Hello Jen-
You write "if you are seeing babies gaining just five ounces a week in the early weeks there is a problem". I respectfully disagree. "Average weight gain for the first three to four months is about six ounces per week, though it is considered acceptable for some babies to gain four or five ounces per week." (The Breastfeeding Answer Book, 3rd ed.) One needs to look at the whole picture-is the baby happy, alert and interactive, feeding at least 8x/24hrs, has a normal developmental and physical exam and is stooling and voiding well? If they are, then 4 oz/week is fine (although it would be appropriate to review breastfeeding practices/management at that point, the mother should not be made to feel that there is a problem). As the Core Curriculum for Lactation Consultant Practice (2nd ed.) notes in defining slow weight gain, "When infants and children gain weight consistently, although slowly; this condition is usually familial or genetic." Giving a mother the impression that her baby needs to gain 7 oz/week or she is not breastfeeding correctly is not only misleading, but demoralizing to the mother, and may lead to inappropriate supplementation or weaning entirely. "A baby's weight gain can affect a mother's feelings about herself and her ability to care for her baby. A mother with a slow-weight-gain baby may feel anxious about her baby's health. She may fell guilty, believing that her baby's slow weight gain means she has not given him the proper care." (The Breastfeeding Answer Book, 3rd ed.)
I wholeheartedly agree with you to advise a mom that 8x/day is the MINIMUM, and if a baby is not thriving (which by all definitions does not include a baby gaining "only" 5 oz/week) to tell mom that she really needs to ratchet up her supply and the best way to do this is with frequency.
As for perspective, you are right. As a pediatric nurse practitioner in the same practice for nearly 10 years, I have watched children grow from a breastfeeding infant, to an active toddler, to a precocious preschooler, to a shy pre-teen. I am very comfortable in saying that an exclusively breastfeeding infant who gains 5 oz/week not only just survives, but thrives.
I think LLL "The Breastfeeding Answer Book" sums it up best: "Make sure the mother understands that breastfeeding is not a by-the-book procedure; it is an intimate relationship with different dynamics from one nursing couple to the next." "Although there are general breastfeeding principles with which it is good to be familiar (for example, in most cases, the more often the baby nurses, the more milk there will be), there are no hard-and-fast rules."
Best Regards-
Stacy D. Kucharczk MSN, RN, CPNP, IBCLC
BestFeeding Lactation Services, LLC
Virginia Beach, Virginia
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