiological handicaps
CENTRAL NERVOUS SYSTEM
 Immaturity of central nervous system is expressed as inactivity
and lethargy, poor cough reflex and in-coordinated sucking and
swallowing.
 Inefficient blood brain barrier.
 Vulnerable for intraventricular–periventricular hemorrhage and
leuco-malacia.
 Retinopathy of prematurity.
 Resuscitation difficulties at birth and recurrent apneic attacks.

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 RESPIRATORY SYSTEM
 Breathing is mostly diaphragmatic, periodic and associated with intercostal
recessions
 Hyaline membrane disease
 Cuboidal alveolar lining- poor alveolar diffusion of gases
 They are vulnerable to develop chronic pulmonary insufficiency
 Pulmonary aspiration and atelectasis
 CARDIOVASCULAR SYSTEM
 In grossly immature infants(less than 32 weeks) EKG shows left ventricular
preponderance.
 Risk to develop thrombo- embolic complications and hypertension.
 The closure of ductus arteriosus is delayed.

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 GI SYSTEM
 Hypoglycaemia
 Regurgitation and aspiration are common.
 Animal fat is not tolerated as well as the vegetable fat due to poor
and incoordinated sucking and swallowing.
 Development of kernicterus at lower serum bilirubin levels.
 Immaturity of the glucuronyl transferase system in the liver leads
to hyper-bilirubinemia.
 Abdominal distention and functional intestinal obstruction

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THERMO REGULATION
 INFECTION
RENAL SYSTEM
TOXICITY OF DRUGS
NUTRITIONAL HNDICAPS
BIOCHEMICAL DISTURBENCE

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These babies are prone to develop:
 Hypoglycaemia
 Hypocalcemia
 Hypoprotenemia
 Acidosis
 Hypoxia.

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COMPLICATIONS OF A PRETERM NEONATE
 Asphyxia: The babies are likely to be asphyxiated
because of anatomical and functional immaturity. Even
minor degree of anoxia may produce subserosal
hemorrhages especially in the heart, lungs and liver. „
 Hypothermia: A low birth weight baby has reduced
subcutaneous as well as brown fat and increased surface
area.

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 Pulmonary syndrome:
This includes: (a) Pulmonary edema (b) Intra-alveolar
hemorrhage (c) Idiopathic respiratory distress syndrome (RDS) (d)
Bronchopulmonary dysplasia. RDS is one of the major causes of
death in preterm babies born before 34 weeks. The deficient lung
surfactant is the principal factor responsible for pulmonary
atelectasis leading to hypoxia and acidosis. Surfactant therapy is
effective in reducing RDS. „

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Cerebral hemorrhage
The causes are: (a) Soft skull bones allow dangerous
degree of moulding leading to subdural or subarachnoid
hemorrhage (b) Fragile subependymal capillaries cannot
withstand minor degree of hypoxia leading to
intraventricular hemorrhage (c) Associated
hypoprothombinemia. „

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 Fetal shock: Apart from the shock sustained during
delivery, it may appear following improper resuscitative
manipulation during the first day or two. „
 Hypoglycemia (blood glucose < 40 mg/dL) is observed
in about 15% of infants due to lack of glycogen stores in
the liver. Cold stress, hyperinsulinemia and poor feeding,
are the causes.
 Heart failure: It may be precipitated by asphyxia with
rapid development of pulmonary edema which in turn
impairs pulmonary aeration. There may be patent ductus
arteriosus.
 Oliguria, anuria

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Infection: Protective passive immunity is usually obtained
from the mother during the later months of pregnancy.
As the transfer of protective immunoglobulins from the
mother to a preterm baby is less, the incidence of
infection is increased by 3–10 folds.
Jaundice: Because of hepatic immaturity, the bilirubin
produced by the excessive hemolysis cannot be
conjugated adequately for excretion as bile, leading to
rise in unconjugated bilirubin which is responsible for
exaggerated physiological jaundice. „
„

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Patent Ductus Arteriosus (PDA): Persistant PDA is inversely
related to gestational age. Up to 30% of PDA closes
spontaneously.
Anemia : Lack of stored iron, hypofunction of the bone marrow
and excessive hemolysis all contribute to anemia. „
Apnea and Sudden Infant Death Syndrome (SIDS) is due to
immaturity of the autonomic nervous system.

