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.
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!
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.