Why have I been referred to this clinic?
At the specialized Small Baby Clinic at UCLH, we assess women whose babies are found to have a low estimated weight on ultrasound or show signs of not growing and not reaching optimal weight during pregnancy.
This includes any baby measuring below the 10th centile, or any baby with a significant drop in abdominal measurement (more than 50 centiles). We also evaluate babies who have abnormal blood flow in the umbilical cord.
The Small Baby Clinic specializes in managing babies who are small in the later stages of pregnancy (from 30-32 weeks onward), when the primary cause of growth restriction is often a poorly functioning placenta. Babies who are small before then may have additional underlying reasons for their size and are therefore assessed in the Fetal Medicine Unit for further testing.
If a baby’s weight or abdominal circumference is measuring below the 10th centile on a growth chart, this means that your baby’s weight is less than expected for your stage of pregnancy. If you have 100 babies ranging from the lightest to the heaviest weight, your baby would have a similar weight to the smallest 10 out of these 100 babies.
The majority of babies (around 70%) who have a weight below the 10th centile are growing normally and are constitutionally small and are meeting their growth potential. About 30% of babies who have a weight below the 10th centile, are small due to the placenta not working as it should do during the pregnancy and has fetal growth restriction.
When a baby is small, there is a small increase in the risk of stillbirth and poor outcomes after birth. This risk varies, from very low in constitutionally small babies to up to seven times higher than the baseline risk in cases of severe placental insufficiency. For more information, you can read FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction (2021). However, with appropriate monitoring throughout the pregnancy and safe timing of birth, these risks can be reduced. This may include the doctor recommending your baby to be delivered before your due date if appropriate.
Small babies might have a small risk of not tolerating labour and have some difficulty in the adaptation to life after birth including feeding difficulties, difficulties in maintaining temperature and glucose levels and jaundice. Significant risks at birth, such as low oxygen level, are extremely rare and the doctor will advise you on the best birth options in case your baby is at risk.
You will be reviewed in the clinic by one or two doctors, who will perform an ultrasound scan to measure your baby to confirm whether or not baby is measuring small; we will check the blood flows (also called Doppler flows) in the umbilical cord and baby’s brain and the fluid around the baby to look at how well the placenta is working. The results of your baby’s weight will be plotted onto a growth chart.
If your baby’s weight and measurements are within the normal range on the growth chart, with normal fluid and blood flows, we will discharge you from the clinic but we may advise for you to have additional scans within the main scan department. If your baby’s weight is below the 10th centile, or there are signs of the baby not reaching their optimal weight, or if there are signs of the placenta not working, we will produce a personalized plan of management for you and your pregnancy. This plan will be based on your baby’s size and ultrasound scan measurements, and we will determine how often we see you in the clinic and the best time for your baby to be born.
If your baby is small due to the placenta not working, most babies will adapt to this and keep on growing throughout the pregnancy. Rarely, as the pregnancy advances, the babies will start to change the blood flow around the body to vital organs such as the brain.
During the ultrasound scan, we will record the blood flow (Doppler flows) in both the umbilical cord and in the brain of your baby to calculate the cerebroplacental ratio or ‘CPR’ which helps us to see if this process is happening.
An abnormal blood flow (Doppler flow) measurement does not necessarily mean you baby needs to be delivered immediately but we may propose a personalized plan for you and your pregnancy involving more frequent ultrasound scans and/or changes to the timing of birth.
We advise that you monitor your baby’s movements all the time, like any other pregnant woman. We also advise that you look out for any signs of pre-eclampsia such as headache, changes in vision, swelling of the arms, legs or face or pain in your upper tummy.
If your baby’s movements slow down, stop, or change, or if you suspect you may be having symptoms of pre-eclampsia, we would advise that you contact the Maternal Fetal Assessment Unit at UCLH using 0203 447 9400 and come in to be reviewed by a midwife and/or doctor.
There is no treatment or intervention to make your baby grow more. If scans show signs that the placenta is not functioning well, we may recommend planning for your baby to be born earlier than your due date (from 37 weeks onward) to reduce the risk of stillbirth and other complications. However, if there are no concerns with placental function and your baby appears to be constitutionally small, we would recommend waiting for spontaneous labour up to your due date.
Our approach will be to promote a low-intervention policy, allowing your baby to grow and develop in the womb for as long as it is safe for both you and your baby.
Most women can give birth vaginally through a process of induction of labour (IOL). If you choose to have an IOL, we recommend that you give birth on Labour Ward, where we will monitor the baby’s heart rate to ensure that your baby is coping with the process.
Sometimes, small babies are unable to cope with labour and require an emergency caesarean section to reduce the risk of poor outcomes after birth. A planned elective caesarean section (ELLSCS) is rarely recommended if we consider that the baby is unlikely to cope with labour or if there is another indication for ELLSCS such as breech presentation or previous caesarean section. You can also choose to have an ELLSCS, if this is your wish, like any other pregnant woman.
In rare cases, the placenta may show signs of very poor function, and we may recommend delivery before 37 weeks. Although this situation is uncommon, if it arises, we will clearly explain the reasons for our concerns. If a cesarean section is planned before 37 weeks, when the baby is still premature, you will be offered two injections of steroids to help mature the baby's lungs and support breathing after birth. We will discuss the benefits and potential risks of the steroid treatment with you if this scenario occurs.
Your baby should be able to stay with you on the postnatal ward, unless they weigh less than 1.7 kg, but is slightly more likely to need admission to the baby unit than other babies.
Small for gestational age babies can have difficulties with feeding and it is very likely that we would want to be sure that your baby is feeding effectively and gaining weight before discharging them from hospital. Be prepared to stay in hospital for a few days with your baby.
We will support and encourage your wish to breastfeed your baby but some babies may need mixed or bottle feeding to supplement the breastfeeding.
Expressing colostrum before delivery (starting from 36 weeks) can also be beneficial, especially for small babies. This practice not only helps you become familiar with breastfeeding techniques but also allows you to store extra milk for supplementation if needed.
Small babies sometimes have difficulty keeping their blood sugars in a safe range, so your baby will have at least two blood tests, taken from the heel before the second and third feed to check their blood sugar level. You may need to supplement the feeds with expressed breast milk, formula or sometimes dextrose gel given just inside your baby’s cheek if their blood sugar level is low. Your midwife will make a feeding plan with you. Please ask for help if you feel that your baby is not feeding properly.
Some small babies have difficulty keeping warm as they lack fat under their skin. Skin to skin care can be a very effective way of doing this. Sometimes we use a little heated blanket in the cot (also called a 'hot cot') to help the baby keep warm.
Both low blood sugar and low temperature can be a sign of infection, so if these issues do not improve with the measures described above, a paediatrician would be called to examine your baby to assess whether extra treatment is necessary.
When you take your baby home, you should ensure that your baby can breath safely, with clear nose and mouth from yourself and other objects, and have familiarised yourself with safe sleeping advice designed to reduce the risk of sudden infant death syndrome and also how to use a sling or baby carrier safely, just like with any other baby. Please refer to the following website for more information:
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For any further information about the small baby clinic, you can contact us at:
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Page last updated: 23 December 2024
Review due: 01 December 2026