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” |
My baby's 10th day visit to pediatrician showed a weight loss of 9 oz and a gain of only 2 oz 4 days later. He seems to be doing ok on the all the indicators- has a healthy appetite, seems satisfied post meals, wets and passes bowels regularly. I've been asked to replace 2 meals with a supplement to meet what the doctor calculated as the 5 oz daily deficit. Also I amto take him back to see the doc on monday- only 3 days after his 2nd visit.
My questions are: should I be concerned with the sluggish uptake on weight? And can a significant weight gain be effected and possible in just 3 days? I'm so worried.
What was your baby's lowest weight AFTER birth? The lowest weight after birth is typically on day 2-3. Weight gain should be figured from that weight. A 2 oz gain in 4 days if likely within the 4-8 oz per week that is average weight gain. With good nursings, good wettings and BMs and a content happy baby there is absolutely no reason to supplement instead of nurse. There is nothing that comes close to optimal nutrition for an infant except breastmilk. The first thing you should look at would be placing nursings closer together. Some very contented babies don't signal to nurse as often as is best for a newborn. During your waking hours space nursings every 60-90 min. and this alone will increase your milk supply and increase baby's intake. Supplementing will only give baby inferior nutrition and lower your supply by taking away two nursings worth of stimulation to supply. Settle in…nurse frequently…and look to the wettings to confirm intake.
Hope that helps.
Thanks for the response. We spent the last week in a children’s' hospital at the insistence of our pediatrician. They tested him for diabetes, hep A B, and C, metabolic disorders, cytomegolo virus, and a few other tests that I can't remember. They did x-rays and ultrasounds and found nothing wrong with him with their testing. However, we suspected he might have a tied tongue and requested a consultation with the ear, nose and throat specialist there. He did have a tied tongue and they released it. However, they said he was burning too many calories breastfeeding and we weren't allowed to breastfeed him until the last day we were there. Now he has nipple confusion and we are trying to reteach him how to latch on. He did put on a pound and a half in a week which I question is a healthy weight gain.
We are now breastfeeding once and supplementing once with a bottle of 24 calorie formula for feeding him until he reaches his "ideal" weight. He is a banana baby so I am concerned that when we switch to all breastfeeding again and his weight gain isn't what the pediatrician thinks it should be if she will always insist we supplement.
To answer your questions, there is dairy in his probiotic and I have a lot of dairy in my diet (milk, cheese, yogurt, etc.). There are milk allergies in my family and his 6 week old cousin is allergic to it but she would fuss constantly. He was displaying colic behavior. It was in the late afternoon and at bedtime and nothing seemed to console him. We even tried at lot of mylicon and baby massage to comfort him and relieve gas before going to the probiotic. However, when we started the probiotic he was very calm at those times.
We were switch nursing at first to keep him awake and then were constantly switching breasts because he would nurse a minute at one, fuss and wouldn't take that breast again with any hold I tried to use on him. That would continue until he became tired and went o sleep for at least half of the feedings a day I have taken him to a chiropractor for a possible neck misalignment and that seems to help a little.
He never had greenish or foamy bm's. He did have cradle cap and dry flaking skin on his head for a while but those have gone away. The link to the dairy info didn't work.
Could the tied tongue have caused a hindmilk/foremilk imbalance in me? I was pumping every two hours at the hospital and now every time we give a bottle but can only get about 30 mils average at a time which isn’t enough to mix with the formula which he won’t take straight. I am now taking more milk plus as a supplement. I have read many articles on Kellymom.com about increasing my pumping volume but none seem to help. Do you have any advice on that?
A tongue-tie can affect a lot of things with nursing and can affect the quantity of foremilk and hindmilk simply because the baby gets frustrated not able to get a good latch and/or doesn’t stick with it long enough to get the quantity of hindmilk they would be getting if they were not struggling with latch and having the short frenulum slowing intake.
Your supply is likely to continue dropping unless you get back to nursing consistently. Even if latching is a struggle most babies will break down and latch within 4-8 hrs if they are not given another option. If you absolutely feel you must supplement while you work on latch I would suggest using finger feeding with an empty syringe or medicine dropper placed beside your finger. The finger doesn’t depress the way a bottle nipple does and you also have control over how much flows. Bottles are too fast and too easy to encourage a baby to relearn latching. More Milk Plus alone without at last 7 nursings a day will not increase supply. The nipple stimulation must go along with the galactagogues for them to work.
I know that this is frustrating, but it can be turned around and your supply can surge remarkably fast if you return to frequent latching.
I would keep an eye out for symptoms of a reaction to dairy. With a family history of dairy allergy it is certainly something to be aware of the symptoms so you would notice it.
What do you mean by banana baby?
Dr Sears says that there are apple, pear and banana babies. Bananas are long and put on weight more slowly.
http://www.askdrsears.com/html/2/t023600.asp
Thanks for the response!
