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| Baby Weight Gains |
What is the 'normal' growth rate for babies?
The general guidelines that are usually given for growth are:
- a baby loses 5-10% of birth weight in the first week and regains this by 2-3 weeks
- birth weight is doubled by 4-6 months and tripled by 12 months
- birth length increases 1.5 times in 12 months
- birth head circumference increases by about 7.6 cm in 12 months.
However, all babies grow differently and these are just general guidelines. If you are concerned about your baby's growth, you can contact your medical adviser for a thorough assessment of your baby's general health and wellbeing.
How can I weigh my baby accurately?
It is quite normal for a breastfed baby's weight gains to vary from week to week. One week they may put on a small amount of weight and the next week they might put on a large amount. Weight gains are usually best looked at over a longer period such as 3 weeks or a month. You might like to weigh your baby once a month and, if you wish, you could average out this weight gain to find an average weekly weight gain.
The correct weighing technique is needed in order to get an accurate result.
- Use the same set of scales if possible. Scales can vary quite a lot.
- Try to weigh your baby in the same set of clothes or similar weight of clothes (or without clothes) and, if possible, at about the same time of the day.
- If your baby has been weighed just before or just after a feed, this can make a difference of 100-200 grams.
- If your baby has just had or is due to have a large bowel motion (poo) this can also make quite a difference!
What is a Growth Chart or a Percentile Chart?
Growth charts are often used to help follow and assess a baby's growth. Your baby's weight can be plotted against a weight-for-age growth chart. Historically, these charts have been made up by measuring the weights of hundreds of different children at each age. The most common type of growth chart is a percentile chart where these hundreds of weights are then divided into 100 equal groups. Some of these groups are then plotted on a graph or listed in a table.
In Australia (except for the Northern Territory), the growth charts currently in use in the baby health books you receive in hospital are based on a majority of non-breastfed babies from the past (between 1963 and 1994). Artificially-fed babies grow differently to those who are breastfed.
You may like to print out and put in your book the newer World Health Organization growth standards, which are based on healthy, exclusively breastfed babies from six countries across five continents. These more accurately show how a normal baby of any ethnicity should grow. As well as being based on breastfed babies, these standards were created from following the same babies as they grew, rather than the old historical method mentioned above.
You can find the World Health Organization child growth standards percentile charts and tables here:
The simplified World Health Organization child growth percentile field tables, which are very easy to read, can be found at:
Girls,
Boys
How do I read a Growth/Percentile Chart?
The following example explains how you should read a percentile chart:
- 3% of children will be below the 3rd percentile and 3% of children will be above the 97th percentile
- 15% of children will be below the 15th percentile and 15% of children will be above the 85th percentile
- 50% of children will be below the 50th percentile and 50% of children will be above the 50th percentile
The 50th percentile is not a pass, it means that 50% of the normal population is below this line and 50% is above it.
If a baby's height or weight is 'off the chart' (above the 97th percentile or below the 3rd), there is a higher chance of something being wrong and it is wise to check with your medical adviser. In many cases though, all is well. Three in every 100 normal babies will weigh less than the 3rd percentile, often because both parents are small.
Does it matter if my baby doesn't 'stick' to a percentile line?
Usually, no.
Because the charts are derived from average weights, lengths etc, individual children shouldn't be expected to follow them exactly. They can and do grow faster or slower at times. One study found that only 12% of babies kept to the percentile line they were born on. Most babies cross percentile lines for both weight and length. After birth larger babies tend to grow more slowly (on average) and smaller ones faster. This is because birth size relates more to nutritional conditions in the womb than to genetics. After birth, babies gradually move to their genetically pre-programmed size and they can take from 6 months to 2 years to do this. After 2 years they then follow this line, more or less, though still with some variations.
When is low weight gain a problem?
Individual babies vary a lot and weight is only one factor in the 'whole picture' of a baby's health and development. Careful assessment of your baby's health is generally recommended if:
- your baby continues to lose weight after the first 10 days of life and does not regain birth weight by 3 weeks
- your baby gains at a rate below about 100 grams a week in the first 3 months
- your baby's weight is less than the 3rd percentile
- your baby's weight drops two percentile lines in 56 days (before the age of 5 months)
- your baby's weight drops two percentile lines in 3 months (after the age of 5 months).
