How important is weight gain, really?

[RomanGoddess]

My DS weighed 4.2 kg (about 9.4 pounds) at birth. By the next day, he had long about 300 grams (10 ounces, think), which is a lot.

10 days later, we visited a breastfeeding-friendly pediatrician. The baby had gained under 100 grams (about 3 ounces?) since the day after the birth. The pediatrician looked a bit worried but just encouraged me to breastfeed like crazy. The following week (so 2.5 weeks after the birth), we were at the ped's office again because my DD was sick. I had DS weighed just out of interest and he was still not back at his birthweight. The ped was visibly worried and told me to start supplementing with pumped milk.

The weeks after that, he was still gaining less than 100 grams (3 ounces) per week. I went to an LLL meeting, where the leader asked me about how many wet and soiled diapers DS was producing (over 8 wet, among which 5 or were also soiled per day) and whether he had gained in length (yes). Based on my responses, she said that she would not bother supplementing with pumped milk, so I didn't, and I didn't bother weighing him after that either, because I didn't want to be consumed by the issue.

My DS is now almost 5 months old. He has dropped from the 90th the the 50th percentile in weight since birth. However, in length, he is over the top on the charts and in head circumference, he is around the 90th percentile. He has super chunky thighs and everyone I meet says he looks so big for a 5-months old.

So my question is, why is there so much fuss about newborns and weight gain? Even sites like Kellymom seem to suggest that your baby should be gaining around 150 grams per week and should be back at his birthweight by two weeks. It seems to me that weight gain almost completely depends on birth weight which itself depends on whether your baby was born in week 38 or week 42, natural or induced/cesarian, etc. A baby that is born in the 98th percentile for weight is not going to stay in that percentile if the high weight is due to him being born post-term and he is genetically meant to be average weight. Which means that the baby is not going to be gaining the supposedly required 150 grams or whatever per week.

I ask because I am sure that any middle of the road ped would have told me to supplement with formula almost immediately (as would a hospital had my DS been born in one). I just wonder how much breastfeeding ends up being undermined by health professionals who think that baby must stay in the weight percentile that he or she was born in.

[PatioGardener]

I think weight gain in newborns is really important. It's a screening tool - something to pick up issues before they get too big. Not all babies who have slow weight gain have milk transfer issues, but some do.

Babies can sometimes transfer enough milk to just stay hydrated, but not enough to grow. They have enough pees, and sometimes even enough poops, but weight gain is very very slow. If nothing is done about this (getting a deeper latch, clipping the tongue-tie, etc) mom's milk supply can down regulate and she can lose her supply. Plus, baby may not be transfering enough milk to get enough calories and nutrients to grow.

IMO newborn weight gain is a crucial tool in breastfeeding support, and health professionals need to be trained to help mother's of slow growing newborns with breastfeeding issues (if they exist). This will help to protect breastfeeding relationships rather than undermine them - as the OP pointed out often happens now.

ETA: We need some good research on how IV fluids during labour affect birthweight - I think this may often be the cause of large losses in healthy infants - and if so, new 'normals' for weight loss in babies of moms who had IV fluids during labour need to be established.

[Cavy]

How did a newborn lose 10 ounce of weight in the first day of life? Was there a LOT of meconium? Or was the birth weight quite over-estimated? That's my suspician, you see...

On topic: I dunno. I just wanted my babies to grow and grow and grow. I think early weight gain (within first 6 weeks) IS important, although I know quite a few babies who had no net weight gain at all for the first 5-6 weeks and they have turned out okay. Some babies are perhaps way too over-monitored about weight gain.

[RomanGoddess]

nak

patiogardiner, what do you mean by milk transfer?

[PatioGardener]

Originally Posted by RomanGoddess

nak

patiogardiner, what do you mean by milk transfer?

The ability of baby to actually get the milk out of Mom's breast and swallow it. It depends on so many things - position of baby at breast, latch, mother's nipple/breast shape, baby's mouth shape, muscle tone of baby etc.

Some examples of things that can affect milk transfer include a tongue-tie in baby (tongue can't move as needed to transfer the milk from mom to baby), latch (baby attaches only to nipple), or very sleepy baby who just won't suck for long enough to get enough milk.

Unfortunately many health care providers look at the latch/attachment in new babies, but don't know to look for milk transfer - or baby swallowing milk. Jack Newman talks about this on his web page, and some of his videos really focus on showing what milk transfer looks like.

I hope that makes sense

[Bluegoat]

I think that at the beginning, it can be useful to watch weight because it can be a good indicator of baby getting enough, or not.

But it depends on a lot of things being done right. The weight being taken properly, extra losses due to fluid retention, is the baby actually getting any milk, how long till mom's milk comes in and baby starts to gain again, and so on. So all these things and others need to be looked at.

Hospitals and doctors don't always, and in cases where their might be a problem, almost always the solution is a bottle of formula - which in many instances makes whatever the problem is worse. To me it is bizarre that there is actually no attempt to figure out the problem so the cause can be addressed.