I didn't think what he gained was bad either; however, the doctor thought it wasnt good enough and as.I mentioned thought it was the metabolic disorder so to make a long story short he had me go to the ER to see a genetic doctor soon to make sure his ammonia was not high…it was not and all test so far have come back normal and genetic doctor says the disorder is not affecting him at all…they admitted us because hey wanted to take test and watch him while they waited for results. Now that the results have come back they still want to watch him to make sure he is gaining to their likings. They are having me weigh him before and after he eats so they can tell how much he is eating…it is done on the same scale and the same way. For instance, before he ate he was 4556kg…after he eats he was 4596kg…so he gained 40 kg. Meaning in that feeding he only got about 1 1/2 ounces of milk. Is this an accurate way to tell how much he is getting? The doctor told me to stop feeding him every hour and to feed him every 2 hours except at night let him.wake up on his own.
My standard recommendation for a mom that is concerned that her baby is gaining too slowly is to keep track of wettings and nurse every 60-90 minutes with one stretch of up to 4 hrs at night. I suggest continuing this until milk supply has increased and baby is nursing well, wetting well, meeting developmental milestones, growing well and there is no concern remaining for rate of gain. The next step would be to let baby wake up on their own at night but continue frequent daytime nursings and monitor that wettings, etc. continue well. The next step would be to let baby space out some of daytime nursings with frequent nursings in the evening. Last step is to relax back into baby's cues for nursing. It makes no sense whatsoever for a doctor to be concerned about weight gain and then tell you to space out nursings to every two hours and not wake at night.
I am not a fan of weighing before and after feedings because there are other variances that are not seen. There are calories that are burned during the process of the feeding which isn't measurable with the scale, so what baby took in is actually the amount of breastmilk plus what was used calorically during the feed. Is baby weighed in the same diaper and clothing, so that any wetting or urine held in bladder is kept constant? Is baby in a cloth diaper? This also can make a difference because urine held in the bladder right up to the beginning of the nursing that is released into a disposable diaper can be absorbed by the chemicals in the diaper designed for that purpose. There are just more variables possible so I think it is a useful tool in micro preemies to insure that there is breastmilk being taken into the system, but have reservations on how accurate it is in judging total intake.
I still think that monitoring wettings is a far better way to judge intake. I've also seen too many parents that were told to weigh before and after feedings become completely stressed out from the constant weighing. It is hard not to doubt your milk supply when it is being scrutinized by the ounce, even when there is no problem and baby is nursing well and taking in plenty as evidenced by 6-8+ wettings per 24 hr.
That is great that his metabolic disorder does not seem to be affecting his nursing. Great to have that confirmation.
Hope that helps.
I am suppose to see the lactation lady tomorrow who.had years of experience and will see what she has to say. They wanted to put him on iv fluids when he wasn't dehydrated but I ask why so they end up not doing that. They are talking about supplementing him with formula or giving him more calories if he don't gain more…I don't plan on letting them do that. He has went in about 24 hours from 4520 kg to 4596 kg. What do u have to say about this? I hope u get to answer before they come tomorrow so I can have an idea of what to say or do if they want to supplement him.
Smart mom to question them as to WHY they wanted an IV. You were correct that he is NOT dehydrated if he is wetting and gaining, even if he isn't gaining at the "average" he is still continuing to gain just below "average". Remember that the figures they are giving you is an averaged figure, which means that some babies gain more than that and some babies gain less. Continued weight gain, adequate wettings, growth in head and height and developmentally on track are far more important things to be looking for than how they line up with the "average".
Continue to monitor wettings and continue to nurse often. You should see gaining continuing and your supply increasing as well with the frequent nursing.
Thank you for replying quickly…I am certain it will be a big help. The insight on the weighing before and after was great info. that I didn't know or think about. Yes, I am weighing him in the same clothes and put a clean diaper on him right before I weigh him…but like u said about the urine and calorie intake… it doesn't make it as accurate. I'm glad cause when I was doing the math it suggested my milk supply was down slightly for his age. I just started to change him before every feeding like the lady said and so far he has had 4 diapers (that's with feeding him about every two with him sleeping till he wakes up at night)..wetting every time after I feed him and the days hasn't even ended from the time I started to do that. His head circu. and length are on track from what doctors say. Be is hitting the milestones for his age and more. In fact, he looks great…I even had a nurse pinch his leg and say he had fat and maybe he's just gonna be small like me (I'm 5'1 and about 120…dad is 5'10 and not sure how much he weighs but is not skinny bit not to to big). I'll see what this experienced lactation woman says and see how experienced she really is. All that u have said makes absolute sense so if she is experienced it should match with what u said. One other thing…should I be concerned that he did poop till 5 days after the last poop…he usually poops 1 every 3 to 4 days but this time it went to the 5th say
Thanks again…I will update.
There is no concern with an exclusively breastfed baby that goes several days inbetween BMs. Don’t be concerned at all. As long as it is soft when it does make its appearance there is no problem.