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Retinopathy of prematurity is a multifactorial disorder
of the retina caused by abnormal neovascularization. It is an
important cause of blindness for the children under 6 years. The
cause is mostly related to the liberal administration of high
concentration of oxygen above 40% for a prolonged period (1–2
days) following birth. Many other factors like extreme
prematurity, hypoxia, lactic acidosis, vitamin E defciency and
bright light have been implicated. The blindness is due to the
formation of an opaque membrane behind the lens. „
Length of stay: Increased length of hospital stay especially for the
neonates who are early preterm

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PROGNOSIS:
The chance of survival is directly related to the birth
weight. A baby weighing more than 1500 g is most likely (95%)
to survive. With intensive neonatal care the survival rate of the
baby weighing 751–1000 g is to the extent of 80%. With
gestational age < 23 weeks, mortality is > 97%. Most of the
deaths (two-thirds) occur within 48 hours.
LONG-TERM PROGNOSIS:
Major handicaps (cerebral palsy), hearing loss, chronic
lung disease and poor growth are observed. Infants less than 2.5
kg more likely to have ADHD

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MANAGEMENT •
 Prevention of prematurity •
 Management of preterm labor •
 Care of preterm neonate
Predictors of preterm labor:
A. Clinical predictors: (i) History of prior preterm birth; (ii)
Multiple pregnancy; (iii) Presence of genital tract infection; (iv)
Symptoms of PTL
B. Biophysical predictors: (i) Uterine contractions (UC) > 4/hr; (ii)
Bishop score > 4; (iii) Cervical length (TVS) < 25 mm.

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C. Biochemical predictors: Fetal fibronectin (fFN) in
cervicovaginal
Principles of Management of Women with Preterm Labor „
 Glucocorticoids to the mother to reduce neonatal RDS, IVH, NEC, BPD and PDA
 Antenatal transfer of the mother with fetus in utero to a tertiary center equipped with
NICU.„
 Tocolytic drugs to the mother for a short period unless contraindicated. „
 Antibiotics to prevent neonatal infection with Group B Streptococcus (GBS). „
 Magnesium sulfate (neuroprotector) to the mother to reduce neonatal cerebral palsy when
pregnancy is <34weeks
 Careful intrapartum monitoring, minimal trauma and presence of a neonatologist during
delivery. „
 Vaginal delivery is preferred, unless otherwise indicated for cesarean birth.

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PREVENTION OF PRETERM LABOR
In about 50%, the cause remains unknown.
 Primary care is aimed to reduce the incidence of preterm labor by reducing the
high-risk factors (e.g. infection, etc.). •
 Secondary care includes screening tests for early detection and prophylactic
treatment (e.g. tocolytics). •
 Tertiary care is aimed to reduce the perinatal morbidity and mortality after the
diagnosis (e.g. use of corticosteroids).
 Investigations: (1) Full blood count; (2) Urine for routine analysis, culture and
sensitivity; (3) Cervicovaginal swab for culture and fibronectin; (4)
Ultrasonography for fetal well being, cervical length and placental localization
and (5) Serum electrolytes and glucose levels when tocolytic agents are to be
used.

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MEASURES TO ARREST PRETERM LABOR
 Bed rest
 Adequate hydration is maintained. •
 Prophylactic cervical cerclage for women with prior preterm birth and short
cervix in the present pregnancy may be benefcial. •
 Tocolytic agents: Various drugs nifedipine, atosiban, progesterone
(micronized) have been used to inhibit uterine contractions. •
.
 Glucocorticoid therapyEither betamethasone (Betnesol) 12 mg IM 24 hours
apart for two doses or dexamethasone 6 mg IM every 12 hours for 4 doses is
given. Betamethasone is the steroid of choice.

