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.



    I am very glad I found this website. It really gave me some ease at mind. My daughter was born at 36 weeks on May 22, 2010. Her weight now is 9.3 lbs. I have only been breastfeeding her since birth, and she only nurses for 5-10 minutes each time. The first 8 weeks she had breasstmilk jundice, and since she was so sleepy all the time and had no energy to nurse, I used to give her pumped milk in a bottle. She always took in 2 ounces each time, and still does the same. In the last two weeks, everytime she goes past 7-8 minutes nursing, she begins to pull off crying. I know for sure that it is not a question of milk supply. I have more than what she needs. So what is wrong with her? Also, just to add, she is very strong and alert. She is barely ever fussy, and never ever does she spit up. I am so worried about her weight gain, and I really want to figure out why she could only nurse for such a short amount of time. If you can help me with this, I would very much appreciate it. THANK YOU in advance.

    1. Cheryl Taylor

      Does she get an air bubble that builds up by about 7-8 min into the nursing? Babies that nurse quickly can take in air that forms a bubble and can be uncomfortable. While many breastfed babies don't need to be burped you might try putting her up to your shoulder and massaging the back to see if a burp releases the pressure and then see if she will latch and nurse a little bit more.

      Why are you worried about her weight gain? What was her lowest weight after birth?

    1. Cheryl Taylor

      She has gained a lot of weight in 3+ months. Identifying the cause of her uncomfortableness at that point in the nursing is where I would suggest you concentrate.

  2. Denise

    Hello! I contacted you for advice on July 11, 2010 concerned because my pediatrician advised me to supplement my baby with formula. I wanted to followup and let you know where we are now before I have to face him again! I followed your advice and nursed my little princess every 60-90 minutes. She has within the last two weeks started stretching some feedings to 90-120 minutes.

    Abigail has reached 10 lbs. now! So to recap, at birth 4.11 lowest recorded weight after birth 4.6, then 7.9 at 10 weeks, and she has reached 10.4 lbs at 18 weeks. So if I am right that is 96 oz. weight gain which averages out to 6 oz. per week (was 5.1). Her head was 12 1/2 inches at birth and is now 15 1/4 at 18 weeks. Length was 17 3/8 at birth and is now 22 inches. I have not been back to the pediatrician, but will be going this week. I wanted your feedback on her weight before I am faced with his! Abigail is happy, playing, laughing and meeting milestones beautifully! I hope this is a Breastfeeding success story that lots of ladies who come here are looking for! ~Denise

    1. Cheryl Taylor

      Thank you for letting me know how wonderfully you are doing! That's great news!! She has more than doubled her weight by 18 weeks which is remarkable and near the top of the average weight gain. If she is continuing to gain so well I see no concern with some spacings of 90-120 minutes. Keep an eye on wettings and make sure they continue well as you move forward with some nursings less frequent.

  3. amy

    My 4-week-old was 6lb. 2 oz. I met the same problem…she lost down to 5lb. 8 oz. and the dr. wanted me to start formula, but she, without formula, was back to 6lb. 2 oz. at 3weeks and 4 days old (which is a 10 oz. gain from her lowest wt.). She is eager to nurse, is very alert when awake, has 8-10 wet diapers per day, and looks great. My only concern is that she only has a bowel movement 1-2 days per week…is this a problem? Her abdomen is not distended, she doesn't seem to be in any discomfort, and when she has a dirty diaper her stool is yellow/orange and soft. Should I worry? My pediatrician is discouraging my breastfeeding…what do I do?

    1. Cheryl Taylor

      First, find a Pediatrician that knows enough about the care of children to know how vitally important it is for you to breastfeed your daughter! You deserve that kind of support!

      It is very very normal for a breastfed baby to go days inbetween bowel movements. My twins went 10 days inbetween for months. The key is the consistency when it makes its appearance. If it is soft there are no concerns. Breastmilk is extremely bioavailable and she is just using every precious drop to grow on!

      You're doing great. Keep it up.

