When your baby wants to be Peter Pan – weight gain problems

Since our little baby was born I have been acutely aware of his weight. Initially we went for weekly weight checks at our baby-clinic to determine whether he was gaining well. It is one of the few ways to determine if he was getting enough breast milk. I even went to buy a bathroom scale (something we never had), so I could get an estimate of what his weight was. Over the last 7 months I have realised I am not alone. Many of my friends struggled with babies that did not gain weight appropriately, causing stress on different levels. Every mom wants to know that her baby is healthy and GROWING, and if it all depends on milk that you cannot even see, it is easy to fall into a negative cycle of slow weight gain – anxiety – decreased breast milk production – slower weight gain – add-on feeds – decreased breast milk production – insufficient weight gain and finally changing over to formula feeding all together.

* In the end I agree it is more important that you have a healthy, GROWING baby, and if formula is necessary to achieve that then please give it, but I am at heart a big breastfeeding-fan, so I would like to help you get over this hurdle without giving up on breast milk! 😉

“Growth is never by mere chance; it is the result of forces working together” –  James Cash Penney

So what is normal weight gain and when should you worry?

During the first few days of life it is normal for your baby to lose weight. This is due to all the excess fluids that you and baby retain during the last few weeks of pregnancy and can be exaggerated if you had an epidural / spinal with extra intravenous fluids during the delivery.  Another contributing factor is the volume of colostrum. This liquid gold is very concentrated specifically to give your baby’s kidneys time to get used to working with larger volumes of fluid. It is however important to make sure your baby does not lose more than 10% of his birth weight, and that he starts gaining weight again after a few days. A term baby should reach at least his birth weight by 7-10days of age, a premature baby can take up to 14days to get back to birth weight.

There-after the general rule of thumb for a healthy weight gain is 20-30grams per day (140-200g/week) for the first 4months.  From 4-6months breastfed babies tend to gain 90-120g/week and 50-80g/week from 6-12months. It is important to understand that these numbers are calculated from the average weights of a large number of healthy babies. This means that there were babies who gained more or less than these suggested weights and were still healthy. ^1,2

“All children, except one, grow up.” ― J.M. Barrie, Peter Pan

Before you start weighing daily or weekly for the rest of your baby’s life… remember that growth over time is more important than one good or bad weight. That is why we use growth charts to keep track of your baby’s weight gain over time. We want your baby to follow the shape of the curve (whether he is above or below the “middle” line). This allows your individual baby (who might have very tall or petite parents) to grow within a healthy margin. We as health care practitioners start to worry when your child drops from the line where he used to grow to a lower curve (percentile), or if the weight stands still, causing a flat line on your curve. Once again this should be seen in context. Your little one might have had a bout of gastro just before the weight was taken, or he might have a chronic disease or syndrome where we expect him to grow slower.

If you are worried that your baby is not gaining weight, take a step back and look at some of the other indicators that your baby is getting enough milk and is growing. Is your baby having 4-6 wet nappies per day? How many dirty nappies per day? (The stool frequency can change after 6 weeks, but before that there is usually a minimum of one stool per day). Is the length- and head-circumference measurements increasing? I have seen many babies have a growth spurt in length before the weight catches up. If your baby’s head is growing in circumference, it means his brain is getting enough calories to grow. Is it the same scale that was used previously? Is the scale calibrated?

If your health care provider is also worried about your baby’s weight gain, they should ask a thorough history, do a good clinical examination and appropriate special investigations to understand why baby is not growing well. The underlying cause is usually due to a lack of provided nutrients (baby is not latching well or has started sleeping through the night and is now missing out on calories previously provided by the night feeds), or due to a problem in the absorption of the nutrients provided (severe reflux and vomiting, allergies, certain metabolic diseases), or due to an increased use of the nutrients (acute or chronic diseases, congenital abnormalities).

It is important to understand the cause so that the treatment can be directed in the right direction. It does not help to only give supplemental feeds when the problem is that the baby is not absorbing any of his feeds. Regular follow-ups with your health care provider is very important until your baby gains weight sufficiently again.

Weight is an indicator of wellness over the last few weeks, while length shows us the wellness over months and years. If a baby does not grow well for a prolonged period of time, it may lead to him not reaching his full potential in height and other areas of his development.  There might be complications of specific vitamin and mineral deficiencies and ultimately permanent damage to the brain. Early identification and treatment may help to prevent long-term complications.³

There is a handy app that you can download to your tablet or cellphone to keep track of your baby’s growth. It helps you keep track of the weight, height and head circumference, and will also show you the child’s weight-for-length (a handy measurement that shows overall wellness).

http://get.growthapp.net/ for Iphones

https://play.google.com/store/apps/details?id=com.abqappsource.childgrowthtracker for Android.

I hope your baby will grow and GROW and GROW! 😉

We continually ask God to fill you with the knowledge of his will through all the wisdom and understanding that the Spirit gives,^[a] 10 so that you may live a life worthy of the Lord and please him in every way: bearing fruit in every good work, growing in the knowledge of God, ¹¹ being strengthened with all power according to his glorious might so that you may have great endurance and patience. – Col 1:9-11

Photo’s from Google Images

1. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/infant-growth/faq-20058037
2. World Health Organization Child Growth Standards, 2006
3. Perrin E, Frank D, Cole C, et al. Criteria for Determining Disability in Infants and Children: Failure to Thrive. Evidence Report/Technology Assessment No. 72. AHRQ Publication NO. 03-E026. Agency for Healthcare Research and Quality, Rockville, MD, March 2003.