Slow Weight Gain and Older Breastfed Babies

posted by Mama Hope | November 16th, 2008 in Growth & Development

Breastfed babies follow a curve that is different than babies who are fed formula. Yet even using the breastfeeding growth charts that are now available, there is always the possibility that — even months after breastfeeding is successfully established — babies may show a reduced weight gain causing concern for the family.

Always be sure your doctor is following WHO growth charts for breastfed babies before becoming too concerned about your child’s weight gain. But if, like me, you still find reasons for alarm, there are a number of resources to help explore the situation and reduce concerns, alongside working with your health provider.

On Election Day we had our weight checkup for Baby Del. We’ve had weight concerns for our breastfed little boy since he turned 7 months old. Here’s a bit of our story for other moms who encounter similar issues. I discovered a few important points to consider along the way, that are especially relevant for breastfeeding moms. I’ve included:

  • Issues that may (or may not) cause concern with your doctor
  • A visual comparison of CDC and WHO growth charts
  • Advice for coping with slow weight gain
  • A La Leche League solution to investigating weight gain issues
  • Notes from Del’s ongoing weight gain story

Issues of Concern in Baby’s Weight Gain

To ensure that breastfeed babies are gaining weight successfully in the first days and weeks after birth, experts recommend tracking and observing elimination patterns (diapers), which can be done manually with a chart or by using a baby tracking software program (see my Trixie Tracker review). But our issues began to crop up later on, after breastfeeding had been established successfully.

Del started out an average baby for weight, born 7 pounds 14 ounces. All went well for his weight gain and we had no problems breastfeeding. At his four month visit, however, Del was leaving the curve of the CDC charts. Then, when we came back at seven months, he was below the 10th percentile. This is when our doctor began pointing out his concern.

slow weight gain at seven months
Del’s weight gain, CDC growth chart
compare WHO breastfeeding growth charts vs. CDC growth charts
Del’s weight gain, WHO breastfeeding growth chart

It was not the amount that Del weighed or the specific percentile he occupied that was the issue, but the curve he was following. Any other doctor might have immediately ordered intrusive tests, but thankfully, our doctor is not one to jump the gun. He first took a look at Del for:

  • Growth in length,
  • Overall appearance of health,
  • History of illness, and
  • Skills and motor development.

Del has always been A-OK in those departments: no sign of stunting in length, no infections or colds, alert, responsive, developing within the normal range. In fact, these days Del is actually taking his first steps and regularly walking from couch to chair to bookshelf on his own — ahead of the game for walking in a way that is typical for small, thin babies. Del also knows how to ask for mom, ask to nurse, wave hello and goodbye, play peek-a-boo, play hide-and-seek with objects hidden under a scarf or bowl, and say “light” and “dog” in baby signs. All happily within normal for a ten-month old baby.

So since his health and development otherwise looked good, Dr. E. basically asked us how Del was eating, told us to feed him solids more often as well as more of the things that he seemed to enjoy and eat easily, and then sent us off to return in one month for a weight check.

Advice for Coping with Slow Weight Gain in 4-Month Old and Older Babies

While I was watching Del closely during this period, what I wasn’t watching as well was my own health. Neither did my doctor ask questions about my health and how that might be impacting my milk supply and Del’s slow weight gain. This is a shame!

Part of the reason I want to share my story is that I’m convinced that part of Little D’s issues have been my own stress and depression, and accompanying inattentiveness to my physical needs. The first thing I should have done is sought out support, but when you’re stressed and depressed it’s hardest to bring yourself to get out and get help!

My recent efforts have made me realize, however, that until you’re finished breastfeeding, your own health is your baby’s health!

