It seems to me that there is a lot we don't know about weight gain in 
babies, especially breastfed ones. My concern is that, with the mothers I 
see anyway, as soon as the baby is at all slower than average in weight 
gain, the pressure to supplement, almost always with formula, gets very 
intense.

I'm not at all suggesting we should let babies starve or go hungry. But I 
think we should look at the baby! My slow-gaining daughter was happy, 
bright, active, developmentally a bit ahead of the average. She looked well. 
I wouldn't even have described her as looking lean, like some of the babies 
I've seen, as she had round chipmunk cheeks and rounded arms and legs. I 
would describe her as petite. I would describe the baby of the mother I 
worked with last year in similar terms - the one who continued to gain 
slowly on formula.

I think that slower than average weight gain should mean "let's look at this 
baby closely, and see if the baby is unhappy or showing signs of discomfort, 
etc." It's a marker for possible problems. This could mean the baby is 
hungry because he's not getting enough milk for whatever reason, or he's 
deliberately taking less milk because of discomfort or other problems, or 
that he has some kind of illness or problem that is preventing him from 
using the milk he's getting. But if the baby is otherwise doing well, then I 
think we need to accept slow gaining as a normal pattern for some babies.

But what I see more often in my community is that if a baby is gaining 
slowly, the FIRST recommendation is to supplement with formula; if that 
doesn't work, plan B is to wean completely and go to formula (on the theory 
that the mother's milk must be "no good" and the baby is filling up on it 
and not taking enough formula). Only if the baby continues to gain slowly on 
formula does someone look at the bigger picture and begin to consider other 
possibilities.

Teresa Pitman 

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