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MANAGEMENT IN LABOR
The principles in management of preterm labor are:
(1) To prevent birth asphyxia and development of RDS
(2) To prevent birth trauma. Duration of labor is usually short.
First Stage
 The patient is put to bed to prevent early rupture of the membranes
 To ensure adequate fetal oxygenation by giving oxygen to the mother by mask
 Epidural analgesia is of choice
 Labor should be carefully monitored preferably with continuous EFM
 Cesarean delivery is done for obstetric reasons only (hypertension, abruption or
malpresentation)

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2nd stage
 The birth should be gentle and slow to avoid rapid compression and
decompression of the head
 Episiotomy may be done to minimize head compression if there is perineal
resistance
 Tendency to delay is curtailed by low forceps. As such, routine forceps is not
indicated
 The cord is to be clamped immediately at birth to prevent hypervolemia and
hyperbilirubinemia
 To shift the baby to neonatal intensive care unit under the care of a
neonatologist

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CARE OF A PRETERM NEONATE
 IMMEDIATE MANAGEMENT FOLLOWING BIRTH
 INTENSIVE CARE PROTOCOL:
The principles that are to be taken for the babies requiring special care are:
 To maintain a relatively stable thermoneutral condition: keep delivery room
warm, dry and then wrap the baby with a warm towel, keep the baby with
mother skin-to-skin contact.
 Adequate humidifcation to counter balance increased insensible water loss
 Oxygen therapy and adequate ventilation.
 To prevent infection.
 To maintain nutrition and adequate nursing care.

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 To maintain body temperature:
The axillary temperature should be between 36.0°C and 36.5°C.
 Fluid Electrolytes:
These infants need increased fluid replacement because of immature renal
function and high insensible water loss. IV fluid therapy is needed and 50–70
mL/kg/day is given when the infant is in an incubator. Serum electrolytes
should be tested at 12 hourly intervals.
 Respiratory support:
 Hyperbilirubinemia:
Serum bilirubin should be maintained < 10mg/dl .
 Infection:

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Nutrition:
Preterm infants are often unable to suck and swallow. Enteral feeding may be
possible depending on gestation age and vigor. Babies may require gavage
feeding or parenteral nutrition. Human milk is the first choice of nutrition for
all low birth weight babies.
Commencement
Early feeding within 1/2 –1 hour of birth is now widely recommended. It
eliminates hypoglycemia, lowers serum bilirubin and neurological sequelae.
Intervals—Depending upon the birth weight, the interval of feeding ranges from
hourly in extreme prematurity to 3 hourly feeds in babies born after 36 weeks

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Methods—The methods used depend on the size and vigor of the infant and his
ability to suck and swallow. Thus, while a comparatively bigger baby with
vigor can be put to the breast right from the beginning, the smaller one should
be fed by any of the following methods.
 Tube (Gavage) •
 Pipette, dropper, katori and spoon •
 Bottle •
 Intravenous
Position
The baby, when fed in a cot, should be placed on right side with the head
raised a little to prevent regurgitation.

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Nature of food:
Undiluted breast milk expressed from the mother or pooled (donor breast
milk) is ideal.
„Calorie requirement:
The calorie intake of 60 calories per kg per day on 7th day is to be stepped up
gradually to 100 on 14th day and about 120–150 on 21st day.
Food volume—To meet the calorie requirements, the amount of milk to be given
is slowly but progressively increased. Requirement on 1st day is 80 mL/kg.
Gradually increased by 15 mL/kg/day to reach 200 mL/kg/day by 8th to 10th
day.

