Normal Weight Gain in the Breastfed Baby

Percentiles, growth charts, curves, oh my…

So much stress over weight gain!

In my experience, the actual weight or point on the growth chart doesn’t matter as much as this: is your baby getting enough every day to have consistent weight gain and growth? What’s important to measure is how much your baby is gaining per day, on average. A baby who is low on the curve, but is gaining adequately, doesn’t need supplementation. 

I see two trends in pediatric care, both reveal lack of understanding of the way lactation works. Some doctors are very quick to recommend supplementation with formula for small or slow growing babies. 

Others are non-alarmists who are not concerned with very slow weight gain. Neither is the best practice for breastfeeding dyads. The former will compromise the benefits of breastfeeding and the latter might mask a problem that can be nipped in the bud. 

If a parent’s goal is exclusive breastfeeding, any concern over amount of milk baby is receiving at the breast warrants a referral for a complete breastfeeding assessment, preferably by an International Board Certified Lactation Consultant (IBCLC). 

IBCLCs discover the reason baby isn’t getting milk and work to fix that root cause. Sometimes it’s  very simple to get the milk intake to increase. Other times it’s more complex. Regardless, it’s worth the effort. Many of my patients come to me supplementing, without having been encouraged to increase their own supply.  When supplementation with milk that isn’t the parent’s own milk, the milk supply must be protected. In other words, stimulation  by hand expression or pumping is needed to let the breasts get the message to keep making milk. See my blog “Please Pump” for more on this topic. 

IBCLCs guide their patients to follow the recommendations  of the Academy of Breastfeeding Medicine (ABM) The ABM says that if baby needs to be supplemented, first choice is mom’s own milk, obtained by hand expression or pump. Second choice is donor human milk. When human milk is unavailable, protein hydrolysate formulas may be preferable to standard infant formula to avoid exposure to intact cow’s milk proteins. 

Back to the subject of how much weight baby should gain. Average is about 1 ounce per day during the first month, about ½ to 1 ounce per day during months 2-6, and about 1/2 ounce per day from six months to one year.  Milestones to look for include not losing more than 7-10% of birthweight in the first week, starting to regain by day 5-7, and reaching birth weight by 2 weeks old. Baby should have 1 wet, 1 dirty diaper on day 1, 2 on day 2, 3 on day 3, 4 on day 4 and after that  at least 6 wet diapers and 4-6 bowel movements per day. Bowel movements should get lighter in color even day, so that by about day 6 they are yellow. 

If your baby isn’t showing expected diaper output, doesn’t ever seems satisfied, or is unable to be roused for a feeding, please reach out to your health care provider immediately. 

Any other concerns or uncertainties warrant a call as well. When in doubt, reach out. If your health care provider doesn’t validate your instincts or needs for breastfeeding information, an IBCLC is the best choice for expert guidance. 

One more thing- the first few weeks are often a challenge. This time passes quickly. It does get easier. Be sure to hold your baby skin to skin, enjoy the snuggles, and feel the love.  

References:

ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, BREASTFEEDING MEDICINE Volume 12, Number 3, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2017.29038.ajk, retrieved  at https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/3-supplementation-protocol-english.pdf

Sears, Dr. Bill; Average Breastfed Baby Weight Gain. Retrieved May 16, 2019 at https://www.askdrsears.com/topics/feeding-eating/breastfeeding/faqs/how-much-weight-will-my-breastfeeding-baby-gain