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” |
We have a 9 and a half week old baby who is not gaining well. He is our first and weighed 7.5 lb at birth, was 20.5 inches long and his head was 14.5 inches around. He was not weighed before we left the hospital (it was an unplanned c-section and a very hectic time) but at his 10 day checkup he was down to 6.5 lb (on a completely different scale). Since he was about two weeks old he has consistently produced 7 to 10 wet diapers a day (cloth) but only 2 to 3 dirty diapers a week. At his 2 month checkup he weighed 7.5 lb but was 23.75 inches long and his head circumference was up to 16 inches. The doctor wasn't worried but told me to eat more fat, even though I hadn't lost a pound since leaving the hospital, and we would re-evaluate him at 4 months. I have been doing that since (and added 10 lbs to myself) and we just took him in for a weighing yesterday because he did seem to be putting on weight. He only weighed 7.75 lb. The family practitioner, who wouldn't even see us, told the nurse to tell me to start giving formula every other feeding to increase his weight. He nurses at least every hour for about 15 minutes a time and wakes me at night about three times (though I take him to bed with me and allow him to nurse at will). He is a sleepy nurser and I have to wake him a lot while nursing. I have spent a day in bed with him and am going to do more. We saw a lactation consultant who recommended I start using a Mother's Milk tea and give the baby acidophilus to increase his appetite (we were already giving him Life Start probiotic since he would cry a lot when we first brought him home and that seems to help a lot). He is a very happy baby who is very alert and active and typically doesn't sleep more than four 30 minute naps a day. I just don't see why giving him formula would be the answer. We are taking him to a pediatrician tomorrow just in case there is something wrong with him. Any advice?
Correction to his age. He is 12 and a half weeks old.
It’s hard to know exactly what is going on without knowing the lowest weight after birth, but mostly that means you don’t have the reassurance of a certain number of ounces per week average. Let’s take a look first at all the things that are going right: plenty of wettings, head circumference growing, growing in height, nursing often, happy, alert, active. A few questions: Is there dairy in the probiotic you are giving him? Do you have dairy in your diet? When he was crying a lot was it because of gas? a typical colic type behavior?
A couple of things I would focus on right now. You’re nursing often which is great, because my first recommendation would be to nurse every 60-90 minutes. When you are nursing are you switching back and forth between breasts? One thing you may want to consider is nursing off one side only, which can increase the amount of hindmilk that the baby gets. If you are nursing every hour, you could do two nursings off one breast and then switch and do the next two off the other breast. The key is to keep the baby nursing off one breast until after the initial foremilk begins to mix in with hindmilk which is higher in fat. Taking a galactagogue (which Mother’s Milk Tea is one of the mildest) is something done to increase supply. With the amount of wettings I would be surprised if milk supply was the problem. Make sure in the process of increasing milk supply that you stay comfortable and don’t get engorged from too much milk, which can lead to plugged ducts. As long as baby is nursing and drinking what you are producing it is fine.
http://drjaygordon.com/breastfeeding/increasing-milk-supply.html
http://drjaygordon.com/breastfeeding/mastitis.html
Regarding increasing the fat in your diet to increase weight gain in baby, you might want to read the information in this article: http://www.kellymom.com/nutrition/milk/change-milkfat.html
The important thing is not for you to be increasing the fat in your diet, but beware of the kind of fat you are consuming.
The other thing to consider is if you see any symptoms of a reaction to dairy, which can affect weight gain. Does he have greenish BM’s? Gas? Colic? Eczema or cradle cap? Nasal congestion? Take a look at this article and see what you think: http://drjaygordon.com/pediatricks/dairy.
Hope that helps.
Hello,
I had a 7.5lb baby boy July 9th 2010. I went to the lactation specialists and learned great techniques for breastfeeding. I am supplementing my child with as SNS system (supplemental nursing) and am pumping at the same time, which is the majority of the supplemental milk (with a smidge of formula to equal 35mL every feeding).
I read the milestones and my child has hit every one of them. I have until this Friday for him to reach his birth weight of 7.5lbs. Our last checkup he was 7 lbs 4oz…..so basically 4 oz to go.
Is this something I am to be concerned about?
What if he doesnt get to weight….now what?
Thanks for the help.
What was the lowest weight after birth? That is much more telling of weight gain. It is normal for a baby to lose up to 10% of their body weight after birth, but some babies drop back more. My own babies all lost more than a lb. after birth so returning to birth weight by two weeks was not expected!
It is far more important that you are seeing good wettings and reaching milestones while continuing to gain than if he is back at birth weight at exactly two weeks after birth.
How often are you nursing? Are you using the SNS every time you are nursing? The very first step for a baby gaining slowly is to nurse every 60-90 minutes with one stretch of up to 4 hrs at night. This will increase mom's supply quickly and baby's intake will increase just as quickly.
