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.

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.

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.

How often will my baby feed?

As you may or may not know, I volunteer as a breastfeeding Peer Supporter at my local hospital and local breastfeeding support groups.  I find that when I visit the hospital on any particular week I often get asked the same question or end up helping each mum with the same task.  One week I might help 3 new mums with latch, the next week I might help 2 mums put a pump together and pump for their special care baby.  Last week I was asked by numerous mums about how often and how long babies should feed.  It's especialy true for first time parents and also parents that have never breastfed a baby before or stopped pretty quickly the last time around.  Actually, if the parents stopped breastfeeding pretty early on with a sibling then I usually ask them when they stopped breastfeeding and find a similar response (2 weeks or 6 weeks typically).

It does concern me that I am asking these questions after the baby is born because a lot of parents attend antenatal classes that talk about breastfeeding.  I know that when I taught breastfeeding classes we covered normal newborn behaviours which included frequency of feedings.  Is it possible that all these parents are missing the breastfeeding class?  Is it that many of these parents cannot afford to attend expensive antenatal classes and instead attend free classes that skirt around the feeding issues because they are too scared to upset anyone?  I did not attend a paid breastfeeding class before the birth of my second, I instead attended a free antenatal class locally so that I could learn how things are done in the UK.  I will say that the breastfeeding session was appalling.  It was advertised as a breastfeeding session so I don't really understand why no real breastfeeding advice was given.  If any of the soon to be parents had already made a decision not to breastfeed then surely they would have stayed at home.  The only piece of advice that was given to us during the session was "Go out and buy a carton of ready to use formula so that when you have problems and the shops are shut you'll be OK".  I guess the midwife hadn't read about the studies that show that when you have formula in the house you are more likely to stop breastfeeding and introduce formula earlier.

I heard yesterday that the NHS has been cutting spending on breastfeeding support and in the areas where spending has already been cut breastfeeding rates have suffered.  When are the people in charge going to realise that the more they spend on preventative measures, the more they will save down the line on hospital visits, obesity, cancer etc.  It's basic mathematics, even the US understands that the more they spend on improving the health of low income families, the more money that can be saved in healthcare costs in the future because babies are born healthier and stay healthier after a better beginning.

"Every dollar spent on prenatal WIC participation for low-income Medicaid women in 5 States resulted in savings in health care costs from $1.77 to $3.13 within the first 60 days after birth".

See references here

I digress!

What are some answers to the questions I am asked frequently?

How often should my baby feed?

Since my son started latching well at about 4-6 weeks after his birth in early 2008 I have never watched a clock.  I feed whenever I am asked.  Babies are amazing.  They are able to communicate with you as soon as they are born.  There are tonnes of little feeding cues that they use to tell you they are hungry.  If you catch these cues early on you'll find your home a little calmer.  When William wasn't latching well and I had sore nipples I would watch the clock and only feed every 3 hours because I wasn't enjoying the feeding.  Once I was able to feed without pain and I wasn't watching the clock because feeding was now an enjoyable, pain-free act William didn't have to cry so much to get attention (food).  Babies don't cry for fun, they cry because they need something, so being able to satisfy that need as soon as possible, or even before the crying starts will reduce the stress in the household.  If feeding doesn't stop the crying then you know it must be something else (sleepy, dirty, bored, overstimulated).  A typical baby will ask for a feed about 8-12 times in a 24 hour period of time.  They may not be regularly spaced out over the day, and they may be clustered together especially in the evening.  This is why it's so important to sleep when the baby sleeps (don't do laundry!).  This is just a guide, an average.  I'm sure there are many babies out there that feed more than 12 times a day and also some that feed 7 times a day.  Watch your baby.  If your baby is healthy, born at term, is pooing and peeing and gaining weight (regained birth weight by two weeks), then follow their lead.

How long should a feed last?

Gosh, a really hard one.  You're going to hear so many different answers to this question from friends and healthcare providers.  Every baby is different, and every meal is different.  Again, I am going to remind you to watch your baby.  If your baby is healthy, born at term, is pooing and peeing and gaining wieght (regained birth weight by 2 weeks), then follow their lead.  I always advise new mums to start out by offering both breast per feed so that after a few weeks it can then be the baby's decision to have both or one per feed and your body has been primed to produce a fabulous supply of milk either way.  Baby will let you know when they are done, they will come off of their own accord or fall asleep.  In the first few weeks, if there is a concern about weight gain then you can burp or nappy change and then offer the second breast.  My son never said no, my daughter would only feed when she wanted to.  As to timings.  Some babies just feed for ages, and others are done in a few minutes.  If baby hasn't fed for a few hours and falls asleep almost immediately at the breast then you may want to consider waking baby up, some breast compressions might also entice baby to feed for longer, but as I mentioned previously watch your baby and compare their feeds to your own.  You probably eat or drink something numerous times a day but each time you eat you don't eat the same amount.  You may have just a cup of tea and a biccie, you may have a large evening meal, or a chocolate passed around in the office.  The baby will feed in a similar fashion and may not always take the same amount each time.  It's the average over the entire day and then week that counts, and then the weight gain seen over the same period.  Look for an average weight gain in the early months of 3.5-7oz per week.  You will definitely learn new puzzle solving skills being a new parent, and to look at the whole picture instead of focusing on just one thing, so look at the baby as a whole.

