marley2580
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We live in societies that place a vast emphasis on measurement and standardisation. Percentiles (even when calculated using bf babies) are guidelines only. Someone has to be on the 2nd percentile and it doesn't mean that baby is any less healthy or well-developed than their friend on the 90th. There are lots of ways to judge whether a baby is developing successfully and weight is only one part of that.
VARIATIONS IN NORMAL PATTERNS OF INFANT WEIGHT GAIN
Weight gain is determined by more than diet, which is why there is such a wide variation in normal patterns of infant weight gain. For example, babies with different body types due to heredity have different metabolic rates, and therefore burn calories differently.
Long and lean babies (we call them "banana babies") are hypermetabolizers. They burn off calories faster than the plumper "apple babies" and "pear babies." Banana- babies are likely to grow more quickly in height than weight, so that they normally plot above average in height and below average in weight on the growth chart.
Apples and pears show the opposite pattern on the chart, usually showing gains in weight faster than height. All these patterns are normal.
A baby's temperament also influences weight gain.
Mellow, laid-back babies tend to burn fewer calories and therefore gain weight more quickly.
Active babies with persistent, motor-driven personalities who always seem to be revved up usually burn more calories and tend to be leaner.
The frequency of breastfeeding influences growth.
Babies who are breastfed on cue and offered unrestricted feedings tend to grow faster.
Infants who sleep next to mother and who enjoy the luxury of unrestricted night nursing tend to grow faster.
Infants who are the product of "baby training" (parenting programs in which babies are fed on a schedule and forced to sleep through the night using variations of the "cry-it-out method) often show delayed growth. Babies who are breastfed according to a parent-imposed and restrictive feeding schedule are not only likely to get less milk, the breastmilk they get will have a lower level of fat and calories because of the longer intervals between feedings.
Various studies have shown that breastfed infants consume fewer calories and a lower volume of milk than formula-fed infants. This doesn't mean that their mothers aren't producing enough milk. Instead, it's an indication that breastfed infants have an amazing ability to self-regulate their calorie intake according to their individual needs. This ability to determine for themselves how much they eat is probably one of the reasons that infants who are breastfed are less likely to have problems with obesity later in childhood.
Is my baby a slow grower?
Slow Growers are babies who are on the lowest edge of the growth charts, though still are steadily gaining weight, and whos growth follows roughly a steady line. The height gains and head growth are also roughly in proportion, and they are meeting their developmental milestones roughly on target.
A slow growing but otherwise perfectly healthy baby :
looks healthy and alert
has good muscle tone
good skin elasticity
at least six to eight wet nappies per day
light coloured urine
has a creamy consistency to their poos (if infrequent then a decent quantity, and soft)
a slow but steady weight gain
Mother has a good let down
Warning signs (possible failure to thrive)
apathetic or crying a lot
slack muscle tone
bad skin elasticity (papery, dry skin that if pinched stays crinkly)
few wet nappies
dark, strong smelling urine
rare poos and then very little and hard
Mother has problems with milk let down
very variable weight gain
(Ruth Lawrence: Breastfeeding a guide for the medical profession, pg 367, Mosby)
Some causes for low weight gain in breastfed babies
Following is a quick sketch of some things to look into when baby is not gaining well. This is by no means complete.
Poor breastfeeding management is the most common cause of low weight gain --.is baby taking in enough calories?
Is baby having enough wet and dirty diapers? This is an indicator of how much milk baby is taking in.
What is baby's nursing pattern? Is baby nursing frequently enough? Some things on baby's side that might interfere with nursing frequency include jaundice, sleepy newborn, distraction and pacifier use.
Is mom letting baby determine when to switch sides, or is she switching after a set time?
Is baby latching well and transferring milk adequately?
Is mom's milk supply adequate? (Remember that pumping output is not a useful indicator of milk supply.)
It is not necessary to pump and bottle feed or to give formula to determine whether baby is getting enough calories. There is a specialized scale (available for rent through Medela) that can be used for pre- and post-feed weights to determine whether baby is taking in enough milk. There is a special procedure that is used for getting these weights - make sure the person doing the weighing is familar with it.
Evaluate baby for medical problems that might interfere with weight gain.
Babies who are sick (with even a minor illness) often slow weight gain or even lose weight.
A few common things that can affect weight gain are ear infection, thrush, reflux, anemia, allergies, and urinary tract infections.
