Look at the Baby, Not the Scale

Look at the Baby, Not the Scale

  • Posted by Dr. Jay Gordon

It sounds simple doesn’t it? Yet I have seen so many moms whose babies have looked healthy, nursed well, met developmental milestones one right after the other and have lost all confidence in breastfeeding due to someone telling them that their baby’s weight was not on the charts. This someone was looking at the scale and charts, rather than the baby.

In the first 24 to 72 hours after birth babies tend to lose about 3-10% of their birth weight and then regain that weight over the next 2 to 3 weeks. If a mother receives lots of IV fluids during labor, the baby could be born “heavier” because of the increased water. The somewhat higher weight could be measured if a baby were weighed right before it peed for the first time. The difference of this extra fluid retention might only be a few ounces, but some parents are told to be concerned when, at their baby’s two week checkup, the baby is a few ounces under birth weight.

Another common problem at early checkups is a baby that is not gaining what the practitioner considers to be “normal weight gain.” There is not general agreement on normal weight gain and the range in texts are from 4 to 8 ounces a week. Some babies are genetically destined to be a lot smaller or larger than others. As I mentioned in the first paragraph: Easy concept, isn’t it?

If you have been told that weight gain is not acceptable, look hard at this list of questions:

  • Is your baby eager to nurse?
  • Is your baby peeing and pooping well?
  • Is your baby’s urine either clear or very pale yellow?
  • Are your baby’s eyes bright and alert?
  • Is your baby’s skin a healthy color and texture?
  • Is your baby moving its arms and legs vigorously?
  • Are baby’s nails growing?
  • Is your baby meeting developmental milestones?
  • Is your baby’s overall disposition happy and playful?
  • Yes, your baby sleeps a lot, but when your baby is awake does he have periods of being very alert?

If you have answered yes to the above questions, you may want to progress on to two important questions which the “charts” seem to ignore.

  • How tall is mom?
  • How tall is dad?

If someone were to ask you what weight a 33 year old man should be, you would laugh. The range of possibilities varies according to height, bone structure, ethnicity and many other factors. Yet babies are expected to fit onto charts distributed throughout the country with no regard to genetics, feeding choice or almost anything else.

There can be nursing problems that can cause slow weight gain; an inadequate “latch-on” is probably the only common breastfeeding problem in the first weeks. This is an easily remedied problem with the right help. In the best of circumstances, breastfeeding should be assessed within the first day or two after birth by a skilled lactation expert. Good hospitals have these LC’s and IBCLC’s on staff and, if not, please line up a consultation within the first 12 hours of life. Your pediatrician can help you with this. If not, call La Leche League and ask them whom they recommend in your area. This is a crucial step in becoming a parent and must not be skipped.

If there are nursing problems, the first answer should never be supplementation but must be to find the best advice and help available. Find quality help in person if possible and online if needed. There is nothing better than having an experienced breastfeeding expert watch you and your baby and give you the help and encouragement and support you need and deserve.
Too many mothers and babies lose the breastfeeding experience and the lifesaving and illness preventing benefits because we doctors are trained to look harder at the scale than we are at the baby.

A few notable examples:

  • Baby, birth weight: 9 lbs. 12 oz.
    Weight 36 hours after delivery: 9 lbs. 2 oz.

I have seen mothers encouraged to supplement because “they have no milk, the baby is hungry and losing weight.” The baby looks good and is nursing every 1 to 3 hours and mom’s nipples are not getting sore. There is no need to do anything but nurse often, switch breasts every 5 minutes or so and wait another day or two for the milk to come in. A thirsty baby nurses strongly and is in no danger. A baby given water or formula might not nurse so strongly and mom’s confidence (and milk supply) will suffer for it. This mom only needs the support of an expert who can be sure that she knows how to latch her baby on to the breast.

  • Same baby, two week checkup: 9 lbs. 6 oz

Forgetting that this represents a 4 oz. weight gain from the 36 hour weight, some docs might recommend supplementation. Again, watch breastfeeding and if everything is going well, don’t worry. A dry, jaundiced baby with darker yellow urine is a different case and needs more help with nursing. This baby still should not get formula. Make sure mom is drinking enough water, nursing often without a set schedule (every 1 to 3 hours) and make very sure that she gets help latching her baby on, especially if she has sore nipples.

  • Same baby, six month checkup: 15 lbs.

Lactation consultation had been successful in the early weeks thanks to mom having found a supportive, smart doctor and being determined to succeed at feeding her baby the best. This big baby (9 lbs. 12 oz. at birth, remember?) had weighed 13 pounds at her four month visit and now weighs 15 pounds. The doctor is paying attention and sees that Mom is 5′ 3″ and Dad is 5′ 9″ and slender. He looks at the charts second and the baby first and isn’t concerned about the baby dropping from a very high percentile at birth to a lower one and then to a lower one still.

I think I’ll conclude this scenario with this happy ending.