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Additional supplements
 All premature babies should receive additional supplement of vitamins and
minerals which should be started after 2 weeks.
 The daily requirement consists of vitamin A 2500 IU, vitamin D 400 IU,
vitamin C 50 mg, folic acid 65 mg and vitamin B1 -0.5 mg. Supplementation
of calcium and phosphate is also essential.
 In addition, iron supplement should be given in the second or third week. A
liquid preparation containing 2–4 mg/kg/day of elemental iron should be given
in two divided doses.
 Intravenous gamma globulin therapy (400 mg/kg/dose) may be given to
prevent infections in selected cases. For very low birth weight (< 1200 g)
babies parenteral nutrition with amino acids, lipids along with dextrose and
multivitamins are given.

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NURSING CARE
The single most important factor is high standard of nursing and one trained nurse
can adequately take care of two or three infants.
(1) The temperature should be taken twice daily and the baby should be weighed
daily to know whether over or underhydrated
(2) Constant supervision especially during the crucial first 48 hours is imperative
(3) Mother should be allowed to care her baby in the nursery
(4) Mother is taught for the general care of the baby and manual expression of
breast milk by pressing over the areola and the nipple.
(5) Intelligent observation, prompt recognition of the abnormality and adequate
measures to rectify the defect can be life saving in many occasions.

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 FAVORABLE SIGNS OF PROGRESS:
The following are the favorable signs:
(1) The color of the skin remains pink all the time.
(2) Smooth and regular breathing.
(3) Increasing vigor evidenced by— (a) movements of the limbs and
(b) cry.
(4) Progressive gain in weight
 ADVICES ON DISCHARGE:
 FOLLOW UP VISIT:
Assessment is done for infant’s general health, weight, hydration and
degree of jaundice. Immunization schedule is verified. Any new
problem need to be identified. Pattern of feeding, its adequacy are
explored. Guidance for infant care is given to mother.

SMALL FOR
GESTATIONAL
AGE (SGA)

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a) Small for Gestational Age (SGA): Birth weight less
than 10th percentile for gestational age
(b) Appropriate for Gestational Age (AGA): Birth
weight lies between the 10th and 90th percentiles for
gestational age
(c) Large for Gestational Age (LGA): Infant’s birth
weight above the 90th percentile for gestational age

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DEFINITION
Small for gestational age (SGA) newborns are those who are
smaller in size than normal for the gestational age most commonly
defined as a weight below the 10th percentile for the gestational
age.
Types of SGA
 Malnourished SGA
 Hypoplastic SGA
 Mixed SGA

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MALNOURISHED SGA[ASYMMETRIC IUGR]
 Malnourishment during latter part of gestation – placental dysfunction
(uteroplacental insufficiency)
 Commonest type of SGA
 Long,thin & marasmic
 Internal organs and liver grossly shrunken
 Head Circumference > CC by 3cm
 Brain unaffected,loose skin folds
 Ponderal index [g/cm]< 2
 Neonatal prognosis – better
 Nutritional rehabilitation
 Growth potential (+)
 Only decrease in cell size, cell number

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HYPOPLASTIC SGA
 Incidence of anomalies 10 – 20 times higher
 Growth retardation in early pregnancy [intrauterine infection genetic defects,
chromosomal aberrations ]
 1/3 rd of IUGR
 Symmetric IUGR
 Decrease in cell number all organs affected, including brain all parameters are
proportionately small
 Ponderal index - normal
 Poor prognosis
 Permanent physical & mental retardation

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MIXED SGA
 Adverse factors during both early mid pregnancy
 Decrease in both cell size and count
 Neither obvious malnourished, nor grossly hypoplastic
Causes of SGA
 Maternal
 Fetal
 Placental
 Environmental

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MATERNAL FACTORS
 Maternal nutrition
 Poor weight gain
 Previous history
 Smoking
 Grand multipara
 Tobacco
 Alcohol
 Maternal disease
FETAL FACTORS
 First born
 IU infections
 Multiple pregnancy
 Genetic defects

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PLACENTAL FACTORS
 Abruption vascular
 Thrombosis
 Placental structural abnormality
ENVIRONMENTAL FACTORS
 Nutritional
 Socio-economic status
 Ethnic/racial/geographic

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DIAGNOSIS
The baby with SGA is often identified before birth. During
pregnancy, a baby's size can be estimated in different ways.
 The height of the fundus
 Maternal weight gain
 USG
 Doppler

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SGA BABIES FEATURES
SGA babies, especially those with IUGR
 Appear thin, pale, and with loose, dry skin.
 The umbilical cord is often thin, and dull-looking
rather than shiny and fat.
 They sometimes have a wide-eyed look.

