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Breastfeeding

Monitoring baby's growth

In the experience of the women who talked to us, the most common method of monitoring their baby's growth was by regularly having their baby weighed. This is usually done by the health visitor, and checking his/her progress against standard growth charts. Most women found it reassuring when their baby put on weight as expected.

 

She was reassured when her baby put on the weight that she was supposed to.

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Age at interview: 38
Sex: Female
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Her, she was putting on the weight that she was supposed to put on, I was concerned that maybe she wasn't putting on the weight, I know when babies leave the hospital they say they drop, they drop their weight, and she did drop, I can't remember what it was now it's written down somewhere, but she put on the weight she was supposed to put on whenever we went to the checks so that was good, it was reassuring really, 'cause I suppose it's the indication that you're doing what you're supposed to be doing, so, yeah it was okay.

However, not all babies put on weight at a rate that matched the growth charts and this worried their mothers. Many found themselves under pressure to introduce infant formula (see 'Getting Support for Breastfeeding') or solid foods such as baby rice and this increased their anxiety even further. Others questioned the knowledge base and belief in breastfeeding of their advisors and the accuracy of the growth charts in use prior to 2007, which neither reflected the normal growth patterns of a breastfed baby (because they were developed for infant formula fed babies) nor took into account regional, genetic or ethnic differences.*1

 

Her baby's weight gain slowed at about four months of age which she thinks is typical of...

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Age at interview: 34
Sex: Female
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What about his weight and his growth?

Well he, I've since found out that he followed a growth pattern which is very typical of exclusively breastfed babies, round about four months, for I think seven weeks he put on, I think he put on eight ounces in seven weeks something like that, which of course the graph in the book goes up and his just.

Plateaued?

Yes actually. And I wasn't going to go to the clinic and have him weighed every week because that would just, you know, it's just another source of something to worry about, but we were having baby massage classes and the babies were all naked and they said well we'll weigh them all seeing they've got and I just didn't want to say, 'Oh no I don't want him weighed' so every week, you know, it was like, 'Oh he's put on a gram this week' [laughs], you know, not, not quite but. And the health visitor did, I think he was about twenty weeks and she started saying, 'Well, you know, perhaps you should think about baby rice' and I was adamant that he was going to be exclusively breastfed for twenty-six weeks, he didn't need anything else other than breastmilk until twenty-six weeks. Baby rice has got fewer calories in it than breastmilk does, so I didn't understand why she was suggesting that I expose him to a potential allergen before the twenty-six weeks and I just ignored her. And then, I think twenty-four, twenty-five and twenty-six weeks he put on, I think he put on a pound in a fortnight just on breastmilk.

How did that make you feel?

[Laughs] smug [laughs].

 

She didn't want to supplement her baby and thinks that health professionals have different views...

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Age at interview: 34
Sex: Female
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I mean obviously I don't know how much milk my daughter has off of me and that can be very daunting in the beginning, but you know, we've been doing this for millions of years, babies know what they're doing and I just leave it to her. If she needs a drink she's going to let me know, you know, and one day she might not have so much but the next day, you know, she'll have what she needs, and it's like us isn't it? If we feel thirsty we'll have a drink so I leave it to her, so I don't know exactly how much milk she does have but she has three meals a day and plenty of milk in-between.

When [daughter] was probably, maybe about six weeks old, so, she was still having the treatment from the chiropractors, we'd been going to [support group], she, her weight was increasing but it wasn't a huge amount, might be one ounce a week, two ounces a week. Although she was feeding all the time, the weight just wasn't piling on as much as the professionals wanted it to. And that was when I first started getting a bit of pressure about supplementing. I didn't want to supplement.

Because?

I didn't want to supplement because it wasn't natural, you really don't know what's in formula milk. I mean these companies aren't doing it out of the goodness of their hearts, they're going to make money so, you know, you've really got no idea of what's in it, and obviously from the asthma point of view. And I started to get a huge amount of pressure, a lot of pressure, not only was I getting pressure from people saying about giving up breastfeeding because it obviously wasn't the right way, but now I was starting to get pressure about just supplementing. And, eventually I think, the lady down at [support group], the lactation consultant, I think she started to get a bit of pressure as well because obviously she was in touch with my health visitor. My health visitor was having pressure and, it was coming from the doctors because, they work from a different type of view, they're very much, gain your weight within three weeks that you've lost when you were born and obviously this is now getting to six weeks and she still hadn't got back up to her birth weight. And, so I gave in and started supplementing her, then we had to go in for, I think it's an eight week check something like that they have, and, the doctor was adamant that I should supplement more and he told me, three times a day, five ounces, and I was just absolutely shocked because I thought, 'That is really going to affect my milk'. We're not talking about just a few ounces now you're talking about quite a bit during the day, so I was a bit upset and I phoned up the lactation consultant at [support group] and I said, you know, 'I'm not really happy'. And, basically they weren't happy with the advice that I'd been given and, it worked out that they ended up having a chat with the doctors down at the surgery because they don't have any, they just have the basic training in breastfeeding, they don't have anything more. And really if you haven't got the training to back-up what you're giving as advice you shouldn't really be giving it. And, so that was when, I've lost my track'

