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” |
What do u say to pumping milking and adding calories to it…to see if that's the problem?
I say that it’s a very, very rare situation in which a mother’s own breastmilk isn’t the perfect makeup of calories, perfect balance of nutrients and immunities that her infant needs. I don’t think that the breastmilk needs to be changed, but I do very often think that baby isn’t nursing often enough.
My daughter had her 9 month check up today. She currently nurses 4 times a day and eats solids 3 times a day. She only gained half a pound since her 6 month check up, and the pediatrician wants me to feed my baby formula for the two daytime liquid feeds. I tried to give her formula today in her sippy cup and she didn't like it. Can't I just increase her solids intake?
My daughter wets plenty of diapers and is very active. She started crawling a week before she turned 8 months old, and by 8 months, she was standing and cruising. She's always on the go. Could this be part of the reason she barely gained any weight the past few months?
I feel worried since the doctor wants to do a weight check in a month.
The answer is not to add formula, but to nurse more often. A 9 mo. old should be predominantly nursing with only small quantities of solids for experimentation. I would not recommend increase solids but instead increase nursings. She should be nursing at least 8x per day for you to maintain good supply and provide her with what she needs to grow and develop well. With her learning to crawl and to cruise/walk in those 3 mo. as well, this greatly affects her calorie use. It’s commonly seen to have a slower rate of gaining when the motor skill acquisition is increasing with an active baby that is constantly moving and working on conquering the next big thing.
Hope this helps.
Boy do I wish I had found this page months ago! Reading these stories both helps me feel at ease about my desicions with my daughter, but also adds to my concern given the "happy endings" I haven't seen yet. My daughter was born 8lbs, 14oz and at first tracked her scale normally (lost 8%, gained it all back within two weeks). But after about four weeks she started dropping curves. She is currently 11months old and weighs just over 15lbs. She is extremely active, alert, and shows no signs of any illness and has been exclusively breastfed. She would never nurse for more than five-ten minutes at a time and would not increase frequency in nursing. Her diapers have always been completely normal for wet and solid contents. Each time she goes for a weigh-in we're told that she may need blood/urine work "next time" but I've never been pressured to suppliment.
I am concerned, however, that now that she's walking she is going to gain even less weight. She eats solids, but again not in any great quantity. At what point should I really be concerned, and could there actually be something medically wrong with her if her only symptom is being tiny?
Her brother was always in the 90th percentile and was an awesome eater, so it may also just require a shift in my perception of what babies and toddlers look like….
It is hard to be concerned about a baby that is active, alert, exclusively breastfed, good wettings and BMs and walking prior to a year. If her head circumference is continuing to grow and her height is also continuing to grow, and she's developmentally on track, happy and alert….I would continue what you are doing and try not to be so concerned with how she compares to other babies her age. I would try to encourage frequent nursing as it is the best possible way to increase intake with the optimal nutrition for her. Some babies nurse very quickly. She obviously does since you are seeing adequate wettings from her nursings. It's also very normal for babies to gain faster in the first half of that first year than they do in the last because of the mobility that they acquire and the amount of calories they burn learning to roll over, sit up, crawl and walk.
Hope this helps.
Thank you for your reply, it really does put my mind at ease. Her head and height have always tracked nomrally (meaning on their respective curves), it's just her weight that has fallen off. The only thing my pediatrician has suggested is that I try to eliminate night feedings. I haven't done this yet as it's her best/longest feeding. I work and pump and we're lucky if she takes 4oz from a bottle in a 9 hour period, so when I am home the last thing I want to do is try to limit nursing in the "hope" that she takes more from the bottle during the day. What if she doesn't? She only wakes once at night to eat, and I don't mind the interruption to my sleep if it gets her more calories. Do you typically recommend eliminating the night feeding for the reason that she may be encouraged to eat more during the day, or is it more for the mother's desire to sleep through the night?
Babies often nurse a lot at night because mom's milk supply increases once she's gotten a little sleep and they are smart little people.
Letdown is often quicker because Mom is so relaxed aka half asleep! The only reason I would suggest one longer stretch at night is if she is gaining well and supply is fine the extra sleep for Mom is a plus. Some babies really do reverse cycle and if you specifically try to eliminate night time feedings they do dramatically drop their intake of breastmilk. I am completely supportive of night time nursing and cosleeping to make it easier for mom, but know that sometimes that needs to be adjusted at different times if it isn't working well for both parties in the nursing dyad.
Hope that helps.
Sorry I have been slow to respond and thanks for your answer!
I AM trying to nurse more, but I have some postpartum issues which are–in all likelihood–being prolonged by the nursing as it is, though I am going to try my utmost to make it the full year!
