Breastfeeding in England: Baby Weight Gain Challenges

Baby weight gain discussions can become very heated. In recent days past the growth charts were not the best guide for breastfed babies having been created using growth data from middle American formula fed caucasion babies. I think even someone who doesn't have a scientific background could tell you that they wouldn't be the most accurate in the case of majority of babies.

"The WHO Multicentre Growth Reference Study (MGRS) was undertaken between 1997 and 2003 to generate new growth curves for assessing the growth and development of infants and young children around the world.
The MGRS collected primary growth data and related information from approximately 8500 children from widely different ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and the USA).
The new growth curves are expected to provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age and to establish the breastfed infant as the normative model for growth and development".

read more here

When comparing the American CDC growth charts and the WHO growth charts differences were found -

" Overall, the CDC charts reflect a heavier, and somewhat shorter, sample than the WHO sample. This results in lower rates of undernutrition (except during the first 6 mo of life) and higher rates of overweight and obesity when based on the WHO standards. Healthy breast-fed infants track along the WHO standard's weight-for-age mean Z-score while appearing to falter on the CDC chart from 2 mo onwards". taken from Comparison of the WHO Child Growth Standards and the CDC 2000 Growth Charts Mercedes de Onis, Cutberto Garza, Adelheid W. Onvango & Elaine Borghi J. Nutr. January 2007 vol. 137 no. 1 144-148

The resulting growth charts are now used for infant growth in the UK, USA and beyond.

Although the charts have been improved, you may still need to keep in mind that many health professionals were trained before the new growth charts were released. You may also want to keep in mind that these same health professionals may not see a huge number of exclusively breastfed babies. Only 3% of babies in the UK are still exclusively breastfed at 5 months old (UK National Statistics), so give them a little bit of a break for being shocked and for expsecting your baby to behave the same as a formula fed baby.

When looking at an infant for signs of good health the health professionals are probably going to be looking for the following -

Baby looks well, alert and happy
Baby has gained back birth weight by 2 weeks of age
Baby is peeing lots and pooping regularly (pooping can slow down after the first few weeks/months)
Baby is content after a feed
Baby is gaining about 1/2oz - 1oz per day in the first few months (3 1/2oz-7oz per week) I think I remember that an ounce is about 28-30g from home economics class at secondary school

These are just guides, all babies are different. Some will gain more and some will gain less. Some will gain more one week than another so weighing too often can put you on high alert. There should be an upward trend though, and after a few weights you should be able to see where on the growth chart your baby has decided to stick. A rough guide in the first year would be a doubling of birth weight by six months and a trebling of birth weight by twelve months.

You have to look at the baby as a whole. A quiet baby that never cries and sleeps a lot, although perfect in your eyes may be missing feeds and may in actual fact not be feeding well so you might not see lots of nappies and weight gain might be slow. If you or your health professional are at all concerned about weight gain sit down and have a frank discussion about it. Talk about all of these things and also talk about any expectations that either of you may have. If either you or your health professional are expecting a weight gain of 20oz in one week then there is bound to be disappointment.

You may see babies in your group of friends with very different growth patterns. There are no awards for having a baby in the 99th percentile for weight, it's not a competition. What you ARE looking for is for YOUR baby to find his or her own percentile. It may take a few weeks to find it, but once they do they usually settle into their curve and stick to it near enough. A sudden deviation from a childs usual curve can be an indication of something not being quite right.

An average feed for a breastfed baby is about 2.5-3oz (references can be viewed here), so you can see why a formula fed baby might gain weight faster. In nursery I was once chastised by a carer for only having 3-4oz in each bottle of expressed milk. The other infants in the class had 6-9oz in their bottles of formula and she assumed that I should do the same. In fact, I never needed to increase the amount above 4oz in the entire first year (he stopped having milk in a bottle at 12 months), and although I provided two additional 1oz bottles each day "just in case", they were never used but kept the carers happy.

William was born at 9lb and stayed in the 90th percentile. He gained weight quickly and easily (my daughter was in the 9th). I always knew that I was in the right when providing for William at nursery, and it was also obvious to me that my baby didn't need to eat something the same size as his arm at every feed (think about that for a minute!).

So, if you or anyone else has concerns about the weight gain of your little bundle of joy I ask you to do one thing -

Think Logically

and don't just reach for the formula.

If you are proud of the fact that you are doing an amazing job of breastfeeding your little cutie you may want to shout about it (in a quiet but obvious way) and Lactivist infant T-shirts with a witty breastfeeding slogan are a great way to do it. With slogans such as -

"I like milk from my mum, not just any old cow"

"Keep Britain Breastfeeding"

"I Love Mummy Milk"

"Care Instructions"