The Lactation Nerd Blog
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for All Lactating People.
for All Lactating People.
Did you know that growth charts aren't created equal? There are specific growth charts that primarily represent formula fed babies, and babies fed human milk.
Very often I have families reach out to me worried that their babies aren't getting enough milk after they took a trip to their pediatrician. "Kelly, they said my baby's in the 10th percentile, and now I'm worried I'm not making enough. Help!"
Does this sound familiar? Hearing that your baby is "low" on the charts may seem scary. If you've ever been concerned about your baby's weight based on their charts, then this post is for you! Please welcome my guest blog contributor, Dr. Krupa Playforth, The Pediatrician Mom, as she shares with you her expert insights about navigating your baby's weight gain, and understanding the growth charts your baby's doctor uses.
Hey there! My name is Kelly Maher Carvell, CLC, CLE.
I offer effective telehealth lactation support and education to modern families.
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Please enjoy this guest post from Dr. Krupa Playforth-
Discussing growth is an important part of well visits but often triggers more anxiety than it should. The expectations for growth in an infant fed with human milk can differ from the expectations in a formula-fed infant and unfortunately this is not always highlighted for parents. Although this is a brief overview, I highly recommend discussing with your pediatrician if you have any concerns about your child’s growth.
I have written in the past about how much I dreaded the weight check visits for my own children. They were both classified as “failing to thrive” at some point (here is a picture of my son’s growth chart from his first year of life) and more than once I left a doctor’s visit tearful and feeling like I was failing at the most basic of maternal skills: feeding my child.
Human milk fed babies often grow more rapidly in the first three months of life, but then their growth velocity drops off between 3-12 months. This is normal. Formula-fed infants, on the other hand, tend to gain weight more rapidly after age 3 months. More than once I have seen providers (and parents) balk at a drop off in growth velocity between the 2- and 4-month visits in breastfed/chestfed patients and become fixated on numbers and percentiles. This often leads to supplementing these exclusively human milk fed infants with formula, and fails to acknowledge that our expectations should be completely different for this population!
My caveat: although this is a general point about growth trajectory, there are certainly exceptions and a drop in the percentiles at this point could be indicative of other more systemic issues. It is important to discuss your child’s growth with their pediatrician and to feel comfortable asking questions if you don’t fully understand or agree with their recommendations.
The World Health Organization developed revised growth charts in 2006. These charts are based on a cohort of infants from around the world who were primarily fed human milk for the first 4 months, and then continued breastfeeding/chestfeeding until 12 months. The CDC growth charts, which are sometimes the default programmed into electronic medical records, use data from a different population: a representative sample of US infants from 1970s-1990s (only about 50% of these infants were ever breastfed, and by 3 months only 33% of them were breastfed).
So for a child who is primarily breastfed/chestfed, the AAP and most pediatricians recommend using the WHO growth charts until about 2 years of age. There are also additional special growth charts that are used for children with certain health issues, such as a history of prematurity, or specific syndromes such as Trisomy 21 (Down Syndrome) or Prader-Willi Syndrome.
Finally, I also want to discuss how even a weight difference of a few ounces can make a dramatic difference on the growth chart in very young infants. You cannot hang your hat on a single number. I once weighed my 6 week old daughter several times throughout a day and found that her weight could vary by up to 3-5ounces depending on whether she had just eaten, or pooped, or had a wet diaper. Additionally, growth charts are not like grades or scores on an exam. It matters far more how a child compares to themselves than how they compare to others (for example, a child tracking consistently at the 10th percentile is less concerning than a child of the same age who was previously consistently at the 90th percentiles and then dropped to the 25th percentile, even if the second child weighs more in absolute numbers).
My children both remain petite, but they are growing and meeting milestones and otherwise thriving. Remember, weight is only one vital sign, and these numbers are only a piece of the puzzle. There are so many factors at play, including genetics, Ultimately, you and your pediatrician are part of the same team, and you have the same goal: please ask them if you have more specific questions about your child’s growth!
-Dr. Krupa Playforth
WHO and CDC growth charts:
AAP policy statement: breastfeeding & the use of human milk:
Healthy Kids article on “How to read a growth chart”:
Kelly Maher Carvell, CLC, CLE
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