His lowest was 6lbs 13oz. He is a pooping and peeing machine. I use the SNS everytime I feed. The pediatrician put us on a eery 3 hour feeding schedule. They weighed him at the lactation place and figured out he was getting 1 ounce from both of my breasts and I also supplement him with 35 mL from the SNS…which ends up giving him a little over 2 ounces at every feeding.
3 hrs. inbetween nursings was not a good recommendation your were given for a 6 lb. 13 oz. baby. With any newborn and when establishing milk supply in the first six weeks nursings should be every two hours at least. 2 oz. every 3 hrs. is unlikely to give the weight gain you’re looking for. Increasing nursing to every 60-90 min from beginning of nursing to beginning of nursing will give you a supply boost as well as increase weight gain for baby. Has the lactation consultant you saw suggested taking galactagogues to increase supply? Is there a reason you were started immediately with a SNS…like breast reduction or other known cause of less mammary tissue? It’s not common to begin with a SNS. My recommendations would have been ones that concentrated on increasing nursings and increasing milk supply. Motherlove Herbal makes a great tincture called More Milk Plus. You can also purchase separately and take fenugreek, blessed thistle and fennel together. You can find them at good healthfood stores.
Thank you cheryl,
We are working with the lactation specialists ans pediatrician on this. We took him yesterday and he was at 7lb 6 oz….close enough. On our own, we ditched the SNS which is only recommended for the 1st week (accoriding to our pediatrician). We decided to supplement his fedddings with a DR Brown glass bottle that contained breast milk and formula. IT WORKED FANTASTIC. The SNS tubing was angering my boy and making him detach. He now feeds beautifully and is gaining weight. I did take the more milk plus on recommendation from our pediatrician. Lesson learned…..just becasue the lactation specialists are giving you advice doesnt mean its good advice. The SNS tubing should have been replaced by a bottle a week ago.
Would recommend getting back to exclusive breastfeeding. Nix that bottle before you have nipple confusion. Increase nursings and your supply will surge, particularly taking More Milk Plus. You're on the road to being there!! Keep it up.
Hi there. My little guy is 8 wks old. He weighs 11 lbs 6 oz and has weighed this for about 2 wks. He is only given breastmilk. According to his Daddy who stays home with him during the day he gets anywhere from 3 to 5 oz at each feeding. He doesn't have a feeding schedule. He eats when he's hungry. He's very alert and happy and very active when awake. He appears as if he's grown but he just hasn't gained any weight for a while. Is this normal?
At 8 weeks you should be seeing continued gaining. 3-5 oz feeding while you are gone is a good size feeding for 8 weeks. Make sure that when you are together that you nurse very often, even hourly during your waking hours. That's the simplest way to increase your supply and increase his intake. Are you pumping while you are away at least every 2-3 hrs? And using a good double electric pump?
My baby girl weighed 7.10 at birth and now at two and a half months has been hoovering at 9 pounds for weeks. My doctor was concerned, so I went to see a consultant. She watched her nurse and stated she has a good latch and enough milk. She further announced that the baby didn't appear skinny. She suggested I eat more often to improve the fat content of my milk. It is now a week later and our home scale detects no change in weight. What should I do?
What was her lowest weight after birth? She probably lost back to near 7 lbs. and has put on 2 lbs in 2 months which is a great weight gain. How often are you nursing? The best way to increase intake is to nurse every 60-90 minutes during all your waking hours. Are wettings good? Meeting milestones? What you are eating does not change your breastmilk fat content but how frequently the breast is emptied can affect it. http://www.kellymom.com/nutrition/milk/change-mil…
Hope that helps.
Took my daughter in for a weighing today, and she's gained 6 ounces in the past week. That makes her 9 pounds 4 ounces at 10 weeks. While I'm glad at this success, I have a question about timing.
From my research, a baby gets the most fat rich milk from hindmilk, so letting the baby decide when to let go of the breast is the best way to make sure they get the most fat rich milk. If feedings are timed from the beginning of one session to another, and you say no more than 90 minutes apart, what do you do for a patient baby? My daughter can stay on a single breast for half an hour, making the session an hour long. That leaves only half an hour until the beginning of the next session.
Is this rule firm, or can the length of time between feedings be calculated with difference to the length of the session?
Thanks for all your help.
Yes you could adjust it a little, but don’t lose the improved weight gain you’ve gotten by adjusting it too much. I wouldn’t suggest adding more than 15-30 min. to your spacing until you’re sure she is continuing a good weight gain. Good work!! I know it’s hard to nurse so often and it seems to suck up your whole day. 1 of my 4 used to take an hour to nurse, too, and I know it can be really hard to patiently sit there. Hang in there…you’re doing great.
I went in for another weigh in today, and although the baby has jumped from 9 pounds 4 ounces on July 27th to 9 pounds 15 ounces today, August 6th, the nurse I spoke to nearly made me cry. She insisted that my baby is losing weight because she has dropped in the growth curves, and kept suggesting I start giving her more formula.