You went to the doctors and they said to give three bottles of five ounces a day.

That's it, yeah they wanted her to have three lots of five ounces and, down at [support group] they're saying, 'I don't think that's a good idea, she's fine, she, okay she's not putting on huge amount of weight, but she's putting on weight.' So the doctor said three lots of five ounces which I was quite horrified about because I thought it's going to really affect my milk, and so I spoke to the lactation consultant at [support group], and it actually worked out to be a different one to my usual one because sh

When their baby seemed not to be putting on enough weight, many women began to question their milk supply and sought help from health professionals or breastfeeding counsellors who often recommended increasing the number of breastfeeds in a day. A few women mentioned the idea of a 'baby-moon' as a way of increasing their milk supply or really teaching a baby to breastfeed. This meant going to bed with the baby for a couple of days, doing nothing but breastfeeding when the baby wanted and having someone else look after them both, the housework, meals and other children. A few women used breastmilk expression and medication in an attempt to improve their milk supply.

 

She began to question herself and her milk supply when her baby gained weight slowly and got help...

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Age at interview: 27
Sex: Female
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What made you worry that you didn't have enough milk for this baby?

I've got, polycystic ovaries, which, I'd read that can affect your milk supply and I'd had a friend who had quite, terrible problems with milk supply. and then when she was, the first twelve or, sort of twelve or fourteen weeks of her life she didn't put on as much weight as the health visitors said she should, she wasn't following the correct line on her chart, in fact this was about, this got to, it was about six or eight weeks and she'd not really put on any, any weight at all, although to me she was fine, and I was happy with how she was doing she, the health visitor said that she wasn't putting on weight at the right rate. This made me start to feel that perhaps, perhaps I wasn't making enough milk, although I've since learnt that, that wasn't, that wasn't the case at all. I worried about it, we did have a phase when she was, I couldn't tell you exactly, but around sort of two, two, three months where she started sleeping a bit too much for a baby for her age. Going large, long gaps between feeds and I was a bit worried that, well I wasn't really worried, but I did contact, I contacted an NCT breastfeeding counsellor, who was absolutely brilliant and said that sometimes, sometimes baby's who, who aren't getting quite enough milk they sometimes don't have, you know, enough energy and they can become sort of more lethargic. And she suggested something so simple that I was amazed that the health visitors hadn't suggested when, she said that if I felt the baby wasn't getting enough milk, or if I felt the baby was sleeping for slightly too long then, wake her up and feed her [laughs]. And looking back now it seems so basic and why on earth was I getting referred to consultant paediatricians for a baby that was failing to thrive before attacking the basic, the basic options of, you know, maybe feed her a little bit more and then she might put on a bit of weight? So we did that for, I think two days, woke her up, I was waking her up every two to three hours.

Night and day?

Yep night and day and, that week she put on about six ounces so, and from there on in she was great, it only took two or three days to get her, you know, back to, back to herself, so and she's not, not had a problem ever since and has put on weight at a wonderful rate so. But I did have a worry, at the time when, and when you think there is something wrong with your baby and when you've got somebody saying to you every week, 'Oh she's not put on enough, how long was she feeding for?' and, you know, you do start to doubt yourself, and this was the first time and, you think, 'My third baby I shouldn't be having these problems I should be' and to some extent I think that the health professionals thought that, 'It's her third baby she's done it enough, she doesn't need any kind of support, we can, you know, we're better off channelling our energies somewhere else'. So I was pretty much sort of left to it, but as I said, I spoke to the NCT breastfeeding counsellor and she sort of said, 'Well let's get back to basics here, what are you worried about?' and I said, "Well I'm worried that, you know, she's having these really long sleeps in the day, you know, sort of five, six hours sometimes' and she said, 'Okay have you tried waking her up?' [laughs] and I thought, 'Well there's, there's an idea'. And once we started that it was absolutely fine, and she's put on weight. Although, I stopped going to get her weighed, I decided that.