In retrospect, my advice for moms with concerns over weight gain and milk supply would be to seek out resources that help calm your concerns and put them into perspective, while also focusing on your own health and working with your health provider:

  • Don’t blame yourself. This is easier said than done, of course. But remember that stress causes problems with milk supply and make exacerbate the problem.
  • Get more information on growth and breastfeeding. Make sure you take a look at the breastfeeding growth charts published by the World Health Organization. On a separate post, I’ve also included links to information on interpreting breastfeeding growth charts. By looking at these charts you may find that your child’s weight gain, while possibly low compared to others, is not within the bounds of concern. The WHO charts delineate this clearly in the areas between the “-2″ and “-3″ z-scores. As you can see above in Del’s charts, the CDC chart paints a much more dire picture when comparing Del’s weight to babies fed aetifially with formula. On the WHO charts though the slowing of his gain is apparent, he never dips below the “-2″ z-score line.Of course, always consult your qualified health provider before making decisions on your child’s health, and never delay treatment based on information you find online! By working with your doctor and reviewing these charts, you may find a bit of peace of mind to keep you healthy and keep the juices flowing, as it were!
  • Get lactation advice. Find your local La Leche League chapter or locate a nearby lactation consultant. Don’t be shy or embarrassed (as I was). This was particularly difficult for me as I had successfully breastfed my first son and couldn’t see why I would need help. I already knew how to do it! But every baby is different, right? Memo to self : don’t let pride get in the way of your health or your children’s!
  • Consider contributing factors for reduced weight gain in older breastfed babies. A great list and resource is on KellyMom.com.
  • Slow Down. I’ve slowed down my posts here on hippie dippie bébé lately, as I’ve slowed down in general. Stress is as bad for your milk supply as it is for your generalized health. It’s so hard for me, but I’m trying to allow myself to do less!
  • Drink water! In the beginning, after baby is born you’re very attentive to your health, of course, but it’s easy to lose focus once you get past those first couple months. Don’t get lax like I did! When I started drinking more water, conscientiously, my let down was more noticeable.

One Solution to Investigating Weight Gain Issues

It has been three months now since the concerns over Del’s weight got serious, and we’ve been visiting every month since then for another check.

I’m happy to report, that the doctor did seem to be satisfied at our last visit, and simply scheduled our 12 month appointment, rather than another one month weight check.

I have to admit that I’m still a bit wary. Although the doctor was happy about Del’s gain, he is still quite low on the charts compared to national averages, and is very close to the z-score point of concern on the WHO breastfeeding charts.

Fortunately, our doctor was looking for Del’s weight *gain,* and less so his weight according to percentiles. In other words, what he is looking at is the angle of the line between points, not how high or low each point on the line resides. He also took into account the fact that my husband is actually quite thin for his height, and mentioned that this might be a potential factor.

Even still, I took the time to talk with my local LaLeche League Leader, Nicole, who was so supportive and helpful, I can’t recommend La Leche League enough!

My La Leche League leader’s suggestion was to pump twice a day, and watch for the layers that form between the skim and the fatty milk after setting the milk in the refrigerator for a few hours. In this way:

  • I’ll be reassured that I’m producing good, fatty and nutritious hindmilk.
  • I’ll be able to directly feed hindmilk to baby either by sippy cup or mixed with cereal, thus knowing for certain that he’s receiving.
  • I’ll add a bit of additional stimulation to promote milk production in case there has been a reduction.

As Nicole stated, it’s hard for us moms to know what’s going on when we’re feeding, especially stay-at-home moms like me who don’t pump regularly. By taking this step, I’ll also have more information about what’s happening, important to reduce my stress no matter what the situation. I’m currently making efforts to acquire a pump so I can begin the experiment!

Of course we’re also feeding Del yummy solids, and though I have had thoughts about solids potentially interfering with milk production, Little Del does still nurse regularly and indicates clearly when he’s “all done,” and we don’t feed him beyond that point. He’s just not a ravenous little eater!

We keep hoping at our next visit Del will post a great gain that rocks the growth charts and eases all of our concerns. Yet I do realize that might never happen, and we may just need to accept his comparatively thin weight. What’s truly important is my breastfeeding habits, taking care of my health, and just enjoying and appreciating Baby Del’s great enthusiasm and ongoing growth and learning. Thanks to the support of my family, friends and community, I’m prioritizing that.

Take care of yourself! I’ll try and do the same!

Mama Hope

Disclaimer: The above content is for informational purposes only and is not intended to give medical advice. This content not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it because of content found on this site.

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10 Responses to “Slow Weight Gain and Older Breastfed Babies”

  1. Thank-you for sharing your journey with Del and his slow weight gain. So many mothers are experiencing this challenge around the country. Part of it is due to the differences in measurement standards as you described. WHO and CDC charts are not the same. Then you must factor in the variety of breastfeeding styles that exist, the amount of supplementation being done and when, whether supplements are of breastmilk or formula, the gene pool of the family of origin to name a few variables.