Looking at your undressed baby can also give you an idea. Does your baby look healthy? Does she have a good skin colour and muscle tone? Does she look the right weight for her size? Does she look like her skin 'fits'? Wrinkly, loose skin with not enough fat beneath the skin is a sign that your baby is not gaining enough weight or is losing weight. The 'wasting' of weight loss first appears around a baby's lower abdomen, buttocks and upper thighs, which is why it is important to remove all your baby's clothes when you do this, especially the nappy.
Together with your medical adviser, you can investigate your baby's general health and wellbeing, checking for signs of adequate milk intake and whether your baby is meeting developmental milestones.
What are the developmental milestones?
0-3 months,
3-6 months,
6-9 months,
9-12 months,
1-2 years,
My baby was gaining weight well and now all of a sudden things have slowed down. What's going on?
- Check your weighing technique. Did you use the same scales, same clothes, same nappy weight? Was your baby weighed before or after a feed, before or after a large bowel motion (poo)?
- Have there been any changes in your baby's behaviour? For example has your baby been taking fewer feeds as a result of sleeping longer at night?
- Have you been trying to feed at set times instead of when the baby indicates?
- Have you (the mother) been stressed or unwell? For some women this can cause a temporary dip in supply.
- Have you just started a new medication such as the contraceptive pill? Could you be pregnant? These factors can cause a dip in your supply.
- Has your baby been ill? Even a small cold can disrupt feeding and weight gain for a week or two.
- Has your baby previously gained well and is now slowing down normally? It is very normal for an exclusively breastfed baby's weight gain to slow down at 3-4 months. The World Health Organization child growth standards, based on healthy breastfed babies, help demonstrate this.
In most cases of sudden weight change, a 'wait-and-see' approach is justified if your baby seems happy and the other indicators of growth and health are fine. If there seems to be a temporary low supply problem, offering a couple of extra breastfeeds a day can help avoid a more serious situation.
My baby has had persistently low weight gains. Is my baby getting enough breastmilk?
Many mums who are worried that their baby is not gaining enough weight are also worried that their baby is not getting enough breastmilk.
These are some reliable signs of adequate milk intake.
Remember - what goes in must come out!:
- After 5 days of age a minimum of 5 heavily-wet disposable, or 6-8 very wet cloth nappies, in 24 hours.
- Pale urine (wee). If your baby's urine is dark and smelly, this is a sign that your baby is not taking in enough milk.
- Good sized, soft poos. Under the age of 6-8 weeks, your baby should have two or more runny poos a day, about the size of the palm of your baby's hand. After this age, it can be quite normal for a baby to poo less often, even once every 7-10 days, as long as when your baby does a poo, there is a large amount of soft or runny poo coming out!
In addition to the 'what goes in must come out' signs above, other reliable signs that result from an adequate milk intake in a healthy baby are:
- Baby has some weight gain after the initial weight loss soon after birth, and some growth in length and head circumference. (Are your baby's clothes getting snugger?)
- Baby looks like she fits in her skin - with good skin colour and muscle tone.
- Baby is meeting developmental milestones.
Even when mums know about the signs of an adequate milk supply they can still sometimes worry that they may not have enough milk. Please do not listen to well-meaning friends or family members who suggest that you express some breastmilk to 'see how much milk you have'. How much milk you can express is a really poor measure of how much milk you have. This is because babies are much better at milking your breast than a pump is. Expressing is a skill that needs to be practised. If you don't normally express, you may find it difficult to get out much milk, despite having a plentiful supply.
