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. Vin

    My baby was 9lbs 1oz at birth, its 2 weeks now and he is 8-8. Doctor was worried and said he should have gained all his weight back and that the first 2 months is when brain cells grow more and he needs more milk. since my wife can only give half oz per feeding from breast annd then no more comes out, we are giving formula. he also suggested bottle as he will lose fewer calories. when we were breastfeeding he was hungry all the time and was very fussy all time time. perhaps the breastmilk production wasnt enough. any help is appreciated

    1. Cheryl Taylor

      A key question is…what was his LOWEST weight after birth? Some babies lose a full pound or more after birth, even though normal weight loss is up to 10% of birth weight. A child’s brain continues to grow dramatically until age two. How often were nursings taking place? A newborn should be nursing every 60 – 90 minutes but no longer than 2 hrs for many weeks. This helps establish mom’s milk supply. Instead of supplementing you may want to consider nursing much more often. You should see milk supply boost within 24-48 hrs of nursing every 60-90 minutes from beginning of nursing to beginning of nursing.

  2. Amelia

    I have a 5 month old exclusively breastfed baby boy who is losing weight.My doctor's advice is feed formula as my breast milk probably doesn't have enough calories. The baby refuses to take a bottle either with breast milk or formula. This has been going on for 3 weeks! I am so worried. I have worked with a lactation consultant to increase my milk supply but the baby is still losing weight. He gained weight normally for the first 3+ months so what happened? It just doesn't make sense. Please let me know what you think.

    1. Cheryl Taylor

      If baby was gaining normally for three months and then suddenly dropped rate of gain, there must be a reason for it. Is he teething? Has he been ill? Take a look at how closely together he is spacing nursing during the day. The first defense when weight gain drops is to nurse every 60-90 minutes from beginning of nursing to beginning of nursing. Are his wettings still good at 6-8 per day?

  3. joy

    Hi, my baby girl was born August 12, 2010 at 8 lb. 11 oz. she dropped to 8 lb. 4 oz. in the first couple days, which the pediatrician at the hospital assured us was completely normal, and that we shouldn't worry. at my daughter's two week checkup, she was back up to 8 lb. 9 oz., and the pediatrician was very pleased with her weight gain. He said she looked healthy and strong, and prescribed us a standard multivitamin for her, just in order to make sure she gets enough vitamin D in the winter (i live in the midwest, and he said that it is becoming more common in the midwest for babies to develop rickets, because of lack of vitamin D in the winter). at this point, i really liked our pediatrician, and he was very supportive of breastfeeding–he couldn't stop emphasizing how important it was. but we had to switch to another pediatrician because of the distance we had to drive to get to the first–two hours! we found a new pediatrician and my daughter went to her one-month checkup, at which point she weighed 8 lb. 14 oz. he said that he wanted to see her gain more weight and recommended that I nurse her more often (she used to eat every 3 hours, and on demand at night). she seems happy and healthy otherwise, and is meeting all the developmental milestones on time (some of them early!), she pees a lot (about 7 or 8 sopping diapers every 24 hours), and poops about 3 or four times a day. she is a very gassy baby, which keeps her up sometimes, but she eats a lot. i did up her schedule to every two and a half hours, and she seems to be just fine with that. i continue to do on demand feeding at night, during which she usually gets up once or twice. what do you think about her weight gain? should i be concerned?

    1. Cheryl Taylor

      With a newborn I usually consider it best that they not go longer than 2 hrs inbetween nursings because you are still establishing your milk supply and they are growing at such a remarkable rate in those early weeks. Her wettings are good and she is gaining steadily…both good. You might see all the increase you want with spacing closer to 2 hrs during the day and continuing with her cuing at night.

  4. Ron Van Marrewyk

    My wife are the proud parents for triplets, our babies were born at 29 weeks on June 8, 2010 and their due date was Aug 24th, they are 32 days corrected today however our smallest girl who now weights 7 lbs 6 ounces only gained 14 grams a day this week. She is still struggling a lot with pooping and must be helped to go every 2 days. Her diapers are always very wet and she is passing gas quite regularly. We are a little concerned with her lack of regularity with her bowel movements and when it does happen it is quite thick. We believe that she is working hard to deal with gas and potentially burning a lot of calories that way. What would you be more concerned with, the weight gain or the bowel movements? What would you do to help the bowel movements, we have been stimulating her anus, doing the bicycle with her legs, and rubbing her tummy clockwise. Do you have any comments or suggestions??

    Thank you

    1. Cheryl Taylor

      Are your babies being breastfed? If they are not, then I would suspect that the formula is causing constipation, which is a common problem. It can be difficult to end up breastfeeding with preemies with the difficulties that can be present in the beginning weeks. It is possible to relactate and bring in supply. Even some breastfeeding could make a remarkable change in their nutrition.

  5. vrupal

    My babies birth weight was 6 pounds 13 ounces(height 20 1/4 inches) and now at her 6 months checkup her weight is 17 pounds 11.5 ounces(height 27 1/3 inches). she is exclusively breastfed baby for 6 months. i have started feeding her solids for 2 weeks now.she nurses very frequently (almost every 2 hrs 5 to 10 minutes). my doctor says the babies weight is on the higher side. Does her not sleeping for 8hrs straight in the night(due to frequent nursing) affecting her weight gain? is this something to worry about? iam really confused whether to continue breastfeeding her at nights or not? Please help

    1. Cheryl Taylor

      An exclusively breastfed baby often packs on rolls of fat until they begin to crawl and learn to walk. The weight gain in the first half of the first year SHOULD be dramatically more than in the second half of the first year. Babies are not as physically active as they are between 6 and 12 mo. Nursing should stay the predominance of an infant's diet until at least one year old, so frequent nursings with a very small amount of solids added is fine.

      Hope that helps.

Comments are closed.