The discussion on normal weight gain in newborns is so interesting, in
particular Heather's comment that a gain of 3 - 3 1/2 oz (90 - 100g) per
week in the first weeks would be normal *for that baby*, and the studies
Barbara cites, and the case-history she describes, illustrating "failure to
feed robustly" as a symptom.

One of the paediatricians who often sends me low-gain or FTT babies in the
early weeks has discovered (and frequently mentioned) in the last couple of
years,  that when his breastfed babies are doing *well*, they have often
gained 1500g - 2000g (3.3 lb - 4.4 lb), or even more, by the time they go
for the 6-week check-up.  This is so consistent that he wonders if the
"normal" expectation, that a thriving baby will gain approx 200g per week,
should not be revised upwards.  In practice, I have to agree.

What I expect nowadays is that a weight loss of 5% - 10% is normal by the
3rd day of life (although I agree that a loss > 7% should alert us to a
possible problem), but after this the baby should be gaining *at least* 30g
(1 oz) per day.  If this is not happening I start looking for causes (often
retained placental fragments, as Barbara describes) or the mom is feeding
the undemanding baby "on demand" and simply assuming that she has a "good"
baby, or *something* is happening.  If you look hard enough there is always
a *reason* for lower gain.

Furthermore, I am beginning to suspect that it is vital to identify low gain
early enough to maximize breastmilk production in the first 3 - 4 weeks,
and/or to prevent the breastmilk supply being compromised.  In fact, I'm
becoming really suspicious that there is a 3 - 4 day "window" period (from
about Day 4 - about Day 7 post partum) during which the switches (?prolactin
receptors, maybe?) for future lactation can be turned on and maximized - or
they can be turned right down.  It seems that if - for whatever reason
(delayed Lactogenesis II, a latching difficulty, a jaundiced baby, a small
baby, mom delaying feeds or using a dummy, many, many "reasons") the baby
doesn't "get enough" during this time, then his condition can quickly
deteriorate to the point that he becomes less and less efficient at
breastfeeding, and the breasts (by remaining overfull) also shut down
production.

Sometimes it's very hard, in retrospect, to identify the original cause of
marginal weight gain in the early weeks.  It could have been the the result
of a mom problem, or a baby problem, and one can become another in domino
fashion. Often it *is* possible to reverse the situation, make suggestions
to enhance the baby's breastmilk intake, and watch the baby who was inching
along start to really grow and thrive.  But my conclusion also, as Barbara
also seems to suggest, is that the low-ish gain is not normal - it *is* a
problem.  I also see part of our function as LCs to provide good
anticipatory guideliines for *preventive* care, which need to be
individually tailored to each unique mom-baby pair, so that *this* mom can
be more aggressive in making sure that *her*  baby "gets enough" during that
very short window of opportunity. I'm also starting to see a connection
between low gain in the first few weeks and problems of "not enough milk"
round about the 4 month mark which could be traced back to this very short
window period.

Pamela Morrison IBCLC, Zimbabwe
mailto:[log in to unmask]

And I know that we shouldn't get totally hung up on numbers, but those
weights always tell a story if you look really closely.

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