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Subject:
From:
Kathy Eng <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 24 Sep 2007 10:03:08 -0500
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Anne, some things I thought about after I closed my computer for the 
night regarding your question on a slow gain baby. I would want to know 
if these weights are with clothing or just a dry, fresh diaper (meaning 
disposable)? If these weights are with clothing, that would account for 
the oddness of the gains, why some weeks are high and some are low. 
Clothing throws the weight off or the baby weighs more one week with 
more clothing or a soaking wet diaper, etc.

If baby has been weighed in clothing, then you must get a new weight 
with just a dry, fresh disposable diaper (cloth diapers may weigh too 
much) and start over.

Now babies do not always gain steady but we like to see 6 ounces gain 
per week in the first 3-4 months. So, if baby was always weighed with 
just a fresh, dry diaper, I would recommend you look back at your 
listing and see what weeks baby was not gaining 6 ounces per week. The 
BAB says weight gain slows at month 3-4 so expect the weight to slow 
down about now. How many weeks does baby gain less than 6 ounces, and 
how many weeks does baby gain more than 6 ounces?  Do you see good 
weight gain in the early days and now tapering off in the last 4-6 
weeks, for example? Or the opposite?

Also, count up the weeks of age baby is currently and take off 2 weeks 
(to account for the first two weeks when we expect baby to be back at 
birth weight). Count up those weeks and multiply by 6 ounces. Add that 
weight to the birth weight. What weight do you get? Compare to 
actuality. Example if 4 weeks old, we want to see a gain of at least12 
ounces, that is 6 ounces times 2 weeks.

Knowing how to calculate weight gain or loss is vital for any IBCLC.

My other thought is that many 3 month old babies are sleeping longer at 
night. I would expect this to be fairly normal. I would also expect a 3 
month old to still be nursing about 8 times (or maybe a bit more) per 24 
hours. If baby is nursing less than 8 times, we often see poor weight 
gain and mom losing her supply. When baby sleeps all night, say 8 hours, 
then baby has to nurse more often in the day unless mom has a huge milk 
supply and baby has a huge tummy. I would expect a 3 month old baby to 
be removing about 3-4 ounces per nursing session, more or less. This 
amount times 8 is 24-32 ounces per 24 hour day. Some babies remove 
greater quantities of milk at each feeding, some mothers have smaller 
storage capacities, some greater, etc. A 3 month old that is truly 
nursing "all the time" meaning every hour all day long and waking 
several times in the night and who is not gaining weight properly needs 
assessment and intervention.

Kathy Eng, BSW, IBCLC

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