Wednesday 29 August 2012

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"

Each Infant T-shirt is available to purchase for only £12 and are made from 100% organic cotton in sizes 3-18 months from BoobieMIlk.

Tuesday 21 August 2012

To Burp Or Not To Burp?

I hear some interesting things at support groups, but this is one that I thought a little funny until I heard if for the fifth time.  Honestly, there is someone telling new mums in my area that breastfed babies NEVER burp.  Maybe you have heard this too?  It's quite interesting to think that advice is being given as if all things "baby" are that black and white.  I, for instance don't burp very often, but I would be lieing if I said I never burp.  When looking at anything baby I think you have to apply the bell urve rule.  Just like the growth charts for weight, height and length, each baby has their place on the curve.  The majority of babies will sit somehwre near the middle of the curve, but there are still plenty of babies that are outliers.  It's not a competition, you don't win a prize for having the most burpy baby of the longest.  The charts are just a guide that shows you the vast range that exists if you randomly line up 100 babies born on the same day.

I'll share my personal experiences with you - William would probably fall into the 1st percentile on the chart for burping (if one existed).  You could probably count the number of times he burped as a baby on one hand.  He started nursery when he was a little over three months old and received expressed breastmilk in a bottle.  He was the only breastfed baby in his class when he started and as you can imagine not all of the carers had a lot of experience with breastmilk fed babies.

I visited William every day for lunch and would call ahead to make sure that he wasn't given a bottle right before I arrived.  At the end of his first week at nursery I arrived to find a really frustrated carer trying to burp William.  SHe told me she had been trying for some time and just couldn't get him to burp.  It had obviously never even occurred to her to stop.  By the time William turned 12 months they decided to stop trying, but you can tell that the idea of a baby not burping was alien to them and so unbelievable that they kept trying.

Ellie is my second cutie and when she arrived I could have assumed that she would be the same as William in every respect, but I had worked with many families and seen how different babies are.  Ellie wouldn't win any prizes for her burping efforts, but she did get fussy and refused to eat if she needed to burp.

The lesson in all of this - You cannot assume ANYTHING with babies, you just have to spend time getting to know your baby so that you can do what works for them.

I don't sell burp cloths or even any devices for patting babies on the back (don't exist I hope), but I do sell adorable breastfeeding slogan t-shirts for newborns - 18 month olds from the wonderful Lactivist that will put a smile on your face and also catch some of the spit-up.

Friday 17 August 2012

One Breast or Two?

Another common question asked by new mums in the early days.  I hear stories of women being told that they HAVE to use one breast only per feed or that they ALWAYS need to use both breasts per feed, often with a minimum or maximum time limit attached to it.

I thought I'd give you my take on the matter and then you can look at your situation to make a decision, or better yet look at your baby to be guided in this decision.  As always I am talking about healthy, term babies who are peeing and pooping and feeding well.

Your baby knows how hungry they are and will ask to be fed.  Over the first few weeks you will learn to read your baby's cues so that you know when they are hungry, tired or need a nappy change.  I find feeding on demand a much more relaxing way to feed as you don't find yourself watching the clock and you can get on with your day until baby lets you know he'she is hungry.

In the first few weeks while you are getting to know your baby, your body is establishing your milk supply and putting down the foundations for your whole breastfeeding journey together.  As with many things, a good foundation is vital for success.  The body will do as you ask, so if you tell your body that you have twins by feeding twice as much then your body will respond by making enough milk to feed two babies..

To get breastfeeding off to the best start possible you need that good foundation.  Once you have established a good supply you then have the freedom to choose any direction you want to take.  You can breastfeed exclusively for as long as desired, you can return to work and pump to maintain your supply and you can also choose to stop on your own terms and not before you reach your goals.  You can always deceases your supply, but it can be more challenging to increase your supply if you never established a good supply in the beginning.

Establishing a good supply in those first few weeks is vital, and so I always encourage new mums to start out strong so that they have a choice in the future.  You don't know what kind of a supply you will have or what your body will do.  One breast may produce more than the other, one may have a faster flow than the other.  You may even have an over supply of milk, but if you start out strong then you can always slow down later.

Let baby finish at the first breast, this means allowing the baby to decide when they are finished and they usually come away all by themselves.  I say finish, but the breasts are never empty and milk production goes on throughout the feed and beyond.  Once the baby has finished with one breast take this natural break as a chance to change a nappy or do some burping (post about burping to come soon).  After a short break offer the second breast.  Think of the second breast as dessert, you don't always have room for dessert but it is nice to have the option.  The few minutes break allow baby to let his/her body to react to the intake and make sure that hunger or full signals have a chance to be heard.  Some babies will always take the second breast breast, some will never take a second breast, and some babies will take it sometimes.  Because we don't know what they will do every time it's nice to give the baby the option and the added breast stimulation is great for milk supply.  My son took both breasts for the first few weeks of life until we noticed that he had started spitting up after every feed for a few days.  Before jumping to a reflux conclusion we thought that maybe he was eating too much and the excess was just coming back up with there being no more room in his tummy.  We offered one breast per feed to see if there would be a difference.  The spitting up stopped and the next time he asked for the second breast at a feed was when he could ask with words and found it amusing to say "other one?".

If your baby is not able to establish a milk supply due to illness or latch issues, a hospital grade pump is the next best thing (after a nursing toddler of course).

Had a baby recently?  Take a few weeks, take the weight off your feet, sit in front of the tv or grab a good book and feed, feed, feed!

Once your supply is set on good foundations you can stop offering the second breast if it is usually refused.  Let your baby and NOT a well-meaning health professional tell you what they need (as long as baby is healthy, peeing, pooping and gaining weight).

Did you receive advise about how many boobs to use per feed or have you had to change your routine for any reason.  Tell me all about it?

The first few weeks of breastfeeding can be challenging on your nursing bras.  Choose a nursing bra that can accommodate small changes in cup size so that you feel comfortable at all times.  Make sure it is comfortable on the loosest setting so that you have room to tighten with wear and weight loss.  Here is a selection of these nursing bras that work perfectly for this reason.