Hi Ya'll

We are told in books that the "average weight gain" should be 4- 8  
ounces a week...do those averages include all kinds of dyads...even  
ones with undiagnosed problems...wouldn't that bring the average down?

We are told some mothers have rapid and copious onset of lactogenesis  
and then down regulate, while others have slow onset and then up  
regulate...
in my humble opinion the second pattern means there is something  
getting in the way of the permissive state and when I see it happening  
I try to address it...

We are told in books that babies need 2-2.5 ounces per pound of body  
weight a day...
but for how long...exactly when does the baby's growth rate slow down  
and his efficiency of use of calories go up so that we should no  
longer expect that...

So I do use numbers but I am not a slave to them, but one can go to  
the opposite extreme and ignore them too much too...

When I see a baby who has gained 5 ounces a week  or under in the  
first two weeks
I almost always find something else going on like...

delayed onset or slow onset
poor milk transfer
or poor management...

Do I see exceptions?
Yep! But very rarely...

If I see a mom where this has happened in the first two weeks I look  
very very hard before I decide the baby is small due to genes...

When nothing has prevented the mother from entering the permissive  
state right after birth and the latch is good and the management is  
good babies will gain above average the first two weeks because when  
there is nothing getting in the way of mothers entering the permissive  
state they will have an oversupply at first and then down  
regulate...and then after mom has down regulated I don't have the  
expectation that under 7 ounces a week means there is a problem...

Just recently I had a mom come to me after 6 months of undiagnosed  
milk supply problems. The baby wasn't fussy so the doctor told mom not  
to worry the baby was just genetically small...

When the baby was finally below the 5th percentile he referred her to  
me. I spent the day with mom and baby. The baby had a pacifier in her  
mouth all day.
I sent the mom home with a milk intake scale. Mom had a way low supply.

Another mother was referred to me with a slow gaining baby. Spent the  
day with mom and baby. Mom wore the baby and nursed a lot.
Baby spit up a lot, not a lot of volume at any one time, just a little  
but pretty frequently.

  The spit up didn't look like a lot to me and I would have thought  
nothing of it if the baby had been fat but I had nothing else to go on.
So I spent the following day doing milk intake assessments with every  
feed and post spit-up weights to account for the loss.
Baby was a slow gainer from reflux.

Now I know to look for silent reflux in the slow gaining baby. I was  
lucky I could see that baby spit up. Sometimes you can't see it.
Some babies with silent reflux go to breast frequently but don't suck  
vigorously enough and underfeed as a coping mechanism for their reflux.

These are only my opinions so I will look forward to reading everybody  
else's responses but let them have the last word on weight gain!

Jen O'Quinn IBCLC

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