babyscale_sm

Look at the Baby, Not the Scale

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 thoughts on “Look at the Baby, Not the Scale”

  1. My son was 5lbs 15oz at birth and was 12lbs 0.9oz at 4m and now at his 6m appt he was only 12lbs 4oz. the Dr gave me 2wks to get my supply up and help him gain some weight. I have been doing everything I can think of and just about all ideas found online. He is happy, reaching milestones and very interactive with us. He fusses while feed and get very frustrated with how slow my milk lets down. If in 2weeks we see no change Dr wants me to suppliment. Any ideas?

    1. So by his 6 mo. appt he had more than doubled his birth weight. That's a great weight gain. What was his lowest weight after birth? He's really had a very good gain. I would not compare his weight against the average breastfed weight gain because he didn't begin life as "average" size. How are his wettings? Is he continuing to gain? Is his head circumference growing? Height? Alert? Active? Hair growing? Nails? Look at the overall picture.
      http://drjaygordon.com/pediatricks/newborns/scale

      If you feel your supply is low, or letdown slow, you may want to consider taking galactagogues that can help with that.

      http://drjaygordon.com/breastfeeding/increasing-m

      Hope that helps.

  2. Please help me! I'm driving myself INSANE (with the help of google like some other mommies…)

    My daughter was born at 7 pounds, 5 ounces. Lowest weight was 6 pounds, 11 ounces. Had regained to 6 pounds 15 ounces by day four. On July 23rd, she weighed 9 pounds, 1 ounce…by July 29th she weighed 9 pounds, 4 ounces. At her two month well check on August 10th she had only gained one ounce.

    She is exclusively breastfed and has started sleeping through the nights. She eats at around 4:30 AM and 6:30 AM. Since I work, I pump and notice that my first morning pumping yields 8-10 ounces. My other pumpings yield around 3-4. I've been advised to start pouring the foremilk into a separate container from that first pumping and just give her the hindmilk. She eats usually 8-10 ounces during the day at her sitter's home. In the evening she nurses constantly. Usually for 60 minutes at a time, 2 to 3 times. She has lots of wet diapers and still poopies every day.

    I have to go back in two weeks for a weight check and I'm just dying of anxiety wondering what I'm doing wrong.

    Do you have any advice? I'd appreciate any feedback.

    1. Also, to note. She has stayed in the 75th percentile for length since her birthday on June 5th. I'm only 5'1" and my husband is 5'9".

  3. Sorry that last line is suppose to say that I have tried to feed him every 90 min. but when he doesn't get a long enough nap he gets cranky and it doesn't seem like he eats well. He now weighs 11 lb 2 1/2 oz. I think my milk supply is going lower cause in 6 days he was gaining 5 oz but this past week he gained only 4 1/2 oz in 7 days. The only difference I did was substitute an oz for four days with an oz of baby food. Do u think I should just go ahead and give the 90 min. thing a try again? I bought some more milk plus from motherlove should I start taking those first to see if that works? I just know that if I keep up this way that he will be on formula till he is one especially with him gaining the min. with the formula…hell never catch up. Sometimes I just want to stop breastfeeding cause of all the problems I have had but inside I know that I couldn't do that…I just wish I had more support.

    1. 4.5 oz in a week if within normal average weight gain. There is no need for concern with the difference from 5 oz to 4.5 oz. I would continue with frequent nursing with this good weekly weight gain. A change of 1 oz. is not going to affect weight gain significantly, but the substitute of breastmilk with a far lesser quality nutrition does make a significant difference. I would recommend exclusively breastfeeding until at least six months for optimal health and development.

      http://drjaygordon.com/breastfeeding/science-of-bhttp://drjaygordon.com/pediatricks/startingout/su