[msmiranda]

My first son was a slow gainer as well. He's always been in the lower weight percentiles (10-25%) -- he's two now -- but average height. I was fortunate that he had only lost 10% of his birth weight before we left the hospital and that our first ped was laid back about the fact that he was not back at his birth weight by two weeks. There was nothing wrong with him, his latch, etc. and he was getting milk, though mine came in on the late side (3 1/2 days after birth). But he did not need formula, and I know that so many people are told to supplement in a similar situation and then that creates problems for the breastfeeding relationship. I agree with PPs that more effort should be made to assess the individual situation rather than jumping straight to formula supplementation. If the ped doesn't have the knowledge to do so, she or he should refer the mom to a lactation consultant.

My current ped told us that he doesn't worry about the initial weight loss after birth because the birth weight is artificially high because a newly born baby is still puffy from amniotic fluid under their skin. When that dissipates, it lowers their weight. Has anyone else heard this explanation?

[mama k nj]

Originally Posted by PatioGardener

ETA: We need some good research on how IV fluids during labour affect birthweight - I think this may often be the cause of large losses in healthy infants - and if so, new 'normals' for weight loss in babies of moms who had IV fluids during labour need to be established.

I totally agree! For most births there is some degree of intervention... at least an IV. So when you are dealing in ounces these are factors that have to be considered.

For the OP, I do think that weight gain is an important tool. That said, weight gain is just one piece of the puzzle and should be considered along with other factors such as dirty diapers, developmental milestones and so on. And of course Drs should be more educated on spotting breastfeeding issues instead of just recommending formula when baby is not gaining exactly to the "chart" I also think that they should be using charts normed only on BFing babies as that is the biological norm.

[PatioGardener]

Originally Posted by msmiranda

My current ped told us that he doesn't worry about the initial weight loss after birth because the birth weight is artificially high because a newly born baby is still puffy from amniotic fluid under their skin. When that dissipates, it lowers their weight. Has anyone else heard this explanation?

I hadn't heard this explanation, but I do know that weight loss after birth is considered normal. The WHO even have it built into their growth charts! Check it out: http://www.who.int/childgrowth/stand...irls_p_0_6.pdf you can see the dip in the 1st week.

[RomanGoddess]

Originally Posted by PatioGardener

ETA: We need some good research on how IV fluids during labour affect birthweight - I think this may often be the cause of large losses in healthy infants - and if so, new 'normals' for weight loss in babies of moms who had IV fluids during labour need to be established.

Good point. My baby was born at home, so there was no IV. However, I had gained a lot of weight during the pregnancy (22kg so close to 50 pounds) and I had a LOT of amniotic fluid in the sac (something like in the 90th percentile) so I am wondering if baby just retained a lot of fluid and that is why he lost 10 ounces of birthweight.

Originally Posted by Cavy

How did a newborn lose 10 ounce of weight in the first day of life? Was there a LOT of meconium? Or was the birth weight quite over-estimated? That's my suspician, you see...

See what I have written above. Plus according the Sears' Baby Book, large babies tend to lose a lot more. 300 grams is a lot but I don't think that it is unheard of. It was still less than 10 percent of his birth weight (4200 grams). The meconium that he pooed very shortly after his birth and thereafter for about a day seemed normal to me...

Originally Posted by msmiranda

My current ped told us that he doesn't worry about the initial weight loss after birth because the birth weight is artificially high because a newly born baby is still puffy from amniotic fluid under their skin. When that dissipates, it lowers their weight. Has anyone else heard this explanation?

This is exactly the explanation given to us by our pediatrician when we were living in France.

My DS was checked for latch, tongue tie, swallowing and religiously for wet nappies. All was okay. It was, however, VERY hot in the first two months after his birth and when I attended our LLL meeting at the end of the first month, the leader told me that some newborns who live in hot climates gain little or no weight at all the month after birth (they use all the milk to stay hydrated, I guess) and they still do just fine.

The other point that I read in the Sears' Baby Book is that "banana babies" - the long skinny types like my DS - tend to gain weight much more slowly in the initial months. Yet it seems that no one in the health care field (apart from Dr. Sears) seems to take this fact into account.

I guess my issue is this: Do we really expect ALL babies who are born in the, say, 90th percentile for weight to remain on the 90th percentile curve? And if not, then by logic, isn't it normal that some babies who are born big will not gain weight at a rate sufficient to keep them on their original growth curve?

A baby who is born in the 90th percentile for weight but who is genetically destined to be in the 50th percentile will probably NOT gain a whole lot of weight initially, not even 3 ounces per week.

[Llyra]

The key issue with weight gain, as I understand it, is brain growth. If baby isn't getting enough to eat, there aren't enough fats and calories to "feed" the enormous growth and development that the brain undergoes in the first few months. So weight gain is an indicator that all is otherwise well-- if baby is getting enough calories to gain weight, then clearly there must be enough for brain development. It is also an indication that nursing is going well and mom's milk supply and baby's suckling are as they should be.

