What's in a baby's weight?

Many mothers will be able to relate to this experience. The experience looks the same; a routine infant check up appointment, baby gets a weight check, the parents are asked some questions about development, etc.  Upon looking at the weight, it is determined the infant is not gaining weight as expected. What does this mean? What is the cause? What should be done? 
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It often is quite shocking to parents, especially mothers, to hear this news. They are perplexed because they thought feeding, usually breastfeeding, was going ok. How is it possible that baby isn’t gaining weight? How is it possible she didn’t know that baby wasn’t growing as expected? Can anything be done? 

Common reasons provided for this phenomena is that mom has low milk supply, baby isn’t getting enough hind milk or baby is too sleepy and isn’t feeding often enough. I don’t think it is quite that simple. 

What I find in these scenarios, because I get calls often after an experience like this, is that what is not communicated to the parents is why we do these checks, why they matter, what they mean and what should be done with the information.

The simple answer is that we expect babes to maintain their own curve that they plotted on at birth (or more ideally 24 hours). When babies start to drop off that curve, this gives us a sign to look and assess what might be happening. This is a clue to ask some more questions and see if there are other pieces that can help tell us what might be happening. We want to know more about feeding behaviour, mood, output. 

Often what I hear is that there is no way baby needs to eat more. They are happy, content, sleep well, don’t really fuss. The opinion is that there is no way it is possible the baby isn't eating enough. People expect a hungry baby to cry, be irritable, to unsettled. I am going to say this is simply not true. I am sometimes more concerned about that “good baby” that sleeps well and always content. A very misunderstood piece of infant wellbeing is that weight gain influences appetite. What I mean by that, is that if a baby is gaining well, they demand to fed and show signs of being hungry regularly with easily identified feeding cues. What we think is a content baby because they have a calm mood, could be a baby who is content but not getting quite enough intake. A baby that is lower weight than expected, will have a lower appetite and will in fact cue less to be feed, will have subtle cues, likely won’t have a late hunger cueing & overall may make little fuss about it. If mother offers they will feed, but commonly have short feeding sessions. When they are being feed, their appetite is low so they do not do an efficient job, leading to milk being left in the breast and the body slowing down production. I give the example that if they are getting 70% of their intake requirement, they will eat at 70% efficiency (this will very baby to baby).  This over time can cause a low supply, which influences their feeding because babies like flow...so low flow, means less interest in feeding and the cycle continues. 

If none of that concern is explained to a family, they leave these routine visits confused and bewildered as to why some one had a concern or what they could/should do about it and have no idea why it happened in the first place. There are lots of factors to consider to understand why this is happening & what the appropriate action for each case should be. 

If you are experiencing a difficult feeding situation where weight gain is a concern, booking a consult with an IBCLC is advisable. With a good assessment by an IBCLC, the root cause can often be determined and a solid plan can be put into place to get the baby fed, get weight gain concerns addressed, increase milk supply, maintain breastfeeding, etc. 

Other things to note in cases of lower than expected weight gain could be: 

• baby sucking fingers after feeds 
• ongoing jaundice 
• green stools 
• edema
• dry skin, cradle cap, eczema 
• less active baby
• longer napping sessions 
• baby only sleeps when being held