  4. Could you please help?
    My daughter delivered on Wednesday the 25th of August 2010. My grandson’s birthweight was 9 lbs. 15 ozs. Her water ruptured but was mostly intact until midway through delivery. Baby’s initial bloodwork showed no infection, normal temperature. They gave him preventative anti-biotics. Then, without checking his blood again, they gave him six more doses, one shot each leg, three different times. He became seriously and painfully constipated. I asked them for water and told them to back off. They refused and implied I was emotionally disturbed. At thirty six hours he measured 9 lbs. 12 ozs. His bloodwork showed 4.52 cpr – their fault! Dehydration can lead to infection. Too much anti-biotic leads to dehydration and constipation. See? Their fault! They put him in the Pediatric ward today and are telling my daughter that because her milk hasn’t come in (it’s day 3) that he’s loosing weight drastically and needs doctor supervision. She is rooming in with him. They are billing all of this to Medi-Cal. I am infuriated. He has yeasty miconium (boogers!) and his poopoo is burning his bottom. They need to prescribe nystatin and let him and my daughter come home. Please help immediately.
    Phone: 760-808-9076
    Remedy Hawke (grandma)

    1. It is very normal for milk to take up to 7 days to come in. 3 days is not of great concern. If they are rooming in are they nursing frequently? Weight down 3 oz. in 3 days is also not of concern. It is normal for newborns to lost up to 10% of their birth weight in the first 2-3 days before they begin to put on weight. How are wettings? Wettings should be one per day of age up to day 7 and then 6-8 per 24 hrs. The diaper area irritated skin could be yeast overgrowth from the antibiotics but could also be irritation from the antibiotics in system. I am not a fan of Nystatin because it doesn't work as often as it does. Take a look at the thrush article on the site and check for other symptoms. I wouldn't hesitate to get a second opinion if she is not pleased with the medical management.

  5. Hi Cheryl,

    My son, who I exclusively breastfeed (and give pumped milk when I'm at work) turned 3 months old last week, and I went in for a weight check, because I'm always concerned about his weight. Here are his weights:

    Born: 6lbs 14.6 oz

    5 days old: 6lbs 4 oz (lowest weight)

    15 days old: 7lbs 1 oz

    4 weeks old: 7lbs 13 oz

    7 weeks old: 9lbs 5 oz

    3 months: 10lbs 14 oz

    From birth to 3 months, he has gained exactly 4 lbs, and the nurse who did his weight check said he was "following his curve", but I noticed that most babies who were born at his size are much bigger at this point! (I also don't love the answer the nurse gave – this ped office seems OVER relaxed about everything). I'll also point out that he's looking pretty long (was born in the 90th percentile for height), it seems he's growing lengthwise faster than weightwise. Should I be concerned? Should I be giving him more milk when i give him bottles (I always assumed he'd make up the difference when I nurse him, which I do more often than bottlefeed)? We were giving him 4 oz at a time, just upped it to 5 oz because this is what the nurse practitioner said to do when I asked her).

    Additionally, my son can continue sucking and sucking forever (we had a 57 minute feed today, as an example). I've been trying to do 1 side for 20-25 minutes, take him off (even if he's still sucking) and then burp him, and if he's not crying, or taking his paci, I don't do the other side. Now I'm reading that the paci might NOT be a good idea…am I not feeding him enough? He's not a cranky kid – always smiling, staring at the world a lot, taking it all in, and meeting his milestones (and often getting there pretty early – he rolled over at 15 days old!)

    Sorry for the long post – I appreciate any and all feedback. I know my son is healthy, I just wish he was a pound or two heavier! I'd be THRILLED if he gained 2 pounds over the next month – any suggestions?

    1. 2 lbs in one month is above average weight gain. There is no reason to set this sort of "goal" for weight gain. Weight gain varies over the weeks with growth spurts at different times. Looking at his overall weight gain he is very much within normal and average weight gain and there should be no need for concern. If he's wetting well and meeting developmental milestones I would not set expectations of a certain weight gain for a baby that is gaining within the norm for breastfed babies. Any gain from 4 to 8 oz. per week is in the range of normal, but I have also seen very healthy and appropriately developing babies that gained 2-4 oz per week consistently. As he gets older, expect to see his weight gain slow down when he begins to sit, crawl and stand. I would suggest that you consider nursing on the other side as well if he'll latch and nurse because it will help you maintain a great milk supply. I typically encourage working mothers to nurse freely and frequently when together with their baby because it's the best way to maintain and/or increase milk supply.

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