So you were saying that something just as simple as feed her more often, wake her up and feed her more often?

Yes I think that when, when there is a problem, which, which there was, it was a problem, the, your instinct is to look f
 

Her baby failed to thrive so she tried extra breastfeeds, expressing breast milk and medication...

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Age at interview: 38
Sex: Female
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Breastfed yes from birth, not totally because we did have a problem where his weight was declining quite a lot and the difficulties with breastfeeding as well, meant that we did have to supplement with one or two bottles of formula which I wasn't happy about but was advised by health advisors to have to do that because his weight was just falling off him.

Okay.

Which is very, very worrying. And to be quite honest we tried so many different positions, [son's] weight was going like this, he might put some on then he, it was like a roller coaster and he was constantly along the bottom centile of the charts, so we always had the problem with the health visitors saying, “Well what is your problem?” and if you, in your practice, your GP's practice you have professionals that say, “Well what is your problem? My boys were bottle fed it didn't affect them” you think, 'Well no, I am trying to do this because I believe it's the best for my baby, I feel I've got support from a really good breastfeeding counsellor, I'm meeting other women that have problems, I want support to continue', 'He's only put an ounce on this week' but it's again, and to be quite honest I don't think really until [son] started to be weaned that suddenly the breastfeeding got better. So when he was weaned at six months and he started on baby rice that's when he started to put weight on consistently, the breastfeeding got better, everything just got better, and it was like we were struggling to get to this six months. 

I was having to put him to the breast quite a lot in order to increase.

What does that mean, quite a lot was how much?

Well quite a lot for me I mean I was always one of these mothers I suppose that liked to leave quite a bit of gap between each feed so that he could digest. So I, he wasn't feeding on me like twenty times a day or something, I would always try and leave a couple of hours between each feed, for him. So as long as he was having five or six feeds within twenty-four hours everybody was happy but of course once his weight stopped it was a case of cramming all these feeds in, in the day. Because I didn't want to disrupt his sleep pattern because he slept really lovely, he would go to bed about seven-thirty, eight o'clock and would not wake up till five for a feed, so I didn't want to then start waking him at ten-thirty for a feed if he was sleeping okay. So I would try and do a lot of my feeding from five-thirty in the morning till seventy-thirty at night so that he could sleep as he wanted to sleep rather than be woken up and put to the breast. So I was doing about seven or eight feeds between five-thirty and seven-thirty at night.

So you were counting the feeds you were doing and doing them regularly, were there other signs that you were looking for that he was okay, that he was thriving?

I was constantly paranoid about his soft spot on the top of his head and that he was dehydrated that really, really did worry me and one day it was just so, so bad that I did end up having to give him a bottle of formula.

So how could you tell what were you looking for?

It was inverted, it was like a divot and even now I still look at it now and again and, but it was really, really low, we knew that he wasn't well, we.

Any other signs of him being dehydrated?

He was always having wet and dirty nappie's but the problem was that we knew that he wasn't feeding properly because he'd

Paradoxically, some women even questioned their milk supply when their baby was gaining weight, usually because he/she seemed fussy and dissatisfied at their breast. This often occurred at busy or disruptive times of the year such as Christmas or summer holidays and when the mother was also very busy with a toddler.

 

Both of her babies became fussy at about three months of age which she thinks is because she didn...

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Age at interview: 30
Sex: Female
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After about three months, I remember it was, it was Christmas Day, Boxing Day I felt my milk supply was going.

Why, what made you think that?

Because he was on, actually it was about a week or so before, as he was about three months old and I used to express every evening a bottle for him.

Why?

So that my husband could feed baby or if we wanted to go out my mother-in-law, father-in-law could feed baby and look after baby so every night I'd express a bottle for the next night which gave me a bit of space and I remember one night and I was struggling to express two ounces whereas previously I'd be able to express six or seven ounces and that to my mind I thought, 'Ok something's not quite right' contacted the health visitor and they were like saying, 'Oh well it's just probably the baby is feeding a lot more during the day and you've not got as much milk during the night, but carry on and your milk supply will come back' I remember persevering for about three weeks and I couldn't express more than, it was a struggle to express more than two ounces at a time and I remember over the Christmas period because I remember it being the four days bank holiday and not having anyone really to speak to Shivam was on my breast every hour nearly and he was gnawing at the breast as such because he, you knew he wasn't getting enough I remember digging out all my leaflets that I'd got from the hospital and my own personal leaflets, getting all the telephone numbers out and ringing people and everyone saying to me, 'Just carry on as normal, it's fine your milk supply will come back' I think I persevered for another four weeks after that and nothing changed and then eventually I bought formula.

