Many mothers who take their babies to the clinic or paediatrician for a regular checkups and vaccinations, do at some stage become worried about the fact that their baby wasn’t gaining weight quickly enough, even though the baby was well within the parameters for weight gain of breastfed babies. The problem is that many doctors and clinic sisters are not familiar with the normal weight gain patterns of breastfed babies, and rely too much upon growth charts that are based on the growth of formula fed babies. Until doctors are familiar with them, we need to keep ourselves informed so that our confidence isn’t challenged to exclusively breastfeed our babies.

Development of growth charts and how they work
Growth charts were originally developed in the States in 1977 to assess the growth of American children. These charts were later adopted by the World Health Organization for international use. The growth charts entail percentile curves that show the distribution of selected body measurements in babies and children. These growth charts were originally developed for formula fed infants. After the year 2000, mixed-fed (breastmilk and formula fed, as well as those who started solids before 6 months) infants were taken into consideration. After 2006, growth charts for exclusively breastfed babies were developed, though the older charts are most commonly used by paediatricians and clinic sisters in South Africa. Clinical charts are available for boys and for girls. The available clinical charts include the following:
1. Length-for-age and Weight-for-age
2. Head circumference-for-age and Weight-for-length

A growth chart isn’t a test. The growth charts show us the statistical distribution of weight, height , etc. in a particular set of babies, children or adults. And in South Africa, across many groups of people with different body types, lifestyles and nutrition – that is a varied amount of results, which is not necessarily taken into account when the growth charts are set. So if a baby is in the 50th percentile for weight on the charts, it means that half of the healthy babies of the same age are heavier and half are lighter; if a baby is in the 10th percentile for height, then 90% of babies of the same age are taller and 10% are shorter. Healthy babies, just like adults, can come in all shapes and sizes – a baby in the 3rd percentile can be thriving and normal as a baby in the 97th percentile. What doctors are generally looking for on a growth chart is that baby stay relatively consistent in their growth pattern. Growth charts are only one part of the puzzle, however, and must be evaluated along with other factors, including:

  • What size are baby’s parents? What were their growth patterns as babies? What about baby’s siblings or other family members? Genetics plays a large part in baby’s size, so don’t ignore it.
  • Is baby gaining consistently, even if it’s not on a curve?
  • Is baby meeting developmental milestones on or near target?
  • Is baby alert, happy, active?
  • Is baby showing other signs of adequate milk intake?

Other than feeding, what influences baby’s growth?
Gestational age is an important factor when looking at growth charts. Obviously, premature babies are lighter and smaller than babies who are born at term (38-42 weeks). But babies that are heavier at birth sometimes don’t gain weight at the same rate as babies of a lighter or average weight. This is because the weight of a baby when they are born relates more to the conditions in the uterus than their inherited genetics.
According to a large Portuguese study excessive neonatal weight loss during the first 96 hours of life was associated with higher maternal age and education, caesarean section and phototherapy treated jaundice. Though this study did not investigate how the timing of cord clamping affects birth weight or neonatal weight loss, it support the case for exclusive breastfeeding. It showed that feeding methods directly impact neonatal weight loss a, and colostrum and breastfeeding were identified as the most appropriate nourishment immediately after birth.
Other factors influencing growth in the first several months are: whether a baby is a boy or a girl (boys tend to grow more quickly than girls), genetics, their socio-economic environment, their overall health, whether parents smoke, nutrition and individual growth factors.

Normal growth for breastfed infants
Healthy, full-term, breastfed infants normally grow more rapidly than their formula-fed peers in the first 2-3 months of life and less rapidly from 3 to 12 months. Because many doctors are still using the old growth charts, they see the baby dropping in percentiles on the growth chart and often come to the incorrect conclusion that the baby is not growing adequately. At this point they often advise that the mother needlessly supplement with formula or solids, and sometimes recommend that they stop breastfeeding completely. Even if the mom realises that her baby is perfectly healthy and doesn’t follow these recommendations, she ends up worrying for no reason.

“In February 2012, the American Academy of Pediatrics, in their policy statement Breastfeeding and the Use of Human Milk, stated that “Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive.”

How else can I tell my baby is growing?

    • Growing into and out of their clothes as the weeks go by
    • Being alert, active, and mostly happy when they are awake.
    • Waking for feeds regularly, showing hunger signs and being satisfied after a feed for periods of time (this may be short or longer periods depending on how often your baby likes to feed – some eat in small snacks and some prefer to feed for longer periods after several hours)
    • Settling for naps and at night (again may be for short or longer periods depending on your baby)
    • Weeing and pooing regularly. They should have at least 6 wet nappies over a 24 hour period. Poos in young babies should be frequent, and mostly move to less frequent as they grow older but should be at least several times a day to once every few days
    • Reaching their developmental milestones. These also vary according to individual babies with a wide variation than normal
    • Average weight gain for the first 3 months is 180 grams per week, 3 months to 6 months is 120 grams per week and 6 months to 12 months 80 grams per week… Remember this might be more or less per week but will usually measure out overall. (Weighing your baby on the same scale, with the same amount of clothes on each time – naked is best – is the only way to get an accurate reading). Other aspects listed here are just as, if not more important as the weight gain itself.

How do I ensure my baby grows well?

  • Ensuring a good start to a breastfeeding relationship – establishing breastfeeding within the first hour after birth
  • Ensure baby has a good latch, ask for help if you need it
  • Baby should feed on demand, this means to have unlimited access to the breast during for at least the first year of life (remember solid food is fun for the first year)
  • For the first 6 months, give your baby no food or drinks other than breastmilk unless medically indicated
  • Practice co-sleeping, this can also mean baby sleeps in the same room as the mother in their own sleeping space, not always in the mother’s bed
  • Give no artificial teats or dummies to breastfeeding infants
  • Breastfeeding isn’t just about milk – it’s about the relationship between mother and child. Lots of touch, talking, eye contact etc. are wonderful for the overall development and health of your baby. If you are bottle feeding, always hold your baby close and feed them. Never prop the bottle and let them eat alone.
    – Find a breastfeeding support group: La Leche League meets up once a month in most areas, or find a friend who has breastfed her children

And mostly, trust your instincts. If you feel your baby is thriving, “bonny” and happy then continue what you’re doing. But if something is making you feel like you should get a second opinion, do that too.
Fonseca, MJ et al., 2014, ‘Determination of weight changes during the first 96 hours of life in full-term newborns’, Birth, vol. 41, issue 2, pp. 160-168