Category — 2.2 Children with Biological Risk Conditions: Low Birth Weight (LBW)

Most newborns weigh between 2500 and 3500 grams when they are born. When a baby’s birth weight is less than this, he or she is considered to have Low Birth Weight (LBW).

LBW can be further sub-divided into the following categories:

• Low birth weight: 1500g-2500g;
• Very low birth weight: 801g-1499g;
• Extremely low birth weight: below 800g.

Many children who are born with low birth weight are also born premature. Many of these children have serious medical conditions and are placed in the neonatal intensive care unit immediately after birth. Some are unable to breathe on their own and may need the help of a machine to breathe and stay alive. This could be because they are born with immature lungs (Fig. 1).

Figure 1. Born with immature lungs

Some of the reasons for low birth weight include:

• Prenatal exposure to alcohol and/or drugs;
• Prenatal exposure to nicotine (cigarettes);
• Mother following a severely restricted diet while pregnant;
• Maternal infection during pregnancy;
• Mother being under a tremendous amount of stress throughout her pregnancy;
• Being a mother who is either over 40 or under 18;
• Additional reasons for low birth weight are unknown. Some mothers who have healthy pregnancies and get excellent prenatal care give birth to premature babies. The reasons for this are unknown.

Some children who are born with LBW develop just fine. Others are slow to reach most developmental milestones. Of those who were slow to reach these milestones, some eventually catch up with their typically developing peers, while others do not. Those who do not may end up with the following characteristics:

• Delays in cognitive development: some children with LBW continue to show delays compared to their peers in all areas related to cognitive development. They may be slower to respond to others. They may process information slowly and seem to struggle with abstract and/or complex terms and directions;
• Delays in the development of academic skills: some of these children will need help in all academic areas, including reading, writing and math;
• Delays in the development of language and communication skills: some of these children may be late to achieve language and communication milestones. They may struggle with their language skills even after they reach school age. Some may have a vocabulary that is smaller than that of their typically developing peers;
• Delays in the achievement of motor milestones: many of these children are late to sit up, walk and run. When they reach school age, they may appear a bit clumsy. They may struggle with activities that involve the use of their large muscles (for example, using the slides and swings on the playground). Others may experience fine motor difficulties such as difficulties with writing (Fig. 2);
• Delays in the development of social/emotional skills: some of these children will struggle in social situations, and may not know how to respond to others. This may be caused by their slightly immature cognitive and language skills.

Figure 2. Difficulty with writing

Some children who are born with LBW may end up with one (or more) of the following diagnoses:

• Cerebral palsy;
• ADHD;
• Learning disabilities;
• Autism;
• Hearing impairment;
• Vision impairment;

Many children born with LBW, especially those with extremely low birth weight, will need the help of highly specialized medical professionals. They may have trouble with their kidneys and/or heart. It is also worth noting that children born with extremely LBW have fewer chances of survival than children who are born with LBW.

Because of the difficulties described above, some children who are born with LBW could benefit from the following services:

• Special education assistance: in school, some of these children may require the help of the school’s special educator. These children are not usually placed on an Individual Education Plan (IEP) unless they are diagnosed with one of the conditions listed above. But that does not mean that they do not need help. They may need a lot of help with academic skills, paying attention, and following directions. They can often get this help from the school’s special educator;
• Speech and language pathologist (SLP): some of these children may continue to need the help of an SLP well into their school years. That is because some them are behind their peers in all aspects of language, especially when it comes to expressive and receptive language skills. An SLP will help these children improve their receptive and expressive language skills, and increase the size of their vocabulary;
• Behavioral interventionist (BI): some of these children may need help managing their behavior. Some may engage in extreme behaviors, such as severe temper tantrums. They may need the help of a BI  to learn how to manage these extremes in behavior;
• Occupational therapy (OT): some of these children may have sensory integration difficulties. Those who do may need the help of an OT who would help them with these difficulties. OTs can also help children who are born premature improve their fine motor skills;
• Vision specialist: some of these children will have vision problems and their vision may need to be monitored by an ophthalmologist. Those who do not have vision problems may still need regular visits with an ophthalmologist, even if their vision is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend  it;
• Hearing specialist: some of these children will have hearing problems and their hearing may need to be monitored by an audiologist. Those who do not have hearing problems may still need regular visits with an audiologist, even if their hearing is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend it;
• Orthopedist: some of these children will need the services of an orthopedist or orthopedic surgeon because of problems with their bones;
• Cardiologist: some of these children may have heart problems and may need to be monitored closely by a pediatric cardiologist.

Although some children who are born with LBW, and especially extremely LBW, continue to experience difficulties well into their middle childhood years, many others do not. Many do catch up with their peers fully and go on to lead very fulfilling, healthy and happy lives.

see References

http://www.successby6ottawa.ca/lbwfpn/english/

http://jama.ama-assn.org/content/287/2/270.full.pdf