Do you have any sense of why that happened?

No.

How did you explain that to yourself? How do you explain it now?

I was distraught I, well at first I thought, that baby didn't want to be fed but then from speaking to other people 'cause he was actually pulling at the breast and gnawing at the breast it was as if, well no he does actually want to be fed I felt like a failure it was horrible 'cause he was just about four weeks, four months stage when I bought my first packet of formula milk for him and all my friends around me had breastfed for so much longer and I thought I really wanted to breastfeed longer and there is nothing. I'd not planned to go back to work for a long time I was going to take the full twelve months maternity, there is no reason for me to stop breastfeeding but it felt as if I had to so I was I was very upset and buying that first packet of formula and giving that first bottle was horrible, I didn't enjoy it at all but he took it fine and he was very happy which kind of made me feel better and the stress went as well but at least he's fed but I wasn't happy about it.

Where do you think that feeling of feeling a failure came from?

As soon as you fall pregnant you start getting leaflets about breastfeeding that it's the best thing you can do for your child and not doing it felt to me not doing breastfeeding was becoming a failure and knowing that friends around me had breastfed for longer it meant that I wasn't reaching the benchmark of what everybody else had done I mean that's what hurt, but it's everywhere as soon as you go into hospital there's leaflets and posters up about breastfeeding and, 'breast is best' everywhere so if you don't do it you are deemed as a failure, that's what I thought anyway.

Did that come from yourself no d

Several women talked about a “weighing culture” and felt that too much emphasis was put on weight gain at the expense of other ways of telling if a baby was growing well (see also 'Cultural aspects of breastfeeding'). They felt that having their baby weighed regularly was putting unnecessary pressure on themselves. Some said that it felt like an exam that they had to pass and, if their baby hadn't put on the required weight, then they had failed. Several mentioned the effect that health visitors, who do the weighing, had on their confidence with breastfeeding depending upon how much weight their baby had lost or gained. One woman called health visitors the “weight police” and another said that she gave her baby infant formula to keep her health visitor happy. Several women, usually the more experienced mothers, made the conscious decision not to become part of that culture and not to have their baby weighed regularly but to trust their own judgement about her/his growth.

 

She felt that regular weighing of her baby was a judgement on her so she stopped going....

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Age at interview: 35
Sex: Female
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I don't go to the health visitor every week and weigh him like I had to do with [first son]. I was told to do that with my first one and, on reflection it was putting a lot of pressure on me, 'cause, you know, [first son] was born very big, he was on the ninety-fifth centile, and then he went gradually down to the fiftieth centile and then it was like, oh my goodness this baby is losing weight, she needs to feed him more and, in fact I was told to give him pots at four months, and, I think it was perhaps possibly too early, [first son] had normal weight, he was always a healthy baby, a healthy boy, and it was such a horrible thing to go every, every week to have this sort of judgement, the weight and the cross of the line and where it would be, it was a pressure on me.

What do you mean judgement?

It seemed to be that, you know, you got this chart and that everybody, every baby has to sort of progress on that line and if you go slightly under it, even like one notch down it's like the end of world and you're doing either something wrong or there is something wrong with your milk, or, you know, you must do something differently, and what amazed me is that my baby, or my boy, was always healthy and happy and thriving in a way, having said that it seemed that this chart was more important than looking at him and seeing that he was happy, so, that was a bit distressing [laughs].

At what stage did you introduce solid foods?

At four months because, as I said, [son], sort of, I think became more normal, he was born very, very big boy, he was over, he was over forty weeks, he was forty-two weeks and a half, and he was born at nine pounds ten, and he sort of, he maintained his weight and then suddenly it just went down gradually over, you know, weeks and that's when the health visitor started saying, 'Oh my god no, there's something wrong with this' and, 'Haven't got enough milk' or, so I, not only had I, you know, questions in my mind about my technique, with the way he was latching on, about how much milk I had and the quality of my milk, I was worried about every aspect of breastfeeding really, because of this little line going down towards the fiftieth centile which is totally normal and he was not underweight, he was happy, he had all, you know, he was chatting, he was, he was, he was well. Having said that, the line was going down, so there was something wrong and I was told to go every week, if not twice a week at one point, and one day I just said to my husband, 'I can't cope with this, I'm not going any more, I know [son's] well, I'm not doing this crazy, you know, monitoring I really can't cope with it', I just had enough, I, you know, it felt like I had to perform some kind of miracle to make this line going up and this line didn't mean anything to me because the baby was fine so. I gave up the monitoring, the close monitoring, and from then on I was much happier and, and the baby was fine so, you know [laughs].