Ellie at her first wedding at only 5 weeks old - she slept through the entire service in her sling and only woke up in time for the toast!

What answers would you give to these questions from your own personal experiences?

How many nursing bras should I buy?

I am often asked the question "How many nursing bras do I need?" and so I thought I'd try to write down my thoughts about this question.  There is no right or wrong answer because every situation is different, but here are some things to consider before you make a decision.

The most common response to this question is 3.  One to wear, one in the wash and one in the drawer.  However, this does not take into consideration your financial status, the time of pregnancy or breastfeeding or whether you have a washing machine in the house.  I’ll try to keep this short as I could talk about it all day and your time is precious.

Here are some things to consider - 

·         How long do you want the bras to last?

·         Do you have large Breasts?

·         How often do you want to wash them?

·         At what stage of pregnancy or breastfeeding are you?

·         What do you want to wear with them?

Timing

For many women the first signs of pregnancy are all about the boobs.  They can become tender and start to grow very early on in pregnancy.  I remember that my cup size increased almost immediately and then they became really tender which meant that I needed new bras and I also needed bras that were comfortable to sleep in so that they didn't move around too much at night which was really uncomfortable.  It's because of the increases in breast tissue and thus cup size throughout pregnancy that wires are not recommended.  If you are willing to check the fit and purchase new bras frequently then you can wear them with confidence, this can be a very expensive route, but completely do-able if you can't live without your wire.  A more flexible wire would be a better option (available from many maternity lingerie manufacturers).  Of course you may not change in size very much or very early so take each day as it comes.

Milk volume increases are usually the largest 3-5 days after birth and your volume should settle at about 2-6 weeks.  Your breasts will still fluctuate a little or a lot between feeds and when you sleep for a while.  Some women don’t ever leak milk, and others leak a lot.  I stopped leaking at about a year.  Transitional bras will be the most comfortable bras during the first few weeks, but sized bras will give more support for a larger cup size and can be a lot more feminine and pretty.

Money Saving Tips - 

To save money during pregnancy avoid buying maternity bras that are sized and are not nursing bras.  A maternity bra is only useful during pregnancy.  A nursing bra can be worn during pregnancy and can then be used for easy access when breastfeeding, so you'll get a lot more use out of it.  If you have a larger cup and enjoy the support from a sized bra then think logically to get the most value for money from them.  The earlier you buy your bras in pregnancy the longer you will get to use them.  If buying in the first few months then make sure you choose a bra with lots of hooks and eyes on the band and buy the bra that fits well on the tightest setting.  This will allow you to loosen the band as the baby pushes up into the ribcage, and if you are able to buy a bra with room in the top of the cup without losing too much support or it being too baggy then you'll have room to grow in the cup department too.  (You may find that during the first few weeks after birth the bra will be a little tight in the cup, but you may still be able to get to wear the bra again once your milk volume settles and if not then, when you introduce solids).

A transitional bra is one that can accommodate small changes in cup size and can last throughout pregnancy and breastfeeding.  I can in fact reveal that I am currently (at this exact moment) wearing one such bra that I have owned for over 4 years through two pregnancies and extended breastfeeding.  Buying a good transitional bra can be worth its weight in gold!

Durability

As you can read above, my nursing bras have gone through the ringers.  They have been washed, dried, been soaked in milk, covered in all kinds of other bodily fluids, probably a bit of mud and play dough thrown in for good measure.  I started wearing nursing bras when I was pregnant with my first.  I ignored the advice to only buy a nursing bra at the end of my pregnancy because I knew that I would be breastfeeding, and any soft cup bras I purchased during my pregnancy would be useless after birth if they couldn't be used for nursing.  They would also be useless after I finished nursing (didn't happen!) because the cup would probably have been a little big.  I love, love, love to save money and this seemed like a no-brainer to me.  I purchased a few transitional nursing bras and wore them throughout my pregnancy.  They lasted about 6 months, and I was horrified, they fell apart before my eyes.  I was told that they were designed to last only 6 months.  Thing was that I owned only a few bras and washed them more regularly than my usual bras.  In fact I was washing them 3 times as often which would mean that they would wear out three times faster.  

