No one knows your child better than you do. |
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Feb 23, 2010
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:
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.
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. A few notable examples:
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 Responses to “Look at the Baby, Not the Scale” |
Thank you again. I nurse whenever my baby asks for it at this point. About every 3-4 hours. He seems happy and is wetting. He will only take one side, will this mess up my supply? Also I never get engorged. shoudlnt I even after a long sleep? Iam going to offer the breast more. I think he is ok. I am just really obsessed making it at least a year. I enjoy it.
Some moms have no difficulty maintaining supply nursing on a single breast per nursing. Some really need the stimulation on both breasts to maintain supply. Be aware of this and you can work to adjust it if necessary. For most nursing moms supply is not as easily tenuous as many think it can be. Our bodies do an amazing job of adjusting supply according to the needs of our baby. Some babies don't cue as quickly as others and will go longer than they might should simply because it's their nature, but if offered sooner will nurse. You are the one that best knows how your body is handling supply and if baby is wetting plenty. Don't be surprised if he goes through growth spurts and suddenly nurses more often for a couple of days. Continue to look to wettings to confirm intake.
I had to be induced and have a section for our 6th child at 35 weeks due to preeclampsia & low fluid level. Abigail weighed in at 4.11 at birth, Rooting reflex was absent and they began formula in the NICU. On day three I was able to get her tiny mouth to latch and started putting her on breast for 10-15 minutes before formula feeds. On day 4 she was released from the hospital weighing 4.6. She received one formula feed before my milk came in and has been breast only since. At her doctors visit yesterday she weighed 7.9 at 10 1/2 weeks. The doctor said she should have gained another pound, diagnosed poor weight gain and advised me to supplement with formula. I admitted she does nurse every hour or two during the day and every 3-4 hours at night, but surely she is getting enough milk. When she is at the breast she is drinking. Then I started spotting last night, so I am now wondering if he is right. I have never spotted with any of my other 5 children who were breastfed until 1-2 years, until they were at least 8 months old. If this is caused by her not getting the hind milk how can I get her to get it? What could be wrong to cause her to nurse so often and yet not gain as expected? Her latch seemed right to me until I watched the videos, maybe she is preferring not taking much more than the nipple. When my milk lets down she does drink in gulps it's on and off for a good 10-15 minutes after the letdown then she goes to sleep. Advice please!
Whoops, counted weeks and she was 9 weeks 5 days at yesterdays appointment! She was born 5/4. I should also add that I am 39, not sure if this has any impact!
Denise you are doing a great job with nursing a premature baby. While 35 weeks is not remarkably early, it is still enough that you will see very typical premature nursing behaviors. It is possible with her birth weight and lack of rooting reflex that dates may have been off and she was actually a little earlier than 35 weeks. There is nothing wrong with her nursing more often than you are used to fullterm babies nursing. It is merely because her stomach is smaller that she needs to nurse more often. The great thing is that your breastmilk is perfectly designed for her and is higher in fat content that it would be for a fullterm baby With a lowest weight after birth of 4 lbs. 6 oz and at almost 10 weeks weighing 7 lbs. oz. that means that she has gained 5.1 oz a week average which is a GREAT gain and very good for a baby born at 4.11! Nursing every 1-2 hrs. all day and 3-4 at night is to be expected until she gains more weight. My first recommendation would not be to supplement, but to space nursings all day at every 60-90 min and only allow one stretch of up to 4 hrs at night and then max of 2 hrs for the other stretch or two and then return to every 60-90 minutes. This will increase her nursings per day significantly. Your age doesn't figure into this as a concern in any way. How are her wettings? Are you seeing 6-8 wettings per 24 hr period? With her gaining so well at 5+ oz per week I wouldn't be concerned about her getting to hindmilk unless you are seeing green frothy BMs regularly that may be a sign of hindmilk/foremilk imbalance. I would rather see you concentrate on spacing nursings every 60-90 min until she gains to about 10 lbs. If she continues to gain at the rate that she has been for these early weeks she should reach 10 lbs. within a couple of months. I would expect that with her birth weight she will be 12-14 lbs at 6 months. Continue to monitor developmental milestones and other aspects of growing…head circumference, height, nails growing, etc.
As for the cycle, this is where your age may be factoring in simply because your body is reacting differently. Some exclusively nursing moms have their cycle return immediately and some don't until after the baby has weaned. It isn't necessarily an indication of milk supply of every situation.