In summary, babies who are nursing, peeing clear urine and wetting diapers well in the first weeks of life are almost always all right. I cannot recall seeing a baby for whom slow weight gain in the first 2 to 6 weeks was the only sign of a problem.

Older babies, 2 to 12 months of age, grow at varying rates. Weight gain should not be used as a major criterion of good health. Developmental milestones and interaction with parents and others are more important. Do not be persuaded to supplement a baby who is doing well. Get help with breastfeeding and use other things besides weight to guide you.


  1. Annalisa

    Hi, my son will be five weeks on 9/29. He was 7 lb, 11 oz at birth, dropped to 6 lb, 5 oz before leaving the hospital and was 6 lb, 6 oz at his first checkup (6 days old). At this point, he seemed to be nursing well, latching on well, etc., although he would occasionally (maybe two or three times a day) get really frustrate and wag his head back and forth as if he couldn't find the nipple. We went for a weight check when he was 9 days old and he was 6 lb, 8 oz. Went back a week later and he was 6 lb, 8 oz again. At this point, his latch seemed to be deteriorating–he would latch well initially but then immediately close his lips closer around the nipple and "gnaw." The pediatrician checked his tongue and said he was tongue-tied and we had it cut three days later (he was almost a month old at this point). During that three-day span, the pediatrician asked to pump after every feeding and feed it to him in a bottle. I was pumping for 30 minutes and only getting 1/2 an ounce, which concerned me. We went back a week later for another weight check (4 days after tongue being cut), and they said he weight 6 lb, 6 oz. Initially after having his tongue cut, he sucked great; i could really feel a difference. But after a day or two, he gradually started going back to his gnawing around the nipple habit and I had a hard time getting him to suck vigorously. So after the last weight check where he lost weight, my pediatrician had me supplement for a few days again and we pumped after each feeding and also gave him formula several times a day. today I went in for a weight check and he weighed in at 7 lb., 1 oz. So according to my pediatrician's office, he gained 11 oz in 3 days–could this possibly be correct!?! I'm beginning to wonder if he is just doing better after having his tongue cut and gained that over the last week and the weight check of 6 lb, 6 oz was simply an error. However, I also did a "test pumping" to see how much i could get out–skipped a feeding with him and pumped instead. I only got 1 1/2 oz, which is quite low from what I understand. so I'm just not sure what's going on.. Also, whenever I pump after feeding, he seems very agitated at the next feeding, like he's having a hard time getting what he needs. So I just have no idea what's going on at this point–if his frenulum wa steh problem, if I have difficulties with supply, or what… Thanks!

    1. Cheryl Taylor

      You cannot judge your milk supply by how much you can pump. Some women do not letdown well for a pump even though they have a full supply. I would not recommend mixing bottle feeding into the situation where you're working on improving latch from a recently clipped tight frenulum. If you are concerned about weight gain the first step would be to nurse every 60-90 minutes from beginning of nursing to beginning of nursing during all of your waking hours.

  2. Sandra

    my baby boy was born 7 lbs, 13 oz. he dropped to 7, 4 in the first few days, but was back up to his birth weight after two weeks. at 8 weeks he was weighed 9, 9. now, 2 months later, at 10, 4, he has only gained a few more oz. he is a skinny little thing, but this article describes him well. he is alert, active, nurses well, meets or passes his developmental goals on time, and has appropriate elimination. i feed him on demand, which usually every 2.5 to 3 hrs. i do offer the breast if he ever gets fussy before that though.

    on the one hand, i'm not worried. as this article states, i should be able to tell if there is a problem. on the other hand, only 11 oz in 2 months does not seem good. i really want to stay exclusively breastfed until 6 months, and then add in solids as he shows interest. i have no desire to ever give him formula. but i would really like to see him gain more than 2 oz a week.

    after researching it, i am thinking about trying to feed him every 1 to 1 1/2 hrs so that he gets more hindmilk. is there anything else i can do?

    1. Cheryl Taylor

      I think you are on track with spacing nursings closer together at least all during your waking hours. It's not that unusual for a baby to gain a larger than "normal" amount of weight in the first couple of months and then slow the pace of weight gain down over the next couple of months. You've already been through checking to make sure all other areas are exactly on track as they should be. I think it's best for baby to wait until a minimum of six months before introducing any solids. More frequent nursings should give you a little bit more gain that you are looking for, but be prepared for a happy, alert, active baby that is near learning to sit and crawl to be burning off a lot of what they take in. Some babies are slender but very healthy, and that may be where your son falls.

      Hope that helps.