    Sadly, too many mothers are being stressed and some ultimately stop breastfeeding or do nominal breastfeeding as a result of this obsession with weight gain among members of the health care team.

    Growth happens in many directions. Frankly, I opt for big brain over big butt.

    We all know people who can eat and seemingly never gain weight. These fast metabolisms often start in infancy and are not being considered adequately when analyzing breastfeeding. I’ve had many mothers in my practice succumb to force feeding their breastfeeding babies to keep up with the charts. Ultimately, no matter what they did even on formula and solids their babies were very healthy, but remained lanky and lighter than their peers.

    Luckily your doctor was supportive of your breastfeeding. Too many doctors these days see a baby who looks well, but take back their support if they are not the fattest baby on the block. A baby who is growing in length, head circumference and weight with precocious motor development is a healthy baby.

    It is true that sometimes there are foundational issues such as hormone imbalances or feeding sessions that are not transfering milk well. I find that more emphasis is being put on frequency than quality of feedings and that can throw off the curve.

    Nonetheless, looking around the world where breastfeeding used to be the norm, it would be rare to see really heavy breastfeeding babies as a rule.

    I am so happy for you that you are taking good care of yourself and have continued to breastfeed your son Del. Your post here will inspire many mothers if faced with similar challenges.

    We talk about this and other related issues every Tuesday @ 11AM EST on The Breastfeeding Salon Show.

    I would love it if you shared your story with our listeners.
    http://thebreastfeedingsalon.c.....oshow.html to listen live or access podcasts.

    You can also follow me @salonmaire on twitter.

  2. Fascinating! We went through similar weight-gain issues with Edward but he was never on the curve to start with so his situation was a bit different. Still, my doctor supported exclusively nursing for the first 6 months, which I did. (And then continued through 20 months when he self-weaned (sob). Wish I had access to all this great information 6 years ago! This will help so many people who are encountering the same situation.

  3. thank you so much for this web site. i have read so much out there about this and yet every time i surf the web i find new sources, including this one. this one has made a lotof difference in my perspective. your baby and mine have an almost identical curve on the WHO charts, which i finally printed out and plotted her curve for myself instead of letting WIC do so with their (CDC?) charts which showed her curve being much lower. ironically, i went to a naturopath a couple times who weighed my baby and plotted the two weights on a chart that showed her not even on the chart!!! i think i should refer her to the WHO charts!
    my girl has always been in the 50% for height, but her weight dropped from the 85% to what is correctly (WHO) the 12% or so, and has recently climbed to that from more like the 10th. hmm.. sounds like a growth spurt. also, the stuff about exclusively BF babies gaining well in the first 3 months (i remember she had a lot more pudge on her then) and then slowing down makes sense. i didnt weigh her after birth until 5 months, at which point she had dropped dramatically, so i dont know when the drop started. the peds say they slow after 6 or even 8 mos, not as early as 5, but i have a feeling that isn’t a rule. anyway, none of it is a rule, and i am really glad you said what you said about me neglecting my health and stressing. i have been learning about letting go of expectations about how things “should” be and accepting more how sometimes there is a unique growth pattern that is not good or bad, but just “is”. the hard part is comparing her to other 10month olds,.. some are really big, even some BF ones!

  4. Thanks, ladies, for your thoughtful comments and words of support!

    “I opt for big brain over big butt.” Maire, I love it! I’m going to try and pop in to listen to your show next Tuesday, though it’s close to another appointment I have. Either way I’m excited to hear of the resource, and I appreciate your sharing your experience. It’s true that there are those who can seem to eat and eat while staying thin, and my husband is one of them! He weighs in at about 20 pounds under the “healthy weight” for his height, even for a small frame. It’s good to be reminded that this kind of metabolism can truly begin in infancy.

    I also appreciate your point about focusing on quality of breastfeeding over quantity. That’s exactly what I’ve been curious about — issues of hindmilk. I’m unfortunately a bit stuck at this point as I’m experiencing your typical delays trying to get a breastpump through my insurance.

