Around midnight on a chilly November night, Lucy’s water broke. She woke up her husband and urged him to get up so that they could head to the hospital. Lucy was 38 weeks and 5 days pregnant with her first child. She worked as a floor nurse in the mother baby unit at the local hospital. Her day has been particularly busy and she felt pretty terrible when she laid her head on the pillow around 10 pm that night. The gush of fluid woke her up and sent her into a sort of panic. She knew that she needed to get to the hospital for antibiotics because she was group b strep positive. As a nurse she knew too much.
Fast forward to first hours postpartum. After a really long labor, prolonged rupture of membranes and fever, Lucy and the baby had been diagnosed with chorioamnionitis. They both received proper treatment, but this complication definitely caused a setback in Lucy’s ability to establish breastfeeding. In the early days of life, she used the nipple shield to get the baby to latch. Unbeknownst to her, the baby was not transferring breast milk well and was therefore losing weight beyond just the normal physiological weight loss.
Subsequently, Lucy’s baby continued to exhibit poor weight gain and was below her birth weight at the 2 week visit with the baby’s doctor. After reviewing all of the information, the pediatrician was understanding. He saw that Lucy’s milk supply was starting to increase and the baby was becoming more efficient at the breast. At that visit, he opted to just continue to monitor the baby with frequent weight checks as things were progressing.
In this article, we will explore newborn weight loss. We will understand why both formula-fed babies and breastfeeding babies lose weight in the early days of life, what defines excess weight loss and ways to increase a newborn’s weight as a breastfeeding mother.
Why do newborns experience weight loss?
Newborn babies typically experience weight loss in the early days after birth as their bodies adjust to fluid shifts. This is a normal physiological response, primarily caused by shedding excess water weight. Your chosen infant feeding method will help determine how much weight loss your newborn may experience. Typically, a breastfed neonate will lose more weight initially than his formula feeding counterpart. This is not necessarily a bad thing, but you need to take a few things into account.
First of all, breastfeeding is a skill that both mom and baby need time to develop. Oftentimes, a newborn may struggle to latch onto the breast initially. This was part of the problem that Lucy was having. Mom’s milk production and milk supply can suffer from the newborn’s inability to extract milk from the breast.
On the other hand, you may have a baby who refuses to latch or is fussy at the breast. There are many reasons why babies exhibit this type of behavior, but it definitely put a damper on milk production.
In addition to other factors related to breastfeeding, newborns whose mothers received intravenous fluids during labor may experience increased fluid loss. This can cause the newborn’s weight loss to appear greater due to the initial inflated birth weight.
What is excess weight loss?
Generally, pediatricians deem 10% loss from birth weight to be considered maximum weight loss for a newborn. As a baby is approaching the 10% mark or beyond, we worry that this excess loss will affect the baby’s fluid balance as well as their nutrient needs.
Normally, all newborns experience physiological weight loss in the first couple of days after birth. Subsequently, their weight should stabilize by the end of the first week of life. Next, they should begin to gain weight after their initial weight loss. Healthy babies usually regain their birth weight by 2 weeks of age.
Newborns who experience significant weight loss may face various complications:
- Concern about an underlying medical condition
- Dehydration and electrolyte imbalances
- Jaundice and its potential complications
- Ongoing issues with nutrition and inadequate feeding due to weakness or malnutrition
As a result of the greater potential for complications in a newborn with excess weight loss, I generally recommend giving extra feedings either at the breast or through supplementation with the bottle. These feedings are in conjunction with continuing to work on breastfeeding. If mom’s milk supply continues to improve and baby seems to be transferring more milk at the breast, we will gradually decrease the extra feedings. As the baby gains weight, we will continue to decrease the supplements slowly over time.
Breastfed infants who experience excessive weight loss should be closely monitored, whether or not supplemental feedings are introduced. In certain countries, home health visitors such as nurses can provide this close monitoring. Fortunately, in my practice, I am able to oversee this monitoring myself.
Expected weight gain for breastfeeding babies
As we learned earlier, we expect that a healthy newborn’s weight will stabilize by around 7 days of age. Subsequently, they should regain their birth weight by two weeks of life. Although this may not be the case for every baby, over 90% of newborns typically achieve this milestone within this time frame.
Regular weight measurements are important for monitoring a baby’s growth, particularly in the first few weeks. If a baby has slow weight gain, more frequent monitoring may be necessary. Once a baby reaches their birth weight, the expected average weight gain is 20-30 grams per day (or 5-7 ounces per week) until they are around 4 months old. While all babies are different, poor weight gain would be considered anything less than 15 grams or half an ounce per day during that time frame.
To keep track of your baby’s expected weight gain and other breastfeeding numbers, be sure to download our breastfeeding math guide.
Troubleshooting excess weight loss in breastfed babies
Neonatal weight loss and poor weight gain in breastfeeding babies are the most frustrating problems that a new mother can experience. Even if you need to supplement your baby temporarily, exclusive breastfeeding is still possible.
Here are some troubleshooting tips that may help to turn your baby’s weight around:
- Don’t adhere to a strict breastfeeding schedule; follow your baby’s feeding cues
- Correct poor breastfeeding techniques; this may require the help of a lactation consultant
- Frequent breastfeeding on demand; feed your baby at the first signs of hunger and feed at least 8-12 times per day in the early days of breastfeeding
- Pay attention to your baby’s breastfeeding patterns
- Be sure that your baby latches deeply to the breast and not just the nipple during breastfeeding
- Offer supplementary feedings via alternative methods of delivery or used paced bottle feeding techniques during feeding sessions
- Practice hands-on breastfeeding (massage your breasts) during feeding and pumping sessions to increase your breast milk supply
- Use an electric breast pump for extra breast stimulation and to get extra milk for your baby
How can 127 Pediatrics help you to succeed with breastfeeding?
At 127 Pediatrics, we not only provide in person pediatric and lactation care for families in our community, but we also offer breastfeeding education and coaching. We are working on developing a breastfeeding curriculum. In the mean time, please subscribe to our YouTube channel and get on our email list. You will get access to great breastfeeding content and stay up to date on our current offerings.
© 127 Pediatrics, April 2024
This article is for information purposes only. Please consult your personal physician for medical advice.
Dr. Andrea Wadley is a pediatrician and lactation consultant. She is board certified in both pediatrics and breastfeeding medicine. In 2018, she opened 127 Pediatrics as a way to provide a different option for pediatric and lactation care in her community.