  3. worried mama

    my son was born at home on sept 14th. the midwife's scale said 7 lbs 5 oz at birth (although it bounced around for a while before concluding that weight). 1 week later on monday, on a different scale in her office FULLY CLOTHED, he weighed 6 lbs 11 oz. that same week on friday at the doctor's office on a different scale, he weighed 6 lbs 5 oz completely NAKED. a few days later the next week on monday, he weighed 6 lbs 5 oz the first time weighed, and 6 lbs 6 oz the second time weighed.

    the dr is saying that if by tomorrow there hasnt been weight gain, she's recommending formula supplementation which i told her i am not even considering. however, i am becoming worried that 2 weeks after birth, supposedly he is a lb less than when he was born.

    he looks and acts healthy otherwise, even in the words of his pediatrician. pees regularly, poops mostly regularly, although not in 24 hours as of right now. however, i know breastfed babies can go up to 10 days without pooping at times and it can be normal! she tells me if he's not pooping at least 3-4 times a day, she would worry about him…..

    i have seen a lactation consultant, i am pumping between feedings to bring up my supply and feeding him the pumped milk, letting him feed and suck as he pleases, taking fenugreek, drinking mothers milk tea… i dont know what else to do and if i should be worried!

    1. Cheryl Taylor

      It sounds like you already KNOW what the real problem is…none of these weights were taken on the same scale or in the same situation. I agree with you that there is no reason to supplement instead of breastfeeding if wettings are good. Yes, breastfed babies can have bowel movements infrequently…even longer than 10 days. The key is what the consistency of the BM is when it makes its appearance. The first thing I recommend for anyone that is concerned with weight gain is to nurse every 60-90 minutes from beginning of nursing to beginning of nursing. Offer one breast until baby slows down then switch to the second side and nurse until he stops.

      Hope that helps.

  4. Mallorie

    My daughter was born 2/23/10 and weighed 8lb 2oz. We left the hospital she was 7lbs 8oz and severely jaundiced. She is now 7 months and weighs 16lbs 8oz. I was told I need to be feeding her more baby food. I currently give her 1-2jars one time a day at dinner. She usually nurses about an hour before eating dinner then again before bed about 1-2hours after eating. I was told she should be eating more because her percentile for her height/weight has dropped from the 50%'s to the 30%'s. I am afraid of feeding her more because I would like her to nurse as often as she is now so I can continue to breastfeed for as long as she wants. Should I be feeding her more baby food?

    1. Cheryl Taylor

      It sounds like you are doing a wonderful job with nursing. 16 lbs. 8 oz. for a 7 mo. old is not remarkably small simply because it isn't at the top of the charts for the US. Consider her genetic makeup…how tall are you? how tall is her father? Sometimes it helps to imagine that there is an "average" size for a 30 yr old male…and it applies to the 6' 7" men as well as the 5' 2" man. It's ludicrous yes? The charts make just as much sense for babies. What you should be looking at is how is she nursing? are her developmental milestones on track? is she wetting well? alert?, hair shiny? eyes bright? Don't be so stressed with the number on the scale or where it falls in line with all the rest of the babies in the US if everything else is going perfectly.

  5. Amber

    We need some help!

    Here's Levi's stats and other info.

    Birth – 7lb 3oz

    Discharge from hospital 6lb 11oz

    1wk – 7lbs

    2wk – 7lb 4oz

    3wk – 7lb 6oz

    4wk – 7lb 9oz

    5wk – 7lb 11oz

    6wk – 7lb 11oz

    * Poops on a regular schedule – once every other day, or every 3rd day. Been this way for three weeks.

    * We have 8-10 wet diapers daily.

    * He nurses every 45-90 minutes during the day, every 3-4hrs at night. He nurses from one breast 30m approx. I offer the 2nd, he's rarely interested.

    * He was tongue tied. It was clipped 10 days ago.

    * I pump 8-10oz daily on top of nursing full time and give him all of that pumped milk.

    * He's milk protein sensitive – I'm dairy free for him now.

    * He's happy. Alert, bright eyed, content after feedings, sleeps great! Strong, holds his head and neck up very well for his age.

    We saw the pedi today for a weight check and he was labeled FTT. She said that my breastmilk wasn't good enough. That it doesn't have enough fat and calories for him. I argued with her that breastmilk has MORE calories and fat than formula, but she said no. She instructed supplementation – 3oz of formula – Nutramigen – after EACH feeding. She said if he starts gaining weight after that, it's just that my milk isn't good enough for him and he needs more calories and formula would be better.

    Please help. We've worked through so many challenges only for me to be told my milk isn't good enough for my baby.

    1. Cheryl Taylor

      Gaining a full pound in six weeks, wetting well, good bowel movements, active nurser is NOT FTT. You are correct that your breastmilk is better in fat than formula and a FAR superior fat at that. Formula is NOT higher in calorie than breastmilk is. Your Ped's information is very simply inaccurate. Remember that supplementing with your breastmilk 8-10 oz per day means that there is that much less stimulation at the breast from nursing. Nursing is by far the priority.

      How long have you been dairy free? A reaction to dairy can cause a lower weight gain, so don't be surprised if you see weight gain improve as you are off of dairy longer. Be vigilant about keeping out ALL dairy from all sources.

      Have you checked into your local La Leche League group? It would help you a lot to be around some breastfeeding knowledgeable people that can offer you some good support in the wonderful job that you are doing.

      Hope that helps.

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