Money Saving Tips –

I think you really do get what you pay for when you are buying nursing bras.  If your goal is to nurse until natural weaning age and possibly go into another pregnancy and dabble in a bit of tandem nursing then you want something that is going to last a long time and withstand a lot of wear and tear.  Think of it as more of an investment, and don’t forget that you can add to your collection at any time.  Spend money on some good transitional bras that will accommodate those changes in size and then add a few good quality sized bras for special occasions and for wearing low cut tops and dresses.  If, on the other hand you have a small budget and you want to breastfeed but you’re unsure of how long you want to breastfeed for or you’re concerned that it won’t work because some of your friends weren’t able to continue breastfeeding, then you can spend a relatively small amount of money and not feel that it has been wasted.  Of course if you do have any difficulties breastfeeding go along to your local support group for help and support.  Sometimes the prices can seem a little high, especially if your goal for breastfeeding is a short one.  A value nursing bra can give you the comfort and easy access that you need without breaking the bank.  If you decide to continue breastfeeding for longer, you can buy more then.

Size Matters

You probably already know this, but support is really important, and is even more important for those larger busted ladies.  As with durability, you really do get what you pay for when it comes to breast support.  You can find transitional bras that can provide some support up to an H cup, and you might feel OK at home lounging or in bed, but you’ll probably want to go for a sized bra for leaving the house in once your milk volume settles down.

Clothing - 

Give this some thought.  You want to buy nursing bras that will wear well with your wardrobe, otherwise you’ll never wear them.  If it’s a special occasion take the dress with you when you buy your bras.  I always tell my in-home fitting clients to try on a T-shirt or their special outfit with the bras to make sure they are happy with the overall look.  If you wear white tops all the time don’t buy lots of black nursing bras and vice versa.  If you need skinny straps then find a nursing bra with skinny straps too.  There are many different styles in many different colours, so hold out for the bra you really need.

Money Saving Tips –

Consider buying some nursing vests.  They can provide some support without the need to wear a nursing bra as well and they can be worn on their own, in bed or under a cardigan or loose top to cover the tummy when feeding.  They can take the place of a nursing bra and act as another bra in your wardrobe.  Some vests provide more support than others, and they come in various shapes and colours for all occasions.  If you choose a longer length nursing vest during pregnancy it will cover your bump and then after delivery will look great with leggings and jeans.

So, maybe you are more confused than ever, but remember that you can add to your collection at any time.

1.       What is your budget?

2.       Look at your size and realistically think about the best type/style of bra for your size.

3.       What stage of pregnancy or breastfeeding are you in, what bra would best suit this time in your life and last the longest with your changing needs.

4.       How often do you want to wash your bras and how long will they last.  Remember that the more you have the less you will need to wash them and the longer they will last.

5.       Make sure that you get the style and colour that will work well with your wardrobe so that you don’t end up hiding them in the back of the drawer never to be worn again.

6.       You can always ask me for help with breastfeeding and with bra suggestions.  If I can’t help I can surely find someone who can.

If you would like to see some examples of transitional nursing bras, nursing vests or nursing bras for larger sizes check out these links from BoobieMilk.

So as you can see, three may be the right number for you, but it might be the wrong number for someone else.  Share with me below what your thought are or what you have been told and how that worked out for you.  Also, share with me how long your nursing bras have lasted and what they have been through I'd love to hear from you.


Snugglebundl were excited to send their blanket out to the Keep Britain Breastfeeding Scavenger Hunt Grand Prize winner but also sad that there was only one winner.  They have asked me to share with you a special coupon code so that you can save when you purchase a brand new Snugglebundl blanket with handles for easily tranferring baby from cot to buggy to car seat while still sleeping.  Please use code snug15 here.

Day 30 Final Day of the Hunt

The final day of the Scavenger Hunt is upon us and you have but a few hours to enter to be in with the chance of winning the Grand Prize, so read as many posts as you can and don't forget to enter all the rafflecopters.  Stay tuned over the next few weeks to find out if you have won any of the competitions.  All winners will be posted on this website and all winners will be emailed too.

Day 30

Attachment Mummy - The Importance of Support in Successful Breastfeeding

Smilernpb - Breastfeeding in the Small Hours

Attachment Mummy - The Early Days of Breastfeeding, A Husbands View & a Theraline Original Pillow Competition

Where Roots and Wings Entwine - Our Breastfeeding Experience

Life Happens So Smile - Gymnurstics

Day 28 and Day 29

Here are some more amazing posts from the Keep Britain Breastfeeding Scavenger Hunt Day 28 and Day 29.  We have a guest post from Downs Side Up, a Mum who is sharing her experiences nursing a baby with Downs Syndrome.

Don't forget that many of the competitions end Saturday night so take a few minutes to read a few more and enter the rafflecopters appropriately.  I will post again today the competition list so that you can take full advantage of all the additional competitions and prizes up for grabs.

Day 28

Mummys Little Peeps - Breastfeeding Beyond the First Month

Circus Queen - Breastfeeding Beyond 1 in not "just" for Mum

Day 29

Life Happens so Smile - Supporting a Breastfeeding Mum


Mixed Bag of All Sorts  - Small Steps Add Up To A Long Breastfeeding Journey

Little Scribbles - As long as we are all happy

Attachment Mummy - Training to be a Breastfeeding Counselor

Downs Side Up - Breastfeeding Against the Odds