• Lisa Paul IBCLC

Preventing problems by following weight gain


Growth charts have long been a passion of mine. It's the math geek in me coming out. I love to plot data and see trends and help parents understand what is normal. Normal is a relative term. What is normal for one baby is not normal necessarily normal for another.


Given this proclivity, I have a scale in my office and record weights at almost every visit. A major requirement of my EHR was that it had to use the WHO Growth Charts. An aside about the WHO Growth Charts - these are charts that are based on breastfed babies around the world. The data was collected at specific times in their growth over a 2 year period. This data does not include babies fed formula, who were premature, who had a mother who smoked, and several other criteria. These charts are about what is normal for a baby who is exclusively fed breastmilk until 6 months and then introduced culturally appropriate foods.

Before opening my private practice lactation business, I worked in WIC (Women, Infants & Children) as a Nutrition Educator. A main part of my job was to recognize when a child under the age of 5 was at risk for being underweight, or actually underweight, based on how their weight plotted on the growth chart. It was my job to educate parents on what that assessment actually meant, and if there was a health risk to the child. In some cases, we would refer them back to their pediatrician for more evaluation. Weight was a piece of the bigger puzzle of the health of a child. Some children are tall and thin, and some are shorter and heavier, which may have more to do with family genetics than the diet of the child.

In other cases, our growth charts would paint a different picture from what the charts used in the pediatrician office painted. WHO charts would show a breastfed baby well within the range of normal when the pediatrician was calling for supplementation. In these cases, my job was to educate the parents on the difference, and provide them with a copy of the WHO growth charts and offer alternative solutions that met both the parents' and pediatrician's goal of a healthy baby.

I can confidently do this because I keep myself educated on the use of growth charts. There are situations, though, where the baby is teetering on the edge - or what we called in the WIC world - "risk for being underweight". Their rate of weight gain slows down, and as it does, they are taking less milk from mom. Once this begins, moms supply drops to match the reduced demand. If not caught early, this cycle can impact baby's growth long term.

How does one catch this? By doing consistent, frequent weight checks that are plotted on a WHO Growth chart. I believe that a baby will be well served to have weight checks at the following milestones:

  • Birth

  • Discharge

  • 1 week

  • 2 weeks

  • 4 weeks

  • 6 weeks

  • 2 months

  • 3 months

  • 4 months

  • 5 months

  • 6 months

  • 9 months

  • 1 year

  • when mom returns to work or any major change occurs

That may seem like a lot. But remember we are trying to establish what is normal for a particular child. AAP guidelines recommend a well-baby visit at 2-5 days, 1 month and then 2 months. Missing weight checks at 1, 2 & 6 weeks puts a huge data gap in establishing normal range. As a lactation consultant, I feel that moms and babies need the support at the above milestones to make breastfeeding a successful journey. I offer special packages to help a mom get that support beyond the pediatrician visits.

While weight is only one piece of data, and in some lactation circles, a controversial one at that, it does provide data that can be tracked and analyzed. It can be useful information in making decisions pertaining to breastfeeding. Weight checks are also a convenient excuse to ask questions, and have a conversation about the breastfeeding journey.

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