The Early Days
If a baby has not met its birth weight by two weeks and it is lower than the third percentile on the growth charts there can be the suspicion of failure to thrive. Failure to thrive can develop slowly and creepingly or appear suddenly and acutely. As a preventative measure it is important in the first four weeks of life (better 6), until your milk supply has regulated itself to the demands of your baby, that you weigh your baby ONCE a week, in the morning before a feed and naked. If they have gained too little in one week, they will probably gain more the next, but you should keep an eye on the situation.
In some cases, an illness in the baby such as infection, high fever, diarrhoea, vomiting and lost a great deal of liquids may result in slower weight gain than is expected. Supplementing with formula does not cure the illness, and may rob the baby of the beneficial effects of exclusive breastfeeding. You can tell when a baby is getting milk and when he is not (see below). A very sleepy nursling must also be closely watched.
Often the reason for a baby not gaining sufficient weight has its roots in breastfeeding management. A baby whos latch is not good cannot efficiently suck, and wont get enough calorie rich hindmilk . If you feed by the clock and dont allow your baby to finish one side, but remove him and give the other side after a certain amount of time. This can lead to a disturbance in the balance of fore and hind milk.
Mistakes in breastfeeding management
dont interrupt a feed let your baby lead and follow its cues, letting him drink as often and as long as he likes on each side.
If the baby is too warmly dressed and the room is hot, he will suck more weakly and become sleepy. Undress him a bit, and wake by massaging the hand, face etc
The length between feeds may be too great follow your babys cues, not the clock. Should your baby sleep a long stretch in one go he may regulate this by needing the breast more often in the wake periods.
Allow your nursling to feed during the night most babies wont sleep longer than four hours in one go for at least the first six weeks.
If you are concerned about your babys weight gain, dont allow it to use a pacifier / dummy. The dummy prevents your baby from sucking on your breast, it pacifies the baby thus extending the length of time before hell cue for a feed.
Dont supplement with liquids or baby formula, much rather feed more often which stimulates your milk supply, or pump an hour after a feed and use this to top up feeds.
When introducing solids milk should still be prioritised up to 12 months. Solid food is almost always lower in calories and fat. A mother who does not continue to prioritise milk feeds may find her baby's weight increase lessen and her supply diminish e.g. if she offers solids soon before breastfeeds.
Problems with the baby
The baby is falling asleep whilst drinking. Wake the baby up by massaging, stroking the face or changing a nappy.
If you have the feeling that the baby drinks only a few sips before falling asleep again, or just nibbles, you should remove it from the breast and change sides other side or change the feeding position.
If the baby is really drinking correctly it wont demand feeds so often as it is getting enough calories. If it is asking for a feed every hour you should check the latch and so on to find out why it isnt sucking correctly.
If your baby is unsatisfied after a feed and does need extra food, it is best to use a feeding device at the breast such as a Supplemental Nursing System (from Medela for example) in order to stimulate supply and help baby learn to breastfeed better.
If he is not getting milk well, it is unlikely the baby has an illness, and more likely the mothers milk supply is down. The most common cause of unusually slow weight gain after the first few weeks or months is that the mothers milk supply has decreased.
Why would your milk supply decrease?
You have gone on the birth control pill. If you have, stop the pill. There are other ways of preventing a pregnancy besides hormones.
You are pregnant.
You have been trying to stretch out the feedings, or "train" the baby to sleep through the night. If this is the case, feed the baby when he is hungry or sucking his hand.
You are using bottles more than occasionally. Even when the milk supply is well established frequent bottles teach the baby a poor latch at a time when the baby expects rapid flow, even if you are giving the baby only breast milk in the bottle. With slow flow, the baby may pull away from the breast, decreasing time at the breast even more, and decreasing breast milk even more.
some babies even without exposure to bottles may still become frustrated at the breast if the flow is slow. There are things that can be done to help in this situation so do seek advice.
An emotional "shock" can, occasionally, decrease the milk supply.
Sometimes an illness, particularly when associated with fever can decrease the milk supply. So can mastitis. Luckily, illness in the mother does not usually decrease milk supply.
You are on a calorie-controlled diet (e.g. less than 2000-2500 calories a day) or drinking insufficiently.
You are doing too much. You don't have to be a super mother. Let the housework go.