Hope this helps.
Whew… I would have thought after happily nursing 5 children and rolling my eyes at all the previous attempts to sabotage our happy nursing that I wouldn't have been so discouraged by the words of that Doctor. Thank you for your reply and encouragement! Yes she has 7-8 wet diapers every day and an orange poop daily. She seems happy, smiles and even coos! Thank you!
Hi, I gave birth to a 7lb 2.9 oz baby last September and he's almost 10 months old. I was induced 2-3 weeks before due date due to preeclampsia. He's always been in the 25-50th percentile for weight at the pediatrician's office until his most recent appt, where he had fallen off to about 15th percentile. In the months between his 6 and 9 month appts, he had begun to crawl and cruise and is now on the go all day long– so very active. The pediatrician thinks that I need to supplement with formula because he is falling off the percentile chart slightly, but he is hitting all his milestones. Here is his average food intake. At 9 months – he was 19 lb 4 oz (although he weighed more at home).
*Early nursing (eats a lot!)
*Breakfast – oatmeal with 4oz of strained fruit and at least 3 oz of breastmilk mixed in. Sometimes he takes another 2 oz of fruit.
*Breastmilk bottle – takes 4-5 oz
*Lunch – 4 oz veggie, 2 oz meat, 4 oz fruit
*Breastmilk bottle – takes 4-5 oz – sometimes loses interest before he's done
*sometimes he gets fruit (4 oz)
*Evening nursing (sometimes this is not very long – he struggles and pulls away
*Dinner – 4 oz veggie, 2 oz meat, 4 oz fruit
He is an awesome solid food eater, but he is so mobile that he has lost a lot of interest in the bottle/breast. He also has spent the last 2 months getting 4 teeth and is really irratible, so when he refused to breastfeed or take a bottle, there's nothing that can make him do it.
My questions
* Is this weight really a problem? He is otherwise very healthy and is hitting all of his milestones (almost walking at 10 months)
* If this is a problem, what would you suggest I do to improve the situation?
Thanks for your help!
19 lb. 4 oz. is a good size baby for 9 mo. The wording that is often used in Pediatrician's offices is a problem…he hasn't "fallen off" of anything.
He's been very active learning to crawl and cruise and should be expected to be continuing to growth in height but not putting on as much fat at the same time because he's burning it off with the frenzied learning pattern of a child that wants to master crawling and going faster!! and beginning to learn the pieces needed to walk. It's comPLETELY normal!
No, I do not think that formula is needed. What does concern me is that he is resisting that evening nursing and is only 10 months old. Is there a reason why he receives expressed breastmilk instead of nursing in the middle of the day? I would do everything possible to increase nursings. Does he nurse again before going to sleep? For an infant under a year old it is truly optimal to have predominantly breastmilk with only small amounts of solids for them to experiment with textures. Rather than pureed baby foods that are spoon fed, it is better to have steamed veggies and ripe fruit cut into little pieces that they can pick up themselves. With this in mind, I would encourage you to increase nursings and reduce the quantity of solids in order to assure that he continues to nurse to a minimum of a year. Breastmilk is so far superior to any other food you could be giving him and will allow for optimal growth and development. It provides the perfect balance of fats for a growing infant when kept in balance with the amount of solids offered.
You can do things that will help to keep his interest while he is nursing…singing a song to him, playing a game of using his finger to touch parts of your face and naming them aloud, putting a necklace of brightly colored beads around your neck that you only wear during nursing…just about anything that will keep his ever active MIND interested while his BODY is taking in needed nutrition. It can be challenging I know. I like pointing to face parts and naming them because it plays into their desire to acquire language. I would take their finger and touch their ear and say EAR then touch my ear and say EAR.
Hope this helps.