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COMMON PROBLEMS OF SGA BABIES.
 IUD, birth asphyxia, hypoglycemia
 Hypocalcemia
 Hypothermia
 Congenital malformatoins
 Infections
 Polycythemia
 Poor growth potential

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MANAGEMENT OF SGA
 Emergency CS – fetal distress
 Screening for congenital malformations
 Early and adequate breast feeding (NGT/IVF)
 Correct
hypoglycemia,hypocalcemia,polycythemia
 Control infections,temperature regulation

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PREVENTION OF SMALL FOR
GESTATIONAL AGE (SGA):
 Prenatal care is important in all pregnancies, and
especially to identify problems with fetal growth.
 Stopping smoking and use of substances such as
drugs and alcohol are essential to a healthy
pregnancy.
 Eating a healthy diet in pregnancy may also help.

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NURSING MANAGEMENT
 Support respiratory effort
 Provide neutral thermal environment
 Protect from infection
 Provide appropriate nutrition
 Monitor glucose level as ordered
 Maintain adequate hydration
 Monitor intake out put
 Administer fluid as ordered
 Provide meticulous skin care
 Facilitate growth and development
 Keep parents informed and provide support to the entire family

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Effect of Enteral Lipid Supplement on Severe Retinopathy of
Prematurity
OBJECTIVE
To determine whether enteral supplementation with fatty acids
from birth to 40 weeks’ postmenstrual age reduces ROP in
extremely preterm infants.
DESIGN, SETTING, AND PARTICIPANTS
A randomized clinical trial, was a multicenter study performed at 3
university hospitals in Sweden from December 15, 2016, to
December 15, 2019. A total of 209 infants born at less than 28
weeks’ gestation were tested for eligibility, and 206 infants were
included. Statistical analyses were performed from February to
April 2020

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INTERVENTIONS:-
Infants received either supplementation with an enteral oil
providing AA (100 mg/kg/d) and DHA (50 mg/kg/d) (AA:DHA
group) or no supplementation within 3 days after birth until 40
weeks’ postmenstrual age
CONCLUSIONS AND RELEVANCE
This study found that, compared with standard of care, enteral
AA:DHA supplementation lowered the risk of severe ROP by
50% and showed overall higher serum levels of both AA and
DHA. Enteral lipid supplementation with AA:DHA is a novel
preventive strategy to decrease severe ROP in extremely preterm
infants.

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RESEARCH STUDY
Risk factors for small-for-gestational-age and preterm births among
19,269 Tanzanian newborns
AUTHORS: Alfa Muhihi1, Christopher R. S , Emily R. Smith,
Ramadhani A. Salum Mshamu, Christina Briegleb, Mohamed
Bakari , Honorati Masanja1 , and Grace Jean
Methods Study design and data collection
This study consist of women and singleton infants enrolled in
a randomized double-blind, placebo- controlled neonatal vitamin
A supplementation trial conducted in Tanzania between August
2010 and March 2013.

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RESEARCH STUDY
. Conclusion
This study identified common and unique risk factors for
term-SGA, preterm-AGA and preterm-SGA ranging from
anthropometric, economic, demographic and behavioral factors.
Some of the risk factors like late ANC attendance, young
maternal age at conception, short maternal stature, and poverty
are potentially modifiable, and provide an opportunity to improve
birth outcomes. In addition, due to high burden of preterm and
SGA births in both urban and rural settings in Tanzania, it is vital
to advocate for universal access to essential newborn care within
the country and similar settings.