Sleep when your baby sleeps. Let the baby nurse while you sleep.
Some medications may decrease milk supply--some antihistamines (e.g. Bendryl), pseudephedrine (e.g. Sudafed).
You are feeding one side only each feeding, so that he gets the high fat hindmilk. Remember, if the baby is not drinking, hes not getting any milk and if hes not getting any milk, hes not getting hindmilk. Finish one side and if he wants more, offer the other.
A combination of some of the above.
What can I do to increase my baby's weight gain?
There are several simple things that have been proven to help with weight gain:
Stop or decrease solid foods, particularly if baby is younger than 6 months. Most solids foods have fewer calories and nutrients than breastmilk, plus they tend to replace (rather than add to) the higher-calorie, more nutritious breastmilk.
Sleep with your baby (this increases prolactin and frequency of nursing).
Learn baby massage -- this has been proven to improve digestion and weight gain.
Carry baby throughout the day in a carrier/sling; get as much skin to skin contact as you can. Both of these things have been shown to improve weight gain.
Nurse often - at least every 2 hours during the day and at least once at night. Frequent nursing increases baby's milk intake.
Make sure you're allowing your baby to completely finish one side before you offer the other by waiting upon her cues that she is finished; i.e. pulling off herself and looking satisfied, going to sleep, changing from an active suck/swallow to more of a pacifier suck, etc. Always OFFER the second side, but don't worry if she doesn't seem to need it. It's much more important that she be allowed to completely finish one side than that she nurse both sides. By doing so she will be assured of reaching enough of the richer, more caloric hindmilk that helps her to go longer between feedings.
Use breast massage and breast compression during nursing.
Pump or hand express for a couple of minutes before nursing. This will remove some of the foremilk so that your baby receives more of the richer, higher calorie hindmilk.
If supplements are medically indicated, breastmilk is preferred over formula as a supplement (exceptions to this are rare), and the average fat/calorie content of mom's milk is higher than that of formula. Mom can pump for 5-10 minutes after nursing (don't interrupt or shorten the nursing session to do this), and offer this higher-fat hindmilk to baby as needed. This is also an option for moms who normally offer expressed milk when they are separated from baby.
VARIATIONS IN NORMAL PATTERNS OF INFANT WEIGHT GAIN
Weight gain is determined by more than diet, which is why there is such a wide variation in normal patterns of infant weight gain. For example, babies with different body types due to heredity have different metabolic rates, and therefore burn calories differently.
Long and lean babies (we call them "banana babies") are hypermetabolizers. They burn off calories faster than the plumper "apple babies" and "pear babies." Banana- babies are likely to grow more quickly in height than weight, so that they normally plot above average in height and below average in weight on the growth chart.
Apples and pears show the opposite pattern on the chart, usually showing gains in weight faster than height. All these patterns are normal.
A baby's temperament also influences weight gain.
Mellow, laid-back babies tend to burn fewer calories and therefore gain weight more quickly.
Active babies with persistent, motor-driven personalities who always seem to be revved up usually burn more calories and tend to be leaner.
The frequency of breastfeeding influences growth.
Babies who are breastfed on cue and offered unrestricted feedings tend to grow faster.
Infants who sleep next to mother and who enjoy the luxury of unrestricted night nursing tend to grow faster.
Infants who are the product of "baby training" (parenting programs in which babies are fed on a schedule and forced to sleep through the night using variations of the "cry-it-out method) often show delayed growth. Babies who are breastfed according to a parent-imposed and restrictive feeding schedule are not only likely to get less milk, the breastmilk they get will have a lower level of fat and calories because of the longer intervals between feedings.
Various studies have shown that breastfed infants consume fewer calories and a lower volume of milk than formula-fed infants. This doesn't mean that their mothers aren't producing enough milk. Instead, it's an indication that breastfed infants have an amazing ability to self-regulate their calorie intake according to their individual needs. This ability to determine for themselves how much they eat is probably one of the reasons that infants who are breastfed are less likely to have problems with obesity later in childhood.
Is my baby a slow grower?
Slow Growers are babies who are on the lowest edge of the growth charts, though still are steadily gaining weight, and whos growth follows roughly a steady line. The height gains and head growth are also roughly in proportion, and they are meeting their developmental milestones roughly on target.
