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|Yes, test weights are appropriate for babies at any age - - weighing a baby before and after a feed, then subtracting the first weight from the second weight to determine the amount transferred from the breast. This is the only accurate method of determining a baby's intake/transfer of milk from the breast, and should only be done with a reliable baby scale such as Medela's BabyWeigh Scale. The lactation consultants at Winchester Medical Center should be able to help you obtain one of these scales as a rental item - - they may be available through Valley Home Health. At Inova Fairfax Hospital, we rent these scales for $4 a day. They are too expensive for families to purchase at $1,000 for Medela's price and about half that from Tanita. But the rent is very do-able and is invaluable in completing a thorough feeding assessment for a baby with weight gain concerns.
To perform an accurate test weight, the baby must stay clothed the same throughout the test weight. Clothes and/or diapers should not be changed during the test weight, and blankets should not be put on or removed during the test weight, in order not to skew the results. The weight is not intended as a true weight (nude weight), but rather to determine transfer of milk, so the baby can remain clothed throughout the test weight. Of course a nude weight can be done for the purposes of the physical assessment but would not be part of the test weight.
This is criteria from The Breastfeeding Answer Book (BAB) regarding Failure To Thrive:
Failure-to-Thrive in a Baby Older Than One Month
weight below 30th percentile
drop in rate of growth of length and head circumference
infant falls two standard deviations on the growth chart
evidence of malnutrition, dehydration - - sunken fontanel, grayish pallor, lethargy, loss of fat layer under the skin, strong urine, inadequate stools
infant does not meet developmental milestones
infrequent and/or ineffective feeds
mother experiences few let-downs
erratic or nonexistent weight gain
When the baby is diagnosed as failure to thrive, immediate supplementation is necessary.
Here's a brief excerpt from The Breastfeeding Answer Book about weight gain:
"Average weight gain for the first three to 4 months is about six ounces per week, although it is considered acceptable for some babies to gain four or 5 ounces per week. The very rapid growth a baby experiences during the first three months typically slows down during months four to 12. An average weight gain for a breastfeeding baby four to 6 months is about four to 5 ounces per week. An average weight gain for the breastfeeding baby six to 12 months is two to 4 ounces per week."
New weight guidelines have also come out in the past year that I am sure will be listed in the next revised edition of the BAB.
Pumping and bottle-feeding a baby is an option but is not accurate in determining what a baby transfers from the breast.
A better way to supplement a baby who needs supplementation is to use tube-feeding at the breast, such as Medela's Supplemental Nursing System (SNS) or Lact-Aid. If you get on Medela's website at http://www.medela.com you can look at their products to find the SNS.
Advantages of using a supplementer at the breast vs. bottle-feeding is that the breast continues to be stimulated and emptied which is critical for protecting mother's milk supply, and there is no risk of nipple confusion/suck confusion/flow confusion or nipple preference/suck preference/flow preference in favor of an artificial nipple/bottle.
Your baby should be nursing at least eight times in 24 hours, and more often during growth spurts. Length of feedings should not be limited in order for the baby to get adequate hind-milk. According to the BAB, "the baby may get plenty of fluids from the watery foremilk but not enough calories needed for growth" when feedings are timed or restricted to so many minutes per breast. One way to supplement a baby is by using Medela's SNS with some pumped hindmilk, to give the baby a high-calorie supplement. I have only seen the Whisper-Wear pumps in print ads. My education and training is to recommend a medical-grade electric breastpump when a mother wishes to express milk for supplementing her baby. The best known/most reputable medical-grade pumps in the U.S. are Ameda's SMB, Lact-E, and Elite; and Medela's Symphony and Lactina. Until recently Medela also had their medical-grade pump, the Classic, available. But they have phased out the Classic in favor of the Symphony.
Pacifiers should be avoided during a baby's waking hours, since no calories are given with this type of sucking. Keeping your baby in a sling (I recall you are a fan of this) is preferred over time spent in a swing (the sling allows more frequent access to the breast).
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