    It truly takes one to know one though, and while I know it’s great advice and I try to live it, I continue to worry when I’m feeling down. It’s so good to have the story up here and to receive support from others to keep my sanity!

    Thanks Didi and Elizabeth for echoing your experiences! It’s true that there are some *big* breastfed babies out there that I see and inevitably compare to Little D! But I am truly lucky that my doctor hasn’t tried to interfere with my breastfeeding.

    My one fear is that there are hidden issues with my breastfeeding that will reduce my supply before I can get feedback and help. But the way I look at it, as long as I’m taking care of myself I’m doing what I can and the opposite could happen easily as well — just by drinking water, a little Mothers’ Milk tea, resting more, doing some light yoga at home for sanity, giving Del attention and slowing down while nursing, and easing off on the stress, perhaps if there is any hidden problem it will just fix itself.

    I still definitely want to get a pump and perhaps some words with a lactation consultant so I can set my fears to rest. But re-reading my words and yours just helps me remind myself that there may be *no* problem with my nursing at all.

    “Big brains over big butts!” This may be a great mantra for us, Didi!

    Thanks again!


  5. I’ve kept records using the cdc charts as well as the WHO charts. Our results are much like yours. On the cdc charts she rapidly drops in percentiles starting at 9 months of age. However on the WHO chart she has remained at the 50th percentile since birth. A very drastic difference.

    Jeskas last blog post..50 day raw challenge: Day 1

  6. Thanks so much for you posts. It’s been very helpful as my son tracks very much the same as Del. My son, Bryce, is almost 21 months old and is still down between the 5th and 15th percentile on the WHO charts for height and weight. My theory is that he continues to eat all natural foods without “fillers.” I am curious if anyone else has a BF baby that eats natural foods and how your child is tracking in these older months. Also, Bryce’s head circumference has always been and continues to be in the 95th percentile.

  7. Kerry,

    Little Del does eat all natural foods, too, and almost entirely organic, so you may have a point there. On the other hand, I am friends with moms who also feed their babies all naturally, and there are some pretty chunky babies out there! I’ve even known of some babies nearly exclusively breast fed past one year that had rolls of the kind of baby fat that my little one just doesn’t have.

    But here’s another theory: we’re all different, and perhaps the increase in formula use and baby food fillers essentially “masks” that difference by an overall increase in the body fat of babies in our industrialized culture. As I mentioned, the WHO charts and studies point out that obesity is an epidemic in our age, and signs of obesity can and do arise in the early years. This is one of the reasons the WHO charts were developed: to aid in diagnosing obesity.

    As a lactation consultant I spoke to emphasized, these days the big concern in nutrition, especially here in America, is obesity, not malnutrition. To her, it defies logic that so many doctors and mothers are emphasizing use of the CDC charts to look for signs of underweight babies, when the real epidemic of our age is the health problems associated with obesity.

    The more time passes, the more I realize that just accepting that Del is a thinner baby is no tragedy. One could apply the same logic to child development. If we can resist our urge to always be on top in every standard of measurement, perhaps we’ll learn to accept our children (and ourselves) in the amazing and beautiful variety that we come in!

  8. hey hope, is del still a lean baby?? pippi is 15 mos now and adorable, and still lean. JUST started walking… post a recent pic of del okay?

  9. Hi Didi!

    Yep Little D is still a lil’ bean pole! He’s been walking for a few months now and he *cannot* stop moving. I’m sure that his level of activity contributes to his being thin.

    I just recently posted some videos of D, they’re here:


    You get a pretty good sense of his activity there too!

    Thanks for saying hi! Pippie and Del are the same age, huh? I guess I already knew that! If you have any pic’s online let me know!

  10. Thank you so much for your posts. You’ve presented the WHO charts in a concise manner which is very appreciated by a tired mama!

    My now almost 8 month old son has also had weight gain issues. I went to a La Leche meeting for the first time recently. One of the moms there suggested trying to up his protein intake from solids. That is what her pediatrician recommended when her 9 month old daughter had slowed in her weight gain. This makes sense since I have read that one of the reasons why formula fed babies gain weight faster is due to the higher amounts of protein.

    BTW, your little D is adorable. :)


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