A slow growing but otherwise perfectly healthy baby :
looks healthy and alert
has good muscle tone
good skin elasticity
at least six to eight wet nappies per day
light coloured urine
has a creamy consistency to their poos (if infrequent then a decent quantity, and soft)
a slow but steady weight gain
Mother has a good let down
Warning signs (possible failure to thrive)
apathetic or crying a lot
slack muscle tone
bad skin elasticity (papery, dry skin that if pinched stays crinkly)
few wet nappies
dark, strong smelling urine
rare poos and then very little and hard
Mother has problems with milk let down
very variable weight gain
(Ruth Lawrence: Breastfeeding a guide for the medical profession, pg 367, Mosby)
Some causes for low weight gain in breastfed babies
Following is a quick sketch of some things to look into when baby is not gaining well. This is by no means complete.
Poor breastfeeding management is the most common cause of low weight gain --.is baby taking in enough calories?
Is baby having enough wet and dirty diapers? This is an indicator of how much milk baby is taking in.
What is baby's nursing pattern? Is baby nursing frequently enough? Some things on baby's side that might interfere with nursing frequency include jaundice, sleepy newborn, distraction and pacifier use.
Is mom letting baby determine when to switch sides, or is she switching after a set time?
Is baby latching well and transferring milk adequately?
Is mom's milk supply adequate? (Remember that pumping output is not a useful indicator of milk supply.)
It is not necessary to pump and bottle feed or to give formula to determine whether baby is getting enough calories. There is a specialized scale (available for rent through Medela) that can be used for pre- and post-feed weights to determine whether baby is taking in enough milk. There is a special procedure that is used for getting these weights - make sure the person doing the weighing is familar with it.
Evaluate baby for medical problems that might interfere with weight gain.
Babies who are sick (with even a minor illness) often slow weight gain or even lose weight.
A few common things that can affect weight gain are ear infection, thrush, reflux, anemia, allergies, and urinary tract infections.
The Early Days
If a baby has not met its birth weight by two weeks and it is lower than the third percentile on the growth charts there can be the suspicion of failure to thrive. Failure to thrive can develop slowly and creepingly or appear suddenly and acutely. As a preventative measure it is important in the first four weeks of life (better 6), until your milk supply has regulated itself to the demands of your baby, that you weigh your baby ONCE a week, in the morning before a feed and naked. If they have gained too little in one week, they will probably gain more the next, but you should keep an eye on the situation.
In some cases, an illness in the baby such as infection, high fever, diarrhoea, vomiting and lost a great deal of liquids may result in slower weight gain than is expected. Supplementing with formula does not cure the illness, and may rob the baby of the beneficial effects of exclusive breastfeeding. You can tell when a baby is getting milk and when he is not (see below). A very sleepy nursling must also be closely watched.
Often the reason for a baby not gaining sufficient weight has its roots in breastfeeding management. A baby whos latch is not good cannot efficiently suck, and wont get enough calorie rich hindmilk . If you feed by the clock and dont allow your baby to finish one side, but remove him and give the other side after a certain amount of time. This can lead to a disturbance in the balance of fore and hind milk.
Mistakes in breastfeeding management
dont interrupt a feed let your baby lead and follow its cues, letting him drink as often and as long as he likes on each side.
If the baby is too warmly dressed and the room is hot, he will suck more weakly and become sleepy. Undress him a bit, and wake by massaging the hand, face etc
The length between feeds may be too great follow your babys cues, not the clock. Should your baby sleep a long stretch in one go he may regulate this by needing the breast more often in the wake periods.
Allow your nursling to feed during the night most babies wont sleep longer than four hours in one go for at least the first six weeks.
If you are concerned about your babys weight gain, dont allow it to use a pacifier / dummy. The dummy prevents your baby from sucking on your breast, it pacifies the baby thus extending the length of time before hell cue for a feed.
Dont supplement with liquids or baby formula, much rather feed more often which stimulates your milk supply, or pump an hour after a feed and use this to top up feeds.
When introducing solids milk should still be prioritised up to 12 months. Solid food is almost always lower in calories and fat. A mother who does not continue to prioritise milk feeds may find her baby's weight increase lessen and her supply diminish e.g. if she offers solids soon before breastfeeds.
Problems with the baby
The baby is falling asleep whilst drinking. Wake the baby up by massaging, stroking the face or changing a nappy.
