Saturday, June 11, 2011

Normal Growth and Development for the Breastfed Infant

As I discuss the "normal" growth and development I have to remind everyone that every child and circumstance must be independently evaluated and guidelines are just that...guides, not concrete walls that determine absolutes...

Although there are facts and figures along with possible complications and interventions that are specifically related to a preemie, I am not going to address the preterm or near-term infant at this time.  This post will relate to full-term, healthy, breastfed infants.

I have to say one of my pet peeves is the CDC Growth Charts, their development and how they have become the final authority on growth for so many medical professionals.  In fact, many doctors use the charts to provide "scripted counsel" and inevitably recommend or require a baby be supplemented with formula. I am curious to know how many doctors or other professionals actually consider how the Growth Charts were developed and the margin of error that accompanies this type of data comparison.  The empirical data (data charted by experience or observation) and "convenient" smooth pattern created from the charted data vary extensively.

To paraphrase how the research was conducted, babies were measured at different increments and the empirical data was charted. Next, babies (not necessarily the same babies) were charted at different ages, points began forming a pattern, and that pattern clearly signified that over time, babies gain weight (not a difficult hypothesis to have to prove).  The problem I have with the charts is the smooth pattern that the researchers defined based on the empirical data...the points do NOT fall symmetrically on the curve, but vary greatly.  Knowing this, a doctor may inform a parent that their child is below weight, but when looking at the original data, the subject used to create the chart may not have fallen on the smooth curve either!

I really cannot do the report justice, but I implore everyone who works with infants and children to become familiar with the CDC Growth Charts Methods of Development.  It is astonishing to know how many people believe these weights and measurements are absolutes and not guides.

One step that I applaud is the transfer of confidence in the CDC Growth Chart to the WHO Growth Charts.  At least this data compares breastfed infants' growth patterns and establishes the child being breastfed as the baseline for a "normal" growth pattern.  WHO Growth Charts should be available for a base comparison, but more importantly, like previously mentioned, individual history and observation is more important.

Recently, I spoke to a mom that was experiencing regular "check-ups" for her breastfed infant because he was considered to be at "high risk."  The mom felt that her breastmilk was not adequate since the pediatrician questioned her son's weight gain and insisted on regular monitoring.  My frustration was compounded by the mom's emotional state.  She felt inadequate, scared, vulnerable, guilty--all emotions I try to alleviate in parents.

I asked her some basic questions.  Was your infant born early?  How much did he weigh at birth? How is breastfeeding going?  How many wet/soiled diapers in 24 hours?  How much did his dad weigh?  Describe his dad's stature.  How much weight has he gained?...etc.  The answers I received verified my hypothesis...the doctor had not taken a and mom were both small in was gaining weight regularly, having plenty of output and was reaching milestones.  I also observed a feed and milk transfer.   

After counseling the parents and suggesting they speak to their pediatrician about their concerns and requesting "medical reasons why the baby needs supplementation" I was assured that the mom had been empowered and restored to her confident self.

Although no child has the same growth pattern, healthy babies do gain weight and grow.  I do not want to give the impression that failure to gain weight or thrive is in any way acceptable.  Monitoring the slow weight gain is also crucial.  Follow up is mandatory.

What patterns are common in most infants?  Here I will be brief, since these facts and figures can be memorized and retained for future use.  Newborns often loose weight after delivery.  I don't like the phrase "7-10% is acceptable"  it may or may not the baby gaining weight now?  Is the baby alert and responsive?  We must be careful to not make blanket statements.  Babies do typically lose weight due to many circumstances following delivery...did the baby have a bowel movement?  Were meds and fluids administered during labor?  Has baby eaten?  Was the baby weighed on the same scale under the same circumstances...these scenarios allow for variation in weight.  We must remember that  babies are born "full".  they have a direct line to the all-you-can-eat buffet.  They are born with extra fat stores to help them during the transition from colostrum to mature milk, and allowing them time to stimulate the breast and cause Lactogenesis II to occur.  Babies are not born starving and in need of an immediate meal.  So, with that being said, panic should not set in when an infant displays some initial weight loss.

I created a reference chart for the common 10% weight loss and kilogram conversion from pounds.  Feel free to download a reference copy from my website under "Resources".

Other noted patterns of the breastfed infant include:

  • Babies regain their birth weight by 10-14 days
  • Birth to 1 month weight gain is .5 to 1 oz. per day
  • 2-6 month weight gain is 3-5 oz. per week
  • Birth weight typically doubles by 4-6 months and triples by a year
  • Head circumference increases by 3 inches in a year
  • Birth to 6 mo. infants gain about 1 in. each month
  • 6-12 months infants gain 1/2 inch each month
  • Infant's length increases by 50% at 1 year
Remember each baby is unique and should not be compared to other babies...the best comparison is made between the same baby the previous time you observed him.

Also, if you are sitting for the exam this year, dedicate some personal time studying age groups and milestones in regard to child development.  My students were surprised at how many of the IBLCE questions related to age group and photo recognition based on "typical" growth in the newborn.

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