  4. Jessica

    I have a 5 week old baby. When she left the hospital she was 7 lbs 4 oz. At her first doctor's appt she was 5 days old and weighed 7 lbs 2 oz. Her lowest weight was 7 lbs 1.5 oz (when she was 13 days old). The doctor was concerned at 13 days old because she had not gained weight and wanted her to be seen again very soon to monitor her weight gain. At 17 days old she was 7 lbs 5 oz. I think that this was because I freaked out at her lack of weight gain and rented a hospital grade breast pump and nursed her frequently and also pumped after each feeding and spoon fed her the pumped milk. Then, we saw a lacation consultant, who watched us nurse and said that my daughter was a lazy nurser, because I had a slow flow. She pre-and post-weighed the baby, and noticed that she only took in .5 oz in about 15 min of nursing. She recommended that I pumped every other feeding and bottle fed her the expressed milk, which I did. She said that I had to do this because since my daughter wasn't an efficient nurser, my supply was in danger. However, this was exhausting and frustrating, so I consulted another LC who watched us nurse during the course of an hour plus and she took in about 2 ounces. That lactation consultant was encouraging and recommended slowing the pumping and only giving her a bottle every other feeding, and only 1 oz. At 25 days old we went back to the doctor and she was up to 8 lbs 2 oz. I continued to follow the advice of the 2nd lactation consultant and nursed, with fewer bottles (maybe 2 per day of 1 oz each). Most recently, at 34 days, she was 8 lbs 7.5 oz. Right now she nurses about every 2. 5 hours, with some shorter clusters, while getting about 2 oz of bottled breastmilk daily. At night her longest stretch of sleep is 3.5 hours. During the day I do wake her for feedings if I think it has been too long (over 2 hours).

    The reason that I am concerned is because she is a sloooow nurser and can take over an hour to nurse. I also would love to eliminate the bottle and have her get what she needs entirely from the breast. I am worried about my supply, so I am pumping in the morning, the middle of the day, and at in the evening (after she nurses) and storing up the milk in the freezer. After each pumping session, I can get about 2-3 oz (which is stored). So while I don't think that supply is an issue, I am worried that it could be if I quit pumping. While nursing, she is not consistently sucking, and I have to wake her up and switch sides to get her to stay active. I can tell that at times during the nursing session that the milk flow has subsided, and that is when she gets sleepy or frustrated, and if I prod her or calm her down, she can stay awake and suck until the next let down occurs. Other times she attempts to pull away with my nipple still in her mouth, which the LC said is her attempt to get the milk to flow faster. Her lengthy nursing sessions are frustrating because I have to work so hard to get her to stay actively sucking.

    I know she is now gaining normally and has adequate numbers of wet and dirty diapers, and is alert when awake, but I am still concerned about her weight gain and also my long term milk supply. My main questions are: Is her nursing behavior acceptable? Is there anything that I can do to increase the speed of the milk flow (I do compressions while she is nursing currently and use hot compresses occasionally)? What else can I do to keep her actively nursing (I try skin to skin, diaper changes, burping, switching breasts, everything the LC recommended)? What do you think about the advice of the LCs? Finally, I know that you recommend nursing every 60-90 min, but she can sometimes spend that long nursing, and then is completely uninterested in eating again, despite my best efforts, for 1-2.5 hours later. What should I do?

    1. Cheryl Taylor

      Some babies just take a long time to nurse. It varies SO much with some babies nursing for 5 minutes and some taking an hour. How are her wettings? If she has 6-8 wettings per day then she is taking in plenty and your supply is fine. There are a few thoughts that I have after reading your story. She isn't taking in a great quantity of EBM but the bottle nipple may be continuing to keep her latch from improving. Has anyone looked at her frenulum and made sure it wasn't too short? A short frenulum (tongue tied) can greatly affect how quickly a baby can transfer milk. With tongue tie you can often notice when they cry that the end of their tongue is in a sweetheart shape because the frenulum doesn't allow the tip of the tongue to come forward past their lips. Take a good look at it and have your LC look. If it IS tied, it's a simple office procedure to clip it and release the tongue. Latch improves immediately afterward.

      Have you considered either fennel to aid with letdown and/or fenugreek and blessed thistle to increase milk supply? Is your water intake good? Have you tried different positions for nursing? Sometimes babies will show new interest in a nursing session if the position is changed from cradle to clutch (football hold). Some really relax and nurse well lying beside mom. You might want to try stroking the breast down toward the nipple WHILE nursing instead of compressions, or alternating.

      While you are concerned with her weight gain I would continue to do everything that you can to not allow nursings to space further than 2 hrs apart during the day and optimally every 60-90 minutes.

      Hope this helps.

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