Another poor measure of how much milk your baby is getting is 'test weighing'. Test weighing for estimating milk supply is only accurate if completed over a period of at least 24 hours on accurately calibrated equipment by someone experienced in test weighing techniques. Babies take different amounts of milk at different feeds and every woman's breast storage capacity is different, so you may need to feed more often over 24 hours to meet your baby's needs - hence test weighing just one feed will NOT tell you whether your baby is getting enough milk overall. Test weighing will also not tell you how much milk your baby needs, which varies from baby to baby. The wet and dirty nappy count will tell you whether or not your milk supply is adequate for your baby's needs. (Note that lactation consultants may use test weighing to assess how well a baby is able to transfer milk. This is a different purpose to assessing milk supply.)
For more information about how to tell if your baby is getting enough milk, refer to the article Not Enough Milk? on this website.
My baby is getting enough breastmilk. What's causing the low weight gains?
If your baby appears to be underweight, with wrinkly, loose skin and yet has a good nappy count indicating enough milk intake, it may be that your baby has an underlying medical condition which is causing a slow weight gain. There are many conditions which could affect weight gain. Some of the common ones include:
- infection (anything from a cold to a urinary infection)
- vomiting or frequent posseting (eg pyloric stenosis or severe reflux) - can mean a baby does not retain enough milk to grow
- a sensitivity to foods in the mother's diet could be a cause of low weight gain (usually along with other symptoms, such as 'colic').
Your medical adviser will be able to help you investigate these and other areas.
My baby is getting enough breastmilk. Is my baby just meant to be small?
Some adults are naturally petite and so are some babies. If your baby appears to be happy and healthy, is meeting developmental milestones, does not appear underweight (does not have loose wrinkly skin) and has a good wet/pooey nappy count, then your baby's low weight gains may be due to family factors (genetics).
I think my baby is NOT getting enough breastmilk. What can I do?
- Is your baby feeding often enough? The simplest and most effective way to increase your baby's milk intake is to breastfeed more often. Babies need at least 6 feeds in 24 hours in the first few months. For most babies, 6 will not be enough; they need 8-12 feeds in 24 hours (or more) to take in enough milk.
- More frequent feeding also means your breasts are relatively 'emptier' (they are never completely empty), which means that your breasts will speed up milk production, increasing your milk supply.
For more information on how to increase your milk supply refer to the article Increasing Your Supply on this website, or refer to the Australian Breastfeeding Association booklet Increasing Your Supply.
- Is your baby feeding for long enough to get a balanced feed? The fat content of your breastmilk steadily rises and usually doubles from the beginning to the end of the feed. If you let your baby decide how long to feed, he will usually be getting enough of both the breastmilk and the fat that he needs.
- Have you only been offering one breast per feed? Some babies only need one breast per feed, other babies need both. Some babies start off just needing one and change as they grow older. You could try offering your baby the second breast.
- Try offering top-up breastfeeds 20-60 minutes after your baby's normal breastfeeds.
- Is your baby sleeping longer at night? Long night sleeps (and therefore missed feeds) can also decrease your baby's milk intake and weight gain. You might consider waking your baby during the night to feed or fit in extra daytime feeds.
- Is your baby attaching and suckling effectively? Babies who are failing to thrive may have a poor sucking action, so they don't empty and stimulate your breasts enough. Face-to-face assessment of this by an International Board Certified Lactation Consultant (IBCLC) or Australian Breastfeeding Association counsellor can be very useful. You can find an IBCLC near you at this website: Find a Lactation Consultant.
- Does your baby have a tongue-tie? This can lead to poor attachment and mean that they cannot drain the breast effectively. An IBCLC can also check for this. In many cases the tongue-tie is snipped, leading to much more effective feeding for the baby and more comfortable feeding for the mum.
- Have you been using a nipple shield? Provided a nipple shield is used properly, it should not cause supply problems. However, if your baby's weight gains continue to be low, it could be that your baby is not transferring milk well through the shield. Consult a lactation consultant or an Australian Breastfeeding Association counsellor to check that your baby is attached properly on the shield. If you baby cannot feed well without the shield, you will also need to express your milk to protect your milk supply and to provide more milk for your baby.
Please feel welcome to call the toll-free National Breastfeeding Helpline on 1800 686 2 686 (drop the last digit if using VoIP or Skype, ie 1800 68 62 68) to talk about anything discussed in this article, or any other breastfeeding related matter.
April 2010
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