Clinical features strongly indicative of a diagnosis of Silver-Russell syndrome, as assessed by the presence of 3 or more of the features below*:
1. Small Gestational Age (birth weight and/or birth length): ≤−2 standard deviation score (SDS) for gestational age
2. Postnatal growth failure: Height at 24 ± 1 months ≤−2 SDS or height ≤−2 SDS below mid-parental target height
3. Relative macrocephaly at birth: Head circumference at birth ≥1.5 SDS above birth weight and/or length
4. Protruding forehead: Forehead projecting beyond the facial plane on a side view as a toddler (1–3 years)
5. Body asymmetry: Leg length discrepancy of ≥0.5 cm or arm asymmetry or leg length discrepancy <0.5 cm with at least two other asymmetrical body parts (one non-face) 6. Feeding difficulties and/or low BMI: BMI ≤−2 standard deviations at 24 months or current use of a feeding tube or cyproheptadine for appetite stimulation *See Wakeling et al 2017, PMID: 27585961 OR Clinical features suggestive or Temple Syndrome