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.

169 Comments

  1. Dimi

    I'm a little bit worried about my daughter's very slow weight gain in this last month or so. She is meeting all her milestones and is a very active and happy little girl. She was born on April 13, 2010, weighing 3235 g and with a length of 49 cm. She has averaged a weight gain of between 150-200 g per week. From when she was very little, around 6 weeks, she started sleeping all through the night, but she continued to gain as she did before, with 6 feedings every 3 hours during the day. At around 12 weeks, her weight gain started to slow down but now it has been since the end of August that her weight fluctuates between 6600 and 6700 grams. I weighed her last night and she weighed 6740 g (14.9 lbs). The highest she has reached is 6760 g in mid September. When we went for a check up at the start of September, she was 63 cm in length.

    I live in Italy and it's totally the norm to weigh your child on a weekly basis, that's why I have the scale. It seems to be accurate as the numbers always mathch up to when she gets checked at the doctor's or even at the hospital in her first visits shortly after being born.

    I understand that babies are supposed to start gaining less at a certain point, but is it normal to gain nothing at all for weeks and to fluctuate like this? Could this slow growth be just because she is so active? Her hair and nails are growing, she used to feed every 3 hours, but when I saw that she was not gaining, I started feeding her every 2, but I see it still makes no difference. Should I go ahead and start her on some rice cereal and see if that helps?

    Thanks for any feedback you can give me. I really appreciate it.

    Dimi

    1. Cheryl Taylor

      It is not unusual for a baby to have a period of not gaining weight, or gaining little weight, when they are teething and right up to the eruption of a new tooth and also when they are beginning to learn to sit up, crawl and walk because there is a spurt of activity that burns extra calories.

      Weighing every week can drive a mom crazy! :) Feeding her closer together during all your waking hours is definitely the first step if you are concerned. She may be so active learning new things that she doesn't signal to nurse as often as she WILL nurse happily if offered. It certainly doesn't hurt to offer more often. My first recommendation is always to nurse every 60-90 min and monitor wettings.

      I never recommend solids prior to a minimum of six months and don't ever recommend processed infant cereals. Steamed veggies and ripe fruit are the best place to start, bearing in mind that solids in the first year for a breastfed baby are merely for experimentation with textures but not an issue of quantity or nutrition, whose needs are being met completely with breastmilk.
      http://www.kellymom.com/nutrition/solids/delay-so

      Hope this helps.

  2. Emily

    My daughter was born July 2 2010 and weighed 7lbs 6oz. I nursed her exclusively until I had to return to work in mid-October. Her babysitter feeds her my expressed milk as well as formula (I don't get enough expressed milk for a full day's feeding even though I pump 3x a day at work) during the week, but I nurse her exclusively (every 2.5 hours)in the evenings and on weekends. She sleeps through the night, but I even wake her up at 1am and nurse her just to get the extra calories in her. She had her 4month check up this week and she only weighed 11lbs 2 oz. This is a very slow gain and I am worried about her. Her doctor said he wasn't worried about her slow gain because she has met all of her milestones and is otherwise healhty, but he did recommend starting solids this month. I don't feel ready for that yet.

    I'm only 5'3'' and my husband is 5'9'', so we're not necessarily tall people, and I have lost quite a bit of weight, though I wasn't trying to do so. Since giving birth to her I have lost about 55 lbs. I wonder if my weight loss has something to do with her slow gain. Is that dumb?

    1. Cheryl Taylor

      She is 4 months old and has gained almost 4 lbs. Was 7 lbs. 6 oz. her lowest weight AFTER birth or her birth weight? You are supposed to figure her weight from her lowest weight after birth. Most babies lose up to 10% of their birth weight in the first 2-3 days following birth. Her gain is within average weight gain and she is meeting all her developmental milestones and healthy.

      If you are wanting to increase her weight gain the first line of defense is to nurse more often when you're together. This will also stimulate your supply to increase. I would recommend nursing every 60-90 minutes in the evening when you're together. You will increase by 2-3 nursings per day simply by spacing those evening nursings closer together.

      Hope that helps.

Comments are closed.