With regards to health visitors–no, I do no think it mandatory that you see one, which is good because I have found some to be a bit of a nuisance and to even go so far as to tell one how to parent and to treat we women loike babies ourselves!
My son saw a pediatric consultant yesterday and while I liked her, I did disagree with her on some respects (particularly as to dietary issues) and who further wants us to see a dietician next week. My son has not gained much weight (a few ounces) in the past 2 1/2 months and nor has he gained in height either (is 24 inches long). It is disconcerting to see children his same age (over 6 months-old) or younger weighing in at 5-10 pounds more than he and being 2 or so inches longer.
This doc thinks organics are not necessary (I disagree) and to forget the whole introducing a new food every few days idea (to rule out allergies and food intolerances)and to add things like cow's milk, butter, cream to his food and to have him gnoshing on things like breadsticks already. I am a LONG time vegan and become further frustrated when people suggest my milk may be lacking in something–hence my son's slow growth or smallness. I eat A LOT of good fats via avocados, olive and flax oils, nuts and seeds and have a weaknesss for houmous! I count calories and protein grams as I did while pregnant where I managed to gain the recommended 25-30 pounds which went away on its own post-birth. My son was gaining 'fine' up until we moved and my mother fell ill a couple of months ago which the doc thought 'interesting'. I am still trying to get some extra nursing sessions in even if it is potentially wreaking further havoc on my my ligaments/joints.
I don't approve of my son having cow's milk and wheat (among other things) before he is a year-old due to the allergy fear. I suggested goat milk's yoghurt, but she the doc did not recommend this…It felt 'odd' to feed my son cow milk's yoghurt last night (organic, full-fat and pasteurised) and he seemed to hack quite a bit some time later and am not sure if it was related.
I had envisioned him being vegan day-one, but have all of a month to get his weight up by the next appointment! Some tests are likely to be run, though upon examining my son, the pediatrician thought him otherwise, 'healthy, alert and active' that there was, 'likely no serious underlying health condition,' and that her 'hunch is that it is a caloric issue'. She did not suggest supplementing with the bottle and formula which was cool, but wants us to 'go wild' with foods though babies are new to foods and their digestive systems reflect this, I should think…
But I also want my baby to GROW!
First, breastfeeding should be helping postpartum challenges in that it provides prolactin with each letdown that helps to provide a calming effect for mom. Another of the biological wonders that a nursing dyad exhibit.
As a Vegan you likely have a better diet than the Pediatric consultant! People who think that a Vegan diet is not healthy for breastfeeding not only don't know the benefits of a Vegan diet but they also don't know much about breastfeeding either. It sounds like you are paying close attention to getting plenty of protein and good fats, and am sure your diet is also full of vegetables and fruits. I might suggest that you consider that if your baby ends up being allergic to peanuts he could be showing a sensitivity to garbanzos as well, so you may need to consider a trial of no humus.
Goat's milk is still dairy, though the protein is smaller than cow's milk, I would still not recommend it when a dairy allergy is a potential concern.
A suggestion that formula or any solid food can provide better caloric content or nutrition is simply silly. Breastmilk is by far the optimal nutrition for an infant.
Frequent nursing, every 60-90 minutes, is still the first step when a baby is gaining slowly. If there is a food allergy it can contribute to a slow weight gain. Have you seen a growth in head circumference?
My daughter has been tiny her whole life. She is 9 months, weighs 16 lbs 10 oz and is 28 in. long. Her pedi wants us to take her to a genetist for blood and urine work. I'm not sure why as my daughter doesn't seem unhealthy. I am exclusively breastfeeding. She eats 3 solids a day. She hasn't started crawling yet, but rolls and sits unassisted. Do you think her weight measurements are to be of concern? Since she is so old, do I need to supplement with formula since my supply is already established? Thanks!
If she is nursing well and wetting well then there is no reason to consider formula. How often is she nursing? How are her wettings? At least 6-8 in a 24 hr period? The first thing that I would recommend if you are concerned about intake would be to nurse more often and make sure that the solids are not replacing nursings. The nutrition that is in breastmilk is so far superior to any solid that you can offer. In the first year it is so crucial that nursing stay the predominance of their diet to insure optimal growth and development.
The real question is not whether her weight is a concern but is ANYthing else a concern in combination with the weight? Look at the whole picture…head circumference growth? height growth? alert? active? skin good color? developmentally on track? (she wouldn't be the first 9 mo. old that hasn't chosen to crawl yet!)….how is the entire assessment of how she's doing? Not just her weight. She also would not be the first healthy 16-17 lb. 9 mo old I've seen either. Some babies are smaller than average and many are genetically disposed to be smaller than average. Take into consideration her genetic makeup in this. How tall are you and her father? The real key is the overall assessment of how she's doing and confirmation of good intake.
Hope this helps.