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Table of contents

The slide title goes here!
Do you know what helps you make
your point clear?
Lists like this one:
● They’re simple
● You can organize your ideas
in a clear way
● You’ll never forget to buy
milk and cookies!
And the most important thing: the
audience won’t miss the point of
your presentation

Pacifier: yes or no?
YES
● Mercury is the closest
planet to the Sun
● Venus is the second planet
from the Sun
● Mars is actually a very
cold place
NO
● Jupiter is the biggest
planet of them all
● Saturn is composed of
hydrogen and helium
● Neptune is the farthest
planet from the Sun

Change is the law of nature?
Infancy
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System
Childhood
Venus has a beautiful name
and is the second planet
from the Sun
Adolescence
Despite being red, Mars is
actually a cold place. It’s
full of iron oxide dust

Differences Between term and preterm newborns
Term Preterm
Mercury is the closest
planet to the Sun and
the smallest one
Venus has a beautiful
name and is the second
planet from the Sun

Purposeful and active play
Unoccupied play
Venus is the second
planet from the Sun
Solitary play
Jupiter is the biggest
planet of them all
Onlooker play
Despite being red, Mars
is a cold place
Associative play
Saturn is a gas giant
and has several rings

About child development
Mercury
It’s the closest planet
to the Sun
Venus
Venus is the second
planet from the Sun
Jupiter
planet of them all
Saturn
It’s composed of
hydrogen and helium
Mars
Mars is actually a very
cold place
Neptune
It’s the farthest planet
from the Sun

—Someone Famous
“This is a quote, words full of
wisdom that someone
important said and can make
the reader get inspired.”

A picture is worth a thousand words

A picture always
reinforces the
concept
Images reveal large amounts of
data, so remember: use an image
instead of a long text. Your
audience will appreciate it

Name of the section
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02

150,000
Big numbers catch your audience’s attention

9h 55m 23s
Jupiter's rotation period
333,000
The Sun’s mass compared to Earth’s
386,000 km
Distance between Earth and the Moon

You can use percentages
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System
Venus has a beautiful name
and is the second planet
from the Sun
Despite being red, Mars is
actually a cold place. It’s
full of iron oxide dust
25% 50% 75%

Desktop mockup
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Our team
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Jenna Doe
Timmy Jimmy

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Name of the section
03

Children’s development centers
mercury
It’s the closest planet
to the Sun
venus
Venus is the second
planet from the Sun
mars
cold place

Language development
3-4 months
planet to the Sun 6-9 MONTHS
Neptune is far away
from Earth
15 MONTHS
cold place 18 MONTHS
planet of them all

INFANCY
3 MONTHS 6 MONTHS 9 MONTHS
Sitting without
support
Standing with
assistance
Standing and
walking alone
Physical development: infancy

Physical development: early childhood
Early
childhood
12 months 15 months 18 months
Standing up and
first steps
Beginning to walk
unassisted
The baby is
stacking bricks

Physical development: childhood
CHILDHOOD
2 YEARS 3 YEARS 4-5 YEARS
Can run and walk
down steps
Can hold a pencil
with control
Can climb, skip and
hop with control

What are the stages of early childhood?
Newborn
planet to the Sun
Infant
Venus is the second
planet from the Sun
Toddler
Neptune is the farthest
planet from the Sun

How much sleep do kids need?
0
4
8
12
16
Infants Toddlers Preschoolers
12 to 16 hours
planet to the Sun
11 to 14 hours
Venus is the second
planet from the Sun
10 to 16 hours
cold place

Infant maximum stomach capacity
1 day
Size of a cherry 5-7
ml/l-2 tbs
3 days
Size of a walnut 22-27
ml/0.75-1 oz
1 week
Size of an apricot 45-
60 ml/l.5-2 oz
1 month
Size of a large egg
5-7 ml/2.5-5 oz

Age of first steps
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Average age
12 to 14 months
10%
55%
35%
Mercury is a very
small planet
Venus has a
beautiful name
Mars is actually a
very cold place

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JANUARY FEBRUARY MARCH APRIL MAY JUNE
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