If you have the feeling that the baby drinks only a few sips before falling asleep again, or just nibbles, you should remove it from the breast and change sides other side or change the feeding position.
If the baby is really drinking correctly it wont demand feeds so often as it is getting enough calories. If it is asking for a feed every hour you should check the latch and so on to find out why it isnt sucking correctly.
If your baby is unsatisfied after a feed and does need extra food, it is best to use a feeding device at the breast such as a Supplemental Nursing System (from Medela for example) in order to stimulate supply and help baby learn to breastfeed better.
If he is not getting milk well, it is unlikely the baby has an illness, and more likely the mothers milk supply is down. The most common cause of unusually slow weight gain after the first few weeks or months is that the mothers milk supply has decreased.
Why would your milk supply decrease?
You have gone on the birth control pill. If you have, stop the pill. There are other ways of preventing a pregnancy besides hormones.
You are pregnant.
You have been trying to stretch out the feedings, or "train" the baby to sleep through the night. If this is the case, feed the baby when he is hungry or sucking his hand.
You are using bottles more than occasionally. Even when the milk supply is well established frequent bottles teach the baby a poor latch at a time when the baby expects rapid flow, even if you are giving the baby only breast milk in the bottle. With slow flow, the baby may pull away from the breast, decreasing time at the breast even more, and decreasing breast milk even more.
some babies even without exposure to bottles may still become frustrated at the breast if the flow is slow. There are things that can be done to help in this situation so do seek advice.
An emotional "shock" can, occasionally, decrease the milk supply.
Sometimes an illness, particularly when associated with fever can decrease the milk supply. So can mastitis. Luckily, illness in the mother does not usually decrease milk supply.
You are on a calorie-controlled diet (e.g. less than 2000-2500 calories a day) or drinking insufficiently.
You are doing too much. You don't have to be a super mother. Let the housework go.
Sleep when your baby sleeps. Let the baby nurse while you sleep.
Some medications may decrease milk supply--some antihistamines (e.g. Bendryl), pseudephedrine (e.g. Sudafed).
You are feeding one side only each feeding, so that he gets the high fat hindmilk. Remember, if the baby is not drinking, hes not getting any milk and if hes not getting any milk, hes not getting hindmilk. Finish one side and if he wants more, offer the other.
A combination of some of the above.
What can I do to increase my baby's weight gain?
There are several simple things that have been proven to help with weight gain:
Stop or decrease solid foods, particularly if baby is younger than 6 months. Most solids foods have fewer calories and nutrients than breastmilk, plus they tend to replace (rather than add to) the higher-calorie, more nutritious breastmilk.
Sleep with your baby (this increases prolactin and frequency of nursing).
Learn baby massage -- this has been proven to improve digestion and weight gain.
Carry baby throughout the day in a carrier/sling; get as much skin to skin contact as you can. Both of these things have been shown to improve weight gain.
Nurse often - at least every 2 hours during the day and at least once at night. Frequent nursing increases baby's milk intake.
Make sure you're allowing your baby to completely finish one side before you offer the other by waiting upon her cues that she is finished; i.e. pulling off herself and looking satisfied, going to sleep, changing from an active suck/swallow to more of a pacifier suck, etc. Always OFFER the second side, but don't worry if she doesn't seem to need it. It's much more important that she be allowed to completely finish one side than that she nurse both sides. By doing so she will be assured of reaching enough of the richer, more caloric hindmilk that helps her to go longer between feedings.
Use breast massage and breast compression during nursing.
Pump or hand express for a couple of minutes before nursing. This will remove some of the foremilk so that your baby receives more of the richer, higher calorie hindmilk.
If supplements are medically indicated, breastmilk is preferred over formula as a supplement (exceptions to this are rare), and the average fat/calorie content of mom's milk is higher than that of formula. Mom can pump for 5-10 minutes after nursing (don't interrupt or shorten the nursing session to do this), and offer this higher-fat hindmilk to baby as needed. This is also an option for moms who normally offer expressed milk when they are separated from baby.
And always smiling so I've completely ignored the charts and standards people set up for babies.
27 lbs and 29 inches. 
I sometimes worry about the other fear -- obesity! Even though I know I shouldn't. It still creeps up.
having said that she then got out another chart - the thriving baby one and we're doing ok. phew. this has certainly given me some food for thought and made me happier. thank you