Hi,
My baby boy wasn born 2/24/10 and weighed 8lbs 13oz at his 2month check up he weighed 10lbs at his 4month check up he weighed 12lbs 8oz. We had a great latch and feeding since birth. He will eat for 10-20min every hr right after birth and then every 3hrs. Since I had to get back to work right @ 2 months
i started pumping and I will get 6oz sometimes 7oz untill this day I still do. the baby has been eating 5-6 bottles a day 5oz each although sometimes he will leave 1oz on a couple of his bottles. We started to suplement because of his weigh issue the doctor was concern I wasn't producing enough milk. The baby laughs, plays, hold his head and moves a lot during the day. However, his doctor seems ver concern about his weight gain and now wants me to give him soy milk. I'm still breastfeeding and still will until he decides he doesn't want to be breastfed. Should we be worried about the baby's weigh gain being @ 4lbs since birth? Keep in mind I am very little and ate little when I was born and even though my husband weighed @ 9lbs at birth he also was a small baby. Really worried about my little one. Thanks
6-7 oz. in a pumping is VERY good. You would have to have a good supply to be able to pump that much in a sitting. Many moms are happy to see 4-5 oz in a pumping. I also think that 12. lbs. 8 oz. at 4 mo. That is almost a lb. a month since birth which is an average weight gain. I would advise continuing to breastfeed as you are since you are doing so well with it. I don't see any reason to supplement a baby that is gaining at this rate. I'm not sure why your doctor is concerned about this weight gain. Average weight gain is 4-7 oz per week and there are a few things to remember about that: it's "average", 7 per week isn't "better" than 4 per week and meeting developmental milestones while continuing to grow in all aspects (head circumference, height, nails, etc) is what you really need to see not just an increased number on a scale. http://drjaygordon.com/pediatricks/newborns/scale…
Thank you so much Cheryl. That is really conforting. I have continued to feed my baby and even thouhg we started to give him formula he still gets that majority of his feedings with breastmilk.
I had a 9 lbs. 2 oz. baby boy (induced, normal vaginal delivery) and he is now 11 days old. We had to take him in for an IV at four days because he was dehydrated…and had lost 9% of his birth weight (8 lbs. 5 oz.). He also wasn't eating enough, nor was he waking up very often (very listless/lethargic). (He's our third child.)
After the IV, he became much better – skin color, responsiveness, alertness, etc. (although he still sleeps a lot), and began feeding normally – he gained four ounces in three or four days, going up to 8 lbs. 9 oz. We went back to the doctor after another four days expecting more weight gain given how much more he was eating. We were shocked to see his weight was still at 8 lbs. 9 oz. Based on on doctor's advice, we are now feeding him every two hours, a minimum of 2 oz. per feeding (feeding him expressed breastmilk via bottle.) We asked if we should supplement his feeding with formula, and the doctor said no.
Needless to say, this has been exhausting, mentally draining and so emotional for us. I'm so worried about his not surviving (I always expect the worst – a trait I hate) – he is 21.5 inches long (86th percentile) yet in the fourth percentile for his weight. The doctor told us not to panic, that we'd keep monitoring his weight and have him checked again on Monday and every four days or so after that until he reaches his birth weight and beyond.
I guess what I hate the most is not knowing what's going on, not understanding why he isn't gaining weight even though he's eating at least 20 ounces a day (25 in the last 24 hours). I will wait until the next weight check before I panic, but any words of advice would be appreciated.
First of all, it is completely normal for an infant to lose up to 10% of their birth weight in the first 2-3 days after birth. ComPLETEly normal. It's the biological process of having been immersed in fluid for 9 months and making the transfer to breathing air along with the process of suckling for mom's milk to come in. The colostrum that is present after birth is all that is needed to give his system a clearing out and preparation to begin doing the digesting on his own. You don't want a newborn baby to have to immediately deal with a stomach full before they have cleared the meconium.
Secondly, what was your birth like? Did you have any pain medications or an epidural? Even a completely natural birth leaves a newborn very tired because it is a big job! An epidural can leave a baby very sleepy and jaundiced, which makes them even sleepier. Pain medications can be passed through the placenta to baby and make them sleepy. It is very common for a newborn to be considerably sleepy for 3-7 days after birth.
Thirdly, what was his lowest weight after birth? That is what you calculate how much he has gained from. Weighing a baby is notoriously inaccurate. If he just had a large bowel movement right before a weighing but 4 days prior had a large bowel movement in his system it can be the 4 oz that week of gain that you're wanting to see. Don't panic. Just nurse every 60-90 min and look at his wettings for confirmation of what is going in. Most importantly you should be nursing at the breast and nursing every 60-90 min during all your waking hours with a newborn to bring your supply in well, begin the process of clearing the jaundice and get nursing established well. 2 hrs. is the absolute maximum for the first six weeks except for one stretch that is up to 4 hrs if baby sleep a longer stretch at night. Remember…what you see coming out is evidence of what has gone in!!