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.
05/2001 |