So you introduced solid food at four months...

Yes.

'because of this line?

Going down, yes, yes.

Did it make any difference?

No, not at all and he wasn't really interested in pots so actually I had, you know, I had this, the first period of [son's] life I worried about the breastfeeding and then I worried about him not taking this, pureed carrots and things, I remember struggling with those pots and trying to tempt him and spend, you know, too much time doing this, and, you know, I think probably, for a month or a month and a half he wasn't interested and the

Most women who experienced pressure over their baby's weight were told that their baby was underweight but one woman was told that her breastfed baby was overweight.*2 A few women talked about the temptation to make comparisons between their baby and other babies in terms of size and development and how this could become competitive and cause unnecessary worry. The mother of a premature baby felt that weight gain was a major parameter in determining when her baby could go home from hospital.

 

Her baby was born prematurely in Germany and she called monitoring her growth a “numbers game”.

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Age at interview: 32
Sex: Female
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I thought while I was in the hospital because there's a lot of pressure to, to do well and to bring your baby on, they put a lot of emphasis on breastfeeding not in a pressurised way but it was made to be very important and they were keen for her to latch on, they were keen for me to breastfeed, and I, at some point I can remember thinking 'Well if I don't, if I don't learn how to do this and I don't get their latch on, and she doesn't, you know, take a, a full feed from me that, that she's not going to be able to go home' and I can remember sort of breaking down in front of the doctor one day and being very upset and saying, you know, 'What's the problem?'. And I, you know, 'You're not going to let me take her home until I can breastfeed properly'. He said, 'No, that's not the case at all'. You know, 'She goes home when she's ready to go home. We would just encourage you to breastfeed because it's better for her'.

So what criteria were used for you to be able to bring your daughter home?

They, what they're looking for I think was maintaining a certain body temperature, reaching a certain weight, I think with premature babies there's always a possibility of jaundice, they like that to have sort of come and gone it, it's going to, and that they can suck well, and that they're feeding well, irrespective of how it's coming either through a formula in a bottle or, or from the breast. So temperature was a lot, we were forever taking Amy's our daughter's temperature by putting a thermometer up her bottom [laughs], which sounds awful and sort of praying that it, would it, you know, even out and it would all be okay and she could, she could come home.

Can you just talk to me a wee bit about your daughter's weight gain?

Mm-hm.

And how you did or didn't follow that and the importance that may or may not have taken?

It had a lot of importance for us because until she'd sort of reached a certain weight we couldn't bring her home. And they were weighed weekly and I don't know, feeding became a big issue, I think this from the very onset, you know, in order to get her home she had to be certain weight and, and that didn't, you know, that didn't sort of go once you'd got home, there always seemed to be weight limits that you're working up to, you know, when they're twenty pounds they can go in a forward facing car seat and, you know, when you're driving home from Germany you and your daughter's in the car seat looking the other way and you can't turn round and see them it's. So [pause] it's, I don't know I suppose it's all you think about, one minute they're drinking four fluid ounces, then it's six fluid ounces, then it's eight and then they drop a feed, you know, and then they do lose weight after they're born anyway. So it just becomes a big numbers game whether it's the time [laughs] or the amount they're drinking, or what they weigh.

*Footnote 1: Recently-published charts developed by the World Health Organisation (WHO) and based on babies who were exclusively breastfed are now available. They are not yet in widespread use in the UK, though some health professionals will be using them. The new charts reflect a similar growth curve internationally with very little difference between culturally diverse groups. Growth charts tend to show smooth lines but an exclusively breastfed baby's weight does not follow this pattern, especially if weighed frequently (see 'growth spurts' in 'What daily life is like with a breastfed baby'). Recommendations from recent research (2006) call for fewer, better quality weighing sessions and more emphasis on breastfeeding effectiveness and women's satisfaction with their breastfeeding experience. Other ways of monitoring a baby's growth include how quickly they grow out of their clothes, how big they feel (for example, putting your hands around the baby' s middle as the father in Interview 37 above says), alertness, happiness, feeding well, achieving developmental milestones, increasing length and head circumference.

* Footnote 2: There is no evidence that an exclusively breastfed baby can be overweight or will become obese in later life. 

Last reviewed November 2018.

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