Thank you so much to everyone for your replies on and off-list to my question. I did not include specifics about his particular infant because the mother and baby are now seeing a wonderful IBCLC in our area. The baby's weight gain at the 6 week visit (I do not remember the specifics right now) was just below what the ped "would like to see." Fortunately, this was not a case where the mother was about to give up on breastfeeding, and she sought help immediately from a very good LC in our area. This LC did keep the diaper on for the weight check to determine milk transfer.  

My post was related more to my confusion about the proper way to weigh an infant. My understanding now is that if the weight is to test milk transfer, the infant should remain in the same clothing and diaper before and after the feed, and that if it is just a weight check, a naked weight is ok.

I was also dismayed becasue the mother had been pumping to get her supply up and she had to ask the MD if it was ok to feed the EBM instead of formula after nursing. His first reccomendation was to feed formula as a suppliment, although he knew she was pumping and had milk on-hand. Shouldn't this be the first course of action if supplimentation is called for and there is EMB available?

Thanks again,
Kellie Whitney, LLLL

Date:    Fri, 13 Oct 2006 09:37:22 EDT
From:    Barbara Latterner <[log in to unmask]>
Subject: Infant Weight Gain Question

Kellie, you asked about infant weights at the pediatrician's office and use 
of diapers.  If a baby has "poor weight gain" it's important to know how many 
ounces shy of normal gain the baby is, based on the norm of 4-8 oz/week in the 
first several months.  That the baby stooled would impact weight by perhaps 
1-3 oz depending on the amount of stool (I've seen this when weighing during 
home visits).  One weight that shows inadequate gain, should be followed up with 
another weight check in several days, with investigation of infant's feeding 
pattern over 24 hr; how long are feeds, how often, amount of swallowing, use of 
both breasts or one, etc.  If it's in the early weeks, assessment of mom's 
milk supply, are her breasts full feeling before a feed and softer following, 
and so on, should also be done at time of visit.  If there is concern about 
infant feeding and or mom's supply, a timely referral to a lactation specialist 
who has time to observe a feed, do feeding weight as indicated, and provide 
intervention to improve weight gain should be done.  Not the unfortunate knee jerk 
reaction of starting infant on formula supplementation.You also didn't 
mention how old this infant is which would impact the seriousness of weight gain; a 
young infant of several weeks could be of more concern than a six month old 
whose weight gain has slowed down.  All this said, infants should be weighed 
naked or in a dry diaper with diaper weight subtracted; the same scale should be 
used for subsequent visits.  I've gone into so much detail because often 
newborns are just limping by with marginal gains due to a breastfeeding problem and 
when that problem is not addressed right away it becomes a bigger problem in 
a couple more weeks, and suddenly baby's not gaining at all or losing weight 
and mom's supply is low.  So rather than quibble about stool or no stool, 
looking at the whole picture of baby and mother is important and could prevent a 
downhill course.  

As for your question about feeding weights, a baby is weighed prior to 
feeding in whatever clothing or diaper he has on, and a post feed weight is taken 
immediately after feed in the exact same clothing and diaper, whether stooling 
occured or not.  So you are right about removing a soiled diaper for a feeding 
weight, it most certainly affects the outcome.



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