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

babaskaal

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

 

Peter PanBefore 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.

Benefits of Breastfeeding

Breastfeeding 1

There are a few brand new babies in our friend-circle, and looking at them, I cannot believe how far my little boy and I have come on our breastfeeding journey in just 5months! I have already forgotten the difficulties of those first few days, and he is now breastfeeding like a pro!

“If we wear our nursing covers backwards like capes, then everyone can see we’re breastfeeding superheroes.”  Cassi Clark, Breastfeeding Is a Bitch: But We Lovingly Do it Anyway

Let us be honest with each other, breastfeeding is the most “natural” choice, but it is definitely not the easiest initially and it does not always come naturally to a brand new mom. As you might know, breastfeeding is ruled by two hormones: Oxytocin and Prolactin, both secreted by the pituitary gland in the brain.1 The regulation of both these hormones are very sensitive to pain, fear, stress, love, happiness and bonding with your baby. So basically, breastfeeding is “all in the mind”…

If you choose to breastfeed, make up your mind that you WILL BE ABLE TO! Your body was made wonderfully, so do not let anybody stir doubt in your mind. Surround yourself with people who will be supportive, and people who can help you when you are struggling and then give it your all. It truly is one of the best gifts you can give your baby and yourself.

“Yet You are He who pulled me out of the womb;
You made me trust when on my mother’s breasts.” 
Ps 22:9

I really want to encourage you to breastfeed! There are so many benefits for mom and baby. To help you stick it out over the long haul, I want to look at a few of the benefits of breastfeeding with you. Today I want to only look at the benefits for mom (after all, you will be doing all the hard work), next week we will look at the benefits for baby in both the short and long term, and then I will share a little bit about my own journey.

Breastfeeding 2

Immediate and Early Benefits for Mom:

  • Bonding. This has a lot to do with the hormone Oxytocin (so called “love-hormone”) that is released both in you and your baby while breastfeeding (the suckling, the close skin-to-skin contact and the eye contact  releases oxytocin, but there is also some of the hormone in your breast milk).2 Oxytocin is also released when you hug someone for longer than 6 seconds and after sex… so it is safe to say that a trusting, positive bond should develop between you and your baby.
  • Reduce bleeding after delivery.Once again… that wonderful hormone Oxytocin! It helps the uterus to contract (just like in labour) which in turn limits the bleeding.
  • Reduce stress and improve sleep. You probably know the answer by now… Oxytocin! 🙂 It makes you feel calm and produces feelings of trust, thus lowering your stress levels. It reduces cortisol, lowers blood pressure and improves digestion. This in turn is the perfect recipe for sleep, giving you a little more of a very valuable and scarce commodity in those first few days.
  • Prolong amenorrhoea and an-ovulation.Breastfeeding exclusively has the natural effect of suppressing ovulation, thereby acting as a natural birth control for up to 6 months (or as long as the woman is exclusively breastfeeding and her menses have not returned). This is not 100% fool proof and your gyne will usually discuss other methods of contraception with you at your 6 week follow-up, but it helps. And who will not take the chance to be free of “Aunt Flo” for as long as possible!

Long-term Mom-Benefits

  • Postpartum weight loss. Yes ladies, you heard right… finally something that burns fat!! Pregnancy tends to add on the kilos, but luckily we have a built-in solution. In a large prospective cohort study, Baker et al.4 showed that greater exclusivity and duration of breastfeeding was associated with greater weight loss at 6 and 18 months postpartum in women of all BMI categories. Another great reason to stick it out!
  • Reduce Type 2 Diabetes Mellitus, Metabolic disease and Cardiovascular risk. During pregnancy your body adapts in order to sustain your growing baby. Some of these changes include a mild degree of insulin resistance and changes in your lipid profile. There is some evidence for a “Reset Hypothesis”5 that happens when you breastfeed so that your cells are once again more sensitive to insulin, and that changes your lipid profile back to a healthier combination, thus decreasing the risk for chronic metabolic diseases.
  • Reduce risk for breast and ovarian cancer. According to a 2002 meta-analysis6 (a very trustworthy type of study), your risk for developing breast cancer is reduced by 4.3% per year of breastfeeding. There is also a decreased risk for ovarian cancer. It is thought that this is due to a decrease in the time that your body is exposed to estrogen (during breastfeeding this hormone is suppressed).

 

Benefits that spill over to the whole family…

(These have nothing to do with your biology or health, but believe me they play a big role in your overall well-being!)

  • It is FREE! Babies cost a lot of money, but this is one area that does not have to cost you a cent for at least 4 months. No need for bottles, formula or sterilizing equipment.
  • It is always the right temperature (no more stumbling to the kitchen to try and heat the bottle in the middle of the night)
  • It is naturally sterile! This saves a lot of time, as you do not have to wash and boil water or microwave or steam bottles and teats. In fact, the microbes that baby get into contact with during breastfeeding are GOOD for him! (More on that in the next post).
  • It is always available! If you stay out for longer than planned and baby wants to eat NOW, it is very easy to just find a quiet corner and let baby eat.

After saying all of that, I am sure you can start to understand why I am very passionate about breastfeeding. In the end however I agree that “fed is best”. I do understand that there are some circumstances where the ideal is not achievable, and I know your mommy-heart only wants what is best for your baby. The goal is to have a baby that is healthy, growing well and loved.

“Successful breastfeeding take courage, resilience, patience, and support and it always has. If your partner or support group hasn’t piled on the accolades for your heroism, then let them know you will expect oohs and has when you make it through the first two to three months (no matter how you got there) and your baby is happy and healthy — because you are awesome!” 
Cassi Clark, Breastfeeding Is a Bitch: But We Lovingly Do it Anyway

 

**** Photo’s taken by myself in multiple museums in Italy and Slovenia in 2015.

 

  1. SESSION 2, The physiological basis of breastfeeding; Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals
  2. Takeda S, Kuwabara Y, Mizuno M; Concentrations and origin of oxytocin in breast milk; Endocrinol Jpn. 1986 Dec;33(6):821-6.
  3. Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM; Breastfeeding and Health Outcomes for the Mother-Infant Dyad; Pediatr Clin North Am. 2013 Feb; 60(1): 31–48.
  4. Baker JL, Gamborg M, Heitmann BL, Lissner L, Sørensen TI, Rasmussen KM; Breastfeeding reduces postpartum weight retention; Am J Clin Nutr. 2008 Dec; 88(6):1543-51.
  5. Stuebe AM, Rich-Edwards JW; The reset hypothesis: lactation and maternal metabolism; Am J Perinatol. 2009 Jan; 26(1):81-8.
  6. Collaborative Group on Hormonal Factors in Breast Cancer; Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease; 2002 Jul 20; 360(9328):187-95.