Since you suggested it, I’ve been doing my best to keep my daughter on an hour and a half feeding schedule. Most of the time I succeed, though when I have to get out of the house one feeding might get a little bit longer interval. I also have the hardest time waking both myself and my daughter up for nighttime feedings, and was so tired last night that I don’t even remember turning off my alarm clock. I woke up at 6 bone tired and guilty for having missed the feeding. So when I went today I wanted to ask how much night time feedings are necessary.
You woulda thought I’d asked to starve my child. This woman gave me a look like she was thinking about calling child services on me. My baby has been sleeping through the night for several weeks now. Waking her up at 3 am is nearly as impossible as it is to wake myself up. And now I’m thinking the only way to get me some sleep and satisfy the health professionals at the same time is to give formula at night.
And then this woman tells me that my daughter is on a lower growth curve for height than she is for weight, and that her weight is proportionate to her weight. I ask her if she hasn’t grown because she’s not eating enough, and she tells me that a baby’s height is genetic, not due to nutrition. So what is everybody complaining about? Shouldn’t a baby be proportionate? Why must all babies fall within a certain range?
So what do you think? Should I start giving her formula at night? I spend so much time feeding that pumping is not only unlikely, but it also yields so little milk that it would take 8 pumpings to get a single serving. Formula at night is the only thing I can think of to keep my sanity, and I hope you have some other advice for me.
Thank you.
Wow…9 oz gain since July 27th. That is huge. You're doing very well! Formula isn't the solution, but I would absolutely recommend that you now keep the daytime feedings frequent but not wake her at night. If you don't wake her at night how many hours will she sleep in a row? She is gaining so well that you can definitely afford at least one longer stretch at night. Initially I would think that there is no concern with going one 6 to 8 hr stretch at night if you continue to nurse at least every 90 min. for the rest of the daytime hours. Keep an eye on her wettings so you have confirmation that she is continuing a good intake.
It is actually great to hear that you are nursing so much that you don't have time to pump. That is what has brought about the great weight gain you've seen this last week. Pumpings are something that should fit into the schedule if you are AWAY from the baby at a time when they would be nursing. If you do not need to be separated from baby and don't need to pump…don't! If you would like to have some freezer stash for emergency or occasional need you can either pump on one side while she is nursing on the other, or, find another time either right after a nursing or 15 minutes before you expect her to wake up. It won't take you long to build a freezer stash even if it's 1-2 oz at a time. You can cool the EBM in the frig and add it to EBM that is already cooled and then move it to the freezer in 4 oz portions.
I think, by far, the most important thing to look at is that she continues to gain, continues to meet developmental milestones, head circumference continues to grow, height continues to grow, you see a happy, alert, active child with bright eyes, healthy skin, nails and hair growing, etc. All babies don't grow at the same rate. The growth charts are working with averages. There are some completely healthy babies that gain at the rate of 2-3 oz per week, but it is below the "average" of what we consider "normal". I certainly understand your frustration as 3 of my own 4 children were 12 lbs. at 6 months. But then I'm the tallest in my family at a whopping 5' 3".
You definitely have to consider the genetics that figure into the picture.
Hope this helps.
Hi, my baby is 5 months. He was born on 2/19/10 and weighed 7.11 and was 19 1/2 in. long. I had a home birth, so he was born natural with no medications. When he got circumcised at about 2 weeks they got him at 6.10. It took him till he was 6 weeks to gain back to his birth weight of 7.11. He as gaining from that point on about a pound a month until recently. At his four month check up they got him at 9.15, on a scale different what they usually weigh on (it was one of those old one that you move to balance out the beam in order to get the weight). At his 5 month check up they used the electric scale which is what they usually used and he was at 9.14. Therefore, he lost an ounce. Could the scale make the difference? Also, from 4 to 5 months he peedlike he was supposed to and even poop almost every day. He is hitting this miles stones intact he gets on all fours and can sit unsupported for a few seconds before needing support. He's very active and alert while he's a wake. I nurse him about 2 to 3 hours between feeding and atone 4 hour at night. He is still peeing good but has went back to 1 poop every 3 or 4 days. The doctor was okay with gain up until now and he says he looks healthy small but healthy, however, he is now concern. He has us coming in for a weight check in a week and wants to see him gain that ounce and at least something more. I don't want to start him on cereal till he is 6 months and I don't want to give formula but what do I do if he does not gain anything or that ounce back by next week. Is this normal for a baby?
It's impossible to determine what the actual continued gain was because of the use of different scales. I would not suggest infant cereal or formula. Breastmilk is far superior to any other option. The simplest thing to do to increase intake is to space daytime nursings closer together. Nurse at least every 90 minutes during the day and intake will increase considerably. With wettings good, BM every 3-4 days, alert, meeting milestones…I would not be concerned at this point, but it warrants seeing if you can fit in more nursings.
Hope that helps.