The other part of weight gain is that a baby that's not gaining might be getting plenty to eat, but have underlying metabolic or other medical issues. The only way these can be identified is to 1. be absolutely positive the child is getting enough calories for normal growth, and then 2. notice that even with those calories, the child doesn't grow normally. That's the indication to start testing for underlying issues.

That said, no, not every child will settle into the same growth curve they started on. My DD2 was born at less than the 5th percentile, and she's now at the 50th. DS was born at the 10th, and settled at about 75th. And DD1 was in the 75th for many months, but is now at the 50th. But what you should NOT see is baby steadily dropping percentiles, once the first few weeks are past. Or a baby who's still losing weight after the first week, once mom's milk is fully in. Or a baby who's still not at birthweight two or three weeks past birth. Or a baby under six months or so who suddenly just stops gaining over a period of time. These are all red flags that something is wrong.

If baby settles comfortably in at a lower curve, and then grows at that rate, then you have a baby who was destined to be that size.

But you're right-- often doctors are very quick to recommend supplementation. Often it's out of genuine concern-- not every baby who gains slowly has a problem, but some do, and they don't want to miss those babies who are having problems. What they often fail to do is to take every possible chance to keep baby exclusively breastmilk by using techniques like before-and-after weights to gain an accurate picture of how much breastmilk baby is receiving, or latch intervention and breast compressions to increase baby's milk transfer, or offering the SNS to keep baby at the breast while being supplemented. They also often overreact to what is a normal child gaining at his/her own genetically appropriate rate, because they are concerned about not catching those few kids who really are not thriving.

[abc123xyz]

I feel like there are several factors that are contributing the this issue. My son was born in the 95th% and at two weeks was in the 50th% and from then on dropped down to the 3-5th%. Not 35th, 3-5th!!! And stayed there...now at 23 months is ahead of his peers! He has always been much taller than fat! My husband is long and lean and I am not overweight (although being pregnant, it's hard to tell!!!)! Genetics play a HUGE role in this!!! Dr's are jumping the gun on their formula propaganda to save themselves malpractice issues but in the end, they are undermining the mother and her confidence! I was given IV fluids while in my last 8 of 44 hours of labor due to dehydration. I didn't expel any fluids until after my DS was born. So, all of those fluids went where??? to my baby! Then they weighed him at birth but not before we left the hospital. There is a huge discrepency there because babies should not be weighed, really, until they are being discharged. I really feel, from personal experience, that they shouldn't be weighed until about 3 days after birth right when the milk really starts flowing because they have had time to rid their bodies of any excess fluids and edema (if present) and burned off the fat stores from life in the womb. That would be an accurate weight as far as measuring for growth.

OP--My answer from my own personal experience is that weights mean nothing TO ME unless a baby is showing signs of failure to thrive or starvation! There are more individual factors to investigate: is baby meeting dvelopmental milestones? growing in length and head circ? Acting satisfied after eating? etc... In my situation, we swtiched dr's because I was told to supplement with formula. Had I not been so certain to prove the world wrong and be able to breastfeed my baby or had I been on the fence about it, I would have totally given up without just cause! I started second guessing my ability to be a mother and to give my baby what he was intended to get. All because one Dr. didn't want to take the time to get to know my baby. Once I switched Dr's. she monitored his growth curve and found that where he grew was his normal. We need more personalized care in our medical system!!!

[RomanGoddess]

Originally Posted by jkseawell

OP--My answer from my own personal experience is that weights mean nothing TO ME unless a baby is showing signs of failure to thrive or starvation! There are more individual factors to investigate: is baby meeting dvelopmental milestones? growing in length and head circ? Acting satisfied after eating? etc... In my situation, we swtiched dr's because I was told to supplement with formula. Had I not been so certain to prove the world wrong and be able to breastfeed my baby or had I been on the fence about it, I would have totally given up without just cause! I started second guessing my ability to be a mother and to give my baby what he was intended to get. All because one Dr. didn't want to take the time to get to know my baby. Once I switched Dr's. she monitored his growth curve and found that where he grew was his normal. We need more personalized care in our medical system!!!

Good for you for following your instincts! That is such a difficult situation to be in! I have the same kind of baby - long and thin. He dropped from only 90th to 50th (not 5th!) percentile and I still got advice to supplement (with pumped milk, mind you, because the ped is a homeopath who does not believe in formula at all except in extreme situations).

[Blueone]

I think it's important. Maybe they don't need to gain quite as much, but they do need to be gaining. It's the same with wet diaper out put. Those 2 together show that they baby is getting what it needs. Sometimes though, babies gain weight slowly but have the appropriate wet diaper output.

Speaking from my experience only, my son was rapidly loosing weight and didn't have the right diaper out put either even after my milk came in he wasn't so I had to start him on formula. After that he had the right diaper out put and started gaining weight so that he was 10th percentile finally. But that was just my personal experience, my son was not doing well at all and feeding 24/7 and I had no milk after half of the feedings (I have hypo thyroid).

If you're worried and your doctor is too, I'd talk with him. But if you aren't and see that there is the appropriate diaper output maybe try switching peds.